# Situation: A 34-year-old man is admitted to the intensive care unit (ICU) after an intentional overdose of an unknown drug with aspiration of gastric contents. He is intubated and receiving mechanical ventilation. The consultation–liaison psychiatry team will see him once he is awake. At 04:00 the nurse calls the resident using the SBAR format (Situation, Background, Assessment, Recommendation): S: "This is the ICU nurse about the client in bed 4; his oxygen saturation has dropped to 89%." B: "He was admitted yesterday for an overdose with aspiration; his ventilator settings are unchanged since 22:00." A: "His breath sounds are coarse on the right and his temperature is 38.6 °C. I am worried he has a new lung infection." R: "I just thought you should know." Which part of this report needs improvement MOST?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630160  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A 34-year-old man is admitted to the intensive care unit (ICU) after an intentional overdose of an unknown drug with aspiration of gastric contents. He is intubated and receiving mechanical ventilation. The consultation–liaison psychiatry team will see him once he is awake.

At 04:00 the nurse calls the resident using the SBAR format (Situation, Background, Assessment, Recommendation):
S: "This is the ICU nurse about the client in bed 4; his oxygen saturation has dropped to 89%."
B: "He was admitted yesterday for an overdose with aspiration; his ventilator settings are unchanged since 22:00."
A: "His breath sounds are coarse on the right and his temperature is 38.6 °C. I am worried he has a new lung infection."
R: "I just thought you should know."
Which part of this report needs improvement MOST?

## 보기

1. Situation, because it leaves out the full set of vital signs
2. Background, because it omits the client's allergy history
3. Assessment, because nurses should not state their own impressions
4. Recommendation, because no specific request is made **✔ 정답**

**정답: 4**

## 해설

The recommendation tells the prescriber what the nurse needs and by when, such as asking the resident to see the client now or to order a chest X-ray and cultures. Ending with "I just thought you should know" leaves the call without an action. The other parts contain the key facts, and stating the nurse's own concern is a proper part of the assessment.

## 심화 해설

SBAR structure and the weak link in this report

The SBAR framework standardizes urgent clinical communication into four sequential components. In this call, the nurse gives a clear Situation (oxygen saturation 89%), a relevant Background (overdose with aspiration, unchanged ventilator settings), and an appropriate Assessment that includes objective findings plus the nurse’s own clinical concern about a new lung infection. The breakdown occurs in the Recommendation. Ending with “I just thought you should know” provides no request for action, no suggested intervention, and no timeframe. A recommendation must state what the nurse needs from the provider and by when, such as requesting bedside evaluation now or ordering a chest X-ray and cultures.

Key point! The recommendation is the action-oriented closing of SBAR. Without a specific request, the receiver may not recognize that a decision or order is being requested, which delays care.

Watch out! Stating a nursing impression such as “I am worried he has a new lung infection” is not a weakness. In SBAR, the assessment component is exactly where the nurse synthesizes findings and expresses clinical concern.

| SBAR component | What this nurse said | Quality of the component |
| --- | --- | --- |
| Situation | Oxygen saturation dropped to 89% in ICU bed 4 | Adequate; identifies the immediate problem |
| Background | Overdose with aspiration; ventilator settings unchanged since 22:00 | Adequate; relevant context is included |
| Assessment | Coarse breath sounds on the right; temperature 38.6 °C; concern for new lung infection | Appropriate; objective data plus nursing judgment |
| Recommendation | “I just thought you should know” | Deficient; no specific request or timeframe |

The purpose of SBAR is not only to transfer information but also to trigger a decision. When the recommendation is vague or absent, the handover becomes a one-way report rather than a request for collaborative action, which weakens patient safety. In this scenario, a stronger recommendation would be, “Please come assess him now; I would like an order for a chest X-ray and blood cultures.” This tells the prescriber what is needed and when.

