Evaluation of a training program using the SBAR communication tool for caregivers managing acute respiratory distress in lung cancer patients: A pilot randomized controlled trial protocol

Background

Family-based caregivers are increasingly important in the management of non-hospitalized lung cancer patients. However, lack of training can negatively impact care including diagnostic errors that can lead to delays in providing appropriate medical treatment. Acute respiratory failure (ARF) is common symptom of lung cancer and requires urgent intervention as well as adequate communication with healthcare professionals (HCPs) to enable appropriate decision-making and improve patient outcomes. Standardized tools such as the Situation, Background, Assessment, Recommendation (SBAR) tool and its French adaptation SAED, standing for Situation, Antécédent, Évaluation et Demande, are designed to facilitate communication among (HCPs).Additionally, digital interventions, such as serious games, are increasingly used to train HCPs though its use for caregivers has not been studied. This pilot study aims to assess an innovative serious game training using the SAED tool combined with standard instructions on self-efficacy for family-based caregivers of lung cancer patients when facing a simulated situation of ARF. The study also aims to examine caregivers' emotional state, quality of life, satisfaction and knowledge about the SBAR tool.

Methods

A monocentric, randomized, controlled, open-label, superiority, parallel-arm trial will be conducted for 18 months with 3 mid-study assessments (NCT05839353). Family caregivers of lung cancer patients will be recruited at the University Hospital Center of Saint Pierre, Reunion Island, France. Participants will be randomized (1:1) into two groups: the experimental group receiving training using the SBAR/SAED tool and standard instructions for managing respiratory distress/dyspnea, and the control group, receiving standard instructions only. The primary outcome will be to determine perceived self-efficacy as measured by the Generalized Self-Efficacy Scale.

Discussion

This study will present a preliminary assessment of training family caregivers in using the SBAR/SAED tool in simulated episodes of ARF in lung cancer patients. Our findings may provide valuable insights into effective training methods for caregivers in critical home care situations and could be widely used for lung cancer management.

Handoff Education Interventions: A Scoping Review Focused on Sustaining Improvements

Handoffs involve the transfer of patient information and responsibility for care between health care professionals. The purpose of the current scoping review was (1) to describe handoff studies with education as part of the intervention and (2) to explore the role of handoff educational interventions in sustaining handoff improvements. This scoping review utilized previously published systematic reviews and a structured, systematic search of 5 databases (January 2006-June 2020). Articles were identified, and data were extracted by pairs of trained, independent reviewers. The search identified 74 relevant articles, most published after 2015 (70%) and conducted in the United States (76%). Almost all of the studies (99%) utilized instruction, 66% utilized skills practice, 89% utilized a memory aid, and 43% utilized reinforcement. However, few studies reported using education theory or followed accepted tenets of curriculum development. There has been a substantial increase over time in reporting actual handoff behavior change (17%-68%) and a smaller but important increase in reporting patient outcomes (11%-18%). Thirty-five percent of studies (26/74) had follow-up for 6 months or more. Twelve studies met the criteria for sustained change, which were follow-up for 6 months or more and achieving statistically significant improvements in either handoff skills/processes or patient outcomes at the conclusion of the study. All 12 studies with sustained change used multi-modal educational interventions, and reinforcement was more likely to be used in these studies than all others (75%, 9/12) versus (37%, 23/62), P = 0.015. Future handoff intervention efforts that include education should use education theory to guide development and include needs assessment and goals and measurable objectives. Educational interventions should be multi-modal and include reinforcement. Future research studies should measure actual handoff behavior change (skills/process) and patient outcomes, include follow-up for more than 6 months, and use education reporting guidelines.

Effectiveness of the SBAR-Based training program in self-efficacy and clinical decision-making of undergraduate anesthesiology nursing students: a quasi-experimental study

BACKGROUND

Structured Situation, Background, Assessment, and Recommendation (SBAR) training technique have been widely utilized in clinical and educational settings. Therefore, the current study investigated the effectiveness of an SBAR-based educational program in students' self-efficacy and clinical decision-making skills.

METHODS

This quasi-experimental study was conducted using a pretest and posttest design and a control group at Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. A total of 70 three- and fourth-year students were recruited for the study using the census method. The students were randomly assigned to the intervention and control groups. The intervention group participated in an SBAR-based educational course consisting of eight sessions held in 4 weeks. Differences in the levels of self-efficacy and clinical decision-making skills before and after participation in the SBAR course were assessed and compared. Data were analyzed using descriptive tests, the Mann-Whiney U test, paired and independent t-tests, and the Wilcoxon test.

RESULTS

The intervention group demonstrated significantly higher levels of self-efficacy with a mean score of 140.66 ± 22.43 (P < 0.001) and clinical decision-making with a mean score of 75.31 ± 7.72 (P < 0.001); while in the control group, the mean score of self-efficacy and clinical decision-making skills was 85.34 ± 18.15 and 65.51 ± 4.49, respectively. Moreover, the Mann-Whitney U test showed that the levels of students' clinical decision-making skills were promoted to the next level after the intervention (P < 0.001); it means the distribution of the level of intuitive-interpretive skill was upgraded from 0 to 22.9%.

CONCLUSION

The SBAR-based training programs can promote the self-efficacy and clinical decision-making skills of anesthesiology nursing students. Considering the weakness of the anesthesiology nursing curriculum at the undergraduate level in Iran, it can be expected that the SBAR-based training course should be included as an educational intervention in the curriculum of anesthesiology nursing students.

Causal links behind why Australian midwifery care is missed

AIMS

The aim of this study is to reliably estimate why midwifery care is missed and to crystallize those factors that have causal links to it.

BACKGROUND

Studies involving the incidences and types of missed midwifery care are sparsely described. The rationales behind these deficits in care are even less well researched.

METHODS

A non-experimental, descriptive method using a Likert developed MISSCARE scale was used to measure consensus estimates made by Australian midwives. Data analysis was undertaken using both Rasch analysis and Structural Equation Modeling.

RESULTS

Midwives' rationales behind why Australian midwifery care is missed can be quantified based on consensus estimates of participating midwives and the variances in the total scores of how important each contributing factor was in accounting for why midwifery care was missed, can be both explained and predicted.

