Leadership And Management In Nursing

Leadership And Management In Nursing
Chapter 1: Introduction Background
Effective communication among healthcare providers is an important tool for the success of the healthcare system. Communication affects the relationships between nurses, patients, physicians, families, and the hospital administration making it a crucial factor for success. Important aspects of quality care such as improved patient safety, reduced mortality rates, and reduced hospital readmissions are all dependent on effective communication. Nurses form the largest part of healthcare professionals communicating constantly with patients and doctors to ensure the delivery of quality care. In these aspects of communication, nurses are involved in shift handoffs during the transition of care. A major challenge is the way information is passed from the outgoing team to the incoming team during shift change which leads to problems in patient care (Bukoh & Siah, 2020). In the emergency department, communication between nurses and physicians also is observed to be a challenge especially during consultations and admission of the patients to the inpatient units. There is a need for quality improvement in the aspect of communication between individual nursing teams and between nurses and physicians in the emergency department.

The emergency department is the busiest unit in any healthcare facility and effective delivery of services can be enhanced through the establishment of good communication channels. Serving hundreds or even thousands of patients every day, nursing teams and physicians should ensure information is passed accurately to minimize errors and to prevent time wastage. When there is poor communication, healthcare providers have to spend extra time to seek clarification or make calls to colleagues which wastes time. The result is increased waiting time in the emergency department, increased medication errors, delayed performance of procedures, and incomplete assessment of patients. Additionally, poor communication can affect healthcare service delivery to admitted patients because they rely on information provided by the emergency department. Poor communication then becomes the source of conflict between individual nursing teams and between nurses and physicians.

Effective communication is a key requirement for collaborative workflow in the healthcare industry. Poor communication affects relationships between healthcare workers and patients get to suffer most due to decreased quality of services provided. According to studies and evidence from the Joint Commission, almost 60% of medical errors are a result of communication breakdown between healthcare professionals (Amudha et al., 2018). In the emergency department, the major problem observed is the lack of a complete guide to the transfer of care between nursing teams which has increased delay times to service delivery and errors in medication administration. For almost a year now, the emergency department has observed an increase in medication errors mostly attributed to poor documentation and communication of care during shift change. Additionally, the nurses and doctors in the ED through the admitting unit do not seem to get along because of communication breakdown. The physicians complain that appropriate inquiries are not made in time, ad lack of detailed information about the patient hinders decision making during critical times.

The communication problem in the department is supported by evidence from employee and patient satisfaction scores. Recent surveys collected in the department demonstrate that nurses are not satisfied with their work because they feel they are under pressure and are mostly blamed when errors occur in the unit. The patient satisfaction scores for the last year demonstrate issues in communication between patients and nurses and patients and doctors. Further surveys indicate that the rate of hospital readmissions in the ER have increased due to ineffective service delivery and premature discharge of patients from the unit. Doctors often make decisions about patients, but most patient care is provided by nurses. These groups need to work collaboratively by utilizing a good communication plan that can lead to improved delivery of services. By improving communication between the two teams, service delivery in the ER through the admitting unit can be maximized.

Problem Statement

Accurate and efficient communication is a key component of providing high-quality care to patients. Unfortunately, poor communication in healthcare is among the leading causes of poor quality service delivery. Communication between individual nursing teams and between nurses and doctors is a big challenge in my healthcare organization. This problem exists in the emergency department and the admitting unit leading to serious consequences to patients and healthcare providers. The main challenge observed is the communication of information during handoffs between incoming and outgoing nurses. Additionally, there are gaps regarding the passing of information from the physicians to the nurses concerning routine care of patients in the ED through the admitting unit. The result is increased medication errors, increased readmissions in the unit, and delayed delivery of services leading to increased waiting times. These changes have greatly affected patient and employee satisfaction. A quality improvement program focusing on improving communication between nurses and other healthcare professionals can improve the levels of care provided to patients in the unit.

