Management and Leadership in Nursing

Nursing Leadership and Management
Chapter 1: Introduction
Background
The quality of communication in interactions between healthcare providers has a major influence on patient outcomes. Communication is a process that enables the exchange of information through speaking, writing, or other media. In healthcare, the quality of services delivered to patients is highly dependent on effective communication portrayed by healthcare teams. Nurses usually act as the first responders to complex crises across all healthcare departments making communication an important tool for the nursing team. Because of the varied educational, social, and cultural backgrounds, nurses must portray an array of communication skills to promote understanding in the care delivery process. The problem of communication between nurses and patients and other healthcare teams has emerged to be a challenge in my healthcare organization. A quality improvement program in the aspect of communication between nursing teams and other healthcare providers is required to improve patient care in the organization.

Effective communication skills are required to ensure information is accurately portrayed to patients, families, and colleagues. Despite the existence of communication during routine patient care, communication during shift handoff is recognized as the most critical for nurses. Shift handoffs serve as means of exchanging patient information to allow continuity of patient care. Breakdown in communication means the exchange of patient information will be incomplete resulting in errors and adverse events that can be costly. Continuous barriers to effective communication can cause a gradual breakdown in relationships hindering important processes in healthcare such as teamwork and interprofessional collaboration (Kostoff et al., 2016). Communication issues in my healthcare organization have affected the exchange of shifts between nurses resulting in poor identification of patient needs and ineffective attendance to patient needs.

The problem of communication among nurses in the organization can be attributed to several factors. The first cause of poor communication is the lack of organizational focus to communication barriers among healthcare teams. For example, recent quality improvement projects in the organization have focused on improving patient care with an emphasis on patient outcomes rather than addressing the root causes of the problems. Data obtained from the office of nursing education indicates that programs to promote communication among healthcare teams were last reviewed five years ago. Most healthcare providers do not understand that communication is a complex process that is circular rather than linear and involves total personality. Lack of emphasis on these aspects has distorted the channels of communication leading to the identified problems among nursing teams.

Effective communication between nurses is crucial for the promotion of workflow during shifts. Shift handoffs represent the transfer of information during the transition of care including an opportunity for patients and nurses to ask questions (Müller et al., 2018). The lack of a clear process for shift handoffs among nurses in the organization is a contributing factor to poor communication. The exchange of information during shifts fails to cover all the critical aspects that could allow continuity of care. The result is poor delivery of patient care, increased errors in medication, and the existence of conflict among nursing teams due to failed processes. To improve communication among nurses, addressing the issue of shift handoffs can be a great start to solving the perceived communication problems in the organization.

The evolving healthcare environment and the increasing complexity of patient needs can contribute to communication challenges in healthcare. For instance, more specialties in healthcare with greater numbers of providers exist leading to several encounters of handoffs during the day. The existence of several healthcare teams may lead to the inability to communicate care leading to errors and safety events. Another cause of communication problems is the huge patient population served by nurses resulting in burnout and lack of enough time. The subsequent shifts are likely to receive incomplete information about the patients with other crucial information missing in the patient reports. Ineffective handoffs resulting from provider or system factors can lead to a host of patient safety problems.

Communication problems among nursing teams can be caused by common barriers to effective communication. Language differences between providers and patients can be a hindrance to effective communication during routine care or even shift changes. Patients are supposed to ask questions about their care or equally assist in planning for their daily care. Language barriers may hinder the exchange of crucial information unless interpreter services are timely provided. Secondly, cultural differences may affect nurse-patient interactions because perceptions on health and illness are different. For example, some patients may prefer to be addressed using their first names instead of surnames while others might not like communication aspects like eye contact or minimal personal space (Kostoff et al., 2016). Emphasizing these aspects during shift handoff can improve communication in the organization.

