Nurse Education Today 80 (2019) 78–84

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Nurse Education Today

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Implementation of an SBAR communication program based on experiential T

learning theory in a pediatric nursing practicum: A quasi-experimental study
Ju-Yeon Uhma, YoungJi Koa, , Suhee Kimb
⁎

a
Department of Nursing, Daegu Haany University, 1 Haanydaero, Gyeongsan-si, Gyeongsangbuk-Do, 38610, Republic of Korea
b
School of Nursing and Research Institute of Nursing Science, Hallym University, 1 Hallimdaehak-gil, Chuncheon-si, Gangwon-do 24252, Republic of Korea

ARTICLE INFO ABSTRACT

Keywords: Background: Effective communication by nurses is crucial to ensure patient safety. A structured communication
Pediatric nursing practicum program increases communication clarity, education satisfaction, and positivity during interprofessional colla-
Role play boration among students. In an effort to facilitate effective communication between nurses and physicians, the
SBAR well-known structured communication tool SBAR (Situation, Background, Assessment, and Recommendation)
Nursing students
has been extensively used in clinical and educational settings.
Objectives: The purpose of the study is to investigate the impact of an SBAR communication program on com-
munication performance, perception, and practicum-related outcomes in senior-year nursing students.
Method: The study employed a non-equivalent control group quasi-experimental design and implemented the
tool in the pediatric nursing practicum of a nursing school. The experimental group participated in a SBAR
program, where role playing using SBAR techniques for different scenarios was used to improve practical
communication among nursing students. The SBAR program was developed based on Kolb's Experiential
Learning Theory. Communication performance was assessed via the SBAR communication tool and the com-
munication clarity scale. Communication perception was measured by handover confidence level. Practicum-
related outcomes of clinical practice self-efficacy, perceived nurse–physician collaboration, and practicum sa-
tisfaction, were also evaluated.
Results: The experimental group demonstrated significantly higher SBAR communication (p < .001), commu-
nication clarity (p < .001), and handover confidence (p < .001) than the control group. Clinical practice self-
efficacy, perceived nurse–physician collaboration, and practicum satisfaction did not differ.
Conclusions: The SBAR program in a pediatric nursing practicum improves SBAR communication, commu-
nication clarity, and perceived handover confidence in senior-year nursing students.

1. Introduction of students in various nursing education programs. Until now, simula-

tion-based education regarding communication has focused mainly on
Collaborative practice in clinical settings is essential for achieving communication between clinicians and patients (Kaplonyi et al., 2017;
optimal patient outcomes (World Health Organization, 2010). Effective MacLean et al., 2017). Notably, it has been found that nursing students
communication between nurses and physicians leads to the provision of experienced difficulties in notifying doctors of patients' health problems
comprehensive services for patients (Lancaster et al., 2015). Commu- in the pediatric nursing practicum (Bowling, 2015). Moreover, nursing
nication performance has been considered by several organizations to reported moderate to severe stress from simulation education, which
be one of the crucial outcomes of nursing education (Australian Nursing may be related to critiques by faculty and peers (Cantrell et al., 2017).
and Midwifery Federation, 2014; Society of Pediatric Nursing, 2017). These reports indicate the limitations of excessive pedagogical de-
However, unclear and imprecise communication is common among pendency on simulation-based approaches to communication educa-
healthcare personnel (Tang et al., 2013). A lack of professional com- tion.
munication and collaboration may be one of the main causes of medi- Furthermore, the Korean Accreditation Board of Nursing Education
cation errors (Farzi et al., 2017). (2017) only accepts simulation classes for 12% of the 1000 required
Simulations are increasingly used to improve the practical capacity practical hours; the greater part of the clinical nursing course is practica

⁎
Corresponding author at: Department of Nursing, Daegu Haany University, Republic of Korea.
E-mail addresses: [email protected] (Y. Ko), [email protected] (S. Kim).

https://doi.org/10.1016/j.nedt.2019.05.034
Received 12 February 2019; Received in revised form 8 April 2019; Accepted 20 May 2019
0260-6917/ © 2019 Elsevier Ltd. All rights reserved.
J.-Y. Uhm, et al. Nurse Education Today 80 (2019) 78–84