CONCLUSIONS

Ten latent variables have significant predictor effects on why midwifery care was missed. These include insufficient human and physical care resources, increased work intensity and issues with workplace communication. These factors are further exacerbated by the midwives' teamwork satisfaction levels, work roster preferences and other midwife demographic variables. The age of midwife, their highest qualification achieved and where they obtained their midwifery credentials had no influence on their consensus estimates as to why midwifery care was missed.

IMPLICATIONS FOR NURSING MANAGEMENT

While this study confines itself to the Australian midwifery context, outcomes are informative for an international midwifery management audience. While the setting of the midwifery practice (be it private or public hospitals) is not significant in predicting why midwifery care is missed, resource allocation for care of mothers and their babies remains instrumental, as a factor contributing to care omissions. Midwife demographic factors including age, type of midwifery qualification and where the credentials were obtained from exerted no influence as to why care was omitted. Midwifery recruitment should focus instead on re-dressing skills and skills mix shortages. Teamwork skills within the midwifery sector requires strengthening, as problems arising from workplace communication, coupled with decreased midwifery staffing numbers and increased work intensity, are strongly thought to be significant reason for missed care.

Management of Aggression in Young Male Adults Using the Virtual Reality-Based Communication Modification Program

High aggression is common and costly for mental health problems in young adults. Because communication is a universal part of social relationships, including conflicts with others, it could be a possible target for mediating aggression. This study aimed to evaluate whether the virtual reality (VR)-based communication modification program can be utilized for aggression management. Fifty-eight individuals with high aggression (n = 30) and with low aggression (n = 28) completed psychological assessments associated with aggression and functional communication, and they participated in the program, consisting of the three tasks: exploring the communication style, practicing functional communication, and expressing empathy. The participants’ selections and their visual analog scale scores, in response to questions in the tasks, were collected as behavioral data. Results indicated that the high aggression group selected blaming dysfunctional communication style more frequently than the low aggression group. VR-based parameters, expected to reflect dysfunctional communication-related characteristics, showed significantly different correlations with aggression-related traits between the two groups. These findings show that our program may accurately represent an individual’s aggressive traits and elicit the appropriate reaction.

Effectiveness of Incorporating Situation-Background-Assessment-Recommendation (SBAR) methods into simulation-based education for nursing students: A quasi-experimental study

BACKGROUND

Situation-Background-Assessment-Recommendation reporting is a structured communication tool. In other studies of simulation-based education, learning was found to increase with increases in the level of flow during scenarios. Also, communication using SBAR was found to facilitate more focus on clinical situations. However, the generalizability of those findings in nursing education and the specific benefits of combining SBAR with simulation remain unclear.

OBJECTIVES

The aims of this study are to incorporate SBAR reporting into simulation-based nurse education, and measure its effects on the students' flow, communication competence, and communication self-efficacy among nursing students, to collect basic data for the development of effective nursing curricula.

DESIGN

This study used a non-equivalent, quasi-experimental pre-post parallel design.

SETTING

The intervention was administered in a simulation center at a nursing school in South Korea.

PARTICIPANTS

One hundred and twenty fourth-year nursing students were recruited through convenience sampling.

METHODS

The participants were quasi-randomly allocated to the control (n = 52) and SBAR (n = 68) groups. The integrated simulation course was conducted twice each week. Learning and reporting SBAR was included as a component of simulation-based education for the intervention group in each session (three scenarios). The dependent variables were communication competence, communication self-efficacy, and flow in the simulation.

RESULTS

SBAR did not affect communication competence or communication self-efficacy in simulation-based education. In contrast, while flow increased in both groups, the increase was greater in the SBAR group.

CONCLUSIONS

SBAR can increase nursing students' flow in simulations. Further studies should focus on how SBAR during simulation-based education affects nursing students' practical competency.

Quality of the Situation-Background-Assessment-Recommendation tool during nurse-physician calls in the ICU: An observational study

BACKGROUND

Situation-Background-Assessment-Recommendation (SBAR) is a tool for structuring communication between healthcare professionals. SBAR reduces medical errors, however few studies have evaluated its quality in real practice.

AIMS

To describe the quality of SBAR utilization by intensive care unit (ICU) nurses during phone conversations with physicians. To assess the influence of nurses' training, professional experience, and call circumstances on this quality.

STUDY DESIGN

This observational study was conducted in the adult ICU of a university hospital in French speaking Switzerland. All consecutive telephone calls from nurses to physicians during a calendar month, were recorded. Those related to a change in patients' clinical status were selected and analysed. The quality of SBAR utilization was assessed using a pre-defined analysis grid. Scores ranged from 0 (worst quality) to 100% (best quality). Nurses' sociodemographics and training record were collected. Multiple regression was used to assess determinants of SBAR quality including nurses characteristics and level of training.

RESULTS

We analysed 290 phone calls, made by 99 nurses. The median SBAR quality score was 41% (interquartile range [IQR] 33-48). Quality scores varied across the four items of SBAR: Situation 88% (81-94), Background 17% (6-27), Assessment 17% (0-33), and Recommendation 33% (17-40). Factors independently associated with higher SBAR quality were age (-0.66%, p = .002, 95% CI [-1.07; -0.25]), primary language other than French (-8.40%, p = .017, 95% CI [-15.29; -1.51]), lack of ICU expertise (-9.25%, p = .013, 95% CI [-16.5;1-1.99]), and SBAR training in pre-graduate nursing education (+11.53%, p = .028, 95% CI [1.27; 22.79]).

CONCLUSIONS

The quality of SBAR utilization remains low in ICU clinical practice. Pre- and post-graduate training seem to improve its quality.

RELEVANCE TO CLINICAL PRACTICE

Pre-graduate mandatory training associated with multiple repetitions could improve nurses' SBAR utilization. Training using the SBAR tool should be combined with the development of nursing skills in assessment and clinical judgment.

Evaluation of a Modified SBAR Report to Physician Tool to Standardize Communication on Neonatal Transport

OBJECTIVE

SBAR (situation, background, assessment and recommendation) is a structured format for the effective communication of critically relevant information. This tool was developed as a generic template to provide structure to the communication of clinical information between health care providers. Neonatal transport often presents clinically stressful circumstances where concise and accurate information is required to be shared clearly between multidisciplinary health care providers. A modified SBAR communication tool was designed to facilitate structured communication between nonphysician bedside care providers operating from remote sites and physicians providing decision-making support at receiving care facilities. Prospective interventional study was designed to evaluate the reliability of a "SBAR report to physician tool" in sharing clinically relevant information between multidisciplinary care providers on neonatal transport.

