Enhancing Nurse Communication Skills with SBAR Experiential Training

Overview

Repeated exposure to the situation, background, assessment, and recommendation (SBAR) tool in didactic and clinical settings during nursing training can improve communication flow, facilitate patient safety and quality of care, and promote communication competency in nursing students (see additional resources 1-5, and 9 -11). 

The purpose of this teaching resource is to integrate SBAR training in the didactic setting with experiential learning in the clinical environment to reinforce student knowledge on using standardized tools such as SBAR for effective communication. Objectives of the teaching are: 

  1. Identify steps in the SBAR process,
  2. Utilize a standardized communication technique, SBAR to communicate with other nurses and health care providers, 
  3. Use the SBAR tool to facilitate clinical reasoning and judgement in a case scenario, 
  4. Demonstrate effective communication competency through role-playing of SBAR handoff reports with other students and instructor using the SBAR-LA rubric.

How to Use

  1. Review the training material which includes PowerPoint slides that will be presented in a didactic classroom environment on SBAR tool. The slides are interactive and will serve as a template for online/on-demand readily available knowledge and topic-based presentation content.  
     
  2. Prerequisite: Review topics on the forms of communication, standards of effective communication, and change of shift/hand-off reports (slides included in the presentation)
     
  3. During the didactic classroom lecture, learners will watch the YouTube video titled “SBAR Nursing Example: Nurse-to-physician communication report NCLEX.”

  4. On Day 2 in the clinical setting, instructor plays the Lippincott audiovisual titled “One-Minute Nurse: SBAR video.” 

    ** Note: Requires access to Lippincott Course Point + Taylor: Fundamentals of Nursing: The Art and Science of Person-Centered Care, Tenth Edition (Chapter 8). Access to this video requires subscription to Lippincott Course Point materials. Register as a new user or to request help to subscribe. Alternatively, users can purchase a hard copy of the textbook at an estimated cost of $119.80. Access to the video and other learning resources is granted once the buyer scratches off the access-code panel on the first page of the hard copy textbook and enters the code on the publisher’s website at https://thepoint.lww.com/activate.
    If the digital copy is chosen and once access has been established, click on “Launch” to open the Taylor, Lynn, and Bartlett: Fundamentals of Nursing: The Art and Science of Person-Centered Care, Tenth Edition.  

    On the Content tab, select Unit 1: Foundations of Thoughtful, Person-Centered Nursing Practice, and click on Chapter 8: Communication. Select the “One-Minute Nurse: SBAR” to play the video. Once video has been played, select “Quiz” to assess understanding of the content of the video.

  5. Clinical instructor completes the Quiz section with the students (in the Lippincott video package) to check students’ knowledge (five questions in all) and discusses rationale for appropriate responses.  

Integrative Learning Strategies

  • Two Videos
    • One to be played during didactic lecture titled “SBAR Nursing Example: Nurse-to-physician communication report NCLEX.” Link
    • The second to be played during clinical rotation and titled “One-Minute Nurse: SBAR video.” Please use the link in item #4 under the “How to Use” section to access the video.  
       
  • Case study discussion and application of concept after watching each video (on two separate days, one during the didactic session and the other on Day 2 of clinical rotation).
     
  • Role-playing
    • Instructor role-plays case scenario with students in class during didactic lecture on SBAR communication tool. *Please note that this day will occur before the commencement of the students’ clinical rotations. The goal is to expose the students to SBAR before their clinical days.
    • The clinical instructor designates time for SBAR activities during rotation (about 15 – 20 minutes) from Clinical Day 2 through Clinical Day 4. Please note that first day in the clinical setting will include general orientation only; SBAR discussions will begin on Clinical Day 2.
    • On Clinical Day 2, instructor observes students in real-time using the SBAR tool for a handoff report and utilizes the SBAR-LA rubric to measure student’s performance for baseline competency. 
       
  • At end of the SBAR activity on Clinical Day 2, the instructor plays the “One-minute Nurse: SBAR” video and discusses with students their responses to the items in the quiz section (the five-question quiz is included at the end of the ‘One-minute SBAR’ video).
     
  • On Clinical Day 3, the clinical instructor role-plays the process of giving and receiving hand-off reports; the activities will include students to instructor, and student to student handoff reporting.
     
  • On Clinical Days 2, 3, and 4, the instructor will conclude each SBAR activity session with discussions on students’ performances regarding the steps to complete an effective handoff report.
     
  • On Clinical Day 5, the instructor will observe students using SBAR tool to give and obtain reports, and instructor will complete the SBAR-LA rubric to evaluate improvement in students’ communication skills.
     
  • A post-clinical debriefing session will be conducted (on last day of clinical – Clinical Day 6) to review the students ‘evaluation with them and to obtain perceptions of their performances on the SBAR activities.  

Assessment Strategies

  1. On Clinical Day 2, the instructor will evaluate student competency using the SBAR-LA grading rubric to document baseline (this will determine the students’ SBAR skills level at that point).
  2. On Clinical Day 3 and Day 4, the instructor will provide verbal feedback to students during each SBAR activity. The aim is to reinforce the SBAR skills acquisition in the students.
  3. On Clinical Day 5, the instructor will conduct a written evaluation of each student’s performance using the SBAR-LA grading rubric to measure improvement. 

