What intervention should the nurse implement to communicate the situation to Maries husband?

Access through your institution

Volume 34, Issue 4, July–August 2013, Pages 295-301

https://doi.org/10.1016/j.gerinurse.2013.04.010Get rights and content

This quality improvement project employed a single-site repeated measures design. The project was implemented in a 137-bed skilled nursing home, part of a faith-based continuing care retirement community in suburban Pennsylvania. All staff nurses, both registered nurses (RNs) and licensed practical nurses (LPNs), were eligible and invited to participate in the project. The project was considered exempt by the New York University Committee on Activities Involving Human Subjects (NYUCIHS).

As reported in Table 1, LPNs comprised over half (52%; n = 21) of the sample and for the majority of the remaining nurses the associate degree was the highest level of educational preparation. The average experience as a nurse (approximately 5 years) was very similar to total years of experience as a nurse in long-term care.

Table 2 reports that thirty-six nurses (90%) reported difficulty communicating with a medical provider. Difficulties communicating with the medical provider are summarized

Consistent with other work that demonstrates the effectiveness of SBAR structured communication interventions,15, 24 the implementation of the INTERACT II SBAR tool suggests improvement in nurse satisfaction with communication. Similar to Whitson and colleagues,16 the nurses' baseline satisfaction scores pre-implementation were relatively positive, although nurses qualitatively identified difficult situations to include physician communication style and language/accent. In their initial

K.M. Haig et al.
J. Dunsford
M.K. McNabney et al.
E. Dayton et al.
J.L. Buchanan et al.
A.F. Bonner et al.
L. Wagner et al.
J.S. Kayser-Jones et al.
I.K. Schmidt et al.
J.G. Ouslander et al.

A.H. Rosenstein et al.

M.P. Cadogan et al.

S.N. Hastings et al.

J. Tjia et al.

The purpose of this study was to develop an Situation-Background-Assessment-Recommendation (SBAR) fall simulation program for Korean nursing students and to evaluate its effectiveness.
This study used a single-blind randomized control pretest–posttest design. The 54 nursing students in their third semester at a college in Korea were selected through convenience sampling (SBAR group 26, handoff group 28). The SBAR-based program was provided to the experimental group, while the general handoff-based program was given to the control group. The program was designed for a total of three sessions each and no more than 120 minutes each. Measurement variables included the knowledge, skill, attitude, communication ability, and its clarity related to falls. The data were analyzed with x2 test, t test, and repeated measures of ANOVA using the SPSS 18.0 program.
The SBAR group showed the improved fall-related skill and communication clarity compared with the handoff group. There was a significant difference in the fall-related knowledge only in a time-dependent manner before and after intervention, while there was no statistically significant difference in the attitude and communication ability related to falls.
SBAR-based simulation program revealed positive results in terms of patient safety of nursing college students compared with the general handoff-based method. Therefore, the SBAR-based simulation program is expected to be used as an educational intervention for nursing students not only to improve abilities in reporting and communication but to prevent or handle patient safety accidents efficiently.
The aim of this project was to embed SBAR as a communication framework into inpatient point of care nurses handover practices on 27 inpatient psychiatric units, and to ensure that the information given/received provided staff with the confidence to provide safe patient care.
A plan-do-study-act quality improvement framework was used to improve the adoption of SBAR in practice. Resources were developed that were relevant to the psychiatric setting; staff were educated, audits and a survey were completed.
The use of SBAR in practice increased from 4% pre intervention to 79% post intervention. Satisfaction with the information received during handover increased from 34% to 41%.

Findings of this project demonstrate that the standardization of handover practices and the implementation of a consistent communication framework across the organization can improve the effectiveness of shift handover, increase staff satisfaction, and improve safety of both staff and patients.
Although specialized communication tools can effectively reduce acute care transfers, few studies have assessed the factors that may influence the use of such tools by nursing staff at the individual level. We evaluated the associations between years of experience, tool-related training, nursing attitudes, and intensity of use of a communication tool developed to reduce transfers in a long-term care facility. We employed a mixed methods design using data from medical charts, electronic records, and semi-structured interviews. Experienced nurses used the tool significantly less than inexperienced nurses, and training had a significant positive impact on tool use. Nurses found the purpose of the tool to be confusing. No significant differences in attitude were observed based on years of experience or intensity of use. Project findings indicate that focused efforts to enrich training may increase intervention adherence. Experienced nurses in particular should be made aware of the benefits of utilizing communication tools.
Nursing home (NH) residents are a frail and vulnerable population often faced with iatrogenic effects of hospital stays when transferred to emergency departments for acute changes in health status. Avoidable or unnecessary transfers of care need to be identified and defined to prevent unintended harm. The aim of this scoping review was to identify characteristics of avoidable or unnecessary transitions of NH residents to emergency departments, and examine factors influencing decision-making by NH staff, residents, and their family members to transfer nursing home residents to emergency departments.
The search strategy began with 5 electronic databases, and a hand search of gray literature. Published qualitative and quantitative studies were included that examined the definition of avoidable or unnecessary transfers, and/or reported factors associated with decision-making to transfer NH residents to emergency departments. Methods included quality assessments, data extraction, and synthesis using content analysis.
A total of 783 titles and abstracts were retrieved and screened resulting in 19 included studies. Results describing “avoidable” or “unnecessary” transfers were grouped into 3 dimensions of factors: management of early-acute or low-acuity symptoms and chronic disease management in NHs, ambulatory care–sensitive indicators, and use of post hoc assessments. Five categories of factors contributing to decision-making to transfer were identified: nursing factors, physician factors, facility/resource factors, NH resident/family factors, and health system factors. A consensus on the definition of “avoidable” or “unnecessary” transfers was not found.
Findings suggest that transfers of NH residents to emergency departments may be avoided with increased care capacity within NHs. The decision-making process involved in the transfer is influenced by many factors, with intentions of both improving clinical outcomes and maintaining quality of life for the NH resident. Acute changes in health status are contextually specific and decisions must consider not only the resident's acute condition, but also resources available in the NH, and resident and family members' preferences for care. A definition of “avoidable” or “unnecessary” transfer must include reliable measurement, yet remain flexible enough to be generalizable to various care facilities to meet the needs of NH residents and manage required care safely within the NH. Robust research aimed at improving the primary care of NH residents is essential to informing health policy reform and education of those providing care in NHs.

