Situation Background Assessment Recommendation (SBAR): Undergraduate Perspectives

Situation Background Assessment and Recommendation (SBAR): Undergraduate Perspectives C Morgan, L Adams, J Murray, R Dunlop, IK Walsh. Ian K Walsh, Centre for Medical Education, Queen’s University Belfast, Mulhouse Building, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6DP Background and Purpose: Structured communication tools are used to improve team communication quality.1,2 The Situation Background Assessment and Recommendation (SBAR) tool is widely adopted within patient safety.3 SBAR effectiveness is reportedly equivocal, suggesting use is not sustained beyond initial training.4-6 Understanding perspectives of those using SBAR may further improve clinical communication. We investigated senior medical undergraduate perspectives on SBAR, particularly when communicating with senior colleagues. Methodology: Mixed methods data collection was used. A previously piloted questionnaire with 12 five point Lickert scale questions and 3 open questions was given to all final year medical students. A subgroup also participated in 10 focus groups, deploying strictly structured audio-recorded questions. Selection was by convenience sampling, data gathered by open text questions and comments transcribed verbatim. In-vivo coding (iterative, towards data saturation) preceded thematic analysis. Results: 233 of 255 students (91%) completed the survey. 1. There were clearly contradictory viewpoints on SBAR usage. A recurrent theme was a desire for formal feedback and a relative lack of practice/experience with SBAR. 2. Students reported SBAR as having variable interpretation between individuals; limiting use as a shared mental model. 3. Brief training sessions are insufficient to embed the tool. 4. Most students reported SBAR helping effective communication, especially by providing structure in stressful situations. 5. Only 18.5% of students felt an alternative resource might be needed. Sub analysis of the themes highlighted: A. Lack of clarity regarding what information to include and information placement within the acronym, B. Senior colleague negative response to SBAR C. Lack of conciseness with the tool. Discussion and Conclusions: Despite a wide range of contradictory interpretation of SBAR utility, most students wish to retain the resource. More practice opportunities/feedback may enhance user confidence and understanding. References: (1) Leonard M, Graham S, Bonacum D. The human factor: the critical importance of effective teamwork and communication in providing safe care. Quality & Safety in Health Care 2004 Oct;13(Suppl 1):85-90. (2) d'Agincourt-Canning LG, Kissoon N, Singal M, Pitfield AF. Culture, communication and safety: lessons from the airline industry. Indian J Pediatr 2011 Jun;78(6):703-708. (3) Dunsford J. Structured communication: improving patient safety with SBAR. Nurs Womens Health 2009 Oct;13(5):384-390. (4) Compton J, Copeland K, Flanders S, Cassity C, Spetman M, Xiao Y, et al. Implementing SBAR across a large multihospital health system. Jt Comm J Qual Patient Saf 2012 Jun;38(6):261-268. (5) Ludikhuize J, de Jonge E, Goossens A. Measuring adherence among nurses one year after training in applying the Modified Early Warning Score and Situation-Background-Assessment-Recommendation instruments. Resuscitation 2011 Nov;82(11):1428-1433. (6) Cunningham NJ, Weiland TJ, van Dijk J, Paddle P, Shilkofski N, Cunningham NY. Telephone referrals by junior doctors: a randomised controlled trial assessing the impact of SBAR in a simulated setting. Postgrad Med J 2012 Nov;88(1045):619-626.

A Strategy for Maternity Care in Northern Ireland 2012-2018

DHSSPS has carried out a review of policy on maternity service provision in Northern Ireland. The review focused on the best available evidence for the care and treatment of mothers-to-be; quality, safety and service sustainability; wider workforce issues; and professional roles and responsibilities. As a result, a draft strategy was developed, which was the subject of a public consultation from 28 September 2011 to 23 January 2012. Following an analysis of the responses to the consultation, the final strategy, A Strategy for Maternity Care in Northern Ireland 2012-2018, was published on 2 July 2012. The Strategy is outcomes focused. The six outcomes are:- give every baby and family the best start in life; effective communication and high-quality maternity care; healthier women at the start of pregnancy (preconception care); effective, locally accessible, antenatal care and a positive experience for prospective parents; safe labour and birth (intrapartum) care with improved experiences for mothers and babies; and appropriate advice, and support for parents and baby after birth The strategy aims to provide women and their partners, HSC staff, commissioners and policy makers with a clear pathway for maternity care in Northern Ireland from pre conceptual care through to postnatal care. Within the document, twenty two objectives have been identified which link to the six outcomes identified above. The HSC Board and Public Health Agency will co-lead on implementation. An action plan will be developed to take account of the outcomes and objectives listed in the document. The Department will receive an annual report on progress towards implementation.

Public Risk Interpretation and Community Resilience Planning: A Case Study in Aberdeen, Washington

Thesis (Master's)--University of Washington, 2016-06

Promoting the 6Cs of Nursing in Patient Assessment

Recognising the deteriorating patient is an essential nursing skill, and structured frameworks should be in place to assist effective patient assessment. The aim of this article is to encourage nurses to consider how to promote the 6Cs of nursing within such assessment. The article provides an overview of the Patient Assessment and Clinical reasoning Tool designed to facilitate the development of clinical reasoning skills and effective communication with other healthcare professionals, therebyenhancing patientcentred care.