Problem Statement

Accurate and efficient communication between nursing teams is a prerequisite to providing high-quality patient care. Communication helps in building strong relationships, promotes collaboration, and ensures coordination of patient care. Unfortunately, communication is among the top healthcare challenges observed to hinder care delivery today. The problem of communication among nurses is a challenge across all inpatient units in my healthcare organization. The main challenge observed is the lack of clear communication channels during shift handoffs. The communication issues have resulted in an increased number of medication errors and the lack of patient involvement in their care. Consequently, conflict among nursing teams has increased alongside issues with patient satisfaction. A quality improvement program focusing on nursing shift handoffs can serve to address the challenge of communication in the organization.

Practice Change, Quality Improvement, or Innovation

Improving quality and safety in healthcare has become a priority today. Effective communication among healthcare team members is identified as the hallmark for safety and highly reliable patient care. Research demonstrates that ineffective communication among healthcare providers leads to about two-thirds of sentinel events and over 91% of medical errors (Shahid & Thomas, 2018). Additionally, the increased cost of care resulting from these errors has put more pressure on providers and healthcare organizations to improve the aspect of communication. Quality improvement programs focusing on improving communication are available to guide new communication approaches in healthcare. Many organizations have focused on methods such as culture change, team training, and technology advancements to improve communication. However, the use of tools such as structured work shift evaluation and the SBAR (Situation-background-assessment-recommendation) communication technique has proven to be the most effective in addressing this healthcare issue.

The proposed quality improvement program to address the challenge of communication among nurses is the implementation of SBAR communication. SBAR is a reliable and validated tool recognized by organizations such as the Joint Commission, World Health Organization (WHO), and the Institute for Healthcare Improvement (IHI) for effective communication during patient handoff. Initially developed by the US military for communication on nuclear submarines, SBAR has been adopted in healthcare facilities, particularly to improve patient safety. The communication strategy is divided into four parts to ensure that staff are concise and that focused information is provided.

S- Situation

The first part of the tool deals with the situation where the nurse describes the current condition of the patient or the reason for calling the physician. The healthcare provider begins by identifying themselves and the unit where the communication process begins. Upon identification, the next step involves identification of the patient by name and the reason for the communication process. The healthcare provider can also describe their concerns at this stage to ensure the receiver gets a clear message of the actual problem.

B- Background

The second part deals with background information where information about the patient’s illness is addressed. During the communication process, the healthcare provider gives the reason for admitting the patient and significant medical history that might aid in decision making. During shift reports for nurses, the outgoing nurse highlights the patient’s background including the diagnosis, admission date, prior procedures, current medications, allergies, laboratory investigations, and relevant diagnostics (Dalky et al., 2020). This information should be collected during the preparation phase to reduce time spent during shift handoffs.

A- Assessment

The assessment part analyzes the current condition of the patient including vital signs, physical assessment, and laboratory investigations (Müller et al., 2018). The healthcare provider should bring out the concerns that prompted the communication process during calls or the reasons for monitoring the patient in subsequent nursing care delivery. The underlying causes of the observed patient problems should be supported by investigations or diagnostic tests to aid in recommending the most probable solution to the patient’s problems.

R- Recommendation

The last part deals with recommendations to correct the identified health problems. The healthcare provider calling should give any advice on what should be done at the end of the conversation. Alternatively, the provider helps the physician to make the right choice depending on the assessment made. During shift handoffs, the outgoing staff can make suggestions on the subsequent care required for the patient including laboratory investigations or imagery tests. Upon completion of the exercise, incoming nurses and patients/families are allowed to ask questions or contribute to the development of a care plan for the patient (Dalky et al., 2020). The IHI SBAR communication tool will be adopted to address the challenge of communication among nurses during shift handoffs in the organization.

Rationale

Poor communication has been a factor in safety events and multiple deaths nationally in the recent past. For healthcare institutions, ensuring patients receive proper care goes beyond performing procedures and making diagnoses to include effective communication. The primary reason for addressing the issue of communication in the organization is to reduce medical errors and costs associated with poor communication. The increasing competition in the healthcare sector requires healthcare organizations to be vigilant in matters of quality and safety. Poor communication hinders positive quality measures by increasing mortality cases, patient readmissions, and length of hospital stays (Dalky et al., 2020). The implementation of the proposed quality improvement program will serve to promote quality, safety, and patient-centered care in the organization.