STUDY DESIGN

The study was conducted between 2011 and 2014 by a dedicated neonatal transport service based at McMaster Children's Hospital which provides care for approximately 500 infants in Southern Ontario annually. In the preintervention phase, 50 calls were randomly selected for the evaluation and 115 consecutively recorded transport calls following adoption of the reporting tool. The quality of calls prior to and after the intervention was assessed by reviewers independently. Inter-rater agreement was also assessed for both periods.

RESULTS

Inter-rater agreement between raters was moderate to perfect in most components of the SBAR "report to the physician tool" except for the assessment component, which showed fair agreement during both preintervention and postintervention periods. There was an improvement in global score (primary outcome) with a mean difference of 0.95 (95% confidence interval [CI]: 0.77-1.14; p < 0.001) and in cumulative score with a mean difference of 8.55 (95% CI: 7.26-9.84; p < 0.001) in postintervention period.

CONCLUSION

The use of the SBAR report to physician tool improved the quality of clinical information shared between nonphysician members of the neonatal transport team and neonatal transport physicians.

KEY POINTS

· Long-Accurate and concise information sharing is crucial for decision-making in neonatal transport.. · Information sharing between multidisciplinary teams can be enhanced by using a commonly understood information sharing template.. · The SBAR report to physician tool improves the quality of information shared between multidisciplinary team members in neonatal transport..

Role-Play versus Standardised Patient Simulation for Teaching Interprofessional Communication in Care of the Elderly for Nursing Students

This study aims to describe and compare the effects of standardised patient simulation and role-play in the acquisition and retention of interprofessional communication in elderly care competence amongst nursing students. In this controlled clustered randomised trial, 121 nursing students attended a workshop on interprofessional communication in elderly care using role-play or standardised patient simulation. The study was conducted between September 2017 and February 2018. Participants’ knowledge, self-efficacy and communication skills were assessed using a simulated scenario at pre-test, post-test and 6-week follow-up points. Between-subject and within-subject differences were measured using counts and proportions of participants who achieved competence. Regardless of the strategy applied, a significant improvement in knowledge, skills, self-efficacy and overall interprofessional communication competence was found between pre-test and post-test. Moreover, there were significant differences between pre-test and follow-up for all the studied variables, but no differences were found between post-test and follow-up. Lastly, when comparing the success rates of both strategies, no significant differences were observed (p > 0.05). In conclusion, standardised patient simulation and role-play have been shown to promote an improvement on knowledge, self-efficacy and interprofessional communication skills in nursing students, although it is not possible to state which strategy is the most adequate for teaching this competency.

Effectiveness of assertiveness training, SBAR, and combined SBAR and assertiveness training for nursing students undergoing clinical training: A quasi-experimental study

BACKGROUND

Nursing students experience notable challenges when communicating with patients, caregivers, and health-care providers during clinical training; this adds to the stress they experience from clinical training and deteriorates their clinical competence.

OBJECTIVES

The aims of this study are to develop and assess a practical program for improving communication skills, clinical practice stress, and clinical competence among nursing students undergoing clinical training. This is performed by administering and evaluating the respective effects of an assertiveness-training program; a program based on the situation, background, assessment, and recommendation (SBAR) technique and a program that combines assertiveness training with the SBAR technique.

DESIGN

This study used a non-equivalent, quasi-experimental pretest-posttest design.

SETTINGS

This study was conducted at the nursing schools of two universities in the north and west of South Korea.

PARTICIPANTS

Ninety-three third-year nursing students were recruited through convenience sampling from two universities in South Korea.

METHODS

The participants were randomly allocated to a group that received assertiveness training only, a group that received the SBAR technique only, or a group that received a combination of assertiveness training and the SBAR technique. Each program featured four sessions of 60-70 min each. Communication competence, communication clarity, assertive behavior, clinical training stress, and clinical competence were measured.

RESULTS

The group that received the combination of assertiveness training and the SBAR technique showed a significant improvement in communication clarity, a significant reduction in clinical training stress compared to both of the other groups, and improved clinical competence when compared to the group that received the SBAR technique only.

CONCLUSIONS

A program that combines the SBAR technique with assertiveness training can be utilized to improve communication skills, reduce clinical training stress, and enhance clinical competence in nursing students.

Situation, Background, Assessment, and Recommendation Stepwise Education Program: A quasi-experimental study

BACKGROUND

A nurse, as the main subject of decision-making in clinical settings, experiences various situations that require communication with a range of health care providers. The communication process is important to the process of recognizing problems and choosing one among the available alternatives after reflection, which requires communication skills based on critical thinking. Communication competence is one of the basic competencies of nurses, and it is also important for providing qualitative healthcare service.

OBJECTIVE

To investigate how Situation, Background, Assessment, and Recommendation Stepwise Education Program (SBAR SEP) developed on the basis of the revised Bloom's Taxonomy affects nursing students on their communication competence and critical thinking.

DESIGN

Non-equivalent control group pretest-posttest design.

SETTINGS

A university in South Korea.

PARTICIPANTS

A total of 96 nursing college students (48 in the experimental group and 48 in the control group).

METHOD

The subjects were allocated using convenience sampling to one of the two groups: SBAR SEP or control. Subjects in SBAR SEP group received a lecture-style training of SBAR a week prior to clinical practicum and performed role-play during the two-week clinical practicum. The duration of the SBAR SEP role-play intervention was 2 weeks, twice a week, for 120 min each session. A control group performed a regular case presentation in the clinical practicum. Data were collected from August to October 2019. Data were analyzed using descriptive statistics, χ² test, independent t-test, and ANCOVA using SPSS 25.0.

RESULTS

A significant increase was observed in the scores of communication competence (p < .001) and critical thinking (p < .001) in the experimental group compared with the control group.

CONCLUSIONS

The SBAR SEP for nursing students is an effective educational method that improves communication competence and critical thinking under similar circumstances at the clinical site.

[Use of the SBAR tool: Assessment of the value of a short training course on the quality of communication between caregivers in the short and long term]

OBJECTIVES

Communication breakdown is one of the main causes of adverse events in clinical routine. The main objective of this study was to assess whether a short training course on medical communication based on the situation-background-assessment-recommendation (SBAR) tool improved the quality of communication in clinical practice.