O poder comunicacional da maratona : uma perspectiva de relações públicas

Tese especialmente elaborada para obtenção do grau de Doutor em Ciências da Comunicação

The grand challenge of food security - general lessons from a comprehensive approach to protecting stored grain from insect pests in Australia and India

We outline a philosophical approach to Grand Challenge projects, with particular reference to our experience in our food security project involving the protection of stored grain from insect attack in two countries on different continents. A key consideration throughout has been the management of resistance in these pests to the valuable fumigant phosphine. Emphasis is given to the chain of research issues that required solution and the assembly of a well-integrated team, overlapping in skills for effective communication, in each country to solve the problems identified along that chain. A crucial aspect to maintaining direction is the inclusion of key end users in all deliberations, as well as the establishment and maintenance of effective outlets for the dissemination of practical recommendations. We finish with a summary of our achievements with respect to our approach to this food security Grand Challenge.

Zika : how to communicate effectively

Communicating Zika virus preventive behaviors, transmission paths, and the underlying science are challenging. There are many scientific unknowns, an uncertainty of the risk, and tragic consequences for pregnant women and their fetuses. Clear, consistent, and frequent communication from trusted sources and channels makes it easier for people to understand Zika information which can help them to make decisions. Effective communication can support attitudes, norms, and behaviors to prevent the spread of Zika and protect pregnant women.

‘Breaking good news’: neurologists’ experiences of discussing SUDEP with patients in Scotland

Since the findings of a Fatal Accident Inquiry (FAI) in 2010, clinicians working in Scotland have been advised to discuss the risk of Sudden Unexpected Death in Epilepsy (SUDEP) with patients immediately or soon after a diagnosis of epilepsy is made. A thematic analysis was used to describe the experiences discussing SUDEP of 10 clinicians (six Consultant Neurologists and four Neurology Registrars) working in Scotland. Five themes were found: Clinicians employ a ‘SUDEP protocol’, suggesting there is a standardised way of discussing SUDEP with patients and all clinicians routinely discuss SUDEP with newly diagnosed epilepsy patients; The FAI has diffused into practice through meetings and discussions with colleagues; ‘Breaking Good News’ refers to the ambivalence clinicians feel about discussing SUDEP; ‘Falsely anticipating anxiety’ refers to clinicians anticipating a distressed response from patients despite this very rarely occurring; Clinicians suggest that ‘pressure hinders effective communication’ to patients – suggesting that the pressure to discuss SUDEP early after diagnosis may have an emotional impact on patients and affect the amount of information they can take in. Implications for guideline development are discussed.

Tutors as mediators of exchange student experiences: evaluation of the international student tutor system at the University of Turku

As academic student mobility is increasing, improving the functionality of international operations is recognised as a competitive advantage at tertiary education institutions. Although many scholars have researched the experiences of exchange students, the role of student tutors and their contribution to exchange students’ experiences is still an unknown factor. This research examines international tutoring at the University of Turku, and aims to understand better the way tutoring contributes to exchange experiences and to explore the functionality of the tutor system and discover areas for improvements. To achieve these goals, the research seeks to answer the fundamental research question: What is the role of tutors in mediating exchange experiences? The theoretical framework combines literature on mediating exchange experiences, the phenomenon of studying abroad, the process of adaptation, the importance of cross-cultural communication, and the role of student tutors as mediators. Based on the literature review, a theoretical model for studying the mediation of exchange experiences is introduced. The model’s applicability and validity is examined through a case study. Three methods were used in the empirical research: surveys, participant observations, and interviews. These methods provided extensive data from three major parties of the tutor system: tutors, exchange students, and the international office. The findings of the research reveal that tutoring – instrumental leading and social and cultural mediating – generates both negative and positive experiences depending on the individuals’ expectations, motivations, relationships, and the nature of the tutoring. Although functional, there are a few weaknesses in the tutor system. Tutors tend to act as effective instrumental leaders, but often fail to create a friendship and contribute to the exchange students’ experience through social and cultural mediation, which is significantly more important in the exchange students’ overall experience in terms of building networks, adapting, gaining emotional experiences, and achieving the stage of personal development and mental change. Based on the weaknesses, three improvements are suggested: (1) increasing comprehensive sharing of information, effective communication, and collective cooperation, (2) emphasising the importance of social and cultural mediation and increasing the frequency of interaction between tutors and exchange students, and (3) improving the recruitment and training, revising the process of reporting and rewarding, and finally, enhancing services and coordination.

Influência da participação social na conservação da biodiversidade em unidades de conservação brasileiras

Tese (doutorado)—Universidade de Brasília, Centro de Desenvolvimento Sustentável, 2016.

Propuesta de un sistema de gestión por procesos para el departamento de negocios caso: Cooperativa de Ahorro y Crédito CREA LTDA.

