RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / Name of the candidate and address (in block letters) / REMMIN JOSEZULEKHA NURSING COLLEGE
ZULEKHA COMPLEX
BIBI ALABI ROAD
BUNDER, MANGALORE - 575001
2. / Name of the Institution / ZULEKHA NURSING COLLEGE
ZULEKHA COMPLEX
BIBI ALABI ROAD
BUNDER, MANGALORE - 575001
3. / Course of Study and Subject / 1st year M. Sc. NURSING
MEDICAL SURGICAL NURSING
4. / Date of Admission to the Course / 30/06/2012
5. / Title of the study
EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON SITUATION, BACKGROUND, ASSESSMENT AND RECOMMENDATION (SBAR) HANDOVER AMONG STAFF NURSES WORKING IN SELECTED HOSPITAL, MANGALORE, DAKSHINA KANNADA.
6.
7.
8. / Brief resume of the intended work
6.1 Introduction
Collaborative communication and teamwork are essential elements for quality care and patient safety. Inadequate communication is being the most common root cause of serious errors. In 2004 the Joint commission on Accreditation of Health care Organization analysed 2455 sentinel events from hospitals across the U.S and reported through root cause analysis and estimated that over 70% of the events were due to communication failures, and approximately 75% of the patients involved died.1
Since 2003 improving communication has been included as a joint commission’s national patient safety goal for hospitals. ln 2006, hand off communications were included as a specific communication subset which include the structured communication tool that is situation, background, assessment and recommendation (SBAR). The SBAR tool provides a framework for organizing information in a clear and concise format, it facilitates consistent collaborative communication between health care providers through out the hospital setting . The joint commission on accreditation of hospitals has added standardized communication to the patient safety goals and recommends SBAR as a best practice.1
6.2 Need for the study:
Change of shift report is the time when responsibility and accountability for the care of a patient are transferred from one nurse to another. With many people involved and numerous elements of information to be transferred, this is also the perfect opportunity for hand off communication to go wrong. The joint commission (2011) identifies communication as the leading issue contributing to patient harm. Research has shown that nearly two- thirds of adverse sentinel events in hospitals are related to communication problems.2
Effective communication can mean the difference between life and death. Ineffective handovers, such as when all required information is not provided, can be hazardous to patients and staff. The method for delivery of shift report varies among hospitals, units, and nurses. Too often this communication is hindered by irrelevant, repetitive, and speculative information. In addition, handover occur at busy times with multiple distractions and time constraints, making shift to shift report a time with high potential for errors related to communication to occur . Therefore improved communication through the use of structured communication techniques, including bedside reporting using the SBAR framework can help streamline information exchanges, and promote patient safety.3
The use of SBAR in south Devon ensure a positive patient experience/ outcome. They achieved an 11% reduction in hospital mortalitiy, 65% in adverse events, 8% reduction in cardiac arrests and 83% reduction in Methycilline resistant staphylococcus aureus bacteraemias.3
An evaluatory survey was conducted in Australia with the aim to examine the nurse’s perceptions of handover and to determine the strengths and limitations of the hand over process. A staff survey form was distributed to the nurses in all the inpatient wards at a metropolitan tertiary hospital. A total of 176 nurses responded to the staff survey. The findings revealed conflicting opinions about the effectiveness of the handover process, although a number of nurses were positive about the current hand over practice, indicating that they were provided with sufficient information about patients and were given opportunity to clarify patient care information. Other nurses identified the aspects of handover that could be improved. These included the subjectivity of handover information, the time taken to handover, repetition of information that could be found in the patients care plans and handing over of the information by a nurse who has not cared for the patient. 4
The researcher during her clinical experience had faced several problems due to improper hand over during shift change. The staff on duty had to call the staff of the previous shift for clearing doubts. As a researcher i realised the importance of giving proper hand over for providing quality nursing care and patient safety.