METHODS

Interventional study, conducted at the Jeanne de Flandre maternity unit (Lille University Hospital, France) between January 2017 and December 2019. The training sessions lasted 1 hour and consisted of a theoretical part, based on the SBAR tool, and of a practical part (video-stimulated recall and role-play case scenarios). The main outcome measure was the evaluation of the quality of the telephone calls made by a caregiver to the on-call doctor, using a questionnaire completed before (Q1) and remotely from training (Q2).

RESULTS

One hundred and twenty health professionals were trained (n=120). Following the trainings, there was an improvement in communication in the short term, whether in terms of relevance (64.9 vs. 52.6, P<0.001) or conciseness of the message (36.9 vs. 32.2, P<0.001), but also in terms of long-term in a real clinical situation (Q2: 3.9 vs. Q1: 3.0, P<0.001). Finally, 81% of participants were satisfied with the training.

CONCLUSIONS

Short training sessions on communication based on the SBAR tool appeared to improve participants' knowledge and skills in the short-term, but also in the longer term in a real clinical situation.

Effectiveness of a training intervention to improve communication between/awareness of team roles: A randomized clinical trial

BACKGROUND

Interprofessional teamwork training of nursing undergraduates is essential to improving healthcare. The absence of clear role definitions and poor interprofessional communications have been listed as the main reasons behind abandonment of the profession by recently graduated nurses.

PURPOSE

The aim of this parallel randomized clinical trial was to evaluate the impact of Situation-Background-Assessment-Recommendation (SBAR) role-play training on interprofessional teamwork skills (role-related and communication-related) and non-technical skills (patient assessment, patient intervention, patient safety, and critical thinking).

METHOD

The intervention group were taught teamwork skills, role and task assignment skills, and use of the SBAR worksheet in a 1-hour role-play training session, while the control group received conventional lecture-based training. Teamwork and non-technical skills were then assessed in high-fidelity simulation scenarios using the KidSIM Team Performance Scale (teamwork skills) and the Clinical Simulation Evaluation Tool (non-technical skills). Cohen's d (d) was used to examine effect size differences.

RESULTS

Compared to the control group, the intervention group improved in 4 teamwork items - 'verbalize out loud' (p < 0.001, d = 0.99), 'paraphrase' (p < 0.001, d = 0.77), 'cross-monitoring' (p < 0.001, d = 0.72), and 'role clarity' (p = 0.002, d = 0.66) - and in a single non-technical skill (patient intervention: p = 0.004, d = 0.66), while also reporting greater confidence in performing patient assessments (p = 0.02, d = 0.56).

CONCLUSIONS

Role-play and SBAR training for undergraduate nurses improved patient intervention, enhanced information sharing in an interprofessional team, and raised awareness of their own and other team members' roles.

Assessing student confidence in interprofessional communication during primary care advanced pharmacy practice experiences (APPEs)

BACKGROUND AND PURPOSE

Students must have experience communicating and interacting with healthcare professionals throughout pharmacy school curricula to effectively develop interprofessional communication abilities and confidence. This study's purpose was to assess student confidence in interprofessional communication utilizing a rubric and checklist inspired by the situation-background-assessment-recommendation (SBAR) technique throughout five-week primary care advanced pharmacy practice experiences (APPEs).

EDUCATIONAL ACTIVITY AND SETTING

A six-item rubric was created for student self-evaluation of interprofessional communication throughout their APPE. Students completed the rubric twice to evaluate change in confidence. Additionally, a pre-post rotation survey was developed to assess students' comfort level rounding with healthcare professionals and interacting/intervening with other healthcare professionals to address a medication-related problem. A paired t-test was used to evaluate changes in perceived student confidence in rubric self-evaluations and pre- and post-APPE surveys.

FINDINGS

From May 2017 to April 2019, 93 students completed primary care APPEs with faculty authors, and 181 encounters were self-evaluated using the rubric. Forty-eight students completed all rubric sections twice; their mean self-evaluation score increased significantly from 15.25/18 to 17.10/18 (P < .001). Self-evaluation scores increased significantly on all rubric sections (P < .05) except professional language (P = .133). Student comfort level rounding with healthcare professionals and interacting/intervening with healthcare professionals to address a medication-related problem increased significantly (P < .001).

SUMMARY

Interprofessional communication practice, preceptor observations and feedback, and utilization of an interprofessional SBAR-inspired communication rubric contributed to improved student confidence in making patient care recommendations to physicians.

Effects of a stepwise handovers ISBARQ programme among nursing college students

Background

Due to a lack of standardized guidelines, it is necessary to verify the effectiveness of educational programmes for nursing students' systematic handover training.

Aims

This study aimed to develop a stepwise nursing handover programme and to examine its effects on awareness of handover Situation, Background, Assessment, Recommendation, communication self-efficacy and satisfaction with handover education.

Design

This was a single-group repeated measures ANOVA study.

Methods

This study was conducted in a nursing department, using a convenience sample of 25 senior nursing students from April 2 to June 22, 2018. The programme was divided into lectures, scenario role-playing and nursing case role-playing. The research questions were analysed using repeated measures ANOVA.

Results

Awareness of handover Situation, Background, Assessment, Recommendation, communication self-efficacy and satisfaction with handover education gradually increased after each step of the programme. The stepwise nursing handover programme, progressing from low to high levels of learning, can be used to improve the nursing handover system and handover communication ability.

Feasibility of a virtual reality-based interactive feedback program for modifying dysfunctional communication: a preliminary study

Background

Functional communication is vital in many areas of daily life, and modifying dysfunctional communication has been emphasized in various social areas, including family and school. The present preliminary study addressed the feasibility of a virtual reality (VR)-based interactive feedback program for the modification of dysfunctional communication.

Methods

Thirty-seven healthy young males completed psychological assessments associated with functional communication and participated in the VR-based program, consisting of the three tasks of ‘exploring the communication style,’ ‘practicing functional communication,’ and ‘expressing empathy.’ Behavioral parameters were recorded based on the participants’ choices among available options and the visual analog scale scores that resulted in responses to questions in the tasks.

