The quality of nursing services is a major indicator of the quality of health services and is one of the determining factors for the image of health service institutions in the eyes of the public (Alhussin et al., 2024)(Tatiwakeng et al., 2021). The quality of nursing services has a relationship with patient safety (Arfebi et al., 2022). The relationship can influence the behavior of the person in doing something including the implementation of nursing and patient safety in communicating effectively, one of them is when the nurse does the handover.

Ineffective communication between health workers will certainly have an impact on the success of treatment and cause side effects in patients, this can reduce the trust and loyalty of patients which in turn causes a decrease in the number of visits (Fajriyah et al., 2023)(Moslehpour et al., 2022). The joint commission reported that more than 60% of poor communications were contributing factors to all of the adverse events in the reviewed hospitals. Ineffective communication is widely encountered in the field of health care, such as in perioperative, intensive care, and patient care in emergency rooms where the rapid and effective management is needed (Müller et al., 2018).

Information transfer during shift changes called handover aims to convey the information from each shift change and ensure the effectiveness and safety in patient care (Handayani & Hasanah, 2024). Handover is closely related to information about the patient's clinical status, the patient's needs, the patient's personal state, to the patient's social factors (Ismuntania et al., 2023). Nurses who exchange guard must arrive at least 15 minutes before participating in the handover so that the handover process runs smoothly (Hasibuan et al., 2022).

The delivery of information during handover is carried out in various ways, one of which is by using the situation, background, assessment, and recommendation (Mulfiyanti & Satriana, 2022). The SBAR communication method is an effective communication technique that aims to help nurses to convey more structured and clear information during handovers and patient transfers (Shinta & Bunga, 2024).

The World Health Organization (WHO) in 2017 recommended improving communication patterns when performing handovers which must use a strategic standard, specifically by using the SBAR communication method (Christina & Susilo, 2021). These recommendations are closely related to efforts to reduce patient safety incidents that can be optimized through SBAR communication (Sembiring et al., 2022). The use of SBAR communication methods can help in communicating, both personally with the team and can improve the culture of patient safety, so that it can create a positive impact on improving the reporting of patient safety incidents (Sulistyawati & Haryuni, 2019).

Previous research explains that SBAR communication is effective in improving the implementation of handover between shifts, which involves not only one but all members of the healthcare team to provide input into the situation of the patient (Hadi et al., 2021). SBAR provides an opportunity for healthcare team members to be able to discuss (Muhdar et al., 2021). This theory supports the research found that the application of SBAR communication to nurses in carrying out handovers at Banjarmasin Regional Hospital gave positive results and seven participants interviewed stated that the use of effective SBAR communication methods facilitated the implementation of tasks and increased accountability in nursing practice (Astuti et al., 2019).

The handover stage has three stages, namely the preparation stage, the process stage, and the handover termination stage (Yetti et al., 2021). Inappropriate handover processes in nursing activities can cause patient safety problems (Nursapriani et al., 2023). Handover activities that are not accompanied by effective communication can result in errors that can harm the patients. The implementation of inappropriate handovers also risks incompatibility in conducting nursing care, thus potentially affecting patient safety and resulting in additional treatment costs (Rahmatulloh et al., 2022).

Based on some of the aforementioned conditions, the researcher is interested in conducting research on the analysis of the implementation of effective communication of SBAR in special hospital inpatient installations. The inpatient room at the hospital where the data was collected has standard operational procedures (SOP) for handover between nursing shifts and has been socialized. The recording and documentation of nursing care has also used an agreed format and is included in the electronic medical record so that the proof of implementation will be recorded in the electronic data. However, in practice, there are still much information that have not been conveyed completely in handover, so the existing SBAR data do not all describe the patient's condition well. To find out whether the data conveyed during the handover is under the principles of effective communication with SBAR can meet the needs in planning and implementing nursing care and can improve nursing care, then there needs to be research conducted.

Compared to the previous studies, this study will analyze how the communication process with the SBAR method is carried out at the time of patient handover. This research is expected to be a useful recommendation for improvement and progress in terms of nurse communication at the research site. This research aims to determine the ability of nurses to carry out communication with the SBAR Method.

The method used in this research is a descriptive quantitative study. The population used by the researcher were nurses who served in the inpatient installation of a government-owned Special Hospital as many as 74 people. In this study, the variable is SBAR communication used when carrying out patient handovers during shift changes in inpatient care. The operational definition of SBAR communication during handover is carrying out handovers using effective communication with the SBAR method. The sampling technique used was purposive sampling technique. The sample taken is a sample that fulfill the set inclusion criteria.

Inclusion criteria include:

Exclusion Criteria

Based on these criteria, 61 research samples were obtained. In this study, the researcher wanted to get directly how the communication process with the SBAR method was carried out at the time of patient handover.

In this study, the method of data collection is observation. The observation guidelines applied use the guidelines that were once used to observe the effectiveness of SBAR communication in research on interpersonal communication. This is conducted as this study has the same focus, namely to find out whether effective SBAR communication can indeed be carried out in handover activities properly/ appropriately, and has an impact on the safety of treated patients in inpatient installations.