Practice Change, Quality Improvement, or Innovation

There is increased and growing evidence that communication and collaboration between healthcare teams lead to improved quality of care. Several interventions are available to improve communication and the organizational goals should determine the best approach to use. Many organizations have utilized interventions such as team training, culture change, and the use of technical solutions to enhance communication. However, evidence-based practices suggest that the use of structured tools can help improve communication between nurses during shift handoffs and during routine communication with other healthcare providers. The SBAR (Situation, background, assessment, recommendation) technique of communication has demonstrated improved care delivery among healthcare teams today. The proposed solution is to design a quality improvement process that utilizes the SBAR handover checklist to improve communication among the nurses.

Improving communication in healthcare is a multidisciplinary approach that requires input from every staff member in the respective units. The proposed method of creating the SBAR handover checklist takes into consideration primarily the nursing team in the emergency department and the nurses in the admitting inpatient unit. The checklist will contain structured elements regarding each part of the situation. The assessment, background, and recommendation will be filled each time, shift handoffs are given, and when the nurses handoff reports on patient care. The situation part represents the current condition of the patient and the working diagnosis. The background represents the history of the patient including past illnesses and the patient medication. The assessment part represents the examiner’s evaluation of the patient’s condition or treatment while the recommendation would include the plan of care and anticipated changes regarding the patient’s treatment.

SBAR technique has helped nurses to have focused and easy communication during the transition of care. The Institute for Healthcare Improvement (IHI) provides information that must be included during SBAR communication. To effectively ensure that each element is followed, the SBAR checklist will contain predetermined points that will be assessed for clarity during shift handoffs. For example, during communication under the situation aspect of SBAR, the nurse presents the situation by identifying himself, the patient, and other healthcare team members. The provider goes ahead to describe the problem the patient is facing and elaborating on the patient’s illness. Effective use of the tool will have to demonstrate that all aspects of each component of SBAR were addressed fully during information exchange.

Rationale

SBAR communication technique can serve to improve organizational performance by focusing on the delivery of quality care to the patients. This approach ensures that there is a more structured form of communication between nurses and other healthcare professionals. It allows for the passing of information in a clear and concise manner while utilizing both verbal communication and writing of information in the electronic record systems (Wang et al., 2017). The quality improvement program aims at improving communication between nurses which can translate to improved patient safety, improved patient satisfaction, and reduced costs.

Effective communication is central to safe and effective patient care. When considering the importance of improved communication, patient safety is one of the top reasons to create good communication channels in hospital departments. Delivering care to patients requires clinical accuracy including proper diagnosis, performing procedures, and transferring care to colleagues. Research establishes that organizations with good communication channels enrich their patient’s health while those with poor communication impact the patient’s well-being (Shahid & Thomas, 2018). Better communication is a strategy that helps institutions to save costs, increase operating efficiency, and protect their patients. These aspects of patient safety can be achieved through the use of SBAR communication in the emergency department.

There is a need to change the communication practice in the emergency department through the admitting unit to promote collaborative care. Good communication improves relationships between healthcare providers and fosters multidisciplinary approaches to patient care (Muller et al., 2018). Effective communication creates a platform for collaboration with colleagues which forms a strategy for problem-solving while improving quality care. The Joint Commission through the introduction of the National Patient Safety Goal to improve communication aims at providing safe, timely, effective, patient-centered, and equitable healthcare. The new practice change involving the adoption of SBAR communication will help to strengthen relationships between nursing teams and other healthcare providers.

Healthcare organizations today are moving towards the delivery of quality care to attract more patients and to meet regulatory standards. Patient satisfaction is observed to influence how organizations initiate change and how the change is sustained in the organization. To ensure the achievement of these outcomes, healthcare providers must communicate adequately and interpret the patient’s information to effectively address their concerns (Vermeir et al., 2015). Additionally, healthcare workers must convey adequate information to patients and colleagues to enable the making of healthy choices that meet the expected outcomes. Poor communication hinders patient satisfaction because of delayed procedures, increased errors, and failure to deliver quality services. The proposed change will ensure nurses in the emergency department and the admitting unit communicate effectively and this will improve patient satisfaction.

