A practical nurse (PN) is caring for a client who suddenly develops acute respiratory distress. The PN prepares to contact the covering healthcare provider using the ISBAR (Identify, Situation, Background, Assessment, Recommendation) communication framework. Place the following statements in the correct order the PN should deliver them.
- 1"Hello, this is the PN on the medical-surgical unit calling about the client in room 314."
- 2"The client is reporting sudden, sharp chest pain and is experiencing acute shortness of breath."
- 3"The client was admitted three days ago for a deep vein thrombosis and is currently receiving intravenous heparin."
- 4"The client's oxygen saturation has dropped to 86% on room air, and I am concerned about a potential pulmonary embolism."
- 5"I need you to come to the unit immediately to evaluate the client and determine if a stat CT scan is needed."
Answer
The correct sequence follows the ISBAR framework: Identify, Situation, Background, Assessment, and Recommendation.
Effective interprofessional collaboration requires standardized communication to ensure client safety and prevent errors. The ISBAR framework organizes critical information logically. The nurse first identifies themselves and the client. Next, the acute situation (chest pain and dyspnea) is reported to immediately establish urgency. This is followed by the relevant background (DVT and heparin) to provide context. Then, the nurse shares their assessment data (vital signs and clinical impression). Finally, the nurse makes a specific recommendation or request (immediate evaluation) to ensure the client receives timely medical intervention.
Step-by-Step Solution
Key Concept
ISBAR Communication Framework