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Research Brief
Utilizing an SBAR Workshop With Baccalaureate Nursing
Students to Improve Communication Skills
Natalie Stevens, Susan McNiesh, and Deepika Goyal
This study evaluated the effectiveness of the Situation-Background-Assessment-Recommendation (SBAR) technique to
reduce anxiety and increase self-confidence levels regarding health care communication among undergraduate nursing
students. Baccalaureate nursing students (n = 35) completed anxiety and self-confidence questionnaires before and after an
SBAR communication workshop and subsequent simulation. A statistically significant increase in postintervention
self-confidence scores was noted with no significant difference in anxiety levels. The findings support the use of SBAR as an
organizing tool to promote nursing students’ self-confidence during communication; however, further efforts are needed to
qualitatively examine how this tool promotes these changes.
KEY WORDS Communication – SBAR – Simulation – Student Anxiety – Student Confidence – Undergraduate Nursing Students
ccording to The Joint Commission (2018), poor communication
is associated with an increased risk of sentinel events, making
effective communication the essential cornerstone of safe
nursing care. Novice nursing students have limited knowledge,
experience, and few opportunities to practice communication in
critical situations, which can negatively impact self-confidence (Yu &
Kang, 2017) and their learning ability in the clinical setting (White, 2014).
Research supports the use of standardized communication frameworks, such as Situation-Background-Assessment-Recommendation
(SBAR), as an organizing framework to promote safe delivery of care
through the systematic delivery of information that is clear and understandable to all individuals involved in the care of the patient (Kostiuk,
2015; Yu & Kang, 2017). The integration of standardized communication frameworks during the education process allows students
opportunities to practice, preparing them to communicate effectively as part of the health care team (McComb & Simpson, 2014).
Using a mixed-methods design, Kostiuk (2015) noted decreased
anxiety (p = .001) and higher perceived confidence (p = .01) among
28 nursing students after students were taught use of a standardized
About the Authors Natalie Stevens, MS, RNC-OB, is a faculty lecturer
at The Valley Foundation School of Nursing, San Jose State University,
San Jose, California. Susan McNiesh, PhD, MS, RNC-OB, is an
associate professor, and Deepika Goyal, PhD, FNP-C, is a professor,
at The Valley Foundation School of Nursing. The authors are grateful
to Teri Lind, simulation faculty, for her involvement in the obstetrical
simulation sessions. For more information, contact Ms. Stevens at
The authors have declared no conflict of interest.
Copyright © 2019 National League for Nursing
doi: 10.1097/01.NEP.0000000000000518
Nursing Education Perspectives
communication framework during handover report. Yu and Kang
(2017) noted communication clarity ratings of 62 undergraduate
nursing students in Korea significantly increased compared to
the control group (p = .001) after participating in multiple clinical
simulation scenarios utilizing SBAR handovers; although not statistically significant, higher confidence scores were achieved in
the experimental group.
Bedside nurses are responsible for recognizing signs and symptoms of clinical significance and communicating them effectively and
accurately to the rest of the health care team. Therefore, it is critical
for nursing students to develop confidence in conveying information
concisely to others on the team. The use of standardized communication frameworks has been shown to improve nursing students’
communication capacity and clarity (Institute for Healthcare
Improvement [IHI], 2016; Lancaster, Westphal, & Jambunathan,
2015). The purpose of this study was to build upon the work of
previous researchers (Kostiuk, 2015; Yu & Kang, 2017) and evaluate the effect of an SBAR communication workshop on the
anxiety and self-confidence levels of undergraduate nursing students when participating in subsequent simulation scenarios.
This study was guided by Benner’s (1982) novice-to-expert theory of
clinical skill acquisition. According to Benner, nurses move along a
continuum of five skill levels (novice, advanced beginner, competent,
proficient, and expert) through exposure to patient care situations and
experiences. Benner emphasized that nurses must repeatedly practice skills in order to develop knowledge and pass through to higher
levels of proficiency. In this study, practice of the SBAR tool was implemented during peer role-play interactions and simulated real-life
scenarios to promote skill development.
Copyright © 2020 National League for Nursing. Unauthorized reproduction of this article is prohibited.
Research Brief
University institutional review board approval and participant consent were obtained prior to data collection. Using a quantitative, descriptive pretest and posttest design, a convenience sample of
junior-level BSN students attending a public university in California
were invited to participate in the study. Students provided demographic
data and completed the Nursing Anxiety and Self-Confidence With
Clinical Decision-Making Scale (NASC-CDM; White, 2014) before
and after the intervention; forms were numerically coded for anonymity. Scored on a 6-point Likert-type tool (1 = not at all/do not agree to
6 = totally/agree), the NASC-CDM includes two subscales measuring anxiety and self-confidence. Subscale scores range between
27 and 162, with higher scores indicative of increased anxiety and
self-confidence. Reliability for the subscales produced alpha values
of .97 and .96, respectively.