Credible Sources

Implementation of evidence-based practices in healthcare is based on the availability of well-supported data from research and national guidelines. Improving communication among nurses and other healthcare teams is a topic that contains numerous research articles and practice change guidelines from accredited bodies. Appendix A provides an evidence summary of 30 credible sources that explore the areas of communication in healthcare, SBAR communication tool use, and the importance of improving communication in healthcare. The sources have utilized various research methods to effectively assess how the SBAR communication checklist improves the quality of care provided to patients. All the synthesized credible sources are research articles retrieved from various databases such as CINAHL, Cochrane, and Pro-quest, except for the national guidelines from the Institute of Healthcare Improvement (IHI) on SBAR communication.

Best Practices

Education and Training

Ineffective communication in healthcare is the main factor for increased errors and the SBAR communication tool is available to improve on the practice. Today, every healthcare organization has adopted the practice standard shift change protocol that involves the use of communication tools but lacks essential education to maximize results (Shahid & Thomas, 2018). During critical situations, nurses and physicians fail to address important elements of patient care leading to increased errors and blame games among the healthcare teams. To improve on this practice, studies suggest the use of education together with the SBAR communication tool. (Wang et al., 2017). Various methods such as role-play simulations and lecturing are proposed for the improvement of SBAR communication among healthcare professionals. Lack of adequate knowledge and skills to use the technique has led to poor communication even with the presence of well-established protocols for SBAR checklist use in healthcare facilities.

Collaborative Practice

Interprofessional collaboration has emerged as a means to address healthcare problems in recent years. The use of the SBAR communication tool in healthcare is closely related to collaborative practice among different healthcare teams. While implementing SBAR communication, lack of interprofessional collaboration, and organizational culture are identified to be the key barriers to the evidence-based practice. While nurses might communicate well during shift change using the SBAR tool, they are also obligated to provide detailed information to physicians when reporting cases. Bonds (2018) explains that standardized handoff communication can only be achieved through teamwork across units. Additionally, the increased use of technology such as telephones and EHR documentation requires interprofessional collaboration for effective communication of care (Kostoff et al., 2016). Therefore, the success of SBAR communication use among nurses is also linked to other organizational factors that should be closely monitored.

Evidence Summary

Tools for Communication

Continuity of patient care is achieved by the transfer of patient information from one healthcare provider to another during shift handover. Studies demonstrate that the transfer of this information is dependent on the establishment of proper communication between the two parties (Bonds, 2018). Because of individual differences, various tools are available to enable a swift transfer of information from one healthcare provider to another regardless of their cadre. The Institute of Healthcare Improvement (IHI) together with other professional organizations such as AHRQ and the Joint Commission recommends the use of the SBAR tool for patient handoffs (IHI, n.d.). Another study conducted to evaluate the presence of communication tools in healthcare identifies team training, multidisciplinary structured work shift evaluation, and the use of electronic SBAR templates as the commonly used tools for communication (Wang et al., 2017). Among these tools, the SBAR communication tool is observed to produce greater results especially on improving communication between nursing teams.

Improving quality and safety in healthcare has become a priority for hospitals worldwide. While addressing the issue of quality, improving communication is observed to be the hallmark of providing safe and reliable care (Wang et al., 2017). An integrative literature review was conducted to determine strategies that are used to improve communication between nurses and physicians in intensive care units. The results from the integrative review identified the use of an electronic SBAR documentation template alongside other checklist tools as effective measures to improve communication. It was observed that the tool increased the frequency of using SBAR communication and it boosted proper reporting of cases in the intensive care units.

Communication Using SBAR Tool

Written communication remains the most prevalent form of communication between healthcare providers (Veimer et al., 2015). In the current evolving and complex healthcare system, effective communication has remained the most important aspect of delivering quality care to patients. Because of communication breakdown, just like in any other industry, the SBAR communication tool is observed to ease the transfer of information in-between shifts. Research conducted to assess the impact and quality of written communication in healthcare suggests that communication is only important with the use of well-established tools (Panesar et al., 2016). The researchers also demonstrate that the implementation of SBAR, either through electronic documentation or paperwork leads to increased frequency of passing information between healthcare teams especially nurses and physicians.

