What does the communication tool SBAR stand for in professional communication among team members?
Symptoms, Background, Alignment, and Referral
Site, Benefits, Agreement, and Resolution
Situation, Background, Assessment, and Recommendation
Situation, Background, Assignment, and Reconciliation
Situation, Background, Assessment, and Recommendation
Effective communication among health care providers and other staff is necessary to ensure patient safety and to promote optimal outcomes. SBAR is an effective communication tool that helps the flow of standardized communication among all health care staff. SBAR stands for Situation, Background, Assessment, and Recommendation. S does not stand for Symptoms or Site. B does not stand for Benefits. A does not stand for Alignment, Agreement, or Assignment. R does not stand for Referral, Resolution, or Reconciliation.
The patient is feeling healthy and refreshed.
The patient, who is 65 years old, is stable with no pain.
The patient is extremely uncooperative and grumbles all the time
The hand-off report should be free of any personal and derogatory statements regarding the patient. The patient's condition is recorded specifically, as opposed to giving generalized statements that patient feels good or better. Biographical details already mentioned in the medical record need not be reported on the hand-off report; these include age, race, or admission diagnosis. Only essential information should be provided such as the patient's name, gender, and nursing diagnosis. Any improvement or decline in the patient's condition is recorded (e.g., the patient is free of pain, had a good sleep, or could not sleep).
The nurse administers 10 mg of morphine every 4 hours and documents it.
The nurse reads back the prescription to the
primary healthcare provider for verification and documents that the order was read back.
The nurse records the details of the instructions and marks it as a telephone order (TO).
The nurse confirms the patient's name, room number, and diagnosis.
After confirming the patient's name, room number, and diagnosis, the nurse should always document when he or she administers a medication. Administering the morphine without documenting it would be inappropriate. When orders are given by telephone, the nurse carefully notes the prescription and reads it back to the primary healthcare provider for verification. In the report, the nurse indicates whether it is a telephone order (TO) or verbal order (VO) and mentions the name of the patient, complete ordering information, name of the primary healthcare provider, and date and time of the TO or VO; the nurse also documents the order was read back to provider. This is signed by the ordering primary healthcare provider within a set time frame. The nurse does not just write that the medications were administered "as per orders." The telephone orders are discretely and carefully documented with specific information such as the date, time, patient, and the primary healthcare provider's name. Vague documentation and informatics can lead to misinterpretation and legal claims.
Swanson's theory of caring comprises five factors. These factors are knowing, being with, doing for, enabling, and maintaining belief. Knowing refers to striving to understand an event as it has meaning in the life of the other. Being with means that the nurse is emotionally present for the patient. Doing for is performing for others as the nurse would have done for self if it were possible. Enabling refers to the activities that facilitate the patient's passage through changes in life. Maintaining belief means keeping faith in the other person's ability to get through an event.
STUDY TIP: Make a mnemonic to memorize the Swanson "5": knowing, being with, doing for, enabling, and maintaining belief. If you take the first letters of each of the five factors, you could use them for the first letters of a silly sentence, such as "Knock before entering dangerous mansions" -- but the mnemonic YOU create will be more beneficial for your memory than the one you just read.
A patient is fearful of upcoming surgery and a possible cancer diagnosis. The patient discusses love for the Bible with the nurse, who recommends a favorite Bible verse. Another nurse disagrees with this recommendation. Which would be an appropriate response to the nurse who states that there is no place in nursing for spiritual caring?
"Spiritual care should be left to a professional."
"You are correct; religion is a personal decision."
"Nurses should not force their religious beliefs on patients."
"Spiritual, mind, and body connections can affect health."
"Spiritual, mind, and body connections can affect health."
Spirituality offers a sense of connectedness intrapersonally (connected with oneself), interpersonally (connected with others and the environment), and transpersonally (connected with the unseen, God, or a higher power). In a caring relationship the patient and nurse come to know one another, so both move toward a healing relationship.
A patient who is quadriplegic complains of being cold and asks for an extra blanket. The nurse covers the patient and draws the room's curtains. Which process did the nurse follow?
Knowing
Doing for
Being with
Maintaining belief
Doing for
Rationale
Doing for is the process in which the nurse carries out tasks for patients as
they would do for themselves, if possible. The quadriplegic patient is unable to cover himself; hence the nurse does the task. Knowing is getting to know the patient. Being with refers to being present emotionally for the patient. Maintaining belief is instilling hope and faith in the patient.