Improving communication in healthcare is identified as a step towards achieving patient-centered care. Patient-centered care involves the provision of care that is responsive to the individual preferences, needs, and values and ensuring that patient values guide all clinical decisions. To ensure all these aspects are met, nurses must collaborate and work in teams while involving patients in their daily plan of care. Shift handoffs provide an opportunity for maximizing collaborative care between nursing teams and patients. While utilizing this opportunity, communicating effectively will form a platform for collaborative care. The use of the SBAR communication tool will strengthen collaborative practices between nurses, other healthcare providers, and patients.

Communication handoffs are critically important in creating a shared model around the patient’s condition. The SBAR technique is among the tools supported to improve communication in healthcare. This tool provides a concrete mechanism that is used to frame conversations around care transitions during routine nursing care and in emergencies. The reason for selecting this tool is because it offers a practical strategy to assist nurses to implement a non-hierarchical communication model for improving clinical care outcomes (Bonds, 2018). Supported by various professional organizations, the SBAR communication tool is crucial for addressing communication issues among clinicians and other healthcare teams. Additionally, the tool is friendly to technology because it can be incorporated into the Electronic Health Record (EHR) system to guide nurses in delivering high-quality patient care through timely and detailed report giving.

Communication is a two-way process of reaching mutual understanding whereby participants create and share meaning. The use of the SBAR communication tool is supported to provide a structure for an interaction that helps the giver and the receiver of information. For instance, the tool ensures that the information giver has formulated their thinking before trying to pass the information to the other party (Rea et al., 2018). Additionally, the tool prepares the receiver on what to expect while reducing interruptions that might hinder communication. The reason for using this tool is because it can be applied in any setting to reduce communication barriers across different disciplines.

Chapter 2: Review of Literature

Credible Sources

The quality of communication in interactions between healthcare providers and patients/families has a major influence on patient outcomes. The consequences of failed communication in/, healthcare include medication errors, delays in hospital discharge, inaccurate patient plans, and poor patient satisfaction. Numerous research has been published to support the importance of communication in healthcare. Several articles are present to provide evidence-based strategies to improve communication including the use of tools like SBAR among healthcare teams. Additionally, professional organizations such as the Joint Commission, Institute of Medicine (IOM), Agency for Healthcare Research and Quality (AHRQ), WHO, and IHI have supported the implementation of evidence-based strategies to address communication breakdown in healthcare. Appendix A in this paper provides an evidence summary of 30 credible sources that explain the need of improving communication among nursing teams using SBAR communication and other supported tools. These sources were obtained from various databases including CINAHL, MEDLINE, EMBASE, ProQuest, COCHRANE, and national guidelines from professional organizations.

Best Practices

Education and Training

The caliber of communication between nursing teams and patients is a key component of healthcare quality. Communication improvement is linked to improved outcomes such as medication compliance and patient satisfaction. Education and training for healthcare workers is a practice that is recommended to improve communication among nurses and other healthcare teams. Studies demonstrate that good communication skills exceed mere academic concerns because it demonstrates the actual care required for the consumer (Rea et al., 2018). Education and training for nurses can help in improving their communication skills and enable the acquisition of communication techniques appropriate in diverse healthcare environments. Among the recommended methods of communication, training includes role-play, simulations, and lecturing. Even with adequate strategies for improved SBAR communication in healthcare, lack of education and training among nurses will eventually hinder the workability of the new strategy.

Ineffective communication between healthcare providers is a major factor in the creation of adverse events today. To address this issue, education and training using appropriate communication strategies are largely recommended. While using this approach, studies demonstrate that the use of appropriate educational approaches yields better results rather than just passing information to the healthcare providers. For instance, role play is a technique that helps participants to experience the decision-making process in an environment that is free from any concerns about the impact of these decisions on their real relationship (Rea et al., 2018). The aim of using role-play is to enable providers to perfect their skills in performing a certain duty. When using this technique, participants are able to experience different problematic decisions and actions that can help in the actual communication of patient care. Apart from the role-play teaching strategy, the lecturing method is also effective in passing information about SBAR communication, especially to students. However, SBAR communication education and training can be best achieved using the role-play method.