Entender a la organización de la empresa como un conjunto de procesos interrelacionados que se gestionan sistemáticamente y que son la base del mejoramiento continuo es imprescindible para obtener el mejor desempeño de los recursos. En base a lo dicho anteriormente, el propósito del presente trabajo de tesis es diseñar un sistema de gestión basado en procesos para la Dirección de Negocios de la Cooperativa de Ahorro y Crédito CREA Ltda. con el fin de lograr una mejorcoordinación entre los diferentes procesos que se realizan en el área de negocios en lo que se refiere tanto a la captaciones de ahorros y las colocaciones de crédito, mediante la estandarización de dichos procesos, logrando una efectiva comunicación entre los involucrados, estableciendo indicadores de gestión para los procesos objeto de estudio.

"I’ll call you when we are ready" (One family’s experience of critical care and end of life decision making)

The purpose of this paper is to explore through narrative accounts one family's expérience of critical care, after the admission of a family member to an Intensive Care Unit (ICU) and their subséquent death five weeks later. Numerous studies support the need for effective communication and clear information to be given to the family. In this instance it was évident from their stories that there were numerous barriers to communication, including language and a lack of insight into the needs of the family. Many families do not understand the complexities of nursing care in an ICU so lack of communication by nursing staff was identified as uncaring behavior and encounters. Facilitating a family's proximity to a dying patient and encouraging them to participate in care helps to maintain some sensé of personal control. Despite a commitment to involving family members in care, which was enshrined in the Unit Philosophy, relatives were banished to the waiting room for hours. They experienced feelings of powerlessness and helplessness as they waited with other relatives for news following investigations or until 'the doctor had completed his rounds'. Explanations of "we must make 'the patient' comfortable" was no consolation for those who wished to be involved in care. The words "I'il call you when we are ready" became a mantra to the forgotten families who waited patiently for those with power to admit them to the ICU. Implications are this family felt they were left alone to cope with the traumatic expériences leading up to and surrounding the death. They felt mainly supported by the priest, who not only administered the last rites but provided spiritual support to the family and dealt sensitively with many issues. Paternalism in décision making when there is a moral obligation to ensure that discussions on end of life dilemmas are an inclusive process with families, doctors, nurses was not understood, therefore it caused conflict within the family over EOL décision making. The family felt that the opportunity to share expériences through telling and retelling their stories would enable them to reconfigure the past and create purpose in the future.

USING INDICATORS OF BIOTIC INTEGRITY FOR ASSESSMENT OF STREAM CONDITION

Multiple indices of biotic integrity and biological condition gradient models have been developed and validated to assess ecological integrity in the Laurentian Great Lakes Region. With multiple groups such as Tribal, Federal, and State agencies as well as scientists and local watershed management or river-focused volunteer groups collecting data for bioassessment it is important that we determine the comparability of data and the effectiveness of indices applied to these data for assessment of natural systems. We evaluated the applicability of macroinvertebrate and fish community indices for assessing site integrity. Site quality (i.e., habitat condition) could be classified differently depending on which index was applied. This highlights the need to better understand the metrics driving index variation as well as reference conditions for effective communication and use of indices of biotic integrity in the Upper Midwest. We found the macroinvertebrate benthic community index for the Northern Lakes and Forests Ecoregion and a coldwater fish index of biotic integrity for the Upper Midwest were most appropriate for use in the Big Manistee River watershed based on replicate sampling, ability to track trends over time and overall performance. We evaluated three sites where improper road stream crossings (culverts) were improved by replacing them with modern full-span structures using the most appropriate fish and macroinvertebrate IBIs. We used a before-after-control-impact paired series analytical design and found mixed results, with evidence of improvement in biotic integrity based on macroinvertebrate indices at some of the sites while most sites indicated no response in index score. Culvert replacements are often developed based on the potential, or the perception, that they will restore ecological integrity. As restoration practitioners, researchers and managers, we need to be transparent in our goals and objectives and monitor for those results specifically. The results of this research serve as an important model for the broader field of ecosystem restoration and support the argument that while biotic communities can respond to actions undertaken with the goal of overall restoration, practitioners should be realistic in their expectations and claims of predicted benefit, and then effectively evaluate the true impacts of the restoration activities.

Comprendere la lingua dell'economia: un'analisi multidisciplinare di terminologia, comprensione e pianificazione

La tesi si concentra sull'analisi del linguaggio economico, prestando particolare attenzione alla sua terminologia. L'importanza della terminologia economica risiede nella sua capacità di facilitare una comunicazione efficace nel campo dell'economia e di permettere una comprensione più ampia dei fenomeni economici da parte del pubblico. Tuttavia, a causa della sua complessità e specificità, essa può risultare difficile da comprendere per il pubblico laico. La ricerca affronta tre questioni chiave: definire la natura della terminologia economica e l'approccio più adatto per descriverla, determinare il livello di comprensione della terminologia economica e le variabili sociali ad essa correlate, e individuare le strategie migliori per diffondere la terminologia economica nella società. Per rispondere a queste domande, l'indagine si avvale di un approccio multidisciplinare che fonde linguistica, sociolinguistica e terminologia. Il risultato è un'analisi profonda del lessico economico e delle sue collocazioni, della comprensione della terminologia da parte del pubblico e delle strategie per migliorare tale comprensione e la sua diffusione.