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Taiwanese Journal of Obstetrics & Gynecology: Wan-Hua Ting, Fu-Shiang Peng, Ho-Hsiung Lin, Sheng-Mou Hsiao
Taiwanese Journal of Obstetrics & Gynecology: Wan-Hua Ting, Fu-Shiang Peng, Ho-Hsiung Lin, Sheng-Mou Hsiao
Original Article
a r t i c l e i n f o a b s t r a c t
http://dx.doi.org/10.1016/j.tjog.2016.06.021
1028-4559/© 2017 Taiwan Association of Obstetrics & Gynecology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://
creativecommons.org/licenses/by-nc-nd/4.0/).
172 W.-H. Ting et al. / Taiwanese Journal of Obstetrics & Gynecology 56 (2017) 171e174
neonatal outcome because it is a time-consuming technique. As a implementation of the first SBAR Collaborative Communication
result, the primary objective of this study was to evaluate the effect Education course in March 2012. The same questionnaires were
of the SBAR technique on the safety attitudes in the obstetric redistributed approximately 1 year and 3 years later (February 2013
department, especially for the nurses, and the secondary outcome and March 2015, respectively). The baseline data on the nurses
was to evaluate the effect of the SBAR technique on the neonatal were also collected. The 5-minute Apgar scores for all neonates
outcome. were reviewed from the birth medical records of the hospital.
The SAQ elicits staff attitudes through the following six safety
dimensions: (1) teamwork climate (6 items); (2) safety climate (7
Materials and methods
items); (3) job satisfaction (5 items); (4) stress recognition (4
items); (5) perception of management (4 items); (6) and working
This study implemented SBAR Collaborative Communication
conditions (4 items) [3,7]. Each item was answered using a 5-point
Education and was conducted in a medical center from February
Likert scale. The analytical results of the Chinese version demon-
2012 to March 2015. As some pregnant women with symptoms and
strated that all six dimensions have good reliability [7].
signs of preterm labor are treated in the obstetrics ward, all nurses
The STATA software program (version 11.0; Stata Corp, College
in the obstetrics ward and delivery room were asked to participate
Station, TX, USA) was used for the statistical analyses. The Chi-
in this study. The Research Ethics Committee of the Far Eastern
square, one-way analysis of variance, Wilcoxon rank-sum, or
Memorial Hospital (Taipei, Taiwan; ClinicalTrials.gov Identifier.
Fisher's exact test was used, as appropriate. A p value < 0.05 was
NCT01570335) approved this study and waived the requirement to
considered statistically significant.
obtain a signed consent form, as the survey was completely
anonymous.
The SBAR Collaborative Communication Education course was Results
offered as a 1-hour session by our experienced obstetricians during
one of the monthly ward meetings annually. It was first conducted Twenty-nine nurses completed the preintervention survey, 34
in March 2012, and the educational session was repeated annually. completed the first postintervention survey, and 33 completed the
It included a 30-minute lecture on fetal heart beat tracings, a second postintervention survey. There were no statistically signif-
10e15-minute case-based discussion, and a video demonstration. icant differences between the three groups in the baseline data
The content of the lecture was tailored to meet the needs of nurses (Table 2).
to identify nonreassuring fetal heart rate patterns. Clinical cases Most of the value ratings for the teamwork climate, safety
were used for the case-based discussion, enabling in-depth dis- climate, job satisfaction, and working conditions significantly
cussion regarding what occurred, specific considerations, and rea- improved at both postintervention surveys compared with the
sons for actions. The video demonstration contained a video from preintervention survey (Table 3). There were no significant differ-
educational web resources, which compared the traditional ences in the stress recognition or perception of management.
communication and a more effective communication using SBAR. A A total of 331 neonates were born with < 7 5-minute Apgar
novel, customized version of the SBAR handover list was developed scores from January 2010 to February 2015 (Table 4). There were no
for reporting the abnormal findings in fetal heart beat tracings significant differences in the number of the neonates with < 7 5-
(Table 1), and it was placed next to the telephone in the ward minute Apgar scores between the pre- and postintervention
station of the delivery room for further reinforcement. The nurses periods. After subgroup stratification (i.e., preterm and term sub-
in the obstetrics department were requested to report their clinical groups), there were no differences between the pre- and post-
findings and recommendations using the novel SBAR handover list intervention periods.
when abnormal fetal heart beat tracings occurred. To save time
during an emergency, the obstetrician was responsible for making Discussion
final clinical decisions after receiving the nurse's report and double
checking the abnormal fetal heart beat tracing as soon as possible. In this study, we found that the teamwork climate, safety
The nurses were also encouraged to ask the physicians to clarify any climate, job satisfaction, and working conditions were improved
order that was unclear. after the implementation of the SBAR technique. The SBAR tech-
All nurses were asked to answer the Chinese-version of the nique can facilitate communication between nurses and
Safety Attitudes Questionnaire (SAQ) [3,7] prior to the
Table 2
Table 1 Baseline characteristics of the nurses for the pre- and postintervention surveys.