EHRs and SBAR Communication

Communication breakdown and the inability to recognize the clinical deterioration of patients are the main reasons for the occurrence of adverse events in healthcare. To solve such healthcare issues, there is increased incorporation of technology to guide patient care and to assist providers in determining patients requiring close monitoring. The use of electronic health records (EHRs) technology presents an opportunity to nurses to incorporate patient handoffs into the system. The use of this technology is supported by the Joint Commission which requires the standardization of SBAR tools to promote consistency in communication. For example, studies suggest the creation of SIGNOUT handoff documents that could allow nurses and physicians to document brief information about the critical aspects of patient care (Panesar et al., 2016). Perhaps the development of handoff tools that are incorporated into EHR systems can help to address the communication breakdown problem among healthcare teams.

There is limited literature evaluating the integration of the electronic health record (EHR) to a structured communication template such as the SBAR. While evaluating the reasons for ineffective communication, factors such as unavailability of information, test results, diagnostics, and good patient records are observed. The use of EHRs can be a step towards the promotion of SBAR technique implementation in the facility. For example, the EHR can provide patient history, test results and provide information that can be used to recommend care during communication. Additionally, the EHR system can be used to create a more advanced SBAR checklist that can be used in specific nursing areas to improve efficiency. An example is an SBAR tool in the geriatric wards that contain background information checks on the potential for falls and assessment checks for mood and impulse control. This information can be used to recommend additional care of the patient, courtesy of the EHR system.

Patient-Centered Care

Patient-centered care involves the provision of care that is respectful and responsive to the patient care needs, values and preferences. During the provision of this care, healthcare teams work together to develop comprehensive care plans for patients. Communication is identified as the central theme of promoting patient-centered care because it links the patient, family, and healthcare providers (Buljac-Samardzic et al., 2020). In patient-centered care, care is collaborative, coordinated, and accessible by the patient at the right time and place. To ensure patient-centered care is achieved, handoff tools such as SBAR ensure the patent/family has an opportunity to contribute to their plan of care (Bonds, 2018). Additionally, the tool brings together multiple healthcare providers to share patient information while considering the patient’s values, preferences, and cultural traditions.

Evidence Summary

The Challenge of Communication in Healthcare

Sharing patient-specific health information during handoffs requires the awareness of the patient’s condition and clinical trajectory. Sharing of patient information should be aimed at promoting collective understanding of the patient’s needs and expectations. Research establishes that communication failure among providers continues to be cognizant despite the implementation of numerous strategies. Among the commonly identified obstacles to effective communication include distractions, insufficient time, and interruptions (Wang et al., 2017). The challenge of communication during shift handoffs is another area of interest in today’s healthcare system. Apart from communication among nurses, communication between nurses and other healthcare teams is also an obstacle to achieving quality outcomes. For instance, 91% of medical errors are caused by communication breakdown among healthcare providers Rea et al., 2018). To effectively solve this challenge, interventions should focus on addressing shift handoffs and other critical areas of information exchange between nurses, patients, and physicians.

There is a large body of literature discussing the inefficiencies of both verbal and written communication in healthcare. For example, nurses and doctors often collide during routine rounding due to failure to communicate patient care, especially in the patient’s notes. Sometimes the healthcare teams do not have adequate time to go through what was written by other teams leading to poor execution of orders and timely assessment of patients. The same can be said about communication of patient information during emergencies and referrals arriving at the emergency department during busy sessions. Studies analyzing the challenge of communication in healthcare suggest the development of standardized tools that can help healthcare providers to communicate patient care effectively (Uhm et al., 2019). For example, the SBAR communication tool is commonly identified across numerous research to have a huge impact in improving communication among nurses during shift handoffs.

