A nurse is giving change-of-shift report using the SBAR technique about a client who has a traumatic brain injury. When reporting information about the client, which of the following should the nurse include in the situation segment of SBAR?

Explanation:

A. Re-collection of data:

This step involves gathering additional information or data about the client's condition. It may be necessary if there are new developments, changes in the client's status, or if the initial data collected was insufficient or inaccurate. Re-collection of data helps ensure that the nurse has comprehensive and accurate information to base the care plan on.

B. Implementation:

Implementation is the phase where the nurse puts the planned interventions into action. This step involves performing nursing actions, administering treatments or medications, providing education and support to the client and their family, and collaborating with other healthcare team members. The nurse follows the care plan developed during the planning phase to address the client's needs and achieve desired outcomes.

C. Evaluation:

Evaluation is the final step of the nursing process where the nurse assesses the client's response to interventions and the effectiveness of the care provided. The nurse compares the client's actual outcomes with the expected outcomes identified during the planning phase. If the outcomes are met, the plan may continue as is or be modified for ongoing care. If the outcomes are not met, the nurse revises the plan as necessary to improve client outcomes.

D. Data Collection:

Data collection is the initial step of the nursing process where the nurse gathers information about the client's health status, including physical, emotional, social, and environmental factors. This step involves conducting assessments, gathering medical history, reviewing laboratory and diagnostic tests, and obtaining information from the client and their family. Data collection forms the basis for identifying nursing diagnoses, developing care plans, and implementing appropriate interventions.

Explanation:

A. Encourage family members to call the client: This option focuses on utilizing the client's existing support system, particularly family members, to maintain communication and emotional connection. Regular phone calls from family members can provide comfort, reassurance, and a sense of belonging, all of which are crucial in reducing social isolation, especially during end-of-life care.

B. Instruct the client to join an online support group: This option suggests using technology to connect the client with others who may be going through similar experiences. Online support groups can offer valuable emotional support and a sense of community. However, this approach may not be suitable for all clients, especially if they are not comfortable or familiar with online platforms, or if they prefer face-to-face interactions.

C. Schedule home visits with the client: This option emphasizes personal, one-on-one interaction by scheduling regular home visits. Home visits allow healthcare providers, family members, and other supportive individuals to be physically present with the client, providing not only emotional support but also addressing any physical or comfort needs the client may have.

D. Ask the client's friends to text the client: Texting is a convenient and quick way to communicate, but it may lack the depth of connection provided by voice calls or in-person interactions. While texting can be an additional method of staying in touch, especially for quick updates or reminders, it may not be sufficient on its own to reduce social isolation significantly.