This study was conducted to determine the ability of nurses to carry out communication using the SBAR method. To obtain the information related to effective communication with the SBAR method, the researcher observed the patient's handover activities carried out by the team of nurses in the inpatient installation at the time of exchange. The observation is using a questionnaire covering SBAR items.

Before distributing the questionnaire, respondents were required with the predetermined criteria which included educational background, and working period. From the total number of nurses in inpatient, the number of nurses was then taken as a sample. From the calculation of this formula, a minimum of 61 nurses were sampled. The demographic data of all respondents can be identified in the following Table 1:

In terms of education, the majority of respondents had Ners degrees, as many as 35 people, who indicated a high commitment to professionalism in the field of nursing. Meanwhile, 26 respondents had a Nursing Diploma Program, showing variations in educational background among health workers. In terms of tenure, 35 respondents had between 1 to 25 years of work experience, reflecting stability and a good level of expertise. A total of 17 people have a working period of less than 1 year, indicating the presence of new entrants in this sector. Only 11 respondents have worked more than 25 years, indicating that the number of senior workers is quite limited. Overall, these data illustrate the diversity of education, and work experience, which has the potential to improve the quality of services in the health sector.

In the era of increasingly complex health services, the effectiveness of communication between health professionals is the main key to ensuring the quality of patient care (Jenstad et al., 2024). One method of communication that has been widely adopted in this context is the SBAR method (situation, background, assessment, recommendation), which is designed to facilitate a clear and structured exchange of information (Coolen et al., 2020). This study aims to evaluate the ability of nurses to apply the SBAR method and its impact on clinical communication. The results of this study are expected to determine the ability of nurses to carry out communication with the SBAR Method. The results of the study can be seen in the following table (Table 2).

Table 2 shows that all variables in the category are very good with situation communication indicating the highest percentage of 97%, background communication at 96%, assessment communication at 74%, and recommendation communication at 95%. The categories in this study are very good = 76% -100%, good = 65% -75%, sufficient = 55% -64% and less = <55% (Depkes, 2005). Table 3 describes the variation of each question as a result of this research. Table 4 describes the statistical analysis. Education and length of service to SBAR communication of nurses on duty.

Effective communication is significant to achieving patient safety, as problems in communication are frequently the leading cause of patient safety incidents (Gao et al., 2024). To reduce errors and improve patient safety, communication should be carried out in a timely, accurate, complete, clear, and understandable manner by the recipient (Maulida & Damaiyanti, 2021). There are 4 aspects that must be met by a nurse, the four aspects are basic communication skills, the ability to pay attention to patients, the ability to understand patients, work/professional communication skills and the ability to apply ethics in communication (Fauziyah et al., 2022). If communication is not carried out properly, the risk of errors in providing nursing care will increase.

The latest effective communication framework used in hospitals is SBAR communication, World Health h Organization requires hospitals to use a strategic standard by using the SBAR communication method (Pane et al., 2023). SBAR communication is a communication consisting of 4 components, namely S (situation) is a picture that occurred at that time, B background is something that is behind the situation that occurred, A (assessment) is an assessment of a problem, R (recommendation) is an action where asking for suggestions for the right action that should be taken for the problem (Nainggolan, 2021). Effective implementation of SBAR can have a positive impact on the quality of patient care by improving communication between the medical team (Sukaesih & Faridah, 2020). Therefore, maintaining consistency in the implementation and routinely evaluating the implementation of SBAR is the key to continued success. This is because SBAR communication is well-structured, correct, and clear communication, therefore knowledge of SBAR communication techniques is important to continue to be improved (Rahmatulloh et al., 2022).

The results of this study indicate that the application of SBAR in Special Hospital Inpatient Installations is generally very good, especially in terms of situations, backgrounds, and recommendations. These results indicate that the SBAR model is effective in conveying important information clearly and systematically. This study also explains that the assessment variable shows the lowest value so there is a potential for improvement. It may be necessary to carry out additional training or refinement of procedures to equalize the understanding and assessment among the medical team. The results of previous studies explain that overall SBAR communication is optimal, in detail the situation stage, background stage, assessment stage, and recommendation stage in the optimal category (Naza et al., 2024). The results of research at other hospitals also explained that the communication of information related to the situation, background, assessment, and recommendations of patients had been carried out effectively. However, there are still inconsistencies in the submission of background information, such as the date of entry and history of previous complaints. Therefore, training and further education can be a solution to deepen the understanding and skills of nurses in conveying information in a structured and comprehensive manner (Mawarni & Yuhansyah, 2024).

The effective use of the SBAR method can reduce miscommunication and improve team coordination in patient care (Martínez-Fernández et al., 2022). This study found indications that the application of a good SBAR method is associated with increased patient satisfaction and decreased incidence of medical errors. Previous research explains that there is a significant relationship between the application of the SBAR method (situation, background, assessment, recommendation) and communication between nurses (Idealistiana & Salsabila, 2022). Nurses skilled in the SBAR method tend to be better to convey information clearly and in a timely manner, which allows the medical team to respond quickly to changes in the patient's condition (Handayani & Hasanah, 2024).