The systematic review by Müller et al. found that SBAR implementation is associated with improved patient safety, but the benefit depends on complete and structured use of all four components, especially the action-oriented recommendation [1]. Studies of SBAR-based handover in nursing similarly emphasize that correct use of the model reduces communication errors and facilitates rapid decision-making [2][3]. A quality improvement study also identified the recommendation component as a common area of incomplete compliance during clinical handover [4]. A handover that ends without a clear request leaves the provider without a defined next step, which is the most important deficiency in this report.References (research sources)

- [1]Impact of the communication and patient hand-off tool SBAR on patient safety: a systematic review.Meta-analysis/systematic reviewMüller M, Jürgens J, Redaèlli M, Klingberg K, Hautz WE, Stock S (2018) · DOI: 10.1136/bmjopen-2018-022202

- [2]Implementation and Evaluation of the SBAR Communication Model in Nursing Handover by Pediatric Surgery Nurses.Research articlePazar B, Kavakli O, Ak EN, Erten EE (2024) · DOI: 10.1016/j.jopan.2023.12.021

- [3]Shift Transition Communication Among Nurses: A Systematic Review of ISBAR and SBAR-Based Structured Handover Tools.Meta-analysis/systematic reviewRasiya A, Raheem UA. (2026) · DOI: 10.1002/nop2.70655

- [4]Improving the Quality and Completeness of Clinical Handover Using the Situation, Background, Assessment, Recommendation (SBAR) Framework: A Closed-Loop Quality Improvement Study at Almanagil Teaching Hospital, Sudan.GuidelineYousif MMO, Abdelgalil MMM, Ali SEM, Hamad HMK, Ali RMK, Abdelbagi AEHE, Abdulaal EIA, Ahmed YAY, Elnour DEG, Mohamed M. (2026) · DOI: 10.7759/cureus.109293

## 임상 시나리오

SBAR Recommendation: Closing the LoopMaking the request explicit in urgent calls
The Recommendation must state what the nurse needs and by when. Saying "I just thought you should know" leaves no action for the provider.

A strong closing request includes a specific action and timeframe, such as "Please come assess the patient now" or "Please order a chest X-ray and blood cultures."

CautionStating a nursing impression like "I am worried he has a new lung infection" is appropriate in the Assessment, not a weakness. The failure is only in the missing action request.

## 핵심 개념

- **SBAR** — A structured communication framework: Situation, Background, Assessment, Recommendation.
- **Recommendation** — The action-oriented closing component of SBAR stating what is needed and by when.
- **Assessment** — The SBAR component where the nurse synthesizes findings and states clinical concern.
- **Aspiration** — Inhalation of gastric contents into the lungs, often causing pneumonitis or infection.

## 같은 주제 문제

- [Situation: The nurse works on a 30-bed acute psychiatric unit of a general hospital. The i…](https://mymerci.kr/pages/nclex_q.php?qn_id=630056)
- [Situation: The nurse works on a 30-bed acute psychiatric unit of a general hospital. The i…](https://mymerci.kr/pages/nclex_q.php?qn_id=630057)
- [Situation: The nurse works on a 30-bed acute psychiatric unit of a general hospital. The i…](https://mymerci.kr/pages/nclex_q.php?qn_id=630058)
- [Situation: A 64-year-old man is in the intensive care unit (ICU) on day 2 after emergency …](https://mymerci.kr/pages/nclex_q.php?qn_id=630061)
- [Situation: A 64-year-old man is in the intensive care unit (ICU) on day 2 after emergency …](https://mymerci.kr/pages/nclex_q.php?qn_id=630062)
- [Situation: The nurse is a staff nurse on an inpatient psychiatric unit. The unit team of p…](https://mymerci.kr/pages/nclex_q.php?qn_id=630156)
- [Situation: The nurse is a staff nurse on an inpatient psychiatric unit. The unit team of p…](https://mymerci.kr/pages/nclex_q.php?qn_id=630157)
- [Situation: The nurse is a staff nurse on an inpatient psychiatric unit. The unit team of p…](https://mymerci.kr/pages/nclex_q.php?qn_id=630158)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._