SITUATION,BACKGROUND,ASSESSMENT , AND RECOMMENDATION (SBAR) MAY BENEFIT INDIVIDUALS WHO FREQUENT EMERGENCY DEPARTMENTS:ADULTS WITH SICKLE CELL DISEASE Authors: Coretta Jenerette, PhD, RN, AOCN, and Cheryl Brewer, MSN, RN, Chapel Hill, NC Section Editors: Reneé S. Holleran, APRN, PhD, CEN, CCRN, CFRN, CTRN, FAEN, FNP-BC, and Andrew D. Harding, RN, MS, CEN, NEA-BC, FAHA E vidence-based research supports the use of situa- tion, background, assessment, and recommenda- tion (SBAR) —a collaborative communication strategy—to improve communication among health care providers. 1-3 SBAR has been found to assist with structur- ing and standardizing communication and is considered an easy-to-remember technique that provides for consis- tent, structured communication between members of the health care team. 4 However, there has been no published support for the usefulness of SBAR as a communication technique between health care providers and patients. We present a vulnerable population, individuals who fre- quent the emergency department, and an example of how SBAR can be used to improve communication and per- haps satisfaction with the care-seeking experience. Sickle Cell Disease Sickle cell disease (SCD) refers to a family of inherited autosomal recessive genetic disorders that affects about 1 in 365 African Americans, with approximately 89,079 per- sons having the disease in the United States. 5 The clinical manifestations of SCD often lead to unpredictable episodes of pain and feelings of inadequacy regarding patients’ care. 6 For these reasons, many adults with SCD avoid the health care system whenever possible and manage their pain at home. 7 Using the iceberg analogy, Smith and Scherer 7 note that most of the iceberg of SCD pain is submerged at home whereas only the tip of the iceberg is seen by health care providers. However, for individuals with SCD who do seek acute care, the majority of visits are related to painful crises. 8,9 The extent of treatment for a painful SCD crisis depends on the health care provider, who assesses the SCD patient’s presentation and ultimately decides whether the individual’s report of pain is credible and deserving of treatment. 10,11 Individuals with SCD are often labeled as “frequent flyers.” Frequent flyers are individuals who frequent the emergency department, visit several emergency depart- ments to obtain pain medication, or are thought to fre- quent the emergency department for nonurgent health concerns. 12 Individuals who need to frequent the emer- gency department need skills to navigate the system to have a positive care-seeking experience. SBAR and SCD Currently, adults with SCD who seek care in an emergency department with complaints of an acute pain episode may wait an average of 90 minutes for the first analgesic to be given. 13 Delays may be due in part to the fact that the pain of SCD is poorly understood and it is difficult to objec- tively assess a pain crisis. Additional barriers to adequate pain management include the fact that most individuals with SCD in the United States are African American and many are of lower socioeconomic status. 14 For these rea- sons and perhaps others, when young adults with SCD seek treatment for acute pain in an emergency department, there is great potential for racial stereotyping, mistrust, and problematic physician-patient communication. 15 These factors may result in a negative pain manage- ment experience. Individuals with SCD are concerned Coretta Jenerette is an Assistant Professor, School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC. Cheryl Brewer is a PhD Candidate, School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC. This work was supported by a grant from the National Institute of Nursing Research (K23NR011061) to C.J. For correspondence, write: Coretta Jenerette, PhD, RN, AOCN, CB # 7460, School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599; E-mail: coretta.jenerette@unc.edu. J Emerg Nurs 2011;37:559-61. Available online 5 May 2011. 0099-1767/$36.00 Copyright © 2011 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved. doi: 10.1016/j.jen.2011.02.012 CLINICAL NOTEBOOK November 2011 VOLUME 37 • ISSUE 6 WWW.JENONLINE.ORG 559