There are several factors that can affect the ability of nurses to apply the SBAR method, there are knowledge, attitude, motivation, and workload (Umiyati, 2022). The level of knowledge encourages the ability of nurses to communicate effectively. Knowledge is defined as mental components generated through experience, the results of previous research explain that nurse knowledge greatly affects the application of the effective communication of SBAR (Manalu et al., 2023). Nurses who have good attitudes tend to have greater opportunities to improve the application of SBAR communication, this is because attitudes significantly affect a person's ability and skills in conveying information so that it will have an impact on good communication (Mardiana et al., 2019). Motivation is one of the factors that influence the implementation of effective SBAR communication used by nurses. High motivation will allow nurses to be more optimal in implementing SBAR communication (Widyastuti, 2023). Excessive nurse workload due to limited time in doing tasks and the high amount of work that must be done can reduce nurse productivity and decrease the quality of nursing services (Maghsoud et al., 2022). The results of this study in detail can be seen in the distribution of the variables below (Table 3):

This study involved 61 nurses with a maximum score of 61 points for each question. The results revealed that communication regarding the nursing diagnosis was the lowest indicator in the application of the SBAR method. These findings underscore the significant challenges that need to be addressed to improve the effectiveness of communication in clinical contexts. The results showed that the nurses tended to convey the nursing diagnoses of patients clearly and systematically in the use of the SBAR method. This can be seen from the low frequency and quality of information related to the diagnosis conveyed in their communication. The absence or incompleteness of information regarding the nursing diagnosis can affect the overall effectiveness of communication within the medical team and have an impact on patient care planning (Rahmayanti et al., 2024).

This study was conducted in a specific special hospital inpatient installation, which may limit the generalizability of the findings to other healthcare settings or facilities. The unique characteristics of the institution and its staff may not fully represent other hospitals. The number of participants involved in this study may not be sufficient to capture the full variability of perspectives and practices related to the SBAR (situation, background, assessment, recommendation) communication framework. This could affect the robustness of the conclusions drawn.

This study examines the implementation of SBAR communication in a special hospital inpatient setting, highlighting its role in improving nursing services and patient outcomes. The demographic diversity among nurses, particularly in age and education level, reflects a strong potential for enhancing care quality. Observations reveal that nurses excel in applying SBAR communication, with high proficiency in the Situation, Background, and Recommendation aspects, although the Assessment aspect shows room for improvement. Challenges in conveying clear nursing diagnoses underline the need for targeted training to enhance this skill. Overall, effective SBAR implementation minimizes miscommunication, strengthens medical team coordination, and positively influences patient satisfaction, emphasizing the necessity for ongoing training and routine evaluations to optimize its use.

This study shows that although the SBAR method is well implemented, particular attention needs to be conducted to improving communication regarding nursing diagnosis to achieve optimal results in patient care. Suggestions for further researchers are expected with a larger number of samples in order to be better represent and illustrate the implementation of effective SBAR communication and the comparison with other hospitals. For Hospital Agencies, it is recommended to conduct regular training on the SBAR method for all nurses and medical staff. The training should include the effective communication techniques as well as simulation of the real situations to improve practical skills. Further researchers are expected to be able to conduct further research to evaluate the longterm impact of the implementation of effective SBAR communication.

The author received a lot of guidance and support from various parties so that the writing of this thesis could be completed on time. Therefore, the author would like to express his deepest gratitude and highest appreciation to Mr. Dr. Arif Widodo, A.Kep, M.Kes,. as the Main Supervisor, Mrs. Vinami Yulian, S.Kep.Ns, M.Sc, Ph.D. as the Assistant Supervisor, Prof. Dr. R. Soeharso Surakarta Orthopedic Hospital who has helped in the implementation of the research, the Head of the library who has provided facilities in completing the literature study, the Lecturers of the Master of Nursing who have provided assistance and direction, my father, mother, husband and children and various other parties that I cannot mention one by one who have helped in the preparation of this thesis.

Roossy Irawati conceived the presented idea. Roossy Irawati developed the theory and performed the computations of statistics. designed the model and the computational framework and analyzed the data. Arif Widodo and Vinami Yulian verified the analytical methods and supervised the findings of this work. All authors discussed the results and contributed to the final manuscript. All authors provided critical feedback and helped shape the research, analysis, and manuscript.

The author received no financial support for the research, authorship, and/or publication of this article.

Ethics approval for the study Description of Effective Communication SBAR (Situation, Background, Assessment, Recommendation) in Patient Handover in Inpatient Installation was obtained from *Health Research Ethics Commission of Muhammadiyah University of Surakarta with number 5210/B.2/KEPK-FKUMS/III/2024 on May 11, 2024.

This study has also obtained ethical approval from the research ethics team of Prof. Dr. R Soeharso Orthopedic Hospital Surakarta with number IR.03.01/D.XXV.2.3/8487/2024 on August 28, 2024.

Data available upon request to first author: Rossy Irawaty at roossyirawati@yahoo.co.id

The authors declare no conflict of interest.