in hospitals, which largely focus on case reports reflecting the nursing practicum satisfaction, clinical practice self-efficacy, and nurse–physi-
process, and have been criticized for their limited approach to real cian collaboration through comparison of pretest and posttest in both
practice in South Korea (Shin et al., 2017). Therefore, strengthening groups.
interdisciplinary communication programs linked to hospital clinical
practica is needed in order to improve the practical capacity of nursing 2.2. Settings and participants
schools.
The programs were delivered through a pediatric nursing practicum
1.1. Literature review for a bachelor of nursing course at a university in South Korea. In a
previous study, the effect size was 0.7 (Noh et al., 2016). An α of 0.05
1.1.1. Standardized communication tool and power of 0.9 meant that an adequate sample size was 36 per group
In an effort to facilitate effective communication between nurses using G*Power. The study involved a total 81 participants, with 41
and physicians, SBAR (Situation, Background, Assessment, and students in the control group and 40 students in the experimental
Recommendation), a well-known structured communication tool, has group. The achieved actual power was 0.928.
been extensively used in clinical and educational settings (Buckley
et al., 2016; Compton et al., 2012). SBAR communication should in- 2.3. The SBAR communication program
clude the patients' current problems (Situation), medical history
(Background), current symptoms and vital signs (Assessment), and 2.3.1. Development of the SBAR program
nurses' recommendations (Recommendation). The SBAR educational The SBAR communication program was developed based on ex-
program improves communication performance among nurses periential learning theory (Kolb, 1984). New knowledge transformed
(Chaharsoughi et al., 2014); in addition, it increases communication from experience into a cognitive framework can induce ideas in stu-
knowledge (Wang et al., 2015), communication clarity (Yu and Kang, dents to solve problems and perform new skills. The learning process
2017), and attitude of interprofessional collaboration (Kostoff et al., has four phases: concrete experience, reflection, abstract con-
2016) among nursing students. ceptualization, and active experimentation (Kolb, 1984). We viewed
pre-practicum orientation based on scenario-based learning as the
1.1.2. Application of experiential learning theory and role play in concrete experience stage, which relies on open-mindedness. This was
communication programs followed by giving the students reflective experiences of communica-
Lisko and O'Dell (2010) developed a medical-surgical course in- tion between nurses and physicians in the real world through articu-
cluding clinical experience in the nursing laboratory, skill demonstra- lating SBAR components of communication situations in clinical set-
tion, scenario-based presentation, and reflection, based on Kolb's ex- tings and analyzing their relevance. Subsequently, the abstract
periential learning theory. The experiential learning theory emphasizes conceptualization stage comprised presenting students with situations
the experiential aspect of the learning process; hence, it seeks to con- in clinical settings and asking them to identify gaps between theory and
tinuously change the experiences of the student. This ongoing educa- practice regarding SBAR. In the final stage, an active experiment was
tional process of alternating the student's experiences help build their implemented for virtual patients, using scenarios and real patients in
knowledge and influence schema (Kolb, 1984). An educational com- clinical settings.
munication program based on experiential learning theory should be The SBAR communication program development process consisted
considered by nursing educators. Virtual environments and role play of three phases, including a literature review, development of scenarios,
using scenarios could allow students to train themselves according to and evaluation of scenarios (Table 1). The program was composed of a
real nurses' roles. Scenario-based learning has been shown to enhance pediatric nursing practicum with an additional four-hour course based
the attitude of nursing students (Richardson et al., 2017). Role play is on existing literature (Bowling, 2015; McCaffrey et al., 2012; Yu and
also an experiential learning technique for introducing learners to be- Kang, 2017). Five scenarios involving common pediatric health pro-
have appropriately in various situations, as it provides them with tar- blems were developed by a faculty with 15-years' experience in pe-
geted practice and feedback to acquire and improve skills and integrate diatric clinical practice. Three were modified from previously devel-
new information (Joyner and Yound, 2006). Role play has been shown oped scenarios for students in a pediatric nursing practicum (Kim et al.,
to be one of the most effective strategies in education for helping stu- 2017). Two scenarios were newly developed. Two pediatric nursing
dents learn how to communicate with each other (Chan, 2012; Yu and professionals reviewed the contents of the scenarios. The experimental
Kang, 2017). group students participated in the SBAR communication program in a
Therefore, this study aimed to evaluate whether an SBAR commu- pediatric nursing practicum. The program was conducted according to
nication program based on experiential learning increased nursing the experiential learning theory's stages and provided students with
students' communication performance, communication perception, and guidelines regarding the program process.
practicum-related outcomes.
2.4. Procedures
2. Methods
The SBAR program was delivered to each practicum team for a one-
2.1. Research design week pediatric nursing practicum and an additional four-hour course. A
class of senior nursing students was divided into A class and B class. A
A quasi-experimental non-equivalent control group pretest and class was set as the experimental group and B class was set as the
posttest design was implemented in a pediatric nursing practicum. control group. Six teams per class were composed of 6 or 7 nursing
The experimental group participated in the SBAR communication students. The program was facilitated in the conference room of the
program, composed of instruction in the SBAR technique, scenarios, school and at the hospital. One practicum instructor facilitated the
and role playing, while the control group received the usual practicum program, introducing the SBAR technique, providing scenarios to stu-
education. The four-phase program was conducted within 2 weeks from dents, checking students' SBAR cases, and guiding students' role plays.
pre-practicum orientation, before the one-week practicum, to the con- The program was delivered in four phases, starting one week after
ference after the finish of the practicum. The impact of the program on the orientation of the hospital practicum and pretest. The first phase
communication performance, communication perception, and prac- developed concrete experience in a clinical setting using scenarios. The
ticum-related outcomes was evaluated using instruments to measure instructor lectured on the SBAR technique; the lecture included the
communication, communication clarity, handover confidence, importance of interprofessional communication, what SBAR is, how we

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Table 1
SBAR communication program.

