title: Beyond communication: the role of standardized protocols in a changing health care environment.
abstract: BACKGROUND
  Communication errors have grave consequences in health care settings. The situation-background-assessment-recommendation (SBAR) protocol has been theorized to improve communication by creating a common language between nurses and physicians in acute care situations. This practice is gaining acceptance across the health care field. However, as yet, there has been little investigation of the ways in which SBAR may have an impact on how health care professionals operate beyond the creation of a common language.
  
  
  OBJECTIVE
  The purposes of the study were to explore the implementation of the SBAR protocol and investigate the potential impact of SBAR on the day-to-day experiences of nurses.
  
  
  METHODS
  We performed a qualitative case study of 2 hospitals that were implementing the SBAR protocol. We collected data from 80 semistructured interviews with nurses, nurse manager, and physicians; observation of nursing and other hospital activities; and documents that pertained to the implementation of the SBAR protocol. Data were analyzed using a thematic approach.
  
  
  RESULTS
  Our analysis revealed 4 dimensions of impact that SBAR has beyond its use as a communication tool: schema formation, development of legitimacy, development of social capital, and reinforcement of dominant logics.
  
  
  CONCLUSIONS
  The results indicate that SBAR may function as more than a tool to standardize communication among nurses and physicians. Rather, the findings indicate that SBAR may aid in schema development that allows rapid decision making by nurses, provide social capital and legitimacy for less-tenured nurses, and reinforce a move toward standardization in the nursing profession. Our findings further suggest that standardized protocols such as SBAR may be a cost-effective method for hospital managers and administrators to accelerate the socialization of nurses, particularly new hires.
authors.affiliation: Mississippi State University, PO Box 9581, Mississippi State, USA. james.vardaman@msstate.edu
authors.forename: James M
authors.initials: JM
authors.lastname: Vardaman
authors.forename: Paul
authors.initials: P
authors.lastname: Cornell
authors.forename: Maria B
authors.initials: MB
authors.lastname: Gondo
authors.forename: John M
authors.initials: JM
authors.lastname: Amis
authors.forename: Mary
authors.initials: M
authors.lastname: Townsend-Gervis
authors.forename: Carol
authors.initials: C
authors.lastname: Thetford
mesh_terms: D003422:Critical Care; D006801:Humans; D033183:Interdisciplinary Communication; D007407:Interviews as Topic; D009730:Nursing Assessment / Q000592:standards; D009741:Nursing Staff, Hospital; D061214:Patient Safety