Exemplar

The following case study will be provided to students during an SBAR activity session by the clinical instructor:

Case scenario: You are a nurse on a medical-surgical course; you are assigned to patient, Juan Lopez, 68 years old, in room 4A on the Medical-Surgical Unit 2B who was admitted with peptic ulcer disease.  As you entered the patient’s room this morning, you found the patient vomiting bright red blood. After obtaining the vital signs, you attempted to communicate the event to the health care provider using the SBAR format. How would you communicate the information using the SBAR tool?

Past medical history: Peptic ulcer, bleeding disorder, and diabetes.

Vital Signs: T 98.8°F, P 111, RR 20, BP 98/50, pulse oximetry 96% on 2L of supplemental oxygen.

Provider: Dr. Chen

Situation:

Hello Dr. Chen, this is Kate from Med-Surg Unit 2B. I am taking care of Mr. Lopez in Room 4A. I am concerned because Mr. Lopez just vomited bright red blood.

Background:  

He was admitted yesterday evening with a diagnosis of peptic ulcer disease, and a history of bleeding disorder and diabetes.  

Assessment:

His vital signs are T = 98.8°F, P = 111, RR = 20, BP = 98/50, pulse oximetry = 96% on 2L of oxygen via nasal cannula. I believe the vomiting may be the reason for his low BP and increased pulse rate.

Recommendation:

I think Mr. Lopez may need intravenous (IV) fluid to replace the lost volume, and some diagnostic tests such as CBC and a metabolic panel. How do you want me to proceed with Mr. Lopez’s case?

Possible Courses

  • Fundamentals of Nursing course
  • Medical Surgical course
  • Any clinical entry-level nursing course

Additional Resources/Publications

American Association of Colleges of Nursing. 2021. The essentials: Core competencies for professional nursing education. Accessed September 25, 2023. https://www.aacnnursing.org/Portals/0/PDFs/Publications/Essentials-2021.pdf.

Davis, Beth P., Sally A. Mitchell, Jeannie Weston, Catherine Dragon, Munish Luthra, James Kim, Hugh A. Stoddard, and Douglas S. Ander. 2021. "SBAR-LA: SBAR Brief Assessment Rubric for Learner Assessment." MedEdPORTAL 17:11184. https://doi.org/10.15766/mep_2374-8265.11184.

Ghosh, Sayani, Lakshmi Ramamoorthy, and Biju Pottakat. 2021. "Impact of structured clinical handover protocol on communication and patient satisfaction." Journal of Patient Experience 8:2374373521997733. https://doi.org/10.1177/2374373521997733.

Institute for Healthcare Improvement. n.d. "SBAR Tool: Situation-Background-Assessment-Recommendation." Accessed November 30, 2023. https://www.ihi.org/resources/tools/sbar-tool-situation-background-assessment-recommendation.

Noh, Gie Ok, and M. J. Park. 2022. "Effectiveness of incorporating Situation-Background-Assessment-Recommendation (SBAR) methods into simulation-based education for nursing students: a quasi-experimental study." Nurse Education Today 109:105252. https://doi.org/10.1016/j.nedt.2021.105252. 

Taylor, Carol R., Pamela Lynn, and Jennifer Bartlett. 2023. Fundamentals of Nursing: The Art and Science of Person-Centered Care. 10th ed. Mexico: Wolters Kluwer.

The Joint Commission. 2017. "Inadequate hand-off communication." Sentinel Alert Event 58. Accessed November 13, 2023. https://www.jointcommission.org/-/media/tjc/newsletters/sea-58-hand-off-comm-9-6-17-final2.pdf. 

Usher, Ronnita, Sherill Nones Cronin, and Nancy L. York. 2018. "Evaluating the influence of a standardized bedside handoff process in a medical-surgical unit." The Journal of Continuing Education in Nursing 49, no. 4: 157-163.

Wilson, Diane, Anuradha Kochar, Andrew Whyte-Lewis, Hilary Whyte, and Kyong-Soon Lee. 2017. "Evaluation of situation, background, assessment, recommendation tool during neonatal and pediatric interfacility transport." Air Medical Journal 36, no. 4: 182-187.

Yun, Jungmi, Yun Ji Lee, Kyoungrim Kang, and Jongmin Park. 2023. "Effectiveness of SBAR-based simulation programs for nursing students: a systematic review." BMC Medical Education 23, no. 1: 507.

YouTube. 2021. "SBAR Nursing Example: Nurse-to-physician communication report NCLEX." Accessed November 13, 2023. https://youtu.be/ltloXhUvi1Y?si=ZLBuXVUFJNz9sllJ. 

Sub-competencies for entry-level professional nursing education:

  • 1.3a Demonstrate clinical reasoning.
     
  • 5.1c Implement standardized, evidence-based processes for care delivery.
  • 5.2f Use national patient safety resources, initiatives, and regulations at the point of care.     
     
  • 6.1b Use various communication tools and techniques effectively.
  • 6.1e Communicate individual information in a professional, accurate, and timely manner.
Posted: June 12, 2024
Submitted by:

Modupeola Adebayo, Assistant Professor, WellStar School of Nursing, Kennesaw State University
Maureen Garringer, Assistant Professor, WellStar School of Nursing, Kennesaw State University
Miranda Hawks, Assistant Professor, WellStar School of Nursing, Kennesaw State University
Alexis Whiddon, Lecturer of Nursing, WellStar School of Nursing, Kennesaw State University
 

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