Development and Evaluation of an SBAR-based Fall Simulation Program for Nursing Students

The SBAR tool for communication and patient safety in gynaecology and obstetrics: a Tunisian pilot study

BACKGROUND

In healthcare, inadequate communication among providers and insufficient information transmission represent primary contributors to adverse events, particularly in medical specialties such as obstetrics and gynecology. The implementation of SBAR (Situation-Background-Assessment-Recommendation) has been proposed as a standardized communication tool to enhance patient safety. This study aims to evaluate the knowledge, attitudes, and practices related to SBAR communication through a pilot study conducted in a middle-income country.

METHODS

This prospective longitudinal study took place in the gynecology-obstetrics department of a Tunisian university hospital from May to June 2019. All medical and paramedical staff underwent comprehensive theoretical and practical training through a 4-hour SBAR simulation. To gauge participants' knowledge, anonymous multiple-choice questionnaires were administered before the training initiation, with a second assessment conducted at the end of the training to measure satisfaction levels. Two months later, the evaluation utilized questionnaires validated by the French National Authority for Health (HAS).

RESULTS

Among the 62 care staff participants in this study, a majority (89%) demonstrated a low level of knowledge regarding the SBAR tool. The majority (75.8%) expressed enjoyment with the training and indicated their intention to implement changes in their practice by incorporating the SBAR tool in the future (80.7%). Notably, over half of the participants (79%) expressed satisfaction with the training objectives, and 74% reported acquiring new information. Evaluation of the practice revealed positive feedback, particularly in terms of clarity, the relevance of communication, and the time spent on the call.

CONCLUSION

Our pilot study showed that the majority of professionals on the ward had little knowledge of the SBAR tool, a good attitude and a willingness to put it into practice. It is essential that healthcare managers and professionals from all disciplines work together to ensure that good communication practice is developed and maintained. Organisations, including universities and hospitals, need to invest in the education and training of students and health professionals to ensure good quality standardised communication.

Don't interrupt me! development of a handoff education bundle to simulate the real world

OBJECTIVES

Ineffective nurse-to-nurse handoff communication is associated with information omissions, diagnostic errors, treatment errors, and delays. New nurses report a lack of confidence and ability in handoff communication, which may stem from inadequate training in prelicensure nursing programs. Our objective was to introduce prelicensure nursing students to a standardized, theory-based method for handoff, including behavioral strategies employed by nurses during interrupted handoff.

METHODS

A handoff education bundle (HEB) was developed. Kern's six-step curriculum model was utilized to design, implement, and evaluate the handoff curriculum.

RESULTS

Student feedback highlighted the importance of integrating multiple, varying distractors during learning cycles and recognition of the impact of distractors on handoff.

CONCLUSIONS

Implementing a HEB at the prelicensure nursing level could promote competency in handoff communication for new graduate nurses.

IMPLICATIONS FOR INTERNATIONAL AUDIENCE

Handoff is an international patient safety priority, as inadequate communication has been linked to adverse patient events.

Effectiveness of SBAR-based simulation programs for nursing students: a systematic review

BACKGROUND

Situation, background, assessment, and recommendation (SBAR) has been extensively used in clinical and nursing education. A structured communication program increases effective communication, positivity, and education satisfaction during inter-professional collaboration among nursing students. This systematic review aimed to identify and synthesize evidence on the effectiveness of SBAR-based simulation training for nursing students.

METHODS

A research protocol was developed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. The protocol for this study was registered in PROSPERO (CRD42021234068). Eight bibliographical databases were searched for studies published between 2001 and 2021, using relevant search terms. Searches were conducted in PubMed, Embase, Cumulative Index to Nursing and Allied Health, and Cochrane Central Register of Controlled Trials for literature in English, and DBpia, Research Information Sharing Service, Korean Studies Information Service System, and Korea Institute of Science and Technology Information for literature in Korean. After screening titles, abstracts, and full-text papers, pertinent data were extracted, and critical appraisals of the retrieved studies were performed. Data were analyzed using the framework approach, and the findings were presented in a narrative summary. The Effective Public Health Practice Project "Quality Assessment Tool for Quantitative Studies" was used to assess the quality of the included studies.

