Presently, there are not any texting “rules.” This permits mobile phone users to express themselves however they see fit. “Texters” frequently use short- hand abbreviations during such exchanges to replace longer, more commonly used phrases.
Although texting has evolved as a widely accepted, even preferred, form of “talking,” messages may be misinterpreted with the absence of voiced emotion and body language.
Business consultants predict that texting will evolve as an accepted form of electronic communi- cation for certain occasions that require only simple questions and answers. When texting colleagues or departments, follow the same guidelines as you would for e-mail (Ruggieri, 2012). Confidential information should never be sent in a text message.
This system allows nurses and others involved in patient care to discuss the current patient status and to set goals for care for the next several hours.
Together, the nurses gather objective data as one nurse ends a shift and another begins. This way, there is no confusion as to the patient’s status at shift change. This same system is often used in emergency departments and labor and delivery units. Larger patient care units may find the
“walking report” time-consuming and an ineffi- cient use of resources.
It is helpful to take notes or create a worksheet while listening to the report. Many institutions now provide a computerized action plan to assist with gathering accurate and concise information during the hand-off report. A worksheet helps organize the work for the day (Fig. 6.1). As specific tasks are mentioned, the nurse assuming responsibility makes a note of the activity in the appropriate time slot. Patient status, medications, and treatments should be documented. Any priority interventions should also be identified at this time. Many institu- tions are now using electronic tablets to assist nurses and other health-care providers to organize and track activities.
Any changes from the previous day are noted, particularly when the nurse is familiar with the patient. Recording changes counteracts the ten- dency to remember what was done the day before and repeat it, often without checking for new orders. During the day, the worksheet acts as a reminder of the tasks that have been completed and of those that still need to be done.
Reporting skills improve with practice. When presenting information in a hand-off report, certain details must be included. Begin the report by iden- tifying the patient, room number, age, gender, and health-care provider. Also include the admitting as well as current diagnoses. Address the expected treatment plan and the patient’s responses to the treatment. For example, if the patient has had mul- tiple antibiotics and a reaction occurred, this infor- mation must be relayed to the next nurse. Avoid making value judgments and offering personal opinions about the patient (Fig. 6.2).
Communicating With the Health-Care Provider
The function of professional nurses in relation to their patients’ health-care providers is to commu- nicate changes in the patient’s condition, share
other pertinent information, discuss modifications of the treatment plan, and clarify orders. This can be stressful for a new graduate who still has some role insecurity. Using good communication skills and having the necessary information at hand are helpful when discussing patient needs.
Before calling a health-care provider, make sure that all the information needed is available. The provider may want more clarification about the situation. If calling to report a drop in a patient’s blood pressure, be sure to have the list of the patient’s medications, the last time the patient received the medications, laboratory results, vital signs, and blood pressure trends. Also be prepared to provide a general assessment of the patient’s present status.
There are times when a nurse calls a physician or health-care provider and the health-care pro- vider does not return the call. It is important to document all health-care provider contacts in the patient’s record. Many units keep calling logs. In the log, enter the health-care provider’s name, the date, the time, the reason for the call, and the time the health-care provider returned the call. If the provider does not return the call in a reasonable amount of time, or patient safety is in jeopardy, the nurse should follow chain of command to make sure patient safety is maintained.
ISBARR
In response to the number of patients who die from or confront a preventable adverse event during hos- pitalization, health-care institutions have been challenged to improve patient safety standards.
This challenge forced health-care institutions to look at the causes of most sentinel events within their environments. Originally known as SBAR (Situation, Background, Assessment, and Recom- mendation), the communication technique has recently been updated to ISBARR or ISBAR.
ISBARR is an acronym for Introduction, Situation, Background, Assessment, Recommendation, and Read-back (Enlow, Shanks, Guhde, & Perkins, 2010; Haig, Sutton, & Whittingdon, 2006).