Learning processa Practicum day Contents Methods Duration

Pretest Scenario I Pretest

SBAR orientation Small group teaching

[1] Concrete
Orientation Scenario I Discussion 1.5 h
experience
Scenario II Role-plays

[2] Reflective Observing SBAR

Day 1-2 SBAR experience 2 days
observation in clinical settings

Role-plays
[3] Abstract Clinical SBAR case I Providing feedback
Day 3 1h
conceptualization Scenario III Small group teaching
Discussion

Observing SBAR
Day 4-5 SBAR experience 3 days
in clinical settings

[4] Active
experimentation Role-plays
Clinical SBAR case II Providing feedback
Conference 1.5 h
Scenario IV Small group teaching
Discussion

Posttest Scenario V Posttest

a
The learning process was based on experiential learning theory (Kolb, 1984). Scenarios included
the following health problems: bronchiolitis with desaturation, febrile convulsion, constipation,
ventricular septal defect with heart failure, and acute gastroenteritis with severe dehydration.

can communicate using the SBAR tool, and the first scenario. Students regarding their cases and received feedback from the instructor.
practiced by role playing SBAR communication using the second sce- Students applied SBAR using the fourth scenario, about a patient with
nario, about patients with constipation. The instructor informed stu- congestive heart failure, as an active experimentation phase. In con-
dents of an assignment about nurses' SBAR cases in which they should trast, the control group students learned regular nursing processes and
engage in observations in the hospital unit for the practicum of the next therapeutic communication with patients and family, in only 30 min.
week.
In the second phase, on practicum days 1 and 2, was carried out to 2.5. Data collection
allow the reflective observation element of experiential learning.
Students were observing the use of SBAR in the clinical setting on their The data were collected from February through June 2018. For a
own. They were taught to recognize how SBAR is used in the clinical pretest, participants filled out questionnaires. Then, audio recordings
setting, experience professional medical communication in the real using the bronchiolitis scenario were conducted after the end of general
world, and reflect on components omitted in the SBAR case in this orientation to the practicum. The posttest was conducted using the
practical setting. In addition, they were given the task of listening to same questionnaires, and audio recordings were made using the sce-
and organizing nurses' communication content using the SBAR tool. nario of patients with acute gastroenteritis following the end of the
The third phase, on practicum day 3, was delivered during an in- program.
structor's visit to the clinical setting. Two to four students engaged in
role play regarding each SBAR case and shared other students' cases. 2.6. Study variables and instruments
Students role played being a clinical nurse notifying the doctor about
the patient's status. The instructor gave students feedback regarding the 2.6.1. Communication performance
adequacy and significance of the SBAR case in each situation. Students SBAR communication was measured using an instrument to assess
were trained in the third scenario, about patients with febrile convul- the accuracy with which nursing students reported patient information
sion. Finally, the instructor helped students to understand gaps between to physicians that employed the SBAR tool regarding patients' problem
theory and practice using both case presentations and scenarios to (Yu and Kang, 2017). This scale contained 12 items in four categories:
support their abstract conceptualization, because some SBAR compo- Situation, Background, Assessment, and Recommendation. Each item in
nents were frequently omitted. The instructor informed students of the tool was rated on a three-point Likert-type scale, with higher scores
second assignment, on other SBAR cases. indicating greater reporting accuracy. Two raters completed the eva-
In the fourth phase, on practicum days 3 and 4, students again luation tool regarding SBAR communication. The Cohen's kappa with
observed the use of SBAR on their own in the clinical setting. They linear weighting (a measure of inter-rater reliability for ordinal cate-
actively experienced SBAR cases in the real clinical world and prepared gories) (Parker et al., 2013) was 0.736 (95% confidence interval [CI]
second SBAR cases in their hospitals during the remaining hospital 0.621–0.851). Kappa values of 0.61–0.80 indicate good agreement
practicum days. Then, during the practicum conference after the hos- (Landis and Koch, 1977).
pital practicum ended, all team members participated in role plays Communication clarity was measured using the interprofessional