Among the areas that are challenging in nursing is the effective exchange of patient information during shift handoff. A research was conducted to assess the nursing handoff skill using the SBAR technique and its effectiveness was assessed using a handoff questionnaire. The observational study involved 64 nurses in internal and surgical wards where handoffs were given using the SBAR technique while an observer assessed the performance of nurses and recorded the results. Upon analysis of the findings, it was observed that nurses paid more attention to routine aspects of patient care and overlooked aspects of reporting clinical background and assessment of systems (Beigmoradi et al., 2019). The conclusion from the study indicates SBAR checklists can help identify areas that are poorly addressed during communication giving room for improvement.

SBAR Communication and Patient Safety

SBAR has been suggested as a means to avoid unclear communication between healthcare professionals. When communication is not clear, patient safety is compromised leading to injuries, prolonged hospital stay, and even death. For instance, the Joint Commission reports that poor communication is a contributing factor in more than 60% of all hospital adverse events (Muller et al., 2018). A systematic review was conducted to determine the impact of communication and the patient handoff tool SBAR on patient safety. Upon analysis of several articles, the researchers found that SBAR communication improves patient safety, especially when used to structure communication over the phone (Muller et al., 2018). This research is supported by Blom et al (2015) who found out that the use of SBAR as a structure leads to improved patient safety.

Lack of quality handovers in healthcare among nurses is undoubtedly the main cause of adverse effects. A systematic review utilizing data from nine studies found out that structured handover formats such as the use of SBAR help in reducing medication errors and general adverse events (Bukoh & Siah, 2020). The results from this research are consistent with findings from an experimental study that demonstrated improvement of knowledge among nurses concerning the communication of care between different teams (Castelino & Latha, 2015). Patient safety is an aspect that is dependent on job satisfaction and collaborative care. A quasi-experimental study conducted in Jordan found out that SBAR communication enhances job satisfaction among nurses (Dalky et al., 2020). This satisfaction ensures that nurses maintain good communication relationships with other providers which improve safety and quality of care.

Recommendation

Ineffective communication during nursing handoffs between the emergency department and inpatient units impacts patient outcomes and has contributed to poor coordination of care, increased medical errors, and low patient satisfaction. Communication between individual nursing teams and between nurses and doctors is a big challenge in my healthcare organization. This problem exists in the emergency department and the admitting unit leading to serious consequences to patients and healthcare providers. To solve this problem, the Institute for Healthcare Information recommends the use of the SBAR communication tool to improve the accuracy, clarity, and consistency of passing information (IHI, n.d.). The tool allows for an easy and focused way to set expectations for what will be communicated and how between members of the team, which is essential for developing teamwork and fostering a culture of patient safety (Dalky et al., 2020). The proposed solution in this project is to design an SBAR handover checklist to serve as a tool to improve communication for nurses.

References

Amudha, P., Hamidah, H., Annamma, K., & Ananth, N. (2018). Effective communication between nurses and doctors: Barriers as perceived by nurses. J Nurs Care, 7(03), 1-6.

DOI: 10.4172/2167-1168.1000455

Beigmoradi, S., Pourshirvani, A., Pazokian, M., & Nasiri, M. (2019). Evaluation of nursing handoff skill among nurses using situation-background-assessment-recommendation checklist in general wards. Evidence Based Care, 9(3), 63-68.