Communication Tools in Healthcare

The quality of communication in interactions between nurses and patients has a major influence on patient outcomes. To improve on the aspect of communication, various tools exist to guide nurses and other healthcare providers. The SBAR communication tool is among the primary methods that are observed to have a huge impact on patient care outcomes (Ting et al., 2017). The Joint commission and organizations like IHI recommend the use of SBAR communication for both the nursing and physician teams. For instance, a recent study analyzed the effectiveness of SBAR communication tools for hand-off in healthcare. The narrative review highlighted various studies that supported the use of SBAR alongside the limitations of using the communication tool. The research concludes that SBAR communication is a structured tool that has shown a reduction in adverse events in hospital settings (Shahid & Thomas, 2018). To its disadvantage, the studies identified SBAR communication can be challenging to use in busy healthcare settings such as the intensive care units (ICU).

Improving quality and safety has become a priority in healthcare worldwide. Effective communication is identified as a key strategy to improve patient safety leading to the provision of highly reliable care. An integrative literature review was conducted to identify measures that can be used to improve communication among healthcare teams. The study which was conducted focusing on findings from intensive care units demonstrates that communication tools can be crucial in addressing the identified healthcare problem (Wang et al., 2017). Among the tools identified to improve communication include the SBAR checklist, team training, and the use of multi-structured work shift evaluation tools. Other studies have tried to compare the use of SBAR communication tools with other tools such as SIGN-OUT and SOAP (Bukoh & Siah, 2020; Buljac-Samardzic et al., 2020). From the comparison, differences are observed in the ease of using the tools across different healthcare units. The intensive care unit is observed to be challenging when it comes to the implementation of communication tools because of the busy nature of the staff.

Importance of SBAR Communication

Communication between healthcare providers accounts for a major part of information flow in healthcare settings. Communication breakdown during the transition of care in hospitals is caused by a lack of standardized tools of communication. Various studies have analyzed the importance of SBAR communication in improving patient outcomes. The first aspect stressed by numerous studies is that the SBAR communication tool provides a structured way of communicating in healthcare. It allows uniformity in passing patient information to other healthcare providers. A prospective study conducted a few years ago found out that SBAR communication allows nurses to have focused and easy communication (Müller et al., 2018). It was also observed that the tool is crucial in capturing important patient information that requires reinforcement during routine care delivery (Achrekar et al., 2016). In conclusion, the study highlights that SBAR in nursing practice for bedside shift handover will improve communication between nurses and thus ensure patient safety.

There is increasing evidence linking the use of SBAR communication tools in improving patient safety. The tool allows for the effective delivery of information to nurses and patients on time. A recent study was conducted to assess the effectiveness of SBAR communication in improving patient outcomes. The systematic review indicates that structured communication using SBAR and other communication tools has a positive impact on reducing adverse events (Bukoh & Siah, 2020). These results are consistent with findings from other studies that highlight the importance of communication in improving patient safety. Additionally, the aspect of patient-centered care is improved when communication tools are used in healthcare. Dalky et al (2020) explain that SBAR communication can be an effective strategy in addressing the issues of patient and healthcare worker satisfaction. The tool ensures all nurses deliver the correct information during shift handoffs and that patients get an opportunity to share their feelings.

SBAR Communication and Shift-Handoffs

Transferring the responsibility of patient care in nursing can occur multiple times per day. The nursing handoff system involves the communication of patient data, information, and knowledge to ensure continuity of care alongside concerns with patient safety. Research demonstrates that effective handoffs are given when standardized tools are used (Pakcheshm et al., 2020). These tools are crucial to the nursing handoff system because they decrease information overload, increase the quality of information exchanged, and decrease the risks to patient safety. Stress has been put on the use of SBAR tools for communication during nursing shift handover because of the observed benefits compared to other available tools. One study found out that the SBAR communication tool is crucial in reducing errors of omission, medication errors, and increased patient/family involvement in the hand-offs (Bukoh & Siah, 2020). Another important issue when using SBAR communication during shift-handoffs is healthcare worker satisfaction. Studies demonstrate that nurses are better satisfied during handoffs if a systematic approach, nursing documentation, bedside handoff, and the use of a standardized tool are applied during the communication process. SBAR communication tool offers nurses an opportunity to incorporate these communication aspects during shift handoffs.