Listening is multifaceted. Besides taking in what a patient says, what else does listening include?
Incorporating the views of the physician
Correcting any errors in the patient's understanding
Injecting the nurse's personal views and statements
Interpreting and understanding what the patient means
Interpreting and understanding what the patient means
Rationale
Listening is powerful. It conveys the nurse's full attention and interest. A true caring presence involves listening. Listen to what is important to another person and the meaning of a situation to that person.
Listening includes "taking in" what a patient says, interpreting and understanding what the patient is saying, and then giving back that understanding to the patient. It does not include incorporating the views of the physician, correcting the errors in the patient's understanding, or injecting the nurse's personal views and statements.
The nurse enters a patient's room, arranges the supplies for a Foley catheter insertion, explains the procedure to the patient, and tells the patient what to expect. Just before inserting the catheter, the nurse tells the patient to relax and says that, once the catheter is in place, the patient will not feel the bladder pressure. The nurse then proceeds to skillfully insert the Foley catheter. Which type of touch is this?
Caring touch
Protective touch
Task-oriented touch
Interpersonal touch
Task-oriented touch
Rationale
Nurses
use task-orientated touch when performing a task or procedure. An expert nurse learns that any procedure is more effective when administered carefully and in consideration of any patient concern. Caring touch is holding a patient's hand, giving a back massage, gently positioning a patient, or participating in a conversation to enhance a patient's comfort and security, self-esteem, confidence in the caregivers, and mental well-being. Protective touch protects the nurse and/or the patient to
prevent physical or emotional harm. Touch can enhance interpersonal relationships, but there is no category of touch labeled interpersonal touch.
A patient loses balance, and the nurse holds the patient to avoid a fall. Which kind of touch is this?
Caring
Protective
Noncontact
Task-oriented
Protective
Rationale
Holding a patient to avoid a fall is an example of protective
touch. The use of touch is often a comforting approach while dealing with patients. Touch is classified into different categories based on the type of touch. Protective touch is used to protect the patient or the nurse. Caring touch helps to comfort the patient and establish a personal connection between the nurse and the patient. Noncontact touch mainly involves eye contact, not physical touch. Task-oriented touch is the touch that takes place while the nurse is performing a nursing task or
procedure.
A patient is admitted to the hospital for the treatment of lymphoma. The nurse enters the patient's room to find the patient worried and depressed. The nurse warmly greets the patient and lightly touches the patient's shoulder. Which type of touch is this?
Caring
Protective
Noncontact
Task-oriented
Caring
Rationale
A caring touch is a nonverbal communication that
helps to comfort the patient and establish a personal connection between the nurse and the patient. A protective touch is used to protect the patient or the nurse. A noncontact touch is mainly eye contact, which does not involve physical touch. A task-oriented touch takes place when the nurse is performing some nursing task or procedure.
The nurse decides to use Swanson's theory of caring in clinical practice. Which caring processes are included in this theory? Select all that apply.
Bias
Knowing
Doing for
Being with
Randomization
Knowing
Doing for
Being with
Rationale
The caring processes of Swanson's theory of caring include knowing, doing for, and being with. Knowing helps to understand an event and adds meaning to life. Doing for a patient is comforting to the patient. Being with a patient provides emotional support to the patient.
Bias and randomization are not part of Swanson's theory.
A 60-year-old patient is undergoing treatment for a brain tumor. The patient is depressed due to the diagnosis. The nurse enters the room and finds that the patient is weeping. On inquiring, the patient starts speaking about the disease and the related problems. To be a good listener, what should the nurse do? Select all that apply.
Maintain good eye contact.
Give complete attention to the patient.
Complete the tasks at hand and return later to talk.
Listen to the patient while simultaneously performing tasks.
Be silent and listen to the patient carefully.
Maintain good eye contact.
Give complete attention to the patient.
Be silent and listen to the patient carefully.
Rationale
When communicating with any patient the nurse should be a patient listener. The patient should feel that the
nurse is genuinely interested in knowing the complaints. The nurse should make good eye contact and give complete attention to the patient. It is important that the nurse listens to the patient with an open mind. The nurse should keep mind and mouth silent and let the patient speak. The nurse should not interrupt or give opinions. It is easy for the nurse to get distracted by tasks on hand and workload, but the nurse should listen to the patient first and then complete the tasks.
How does the nurse demonstrate caring to family members?
