Running Head: TEACHING PROJECT SUMMARY

Teaching Project Summary Paper

Erin Keim

Old Dominion University

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Introduction

I am a PACU nurse (Post-Anesthesia Care Unit). This is a fast-paced unit that sees 30-50

cases a day come through the doors and it requires each nurse to be efficient and communicate

well. Each nurse sees 1-2 patients at a time and recovers each patient in usually two hours or

less. I see roughly eight patients a day, on average. Because this unit has such a high turnover

rate, with patients coming and going quickly, it is crucial to have an effective communication

tool between nurses with handoff of care. The SBAR (Situation, Background, Assessment,

Recommendation) form is a tool used throughout the hospital as a means of communication to

the next nurse. The SBAR form used in PACU is specific for surgical procedures. The SBAR

form covers the patients procedure, surgeon, date/time, medical/surgical history, allergies,

medications/fluids received in the Operating Room, estimated blood loss, urine output, drain

output in the operating room, IV site, drains, catheters, incisions and dressings, a quick

assessment, any STAT orders or consults, and any other pertinent information. Any valuable

information a nurse would need about a surgical patient coming to his/her floor would be on this

form (see Appendix A for blank SBAR form).

Needs Assessment

A problem that I have identified in the PACU is many nurses are not completely filling

this form out before faxing it to the floor the patient is being admitted to. Many times there are

days where there are too many surgical patients and not enough open hospital beds to

accommodate them. In this situation, a PACU nurse will then assume care of four medical-

surgical patients who are now considered in holding for a room. The recovery nurse is often

found with incomplete SBAR forms, requiring the hold nurse to search for needed information.

This causes problems when the recovery nurse has a maximum patient load of two and the hold
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nurse now has four. It also poses issues with the floor nurse, who does not know the patient or

has had time to assess the patient, receives an incomplete form. In an emergency situation, if the

nurse needed vital information regarding the patient, she could easily look on the form to find

most of it. She should have a well-developed picture of the patient and their health before the

patient even arrives to her unit. According to the ANA Standards of Practice, it is essential that

the nurse have an accurate assessment of the patient in order to identify the potential problems,

plan their care, and implement any interventions during the patients stay in PACU. A good

nurse cannot help any patient unless she can thoroughly assess her patients.

A survey was collected (see Appendix B for Needs Assessment Survey) to determine

learning styles, preferences, and problems in PACU before the teaching session took place. Data

was then used to correlate with visual aids and teaching styles.

Teaching Plan

On the unit I work in, we have 12 PACU nurses, usually 8-10 a day, working four, 9

hour shifts. On a typical day, two to three nurses arrive at 0800, one or two at 0900, one at 1000,

one or two at 1200, and one at 1300. Because it is such a fast-paced work day, timing for the

teaching session is crucial and would need to work around the case load and be planned on a

lighter case day. The backgrounds of the nurses are: Intensive Care Unit (ICU), telemetry, and

Emergency Department. The mornings are usually unpredictable- one day the cases may be

coming out slowly, and others, there are cases waiting for nurses at 0800. The busiest hours of

the day are anywhere from 1000-1500. Because of the time constraint and busy atmosphere, it

was thought that the best time to do this teaching session would be on late start Thursdays at

0800 before cases come out. Discussion, visual aids, and demonstration were decided to be the

best route of instruction.

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When I was thinking about which issue poses the biggest problem in PACU that could be

resolved with a teaching session, my choices were two: SBAR form completion and

communication between nurse and anesthesiologist for sign-out of patient from anesthesia care.

The SBAR form would be something easily corrected with one session, whereas the

anesthesia/nurse problem would take some tweaking in many areas and would require a much

larger teaching group, considering there are 12 PACU nurses and 10+ anesthesiologists. From

what I have learned over the years, nurses like instruction to be short and to the point, especially

when it is during their workday. It is impossible to do this teaching session during the middle of

the day, when most people are there due to it being the busiest. On most floors, the busiest times

are at the beginning after change of shift and at the end. In PACU, it is right in the middle of the

day.

The nurses were told in advance about the teaching session, including what day and what

time it would be. Flyers were posted throughout the unit. Anyone that absolutely could not

attend was given opportunities for one-on-one teaching on another day that was appropriate.

This session was held in the break room. A presentation poster including a blank SBAR form

with category descriptions, as well as a SBAR form with sample information was included.

Blank SBAR forms were given to each nurse in attendance. Power point was set up (see

Appendix C for Teaching Session PowerPoint). Other materials included pens/pencils and

clipboards to write on.

