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chapter 6 | Getting People to Work Together 81 CikguOnline
table 6-2
SBAR (Situation, Background, Assessment, Recommendation)
Elements Description Example
Situation Brief description of the existing situation Critical laboratory value that needs to be
addressed (critical blood gas value, International
Normalized ratio [INR], etc.)
Background Medical, nursing, or family information Patient admitted with a pulmonary embolus and on
that is significant to the care and/or heparin therapy, receiving oxygen at 4 L via nasal
patient condition cannula; what steps have been taken
Assessment Recent assessment data that indicate Vital signs, results of laboratory values, lung sounds,
the most current clinical state of mental status, pulse oximetry results,
the patient electrocardiogram results
Recommendation Information for future interventions Monitor patient
and/or activities Change heparin dose
Repeat INR
Repeat computed tomography or ventilation-
perfusion scan

communicating patient information for hand-off work. Do people listen to us—our managers, upper
reporting (Haig, Sutton & Whittingdon, 2006; management, human resources? Being able to com-
IHI, 2006). municate with each other—to be able to speak
directly with your peers, physicians, or managers in
Health-Care Provider Orders a way that is nonconfrontational—is really impor-
Professional nurses are responsible for accepting, tant to having good working relationships and to
transcribing, and implementing health-care providing good care. You need to have mutual
provider orders. The two main types of orders are respect. (Quoted by Trossman, 2005, p. 1.)
written and telephone. Written orders are dated and Communicating With Patients
placed on the appropriate institutional form. and Their Families
Telephone orders are given from the health-care
Communicating with patients and their families
provider directly to the nurse by telephone. Many
occupies a major portion of the nurse’s day. Nurses
health-care institutions are moving to maintaining
teach patients and their families about medications
the electronic medical record (EMR) and away
and the patient’s condition, clarify the treatment
from verbal orders as the health-care provider is
plan, and explain procedures. To do this effectively,
present and can enter the order on the appropriate
nurses need to use communication skills and recog-
form in the patient’s record. A telephone order
nize the barriers to communication.
needs to be written on the appropriate institution-
The health-care consumer may enter the setting
al form, the time and date noted, and the form
in a highly emotional state. Nurses need to recog-
signed as a telephone order by the nurse.
nize the signs of an anxious or angry patient and
Most institutions require the physician to cosign
promptly intervene to defuse the situation before it
the order within 24 hours. When receiving a tele-
escalates. Practicing good listening skills and show-
phone order,repeat it back to the physician for con-
ing interest in the patient often helps.
firmation. If the health-care provider is speaking
Short-term stays and early-morning admissions
too rapidly, ask him or her to speak more slowly.
on the day of surgery make patient teaching a chal-
Then repeat the information for confirmation.
lenge. The nurse must complete the admission
Professionalism and a courteous attitude by all par-
requirements, surgical checklists, and preoperative
ties are necessary to maintain collegial relationships
teaching within a short time. Time for postopera-
with physicians and other health-care professionals.
tive teaching is also shortened. It is important for
One nurse explained their importance as follows:
the nurse to communicate clearly and concisely
RN satisfaction simply is not about money. A major what will be done and what is expected of the
factor is how well nurses feel supported in their patient. Allow time for questions and clarifications.