Author Archive
Friday, September 5th, 2014
111
Instructor’s Guide – When Shared Mental Models Shatter
Overview:
This story addresses the impact disruptive behavior has on teamwork, communication, patient safety, and patient satisfaction. Each person involved in patient care, regardless of position, must conduct themselves in a professional manner.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe the importance of adopting standards of professional conduct.
- Classify individual behaviors as acceptable and unacceptable.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Teamwork and Collaboration:
- Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
Reflection Questions: Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
*Following each question are some potential answers
- What does this story illustrate about the importance of adopting standards of professional conduct?
A: There was a great deal of unspoken communication during this scenario due to the fact that staff didn’t want to “upset” the doctor. This situation may have been avoided if there were standards of professional conduct in place.
- Describe the behavior in this story that you believe to be unprofessional. What should have been done instead?
A: Everyone in the scenario participated in unprofessional behavior. The patient should have been the focus of the scenario and not the potential problems with the surgical team and doctor.
Discussion Questions: Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: We learned that disruptive behavior impacts more than just the team, it could also impact patient care.
- What one thing can we do to show respect for each other by ensuring everyone is accountable for professional behavior?
A: If everyone were responsible for their own behavior this situation may have turned out differently. The team did not show respect to the doctor by not telling him the equipment he wanted was not available and the doctor did not show respect to the team when he blamed the patient’s condition on their inability to get him the equipment he had requested.
Suggested Classroom Mastery Activities: These activities can be tailored for individuals or groups in a face to face or online setting.
- Read the Professional Conduct Survey. Create a presentation that describes two major problems that occur between doctors and nurses (see table 6) and describe how those might be dealt with, using the solutions suggested, as well as your own ideas.
- Make a list of the behaviors exhibited by all of the professionals in this story and classify them as acceptable or unacceptable. Discuss your reasoning for your classification with a classmate.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe the importance of adopting standards of professional conduct. |
Student struggles to describe the importance of adopting standards of professional conduct. |
Student can describe the importance of adopting standards of professional conduct, but needs more practice. |
Student can accurately describe the importance of adopting standards of professional conduct. |
| Classify individual behaviors as acceptable and unacceptable. |
Student struggles to classify individual behaviors as acceptable and unacceptable. |
Student can classify individual behaviors as acceptable and unacceptable, but needs more practice. |
Student can accurately classify individual behaviors as acceptable and unacceptable, and provide explanations. |
Story-Specific Best Practices and Proven Tools:
In addition to the ideas generated by students and mentioned in the activities, there are established best practices that may be appropriate to introduce or reference during this lesson to support communication. (Details and definitions can be found in the Best Practices section of the website.) Some best practices to consider for improving team communication include:
- CUS
- Huddles
- STEP
- Briefs
- Debriefs
- I’M SAFE
- DESC Script
- Feedback
- “Speak Up”
- 4 Step Process
- PEARLA
- Collaboration
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, September 5th, 2014
110
Instructor’s Guide – Double Check Three Times
Overview:
This story addresses the issue of double checking and verifying patient identification before administering medication while dealing with fatigue, and simultaneously anticipating family needs when moving a patient to a new room. Adding fatigue to the situation suddenly opens up the possibility for serious error.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe strategies to assess and manage the effects of fatigue on individual and team performance.
- Explain the importance of developing and maintaining communications systems for signaling team members, patients, and family members when changes occur in the plan of care.
- Describe methods for ‘double checking’ high risk patient care practices such as medication administration.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Teamwork and Collaboration:
- Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
- Safety:
- Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
Reflection Questions: Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
*Following each question are some potential answers
- What does this story illustrate about the importance of communicating with team members, especially when fatigue becomes an issue at the end of a shift?
A: Mistakes or the potential for a mistake can easily be made, especially when a health care professional becomes tired.
- What could this team have done to alleviate the stress and safety concerns caused by Mr. Pappas’ move to a new room?
A: The nurse, Diane, could have been notified of the move prior to it happening.
- What were some ways that Diane employed “double-checking” during this story? What might the consequences have been if she hadn’t?
A: She asked the patient to state their name and date of birth while she “double-checked” the name band. She also noted the name of the patient on the medication bag did not match that of her patient.