A handover list for reporting the abnormal fetal heart beat tracings.
Variables Preintervention 1st postintervention 2nd postintervention pa
Bed No.: survey (n ¼ 29) survey (n ¼ 34) survey (n ¼ 33)
Name: Age (y) 0.80
21e31 13 (45) 15 (43) 15 (45)
Gestational wk: ( ) < 37 wk, ( ) 37 wk
31e40 12 (41) 16 (47) 14 (42)
1 Cervical dilation: ( ) 3 cm, ( ) 4e9 cm, ( ) 10 cm (fully dilated) 41e50 4 (14) 2 (6) 4 (12)
2 Presence of fetal heart rate decelerations (< 110 beats/min)? 51e60 0 1 (3) 0 (0)
( ) No Working 0.17
( ) Yes experience
( ) Early deceleration (y)
( ) Late deceleration <1 1 (3) 4 (9) 4 (12)
( ) Variable deceleration 1e2 2 (7) 1 (3) 5 (15)
3 Recommendation: 3e4 11 (38) 9 (26) 4 (12)
( ) Prompt vaginal delivery 5e10 9 (31) 14 (41) 10 (30)
( ) Emergency cesarean section 11e20 4 (14) 6 (18) 9 (27)
( ) Observation (consider oxygen supplementation, the left decubitus position, > 20 2 (7) 0 (0) 1 (3)
or intravenous fluid hydration)
Data are presented as n (%).
( ) Others a
Chi-square test.
W.-H. Ting et al. / Taiwanese Journal of Obstetrics & Gynecology 56 (2017) 171e174 173
Table 3
Comparison of the SAQ scores for nurses among the pre- and postintervention surveys.
Teamwork climate 58.6 (11.2) 67.3 (12.5) 70.8 (15.1) 0.002 a vs b, 0.007
a vs c, 0.0007
Safety climate 61.1 (10.9) 67.7 (12.6) 71.0 (15.5) 0.01 a vs b, 0.03
a vs b, 0.006
Job satisfaction 52.5 (18.7) 61.8 (17.4) 70.2 (21.0) 0.002 a vs c, 0.002
Stress recognition 62.9 (16.8) 69.5 (15.2) 68.9 (18.7) 0.26 e
Perception of management 59.4 (12.9) 66.9 (15.0) 67.8 (21.5) 0.12 e
Working conditions 61.4 (13.7) 65.8 (14.1) 72.5 (17.0) 0.02 a vs b, 0.005
b vs c, 0.04
Table 4
Comparison of the 5-minute Apgar scores of neonates between the pre- and postintervention periods.a
Variables Preintervention period 1st post intervention period 2nd postintervention period pb
(n ¼ 3358) (n ¼ 1346) (n ¼ 2539)
obstetricians, improving the teamwork climate. Consistent with This study is limited by the discrepancy between the number of
other studies that demonstrate the effectiveness of the SBAR nurses in each survey period and the lack of a control group.
technique in structured communication interventions, the imple- However, the anonymous questionnaires and long-term follow-up
mentation of the SBAR Collaborative Communication Education data should increase the reliability of our data.
course improved the safety climate [8,9]. In conclusion, the SBAR technique, using a novel structured
Although the percentage of low neonate Apgar scores did not handover list, is a feasible tool for facilitating nurseeobstetrician
improve after the intervention, the SBAR technique and our communication, and it may improve most dimensions of the safety
customized version of the SBAR handover list might help nurses attitudes in the obstetrics department.
organize their findings and make concise reports [10,11], improving
the safety climate. The SBAR technique might better prepare nurses Conflicts of interest
before making calls and might improve their confidence in
communicating with the obstetricians through structuring the The authors have no conflicts of interest relevant to this article.
communication. Although the SBAR technique might be time-
consuming, the implementation of SBAR improved job satisfac-
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