Welcome this is Tammy and I'm with NurseMinder and in today's video
we're going to be talking about how you can communicate with your colleagues,
with your nurse supervisor, and even the physician
or those specialists around the bed in a very clear and succinct way. We call it
the SBAR and we are going to dissect this
right after this.
Welcome back my name is Tammy and this is NurseMinder and on this channel we do
everything nursing so if you're new here consider subscribing below so that you
get the next video when it's released. All right so we're going to talk about
SBAR we're first going to just mention a little bit
about why we use it when we use it and then we're going to break down what
each of these letters stands for now stick around to the end of the video
because I do have a free download I want to talk about
that you can utilize to make this even easier
for you. So first of all sharing a concern with a fellow colleague, your
nurse supervisor, or physician you really want to make sure that people
hear what you have to say so they can understand you.
It is extremely important in healthcare that when we
pull together these pieces of information that we are concise
and clear so that others can interpret the situation.
In healthcare one of the tools that we use to help communicate that information
is called SBAR. Now good communication skills are
essential and SBAR is a model that helps nurses clearly articulate key
elements of a patient's experience so that the team can make informed
decisions on care goals and outcomes. Now for some
people whether you're new or you've been nursing for a long time
talking with the physician is an anxiety provoking moment.
I know because I teach a lot of students and it is one of the things that really
gives them a lot of concern. Now it is true there are some physicians
and charge nurses and colleagues that will be way more excited to hear
about what you have to share than others and by excited I mean they'll be open to
hearing you they'll want to know more information
and they might even explain their rationale to you
and then of course there's the other side of that those team members who are
just focused, in out, give me what I need to know and it may feel like they really
don't have time for you. It does not matter which situation
you're in, as a healthcare provider you have a responsibility to advocate
for that patient to the best of your ability
and that means sharing information so that's why in this video we're going to
talk about SBAR it's a really commonly used tool to help
nurses shape that information to make that conversation a little less
anxiety provoking. Okay it's time to break down SBAR. The S
stands for situation and the question you want to be asking yourself
are well there's two questions you want to be asking yourself first is
what is my major concern and what's going on
right now? So you may be working with this patient for several days or it's
your first encounter it doesn't matter what you recognize is that something
isn't within the parameters of normal for this patient
or progressing where you think things need to go.
So for example if you had come in and you're working with Mr Terry Manner today
and Mr Terry Manner is say 56 year old male
who is post surgery for a knee replacement
and you walk in and he is on the floor crying holding his leg that would not be
the expected patient presentation you would hope to see
if we were managing this patient's care. So what is going on right now
is Mr Terry Manner is on the floor crying in pain.
Now background - we're looking at the pertinent facts so this is
the patient's admission diagnosis and medical history
So if i were to build on Mr Terry Manner is on the ground crying in pain holding
his knee, current situation, the background is he's
postop day three for a knee replacement to the
right side and his medications are morphine
two milligrams every 12 hours and if there's any relevant past medical
history - is this his first knee replacement? did he have is he
obese? are there mobility issues? potentially
any psychiatric history as well you want to keep the relevant facts only in the
background. A stands for assessment this is where
you're going to answer the question what did i do?
Well you should be doing a set of vital signs anytime you call the physician
they're most likely to ask you what was their vital sign so definitely
do that, if this is MrTerry Manner who's postop
day 3 he's on the ground crying holding his knee
I will also include a pain assessment. I may include a mobility assessment,
I might include a medication assessment his last medication
was given at this time at that time he was
stating no pain and now it's only been two hours and he's
in uncontrollable pain. So the question is what did you find and
what do you think is going on so in your assessment in your discussion
with him maybe he tells you that he banged his knee
on the bed railing and that's what knocked him to the ground and why he's
in so much pain, or perhaps when you assessed him you
found that there was a lot of swelling and oozing coming from that
site and you're thinking it's infected, and finally
R stands for recommendation what do you need to have done or what do you think
should be done to help this patient? In our example of Mr Terry Manner perhaps
what you're looking for is an increase in medication dosing
maybe a one-time prn dose to help him through this acute phase of this
recovery, perhaps what you would like for the physician to do would be to come in
and see so your recommendation might be would
you like to come up and see him and assess him?
or would you like us to order an x-ray because we're not sure if he's fractured
it based on your assessment his mobility
maybe was deficient - would you like us to order
some lab work? can we increase his medication dosing?
All right so let's just recap those pieces: S is situation
what is my major concern and what is happening right now;
B is for background what are the pertinent facts
A is for assessment what did you find and what do you think is going on and
then recommendations what would you need or want to happen
right now and what should be done to fix the problem.
So let's do the SBAR on maybe something a little bit more acute
in that you haven't known this patient for a few days but in fact this is a new
patient to your floor, to your emergency department, to your
unit, or that you see in the community and you
just walked in and this is the story that you get.
