Nursing Practice Through Reflective Analysis of SBAR Communication

Introduction

In nursing, reflective practice helps the nurses in making sense of their actions to learn and improvise their skills in enhancing their strength and resolving identified weakness. SBAR is one of the key communication frameworks been used to make meaningful communication by the nurses with the doctor. In this study, one of the instances of using SBAR in develop care for Mr J is to be discussed. The Borton’s Reflective Model is to be used in reflecting the situation because it is a straightforward framework to be implemented in easily reflecting any situation to understand and advocate the responsibilities accordingly (Delves-Yates, 2021). For those seeking nursing dissertation help, this approach provides a practical example of how to apply communication frameworks effectively in clinical settings.

What?

In caring for Mr J my role was providing nursing support and monitor his health to determine any sudden changes and act accordingly in managing the condition. I effectively performed the role which is evident as Mr J on showing sudden breathless and increased heart rate, I thoroughly assessed his health vitals to be reported to the responsible physicians for discussion of further care. It is mentioned that prior to use of SBAR, the nurses are required to communicate with the resource nurse for initial assistance and make detailed chart of patient vitals, lab results and medication been delivered (Shahid and Thomas, 2018). As a nurse, I already performed the role which ensured I took enhanced care of the patient as with consultation I reached the idea of immediately providing supplement oxygen to the patient for relief and stop the blood transfusion till the physician arrives. I also charted the current vitals of the patient to report it to the physician. However, the problem faced is that no diuretics were prescribed to Mr J which are essential medicine in avoiding and reducing vascular overload during blood transfusion. Since I am not a certified nurse with medication prescribing ability, I was unable to provide the determined medication needed for the patient. Moreover, during initial admission of Mr J when I was also present, I forgot to ask the physician the diuretic medication to be provided due to which transfusion overload was unable to be prevented.

So What?

According to NMC Code of Conduct, the nurses are to act in best interest of the patient and ensure their enhanced health as well as well-being (NMC, 2018). As nurses by timely implementing SBAR to make communication with the physician caring for Mr J was effective decision as it helped in taking effective emergency action which is in the best interest of the patient. This is evident as I alerted the sudden change in health of Mr. J to physician for him to come and immediately review would help to understand in detail the damage caused if any due to transfusion overload and exact action to be further performed in improving his health. The nurses are to be accountable for their role and provide care within their expertise to ensure safe healthcare for the patient (Perry et al., 2018). This is because nurses by acting beyond their expertise would cause error in care that would make the patient to suffer negative health consequences (Mertens et al., 2019). In caring for Mr J, my strength was that I acted with accountability and within my expertise which helped me in avoiding error in care. It is evident as I provided supplemented oxygen to Mr J which was within my expertise to control his dyspnea but did not went beyond to provide any medication to control his transfusion overload or heartbeat as it would have led me to create error in care.

One of the weakness faced in using SBAR is that while detailing the assessment of the patient to the physician, I forgot to mention that diuretic medication is not provided previously during the admission to Mr J. The antidiuretic is administered as common practice during blood transfusion to ensure avoidance of vascular overload which could be imposed by the extra blood volume delivered to the patient during transfusion (Mickelsen et al., 2021). As a result, Mr J had to face transfusion overload due to my carelessness leading to delivering him quality care. However, in using SBAR, my strength was that I was able to provide detailed information about the situation and background of the patients to the responsible physician to be able to identify the patient immediately and the emergency situation. Moreover, I was able to act responsibly in asking recommendation for care from the physician till he comes to care for the patient. This acts as strength as acting on the recommended care by physician during emergency by the nurses helps them in avoiding delay in care and quality care support to the patient (An et al., 2020).

Now What?

The study led me to understand that in effectively implementing SBAR, it is responsibility of the nurse to make through assessment of medication, health vitals and lab tests of the patients to be reported to the physician. This is because hindered information delivery cause hindered care support to the patients (Müller et al., 2018). Thus, in further care, I as a nurse would focus on mentioning the medication administered apart from health vitals and lab tests of the patient to effective implement SBAR for successful communication. In order to achieve it, I would self-taught myself by going through various case examples regarding the best way to implement SBAR in communication.

Conclusion

The above discussion concludes that SBAR is used to inform sudden health changes of Mr J who is on blood transfusion after being detected with low hemoglobin following last round of chemotherapy for his skin cancer. As a nurse, I effectively worked within my expertise and ensure care in interest if the patients. Moreover, I was successful in explaining health background and situation of the patient to the physician caring for Mr J to help him easily identify and relate the condition of the patient. However, I made poor assessment by failing to inform the physician the medication no been provided to Mr J due to which the sudden emergency was mainly raised.

References

An, Y., Yang, Y., Wang, A., Li, Y., Zhang, Q., Cheung, T., Ungvari, G.S., Qin, M.Z., An, F.R. and Xiang, Y.T., 2020. Prevalence of depression and its impact on quality of life among frontline nurses in emergency departments during the COVID-19 outbreak. Journal of affective disorders, 276, pp.312-315.
Delves-Yates, C., 2021. What is Reflection?. Beginner′ s Guide to Reflective Practice in Nursing, p.5.
Mertens, F., De Gendt, A., Deveugele, M., Van Hecke, A. and Pype, P., 2019. Interprofessional collaboration within fluid teams: Community nurses' experiences with palliative home care. Journal of clinical nursing, 28(19-20), pp.3680-3690.
Mickelsen, R., French, V. and Amaya, S., 2021. Hydatidiform Mole with Coexisting Fetus and Syndrome of Inappropriate Antidiuretic Hormone Secretion: A Case Report. Journal of the Endocrine Society, 5(10), p.129.
Müller, M., Jürgens, J., Redaèlli, M., Klingberg, K., Hautz, W.E. and Stock, S., 2018. Impact of the communication and patient hand-off tool SBAR on patient safety: a systematic review. BMJ open, 8(8), p.e022202.
Perry, C., Henderson, A. and Grealish, L., 2018. The behaviours of nurses that increase student accountability for learning in clinical practice: An integrative review. Nurse education today, 65, pp.177-186.
Shahid, S. and Thomas, S., 2018. Situation, background, assessment, recommendation (SBAR) communication tool for handoff in health care–a narrative review. Safety in Health, 4(1), pp.1-9.

Appendix:

Care Event:

I was entrusted to care for Mr. J who is admitted in the Haematology ward for showing signs of low haemoglobin after the chemotherapy session for his skin cancer. Mr. J during admission showed paleness along with minimum shortness of breath, feeling of cold in the hands and legs and dizziness. The symptoms were immediately expressed after the chemotherapy and thus, full blood count of the patient was done to ascertain his red blood cell level. This is because chemotherapy acts to destroy bone marrow which leads in low red blood count in the body (). Mr. J was provided 2 unit of blood since his haemoglobin fell to 80g/l since the last round of chemotherapy. After the first unit of blood was provided for 90 min, the second unit was initiated ½ hour later. During half of the blood transfusion, he was seen to develop increased breathlessness and dyspnoea in the last 10 mins. His heart rate was seen to be increased to 120beats/min and his blood pressure also increased to 190/100. As a nurse, I was worried regarding the sudden change in his health and discussed the situation with the resource nurse who mentioned to immediately stop the transfusion and initiate supplement oxygenation while waiting for the responsible physicians to attend the patient as soon as possible. I focussed on using SBAR in communicating the situation to the physician. During communication, I forgot to mention that no diuretic was prescribed to the patient but mentioned I have provided him supplement oxygen to minimise his breathing difficulty. The physician assessing Mr J was present in other ward replied to be immediately coming and praised me for my actions.