The "R" in SBAR......nope

Nursing Students Student Assist

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I'm really not understanding the recommendation part of SBAR. I understand what it is that I'm supposed to do (tell the attending provider what my recommendations are), but I have no idea how to go about doing this. I think it's because I'm a nursing student. Not a medical student. (Sarcasm, sorry, I'm frustrated). How am I supposed to know every single diagnostic test? Somebody please shed some light on this. I am starting to think I'm just not smart enough to be a nurse.

Specializes in Emergency Department.
Do you want to be an RN who can collaborate with the provider, or who is blindly dependent on others to tell her what to do?

Here. I. Stand. Thank you for your input and for giving me some great examples from your practice for me to chew on. I definitely don't want to be blindly dependent on others to tell me what to do, thank you for putting that in perspective for me! I really want to get better at SBAR, and do everything I can to be as clear and concise as possible for my future patients. It seems like S+B = A, and the R is dependent on the A. Am I on the right track?

Getting there.

S+B+Clinical knowledge/experience + Critical Thinking = A... and once you have "A" you can then figure out what to do about it = R.

"Personally, I'm used to doing SBAR in a slightly different order: RASB. That way is essentially what I want, why I want it, and the evidence/info that led me there."

AkulahawkRN, as a nurse who has much more experience than I do with report techniques, do you think RASB is more efficient than SBAR? Also, do you think writing a SOAP note before contacting the provider using SBAR/RASB would be helpful? (just for practice, while in school, I'm not sure if nurses actually have time to do both once they are in the field...).

Specializes in Emergency Department.
"Personally, I'm used to doing SBAR in a slightly different order: RASB. That way is essentially what I want, why I want it, and the evidence/info that led me there."

AkulahawkRN, as a nurse who has much more experience than I do with report techniques, do you think RASB is more efficient than SBAR? Also, do you think writing a SOAP note before contacting the provider using SBAR/RASB would be helpful? (just for practice, while in school, I'm not sure if nurses actually have time to do both once they are in the field...).

It's more like I'm a Paramedic who has become an RN. Essentially the RASB format is what I used when I had to make base contact for orders for a particular patient. I wouldn't say that the format I use is more efficient than SBAR, but I should be very certain that I need that particular order if I'm going to use the format I'm used to.

To give you an example of what I mean, for the Pneumonia/Pulmonary Edema patient above, in order for me to keep me out of trouble, I would have had to do a 2 step request to do it right... I would have had to ask for a CXR and ask for orders that would cover both the Pneumonia and Pulmonary Edema situation to be most efficient. Here's the issue with doing it with my format... Given the coorifice lung sounds, high WBC's, and other findings that suggested pneumonia, I would have been asking for ABX because I'd have been thinking pneumonia also. I wouldn't have looked all that competent. Given that a CXR can help differentiate between the two problems, asking for that first would have made me look much more competent and would have set up a follow-on call for a lasix order to deal with the pulmonary edema.

Using SBAR, especially in the clinical setting just makes things a whole lot easier and allows for the nurse to say (as stated above, all credit due...) "What are your thoughts?" This wouldn't make the nurse look less than competent... or appear to overstep some boundaries.

Am I on the right track?[/b]

Getting there.

S+B+Clinical knowledge/experience + Critical Thinking = A... and once you have "A" you can then figure out what to do about it = R.

Ok, so knowing things like lab values (hematocrit, hemoglobin, CBC, etc.) would be the Clinical Knowledge, and the Critical Thinking would be something like.....my pt has coffee grounds in her emesis. So, I could ask myself what the cause could possibly be, (maybe a GI bleed)?. Then assess her VS and she has a fever. Could I look at the lab results as part of the assessment? Like, if she has a high WBC count? Then assess current meds, (I think Coumadin is a high risk one so lets say she's taking that). Could the R then be something like "What do you think of switching her Coumadin to something else?" (Or is that overstepping my bounds?) Or, could I recommend an x-ray or some diagnostic test for GI bleed?

Am I closer? I feel like I'm understanding it a bit more but it still feels really sloppy or out of order when I do it.

To give you an example of what I mean, for the Pneumonia/Pulmonary Edema patient above, in order for me to keep me out of trouble, I would have had to do a 2 step request to do it right... I would have had to ask for a CXR and ask for orders that would cover both the Pneumonia and Pulmonary Edema situation to be most efficient. Here's the issue with doing it with my format... Given the coorifice lung sounds, high WBC's, and other findings that suggested pneumonia, I would have been asking for ABX because I'd have been thinking pneumonia also. I wouldn't have looked all that competent. Given that a CXR can help differentiate between the two problems, asking for that first would have made me look much more competent and would have set up a follow-on call for a lasix order to deal with the pulmonary edema.

Using SBAR, especially in the clinical setting just makes things a whole lot easier and allows for the nurse to say (as stated above, all credit due...) "What are your thoughts?" This wouldn't make the nurse look less than competent... or appear to overstep some boundaries."

I see what you're saying. Definitely more efficient to use SBAR in that scenario. Was SBAR hard for you to grasp when you first learned about it as a student? You all seem so CLEAR and CONCISE with your SBAR's and not redundant or awkward like mine....It's great to see all of these awesome examples and I must admit I'm a bit envious! I hope my SBAR's will look as good as all of the other examples you guys have given me. It really makes me want to keep trying. Thanks for the encouragement!

Specializes in Medical and general practice now LTC.

closing for staff review

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