Results

Participants completed the program without dropping-out and reported 10.76 (SD, 9.66) in the Simulator Sickness Questionnaire and 106.97 (SD, 16.66) in the Presence Questionnaire. In exploring the communication style, there was no difference between the dysfunction level-with family and dysfunction level-with a friend, but only the dysfunction level-with family showed significant correlations with the level of communication with parents. In practicing functional communication, the communication scores with the placating, blaming, and computing styles significantly increased according to the repetition of trials. In expressing empathy, the empathetic feeling score was negatively correlated with the perspective-taking score, whereas the emotional intensity score was positively correlated with the level of differentiation of the self.

Conclusion

These results suggest that the program may have a tolerable level of cybersickness, an adequate level of presence, an improvement in the behavioral parameters that may reflect the important aspects of communication, and a proper reflection of psychological states or interpersonal characteristics. The use of this program can be an important starting point for the development of a more convenient method for delivering VR programs designed to modify dysfunctional communication, which can further increase computerized dissemination.

Increasing Physician Assistant Students' Team Communication Skills and Confidence Throughout Clinical Training

PURPOSE

An intervention was designed to increase physician assistant students' team communication skills using the Situation-Background-Assessment-Recommendation (SBAR) tool.

METHODS

A variety of learning activities were implemented longitudinally over 9 months of clinical education. Instructional activities included an interactive lecture, deliberate practice of SBAR at clinical training sites, self-assessment, and small group discussion. Evaluation involved survey of students' perceived learning outcomes and direct observation of students' proficiency using SBAR during a simulated patient encounter.

RESULTS

At the beginning of their clinical training, many students (75%) did not have a structured tool for communicating on health care teams. The SBAR tool was readily understood by students following a lecture (89%) and increased their confidence in communicating with preceptors (62%-83%) and nonpreceptors (62%-79%). A majority of students proficiently demonstrated the SBAR components (82%-86%) at the conclusion of the program.

CONCLUSION

This approach can be adopted and adapted by other programs aiming to teach and evaluate SBAR and other team skills to better prepare new health professionals to effectively communicate on health care teams.

Evaluating Nurse-Physician Communication With a Rubric: A Pilot Study

Poor communication is a leading cause of sentinel events. The aims of this pilot study were to determine whether the ISBAR (Identification, Situation, Background, Assessment, and Recommendation) Interprofessional Communication Rubric (IICR) was a reliable tool among nurses and to examine the communication performance of new graduate nurses in a hospital-based simulation center. The IICR demonstrated reliability among raters in this setting (r_s = .91). The new graduate RNs' communication performance scores were low, warranting continued professional development. The IICR may be used to guide continued education and development for nurse-physician communication. [J Contin Educ Nurs. 2019;50(4):163-169.].

Situation, background, assessment, recommendation (SBAR) technique education enhances pharmacy student communication ability and confidence

BACKGROUND AND PURPOSE

The Situation, Background, Assessment, Recommendation (SBAR) technique is a method that can be incorporated into a professional healthcare curriculum to enhance students' ability to communicate information logically and concisely. This educational research activity was designed to assess the impact of SBAR training on pharmacy students' ability to communicate pharmacotherapy recommendations during a simulated telephone intervention with a prescriber. Secondary objectives were to evaluate the impact of the activity on student self-perception of confidence, potential correlations between prior experience and both performance and confidence, and the activity's overall quality and value.

EDUCATIONAL ACTIVITY AND SETTING

Third professional year pharmacy students enrolled in a required communications course completed the simulated telephone intervention both before and after SBAR training. The teaching and learning activity was evaluated by comparing pre- and post-activity intervention scores, and a post-activity survey measuring secondary study objectives.

FINDINGS

Of the 198 students enrolled in the course, 197 consented to participate in the study (99% response rate). Median scores on pre- and post-activity interventions were 12/20 and 18/20 points, respectively (p < 0.001). Student-perceived confidence in the ability to deliver a pharmacotherapy-related intervention improved (p < 0.001) and most students (92%) indicated that the activity enhanced their communication skills. There was a significant positive correlation between previous pharmacy-related experience and student confidence, both before and after SBAR training.

SUMMARY

SBAR training is a valuable component of pharmacy education. Training will be introduced earlier in the curriculum and incorporated into a variety of activities and courses, including interprofessional educational activities.

“SACCIA Safe Communication”: Five core competencies for safe and high-quality care

Background

Communication has emerged as a critical component in delivering safe, high-quality care. The evidence is clear that health outcomes are enhanced when clinicians communicate well, and compromised when they interact poorly. It is important to understand the core aspects of interpersonal sense-making that hinder or foster favorable health outcomes. This study introduces an evidence-based “SACCIA Safe Communication” (Sufficiency, Accuracy, Clarity, Contextualization, Interpersonal Adaptation) framework to fill this gap.

Method

Sixty narratives of patient safety events were coded using qualitative content analysis guided by the “Hannawa SACCIA Safe Communication” framework.

Results

The analyses yielded 367 communication errors. Of these errors, 160 related to unsafe encoding, 92 to unsafe decoding, and 115 to unsafe transactional communication. Sufficiency errors were most frequent (124), followed by communication errors of contextualization (117), accuracy (84), interpersonal adaptation (26), and clarity (16).

Conclusions

The Hannawa SACCIA Safe Communication framework identifies interpersonal communication processes that commonly compromise the safety and quality of care. Narrative excerpts from the cases in this study exemplify what these processes look like in daily care encounters. The framework bridges across contexts and interpersonal settings. Furthermore, it explains various types of patient safety events (e.g. patient falls; unsafe handoffs or surgeries; diagnostic and medication errors). Therefore, it serves as a useful approach to describe and understand interpersonal communication as a critical factor in the provision of safe and high-quality care.