Discussion Questions: Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: New orders must be checked before any medication is administered. Diane should have double checked the orders and medication before bringing them into the patient’s room.
A: As we get tired it may be more difficult to adjust to changes. Mr. Pappas was moved to another room, but Diane did not realize this until after it had been done.
- What is something you can do to improve your ability to manage the effects of fatigue to prevent errors?
A: Double check all medication orders before administering the medication. Be sure to check on your patients regularly, as well as the chart, to determine if any changes have been made.
Suggested Classroom Mastery Activities: These activities can be tailored for individuals or groups in a face to face or online setting.
- Brainstorm ways you could and your team could manage the effects of fatigue to prevent errors. Compare your ideas with those of another classmate, and discuss the ones that you feel are the most effective or innovative.
- Develop a checklist that this team could use for signaling team members, patients, and family members when changes occur in the plan of care.
- Describe some other situations in which double-checking could be used to ensure patient safety.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe strategies to assess and manage the effects of fatigue on individual and team performance |
Student struggles to describe strategies to assess and manage the effects of fatigue on individual and team performance. |
Student can describe strategies to assess and manage the effects of fatigue on individual and team performance, but needs more practice. |
Student is able to accurately describe strategies to assess and manage the effects of fatigue on individual and team performance. |
| Explain the importance of developing and maintaining communications systems for signaling team members, patients, and family members when changes occur in the plan of care. |
The student struggles to explain the importance of developing and maintaining communications systems for signaling team members, patients and family members when changes occur in the plan of care. |
The student can explain the importance of developing and maintaining communications systems for signaling team members, patients and family members when changes occur in the plan of care, but needs more practice. |
The student can accurately explain and elaborate on the importance of developing and maintaining communications systems for signaling team members, patients and family members when changes occur in the plan of care. |
| Describe methods for ‘double checking’ high risk patient care practices such as medication administration. |
Student struggles to describe methods for ‘double checking’ high risk patient care practices such as medication administration. |
Student can describe methods for ‘double checking’ high risk patient care practices such as medication administration, but needs more practice or cannot provide relevant examples. |
Student can describe methods for ‘double checking’ high risk patient care practices such as medication administration and provide relevant examples. |
Story-Specific Best Practices and Proven Tools:
In addition to the ideas generated by students and mentioned in the activities, there are established best practices that may be appropriate to introduce or reference during this lesson to support communication. (Details and definitions can be found in the Best Practices section of the website.) Some best practices to consider for improving team communication include:
- STEP
- Huddles
- Check-Backs
- 3 Ws—Who Am I, What Am I Doing, and Why Do I Care
- I’M SAFE
- Cross Monitoring
- Task Assistance
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, September 5th, 2014
109
Instructor’s Guide – Seize the Moment
Overview:
This story is about how every staff member’s job is to recognize that what we experience as routine is for the patient a journey that is filled with fear and concern. It emphasizes the positive impact staff members have on patients when they provide reassurance and support.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe how going beyond your role to address the emotional needs of patients can positively impact their experience.
- Describe strategies that can be used by individuals and team members to help deliver an exceptional patient experience regardless of position, role, or status.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Patient-Centered Care:
- Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
- Teamwork and Collaboration:
- Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
Reflection Questions: Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
*Following each question are some potential answers
- Explain how this story demonstrates the effect of going beyond your role on the patient’s total experience.
A: Olivia did not have to volunteer to stay with Mrs. Ferren, but she made the commitment to stay.
A: Terrell did a nice job of explaining what he was doing and what to expect during the transfer to the radiology department.
- Describe how Terrell and Olivia’s teamwork helped make Mrs. Ferren’s experience more pleasant and safe.
A: Mrs. Ferren was treated with respect and dignity during this experience. Terrell and Olivia included Mrs. Ferren in their discussion and made it known they were there to help her.
Discussion Questions: Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: We learned that someone may have a specific job, like housekeeping, but they can still fill a vital role in comforting patients.
A: We must also remember that every job is important and they each aid in the support of the patient.
- How does this story illustrate the importance of all roles in the hospital for consistent patient-centered care, regardless of hierarchy?
Suggested Classroom Mastery Activities: These activities can be tailored for individuals or groups in a face to face or online setting.
- Brainstorm a list of ways to go beyond your role when working with patients. What could you do to make their everyday experiences more pleasant? Compare your list with a partner’s, and share your top three most interesting or innovative ideas with the class for discussion.
- Think of an everyday scenario you will encounter in your job. Write a short story that reflects how you could work with your team to make that scenario more pleasant for your patients, and address both their emotional and physical needs.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe how going beyond your role to address the emotional needs of patients can positively impact their experience. |
Student struggles to describe how going beyond their role to address the emotional needs of patients can positively impact their experience. |
Student can describe how going beyond their role to address the emotional needs of patients can positively impact their experience, through innovative ideas. |
Student can accurately describe and apply assertive statements or signal phrases to express safety concerns using the CUS technique. |
| Describe strategies that can be used by individuals and team members to help deliver an exceptional patient experience regardless of position, role, or status. |
Student struggles to generate and describe innovative strategies that can be used by individuals and team members to help deliver an exceptional patient experience. |
Student can generate and describe some strategies that can be used by individuals and team members to help deliver an exceptional patient experience, but needs more practice. |
Student can generate and describe innovative strategies that can be used by individuals and team members to help deliver an exceptional patient experience. |
Story-Specific Best Practices and Proven Tools:
In addition to the ideas generated by students and mentioned in the activities, there are established best practices that may be appropriate to introduce or reference during this lesson to support communication. (Details and definitions can be found in the Best Practices section of the website.) Some best practices to consider for improving team communication include:
- STEP
- Huddles
- Cross Monitoring
- 3 Ws—Who Am I, What Am I Doing, and Why Do I Care
- Collaboration
- Handoff
- Task Assistance
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, September 5th, 2014
108
Instructor’s Guide – Decision to Indecision
Overview:
This story addresses the importance of effective and consistent forms of team communication. Staff should feel empowered to speak up, assert, and advocate on behalf of the patient and the team regardless of perceived organizational hierarchies.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe and apply assertive statements or signal phrases to express safety concerns among team members regardless of hierarchy, using the CUS Technique.
- Describe the importance of adopting communication methods and strategies for improving team decision-making during emergent situations that include the patient and family.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Evidence-Based Practice (EBP):
- Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
- Safety:
- Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
- Teamwork and Collaboration:
- Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
QSEN Evidence-Based Practice Enrichment
TeamSTEPPS® Best Practice: CUSTeam Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals.The CUS technique provides a framework for conflict resolution, advocacy, and mutual support. Signal words, such as “danger,” “warning,” and “caution” are common in the medical arena. They catch the reader’s attention. “CUS” and several other signal phrases have a similar effect in verbal communication. When they are spoken, all team members will understand clearly not only the issue, but also the magnitude of the issue.
- CUS Technique:
- First, state your Concern.
- Then state why you are Uncomfortable.
- If the conflict is not resolved, state that there is a Safety issue.
Reflection Questions: Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
*Following each question are some potential answers
- Describe how breaks in Evidence-Based Practice (EBP) put the patient and her baby in danger in this story.
A: The nurse knew the fetal heart monitor indicated there was a potential problem, but she did not make that clear to the OBGYN.
- What do you believe Beth did well in the story?
A: She continued to monitor the baby and mother. She also began to prepare the family for potential issues.
- Describe the barriers that Beth faced in her attempt to advocate for her patient with other team members. How could use of the CUS Technique have helped her overcome those barriers?
A: She only hinted suggestions to the Dr. She did not state her concern or that she was uncomfortable with the situation.
Discussion Questions: Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: Being proactive and noting a concern is an important part of patient care. Nurse Beth could have used ‘CUS’ earlier in the shift when she noted the potential problem with the fetal heart tones.
- What one thing can you do as a team member to improve your communication with your team during emergent situations while including patients and families?
A: Be direct and state the actual concern with the Dr. Do not assume the doctor or other health care professions see the same thing you do.
Suggested Classroom Mastery Activities: These activities can be tailored for individuals or groups in a face to face or online setting.
- Rewrite Beth’s initial interaction with Dr. Pappas, demonstrating how she could have used the CUS technique to better advocate for Tracy.
- Pretend you are evaluating Dr. Pappas’ handling of the situation in the story. Describe what he could have done to better connect with his patients and team.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe and apply assertive statements or signal phrases to express safety concerns among team members regardless of hierarchy, using the CUS Technique. |
Student struggles to describe and apply assertive statements or signal phrases to express safety concerns using the CUS technique. |
Student can describe and apply some assertive statements or signal phrases to express safety concerns using the CUS technique, but needs more practice. |
Student can accurately describe and apply assertive statements or signal phrases to express safety concerns using the CUS technique. |
| Describe the importance of adopting communication methods and strategies for improving team decision-making during emergent situations that include the patient and family. |
Student struggles to describe the importance of adopting communication methods and strategies for improving team decision-making during emergent situations that include the patient and family. |
Student can describe the importance of adopting communication methods and strategies for improving team decision-making during emergent situations that include the patient and family, but needs more practice. |
Student can accurately describe the importance of adopting communication methods and strategies for improving team decision-making during emergent situations that include the patient and family. |
Story-Specific Best Practices and Proven Tools:
In addition to the ideas generated by students and mentioned in the activities, there are established best practices that may be appropriate to introduce or reference during this lesson to support communication. (Details and definitions can be found in the Best Practices section of the website.) Some best practices to consider for improving team communication include:
- CUS
- STEP
- Two-Challenge Rule
- Huddles
- Briefs
- Debriefs
- Feedback
- Advocacy and Assertion
- Collaboration
- Call-Out
- Cross Monitoring
- “Speak Up”
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Thursday, September 4th, 2014
107
Instructor’s Guide – Anything Else You Want to Tell Us
Overview:
This story is about bedside handoffs and the opportunities they present to share and receive information with the patient and the family. When done well, trust and connections will be established, resulting in staff members meeting the patient’s needs more efficiently.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Recall and describe ways to engage patients to make an emotional connection.
- Describe the importance of examining the accuracy of patient information across the care continuum by including the patient and family members in the assessment and handoff process.
- Demonstrate the ability to articulate a patient-centered approach to bedside handoffs to establish personal connections with patients and families, using the I PASS the BATON technique.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Safety:
- Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
- Patient-Centered Care:
- Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
- Teamwork and Collaboration:
- Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
QSEN Evidence-Based Practice Enrichment
Evidence-Based Best Practice: I PASS the BATON
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals.
- I PASS the BATON is a powerful tool that can be used for handoff of care anytime the complete responsibility for the patient from one entity to another, i.e., department to department or facility to facility. I PASS the BATON is a long acronym and usually the caregivers who adopt this tool build a checklist that uses the acronym as its foundation. The letters stand for:
- I PASS the BATON Technique:
- I (Introduction) Introduce yourself and your role/job
- P (Patient) Name, identifiers, age, sex, location
- A (Assessment) Present vital signs, chief complaint, symptoms and diagnosis
- S (Situation) Current status/circumstances
- S (Safety Concerns) Critical lab values/reports, allergies, alerts
- B (Background) Co-morbidities, previous episodes, current medications, family history
- A (Actions) What actions were taken or are required
- T (Timing) Level of urgency and timing/prioritization of actions
- O (Ownership) Who is responsible for care going forward, including patient and family
- N (Next) What will happen next? What is the plan?
Reflection Questions: Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
*Following each question are some potential answers
- What do you believe were the most critical safety concerns revealed in the story? How could they be prevented in the future?
A: Getting an accurate medication history of the patient is a top priority. There may be other priorities, but with an accurate history the patient cannot be prepared for surgery.
- How does this story illustrate the importance of making a personal connection with the patient and family? What were some things that Teresa and Cathy did to ensure that they had the patient’s trust and full attention?
A: They communicated clearly with the patient and his wife. They also did not say anything negative about the E.R. in front of the patient.
- How could a checklist based on the “I PASS the BATON” technique have alleviated some of the issues in this story? What procedures do you think this hospital needs to address and why?
A: A checklist could have been started in the E.R. or when the patient was admitted to the unit. The nurse was being proactive in her work, however this could have easily turned into a devastating error.
Discussion Questions: Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: Good communication, thinking ahead, and making observations is an important part of nursing work.
- What other things can we do to ensure we have the most accurate patient information during handoffs, especially at shift changes?
A: One way is to verbalize the things that are missing or that have not been previously discussed. The oncoming nurse should never assume a checklist has been completed or that previous work has been done by another department.
- What one thing could you do in your role to make a personal connection with patients and families during shift changes?
A: It works well if a nurse can start the shift change process about 30-45 minutes before the actual change of shift. Let the patient know you will be leaving at a certain time. Let them know you will be giving report to another nurse and that they will be well cared for in the coming hours. This is a good time to ask if they have any questions or concerns before the actual change of shift.
Suggested Classroom Mastery Activities: These activities can be tailored for individuals or groups in a face to face or online setting.
- Brainstorm a list of ways to better engage patients and families during shift change handoffs to make more personal connections. Compare your list with a classmate’s and share your three best ideas with the class.
- Research what complications for Antwon’s surgery he might have experienced had his pre-existing heart conditions and diabetes not been discovered by Teresa and Cathy. Develop a presentation to demonstrate why it is so important to examine the accuracy of patient information, based on what might have happened if Antwon’s surgery had proceeded without this information.
- Make a checklist for a shift change handoff using the I PASS the BATON technique. Go back through the story and evaluate Teresa and Cathy’s performance in this handoff on your checklist.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Recall and articulate ways to engage patients and make an emotional connection |
Student struggles to recall and articulate ways to engage patients and make an emotional connection. |
Student can recall and articulate some ways to engage patients and make an emotional connection, but needs more practice |
Student can accurately recall and articulate ways to engage patients and make an emotional connection. |
| Describe the importance of examining the accuracy of patient information across the care continuum by including the patient and family members in the assessment and handoff process. |
Student struggles to describe the importance of examining the accuracy of patient information and including the patient and family in assessment and handoff procedures. |
Student can describe the importance of examining the accuracy of patient information and including the patient and family in assessment and handoff procedures, but lacks authority on the subject. |
Student can accurately describe the importance of examining the accuracy of patient information and including the patient and family in assessment and handoff procedures. |
| Demonstrate the ability to articulate a patient-centered approach to bedside handoffs to establish personal connections with patients and families, using the I PASS the BATON technique. |
Student struggles to demonstrate the ability to professionally articulate a patient-centered approach to bedside handoffs through the use of I PASS the BATON. |
Student can demonstrate some ability to articulate a patient-centered approach to bedside handoffs through the use of I PASS the BATON, but needs more practice with the technique. |
Student can demonstrate the ability to professionally articulate a patient-centered approach to bedside handoffs through the use of I PASS the BATON. |
Posted in Pro ED Guides, Teacher Guides | No Comments »
Thursday, September 4th, 2014
106
Instructor’s Guide – Missed Our Chat Today
Overview:
This story is about making a human connection with a patient and how small personal touches and recognizing the needs of others are the key to an exceptional patient experience.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Recall and describe ways to engage patients to make an emotional connection.
- Discover and explain techniques for seeing care through the patient’s eyes.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Patient-Centered Care:
- Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
Reflection Questions: Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
*Following each question are some potential answers
- How might you make an emotional connection with a patient on a regular basis in your role?
A: Human connectedness is an important aspect of care giving. Active listening and episodes of demonstrating being “present” are ways to support a connectedness with your patients that will allow for you to have an emotional connection.
- What is one thing you could do to see through the patient’s eyes to better anticipate their emotional needs?
A: Provide an environment that encourages your patient be transparent with you regarding their needs. With the national trend toward shared decision-making, the importance of therapeutic communication is increasingly emphasized and supports meeting the emotional needs of our patients.
Discussion Questions: Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: The emotional needs of our patients can be met by all members of the team, including those in non-clinical positions. Supporting a culture of patient centeredness encourages this therapeutic environment.
- Describe how Helen made a difference for Mr. Lafleur during his hospital stay.
A: Helen should be commended for her attention to detail and contribution to his care. Her taking note of the “crushed” nature of his pillows, demonstrates that she was able to truly put herself in his position and say what would help me with my leg swelling? What would I want if I were in his shoes?
- What does this story illustrate about the importance of communicating with the entire hospital staff about patient care, not just the medical team?
A: Having a culture of patient centeredness and teamwork requires intentional effort and should be infused into all communications at all levels of the organization. As nurses at the bedside, we can establish that the non-clinical team members, contributing and interacting with our patients, are expected to consider them as their patients as well.
Suggested Classroom Mastery Activities: These activities can be tailored for individuals or groups in a face to face or online setting.
- Describe a time you experienced excellent care as a patient in a medical setting, where the staff (regardless of role) reached out to you as a person. Why was it important to you? If you don’t have a personal experience, ask your friends or loved ones to share their experience.
- Brainstorm a list of ways to make an emotional connection with patients on a regular basis in your role. Compare your list with a classmate’s and discuss your ideas. Present the three that you deem to be the most innovative and effective.
- Write the end of this story from Mr. LaFleur’s perspective. How do you think he might have reacted to Helen’s note?
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Recall and describe ways to engage patients to make an emotional connection. |
The student struggles to recall and describe ways to engage patients to make an emotional connection. |
The student can recall and describe some ways to engage patients to make an emotional connection. |
The student can recall and describe personal and innovative ways to engage patients to make an emotional connection. |
| Discover and explain techniques for seeing care through the patient’s eyes. |
The student struggles to articulate techniques for seeing care through the patient’s eyes. |
The student can articulate some techniques for seeing care through the patient’s eyes, but needs more practice. |
The student can articulate innovative techniques for seeing care through the patient’s eyes. |
Posted in Pro ED Guides, Teacher Guides | No Comments »
Thursday, September 4th, 2014
105
Instructor’s Guide – The Courage to Make the Call
Overview:
This story is about how a nurse questions a written physician order that doesn’t seem to make sense clinically. The physician is contacted immediately and the order is changed preventing a medication error. It is a prime example of the value of cross monitoring.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe the importance of comparing written orders in the context of the entire patient care plan to ensure accuracy and patient safety.
- Explain and apply evidence-based strategies that can limit distractions, interruptions, and multitasking during critical care activities.
- Recognize the importance of cross monitoring skills across the medical care team, regardless of position, status, or hierarchy to create trust and prevent errors.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Safety:
- Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
- Evidence-Based Practice (EBP):
- Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
- Teamwork and Collaboration
- Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
QSEN Evidence-Based Practice Enrichment
Evidence-Based Best Practice: Handoffs
Handoffs include the transfer of knowledge and information about the degree of uncertainty (or certainty about diagnoses, etc.), response to treatment, recent changes in condition and circumstances, and the plan (including contingencies). In addition, both authority and responsibility are transferred. Lack of clarity about who is responsible for care and for decision-making has often been a major contributor to medical error (as identified in root cause analyses of sentinel events and poor outcomes).
Reflection Questions: Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
- What systemic errors or lack of procedures put Mr. Carlson in danger in this story? What individual errors could have caused him harm?
- Proper handoffs are an evidence-based practice (EBP) that help ensure patient safety. What went well in the handoff of Mr. Carlson from Diane to Carol? What could have been improved?
- What might have been the consequences for Mr. Carlson had Carol and Diane not called Dr. Jackson? What does this story illustrate about the need to communicate, regardless of hierarchy?
Discussion Questions: Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: That change of shift report can be a chaotic time, even if there isn’t a code at the same time.
A: It’s important to have a good handoff even when other things are occurring in the hospital.
A: Nurses are responsible for the care given to each patient, even if the doctor or another health care professional has not done the right thing in a previous situation.
- What one thing can you do to improve mutual trust among a team so you always ‘have each other’s back’ regardless of individual personalities?
A: It was important that Diane did not leave until the current situation was handled. She stayed until the handoff was complete.
A: It was appropriate for Carol to call Diane at home. Diane may have known some information about the change in medication dosage and avoided a call to the doctor.
A: Diane made it clear that she was willing to call the Dr., even if he was going to become upset. The patient needs to be the first priority.
- How can you improve your ability to manage distractions, interruptions, and multitasking to prevent errors?
A: Be sure to deliver a proper handoff when giving report to another health care professional.
A: Check for new orders and be sure they are appropriate for the patient.
A: Don’t hesitate to ask for clarification on an order if you are unsure. This may be to another nurse, the charge nurse, or a Dr.
A: Stay focused on the task at hand and try not to get distracted and behind in patient care, charting, or daily tasks.
Suggested Classroom Mastery Activities: These activities can be tailored for individuals or groups in a face to face or online setting.
- Research cases where common dosage errors resulted in harm to a patient. Present a case to the class and describe how the error could have been prevented.
- Create a list of techniques you might be able to use that can limit distractions, interruptions, and multitasking during critical care activities. Compare your list with a classmate and discuss which you think would work for you.
- Rewrite an ending to this story in which Carol and Diane decide not to call Dr. Jackson with the consequences that you believe Mr. Carlson might have faced if they had followed Dr. Jackson’s orders.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe the importance of comparing written orders in the context of the entire patient care plan to ensure accuracy and patient safety. |
Student struggles to describe patient-centered principles that can be applied to routine patient and family interactions. |
Student can describe some of the importance of comparing written orders in the context of the entire patient care plan, but lacks essential elements. |
Student can accurately describe the importance of comparing written orders in the context of the entire patient care plan. |
| Explain and apply evidence-based strategies that can limit distractions, interruptions, and multitasking during critical care activities. |
Student struggles to explain and apply evidence-based strategies that can limit distractions, interruptions, and multi-tasking during critical care activities. |
Student can explain and apply some evidence-based strategies that can limit distractions, interruptions, and multi-tasking during critical care activities, but lacks essential elements. |
Student can accurately explain and apply evidence-based strategies that can limit distractions, interruptions, and multi-tasking during critical care activities. |
| Recognize the importance of cross monitoring skills across the medical care team, regardless of position, status, or hierarchy to create trust and prevent errors. |
Student struggles to recognize and articulate the importance of cross monitoring skills across the medical care team. |
Student can recognize and articulate some of the importance of cross monitoring skills across the medical care team, but lacks essential elements. |
Student can recognize and articulate the importance of cross monitoring skills across the medical care team. |
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Friday, August 29th, 2014
104
Instructor’s Guide – You Tell Me All About It
Overview:
This story is about a staff member who goes beyond her role to deliver an excellent patient experience. Seeing the person, not just the patient, is essential to making personal connections leading to outstanding care from the patient perspective.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe patient-centered principles that can be applied to routine patient and family interactions, and the importance of valuing all members of the team.
- Describe patient needs beyond immediate clinical tasks by seeing the person, not just the patient.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Patient-Centered Care:
- Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
Reflection Questions: Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
- As a member of the housekeeping department, Ernestine might not be considered part of the patient care team by some medical staff. What does this story demonstrate about the need to value all members of the team, regardless of their role?
- What do you believe Ernestine did in this story that demonstrated her ability to see the person, not just the patient? How could you apply that thinking to your role?
Discussion Questions: Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: It is important to realize that many aspects of communication are non-verbal. Listening between the lines to the tone, body language and non-verbal ques were essential to understanding this patient’s need for meaningful presence.
A: Meeting the physical needs of a patient on bedrest are foundational, but the emotional and spiritual aspects of care should not be underestimated.
A: Listening to what is important to the patient, should be the focus of our assessment and care planning for a patient centered approach to care.
- What’s one thing you could do to see through the patient’s eyes and go beyond your role to deliver exceptional care?
A: Being a therapeutic presence, as modeled by Ernestine in the story, can allow patient’s time to feel safe enough to share beyond the structure of direct questions or task related interactions.
Suggested Classroom Mastery Activities: These activities can be tailored for individuals or groups in a face to face or online setting.
- Imagine you are presenting the importance of patient-centered care to your team. Develop a presentation that highlights the importance of applying patient-centered care principles to routine patient and family interactions.
