Using SBAR and KSA to Promote Critical Thinking Among Graduating BSN Students

Background: SBAR (situation, background, assessment, recommendation) was developed by the US Navy for high-risk communication among submarine crew, and later modified for use in the healthcare setting. SBAR is endorsed by... [ view full abstract ]

Background: SBAR (situation, background, assessment, recommendation) was developed by the US Navy for high-risk communication among submarine crew, and later modified for use in the healthcare setting. SBAR is endorsed by The Joint Commission as a risk mitigation strategy for optimizing communication of patient concerns or change in patient status. As a component of the Quality and Safety Education for Nurses initiative, the KSA (knowledge, skill, attitude) strategy improves safe and quality nursing care through comprehensive clinical competency education.

Aim/Objective: To promote critical thinking in complex clinical settings, SBAR and KSA assignments were implemented during two medical-surgical clinical practicums for graduating BSN students at a major US university.

Description: SBAR and KSA templates were developed/provided to guide assignments, and students were invited to attend optional SBAR and KSA workshops. In Fall 2014, students were asked to complete five SBAR assignments during a 90-hour clinical practicum for a pass/fail grade. Minor revisions were made to the SBAR template based upon faculty and student input. The following semester (Spring 2015), students were required to complete three SBAR assignments, and two KSA assignments, during their last 90-hour clinical practicum. Each assignment was worth 16% of the final course grade score. Rubric-style evaluation tools were developed and used by the supervising faculty to review/grade the assignments.

Impact: SBAR assignments promoted critical thinking to identify/prioritize a patient concern or change in patient status, relevant background information, targeted assessment, and targeted/prioritized nursing interventions. KSA assignments promoted awareness of high-risk nursing interventions and risk mitigation strategies to ensure patient safety and optimal patient outcomes. Faculty review of completed assignments identified common themes in problematic critical thinking, resulting in remediation and proposed curriculum modifications.

Conclusion/Implications: SBAR and KSA assignments provided opportunities for enhanced student critical thinking prior to entry into professional practice as a Registered Nurse (RN).