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clinical communication tool (Marshall et al., 2009). The scale consisted 3. Results
of eight questions with a five-point Likert scale. The Cohen's kappa with
quadratic weighting (a measure of inter-rater reliability for five ordinal The students in the experimental group were similar in demo-
categories) between the two raters was 0.724 (95% CI 0.483–0.964). graphics to those in the control group (Table 2).
The results indicated that students in the experimental group re-
2.6.2. Communication perception ported significantly higher SBAR communication, communication
Handover confidence was assessed using a visual analog scale clarity, and handover confidence compared to students in the control
(VAS), with a higher score indicating stronger confidence (Yu and Kang, group. Clinical practice self-efficacy, perceived nurse–physician colla-
2017). boration, and practicum satisfaction did not differ between the groups.
There was a significant increase in SBAR communication, with
2.6.3. Practicum-related outcomes scores of 17.65 ± 3.16 for the experimental group and 9.02 ± 2.52
Practicum satisfaction was also evaluated using a VAS, between 0 for the control group at posttest (p < .001). Moreover, there was a
(dissatisfied) and 10 (fully satisfied). Perceived nurse–physician colla- significant difference in all domains' scores between two groups. In the
boration level was evaluated using a Korean version of the nurse–- control group, the mean differences between posttest and pretest scores
physician collaboration scale, including 27 questions measured on a of subscales were 1.02–0.56. In the experimental group, differences
five-point Likert scale (Mun, 2015). Cronbach's α value was 0.91. between posttest and pretest scores of subscales were 1.55–2.87
Clinical practice self-efficacy through the practicum was measured (Table 3).
using a Korean version of the learning self-efficacy scale to assess the Students showed a significant increase in communication clarity at
individuals' perception related to trying new things, including 10 items posttest, with scores of 29.90 ± 3.32 for the experimental group and
with a seven-point Likert scale (Park and Kweon, 2012). Cronbach's α 22.41 ± 2.24 for the control group (p < .001) (Table 3).
value was 0.93. There were significant differences in handover confidence at
posttest, with reporting scores of 6.05 ± 1.63 in the experimental
group and 5.14 ± 1.81 in the control group (p < .001) (Table 4).
2.7. Data analysis
There were no significant differences in the practicum satisfaction
between the two groups: 7.92 ± 1.54 in the experimental group and
Descriptive statistics, such as mean and percentage, were used to
7.46 ± 1.50 in the control group (p = .876). There were no significant
assess participants' characteristics. We conducted chi-squared tests and
differences in the clinical practice self-efficacy: 59.52 ± 6.64 score in
independent t-tests to examine the homogeneity of the groups and used
the experimental group and 56.87 ± 6.87 score in the control group
an independent t-test for comparison of outcomes between the control
(p = .109). The nurse–physician collaboration was 101.47 ± 10.73 in
and experimental groups using SPSS Statistics 24.0.
the experimental group and 98.00 ± 12.47 in the control group
(p = .904) (Table 4).
2.8. Ethical considerations

This study was performed after receiving approval from the in- 4. Discussion
stitutional review board of D Hospital. The students were informed of
the need, purpose, and methods of this study by the researcher and The SBAR communication program included effective components,
voluntarily participated in this research. such as scenario and role play on nursing education, as well as SBAR

Table 2
Participants’ demographics.
Variables Categories Total (n=81) N(%) or Exp (n=40) N(%) or Cont (n=41) N(%) or t or Chi- p
M ± SD M ± SD M ± SD square

Age 22.32 ± 2.43 22.65 ± 21.97 22.65 ± 2.93 1.26 0.209

Gender Female 73 (90.1) 38 (95.0) 35 (85.4) 2.11 0.264
Male 8 (9.9) 2 (5.0) 6 (14.6)
Religion Yes 32 (39.5) 14 (35.0) 18 (43.9) 1.77 0.621
No 49 (60.5) 26 (65.0) 23 (56.1)
Attendance of communication class Yes 46 (56.8) 25 (62.5) 21 (51.2) 1.05 0.372
No 35 (43.2) 15 (37.5) 20 (48.8)
Activity of club or student council Yes 51 (63.0) 27 (67.5) 24 (58.5) 0.69 0.492
No 30 (37.0) 13 (32.5) 17 (41.5)
Satisfaction of theory subjects Not satisfied at all 0 0 0 −0.90 0.367
Not satisfied 1 (1.2) 0 1 (2.4)
Neutral 21 (25.9) 9 (22.5) 12 (29.3)
Satisfied 53 (65.4) 28 (70.0) 25 (61.0)
Very satisfied 6 (7.4) 3 (7.5) 3 (7.3)
Satisfaction of clinical practice Not satisfied at all 0 0 0 −0.86 0.392
Not Satisfied 2 (2.5) 0 2 (4.9)
Neutral 25 (30.9) 12 (30.0) 13 (31.7)
Satisfied 50 (61.7) 26 (65.0) 24 (58.5)
Very satisfied 7 (8.6) 2 (5.0) 5 (4.9)
Average academic grade < 2.5 5 (6.2) 1 (2.5) 4 (9.8) 3.98 0.408
2.5−3.0 27 (33.3) 7 (17.5) 20 (48.8)
3.0−3.5 30 (37.0) 14 (35.0) 16 (39.0)
> 3.5 19 (23.5) 18 (45.0) 1 (2.4)
Experience of hospital visiting Yes 3 (3.7) 1 (2.5) 2 (4.9) 0.32 > 0.999
program No 78 (96.3) 39 (97.5) 39 (95.1)
Experience of hospital internship Yes 6 (7.4) 1 (2.5) 5 (12.2) 2.77 0.096
No 75 (92.6) 39 (97.5) 36 (87.8)

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Table 3
Comparisons of SBAR communication and communication clarity between the two groups.
Variables Categories Range Groups Pre-test (M ± SD) Post-test (M ± SD) t or F p