View all citing articles on Scopus

There is an abundant literature about the experience of caregiving for a spouse living with Alzheimer's disease (AD), but there are very few qualitative studies about caregiving for persons living with Frontotemporal Degeneration (FTD). FTD causes a change in personality and affected persons may lose the ability to adhere to social norms. Thus, the emotional loss caregivers experience is often confounded by anger in response to embarrassing and socially inappropriate behaviors. In this paper, we offer a glimpse of this lived experience through the voices of two spouses whom we interviewed, each with experience caring for persons living with FTD. We suggest that FTD caregivers experience a loss of emotional attachment to their spouse because of their partner's behavioral symptoms. This loss gives rise to feelings of isolation and anger as caregivers assume new roles and reimagine their future. The findings from these interviews illuminate the need for more research and greater attention and support for FTD caregivers early in the disease trajectory.
Communication problems among health care personnel during critical clinical situations can jeopardize patient safety. SBAR, a structured-communication technique, has been adapted from aviation and the military as a strategy for clear communication based on a statement of the situation, background, assessment, and recommendations related to a critical issue. Nurses’ use of SBAR and physician perception of communication quality after SBAR implementation was assessed at a 13-hospital health care system.
Baylor Health Care System initiated a campaign to implement SBAR and train staff in SBAR techniques across its hospitals. Nurse surveys and physician audits were conducted.
Of 156 nurses interviewed, 152 (97.4%) had been educated about SBAR, and 91 (58.3%) used SBAR for critical communication. Of 84 nurses whose proficiency with SBAR was assessed, 72.6% demonstrated good or high proficiency. Of the 155 physicians who responded to the physician survey, 121 (78.1%) said that the last report they received was adequate to make clinical decisions. Of the 27 who indicated that the last report was not adequate to make clinical decisions, 25 (92.6%) had not received the report in SBAR format.
SBAR was generally well understood. Challenges included inconsistent uptake across facilities, lack of physician education about SBAR, and a tendency to view SBAR as a document rather than a verbal technique. Future research will address the need for refresher education with nurses after initial SBAR education, the need for formal physician education about SBAR use, and the possibility of conducting annual competency validation of the utilization of SBAR. Research should also examine the effect of SBAR on quality of care and patient outcomes in controlled trials.
After-hours telephone communications are common in patient management. Patterns of communication of key information during after-hours phone calls were evaluated, and the utility of problem-specific Situation, Background, Assessment, Recommendation (SBAR) forms in improving this communication was assessed.
In a randomized trial using a simulated on-call setting, 20 nurses called physicians regarding six cases adapted from inpatient records and based on the six most common reasons for after-hours nurse-physician communication. Three of the cases were handled without the SBAR forms (control cases), and three cases were handled with the forms (SBAR cases). Two cue types of communication were evaluated: situation cues, which conveyed the patient’s situation (for example, a patient is confused), and background cues, which conveyed problem-specific data indicated on the SBAR forms (for example, the patient has a low sodium level).
Ninety-two phone calls were analyzed (43 SBAR/49 controls). Most of the nurses reported the situation cues (SBAR 88%, control 84%, p = .60) but not the background cues. There was a trend toward fewer background cues communicated in the SBAR cases (14% versus 31%, p = .08). In 14% of the cases, on average, nurses omitted information or reported wrong information regarding the background cue. Physicians asked questions that resulted in the communication of the cues in a minority of the cases when the background cues were not originally provided by the nurses (SBAR 6%, control 16%, p = .39).
In after-hours phone communication between physicians and nurses, significant information was often not communicated and physicians did not elicit the necessary information. Simply providing an SBAR–based form did not ensure complete communication of key information.
Quality of life (QoL) preferences are an important consideration with respect to the Pharmacists' Patient Care Process (PPCP) and should be assessed prior to implementing a patient-centered plan. The objectives of this intervention were to determine if the design of a QoL activity impacts student performance, and to discern student perceptions of an innovative, case-based activity.
Two cohorts of students in their second professional year were asked to present an article that included a QoL consideration. The two student cohorts were asked to complete the activity using a case report and modified SBAR (Situation, Background, Assessment, Recommendation) format. Presentations were graded using a rubric, and scores were assessed retrospectively. An unpaired t-test was used to examine differences. The final cohort of students was also asked to complete a survey to gather their perspectives. Results were described using descriptive statistics; thematic analyses were also performed.
Students who completed the SBAR activity (N = 71) performed significantly better than those who completed the article (N = 98) presentation (95.62 ± 5.47 vs. 86.30 ± 16.54, P < .001). Those who completed the survey (N = 22) felt they made moderate to excellent progress explaining QoL (86%) and that the activity was helpful (68%). Overall, students reported an improved understanding of the patient's perspective.
The PPCP requires that students must consider the patient's QoL in order to develop an optimal patient-centered plan. Activities such as this may improve student understanding of QoL implications.