chapter 6 | Getting People to Work Together 81communicating patient information for hand-off
reporting (Haig, Sutton & Whittingdon, 2006;
IHI, 2006).
Health-Care Provider Orders
Professional nurses are responsible for accepting,
transcribing, and implementing health-care
provider orders. The two main types of orders are
writtenand telephone. Written ordersare dated and
placed on the appropriate institutional form.
Telephone ordersare given from the health-care
provider directly to the nurse by telephone. Many
health-care institutions are moving to maintaining
the electronic medical record (EMR) and away
from verbal orders as the health-care provider is
present and can enter the order on the appropriate
form in the patient’s record. A telephone order
needs to be written on the appropriate institution-
al form, the time and date noted, and the form
signed as a telephone order by the nurse.
Most institutions require the physician to cosign
the order within 24 hours. When receiving a tele-
phone order, repeat it back to the physician for con-
firmation. If the health-care provider is speaking
too rapidly, ask him or her to speak more slowly.
Then repeat the information for confirmation.
Professionalism and a courteous attitude by all par-
ties are necessary to maintain collegial relationships
with physicians and other health-care professionals.
One nurse explained their importance as follows:
RN satisfaction simply is not about money. A major
factor is how well nurses feel supported in theirwork. Do people listen to us—our managers, upper
management, human resources? Being able to com-
municate with each other—to be able to speak
directly with your peers, physicians, or managers in
a way that is nonconfrontational—is really impor-
tant to having good working relationships and to
providing good care. You need to have mutual
respect. (Quoted by Trossman, 2005, p. 1.)Communicating With Patients
and Their Families
Communicating with patients and their families
occupies a major portion of the nurse’s day. Nurses
teach patients and their families about medications
and the patient’s condition, clarify the treatment
plan, and explain procedures. To do this effectively,
nurses need to use communication skills and recog-
nize the barriers to communication.
The health-care consumer may enter the setting
in a highly emotional state. Nurses need to recog-
nize the signs of an anxious or angry patient and
promptly intervene to defuse the situation before it
escalates. Practicing good listening skills and show-
ing interest in the patient often helps.
Short-term stays and early-morning admissions
on the day of surgery make patient teaching a chal-
lenge. The nurse must complete the admission
requirements, surgical checklists, and preoperative
teaching within a short time. Time for postopera-
tive teaching is also shortened. It is important for
the nurse to communicate clearly and concisely
what will be done and what is expected of the
patient. Allow time for questions and clarifications.table 6-2
SBAR (Situation, Background, Assessment, Recommendation)
Elements Description Example
Situation Brief description of the existing situation Critical laboratory value that needs to be
addressed (critical blood gas value, International
Normalized ratio [INR], etc.)
Background Medical, nursing, or family information Patient admitted with a pulmonary embolus and on
that is significant to the care and/or heparin therapy, receiving oxygen at 4 L via nasal
patient condition cannula; what steps have been taken
Assessment Recent assessment data that indicate Vital signs, results of laboratory values, lung sounds,
the most current clinical state of mental status, pulse oximetry results,
the patient electrocardiogram results
Recommendation Information for future interventions Monitor patient
and/or activities Change heparin dose
Repeat INR
Repeat computed tomography or ventilation-
perfusion scan