Recommendation

Effective communication by nurses is important to ensure patient safety. The problem of communication among nurses and other healthcare teams exists in my organization. There is a lack of clear guidelines on shift handoffs for nurses leading to poor quality outcomes such as increased medication errors and poor patient satisfaction. The use of communication tools such as the SBAR checklist is identified by professional organizations to improve patient safety through improved communication (Pakcheshm et al., 2020). The review of evidence-based practices from the literature identifies various strategies to improve communication among nurses. SBAR communication tool is identified to be the most appropriate strategy to improve patient safety and other quality outcomes in healthcare organizations (Shahid & Thomas, 2018). The tool provides a structured method that can be used by nurses, physicians, and other healthcare providers during routine patient care and emergency communications. To improve communication in my healthcare organization, I propose the adoption of the IHI SBAR communication checklist to guide the exchange of patient information during nursing shift handoffs. Through the implementation of this tool, patient satisfaction reduced medical errors, and improved care coordination between nursing teams can be realized.

SBAR communication technique is an easy way to build communication in healthcare, especially during critical situations. Supported by evidence, the strategy can be used by multiple healthcare teams in different departments. For instance, SBAR communication use is recommended in inpatient and outpatient units, over-the-phone conversations with clinicians, communication during patient transfers, and conversations with peers during change of shift reports (Bonds et al., 2018). To ensure the SBAR communication technique is effectively incorporated into nursing units, the use of education and training is recommended. Education and training using lecturing and role-play methods offers nurses an opportunity to experience the decision-making process in an environment that is free from any concerns about the impact of these decisions on their real relationship (Rea et al., 2018). To improve communication among nurses in the facility, I recommend the use of an education and training approach before the actual implementation of the SBAR communication strategy. I believe this approach will increase the knowledge and understanding of nurses on the importance of communication and how to improve patient safety during routine care delivery.

References

Achrekar, M. S., Murthy, V., Kanan, S., Shetty, R., Nair, M., & Khattry, N. (2016). Introduction of situation, background, assessment, recommendation into nursing practice: A prospective study. Asia-Pacific Journal of Oncology Nursing, 3(1), 45–50. https://doi.org/10.4103/2347-5625.178171

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

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

Buljac-Samardzic, M., Doekhie, K. D., & van Wijngaarden, J. (2020). Interventions to improve team effectiveness within health care: A systematic review of the past decade. Human Resources for Health, 18(1), 2. https://doi.org/10.1186/s12960-019-0411-3

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

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

Pakcheshm, B., Bagheri, I., & Kalani, Z. (2020). The impact of using “ISBAR” standard checklist on nursing clinical handoff in coronary care units. Nursing Practice Today, 7(4). https://doi.org/10.18502/npt.v7i4.4036

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

Rea, T., Simeone, S., Annunziata, M., Serio, C., Esposito, M. R., Gargiulo, G., & Guillari, A. (2018). Effectiveness of the situation-background-assessment-recommendation (SBAR) methodology in patient handovers between nurses, Italy. The Journal of Hygiene & Public, 74(3), 279–293. https://pubmed.ncbi.nlm.nih.gov/30235468/

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. https://doi.org/10.1186/s40886-018-0073-1

Ting, W. H., Peng, F. S., Lin, H. H., & Hsiao, S. M. (2017). The impact of situation-background-assessment-recommendation (SBAR) on safety attitudes in the obstetrics department. Taiwanese Journal of Obstetrics & Gynecology, 56(2), 171–174. https://doi.org/10.1016/j.tjog.2016.06.021

Uhm, J. Y., Ko, Y., & Kim, S. (2019). Implementation of an SBAR communication program based on experiential learning theory in a pediatric nursing practicum: A quasi-experimental study. Nurse Education Today, 80, 78–84. https://doi.org/10.1016/j.nedt.2019.05.034