Whether referred to as SBAR or ISBARR, the technique provides a framework for communi- cating critical patient information in a systemized and organized fashion. The ISBARR method focuses on the immediate situation so that deci- sions regarding patient care may be made quickly and safely.
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Name ______________________ Room # ________ Allergies _____________________
0700 0800 0900 1000 1100 1200 1300 1400 1500 1600 1700 1800
Name ______________________ Room # ________ Allergies _____________________
0700 0800 0900 1000 1100 1200 1300 1400 1500 1600 1700 1800
Name ______________________ Room # ________ Allergies _____________________
0700 0800 0900 1000 1100 1200 1300 1400 1500 1600 1700 1800
Figure 6.1 Organization and time management schedule for patient care.
Although originally established by the U.S.
Navy as SBAR to accurately communicate critical information, the technique was adapted by Kaiser- Permanente as an “escalation tool” to be imple- mented when a rapid change in patient status
occurs or is imminent. Both the Joint Commission and the Institute for Health Care Improvement have mandated that health-care institutions employ a standardized reporting/hand-off system and promote the use of the SBAR technique (Haig,
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Room # ________ Patient Name _______________ Diagnoses ___________________
Diet ___________ Activity _________________________________________________
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2000 0200
2100 0300
2200 0400
2300 0500
2400 0600
Figure 6.2 Patient information report.
Sutton, & Whittingdon; www.rwjf.org, 2013; IHI, 2006; TJC, 2009). The use of the ISBARR format helps to standardize a communication system to effectively transmit needed information to provide safe and effective patient care. Table 6-2 defines the steps of the ISBARR communication model.
The implementation of ISBARR as a com- munication technique has demonstrated success in reducing adverse events and improving pati- ent safety. It also allows nurses, health-care pro- viders, and members of the interprofessional team
to communicate in a collegial and professional manner.
Health-Care Provider Orders
Professional nurses are responsible for accepting, transcribing, and implementing health-care pro- vider orders. It is important to remember that nurses may only receive orders from physicians, dentists, podiatrists, and advanced practice regis- tered nurses (APRNs) who are licensed and cre- dentialed in the state in which they are working.
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Orders written by medical students need to be countersigned by a physician or APRN before implementation.
The three main types of orders are written, tele- phone, and faxed. Some health-care institutions are looking into the possibility of receiving health- care provider orders through e-mail. These orders include the provider’s name, date, and time and provide an electronic record of the order.
Written orders are dated and placed on the appropriate institutional form. The health-care provider gives telephone orders directly to the nurse by telephone. Faxed orders come directly from the health-care provider office and need to be initialed by the provider. Telephone orders, e-mail orders, and faxed orders also need to be signed when the health-care provider comes to the nursing unit. It is important to verify the institution’s policy on telephone, e-mail, and faxed orders.
Many health-care institutions are moving to maintaining the EMR and away from verbal orders as the health-care provider is present and can enter the order on the appropriate form in the patient’s record. A telephone order needs to be written on the appropriate institutional form, the time and date noted, and the form signed as a telephone order by the nurse.
When receiving a telephone order, repeat it back to the physician for confirmation. If the health-care provider is speaking too rapidly, ask him or her to speak more slowly. Then repeat the information for
confirmation. If a faxed document is unclear, call the health-care provider for clarification. Most institutions require the health-care provider to cosign the order within 24 hours.
Professionalism and a courteous attitude by all parties are necessary to maintain collegial relation- ships with physicians and other health-care profes- sionals. One nurse explained their importance as follows:
RN satisfaction simply is not about money. A major factor is how well nurses feel supported in their work. Do people listen to us—our managers, upper management, human resources? Being able to com- municate with each other—to be able to speak directly with your peers, physicians, or managers in a way that is nonconfrontational—is really impor- tant to having good working relationships and to providing good care. You need to have mutual respect. (Quoted by Trossman, 2005, p. 1.)
This statement finds support in the IOM report (2010) and research conducted by the American Nurses Credentialing Center (ANCC), which holds responsibility for MAGNET designation (ANCC, 2012).