The findings can be interpreted as accurate and nondiscriminatory due to the inclusion of nurses with a wide range of backgrounds eliminating a possibility of bias among participants. The race, gender, and educational level distribution can be considered representative of the majority of similar healthcare organizations.
Setting and Organization
In the case of data derived on the setting, the pre-setting and post-setting values were 6.23 and 8.57, respectively. Therefore, a statistically significant improvement has been observed with an increase in CEX score by 37.56%. In the case of organization and efficiency factors, the pre-organization and post-organization scores were 5.77 and 8.60, respectively. In other words, a statistically significant increase was observed, which was 49.04%. Therefore, the SBAR framework of communication improved both setting and organization components by a substantial margin. The data received by the author in the process of studying the influence of the algorithm demonstrate the extreme efficiency and usefulness of using SBAR technology. The study results confirm the effectiveness of the SBAR technology in the work of medical personnel. Thus, the author recommended the use of the algorithm to improve the quality of patient care, facilitate the work of medical personnel, and reduce the number of medical errors.
Communication Skills and Content
The implementation of the SBAR led to 32.66% improvement in the areas of communication skills exhibited by the nursing professionals due to a change from a CEX score of 6.43 in pre-communication skills to 8.53 in post-communication skills. The pre-content and post-content scores are 5.70 and 8.60, respectively. The latter CEX scores are indicative of a 50.88% improvement in regards to the factor of content.
Clinical Judgment and Humanistic Quality/Professionalism
In the case of clinical judgment, CEX score, pre-clinical judgment, and post-clinical judgment values were 5.67 and 8.77, respectively. The improvement in this area was equal to a 54.67% increase, which is more than half. For the professionalism and humanistic quality domains, the increase was 28.38% due to a change from the CEX score of 6.80 to 8.73. As a result of the conducted research, the DNP candidate provided the staff with a 30-minute on-the-job training on using the SBAR tool during the shift transfer. In addition, the project allowed one to study the process of performing shift transfer by nurses using the SBAR tool. The research on the SBAR algorithm enables the DNP candidate to thoroughly and effectively analyze and improve the quality of the communication process of medical personnel.
Overall Sign-out Competence and Medication Errors
The CEX value for pre-overall sign-out competence was 6.73, and for post-overall sign-out, competence was 8.73, which means a 29.72% increase. However, the medication errors prior to SBAR use were around 0.10, but after the integration measurements showed a zero error rate. Therefore, SBAR led to a 100% decrease in medication errors rate. A significant increase in positive results can be observed after the start of the use of SBAR technology in medical institutions. Significant improvements in the level of efficiency of interaction of medical personnel, communication skills, setting, organization, content, clinical judgment, humanistic qualities, professionalism, and sign-out competence are noticeable. In addition, based on the statistical data obtained as a result of the study, due to the introduction of the SBAR algorithm, the number of medical errors has significantly decreased. Based on the data obtained, the SBAR algorithm makes the communication process between medical professionals more efficient and informative, which reduces the number of medical errors.
Barriers for Implementation
Although the SBAR method is a reliable and effective communication tool that can be implemented into medical practice without much difficulty, there are certain limitations. For example, patients with complex medical histories and care plans, especially in intensive care settings, nursing staff behavior, Pandemic, different shifts, have problems using this algorithm (Abbasi, 2020). The SBAR tool requires the minimum training and education of all clinical staff so that communication is well and effectively understood and validated.
However, difficulties may arise if a medical professional resists any changes, rejecting everything new. In addition, the complaint of the nursing staff during the shift report on a relatively time-consuming process can also cause limitations. Thus, when making changes to the usual communication between medical professionals, it is necessary to carefully consider all the nuances and possible limitations in order to cope with them effectively.
The current impact of the pandemic should not be overlooked as a potential barrier since the current practice conditions are highly restricted due to the virus. Therefore, there is a strong possibility that the integration of SBAR might face major administrative and legislative challenges due to the additional level of the burden imposed on already stressed healthcare workers. Therefore, such an outstanding method of communicative practice can be regarded as non-urgent or unimportant due to the prevalence of other priorities.
Implications for Advanced Nursing Practice
The use of the SBAR tool helps to improve the coordination of prescribing and taking medications and reduce the frequency of adverse medical events. The introduction of the SBAR algorithm affected the increase in unplanned hospitalization in the intensive care unit and a significant decrease in the number of unexpected deaths of patients. Thanks to the CEX tool, it became possible to advance detection, launch, and response by improving communication between medical personnel. The structured SBAR protocol for the presentation of patient cases by nurses during interdisciplinary rounds has led to a reduction in medication errors and review time during multidisciplinary rounds.
Plan for Sustainability
Some patients have more complex needs and problems, so they are managed by an interdisciplinary team in a hospital setting. It promotes collaborative decision-making and conflict resolution between team members, likely improving patient satisfaction and outcomes. Clinical information about the patient plays a critical role in his treatment, so communication between medical personnel should be clear, consistent, and concise. The SBAR communication tool is the most effective means of maintaining a common language between team members.