Effect of Stepwise Communication Education Program using SBAR among Nursing Students: Focusing on Scenarios and Nursing Case-based Role Playing

Purpose: This study intends to examine the effects of a stepwise communication education program among nursing college students, focusing on scenarios and nursing case-based role playing. Methods: The study design was a one-group repeated measure ANOVA. Participants were 27 nursing students in practice. Students participated in 5-week stepwise communication education program using SBAR; including 1 week of lecture education, 4 weeks of scenarios and nursing case-based role playing. The data were collected at each level of the education process: pre-education, after 1 week of lectures, and after completion of scenarios and nursing case-based role playing. Repeated measures ANOVA was used to determine changes in SBAR technique knowledge and communication self-efficacy. Results: The stepwise communication education program using SBAR was effective in increasing SBAR technique knowledge, and communication self-efficacy. The lecture-based education was effective only in the area of SBAR technique knowledge and its subscale, attitudes towards SBAR. However, scenarios and nursing case-based role playing was broadly effective across communication self-efficacy, SBAR technique knowledge, and its subscale, knowledge of the SBAR. Conclusion: Based on this study, we propose that it is necessary to confirm the effect of long-term SBAR communication education using scenarios and nursing case-based role playing in nursing students' practice.

Effectiveness of a role-play simulation program involving the sbar technique: A quasi-experimental study

BACKGROUND

Accurate, skilled communication in handover is of high priority in maintaining patients' safety. Nursing students have few chances to practice nurse-to-doctor handover in clinical training, and some have little knowledge of what constitutes effective handover or lack confidence in conveying information.

OBJECTIVES

This study aimed to develop a role-play simulation program involving the Situation, Background, Assessment, Recommendation technique for nurse-to-doctor handover; implement the program; and analyze its effects on situation, background, assessment, recommendation communication, communication clarity, handover confidence, and education satisfaction in nursing students.

DESIGN

Non-equivalent control-group pretest-posttest quasi-experimental.

PARTICIPANTS

A convenience sample of 62 senior nursing students from two Korean universities.

METHOD

The differences in SBAR communication, communication clarity, handover confidence, and education satisfaction between the control and intervention groups were measured before and after program participation.

RESULTS

The intervention group showed higher Situation, Background, Assessment, Recommendation communication scores (t=-3.05, p=0.003); communication clarity scores in doctor notification scenarios (t=-5.50, p<0.001); and Situation, Background, Assessment, Recommendation education satisfaction scores (t=-4.94, p<0.001) relative to those of the control group. There was no significant difference in handover confidence between groups (t=-1.97, p=0.054).

CONCLUSIONS

The role-play simulation program developed in this study could be used to promote communication skills in nurse-to-doctor handover and cultivate communicative competence in nursing students.

Interprofessional Team Training at the Prelicensure Level: A Review of the Literature

PURPOSE

The authors undertook a descriptive analysis review to gain a better understanding of the various approaches to and outcomes of team training initiatives in prelicensure curricula since 2000.

METHOD

In July and August 2014, the authors searched the MEDLINE, PsycINFO, Embase, Business Source Premier, and CINAHL databases to identify evaluative studies of team training programs' effects on the team knowledge, communication, and skills of prelicensure students published from 2000 to August 2014. The authors identified 2,568 articles, with 17 studies meeting the selection criteria for full text review.

RESULTS

The most common study designs were single-group, pre/posttest studies (n = 7), followed by randomized controlled or comparison trials (n = 6). The Situation, Background, Assessment, Recommendation communication tool (n = 5); crisis resource management principles (n = 6); and high-fidelity simulation (n = 4) were the most common curriculum bases used. Over half of the studies (n = 9) performed training with students from more than one health professions program. All but three used team performance assessments, with most (n = 8) using observed behavior checklists created for that specific study. The majority of studies (n = 16) found improvements in team knowledge, communication, and skills.

CONCLUSIONS

Team training appears effective in improving team knowledge, communication, and skills in prelicensure learners. Continued exploration of the best method of team training is necessary to determine the most effective way to move forward in prelicensure interprofessional team education.

An Interprofessional Simulation Using the SBAR Communication Tool

Objective. To determine the impact of an interprofessional simulation using the SBAR (situation-background-assessment-recommendation/request) communication tool on pharmacy students' self-perception of interprofessional competence and reactions towards interprofessional collaboration. Design. Ninety-six pharmacy students participated in an interprofessional simulation within a required applications-based capstone course. Pharmacy students collaborated with nursing students on multiple patient cases in various settings using the SBAR communication tool over the telephone. Assessment. Pharmacy students' responses to all 20 items on the Interprofessional Collaborative Competency Attainment Survey (ICCAS) completed after participating in the simulation indicated significant positive changes. The themes identified in students' reflection papers indicated the simulation was beneficial and student responses on satisfaction surveys were positive with a mean score of 4.2 on a 5-point Likert scale. Conclusion. Implementation of an interprofessional simulation using the SBAR communication tool improved pharmacy students' self-perception of interprofessional competence and attitudes toward interprofessional collaboration.

Tools for structured team communication in pre-registration health professions education: a Best Evidence Medical Education (BEME) review: BEME Guide No. 41

INTRODUCTION

Calls for the inclusion of standardized protocols for information exchange into pre-registration health professions curricula have accompanied their introduction into clinical practice. In order to help clinical educators respond to these calls, we have reviewed educational interventions for pre-registration students that incorporate one or more of these ?tools for structured communication?.

METHODS

Searches of 10 databases (1990?2014) were supplemented by hand searches and by citation searches (to January 2015). Studies evaluating an intervention for pre-registration students of any clinical profession and incorporating at least one tool were included. Quality of included studies was assessed using a checklist of 11 indicators and a narrative synthesis of findings undertaken.

RESULTS

Fifty studies met our inclusion criteria. Of these, 21 evaluated the specific effect of a tool on educational outcomes, and 27 met seven or more quality indicators.

CONCLUSIONS

Pre-registration students, particularly those in the US, are learning to use tools for structured communication either in specific sessions or integrated into more extensive courses or programmes; mostly 'Situation Background Assessment Recommendation' and its variants. There is some evidence that learning to use a tool can improve the clarity and comprehensiveness of student communication, their perceived self-confidence and their sense of preparedness for clinical practice. There is, as yet, little evidence for the transfer of these skills to the clinical setting or for any influence of teaching approach on learning outcomes. Educators will need to consider the positioning of such learning with other skills such as clinical reasoning and decision-making.

Assessment of Three "WHO" Patient Safety Solutions: Where Do We Stand and What Can We Do?

Background:

Most medical errors are preventable. The aim of this study was to compare the current execution of the 3 patient safety solutions with WHO suggested actions and standards.

Methods:

Data collection forms and direct observation were used to determine the status of implementation of existing protocols, resources, and tools.