The study intervention included two parts. The first part consisted
of an SBAR communication workshop; the second part included a
simulation session to practice using the SBAR format in clinical scenarios. Training materials for the workshop were developed by the primary investigator from evidence-based literature, IHI (2016) guidelines,
and SBAR-related material in the nursing curriculum. The primary investigator presented a 20-minute lecture that included SBAR format review
and detailed examples of how to prioritize and organize assessment
findings into the format. Working in small groups, the students then applied the SBAR technique to a series of case studies.
Six to eight weeks after the SBAR communication workshop,
students attended a regularly scheduled obstetrical simulation session in the nursing laboratory. Groups of eight to nine students participated in three simulation scenarios that focused on acute obstetrical
events: postpartum hemorrhage, neonatal sepsis, and precipitous
vaginal delivery. Students rotated through the scenarios as either observers or active participants with an overall objective to use SBAR
when reporting patient information to the charge nurse or physician
in each scenario. At the end of the simulation session, participants
completed the NASC-CDM posttest questionnaire.
Of a possible 60 students, 35 (58 percent) completed both the preand posttest NASC-CDM. The majority were female (n = 25, 71.4
percent) between 20 and 37 years of age; the majority self-identified
as Asian (n = 20, 57.2 percent), Hispanic (n = 5, 14.3 percent), or
Caucasian (n = 4, 11.4 percent). Participant characteristics, anxiety,
and self-confidence scores were analyzed using descriptive statistics
and inferential tests.
Paired t-test analysis revealed a statistically significant increase in
mean self-confidence from pre- (range = 70 to 140) to postintervention (range = 75 to 157), p = <.05, t = −2.434. No significant difference
was noted in anxiety scores before and after the intervention.
Findings support the use of an SBAR communication workshop to
enhance students’ self-confidence levels with regard to health care
communication. Our findings are in accord with Kostiuk (2015), who
also noted a significant increase in nursing students’ confidence levels
118 March/April 2020
(p = .01) after completing a standardized communication framework
workshop. However, Kostiuk’s findings have limited generalizability
given all 28 participants were female and of European descent,
whereas our sample was more diverse with regard to gender and race.
The findings should be interpreted with caution given the small
sample size, convenience sampling, and time lapse (six to eight
weeks) between the SBAR communication workshop and simulation
session. A post hoc power analysis indicated the sample size was
sufficient to detect a change in self-confidence but not in anxiety; a
sample size >100 would have been required to note a change in anxiety. The time lapse between the communication workshop and simulation session, where students practiced SBAR, further limits our
findings. It is unknown whether other factors influenced self-confidence,
for example, more time spent in clinical and/or more exposure to
clinical experiences.
Nurses must be able to competently assess and communicate
patient care needs to others on the health care team; yet nursing students often harbor high levels of anxiety and lack self-confidence
when communicating with the team. Therefore, it is critical for nurse
educators to integrate the use of standardized communication frameworks into all levels of undergraduate nursing curricula to assist students with organizing and disseminating information. The use of
SBAR can promote nursing students’ self-confidence during health
care communication; however, more efforts are needed to examine
the effect of SBAR utilization on students’ anxiety levels. Future researchers should strive to recruit more diverse samples in order to increase the generalizability of findings. In addition, more qualitative inquiry
is needed to examine how standardized communication frameworks
enhance knowledge, skills, and attitudes regarding health care communication (Anderson & Nelson, 2015).
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Joint Commission. (2018). Hospital: 2018 National patient safety goals. Retrieved
from https://www.jointcommission.org/assets/1/6/2018_HAP_NPSG_
Kostiuk, S. (2015). Can learning the ISBARR framework help to address nursing
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Lancaster, R. J., Westphal, J., & Jambunathan, J. (2015). Using SBAR to promote
clinical judgment in undergraduate nursing students. Journal of Nursing Education, 54(Suppl. 3), S31-S34. doi:10.3928/01484834-20150218-08
McComb, S., & Simpson, V. (2014). The concept of shared mental models in healthcare collaboration. Journal of Advanced Nursing, 70(7), 1479-1488. doi:10.
White, K. A. (2014). Development and validation of a tool to measure self-confidence
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Yu, M., & Kang, K. J. (2017). Effectiveness of a role-play simulation program involving
the SBAR technique: A quasi-experimental study. Nurse Education Today, 53,
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Copyright © 2020 National League for Nursing. Unauthorized reproduction of this article is prohibited.