We're looking at Mrs Sonia Dubois we know she's 27 years old
and you walk in and she's now been complaining of feeling short of breath
for three hours. So we can't SBAR yet
because we need to do our assessment and do a little bit of digging around.
So remember S is for situation: the situation is
she's been short of breath for three hours.
Background as we talk with her we find that
she initially came in because she had a cough
cold that was unresolving for the last week and that was her big concern.
So background is coughing cold over one week
one over 52 is one week
and that she has been febrile
times 24 hours
So as you've talked with her and you've gathered a little bit of history
you realize her background that she's had this cough cold for one week,
she's been febrile for the last 24 hours she has no history of asthma she does
have her immunizations up to date and she's on no medications and she has
no allergies. So that's part of her background now
assessment we need to actually look listen feel find out what's going
on with her so after you have done her set of vital signs -
Okay so we've done our assessment on Mrs Dubois and what we found is that her
heart rate is 118 and her respiratory rate is 24.
On room air she's sat'ing at 92 percent she does have a lower blood pressure 102
over 68 but this is our first time seeing her so
we don't know if that's her normal and her temperature is 37.9 so she does
have a mild fever. Because I want to focus in on her issue
she's short of breath I'm going to do a focused respiratory
assessment as well and I note that her breathing is a bit labored
she does not have any accessory muscle use she does have wheezing to both
lower lobes and no cough. Let's add that in there as well
Now the last thing is what do we think is going on and what do we want to have
happen? So this is for recommendation.
Based on this history and this presentation this could be
maybe it's seasonal allergies right now it's spring here so
query that could be one thing that you offer
and I believe it's always important to have a differential so that we don't get
stuck and honed in on one thing. We should at least have two or three
potential things that could be coupling our patients
symptoms. So perhaps we think it's seasonal allergies
we're wondering if she's been exposed to COVID
so we're wondering if this might be a COVID patient
and then the other thing we're wondering is is there any anxiety?
So these are some things that we think might be going on, these are our
differentials, but what do we want from the doc?
Query send a swab for COVID,
or isolate, um maybe get a ventolin order. All right
so now we're going to put this together as if we're actually now
sharing this information with our charge nurse or the physician
so you can see how it sounds you don't have to say SBAR as you report it out,
you certainly can, and maybe i'll just show you both ways
so - hi i want to just report to you on Mrs
Sylvia Dubois she's our new admission that 27 year old female who
is complaining of shortness of breath. She
initially came to us with a cough cold for a week's history and she's been
febrile for the last 24 hours. She has no history of asthma, she's
positive for immunizations are all up to date she's had this year's flu shot
and she has no medications that she takes on a regular basis.
She's negative for any allergies I did her assessment
and her vital signs were a little concerning her heart rate's elevated at
118. her respiratory rate is 24. now she is
sat'ing 92 on room air but she has a temperature of
37.9 and her blood pressure is a little bit low it's 102 over 68.
After listening to her lungs and assessing her respiratory system
her breathing is a little labored but there's no accessory muscle use
no cough and there is some wheezing in the lower lobes.
I'm not sure if this is seasonal allergies and I'm wondering if she's
been either exposed to COVID or she's really
stressed about that so I'm wondering if you would like us to swab her for COVID
isolate her or maybe we can try a ventolin order to see if that helps
reduce her shortness of breath.
I'm going to repeat that again but this time I'm going to put in each of the
headings to show you how you can still use those
to help focus the information that you give.
I will pretend i'm talking with the charge nurse.
I'd just like to talk to you about Mrs Sonia DeBois, the 27 year old that just came
on the floor. Her situation is that she's been
complaining of shortness of breath for the last
three hours. Now her background is that she came to us with a cough cold for the
last week she did say she's been febrile for
twenty for the last 24 hours she has no history of asthma, allergies,
she's not taking any medications and her immunizations are up to date.
In my assessment I found her vital signs to include a higher heart rate at 118.
Respiratory rate is elevated at 24 but her oxygen sats are fine at 92
on room air, now her blood pressure I'm not sure if it's low for her but it's
102 over 68 and she's febrile at 37.9. I did take a
listen to her lungs and assess her respiratory system,
no cough, no accessory muscle use, she's a little bit labored and there is some
wheezing in the lower bases. Now in terms of my recommendation I'm
not sure if, you know, it's seasonal allergies or this is COVID
or even just stress related to those situations so I'm wondering if
we should ask for an order I am wondering if i can get an order for Ventolin to see if
that helps support her and if we should swap her for COVID and
isolate her. So in summary what we've covered today
is a communication tool for nurses and healthcare providers
that will really focus in on the relevant information that you need to
share to help the healthcare team create the
best possible outcomes and design solutions to the
patient's problems. Now in the description box below what
I've created for you is a download, keep this on your
clipboard put it by the phone. It identifies each section of the SBAR
and it's got some script here to help you shape
your conversation with the team. Thanks for watching.
Be sure to comment below and let me know if this has been helpful.
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next video is released and until next time make it a great day :)