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)
Achrekar et al., 2016	CINAHL	Yes	Yes	Level IV, Prospective study	SBAR communication technique has helped nurses to have an easy transition during shift handover. The use of the technique helped in ensuring patient safety. My research aims at implementing SBAR communication tool to improve communication between nursing teams during shift handoffs.	Yes
Bukoh and Siah, 2020	Cochrane	Yes	Yes	Level I, Systematic review	The use of structured communication tools reduced incidences of medication errors and led to improved patient satisfaction. My research aims to improve communication using SBAR communication tool.	Yes
Dalky et al., 2020	CINAHL	Yes	Yes	Level III, Quasi-experimental	There was improved communication and relationships between nursing teams upon the implementation of SBAR communication strategy. My research also aims at improving communication between nursing teams during shift handoffs.	Yes
Shahid & Thomas, 2018	EMBASE	Yes	Yes	Level VII, Narrative review	SBAR communication has improved communication, reduced adverse events and promoted patient safety. My research addresses quality improvement in the organization through the use of SBAR communication tool.	Yes
Wang et al., 2017	CINAHL	Yes	Yes	Level I, Integrative review	Tools such as SBAR communication checklist, multidisciplinary team evaluation, SIGNOUT and team training were identified to improve communication among healthcare providers. My research focuses on the role of SBAR tool in improving communication among nurses.	Yes
Pakcheshm et al., 2020	PubMed	No	Yes	Level III, Quasi-experimental	Transition of information based on standard checklists with a specific framework can increase the frequency of information provided during clinical handoff. A recommendation was made to train nurses on the use of communication tools such as ISBAR/SBAR. My research intends to use the tool in addressing the issue of communication among nursing teams.	Yes
Uhm et al., 2019	Cochrane	Yes	Yes	Level III, Quasi experimental study	SBAR communication education improved clarity and increased perceived handover confidence in nursing students. My research uses SBAR communication to improve patient care outcomes. An educational approach should be used during the implementation of my new change.	Yes
Panesar et al., 2016	MEDLINE	Yes	Yes	Level IV, Prospective study	There was improved documentation and increased frequency of communication among nurses and physicians upon the implementation of SBAR communication. My research aims at improving communication using the same strategy.	Yes
Bonds, 2018	ProQuest	Yes	Yes	Level III, Quasi-experimental	There was improvement of documentation of patient data in EHR upon the implementation of SBAR communication. My research aims at addressing communication problem among nurses to improve patient care delivery.	Yes
Rea et al., 2018	PubMed	Yes	Yes	Level I, Integrative review	The use of SBAR communication is supported by literature to improve documentation of patient information and communication between healthcare teams. My project uses SBAR communication to improve communication between nursing teams and patients.	Yes
Ting et al., 2017	PubMed	Yes	Yes	Level IV, Cross-sectional	Quality measures such as patient satisfaction and patient safety improved upon the implementation of SBAR communication. The results indicate that my project can improve communication aspects among providers and patients.	Yes
Bulijac-Samardzic et al., 2020	MEDLINE	Yes	Yes	Level I, Systematic review	Various strategies including training, the use of communication tools and redesigning organizational processes were identified to improve team effectiveness in healthcare. My research used the SBAR communication tool to improve organizational performance through the improvement of communication.
Kostoff et al., 2016	PubMed	Yes	Yes	Level VII, Simulation case study	Interprofessional collaboration was improved through the use of SBAR communication. My research aims at improving quality in aspects of communication and collaboration using the SBAR shift handoffs.	Yes
Muller et al., 2018	EMBASE	Yes	Yes	Level I, Systematic review	There was moderate evidence of improved communication when using SBAR communication among physician and nursing teams. My project aims at improving communication among nursing teams using SBAR technique.	Yes
Hilda et al., 2018	PubMed	Yes	Yes	Level IV, Cross-sectional study	A better patient safety culture can be promoted through the use of SBAR communication by nurses. My project emphasizes the promotion of patient-centered care and improved quality through implementation of SBAR handoffs.	No
