While giving change-of-shift report using I-SBAR, a nurse suggests that a client be ambulated at least four times during the next shift in order to decrease the client’s peripheral edema. Which portion of I-SBAR does a nurse make suggestions regarding actions and interventions? A committee of nurses have been tasked with reviewing an increase in central line infections on their unit. Explain the process that they should follow. The home health nurse is conducting a home safety assessment for an older adult client following a hospital admission for frequent falls. List three (3) assessment findings that require intervention.

SOLUTION

1. While giving change-of-shift report using I-SBAR, the portion where a nurse makes suggestions regarding actions and interventions is the “Recommendation” or “Request” part of the SBAR format. In this case, when the nurse suggests that the client be ambulated at least four times during the next shift to decrease peripheral edema, it falls under the “Recommendation” section.
2. The committee of nurses reviewing an increase in central line infections on their unit should follow a systematic process:
   • Data Collection: Gather information on the number and types of central line infections, as well as contributing factors such as insertion techniques, maintenance practices, and adherence to infection control protocols.
   • Root Cause Analysis: Conduct a thorough analysis to identify underlying causes or contributing factors to the increase in central line infections. This may involve reviewing medical records, observing practices, and interviewing staff members involved in central line care.
   • Evidence-Based Interventions: Implement evidence-based interventions to address identified issues and reduce the risk of central line infections. This may include staff education on proper insertion and maintenance techniques, improving hand hygiene practices, optimizing catheter site care, and enhancing surveillance and monitoring systems.
   • Continuous Monitoring and Evaluation: Monitor the impact of interventions over time and regularly review infection rates to ensure sustained improvement. Adjust interventions as needed based on ongoing data analysis and feedback from frontline staff.
3. Assessment findings during a home safety assessment for an older adult client following hospital admission for frequent falls that require intervention may include:
   • Unsafe Home Environment: Identify hazards such as loose rugs, poor lighting, uneven flooring, or clutter that increase the risk of falls. Interventions may include removing tripping hazards, installing grab bars or handrails, improving lighting, and decluttering pathways.
   • Impaired Mobility: Assess the client’s mobility status, including strength, balance, and gait stability. Interventions may involve implementing a home exercise program to improve strength and balance, providing assistive devices such as walkers or canes, and arranging for physical therapy or rehabilitation services.
   • Medication Management: Review the client’s medication regimen and assess for potential side effects or interactions that may contribute to falls. Interventions may include medication reconciliation, simplifying the medication schedule, and educating the client about medication adherence and potential fall risks.