Verktøyet ISBAR fører til bevisst og strukturert kommunikasjon for helsepersonell

Abstract

Background: ISBAR is a patient safety communication structure that aids simplified, effective, structured and anticipated communication between healthcare personnel. No research has previously been conducted on master's students' experiences of using ISBAR in Norway. In the past, there have been calls for education strategies that ensure students receive training in patient safety communication. Objective: To elucidate specialist nursing students' experiences of using ISBAR as a communication structure in clinical practice on a master's degree programme in specialist nursing. Method: The study has a qualitative descriptive design, and comprises three focus group interviews. A qualitative content analysis was carried out. Results: Using the tool made the students' communication more conscious, structured, clear and predictable. They conveyed objective, unambiguous and specific observations and changes instead of giving unfounded opinions. The students more readily proposed solutions of their own and clarified medical regulations. Using ISBAR made them feel more confident about their own communication and expertise, and improved their teamwork and patient safety. However, the ISBAR tool presented some challenges for the students since the communication structure had not been implemented at the hospital. Conclusion: Using ISBAR increases the awareness of users' own structured communication and expertise and allows them to obtain a quicker overview of patient situations. The findings highlight the importance of systematic training and simulation with the ISBAR structure in order to improve patient safety, both in the training of specialist nurses and in the specialist health service. Teamwork and communication between healthcare personnel are vital to quality of care and patient safety (1, 2). Patient safety is defined as protection against unnecessary harm resulting from the health service's efforts or lack of efforts (3). Communication failures in treatment teams are one of the most common causes of adverse events in the specialist health service, and about 70 per cent are due to human errors in non-technical skills such as communication, management and decision-making (1, 4, 5). A lack of structure and standardisation is sometimes to blame for communication failures (6). The communication structure Identify, Situation, Background, Assessment and Recommendation (ISBAR) was created to standardise the effective transfer of information in the US armed forces. ISBAR was adopted by the public health service in the 2000s (1, 7) (Table 1). What is ISBAR? ISBAR is one of several frameworks for communication between healthcare personnel in relation to patient situations. Use of the instrument is considered to improve patient safety through more structured, focussed and concise communication among healthcare personnel (1, 8, 9). The US healthcare system implemented ISBAR around 2003, and its overarching goal in patient safety work is to improve communication (1). Norway introduced a national programme for patient safety in 2...

Antologiens sentrale begreper og perspektiver

“…Alle hadde fått teoretisk innføring i simulering som pedagogisk metode, repetisjon i bruken av systematisk pasientobservasjon og tiltak med ABCDE-algoritmen (airway, breathing, circulation, disability, exposure/environment), sikker muntlig kommunikasjon i henhold til ISBAR-prinsippet (identifikasjon, situasjon, bakgrunn, aktuelle vurderinger, råd) (Moi, Söderhamn, Marthinsen & Flateland, 2019), informasjon om «casen» eller «scenarioet» (Struksnes et al, 2015) samt praktisk trening i hjerte-lunge-redning.…”

“…De følte seg også mer sikre på egen kompetanse og kommunikasjon, og de klarte raskere å få oversikt over pasientsituasjoner. Disse elementene førte til forbedret pasientsikkerhet (Moi et al, 2019).…”

Utfordringer i tverrfaglig samarbeid. Kommunal helse- og omsorgstjeneste samt kommunalt barnevern

“…Dette er også gjenkjennbart fra tidligere studier, som viser at manglende pasientopplysninger gjør det vanskelig å treffe riktig behandlingsvalg (Rolfsjord, Mdala & Straand, 2019) og dermed truer pasientsikkerheten. Å bruke standardiserte vurderingsverktøy, for eksempel ABCDE for å identifisere tidlig endring hos pasienten og ISBAR for sikker overføring av informasjon, kan bidra til økt kvalitet i vurdering av pasientens tilstand og videre rapportering (Moi et al, 2019). Samtidig viser våre funn at sykepleierne føler at egen kunnskap ikke strekker til, og de er ikke komfortable med å bruke disse vurderingsverktøyene.…”

Tidlig oppdagelse av forverret tilstand

“…Metoden ble opprinnelig utviklet for det amerikanske forsvaret, men har blitt videreutviklet for bruk i helsevesenet (Pope, Rodzen & Spross, 2008). En studie viser at masterstudenter innen sykepleie som brukte ISBAR, fikk en mer bevisst og strukturert kommunikasjon, ble bedre på teamarbeid og opplevde at pasientsikkerheten ble bedret (Moi, Söderhamn, Marthinsen & Flateland, 2019). Devereaux og kolleger (2016) studerte innleggelser fra sykehjem til sykehus før og etter at ISBAR ble tatt i bruk, og fant både en signifikant reduksjon i reinnleggelser innen 30 dager og i unødvendige innleggelser på sykehus.…”