DOI: 10.22038/EBCJ.2019.40897.2078

Bonds, R. L. (2018). SBAR tool implementation to advance communication, teamwork, and the perception of patient safety culture. Creative Nursing, 24(2), 116–123.

https://doi.org/10.1891/1078-4535.24.2.116

Blom, L., Petersson, P., Hagell, P., & Westergren, A. (2015). The SBAR model for communication between health care professionals: A clinical intervention pilot study. International Journal of Caring Sciences, 8(3), 530-535.

https://www.jenonline.org/article/S0099-1767(15)00228-7/fulltext

Bukoh, M. X., & Siah, C. J. R. (2020). A systematic review on the structured handover interventions between nurses in improving patient safety outcomes. Journal of Nursing Management, 28(3), 744-755. https://doi.org/10.1111/jonm.12936

Castelino, F., & Latha, T. (2015). Effectiveness of protocol on Situation, Background, Assessment, Recommendation (SBAR) technique of communication among nurses during patients’ handoff in a tertiary care hospital. International Journal of Nursing Education, 7(1), 123-127. DOI : 10.5958/0974-9357.2015.00025.2

Dalky, H. F., Al-Jaradeen, R. S., & AbuAlRrub, R. F. (2020). Evaluation of the situation, background, assessment, and recommendation handover tool in improving communication and satisfaction among Jordanian nurses working in intensive care units. Dimensions of Critical Care Nursing : DCCN, 39(6), 339–347.

https://doi.org/10.1097/DCC.0000000000000441

Institute for Healthcare Improvement. (n.d.). SBAR tool: Situation-Background-Asssessmnet-Recommendation. Retrieved from

http://www.ihi.org/_layouts/15/ihi/login/login.aspx?ReturnURL=%2fresources%2fPages%2fTools%2fsbartoolkit.aspx

Kostoff, M., Burkhardt, C., Winter, A., & Shrader, S. (2016). An interprofessional simulation using the SBAR communication tool. American Journal of Pharmaceutical Education, 80(9). https://doi.org/10.5688/ajpe809157

Müller, M., Jürgens, J., Redaèlli, M., Klingberg, K., Hautz, W. E., & Stock, S. (2018). Impact of the communication and patient hand-off tool SBAR on patient safety: A systematic review. BMJ Open, 8(8), e022202.

https://doi.org/10.1136/bmjopen-2018-022202

Panesar, R. S., Albert, B., Messina, C., & Parker, M. (2016). The effect of an electronic SBAR communication tool on documentation of acute events in the pediatric intensive care unit. American Journal of Medical Quality : The official journal of the American College of Medical Quality, 31(1), 64–68. https://doi.org/10.1177/1062860614553263

Shahid, S., & Thomas, S. (2018). Situation, background, assessment, recommendation (SBAR) communication tool for handoff in health care–A narrative review. Safety in Health, 4(1), 7. Retrieved from

https://safetyinhealth.biomedcentral.com/articles/10.1186/s40886-018-0073-1

Vermeir, P., Vandijck, D., Degroote, S., Peleman, R., Verhaeghe, R., Mortier, E., … & Vogelaers, D. (2015). Communication in healthcare: A narrative review of the literature and practical recommendations. International Journal of Clinical Practice, 69(11), 1257-1267.

https://doi.org/10.1111/ijcp.12686

Wang, Y. Y., Wan, Q. Q., Lin, F., Zhou, W. J., & Shang, S. M. (2017). Interventions to improve communication between nurses and physicians in the intensive care unit: An integrative literature review. International Journal of Nursing Sciences, 5(1), 81–88.

