1. Cudjoe, Kim Giselle BSN, RN

Article Content

We're often confronted with communication barriers due to the complexity and diversity of our healthcare system. Communication challenges can be a result of human factors, such as poor communication skills; lack of resources to support communication training; lack of support for active communication in the clinical setting; or an inappropriate environment for handoff due to interruptions. These barriers can threaten patient safety, negatively affect clinical outcomes, and impede the delivery of quality care.


Effective communication is essential because it allows us to exchange patient information among our colleagues, physicians, and other members of the multidisciplinary healthcare team. Successful communication in the healthcare setting develops therapeutic nurse-patient relationships, facilitates the development of team collaboration, reduces the risks of errors, promotes patient satisfaction and positive clinical outcomes, and increases the quality of care.



One communication tool that's utilized in the clinical setting is the situation, background, assessment, and recommendation (SBAR) technique. Situation represents the problem that's being reported to the physician; background is the brief history of the patient that can help identify the cause of the problem; assessment refers to the nurse's observations, including symptoms and vital signs; and recommendation encompasses the nurse's requests of the physician or care plan suggestions.


The Joint Commission describes SBAR as the "best practice for standardized communication in healthcare." Nurses use the SBAR technique to report concise, pertinent, and complete verbal information when communicating with physicians, engaging in handoffs, and giving nurse-to-nurse shift reports. Nursing reports and handoffs need to be performed efficiently because they provide us with the opportunity to ask questions, seek clarification, and confirm information.


SBAR can be especially valuable when we're required to report a critical situation to physicians in which effective communication is vital to the patient's clinical outcomes and safety. The main objective of using SBAR is to verbalize an emergent condition and receive solution-oriented feedback.



Adding "identity" to the SBAR acronym allows you to identify yourself to the receiver of the information. The use of ISBAR is impactful because it forms a systematic framework for effective communication. Let's take a look at an example.


* Identity: Identify yourself, the physician, and the patient."Good morning, Dr. Smith. This is Nurse Kim, RN. I'm calling about your patient Mrs. Jane on 6A, Room 601."


* Situation: Clearly describe the current situation, observations, and concerns."The patient is complaining of shortness of breath with worsening upon exertion. Her oxygen saturation was 88% on room air. She was placed on supplemental oxygen 2 L via nasal cannula and her oxygen saturation is now 92%. Her respirations are 26, pulse is 108, BP is 95/64, and temperature is 101.2[degrees] F. She has a cough with mucus production that's green and tinged with blood. She reports chest pain when coughing as a 7 out of 10 on the pain scale and feelings of fatigue and anxiety."


* Background: Provide a clear and brief patient background/history."Mrs. Jane is a 65-year-old female who was admitted with the diagnosis of chronic obstructive pulmonary disease exacerbation 4 days ago. Her initial clinical presentation on admission included persistent dyspnea and chest tightness. She also had a cough that was producing clear sputum and chest tightness. She was noted for use of accessory respiratory muscles. She received orders for a bronchodilator every 4 hours, oral corticosteroid, oximetry monitoring, and supplemental oxygen for an oxygen saturation of less than 92%. She has been on enoxaparin for deep vein thrombosis prophylaxis."


* Assessment: What's your assessment?"I think Mrs. Jane is exhibiting symptoms that may be associated with pneumonia."


* Recommendation: Give your recommendations and state any requests.



"Dr. Smith, will you be coming to see the patient? Would you like me to contact radiology for a stat chest X-ray? Should I initiate an I.V. for antibiotic infusion?"


The ISBAR technique is an important practice that needs to be adopted within the healthcare industry, as well as introduced in nursing schools, to prevent communication gaps, promote complete communication through patient handoffs and transitions of care, and maintain successfully sustained communication throughout the care continuum.


Highest standards

Conversation that's standardized and structured can improve communication, build collaboration and collegiality, improve clinical outcomes and patient satisfaction, facilitate the continuity of care, and promote patient safety. Consider incorporating ISBAR into your practice today.




Agency for Healthcare Research and Quality. Pocket guide: TeamSTEPPS.


Cairns LL, Dudjak LA, Hoffmann RL, Lorenz HL. Utilizing bedside shift report to improve the effectiveness of shift handoff. J Nurs Adm. 2013;43(3):160-165.


Labson M. SBAR-a powerful tool to help improve communication!


Ortega L, Parsh B. Improving change-of-shift report. Nursing. 2013;43(2):68.