Exploring a Nursing Home-Specific, Interdisciplinary, Function-Focused, Communicative Framework Based on Situation, Background, Assessment, and Recommendation

10.1097/jnr.0000000000000428

Min Sun PARK；Su Jung LEE；Young Rim CHOI；Sung Ok CHANG

older adults ； communication ； interdisciplinary studies ； nursing homes ； SBAR

The Journal of Nursing Research

29卷3期（2021 / 06 / 01）

1 - 10

英文

Background: Improved methods of communication are needed among professionals in related fields to address the increasing complexity of clinical situations and various levels of functioning experienced by older adults who live in nursing homes. Purpose: The purpose of this study was to explore function-focused clinical communication among nurses and providers based on the Situation, Background, Assessment, Recommendation (SBAR) approach toward interdisciplinary collaboration to maintain function among nursing home residents and to identify the characteristics of SBAR flows in nursing homes. Methods: Detailed interviews with 28 interdisciplinary professionals working in four nursing homes were conducted. Directed qualitative content analysis was used to identify the internal attributes of SBAR-based communication. Case analysis was conducted to identify SBAR flows. Results: Four themes emerged as key factors for function-focused interdisciplinary staff communication in nursing homes. Effective nursing care to maintain function among nursing home residents requires accurate awareness of abnormal circumstances. Knowledge of assessment and resident background are needed to address situations requiring intervention and identify the problems underlying a resident's current state. The optimal therapeutic environment is created by sharing roles and tasks among practitioners through referrals. Twelve generalized situations requiring function-focused communication (i.e., dislocation of body line because of joint contracture, change in walking, difficulty of moving because of pain, difficulty in eating, fever, change in sleep pattern, change in excretion pattern, change in weight, change in condition, change in problematic behavior, decrease in cognitive function, and change in relationships) and the related nurse-centered SBAR pathways were identified. Conclusions/Implications for Practice: These results represent a first prototype for developing practical communication guidelines for nursing-home-specific function-focused care and provide new insights into the interdisciplinary approach.