SBAR communication S 0–6 Exp (n = 40) 3.47 ± 1.35 5.02 ± 1.04 −5.25 < 0.001
Cont (n = 41) 3.68 ± 1.57 3.60 ± 1.44
B 0–6 Exp (n = 40) 0.95 ± 1.01 3.82 ± 1.81 −6.25 < 0.001
Cont (n = 41) 0.74 ± 0.97 1.29 ± 1.28
A 0–10 Exp (n = 40) 5.00 ± 1.66 6.97 ± 1.74 −6.04 < 0.001
Cont (n = 41) 5.02 ± 1.75 4.00 ± 1.58
R 0–2 Exp (n = 40) 0.05 ± 0.22 1.82 ± 0.44 −16.98 < 0.001
Cont (n = 41) 0.14 ± 0.52 0.12 ± 0.33
Total 0–24 Exp (n = 40) 9.47 ± 2.43 17.65 ± 3.16 −11.18 < 0.001
Cont (n = 41) 9.58 ± 2.67 9.02 ± 2.52
Communication clarity Total 0–40 Exp (n = 40) 22.40 ± 2.20 29.90 ± 3.22 −12.11 < 0.001
Cont (n = 41) 22.98 ± 3.00 22.41 ± 2.24

S, Situation; B, Background; A, Assessment; R, recommendation.

Table 4
Comparisons of handover confidence, practicum satisfaction, clinical practice self-efficacy, and perceived nurse-physician collaboration between the two groups.
Variables Groups Pre-test (M ± SD) Post-test (M ± SD) M (df) ± SD t p

Handover confidence Exp (n = 40) 4.27 ± 1.73 6.05 ± 1.63 1.77 ± 1.84 −4.40 < 0.001
Cont (n = 41) 5.02 ± 1.73 5.14 ± 1.81 0.12 ± 1.51
Practicum satisfaction Exp (n = 40) 7.25 ± 1.72 7.92 ± 1.54 0.67 ± 2.20 −0.15 0.876
Cont (n = 41) 6.85 ± 1.31 7.46 ± 1.50 0.60 ± 1.48
Clinical practice self-efficacy Exp (n = 40) 55.0 ± 7.92 59.52 ± 6.64 4.52 ± 7.36 −1.62 0.109
Cont (n = 41) 55.18 ± 8.64 56.87 ± 6.87 1.69 ± 8.33
Nurse-physician collaboration Exp (n = 40) 97.30 ± 10.29 101.47 ± 10.73 4.17 ± 13.44 −0.12 0.904
Cont (n = 41) 94.16 ± 11.67 98.00 ± 12.47 3.83 ± 11.87

tools. Both scenarios and role play are extensively used in various (Bogossian et al., 2014). The total score of 17.65 at posttest following
nursing curricula and these strategies have various advantages in stu- the implementation of the program was higher than that of 17.29 in a
dents' learning (Richardson et al., 2017; Thomas et al., 2009; Yu and previous study with SBAR role play using simulation, and there were
Kang, 2017). Chaharsoughi et al. (2014) carried out the SBAR program significant changes in scores for the Situation, Background, and Re-
with role plays for nurses. We included common childhood health commendation domains, but not the Assessment domain (Yu and Kang,
problems, such as respiratory and febrile disease. Scenarios pertaining 2017). In particular, the improvement of the Recommendation domain
to major health problems could help nursing students improve their following the program is noteworthy, because Recommendation accu-
clinical capacity because they cannot experience all clinical situations racy is low among nurses (Spooner et al., 2016).
in the hospital practicum. In addition, the introduction of SBAR before Second, the program increased students' perception on commu-
the practicum could enhance students' interests in nurse–physician nication clarity. This result is similar with that of a study that conducted
communication. Clarity and precision of message are important for an SBAR education program involving role play and simulator-en-
effective interprofessional communication (Robinson et al., 2010). hanced communication clarity (Yu and Kang, 2017). The program was
The SBAR communication program was implemented in a pediatric not effective in terms of the “Emphasis on an emergency patients'
nursing practicum. The use of scenarios and observation of SBAR problem” item, a result that resembles the finding of a previous study
communication in clinical settings provided concrete experience to the (Yu and Kang, 2017). Therefore, nursing faculties should educate stu-
students, helping them to understand communication problems be- dents to recognize and respond to clinical deterioration (Bucknall et al.,
tween nurses and physicians. Understanding gaps between theory and 2016).
practice is necessary for students' abstract conceptualization regarding Third, the program enhanced nursing students' handover con-
the use of SBAR because parts of information conveyed during com- fidence. Findings of previous studies were mixed. Thomas et al. (2009)
munication between nurses and physician tend to be omitted (Joffe reported that simulation-based education had a positive impact on
et al., 2013). Accordingly, the instructor provided participants feedback handover confidence, while Yu and Kang (2017) reported that there
about real cases observed in the clinical setting. Although simulation- was no significant improvement. This is possibly because our program
based educational programs are effective in educational contexts, par- provided various scenarios and repeated feedback to nursing students
ticularly as it pertains to communication, there has been limited re- who have been adequately exposed to SBAR cases.
search testing whether this communication improvement in the simu- Fourth, the program was not effective in increasing practicum sa-
lation room reflects real performances in hospitals (Kaplonyi et al., tisfaction. The posttest means of 7.92 in the experimental group and
2017). 7.46 in the control group were higher than those of 7.42 in the ex-
First, the implementation of SBAR communication effects an in- perimental group and 5.35 in the control group in a previous study (Yu
crease of SBAR communication. In a previous study, the SBAR program and Kang, 2017), but there was no significant difference between the
with role play for nurses positively influenced SBAR communication two groups in this study. Practicum satisfaction has relationships with
(Chaharsoughi et al., 2014). All four categories' scores significantly various factors, such as stress and depression (Jeong and Park, 2013),
increased following participation in the program, with particularly curriculum, grades, and satisfaction on nursing major (Kim et al.,
higher improvements occurring in the Background domain. This is 2013). To enhance students' practicum satisfaction, efforts to decrease
noteworthy because nurses often omit information or report wrong psychological distress related to the practicum, as well as improvements
information regarding the background cue (Joffe et al., 2013). There of educational factors by school faculty members, may be necessary.
was a small change in the Situation domain, suggesting that nursing Fifth, this program was not effective in increasing clinical practice
students did recognize the aggravating situation of the patients self-efficacy. Simulation education's effects on self-efficacy depend on

