Using SBAR to Enhance Clinical Reasoning Skills in Junior Undergraduate Nursing Students

Determining the most appropriate teaching strategy to develop clinical reasoning skills is a priority goal of any clinical nursing faculty. The challenge is to be able to engage students in developing their clinical reasoning and clinical judgment as well as measuring this development. In the Fall 2018 semester, the unique teaching strategy of utilizing SBAR as a method to develop clinical reasoning in the student was utilized. A novel Clinical Confidence Tool was piloted as a pretest/posttest to measure clinical confidence in various clinical areas. During their second semester of medical-surgical hospital clinical, undergraduate junior nursing students presented their patient to the clinical faculty using an SBAR method. Students had learned about SBAR in their first semester, but applying SBAR during clinical had not yet been attempted. The teaching strategy was implemented in the third week of clinical through the last week for a total of five separate clinical days. Students have two patients during each clinical day. For the “Situation” portion of the SBAR, students provided the reason for admission and/or the reason for still being in the hospital. The patient’s pertinent and most recent history leading to admission were presented in the “Background” portion. In “Assessment”, the students identified nursing diagnoses and provided assessment data including focused assessment findings, diagnostic results, and pharmacological interventions to support the nursing diagnoses. The student determined the nursing problems and priorities then provided the day’s SMART goals and plans. Preliminary tool results demonstrated students felt more confident with their clinical judgment at the end of the semester. Qualitative feedback indicated that the strategy allowed students to envision the clinical picture while sifting through data to determine the priorities and appropriate plan of care. Students highly valued timely instructor feedback and support. The SBAR report allowed clinical faculty to facilitate students “thinking as a nurse” and to intervene to correct thought processes in real time.