A nurse is preparing to provide change-of-shift report. Using the SBAR communication technique, which of the following client information should the nurse include in the “A” portion of the report?
A.
The client rates her pain at a 3 on a 0 to 10 pain rating scale
B.
The client has type 2 diabetes mellitus.”
C.
The client is 2 hours postoperative following a cholecystectomy.
D.
The client should wear compression stockings.”
The Correct answer and Explanation is:
The correct answer is C. The client is 2 hours postoperative following a cholecystectomy.
Explanation
The SBAR communication technique stands for Situation, Background, Assessment, and Recommendation. It is a structured method that facilitates clear and concise communication among healthcare providers, especially during change-of-shift reports. Each component of SBAR serves a specific purpose, and understanding what information to include in each segment is crucial for effective handoffs.
Assessment (A): This section refers to the nurse’s clinical judgment regarding the client’s current condition. It includes data relevant to the patient’s status, any changes since the last report, and the implications of those changes for ongoing care.
In this scenario, option C, “The client is 2 hours postoperative following a cholecystectomy,” falls under the Assessment category because it indicates the patient’s current state post-surgery. Being just 2 hours postoperative signifies that the client is in a critical period where close monitoring is necessary. This information alerts the incoming nurse to the need for vigilant assessment of vital signs, potential complications such as bleeding or infection, and pain management.
Why the other options don’t fit:
- A. The client rates her pain at a 3 on a 0 to 10 pain rating scale: While pain levels are important, this information is more suited to the Situation or Background sections, as it describes a symptom rather than a clinical assessment.
- B. The client has type 2 diabetes mellitus: This is background information and helps provide context about the patient’s medical history, but it does not reflect the current assessment of the patient’s postoperative condition.
- D. The client should wear compression stockings: This is a recommendation for preventive care and is relevant for the Recommendation section. It does not provide an assessment of the patient’s current clinical status.
In summary, option C best represents the Assessment portion of the SBAR technique, as it reflects the nurse’s evaluation of the patient’s immediate postoperative state, which is vital for ensuring continuity of care.