Randmaa et al., 2016	MEDLINE	Yes	Yes	Level IV, Prospective study	The retention of information by nurses upon implementation of SBAR communication was still poor. SBAR technique did not yield positive outcomes regarding healthcare worker retention of critical patient information. The research indicates that SBAR technique can have some setbacks during its implementation.	No
Yu & Kang, 2017	ProQuest	Yes	No	Level III, Quasi-experimental	The level of confidence on shift handover among nurses did not increase upon the implementation of SBAR communication. The study shows my project might fail to attain the expected results prompting modification.	No
Shahid et al., 2020	ProQuest	Yes	Yes	Level IV, Prospective study	The use of SBAR communication improved the quality of information shared between healthcare providers in the neonatal unit. These finds inform on the potential success of my project to improve communication among nursing teams.	No
Raeisi et al., 2019	MEDLINE	Yes	Yes	Level I, Systematic review	The study identified challenges in communication attributed to lack of checklist use and poor coordination of services during shift handoffs. My project aims at addressing these problems using SBAR communication tool.	No
Inanloo et al., 2017	EMBASE	Yes	No	Level III, Quasi experimental	Training of healthcare providers to use SBAR technique led to improvement of nursing report giving during shifts. My proposed change focuses on improving communication between nurses using SBAR communication.	No
Koli and Fillipidou, 2017	Cochrane	Yes	Yes	Level IV, Prospective study	The comparative study demonstrated strength of nursing teams in adopting and using SBAR communication technique compared to physicians. The study indicates that the new project is likely t yield positive communication results with the use of SBAR tool for communication.	No
Amudha et al., 2018	Cochrane	Yes	Yes	Level VI, Qualitative research	It was established that nurse-physician communication problems are attributed to readiness for work, working environment, and physician attributes. This research indicates that there is more to communication improvement than the use of SBAR tool and other communication tools.	No
Beigmoradi et al., 2019	PubMed	Yes	Yes	Level IV, Retrospective study	The study indicated that less attention was given to the SBAR aspects of ‘Assessment’ and ‘Background’. The study indicates that I should put emphasis on all aspects of patient data identification during SBAR communication implementation.	No
Abbasdaze et al., 2020	PubMed	Yes	No	Level VII, Quality improvement project	SBAR implementation increased the mean score of quality patient care scale. My research aims at improving quality and safety through the implementation of SBAR communication handoff.	No
Barilaro et al., 2019	CINAHL	Yes	No	Level IV, Cohort study	Nursing communication is the key to establishing good therapeutic relationships and is associated with patient satisfaction. My research deals with improving communication among nursing teams to achieve patient satisfaction.	No
Lotfi et al., 2019	PubMed	Yes	Yes	Level IV, Descriptive-correlational study	The weakness of nurses’ communication with patients was evident and patients were dissatisfied with the care received. My project addresses the identified issue using BAR communication tool.	No
Coolen et al., 2020	CINAHL	Yes	Yes	Level VI, Qualitative study	The study demonstrated that adoption of SBAR communication was influenced by factors like individual preferences, departmental influences and cultural factors. The findings demonstrates the use of SBAR communication in my organization may face similar challenges.	No
Padgett, 2018	Cochrane	Yes	No	Level IV, Prospective study	Patient-centre care was observed to be the central theme during the improvement of communication among healthcare teams. Consequently, patient care improved when SBAR communication was used. My research uses the same approach to improve quality and patient safety in the organization.	No
Rahomauly et al., 2019	CINAHL	Yes	Yes	Level VI, Quality Improvement Project	There was improvement in awareness and understanding of SBAR communication. SBAR strategy assessment required controlled and simulated environments that are difficult to replicate in ideal healthcare setting. This study indicates that SBAR communications can have setbacks that can affect its full implementation in healthcare.	No
Van der Wulp et al., 2019	PubMed	Yes	Yes	Level IV, Prospective study	Handovers in the acute medical assessment unit were poorly structured. Implementing SBAR-R communication strategy led to improved handover practice and increased situational awareness. My research aims at implementing SBAR communication to improve quality and patient safety aspects.	No

OTHERS:

Related Posts: