As nurses, we’re constantly bombarded with acronyms and frameworks to guide our work—SBAR, OLD CARTS, ADPIE, and more. It can feel overwhelming to keep track of them all, especially when each one seems to have its own purpose. But it doesn’t have to be complicated. When we understand how these tools tie together, they become a less complicated part of our daily practice, helping us care for clients more effectively. Let’s break down SBAR, OLD CARTS, and ADPIE, explain what each letter in these acronyms stands for, and see how they work as a team in a way we can understand.
What is ADPIE? The Nursing Process Explained
ADPIE is the nursing process, a step-by-step way to provide care. Each letter in ADPIE stands for a key concept in the process:
- A for Assess: Gather information about your client, like their symptoms or vital signs (e.g., heart rate, temperature).
- D for Diagnose: Determine what the issue is, like “they’re in pain because of an injury.”
- P for Plan: Decide how to respond, like giving prescribed medicine or calling the doctor.
- I for Implement: Do the plan, like giving the medicine or helping the client rest.
- E for Evaluate: Check the effectiveness. Did the pain get better? If not, go back and start again.
ADPIE is like a roadmap for nursing care. It’s a cycle that keeps us organized as we work through a client’s needs, making sure we don’t miss anything important. This framework has been a cornerstone of nursing practice since it was formalized by theorists like Ida Jean Orlando in the 1950s (Alligood, 2017).
What is OLD CARTS? A Tool for Understanding Symptoms
OLD CARTS is a framework to help you ask the right questions when a client has a symptom, like “I have a headache.” Each letter in OLD CARTS stands for a concept that helps you get a full picture of what’s going on:
- O for Onset: When did it start? “Did your headache start this morning?”
- L for Location/Radiation: Where is it? “Where does your head hurt? Does the pain move anywhere else?”
- D for Duration: How long has it been going on? “How long have you had this headache?”
- C for Character: What does it feel like? “Is it a sharp pain or a dull ache? Does anything make it change?”
- A for Aggravating factors: What makes it worse? “Does noise or light make your headache worse?”
- R for Relieving factors: What makes it better? “Does lying down help?”
- T for Timing: Does it come and go? “Is the headache always there, or does it stop and start?”
- S for Severity: How bad is it? “On a scale of 1 to 10, how much does it hurt?”
OLD CARTS helps you dig into the details of a symptom so you can understand it fully. It’s especially useful when you’re first checking on a client and need to gather all the facts. While the exact origin of OLD CARTS is unclear, it likely emerged in medical and nursing education during the late 20th century as a practical tool for teaching students how to assess symptoms systematically. It became widely adopted in healthcare settings because of its straightforward approach to gathering a history of present illness, often credited to the need for standardized methods in clinical practice (Bickley, 2020).
What is SBAR? A Way to Communicate Clearly
SBAR is a tool for sharing information with your team, like doctors or other nurses, especially when something important is happening with a client. Each letter in SBAR stands for a concept that keeps your communication focused:
- S for Situation: What’s going on right now? “My client has a headache that started two hours ago.”
- B for Background: What’s the client’s history? “They have a history of migraines and were fine until today.”
- A for Assessment: What do you think is happening? “The headache is a throbbing pain, 8/10, and light makes it worse.”
- R for Recommendation: What should we do? “I think we should give their migraine medicine and let the doctor know.”
SBAR started in the U.S. Navy in the 1940s, used for clear handoffs during submarine missions. It was brought into healthcare in the 1990s, with Kaiser Permanente adopting it in 2002 to improve communication and reduce errors (Thomas et al., 2009). SBAR keeps your communication clear and to the point, whether you’re talking during a shift change, calling a doctor, or writing a note in the chart. It makes sure everyone understands the key points quickly.
Tying ADPIE, OLD CARTS, and SBAR Together
With so many frameworks, it might seem like a lot to juggle, but SBAR, OLD CARTS, and ADPIE actually fit together naturally. They each play a role in the care process, and when you see how they connect, they become less overwhelming. Let’s walk through an example of a client with a headache to show how these tools team up.
Start with ADPIE and Use OLD CARTS to Assess
The nursing process, ADPIE, is your main guide. You begin with the Assess step (the A in ADPIE), which means gathering information about your client. Let’s say your client says, “I have a headache.” You use OLD CARTS to ask the right questions and get the full story:
- Onset (O): “It started two hours ago.”