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study design; the simulation had a positive impact on self-efficacy in publication.

pretest-posttest designs, but self-efficacy in the simulation group did not
appear higher than under other teaching methods in experimental Acknowledgments
studies (Cant and Cooper, 2017). In another study, self-efficacy in-
creased in a dedicated education unit that provided individual men- The abstract has been selected for a poster presentation at the 22nd
torship (George et al., 2017). Notably, these findings suggest that strong East Asian Forum for Nursing Scholars (EAFONS) 2019, to be held on
environmental support pertaining to the clinical practicum and re- January 17 and 18, 2019, in Singapore. This abstract has also been
peated education should be provided to increase the self-efficacy of the selected for The Best Poster Presentation Award competition.
nursing students.
Sixth, we observed no change in the perceived collaborations be- References
tween nurses and physicians between the two groups. This finding is
contrary to a previous study reporting that SBAR simulation education Australian Nursing and Midwifery Federation,. (2014). National practice standards for
for pharmacy students increased favorable attitudes regarding the in- nursing in general practice Retrieved June 1, 2018, from http://anmf.org.au/pages/
national-practice-standards-for-nurses-in-general-practice.
terprofessional collaboration and self-concept of interprofessional Bogossian, F., Cooper, S., Cant, R., Beauchamp, A., Porter, J., Kain, V., Bucknall, T.,
competence (Kostoff et al., 2016). A two-hour lecture on communica- Phillips, N.M., 2014. Undergraduate nursing students' performance in recognising
tion skills and the importance of collaboration increased favorable at- and responding to sudden patient deterioration in high psychological fidelity simu-
lated environments: an australian multi-centre study. Nurse Educ. Today 34,
titudes toward collaboration and communication among nurses 691–696. https://doi.org/10.1016/j.nedt.2013.09.015.
(McCaffrey et al., 2012). Experiences of inadequate communication Bowling, A.M., 2015. The effect of simulation on skill performance: a need for change in
could lead to inadequate learning for students in the real world pediatric nursing education. J. Pediatr. Nurs. 30 (3), 439–446. https://doi.org/10.
1016/j.pedn.2014.12.010.
(Jarvelainen et al., 2018). To enhance perceived collaborations be-
Buckley, S., Ambrose, L., Anderson, E., Coleman, J. J., Hensman, M., Hirsch, C., Hodson,
tween nurses and physicians, further modifications of this program will J., Morley, D., Pittaway, S., Stewart, J., 2016. Tools for structured team commu-
be needed for nursing students. nication in pre-registration health professions education: a best evidence medical
education (beme) review: Beme guide no. 41. Med. Teach. 38(10), 966–980. 10.
In summary, the SBAR program improves communication skill ac-
1080/0142159x.2016.1215412.
quisition of nursing students and there were no improvements in gen- Bucknall, T. K., Forbes, H., Phillips, N. M., Hewitt, N. A., Cooper, S., Bogossian, F., 2016.
eral perception related to practica. These findings present comparable An analysis of nursing students' decision-making in teams during simulations of acute
outcomes with other SBAR communication programs using simulators. patient deterioration. J. Adv. Nurs. 72(10), 2482–2494. https://doi.org/10.1111/jan.
13009.
The SBAR communication program linked to a clinical practicum, Cant, R.P., Cooper, S.J., 2017. Use of simulation-based learning in undergraduate nurse
without the use of a simulator, could be a cost-effective strategy; this is education: an umbrella systematic review. Nurse Educ. Today 49, 63–71. https://doi.
particularly true for a nursing curriculum that only allows a relatively org/10.1016/j.nedt.2016.11.015.
Cantrell, M.L., Meyer, S.L., Mosack, V., 2017. Effects of simulation on nursing student
low number of hours for simulation courses. stress: an integrative review. J. Nurs. Educ. 56 (3), 139–144. https://doi.org/10.
3928/01484834-20170222-04.
4.1. Limitations of the study Chaharsoughi, N.T., Ahrari, S., Alikhah, S., 2014. Comparison the effect of teaching of
sbar technique with role play and lecturing on communication skill of nurses. J.