https://doi.org/10.1016/j.ijnss.2017.09.007

Appendix A

Credible Sources

Author(s) (Formatted as in-text citation)	Database (CINAHL, EBSCO, Cochrane, Pro-Quest)	Peer-Reviewed (Yes/No)	Applicability (Yes/No)	Evidence Grade (Strength/ Hierarchy)	Appraisal (Brief summary of findings; how findings inform your project?)	Inclusion (Yes/No)
Amudha et al., 2018	Cochrane	Yes	Yes	Level VI, Qualitative research	The research established that nurse-physician communication problems are attributed to readiness for work, working environment, and physician attributes. These findings indicate that there is reason to enhance effective communication between nurses and doctors through effective communication strategies as emphasized in my project.	No
Bukoh and Siah, 2020	Cochrane	Yes	Yes	Level I, Systematic review	It was established that structured handovers reduced the incidence of patient complications, medication errors and adverse events. My research aims at improving communication between nurses and doctors using a structured SBAR checklist.	Yes
Koli and Fillipidou, 2017	PubMed	Yes	Yes	Level IV, Prospective study	Nurses performed well on the use of SBAR communication compared to doctors. This study suggests that improvement is required in the use of SBAR communication especially among the physicians.	No
Vermeir et al., 2015	Cochrane	Yes	Yes	Level VII, Narrative review	Poor communication in healthcare can compromise patient safety and lead to ineffective use of resources. This project demonstrates that there is a need for the implementation of projects to improve communication in healthcare. My project utilizes the SBAR communication technique as a tool to improve communication.	Yes
Wang et al., 2017	Pro-Quest	Yes	Yes	Level I, Integrative review	The reviewed studies reported on the use of communication checklists, electronic SBAR documentation templates, multidisciplinary evaluation and team training to improve communication in healthcare. My project uses the SBAR checklist, a tool identified to promote communication in the emergency department.	Yes
Inanloo et al., 2017	EMBASE	Yes	No	Level III, Quasi experimental	The findings from the study indicated that SBAR technique training led to improvement in reporting by the nurses caring for the patients. These findings support my project which aims at utilizing the SBAR communication checklist to improve nurse reporting in the ED.	No
Pokojova & Bartlova, 2018		Yes	Yes	Level I, Systematic review	The systematic review identified that SBAR, IPASS technology and checklist for trauma patients to be among the common tools for improving communication in healthcare. The findings identify SBAR communication as a strategy to improve communication just like in my project.	No
Blom, 2015	CINAHL	Yes	Yes	Level IV, Descriptive study	The introduction of SBAR led to increased experience of a functional structure for oral communication among healthcare professionals. My research also deals with the use of SBAR as a tool to improve communication among nurses.	Yes
Rumohauly et al., 2019	PubMed	Yes	No	Level VII, Quality improvement project	The implementation of SBAR teaching methods improved the proportion of nurses using the practice exclusively for handover. The study capitalizes on increased awareness of the SBAR technique which is the proposed solution to communication problems in my project.	No
Raeisi et al., 2019	MEDLINE	Yes	Yes	Level I, Systematic review	The systematic review found out that there are challenges in communication , non use of checklist and non-coordination during the handover process. My project aims at utilizing the SBAR checklist to solve the communication problem identified in the study.	No
Padgett, 2018	Cochrane	Yes	No	Level IV, Prospective study	The implementation of SBAR communication during patient transfer demonstrates improvement in aspects of patient care and opportunities for improvement at practice hospital. My project uses the same approach to improve communication among nursing teams.	No
Bakon et al., 2017	CINAHL	Yes	Yes	Level I, Systematic review	The iSoBAR model and its adaptations remain the only model employed across various specialties. However, the model does not demonstrate superior efficacy. My research utilizes the identified SBAR model to improve communication among the nursing team in the ED.	No
Shahid et al., 2020	PubMed	Yes	No	Level IV, Prospective study	The use of SBAR improved the quality of clinical information shared between physicians and non-physician members of the neonatal transport team. This study supports my project that SBAR checklist can improve quality of information shared between healthcare teams.	No
Coolen et al., 2020	CINAHL	Yes	Yes	Level VI, Qualitative study	The professional use of SBAR was influenced by individual, departmental and cultural factors. This study suggests that while the SBAR tool can be used in healthcare, it is important to consider other factors affecting its implementation.	No