Results:

In the field of patient hand-over, there was no standardized approach. In the field of the performance of correct procedure at the correct body site, there were no safety checklists, guideline, and educational content for informing the patients and their families about the procedure. In the field of hand hygiene (HH), although availability of necessary resources was acceptable, availability of promotional HH posters and reminders was substandard.

Conclusions:

There are some limitations of resources, protocols, and standard checklists in all three areas. We designed some tools that will help both wards to improve patient safety by the implementation of adapted WHO suggested actions.

The effect of a psychological empowerment program based on psychodrama on empowerment perception and burnout levels in oncology nurses: Psychological empowerment in oncology nurses

Objective:

Oncology nursing is stressful by its nature, and nurses in the field experience a high amount of stress and burnout. In order to cope with occupational stress, nurses need to employ flexible adjustment mechanisms that allow them the power to process their experiences. Failure of efficient stress management causes burnout, and burnout is closely related to powerlessness. It is therefore believed that the occurrence of burnout can be reduced by means of psychological empowerment of nurses. Our study was conducted to determine the effect of a “psychodrama-based psychological empowerment program” on (1) the perception of empowerment and (2) the levels of burnout in oncology nurses.

Method:

The sample was made up of 82 oncology nurses (38 nurses in the study group and 44 in the control/comparison group). Study data were collected using the Psychological Empowerment Scale, the Nurse Work Empowerment Scale, and Maslach's Burnout Inventory. The study group attended a “psychodrama-based psychological empowerment program” (2 hours, 1 day a week, for 10 weeks). For data assessment, we employed an independentttest and one-way analysis of variance.

Results:

The psychological empowerment and workplace empowerment scores of nurses in the study group increased and their burnout scores decreased following attendance in the psychodrama-based psychological empowerment program.

Significance of results:

We found that the psychodrama-based psychological empowerment program increased psychological empowerment and enhanced perception of workplace empowerment while decreasing levels of burnout in oncology nurses. The program is recommended and should allow oncology nurses to benefit from their personal experiences and thus increase self-empowerment, to enhance their perception of empowerment, and to prevent burnout.

Can Learning the ISBARR Framework Help to Address Nursing Students' Perceived Anxiety and Confidence Levels Associated With Handover Reports?

BACKGROUND

Standardized communication frameworks are believed to help students feel more confident and less anxious about handover reports. One of the handover communication frameworks being used in nursing programs was the ISBARR framework (Identify, Situation, Background, Assessment, Recommendation, and Repeat). The aim was to explore whether learning the ISBARR framework affected nursing students' perceived anxiety and confidence levels associated with handover reports.

METHOD

The study tested null hypotheses by analyzing pre- and posttest data collected with the Competitive State Anxiety Inventory-2 (CSAI-2) survey. Three qualitative questions were included in the posttest to compare with the quantitative data. Statistical significance was set at p = .02.

RESULTS

The results revealed that learning the framework had a strong effect in reducing the perceived somatic anxiety levels, a medium effect on increasing perceived confidence levels, and a medium effect in reducing the perceived cognitive anxiety levels.

CONCLUSION

Findings suggested that learning the standardized framework may help to address students' perceived anxiety and confidence levels associated with handover reports and generate a mental picture of handover reports.

Are Nursing Students Appropriate Partners for the Interdisciplinary Training of Surgery Residents?

BACKGROUND

Interdisciplinary team training in a simulation center recreates clinical team interactions and holds promise in improving teamwork of clinicians by breaking down educational silos. The objective of our study was to assess the appropriateness of interdisciplinary training with general surgery residents and nursing students.

METHODS

Over 2 consecutive academic years (2012-2013 and 2013-2014), general surgery residents participated in interdisciplinary team-training simulation-based sessions with senior nursing students. Scenario objectives included demonstration of appropriate teamwork and communication, and clinical decision making; sessions incorporated interdisciplinary debriefing of the scenarios. Participants were asked to assess their team-training experience and the appropriateness of their team-training partner. Responses were compared.

RESULTS

A total of 16 team-training sessions were conducted during the study period. Overall, 12 surgery residents (67%) and 44 nursing students (63%) who had participated in at least 1 session responded to the survey. Although both residents and nursing students indicated that the knowledge and team skills acquired during these sessions were useful to them in clinical practice (73% vs 86%, respectively; p = not significant), residents rated their educational value lower (3.3 vs 4.3 on a 5-point scale, respectively; p < 0.01) and only 18% of the residents felt that these sessions should be continued compared with 90% of nursing students (p < 0.05). Most useful components of the sessions were participation in the scenario (73%) and debriefing (54%) for residents and for the nursing students, debriefing (91%), observation of others (68%), and interaction with resident physicians (66%) ranked highest; 48% of student nurses preferred residents as team-training partners whereas 100% residents preferred practicing nurses and 0% with nursing students owing to their limited clinical experience.

CONCLUSIONS

Interdisciplinary team training and debriefing of surgery residents with nursing students is feasible and highly valued by nursing students. Nevertheless, our experience indicates that residents do not prefer nursing students as team-training partners owing to their limited clinical experience and would rather train with experienced nurses.

Improving Chinese nursing students' communication skills by utilizing video-stimulated recall and role-play case scenarios to introduce them to the SBAR technique

PURPOSE

Effective communication among healthcare workers is critically important for patient safety and quality care. The purpose of this pilot study was to evaluate outcomes of a workshop designed to teach Chinese nursing students to use the Situation-Background-Assessment-Recommendation (SBAR) communication tool and examine their attitudes toward utilizing SBAR as a communication tool.

METHOD

A convenience sample of 18 master's degree nursing students at a Chinese university was introduced to SBAR through a workshop. The workshop combined the SBAR tool, video-stimulated recall and role-play case scenarios to illustrate potential positive and negative communication-related patient outcomes. Students completed a 12-item questionnaire before and after participating in the workshop. Four of the items examined the four elements of the SBAR tool (situation, background, assessment, recommendation, score range 0-20), and eight of the items evaluated students' self-perceived attitudes towards utilizing the SBAR tool in their clinical practice (score range 0-40).