Caring Sci. 3 (2), 141–147. https://doi.org/10.5681/jcs.2014.015.
First, this study has limited generalizability, as it was a single-in- Chan, Z.C., 2012. Role-playing in the problem-based learning class. Nurse Educ. Pract. 12
stitution study. Second, the instruments used to evaluate the practice- (1), 21–27. https://doi.org/10.1016/j.nepr.2011.04.008.
Compton, J., Copeland, K., Flanders, S., Cassity, C., Spetman, M., Xiao, Y., Kennerly, D.,
related outcome variables did not influence the difference in percep- 2012. Implementing sbar across a large multihospital health system. Jt. Comm. J.
tions between the two groups, because the program was conducted Qual. Patient Saf. 38 (6), 261–268.
within a relatively short period. Farzi, S., Irajpour, A., Saghaei, M., Ravaghi, H., 2017. Causes of medication errors in
intensive care units from the perspective of healthcare professionals. J. Res. Pharm.
Pract. 6 (3), 158–165 (10.4103/jrpp.JRPP_17_47).
5. Conclusions George, L. E., Locasto, L. W., Pyo, K. A., T, W. Cline., 2017. Effect of the dedicated
education unit on nursing student self-efficacy: A quasi-experimental research study.
We developed an SBAR communication program based on experi- Nurse Educ. Pract. 23, 48–53. https://doi.org/10.1016/j.nepr.2017.02.007.
Jarvelainen, M., Cooper, S., Jones, J., 2018. Nursing students' educational experience in
ential learning theory in a pediatric nursing practicum. The SBAR regional Australia: reflections on acute events. A qualitative review of clinical in-
communication program improves senior nursing students' commu- cidents. Nurse Educ. Pract. 31, 188–193. https://doi.org/10.1016/j.nepr.2018.06.
nication skill acquisition and handover confidence by effectively in- 007.
Jeong, S.H., Park, S.H., 2013. Relationship among stress, depression, and satisfaction to
tegrating the situations they face into scenarios and by observing si- clinical practice among nursing students. Korean J. Rehabil. Nurs. 16 (1), 47–54.
tuations in the real clinical setting. It is uncertain whether the program Joffe, E., Turley, J.P., Hwang, K.O., Johnson, T.R., Johnson, C.W., Bernstam, E.V., 2013.
improved nursing students' other perceptions related to the practicum. Evaluation of a problem-specific sbar tool to improve after-hours nurse-physician
phone communication: a randomized trial. Jt. Comm. J. Qual. Patient Saf. 39 (11),
Multi-institutional studies and applications in other nursing practica are 495–501.
needed to evaluate the impact of the SBAR communication program on Joyner, B., Yound, L., 2006. Teaching medical students using role play: twelve tips for
nursing students' communication skills and perception outcomes. successful role plays. Med. Teach. 28 (3), 225–229. https://doi.org/10.1080/
01421590600711252.
Kaplonyi, J., Bowles, K.A., Nestel, D., Kiegaldie, D., Maloney, S., Haines, T., Williams, C.,
Funding source 2017. Understanding the impact of simulated patients on health care learners' com-
munication skills: a systematic review. Med. Educ. 51 (12), 1209–1219. https://doi.
org/10.1111/medu.13387.
This study received funding from the Center for Teaching and
Kim, J., Lee, A.-R., Eo, Y., 2013. Clinical practice performance according to type of
Learning of Daegu Haany University (January 2018). practices and satisfaction of clinical practice in students at child health nursing. J.
Korean Acad. Soc. Nurs. Educ. 19 (4), 542–548.
Ethical approval Kim, HS., Oh, J., Park, CS., Yu, MA., Yoo, H., Choi, JH., Kim, G., Choi, EK., 2017.
Pediatric nursing caring for children and their families. Soomoonsa, Paju,
Kyeonggi-do.
This study was performed after institutional review board approval Kolb, D.A., 1984. Experiential Learning: Experience as the Source of Learning and
(IRB No. DHUMC-D-18004 January 20/2018) in Daegu Oriental Development. Prentice Hall, Englewood Cliffs, NJ.
Korean Accreditation Board of Nursing Education, 2017. Manual for Korean Nursing
Hospital of Daegu Haany University. Education Accreditation. Retrieved October 10, 2017 from. https://www.kabone.or.
kr/HyAdmin/upload/goodFile/120190121095056.pdf.
Declaration of Competing Interest Kostoff, M., Burkhardt, C., Winter, A., Shrader, S., 2016. An interprofessional simulation
using the sbar communication tool. Am. J. Pharm. Educ. 80 (9), 157. https://doi.org/
10.5688/ajpe809157.
There were no known conflicts of interest associated with this