To ensure the sustainability of structured SBAR communication, it is necessary to implement it in medical institutions and train staff to use it. The hospital management should arrange consultations and assist in mastering the SBAR algorithm. If it is possible to reduce errors in communication between medical workers to a minimum, then the safety of patients, the quality of medical care, and the condition of medical personnel will significantly increase. Ward training sessions and visual aids can offer practical and scalable methods to increase awareness and understanding of the SBAR communication tool for handover. Ultimately, strengthening communication requires the involvement of senior staff to promote an ethical culture of transmission.
In his article “The Impact of SBAR Communication Model on Observance of Patient Safety Culture by Nurses of the Emergency Department of Shahid Beheshti Hospital in Qom in 1396” (2020), Abbasi states the following. The author claims that ensuring patient safety is one of the most important goals of the healthcare sector. Careful attention to the phenomenon of professional communication skills can reduce the number of critical medical errors. The author talks about the importance of implementing the SBAR algorithm, which has qualitatively improved the culture of patient safety and the responsibility of medical workers. This study helped the authors of this work, as it contains results proving that the SBAR communication model is an effective means of improving the safety culture.
Hasan et al., in their article “Evaluating handoffs in the context of a communication framework” (2017), believe that the transfer of patient care services leads to increased opportunities for errors during this process. The authors of the article conducted a study that evaluated the process of transferring patients in the context of a specific communication system. This study identified assessment tools for the source, recipient, and observer to identify factors affecting the transmission process. In addition, the authors qualitatively assessed the relationship between the indicators. This study is of great value because it studies and analyzes the factors that worsen the communication process between medical personnel. The authors describe internal and external distractions and suggestions for improving the transfer process to improve overall efficiency and patient safety.
Noh et al., in their article “Effect of Stepwise Communication Education Program using SBAR among Nursing Students: Focusing on Scenarios and Nursing Case-based Role-Playing” (2018), state the following. The authors believe that a step-by-step educational program on communications among students of the College of Nursing significantly affects effective professional activity. The authors note the importance and usefulness of scenarios and role-playing games based on nursing cases. The authors of this article conducted a study that focused on teaching the proficiency of SBAR algorithm technicians among nursing students. The study results showed that the program of step-by-step communication training using SBAR was effective in increasing knowledge about the SBAR technique and self-efficacy of communication. This study allowed the authors to identify the existing limitations that prevent medical personnel from mastering the SBAR tool.
Streeter et al., in their article “Communication Behaviors Associated with the Competent Nursing” (2015), claim the following. There is a real connection between misunderstanding among medical professionals and severe mistakes in the treatment of patients, which can lead to severe consequences. The authors talk about the standardization of the data transmission process to reduce communication errors and improve communication between medical professionals. Modernization of the communication process between nurses positively affects their communicative competence and professional activity in general. This study was helpful because it contains the results of a survey of more than two hundred and eighty nurses who confirm that the exchange of information has a productive effect on their professional activities.
In addition, the authors of this work searched for published studies on the transfer of services in the PubMed database. The literature found in the database has been thoroughly analyzed and compared with known facts regarding patient care and the importance of effective communication. Painstaking work with numerous medical articles from the relevant literature was performed, which provided significant assistance to the authors of this study. Data were obtained via an extensive literature search and conversations with practicing providers.
Application of the AACN DNP EssentialScientific Underpinnings for Practice
The work conducted throughout the study illuminates the key importance of communicational accuracy and precision in a healthcare system, where medical errors can have a dire impact on patients’ safety and wellbeing. The project adheres to the fundamental scientific underpinning of practice because it focuses on governing the optimal function of human beings, who receive the care they need. In other words, the use of the SBAR tool provides a correct set of frameworks for communication, which was highlighted with the CEX evaluation method. The implementation of SBAR provides a positive change in the work safety environment benefiting and improving outcomes among patients.
Organizational and Systems Leadership for Quality Improvement and Systems Thinking
Organizational and systems guidance is vital for DNP graduates to advance patient and care outcomes. The project showed a drastic increase in accuracy and precision of conveyed information in regards to nurse handoff. The latter, in turn, significantly reduced the rate of errors taking place due to poor communicative practices. In other words, it is evident that SBAR removes the points of inaccurate communication and information transfer. The use of the SBAR algorithm to reduce medication errors in the shock trauma unit highlighted an excellent method that would ultimately ensure patient safety. Focusing attention and discussing an alternative in which positive changes can occur helped to translate the confirmed theory into clinical practice. Therefore, the project succeeded at developing and evaluating a highly effective strategy in order to manage the ethical issue in the healthcare organization and patient care. The project adheres to the second essential of the DNP Essentials.
Clinical Scholarship and Analytical Methods for Evidence-Based Practice
The implementation of SBAR at the target healthcare organization adheres to the third essential of the DNP Essentials as well. The main reason is that the study succeeded at evaluating outcomes of practices due to the use of a reliable evaluative tool, which is CEX. The overall impact of the project is direct, where it substantially improves the overall safety of patient-centered care. Nurses communicating with the use of SBAR are less likely to make medical errors, which is why the findings are relevant in order to be able to develop improved practice protocols and frameworks of communication practices in the clinical setting.