RESULTS

Twelve studies were included: 3 randomized controlled trials and 9 quasi-experimental studies. Two overarching themes were noted, namely communication clarity and critical thinking. The results of six out of 12 studies produced significant results in favor of SBAR-based simulation in terms of communication clarity. Divergent results were obtained regarding communication ability, critical thinking, confidence, learning self-efficacy, and attitude toward patient safety. The results of these studies highlight that communication clarity ultimately leads to positive results in terms of nursing students' behaviors related to patient safety.

CONCLUSIONS

This review provides a comprehensive update of the literature on the effectiveness of SBAR-based nursing simulation programs for nursing students. These programs were found to have positive learning outcomes because of clear and concise communication. Further studies on the effectiveness of various learning outcomes derived from SBAR-based programs are required.

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.

A Literature Review of Simulation-Based Nursing Education in Korea

This study reviewed the papers that studied the effect of simulation nursing education in the nursing field and examined the trend of simulation nursing education for nursing college students in Korea.

BACKGROUND

Simulation-based education started receiving attention as a pedagogical method in order to provide medical service of high quality in an ethical and safe environment. This has been of great importance during the coronavirus disease 2019 global pandemic. This literature review was conducted to suggest a direction for simulation-based nursing education in Korea.

METHODS

For literature searches, the authors used the following search terms in the Web of Science, CINAHL, Scopus, PubMed-'utilization', 'simulation,' 'nursing student', 'nursing education'. A final search was conducted on 6 January 2021. The materials for this study were collected through literature searches according to the PRISMA guidelines.

RESULTS

25 papers were selected as the final literature for analysis. The study was conducted for 48 percent of senior students in nursing college students in Korea (N = 12). High fidelity (HF) as the simulation type was 44 percent (N = 11). The simulation education subjects were composed of 52 percent adult health nursing (N = 13). According to educational goals described by Benzamine Bloom (1956), 90% in the psychomotor domain is considered a positive learning achievement.

CONCLUSIONS

Effectiveness in the psychomotor domain through simulation-based training is correlated with expert nursing. It is essential to develop a systematic debriefing model and methods to evaluate performance and learning in the short- and long-term to expand the effectiveness of simulation-based education in nursing.

Usability Evaluation of the Preoperative ISBAR (Identification, Situation, Background, Assessment, and Recommendation) Desktop Virtual Reality Application: Qualitative Observational Study

BACKGROUND

Systematic communication, such as the ISBAR (identification, situation, background, assessment, recommendation) approach, comprises a generic, transferable nontechnical skill. It can be used during the handover of patients set to undergo surgery and can be practiced in various ways, including virtual reality (VR). VR increasingly has been implemented and valued in nursing education as a positive contribution to teach students about pre- and postoperative nursing. A new nonimmersive 3D learning activity called the Preoperative ISBAR Desktop VR Application has been developed for undergraduate nursing students to learn preoperative handover using the ISBAR approach. However, the usability of this learning activity has not been studied.

OBJECTIVE

This study aimed to investigate how second-year undergraduate nursing students evaluated the usability of the Preoperative ISBAR Desktop VR Application.

METHODS

This was a qualitative study with observation and interviews. The inclusion criteria were undergraduate second-year nursing students of varying ages, gender, and anticipated technological competence. The System Usability Scale (SUS) questionnaire was used to get a score on overall usability.

RESULTS

A total of 9 second-year nursing students aged 22-29 years participated in the study. The average score on the SUS was 83 (range 0-100), which equals a "B" on the graded scale and is excellent for an adjective-grade rating. The students expressed increased motivation to learn while working in self-instructed desktop VR. Still, a few technical difficulties occurred, and some students reported that they experienced some problems comprehending the instructions provided in the application. Long written instructions and a lack of self-pacing built into the application were considered limitations.

CONCLUSIONS

The nursing students found the application to be usable overall, giving it an excellent usability score and noting that the application provided opportunities for active participation, which was motivational and facilitated their perceived learning outcomes. The next version of the application, to be used in a randomized controlled trial, will be upgraded to address technological and comprehension issues.

Application of Nursing Intervention Based on Intelligent Grip Strength System in Patients with Tumor PICC: A Case-Control Study on Promoting Functional Exercise and Quality of Life

Objective

A case-control study was conducted to elucidate the impact of application of nursing intervention based on intelligent grip strength system in patients with tumor peripherally inserted central catheter (PICC) on promoting functional exercise and life quality.

Methods

A total of 100 patients with tumor PICC treated in our hospital from April 2019 to April 2021 were enrolled. The patients were randomly assigned into control group and study group. The control group received routine nursing, and the study group received nursing intervention based on intelligent grip strength system.

