Title : Nurses' adherence to the SBAR (situation, background, assessment, and recommendation) protocol and associated factors in clinical handoffs: A cross-sectional study in a tertiary hospital, Karachi

Background: Clear communication during nurse handovers is vital for safe, effective patient care. Although bedside reporting is recommended, it is often inconsistently practiced. The SBAR framework (Situation, Background, Assessment, and Recommendation) offers a structured approach to reduce communication errors and strengthen continuity of care. However, evidence shows variable adherence to SBAR. This study evaluated nurses’ adherence to SBAR during bedside handovers and explored factors influencing adherence.

Methods: An analytical cross-sectional study was conducted in the medical and surgical wards of Aga Khan University Hospital, Karachi, from July to September 2025. Nurses were observed during handovers across morning, evening, and night shifts using a structured SBAR checklist, with each element marked as present or absent. Structured questionnaire was filled to capture independent factors including workload, SBAR knowledge, experience, and shift timing. Logistic regression was used to examine associations between SBAR and experience and demographic variables.

Results: The SBAR protocol was followed by 170 of the 237 nurses, resulting in a 72% total adherence rate. SBAR knowledge showed strong predictor to SBAR adherence. Nurses who rated their SBAR knowledge as unsatisfactory were significantly less likely to adhere to the protocol compared to those with satisfactory knowledge (AOR = 0.02, 95% CI: 0.06–0.126). Although nurses with more than two years of experience showed higher adherence, this association was statistically insignificant (AOR = 1.06, 95% CI: 0.36 – 3.05). Lastly, the handover method had a substantial impact on SBAR use; nurses who used patient red file for their handover method were less likely to follow SBAR as compared to kardex method (AOR = 0.18, 95% CI: 0.07–0.46).

Conclusion: In the tertiary care setting, nurses had a high level of SBAR adherence. SBAR handover technique and knowledge showed significant predictors. Experience, gender, marital status, education, shifts and workload were among the other factors which did not significantly affect the results. These results highlight the value of standard handover practice and focused assistance in encouraging consistent SBAR use and enhancing nurse to nurse communication.

Keywords: SBAR (Situation, Background, Assessment, Recommendation), Nursing handover, Clinical communication, Nurse Adherence, Shift handover, Workload.

Misbah Mehdi is an MSc student in Epidemiology and Biostatistics at Aga Khan University, Karachi, Pakistan, and serves as a Research Specialist for the PROPS Project. I holds a Bachelor of Science in Nursing from Dr. Ziauddin University and has clinical experience in tertiary care hospitals. My research interests include patient safety, clinical communication, maternal and child health, epidemiology, and implementation research. My current research focuses on nurses' adherence to the SBAR communication protocol during clinical handoffs and factors influencing standardized communication in healthcare settings.