6.3 Review of literature
The literature has been organized under the following headings :
· Literature related to effectiveness of SBAR
· Literature related to effectiveness of hand over with the use of written guidelines and protocols
· Literature related to changes in the nurses hand over to improve the quality of hand over
· Literature related to effectiveness of structured teaching programme
Literature related to effectiveness of SBAR
An evidence based practice study on situation, background, assessment and recommendation communication in paediatrics/ peri natal services department of a 271- bed community hospital in northern Arizona. A convenience sample of 215 staff working in a hospital was asked to participate in a pre/ post test intervention survey. Descriptive, independent samples t tests and mann-whitney u non parametric statistics were used for analysis. The SBAR intervention proved so successful across the entire health care organization to facilitate improvement in communication and patient safety5
Communication problems among health care personnel during critical clinical situations can jeoparadize patient safety. Nurses use of SBAR and physician perception of communication quality after SBAR implementation was assessed at a 13 hospital health care system. Out of 156 nurses interviewed,152 (97.4%) had been educated about SBAR and 91(58.3%) used SBAR for critical communication. Of 84 nurses 72.6% demonstrated good or high proficiency. Of the 155 physicians who responded to the physician survey, 121(78%) said that the last report they received was adequate to make clinical decisions. Of the 27 who indicated that the last report was not adequate to make clinical decisions, 25 (92.6%) had not received the report in SBAR format. As a conclusion SBAR was generally well understood. Future research will address the need for refresher education with nurses after initial SBAR education, the need for formal physician education about SBAR use and the possibility of conducting annual competency validation of the utilization of SBAR.6
A study conducted in a rehabilitation setting about the effectiveness of SBAR. Participants included team members from a broad range of professions (nursing medicine, rehabilitation specialists) .Over the course of a six month period, the SBAR tool was implemented within one inter professional team, and educational workshops were provided to give clinical support staff an understanding of communication issues and safety, barriers to communication and how communication may be structured using the SBAR tool. The SBAR communication process is a useful means of structuring verbal communication within an inter professional team in a rehabilitation setting. Based on the experiences and success of this study SBAR will continue to be introduced to other units across the organizations.7
Effectiveness of hand over with the use of written guidelines and protocols
A survey was conducted in Taiwan in 2006 to explore the factors that affect shift report content completeness. The researcher found that surgical ward shift reports were not being adequately completed, with 29.4% of content items on shift reports not reaching 80% completeness and found the factors that included lack of understanding of shift report contents, inappropriate shift reporting standards, lack of speciality- related knowledge and guidance in the shift report, and discontinuities in patient care allocation. Based on these findings, the researchers revised, redesigned the report format, following implementation of changes; found that100% shift report items had reached 80% completeness .They found full staff participation and applied to new staff training in the hospital.8
An experimental study was done in 2007in UK, which aims to compare the reliability of 3 different hand over conducted by junior doctors. There was no published standard of hand over. The researcher observed the hand over of 12 simulated patients over 5 consecutive hand over cycles between. Three hand over styles were used and assessed clinical information lost per hand over cycle. After five hand over cycles, only 2.5% of patient information was retained using the verbal–only handover method,85.5% was retained when using the verbal with note taking method and 99% was retained when a printed handout containing all patient information was used. Verbal hand over with note taking was shown to be effective method of hand over.9
Changes in nurses handover to improve the quality of hand over
An evaluatory study done in Mauritius in 2005 aimed to evaluate the implementation of new system of bedside hand over that takes place within the nurses working in the gynaecological ward. A force field analysis showed that there was dissatisfaction with the traditional method of hand over which had led to an increase in the number of critical incidents and complaints from patients, relatives and doctors. The problems identified were a fear of accountability, lack of confidence and a fear that this change would lead to more work. Analysis of the results of semi-structured interviews with 40 patients, showed that a 96% overall satisfaction level was achieved. An evaluation had shown that the process of change was successfully implemented to the satisfaction of patients, and staff in general10
Effectiveness of structured teaching programme
A Quasi experimental study with pre and post test with control group was under taken in different hospitals, Hassan. Data were collected from 60 staff nurses, 30 control group and 30 experimental group to assess the effectiveness of structured teaching programme on cardio pulmonary resuscitation. Results analysed using descriptive and inferential statistics. Findings showed that in pre test experimental group as well as control group nurses are having average knowledge on cardio pulmonary resuscitation. In post test, after implementation of structured teaching programme experimental group staff nurses scored up to 80% where as in control group only 42.5% knowledge regarding cardio pulmonary resuscitation. The study proved structured teaching programme was effective in improving knowledge. 11
6.4 Statement of the problem
“Effectiveness of structured teaching programme on situation , background, assessment and recommendation (SBAR ) handover among staff nurses working in selected hospital, Mangalore, Dakshina Kannada.
6.5 Objectives of the study
1. To determine the pre test level of knowledge on SBAR handover among staff nurses working in selected hospital, Mangalore.
2. To find out the effectiveness of structured teaching programme on level of knowledge on SBAR handover among staff nurses working in selected hospital, Mangalore.
3. To find out the association between the pre test level of knowledge and selected demographic variables such as age, gender, years of experience and level of education.
6.6 Operational definitions
Effectiveness: In this study, effectiveness refers to the extent to which structured teaching programme will achieve a gain in knowledge regarding SBAR in patient hand over among staff nurses working in selected hospital, Mangalore.
Structured teaching programme: In this study, it refers to systematically developed instructional method and teaching aid designed for staff nurses to provide education regarding SBAR with the help of power point presentation of 45 minutes.
Situation, background, assessment and recommendation (SBAR) hand over: In this study, SBAR refers to a patient hand over system in which, situation refers to patient’s name, age, sex, bed number and chief complaint for admission. Background refers to patient’s admitting diagnosis and number of hospital stay since admission and past history. Assessment refers to patients recent vital signs and other diagnostic reports. Recommendation refers to patients management of condition.
Staff nurses: In this study, staff nurses refers to all registered nurses working in medical surgical wards in a selected hospital, Mangalore.
6.7 Assumptions
The study assumes that
· Staff nurses may have some knowledge about SBAR hand over.
