Accountable Healthcare - Better Communication for Nurses
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August 18, 2020

Better Communication for Nurses

What does effective communication mean to you? All individuals have their own natural ways of communicating that stem back to culture, past experiences, and background. How one culture communicates may seem very different to another.  Health care melds together practitioners and professionals with various experiences, abilities, and backgrounds. Therefore, it is critical for nurses to develop systems to communicate effectively.

Communication is an important skill for any industry. There are numerous resources available that provide tips to improve communication. But what about communication geared toward nurses? Nurses need to communicate changes in patient condition, hand-off during shift changes, and information to families in a succinct and clear way. Brushing up on communication skills or learning new ways to clearly communicate is always a smart idea for both new and experienced nurses. 

“Communication skills can be effectively trained but are best achieved through reviewing our own style of communication,” according to K.C. Rajashree, author of a 2011 study on training programs in communication skills for health care professionals. As a component to improving our communication skills as nurses, we must take an honest look at ourselves and how we as individuals communicate. If we do not assess ourselves, we won’t realize the areas we need to improve on in the first place. We can assess ourselves by checking if the information we’re communicating is clear enough or too detailed; do we “get our point across?” Or is the person guessing at what we’re trying to say?

As we know, “effective communication within a healthcare setting is critically important.  Workers of varying skill sets within a healthcare setting must communicate clearly with each other to best coordinate care delivery to patients, ” says Haran Ratna, author of a 2019 study published in Harvard Public Health Review. One commonly used method is SBAR. SBAR means Situation Background Assessment Recommendation. Clinicians use this acronym because it delineates the pertinent information that is to be conveyed. Some facilities provide SBAR tear-off worksheets so that it can be used conveniently and consistently.

Other communication methods include Call-Out, Check-Back, and Hand-off. These tools involve team communication and many are “closed loop.” That means the person receiving the message repeats it back to ensure accuracy and receives confirmation that what they’ve heard is correct. Closed loop is beneficial particularly during a code or emergency when someone must ensure the information conveyed is accurate.

Ticket-to-Ride is a method for brief hand-offs. This method would be used if the patient were leaving the unit for a test.  Ticket-to-Ride would convey basic information to the staff accepting the patient in order to keep the patient safe. This method is not the same as a change of shift hand-off; it is only basic information for short-term care.

Studies have shown that training nurses on improving communication increases patient safety. A study by Dingley, et al developed a communication “toolkit” that provided various communication strategies and ways to implement teamwork. The toolkit included four “tools”:   

  • SBAR (or a standardized communication tool)
  • An escalation process
  • Daily multi-disciplinary rounds with goals
  • Team huddles during each shift

The study also revealed that using the toolkit consistently could be translated into other care settings besides a hospital.  Using the toolkit showed improvement in communication between disciplines; however, implementation was dependent on managers and leadership. With creating any new habit, consistency is key. Providing education can encourage consistency as well as having the tools easily accessible through templates or worksheets. 

BATHE protocol is another method, similar to SBAR. BATHE stands for Background, Affect, Trouble Handling, Empathy. This method is useful for communicating with patients, their families, or in a conflict situation. Observing the affect of the person is useful. If the person has a flat affect or is withdrawn, the nurse’s tone of communication may differ compared to having an upbeat or happy affect. Trouble Handling is another component to consider. What is troubling the patient and how are they dealing with it? This method is useful in psychiatric settings.

Which method is best? It all depends on the situation. In an emergency, closed loop communication works by repeating back the information. During change of shift hand-offs, more information is conveyed and clarity is important. In the case of Ticket-to-Ride, the information is brief and basic—just the facts to keep the patient safe. SBAR and other methods are appropriate when speaking with doctors and other team members by organizing information and maintaining consistency in the way communication occurs. Check with your unit’s educator or hospital policies. Your hospital may prefer one method versus another. 

Nurses may take for granted the act of effective communication. However, communicating clearly and accurately makes all the difference in quality of care and patient safety. Utilizing SBAR, Hand-off, BATHE, or other tools with closed loop methods can improve transfer of information between nurses and others.  By polishing nurses’ communication skills, patients and the health care team as a whole will benefit.