Kostoff et al., 2016	PubMed	Yes	No	Level VII, Simulation case study	The use of SBAR among the participants improved perception towards interprofessional collaboration. The findings provide support to my study that SBAR communication can improve collaboration among nurses and other healthcare teams.	Yes
Yu & Kang, 2017	Pro Quest	Yes	No	Level III, Quasi-experimental	There was no significant difference in handover confidence upon implementation of the SBAR communication technique. The results demonstrate that communication might not be achieved effectively upon implementation of the SBAR technique in the ED.	No
Dalky et al., 2020	CINAHL	Yes	Yes	Level III, Quasi-experimental	The use of the SBAR technique improved communication and general relationships among nurses. The study supports my research which utilizes the SBAR checklist to improve communication among nursing teams.	Yes
Achrekar et al., 2016	EMBASE	Yes	Yes	Level IV, Prospective study	Significant improvement in the situation domain of SBAR was observed including aspects of documentation. The study indicates that the use of SBAR does not lead to 100% improvement in the checklist domains.	No
Abbasdaze et al., 2020	Cochrane	Yes	No	Level VII, Quality improvement project	SBAR implementation increased the mean score of quality patient care scale. This evidence suggests that implementation of SBAR can lead to improved quality care in aspects of communication.	No
Bonds, 2018	PubMed	Yes	Yes	Level III, Quasi-experimental	Standardized handoff communication utilizing the SBAR method increased by 100%, and documentation of intraoperative antibiotics on the electronic medication administration record increased by 43%. The study demonstrates that the use of the SBAR checklist can also improve communication among nurses in other departments such as the ED.	Yes
Uhm et al., 2019	PubMed	Yes	No	Level III, Quasi experimental study	The study group demonstrated higher SBAR communication clarity and handover confidence than the control group. My project aims at using the same approach to improve communication among nurses in the emergency department. This study informs on the success of the project.	No
Panesar et al., 2016	MEDLINE	Yes	No	Level IV, Prospective study	The implementation of an electronic SBAR note is associated with more complete documentation and increased frequency of documentation of communication among nurses and physicians. The positive results indicate that SBAR can be used to improve communication among nurses in the ED.	No
Ting et al., 2017	PubMed	Yes	Yes	Level IV, Cross-sectional	Implementation of SBAR communication improved aspects of safety, job satisfaction and working conditions in the experimental facility. The positive results indicate that my project can also improve communication in the Ed using the SBAR technique.	No
Randmaa et al., 2016	Cochrane	Yes	Yes	Level IV, Prospective study	Implementation of the SBAR tool did not lead to significant retention of information after intervention. This study demonstrates that the SBAR communication strategy might not be used as a long-term communication tool in healthcare.	No
Muller et al., 2018	CINAHL	Yes	Yes	Level I, Systematic review	The review found moderate evidence for improved patient safety through SBAR implementation, especially when used to structure communication over the phone. This evidence shows that communication among nursing teams can be improved while using the SBAR strategy.	Yes
Hilda et al., 2018		Yes	Yes	Level IV, Cross-sectional study	The results of the study showed that nurses who used the SBAR communication method had a better patient safety culture (p = 0.000). My project also deals with the SBAR communication tool use to improve aspects of nursing care in the emergency department.	No
IHI, 2020	IHI Website	Yes	Yes	Level I, National practice guidelines	The IHI recommends the use of the SBAR tool for communication between physicians and other healthcare professionals. My project demonstrates the use of the national guidelines to improve communication among nurses using the recommended SBAR worksheet.	Yes
Beigmoradi et al., 2019	PubMed	Yes	Yes	Level IV, Retrospective study	Less attention was always paid to the SBAR domains of assessment and background. The study demonstrates that I should emphasize the four domains of SBAR during the implementation of the project.	Yes
Castelino et al., 2015	CINAHL	Yes	Yes	Level II, randomized controlled trial	The post-test results indicated improved knowledge on the use of SBAR communication among the study population. The study indicates that the use of SBAR requires informed healthcare professionals and it can improve communication if healthcare providers are well-educated.	Yes
Shahid & Thomas, 2018	EMBASE	Yes	Yes	Level VII, Narrative review	SBAR communication tool is easy to use and can be modified based on most of the clinical settings. It was also observed that SBAR communication tool use requires educational training and culture change to sustain its clinical use. This review informs my project that I should expect challenges in attaining the set goal and other aspects such as organizational culture might hinder the achievement of positive results.	Yes

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