6.8 Delimitations
The study will be delimited to staff nurses working in medical surgical wards in selected hospital in Mangalore.
6.9 Hypotheses
All hypotheses will be tested at 0.05 level of significant.
H1: There will be a significant difference in mean pre test level of knowledge and mean post test level of knowledge on SBAR handover among staff nurses.
H2: There will be significant association between the pre test level of knowledge and selected demographic variables of staff nurses such as age, gender, years of experience and level of education.
Material and methods
7.1 Source of data
Data will be collected from staff nurses working in medical surgical wards of selected hospital in Mangalore.
7.1.1 Research design
Research design for this study is pre experimental one group pre test, post-test design.
7.1.2 Setting
The study will be conducted in selected hospital in Mangalore.
7.1.3 Population
The population for the study will comprise of staff nurses working in medical surgical wards in Mangalore.
7.2 Method of data collection
7.2.1 Sampling procedure
Simple Random sampling technique will be used for this study.
7.2.2 Sample size
In this present study, the sample size will be consisting of 60 staff nurses
7.2.3 Inclusion criteria for sampling
· All registered staff nurses working in medical surgical wards.
7.2.4 Exclusion criteria for sampling
Staff nurses :
· Who are not present at the time of data collection.
· Who are working in intensive care units and operation theatre.
7.2.5 Instruments intended to be used
In this study instruments will be:
Part I: Baseline Proforma.
Part II: structured knowledge questionnaire to assess knowledge.
7.2.6 Data collection method
Formal permission will be obtained from the concerned authorities. The purpose of the study will be explained to the participants and informed consent will be taken from them. Pre test will be conducted using structured knowledge questionnaire by paper pen method to assess knowledge of staff nurses on SBAR hand over. On the same day a structured teaching programme on SBAR handover with the help of power point presentation for the duration of 45 minutes will be given to the staff nurses in the conference hall. After seven days post test will be conducted using the same structured knowledge questionnaire to assess the knowledge of staff nurses on SBAR handover.
7.2.7 Plan for data analysis
· Collected data will be analysed using tables, diagrams and graphs.
· The knowledge of staff nurses will be analysed using mean and standard deviation.
· The association between pre-test scores and selected demographic variables will be tested by chi -square test.
7.3 Does the study require any investigations or interventions to be conducted on patients, or other animals? If so please describe briefly.
Yes, Structured teaching programme will be provided to the staff nurses
7.4. Has ethical consideration been obtained from the institution in case of the above?
Yes, ethical clearance has been obtained from the concerned ethical committee and certificate is attached.
References
1. Cynthia D, Gayle K. Collaborative communication integrating SBAR to improve quality / patient safety outcomes. Journal for health care quality. 2009; 31(5).
2. Kathleen N. Bedside reporting and SBAR improving patient communication and satisfaction. Journal of paediatric nursing. 2012 ;27: 760-762.
3. Peggy Christie, Hazel Robinson. Using a communication framework at handover to boost patient outcomes. Nursing Times. 2009 Dec;105 (47).
4. O’Connel B, Macdonald k, Kelly c. Nursing Handover. It’s time for a change contemporary nurse.2008; 30(1).
5. Beckett C.D, Kipnis G .Collaborative communication. Journal for health care quality. 2009;31(5) :19-28.
6. Compton, Kennerly .Implementing SBAR across a large multihospital health system. Joint commission journal on quality and patient safety.2012 Jun ; 38(6):261-268.
7. Nancy Boaro, Carol Fancot, Ross Baker, Angie Andreoli. Using SBAR to improve communication in interprofessional rehabilitation teams. Journal of interprofessional care . 2010; 24 (1) :111-114.
8. Fang L, Ming Y, Yu W.C A project to improve the completeness of nursing shift reports in the surgical ward.Hu Li Za Zhi. 2006; 53(3):52-9.
9. Bhabra G, Mackeith S, Monteiro P, Pothier D.D. An experimental comparison of handover methods. Annals of Royal College of Surgery, England. 2007; 89(3): 298-300.
10. Kassean H.K, Jagoo Z.B. Managing change in the nursing hand over from traditional to bedside hand over: A Case study from Mauritius. Bio-med central nursing. 2005;4(1).
11. Christopher D. A quasi experimental study to assess the effectiveness of structured teaching programme on knowledge and skill of cardio pulmonary resuscitation among staff nurses working in selected hospitals, Hassan, Karnataka, 2007 Feb ; 20: 12.
9 / Signature of the candidate
10 / Remarks of the guide
11 / Name and designation of (in block letters)
11.2 Guide / MS. G. PRATHIBA
ASST. PROFESSOR
HOD MEDICAL SURGICAL
ZULEKHA NURSING COLLEGE
11.2 Signature
11.3 Co-guide (if any)
11.4 Signature
12 / 12.1 Head of the department / MS. G. PRATHIBA
ASST. PROFESSOR
HOD MEDICAL SURGICAL
ZULEKHA NURSING COLLEGE
MANGALORE
12.2 Signature
13 / 13.1Remarks of the Chairman and Principal
13.2 Signature
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