There were three objectives used during this teaching session. The first one was

cognitive and the nurses were to discuss within 5-10 minutes, three reasons why we use the

SBAR form as a form of communication between nurses. An affective outcome used was for the
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nurses to express their top five concerns with the inappropriate use of the form and what dangers

it could have caused. And, finally, a psychomotor outcome was used with the nurses showing

100% accuracy in completing the SBAR form with a given scenario. Each outcome was

evaluated using verbal communication/affirmation as well as return demonstration. Each nurse

had to show 100% accuracy after the teaching session on one of her patients. Two nurses out of

the twelve had to be reminded about not leaving blanks, but, overall, the nurses responded well

to this teaching session and felt confident to continue using the form with each patient. The

poster presentation was left in the break room for future reference. The teaching session was

successful and nurses expressed their understanding of the content.

Implementation

Through the use of the SBAR form, poster, and Power Point presentation, the nurses felt

comfortable with the use of the visual aids. There are a few nurses who are from other countries,

but they have been in PACU for 5+ years and are familiar with the SBAR form. The more

seasoned nurses stated that they felt comfortable helping their peers, the newer PACU nurses.

Many of the nurses learn through peer reinforcement. Through polite reminders and

encouragement, the nurses were able to keep each other on target with the SBAR completion.

Time was the biggest obstacle in this teaching session, due to the high volume of patients

coming and going in the PACU. Morning was the best time to teach, but it was still challenging

due to the anticipation of patients coming from the Operating Room (OR).

Evaluation

Each nurse was evaluated during the teaching session as well as throughout the day.

Questions were answered throughout the day as well as visual aids such as the poster, left in the

breakroom as a reference. This teaching session was effective due to the high number of nurses
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completing the form without much coaching. Those who did have questions or leave any blanks

were promptly addressed.

Summary

After this teaching session, I have learned that everyone learns differently. As nurses, not

only do we have to consider the different learning styles, but also time constraints because

nursing is such a busy profession. Anything that is too long needs to be set aside on its own and

count as an education day in which the nurses only focus on that. Nurses need visual aids as well

as the verbal and hands-on. Leaving the poster behind for a little while after the session

reinforces what they have learned and they know that they can look to it for clarification.
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"I pledge to support the honor system of Old Dominion University. I will refrain from any form

of academic dishonesty or deception, such as cheating or plagiarism. I am aware that as a

member if the academic community, it is my responsibility to turn in all suspected violators of

the honor system. I will report to Honor Council hearings if summoned." Erin Keim 4/9/17
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References

Allen, J. (2014). Perianesthesia nursing standards, practice recommendations, and interpretive

statements: 2015-2017. Cherry Hill, NJ: American Society of PeriAnesthesia Nurses.

Bastable, S.B. (2014). Nurse as educator: principles of teaching and learning for nursing

practice. Burlington, MA: Jones & Bartlett Learning.

Looking to improve your bedside report? Try SBAR: Nursing made Incredibly Easy. (n.d.).

Retrieved April 12, 2017 from

http://journals.lww.com/nursingmadeincrediblyeasy/Fulltext/2011/09000/Looking_to_im

prove_your_bedside_report__Try_SBAR.14.aspx

Powell, S.K. (n.d.). Editorial: SBAR-Its Not Just Another Communication Tool. Retrieved April

12, 2017, rom http://www.nursingcenter.com/journalarticle?Article ID=733782

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Appendix
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Appendix A-Blank SBAR Form

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Appendix B- Needs Assessment Survey

PACU Survey

Best way
for you to
learn

Best time
for you to
learn

Problems
identified
at work
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Appendix C- Teaching Session Powerpoint

SB AR
r ep ort
e
plet f care
c o m
r ou ghly
a n d-off o
o
o w to th orm for h
H f
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SBAR
way o is an easy
next f handing and stand

the
n

?
infor urse. Ma off repor ardized

form
m t
cover a on on ny areas to the
o
e use
proce ed includ the pa e f
i nt are
anest dure, m ng: the
e
medi hesia, sur , type of
SBAR
c g
medi al history eon, pas
do w

c t
outpu a ons giv , allergies
,
drain t, incision en, intake
nurse s, etc. It g s, dressin and
g
to tak the infor ives the n s,
Why

e car m e
e of t a on she xt
he pa ne
ent! eds
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t
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se th
e SBA reasons t

ss!
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t ar e m?
t o us t
Discu ing th he pros a
e SBA nd
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easie an we ma
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nurse and be e e things
Now

? r for
the n
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ou th
S B AR in
form k the use
of a is o
me w helpful o f a
aster r mo r
? e
TEACHING PROJECT SUMMARY 16

sa m ple
the

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TEACHING PROJECT SUMMARY 17

o u t the B e
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TEACHING PROJECT SUMMARY 18

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here
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-A e
r
ques this inserv
ons d ice, w

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be e u feel tha e?
er Ti r u nd t you
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t ho r o o o
ughly fi ll the SB f why
t

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Ques

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impro ge s o
v e me ns o n
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form t
is imp fi lling out
ortan t he
t?
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and a ghout the ster
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