Helping the family to become active participants in care
Preventing the family from providing activities of daily living (ADLs)
Sharing all health care information without the patient's permission
Allowing the family to make health care decisions for the patient
Helping the family to become active participants in care
Rationale
The
nurse sees the patient and the whole family as active participants in the care of the patient. Therefore, the nurse should include the family members willing to perform activities of daily living (ADL). The patient must give permission to share health care information, even with family members. Patients make their own health care decisions.
Which is a strategy for creating work environments that enable nurses to demonstrate more caring behaviors?
Increasing the working hours of the staff
Decreasing salary benefits of the staff
Creating a setting that allows flexibility and autonomy for staff
Encouraging increased input concerning nursing functions from physicians
Creating a setting that allows flexibility and autonomy for staff
Rationale
Encouraging flexibility and autonomy increases nursing satisfaction. When nurses' job satisfaction is high, they have a
greater connectedness with their patients and believe that caring practices are part of the nursing culture. Increasing the working hours of staff usually decreases nursing satisfaction. Encouraging increased input concerning nursing functions from physicians decreases nursing autonomy and thus decreases nursing satisfaction. Decreasing salary benefits usually decreases job satisfaction.
A patient is admitted to the hospital for treatment of lymphoma. The nurse enters the patient's room to find the patient worried and depressed. According to the caring principles, what should the nurse do? Select all that apply.
Leave the patient alone.
Greet the patient and gently touch the patient's shoulder.
Make good eye contact and sit next to the patient.
Do necessary work and leave without speaking.
Ask the patient about any concerns and listen to complaints patiently.
Greet the patient and gently touch the patient's shoulder.
Make good eye contact and sit next to the patient.
Ask the patient about any concerns and listen to complaints patiently.
Rationale
The nurse should always follow the caring principles when caring for any patient. The patient who is suffering from lymphoma may get depressed at times. The nurse must be patient enough to handle such patients. The nurse should greet the patient warmly and touch the patient's shoulder gently to
acknowledge the patient's presence. Making good eye contact and sitting next to the patient gives the impression that the nurse is interested in listening to the patient's problems. Asking about the patient's concerns and listening patiently is an important principle of caring, which makes the patient feel that the nurse is not there just for her task but connects with the patient on a personal level. Greeting the patient does not imply that the nurse is disturbing the patient. The patient may
feel uncared for if the nurse leaves the room without speaking.
The nurse has been asked to secure a nasogastric tube for a patient with abdominal distention. The patient becomes anxious upon seeing the tube. Which nursing intervention would be helpful to manage this patient's anxiety?
Explaining the procedure to gain the patient's confidence
Remaining quiet while securing the tube
Securing the tube after administering antianxiety drugs
Securing the tube as quickly as possible before the patient's anxiety becomes overwhelming
Explaining the procedure to gain the patient's confidence
Rationale
The nurse can relieve the patient's anxiety and enhance comfort by explaining the procedure in detail. Explaining the procedure can also help to gain the patient's confidence. The nurse should speak to the patient quietly to provide reassurance and support while
securing the nasogastric tube. There is no need for antianxiety drugs. Performing the procedure very quickly will not necessarily prevent patient anxiety and may cause a safety risk.
The nurse gently touches the shoulder of a patient lying with eyes closed. When the patient opens his eyes, the nurse smiles and asks how he is feeling. Which kind of touch is this?
Caring
Protective
Task-oriented
Healing touch
Caring
Rationale
In this scenario, the nurse practices caring touch. Caring touch is a form of nonverbal communication. It helps to improve a patient's comfort and security, enhances self-esteem, increases confidence in the caregivers, and improves mental well-being. Protective touch is used to protect the patient from any harm. Task-oriented touch occurs when the nurse is performing nursing duties. Healing touch is a type of energy therapy used for healing certain
diseases.
The nurse holds the hands of a patient when talking to the patient during rounds. Which is a likely impact of the nurse's behavior?
The patient feels isolated.
It enhances the patient's physical discomfort.
The patient's caregivers feel embarrassed.
It enhances the self-esteem and mental health of the patient.
It enhances the self-esteem and mental health of the patient.
Rationale
It is very important for the nurse to have a therapeutic relationship with the patient. By holding the patient's hands, the nurse extends caring touch to the patient, which in turn enhances the self-esteem and mental health of the patient. The patient is likely to feel more connected to the nurse rather than isolated. Caring touch increases comfort and security in the patient. The patient and the patient's caregivers may or may not feel embarrassed by holding hands.