RESULTS

Pre- and post-workshop scores on the four elements of the SBAR tool demonstrate significant improvement in knowledge of SBAR (14.0±2.9 vs. 16.6±2.2, respectively; p=0.009). Pre- and post-workshop scores on the items testing students' self-perceived abilities also demonstrate significant improvement (26.9±3.5 vs. 32.6±4.5, respectively; p<0.01) in using SBAR. Total scores increased significantly from 40.9±5.0 to 49.2±5.9 (p<0.01). Moreover, 93.8% of the students agreed and strongly agreed that they would use SBAR during clinical practice.

CONCLUSION

Participating in the SBAR workshop in combination with video-stimulated recall and role-play case scenarios significantly improved the Chinese nursing students' knowledge of SBAR and their self-perceived attitudes towards using SBAR tool. Future studies using a larger sample size and longer post-workshop follow-up are needed to confirm the long-term benefits of the workshop.

Learning to think like a nurse: the development of clinical judgment in nursing students

The purpose of this project was to examine the clinical judgment and reasoning skills of nursing students in high-fidelity simulation. Two levels of students (N = 104), novices and those who are slightly more advanced, participated in individual videotaped simulations. Afterward, interviews were conducted to explore what the student was thinking and feeling during simulation. Five themes emerged from the interviews: thinking like a nurse, assessment, looking for answers, communication, and magical or reflective thinking. There was a clear distinction in the reasoning skills of the novice students compared with students with more clinical experience. Tanner's model of clinical judgment in nursing is used to understand the findings of the study.

Prevention of inpatient hypoglycemia with a real-time informatics alert

BACKGROUND

Severe hypoglycemia (SH), defined as a blood glucose (BG) <40 mg/dL, is associated with an increased risk of adverse clinical outcomes in inpatients.

OBJECTIVE

To determine whether a predictive informatics hypoglycemia risk-alert supported by trained nurse responders would reduce the incidence of SH in our hospital.

DESIGN

A 5-month prospective cohort intervention study.

SETTING

Acute care medical floors in a tertiary care academic hospital in St. Louis, Missouri.

PATIENTS

From 655 inpatients on designated medical floors with a BG of <90 mg/dL, 390 were identified as high risk for hypoglycemia by the alert system.

MEASUREMENTS

The primary outcome was the incidence of SH occurring in high-risk intervention versus high-risk control patients. Secondary outcomes included: number of episodes of SH in all study patients, incidence of BG < 60 mg/dL and severe hyperglycemia with a BG >299 mg/dL, length of stay, transfer to a higher level of care, the frequency that high-risk patient's orders were changed in response to the alert-intervention process, and mortality.

RESULTS

The alert process, when augmented by nurse-physician collaboration, resulted in a significant decrease by 68% in the rate of SH in alerted high-risk patients versus nonalerted high-risk patients (3.1% vs 9.7%, P = 0.012). Rates of hyperglycemia were similar on intervention and control floors at 28% each. There was no difference in mortality, length of stay, or patients requiring transfer to a higher level of care.

CONCLUSION

A real-time predictive informatics-generated alert, when supported by trained nurse responders, significantly reduced inpatient SH.

An evaluation tool to measure interdisciplinary critical incident verbal reports

AIM

The aim was to develop a tool that educators can use to evaluate whether student interdisciplinary critical incident reports are effective.

BACKGROUND

Graduate nurses are expected to give physicians concise reports on patient problems. Educators need a method to evaluate whether student reports are effective.

METHOD

Students were given instruction and practice in giving verbal reports on critical incidents. An evaluation tool was piloted in this study.

RESULTS

Using a paired t-test, it was found that the tool can measure a significant improvement in verbal reports (t = 9.72, df 35, p < .000). Interrater reliability was 94.8 percent.

CONCLUSION

The tool can be used to identify weaknesses within a report so that students can receive specific feedback about their communication. As more interdisciplinary training occurs, this tool might be used to promote discussion between disciplines.

Comparison the Effect of Teaching of SBAR Technique with Role Play and Lecturing on Communication Skill of Nurses

INTRODUCTION

Ineffective communication is a main factor in engender of unwanted hospital errors and impede suitable patient care. SBAR technique (Situation-Background- Assessment- Recommendation) is a standard tool for building communication among healthcare professionals. While educating the SBAR technique requires appropriate educational methods, but this issue has been less investigated. So, the aim of present study was to compare the effect of educating the SBAR technique with role play and lecturing on communication skills of nurses in transferring patients to next shift.

METHODS

This quasi-experimental study conducted by participating 78 nurses who assigned to role play and lecturing groups randomly. SBAR technique was educated to each group separately. At the end of the learning session in each group, the skills of the participants in performing SBAR technique were investigated by the standard SBAR scale. Data analysis was performed by using SPSS statistical software version 11.5.

RESULTS

Comparison the total score of performing SBAR technique using independent samples t-test showed statistical differences between mean score of role play and lecturing groups. Similarly, comparison the scores of skill in performing each four parts of SBAR technique showed statistical differences between two groups.

CONCLUSION

Role play is an effective educational method in teaching SBAR technique for nurses and it can be used as a tool for build effective communication between healthcare professionals.

Use of virtual clinical simulation to improve communication skills of baccalaureate nursing students: a pilot study

BACKGROUND

According to The Joint Commission (2012), the leading cause of sentinel events in the United States was miscommunication. Lack of thorough and accurate communication remains a serious challenge in healthcare and an educational priority in schools of nursing. Virtual clinical simulation is an online educational approach where students use avatars to practice various skills.

OBJECTIVES

The purpose of this pilot study was to evaluate the educational innovation of using virtual clinical simulation to improve communication skills of BSN students. The objectives of the simulations were to 1) recognize significant patient data and 2) accurately perform the ISBAR communication technique.

DESIGN

The study used a within-group, time-series design with eight students. Students participated in two synchronous virtual simulations in an online virtual clinical environment called CliniSpace. Students performed in groups of four to five students.

METHODS

Students performed in two virtual simulations in groups of four to five students. Student performances were scored by two raters using the CliniSpace ISBAR Rating Sheet. Field notes from debriefing sessions were analyzed for content.

RESULTS

Mean group student performance scores more than doubled from performance one to performance two. This change was found to be statistically significant, p<.001. Field notes revealed that students listened to how their peers communicated and learned from them. Students expressed having less anxiety, knowing what to expect, and having "better flow" with communication. Students verbalized learning to assess the patient prior to calling the physician and to give a recommendation to the physician.