Results

First of all, we compared the nursing satisfaction between the two groups: the study group was very satisfied in 43 cases, satisfactory in 6 cases, and general in 1 case, and the satisfaction rate was 100.00%, while in the control group, 29 cases were very satisfied, 10 cases were satisfied, 6 cases were general, and 5 cases were dissatisfied. The satisfaction rate was 90.00%. As such, the nursing satisfaction of the study group was higher compared to the control (P < 0.05). Secondly, we compared the average blood flow velocity per unit time of axillary vein at different moments. Before catheterization, there exited no significant difference (P > 0.05). The average blood flow velocity per unit time of axillary vein in the study group was faster compared to the control at different time points (P < 0.05). In terms of the average blood flow velocity per unit time of axillary vein at different time points between the two groups, there exited no significant difference before catheterization (P > 0.05). But 14 and 28 days after catheterization, the average blood flow velocity per unit time of axillary vein in the study group was better when compared to the control (P < 0.05). Comparing the incidence of catheter-related complications, the incidence of catheter-related complications such as redness and swelling, phlebitis, catheter occlusion, and catheter slip in the study group (12.00%) was lower compared to the control (60.00%) (P < 0.05). There was no significant difference in vascular diameter, peak blood flow velocity, and vascular pressure between the two groups before nursing (P > 0.05), but after nursing, the vascular diameter and peak blood flow velocity group were higher, and the vascular pressure was lower in the study (P < 0.05). Comparing the scores of functional exercise compliance, the scores of grip exercise compliance, exercise monitoring compliance, active help seeking compliance, exercise attention compliance, and the total score of compliance in the study group were higher compared to the control (P < 0.05). Finally, we compared the scores of life quality. Before nursing, there exhibited no significant difference between the two groups (P > 0.05). The scores of physiological function, psychological function, social function, and health self-cognition in the study group were lower when compared to control (P < 0.05).

Conclusion

The utilization of intelligent grip strength system can improve the functional exercise compliance of PICC patients, effectively facilitate the venous blood circulation of upper limbs, and strengthen the life quality, as well as reduce the incidence of catheter-related thrombosis. However, more multicenter, large sample, randomized controlled studies should be carried out to explore the impact of intelligent grip strength system on the long-term effect of functional exercise in patients with PICC.

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.

SBAR-LA: SBAR Brief Assessment Rubric for Learner Assessment

INTRODUCTION

Structured communication tools are associated with improvement in information transfer and lead to improved patient safety. Situation, Background, Assessment, Recommendation (SBAR) is one such tool. Because there is a paucity of instruments to measure SBAR effectiveness, we developed and validated an assessment tool for use with prepractice health professions students.

METHODS

We developed the SBAR Brief Assessment Rubric for Learner Assessment (SBAR-LA) by starting with a preliminary list of items based on the SBAR framework. During an interprofessional team training event, students were trained in the use of SBAR. Subsequently, they were assigned to perform a simulated communication scenario demonstrating use of SBAR principles. We used 10 videos from these scenarios to refine the items and scales over two rounds. Finally, we applied the instrument on another subset of 10 students to conduct rater calibration and measure interrater reliability.

RESULTS

We used a total of 20 out of 225 videos of student performance to create the 10-item instrument. Interrater reliability was .672, and for eight items, the Fleiss' kappa was considered good or fair.

DISCUSSION

We developed a scoring rubric for teaching SBAR communication that met criteria for validity and demonstrated adequate interrater reliability. Our development process provided evidence of validity for the content, construct, and response process used. Additional evidence from the use of SBAR-LA in settings where communication skills can be directly observed, such as simulation and clinical environments, may further enhance the instrument's accuracy. The SBAR-LA is a valid and reliable instrument to assess student performance.