- Location (L): “It’s on the right side of my head.”
- Duration (D): “It’s been constant since it started.”
- Character (C): “It’s throbbing, and I feel nauseous.”
- Aggravating factors (A): “Bright lights make it worse.”
- Relieving factors (R): “Lying in a dark room helps a little.”
- Timing (T): “It hasn’t stopped since it started.”
- Severity (S): “It’s 8 out of 10.”
You also check their vital signs, like blood pressure, to round out your assessment. OLD CARTS makes sure you don’t miss any details about the headache, giving you a solid foundation to move forward in the nursing process.
Use OLD CARTS to Inform the Diagnose Step
Next, in the Diagnose step (the D in ADPIE), you think about what the headache might mean. The details from OLD CARTS—like the throbbing pain, nausea, and light sensitivity—point to a possible migraine. You might identify a nursing diagnosis like “Acute Pain related to migraine headache.” OLD CARTS gives you the clues you need to make sense of the client’s problem.
Plan with SBAR to Share Your Thoughts
In the Plan step (the P in ADPIE), you decide what to do based on your diagnosis. The headache is severe, so you think the client needs their migraine medicine and a quiet room. You also need to tell the doctor. This is where SBAR comes in to help you communicate clearly:
- Situation (S): “My client has a headache that started two hours ago.”
- Background (B): “They have a history of migraines and no recent injuries.”
- Assessment (A): “It’s a throbbing pain on the right side, 8/10, with nausea and light sensitivity.”
- Recommendation (R): “I recommend giving their prescribed migraine medicine and notifying the doctor for further orders.”
SBAR organizes your thoughts so you can share your plan with the team without missing anything important, whether you’re speaking or writing a note.
Implement and Update with SBAR
During the Implement step (the I in ADPIE), you carry out your plan. You give the migraine medicine and help the client rest in a dark room. If you need to update the team, SBAR helps again: “Situation: The client’s headache is still 8/10 after 30 minutes. Recommendation: I think we need the doctor to see them now.” SBAR keeps everyone on the same page as you put your plan into action.
Evaluate and Reassess with OLD CARTS
Finally, in the Evaluate step (the E in ADPIE), you check if your plan worked. You use OLD CARTS again to ask about the headache: “Is the severity (S) still 8/10? Has the nausea gone away?” If the pain is now 3/10 and they feel better, your plan worked. If not, you go back to the Assess step and start over. You can use SBAR to share the update: “Situation: The client’s headache is now 3/10. Assessment: They’re more comfortable. Recommendation: Continue monitoring.”
Why This Connection Matters
When you see how ADPIE, OLD CARTS, and SBAR fit together, they stop feeling like separate tasks and start feeling like one smooth process. ADPIE is your overall guide for giving care. OLD CARTS helps you gather details during the Assess step, making sure you have all the facts. SBAR helps you share those facts and your plan with the team during the Plan, Implement, and Evaluate steps. Together, they help you:
- Be thorough when checking on your client (OLD CARTS in Assess).
- Make sense of what’s going on (Diagnose).
- Share your ideas clearly (SBAR in Plan and Implement).
- Check if your care worked (Evaluate, with OLD CARTS and SBAR updates).
A Simple Way to Use Them
Think of ADPIE as your main roadmap for care. Use OLD CARTS during the Assess step to dig into your client’s symptoms. Then, when you need to tell your team what’s going on or what you think should happen, use SBAR to keep your message clear. As you move through the nursing process, these tools will work together to keep you organized and focused.
Wrapping Up
Nursing comes with a lot of acronyms and frameworks, but they don’t have to be overwhelming. ADPIE, OLD CARTS, and SBAR are designed to work together to help you care for your clients. ADPIE guides your overall process, OLD CARTS helps you understand symptoms, and SBAR makes sure you can communicate clearly with your team. When you tie them together, they become a natural part of your workflow, making your job as a nurse easier and more effective.
References
- Alligood, M. R. (2017). Nursing theorists and their work (9th ed.). Elsevier.
- Bickley, L. S. (2020). Bates' guide to physical examination and history taking (13th ed.). Wolters Kluwer.
- Thomas, C. M., Bertram, E., & Johnson, D. (2009). The SBAR communication technique: Teaching nursing students professional communication skills. Nurse Educator, 34(4), 176–180. https://doi.org/10.1097/NNE.0b013e3181aaba54