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J.-Y. Uhm, et al. Nurse Education Today 80 (2019) 78–84

Lancaster, G., Kolakowsky-Hayner, S., Kovacich, J., Greer-Williams, N., 2015. a pre and post educational intervention study. Nurse Educ. Today 54, 51–55. https://
Interdisciplinary communication and collaboration among physicians, nurses, and doi.org/10.1016/j.nedt.2017.04.022.
unlicensed assistive personnel. J. Nurs. Scholarsh. 47 (3), 275–284. https://doi.org/ Robinson, F.P., Gorman, G., Slimmer, L.W., Yudkowsky, R., 2010. Perceptions of effective
10.1111/jnu.12130. and ineffective nurse-physician communication in hospitals. Nurs. Forum 45 (3),
Landis, J.R., Koch, G.G., 1977. The measurement of observer agreement for categorical 206–216. https://doi.org/10.1111/j.1744-6198.2010.00182.x.
data. Biometrics 33 (1), 159–174. Shin, S., Yang, E., Hwang, E., Kim, K., Kim, Y., Jung, D., 2017. Current status and future
Lisko, S.A., O'Dell, V., 2010. Integration of theory and practice: experiential learning direction of nursing education for clinical practice. Korean Med. Educ. Rev. 19 (2),
theory and nursing education. Nurs. Educ. Perspect. 31 (2), 106–108. 76–82.
MacLean, S., Kelly, M., Geddes, F., Della, P., 2017. Use of simulated patients to develop Society of Pediatric Nursing, 2017. Pediatric nurse core competencies Retrieved March 5,
communication skills in nursing education: an integrative review. Nurse Educ. Today 2018, from. http://www.pedsnurses.org/page/core-competencies.
48, 90–98. https://doi.org/10.1016/j.nedt.2016.09.018. Spooner, A.J., Aitken, L.M., Corley, A., Fraser, J.F., Chaboyer, W., 2016. Nursing team
Marshall, S., Harrison, J., Flanagan, B., 2009. The teaching of a structured tool improves leader handover in the intensive care unit contains diverse and inconsistent content:
the clarity and content of interprofessional clinical communication. Qual. Saf. Health. an observational study. Int. J. Nurs. Stud. 61, 165–172. https://doi.org/10.1016/j.
Care 18 (2), 137–140. https://doi.org/10.1136/qshc.2007.025247. ijnurstu.2016.05.006.
McCaffrey, R., Hayes, R.M., Cassell, A., Miller-Reyes, S., Donaldson, A., Ferrell, C., 2012. Tang, C.J., Chan, S.W., Zhou, W.T., Liaw, S.Y., 2013. Collaboration between hospital
The effect of an educational programme on attitudes of nurses and medical residents physicians and nurses: an integrated literature review. Int. Nurs. Rev. 60 (3),
towards the benefits of positive communication and collaboration. J. Adv. Nurs. 68 291–302. https://doi.org/10.1111/inr.12034.
(2), 293–301. https://doi.org/10.1111/j.1365-2648.2011.05736.x. Thomas, C.M., Bertram, E., Johnson, D., 2009. The sbar communication technique:
Mun, E-H., 2015. Reliability and validity of the korean version of nurse-physician col- teaching nursing students professional communication skills. Nurse Educ. 34 (4),
laboration scale (K-NPCS) (Master dissertation), Eulji University Daejeon, South 176–180. https://doi.org/10.1097/NNE.0b013e3181aaba54.
Korea. Wang, W., Liang, Z., Blazeck, A., Greene, B., 2015. Improving chinese nursing students'
Noh, G.O., Son, H.K., Kim, D.H., 2016. Effect of sbar education program based on si- communication skills by utilizing video-stimulated recall and role-play case scenarios
mulation practice on report clarity and confidence in nursing students. Korean J. to introduce them to the sbar technique. Nurse Educ. Today 35 (7), 881–887. https://
Health Commun. 11 (2), 145–153. doi.org/10.1016/j.nedt.2015.02.010.
Park, S.Y., Kweon, Y.R., 2012. The effect of using standardized patients in psychiatric World Health Organization, 2010. Framework for Action on Interprofessional Education
nursing practical training for nursing college students. J. Korean Acad. Psychiatr. and Collaborative Practice. Retrieved June 5, 2018, from. http://www.who.int/hrh/
Ment. Health Nurs. 21 (1), 79–88. resources/framework_action/en/.
Parker, R.I., Vannest, K.J., Davis, J.L., 2013. Reliability of multi-category rating scales. J. Yu, M., Kang, K.J., 2017. Effectiveness of a role-play simulation program involving the
Sch. Psychol. 51 (2), 217–229. https://doi.org/10.1016/j.jsp.2012.12.003. sbar technique: a quasi-experimental study. Nurse Educ. Today 53, 41–47. https://
Richardson, J., Grose, J., Bradbury, M., Kelsey, J., 2017. Developing awareness of sus- doi.org/10.1016/j.nedt.2017.04.002.
tainability in nursing and midwifery using a scenario-based approach: evidence from

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