Effects of flipped-learning-based simulation for nursing students: a retrospective survey

This study analysed whether Situation-Background-Assessment-Recommendation (SBAR) simulation, which uses a flipped learning method, improves undergraduate nursing students' academic performance and core competencies when applied in the mental health nursing practicum, as compared with traditional in-person simulations. To this end, a retrospective survey was employed. A group of 37 students who participated in the flipped learning-based SBAR simulation practicum was compared with a group of 37 students who participated in the practicum using a traditional learning method, in terms of their academic performance and core competencies. The 90-h practicum included four three-hour SBAR simulation sessions. Students were assessed at baseline, immediately after the two-week practicum, and four weeks later. The effects of group, time, and group-by-time interactions between the groups were verified using generalized estimating equations with an autoregressive correlation structure. Data were collected between March and July 2017, in South Korea. The results indicated that SBAR simulation significantly improved nursing students' communication performance compared with the traditional learning method. The clinical practicum based on SBAR improved core competencies at the post-practicum and four weeks later. In conclusion, the application of the flipped learning-based SBAR simulation can improve nursing students' communication skills and can be utilized as an effective teaching method to promote higher order competencies to apply, analyse, and evaluate knowledge beyond simple understanding and information recall. This study has addressed how academic performance and core competencies in nursing can be improved through SBAR simulation using a flipped learning method and shown its positive impact on nursing students' communication skills and higher order competencies.

Factors influencing the patient safety climate in intensive care units: cross-sectional study

Background

Measuring the patient safety climate of a health service provides important information about the safety status at a given time. This study aimed to determine the factors influencing the patient safety climate in Intensive Care Units.

Methods

An analytical and cross-sectional study conducted in 2017 and 2018 in two adult Intensive Care Units of a Brazilian Teaching Hospital. The Safety Attitudes Questionnaire instrument was applied with the multidisciplinary teams to determine the factors influencing the patient safety climate. Data were double entered into a database and processed using the R (version 3.5.0) statistical software. Position, central tendency and dispersion measures were taken and absolute and relative frequencies, mean and confidence intervals were calculated for the quantitative variables. Linear regression was performed to verify the effect of variables on the SAQ domains. Variables with a p-value of less than 0.25 were selected for multivariate analysis.

Results

A total of 84 healthcare providers participated in the study. The mean Safety Attitudes Questionnaire score was 59.5, evidencing a negative climate. The following factors influenced the safety climate: time since course completion, professional category, type of employment contract, complementary professional training, and weekly workload.

Conclusions

The factors identified indicate items for planning improvements in communication, teamwork, work processes, and management involvement, aiming to ensure care safety and construct a supportive safety climate.

Building a Handoff Communication Virtual Experience for Nursing Students Using Virtual Humans

Effective communication among healthcare professionals is critical to delivering safe, high-quality patient care. One important real-world skill that nursing students must acquire is generating accurate handoff communication reports. The central aim of this study was to build, assess, and revise a virtual experience simulation that allows nursing students to observe a standardized clinical situation in an immersive environment and then practice the situation-background-assessment-recommendation communication method. This between-groups experimental study, which was modified in light of COVID-19 concerns, evaluated how well 69 prelicensure nursing students understood a handoff communication report after viewing a virtual human patient and nurse interact during a triage assessment scenario. Results indicate student comprehension levels did not differ based on which of two metacognitive learning strategies was used. Participants in both study groups were able to accurately complete a situation-background-assessment-recommendation instrument based on the virtual experience. Further, they believed that watching a virtual nurse perform a triage assessment would help them perform one themselves in a similar virtual environment. There was also an unexpected study finding related to patient safety within the context of the simulation. This finding warrants further research that will lead to revision of the virtual experience used to train future nurses.

Contemporary Integrative Review in Simulation-Based Learning in Nursing

Background: In general, simulation-based learning (SBL) has been a part of nursing education in the past two decades, though nursing educators are facing difficulties in evaluating its effectiveness in theory and practice. The aim of this review was to synthesize the research findings regarding the effects of SBL among nursing students from published scientific articles. Methods: This integrative review focused on articles published in English between 2016 and 2020, identified by using electronic databases such as Cochrane Library, PubMed, Medline (Ovid), SCOPUS, RISS, and Korea Med. Results: Fifteen articles were selected by a step-by-step process. Data were synthesized and effects of SBL methods were derived under four themes: ‘Knows A Self Com_p’ such as knowledge and skills; Attitude; Self (learning, efficacy, determination, competency, confidence, utilization, satisfaction, assessment); and Com(n) (competency, communication, and confidence) and P (perceptions and performance). Conclusion: The review results showed that SBL is the best method for teaching clinical practice. Article-focused simulations with simulators were more effective than classroom teaching, depending on the context, topic, and method. The overall results showed that SBL is a positive, safe and effective method for nursing students in clinical and simulation room settings to improve the skills and practice of client care.