Information Systems/Technology and Patient Care Technology for the Improvement and Transformation of Health Care
The project precisely adheres to the fourth essential of the DNP Essentials since it directly uses a combination of information systems to promote improved care. It should be noted that SBAR can be utilized and integrated into the healthcare systems because its principles are clear and programmable. Analytical methods were used to critically and effectively evaluate the effectiveness of using SBAR technology, and information technology was used to collect data and obtain evidence for changing practices. In addition, the project uses CEX as an evaluative program to monitor outcomes as well as assess critical elements, which demonstrates the technical skills and conceptual ability on the basis of accuracy and timeliness.
Health Care Policy for Advocacy in Health Care
The given project adheres to the fifth essential of the DNP Essentials because it the current healthcare communication practices at the target organization and proposes clear directions for future developments at such facilities by demonstrating leadership. The findings can be expanded and used to influence the current policies in regard to healthcare practice, where SBAR can be made a mandatory requirement for such a change. In addition, the results are highly educative for others, including policymakers, and it advocates a more improved state of the nursing profession. Lastly, it advocates for social justice and ethical policies since SBAR is capable of reducing the impact and occurrence rate of medical errors.
Interprofessional Collaboration for Improving Patient and Population Health Outcomes
The project adheres to the sixth essential of the DNP Essential by directly employing means for effective communication as well as collaboration through the SBAR framework. The latter is highly structured and rigid, which makes the interprofessional cooperative efforts significantly more defined and coordinated rather than previously utilized sporadic practices. Its implementation inherently employs leadership skills and consultative abilities with a wide range of medical teams to promote a positive change in healthcare delivery systems.
Clinical Prevention and Population Health for Improving the Nation’s Health
The project adheres to the seventh essential of the DNP Essential by benefits population’s health and improving clinical prevention through medical error reduction, which, in turn, increases the nation’s wellbeing and health. The project analyzes key data from the target organization and synthesizes core concepts to develop as well as implement interventions through SBAR. In addition, it uses evaluative tools, such as CEX, to improve health status and safety among patients due to a reduction in medical error occurrence rates. The study provides a template in the form of SBAR in order to propose novel care delivery models related to all key aspects of health since medical errors can have multifaceted ramifications.
Advanced Nursing Practice
The project adheres to the eighth essential of the DNP Essential because illness and health parameters are assessed in a systematic and comprehensive manner in a complex communicative environment of nurse handoffs. It opens a pathway for effective interventions, such as SBAR, in order to partnerships with patients since the latter’s safety is of paramount importance. The project does not focus on particular nurses but rather implements systems thinking in order to support nursing professionals by educating and guiding them with the use of SBAR. In addition, the project thoroughly succeeds at evaluating relationships between practice and organizations with the utilization of analytical and conceptual skills demonstrated throughout the study.
In this chapter, the findings are interpreted, and the limitations of the study and nursing implications are discussed.
Shock trauma is an experience of meeting with a threat to life, which cannot be integrated into the psyche immediately and for a very long time because this experience goes beyond the capabilities of the psyche. The Shock Trauma Unit helps patients cope with serious stress and provides psychological medical care. Unfortunately, medical errors caused by a disruption of communication between hospital staff are one of the leading forms of errors in the healthcare sector. The use of the SBAR tool is designed to improve the effectiveness of communication between medical personnel in order to reduce the number of errors in the process of taking medications.
Strengthening the regular use of the SBAR tool and standardized communication is an essential link in improving patient treatment outcomes. Thus, the possibility of submitting this evidence-based quality improvement initiative and findings to a group of colleagues becomes a useful ingredient in the evolution of a safety culture. Considering the clear risks to patient safety related to the transfer of medical services, particularly in the conditions of the shock trauma department, the outcomes were clinically relevant and encouraging. It is advisable to anticipate that continued enhancements will proceed to improve the transmission of patient information and restore patient safety. The results of this study project have shown that the use of the SBAR tool in the conditions of the shock therapy department significantly reduces the likelihood of an error in the process of taking medications.
Abbasi, M. (2020). The impact of SBAR communication model on observance of patient safety culture by nurses of the Emergency Department of Shahid Beheshti Hospital in Qom in 1396. Iranian Journal of Nursing Research, 15(1), 49-58.
Hasan, H., Ali, F., Barker, P., Treat, R., Peschman, J., Mohorek, M., Redlich, P., Webb, T. (2017). Evaluating handoffs in the context of a communication framework.
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Noh, Y. G., & Lee, I. (2018). Effect of stepwise communication education program using SBAR among nursing students: focusing on scenarios and nursing case-based role playing. The Journal of Korean Academic Society of Nursing Education, 24(2), 115-126.
Streeter, A. R., & Harrington, N. G. (2017). Nurse handoff communication. Surgery, 161(3), 861-868.