1. Asadi, N.,Memarian, R.,Vanaki, Z.(2019).Motivation to care: A qualitative study on Iranian nurses.The Journal of Nursing Research,27(4),e34.
   連結：
2. Lee, S. J.,Kim, M. S.,Jung, Y. J.,Chang, S. O.(2019).The effectiveness of function-focused care interventions in nursing homes: A systematic review.The Journal of Nursing Research,27(1),1-13.
   連結：
3. Shin, J. H.(2019).Nursing staff characteristics on resident outcomes in nursing homes.The Journal of Nursing Research,27(1),1-9.
   連結：
4. Alexander, G. L.(2015).Nurse assistant communication strategies about pressure ulcers in nursing homes.Western Journal of Nursing Research,37,984-1004.
5. Anderson, R. A.,Issel, L. M.,McDaniel, R. R., Jr.(2003).Nursing homes as complex adaptive systems: Relationship between management practice and resident outcomes.Nursing Research,52,12-21.
6. Ashcraft, A. S.,Owen, D. C.(2017).Comparison of standardized and customized SBAR communication tools to prevent nursing home resident transfer.Applied Nursing Research,38,64-69.
7. Colón-Emeric, C. S.,Corazzini, K.,McConnell, E. S.,Pan, W.,Toles, M.,Hall, R.,Cary, M. P., Jr.,Batchelor-Murphy, M.,Yap, T.,Anderson, A. L.,Burd, A.,Amarasekara, S.,Anderson, R. A.(2017).Effect of promoting high-quality staff interactions on fall prevention in nursing homes: A cluster-randomized trial.JAMA Internal Medicine,177,1634-1641.
8. Cornell, P.,Gervis, M. T.,Yates, L.,Vardaman, J. M.(2013).Improving shift report focus and consistency with the situation, background, assessment, recommendation protocol.Journal of Nursing Administration,43,422-428.
9. Griffiths, D.,Morphet, J.,Innes, K.,Crawford, K.,Williams, A.(2014).Communication between residential aged care facilities and the emergency department: A review of the literature.International Journal of Nursing Studies,51,1517-1523.
10. Hsieh, H. F.,Shannon, S. E.(2005).Three approaches to qualitative content analysis.Qualitative Health Research,15(9),1277-1288.
11. Institute for Healthcare Improvement. (2019). SBAR communication technique. http://www.ihi.org/Topics/SBARCommunicationTechnique/Pages/default.aspx
12. Kim, H. J.,Choi, J. E.,Kim, M. S.,Kim, S. J.,Chang, S. O.(2016).Nurses' clinical decision-making for preserving nursing home residents' remaining abilities.Journal of Clinical Nursing,25,1326-1335.
13. Kim, H. S.(2010).The nature of theoretical thinking in nursing.Springer.
14. Kim, S. J.,Kim, M. S.,Kim, H. J.,Choi, J. E.,Chang, S. O.(2014).Nursing home nurses' ways of knowing about peaceful deaths in end-of-life care of residents: Personal knowledge and strategies.Journal of Hospice and Palliative Nursing,16,438-445.
15. Padgett, D. K.(1998).Does the glove really fit? Qualitative research and clinical social work practice.Social Work,43,373-381.
16. Panesar, R. S.,Albert, B.,Messina, C.,Parker, M.(2016).The effect of an electronic SBAR communication tool on documentation of acute events in the pediatric intensive care unit.American Journal of Medical Quality,31,64-68.
17. Park, M. S.,Kim, G.-T.,Lee, S. J.,Kim, M. S.,Jeong, E.-H.,Chang, S. O.(2019).Sequential two-stage network and thematic analysis for exploring an interdisciplinary care approach in nursing homes.Computers, Informatics, Nursing: CIN,37(9),473-481.
18. Park, M. S.,Lee, S. J.,Chang, S. O.(2019).Exploring a nursing home-specific interdisciplinary approach: Toward palliative care for the demented and complex-disabled elderly.Journal of Hospice and Palliative Nursing,21(6),E9-E15.
19. Park, M. S,Lim, S. Y.,Kim, E. Y.,Lee, S. J.,Chang, S. O.(2018).Examining practical nursing experiences to discover ways in which to retain and invigorate the remaining functions of the elderly with a demented and complex disability in nursing homes.Japan Journal of Nursing Science: JJNS,15,77-90.
20. Renz, S. M.,Carrington, J. M.(2016).Nurse-physician communication in long-term care: Literature review.Journal of Gerontological Nursing,42,30-37.
21. Resnick, B.,Galik, E.,Boltz, M.(2013).Function focused care approaches: Literature review of progress and future possibilities.Journal of the American Medical Directors Association,14,313-318.
22. Shaw, C.,Williams, K. N.,Perkhounkova, Y.(2018).Educating nursing home staff in dementia sensitive communication: Impact on antipsychotic medication use.Journal of the American Medical Directors Association,19,1129-1132.
23. Thomas, C.M.,Bertram, E.,Johnson, D.(2009).The SBAR communication technique: Teaching nursing students professional communication skills.Nurse Educator,34,176-180.
24. Townsend-Gervis, M.,Cornell, P.,Vardaman, J.M.(2014).Interdisciplinary rounds and structured communication reduce re-admissions and improve some patient outcomes.Western Journal of Nursing Research,36,917-928.
25. Williams, K. N.,Perkhounkova, Y.,Jao, Y.-L.,Bossen, A.,Hein, M.,Chung, S.,Starykowicz, A.,Turk, M.(2018).Person-centered communication for nursing home residents with dementia: Four communication analysis methods.Western Journal of Nursing Research,40(7),1012-1031.
26. Xyrichis, A.,Reeves, S.,Zwarenstein, M.(2018).Examining the nature of interprofessional practice: An initial framework validation and creation of the InterProfessional Activity Classification Tool (InterPACT).Journal of Interprofessional Care,32(4),416-425.