- Think of a time when a medical professional looked beyond your status as a patient and saw the person? Share your story and why it was important to you.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe patient-centered principles that can be applied to routine patient and family interactions, and the importance of valuing all members of the team. |
Student struggles to describe patient-centered principles that can be applied to routine patient and family interactions. |
Student can describe some patient-centered principles that can be applied to routine patient and family interactions, but needs improvement. |
Student can accurately describe patient-centered principles that can be applied to routine patient and family interactions. |
| Describe patient needs beyond immediate clinical tasks by seeing the person, not just the patient. |
Student struggles to describe patient needs beyond immediate clinical tasks by seeing the person, not just the patient. |
Student can describe some patient needs beyond immediate clinical tasks by seeing the person, not just the patient, but needs improvement. |
Student can accurately describe patient needs beyond immediate clinical tasks by seeing the person, not just the patient. |
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Friday, August 29th, 2014
103
Instructor’s Guide – You’re Part of Our Care Team Now
Overview:
During a routine delivery, the baby is unresponsive requiring resuscitation and a transfer to the neonatal intensive care unit. Prior planning and coordination are essential for successful handoffs in emergent situations.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Summarize information that should be included in a pre-delivery team briefing for staff, the patient, and family.
- Describe strategies and methods to ensure safe, timely, and closed-loop handoffs between units especially during emergent situations.
- Describe strategies to improve communication between team members, patients and families.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Teamwork and Collaboration:
- Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
- Evidence-Based Practice (EBP):
- Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
QSEN Evidence-Based Practice Enrichment
Evidence-Based Best Practice: Check-Backs
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals.
- A check-back is a closed-loop communication strategy used to verify and validate information exchanged. The strategy involves the sender initiating a message, the receiver accepting the message and confirming what was communicated, and the sender verifying that the message was received. Typically, information is called out anticipating a response on any order which must be checked back.
Reflection Questions: Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
- Describe the information that could have been included in a pre-delivery briefing for the team, patient and family that could have alleviated some stress in this story?
- How were check-backs used appropriately in this story to ensure safe, timely, and closed-loop handoffs between units? How could they have been used more effectively?
- Which staff member do you believe was the most responsive to the needs of the patients and in this story? Why?
Discussion Questions: Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: Javier and Elisa heard what was happening in the delivery room, but could not fully understand what was happening with their baby.
A: Javier and Elisa had to make assumptions about the health of the new born baby.
A: There did not appear to be a good check-back dialogue as the delivery nurse had not finished her assessment of the baby and the NICU then took the baby to the NICU.
- What are some things this team could have done to improve the way they communicated and to ‘stay on the same page’?
A: Javier and Elisa could have been informed from the moment the baby was born that the NICU was being notified and why.
A: A better check-back dialogue could have been initiated. It appeared as if the nurses knew what to do, but they were not communicating that information back.
- Which staff member do you believe was the least response to the needs of the patients in the story? Why?
A: The Dr. delivering the baby appears to be the least responsive to the patient. Elisa was not informed of what the APGAR numbers meant or why the NICU nurse was being called. The Dr. could have kept Elisa and Javier informed of the situation.
Suggested Classroom Mastery Activities: These activities can be tailored for individuals or groups in a face to face or online setting.
- Create (and optionally deliver to the class orally) a pre-delivery briefing that could have been given to the team, the patient and her husband prior to this delivery.
- Develop a check-back dialogue between the delivery team and the transport team to demonstrate a successful closed-loop handoff in a similar delivery scenario.
- Create a list of effective ways to improve communication with team members and patients in the delivery ward.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Summarize information that should be included in a pre-delivery team briefing for staff, the patient, and family |
Student does not include adequate relevant information in a mock pre-delivery team briefing that includes the team and patient. |
Student includes some relevant information in a mock pre-delivery team briefing that includes the team and patient. |
Student includes relevant information in a mock pre-delivery team briefing that includes the team and patient. |
| Describe strategies and methods to ensure safe, timely, and closed-loop handoffs between units especially during emergent situations |
Student struggles to describe strategies and methods to ensure safe, timely, and closed-loop handoffs between units. |
Student can describe some strategies and methods to ensure safe, timely, and closed-loop handoffs between units, but information is incomplete. |
Student can accurately describe strategies and methods to ensure safe, timely, and closed-loop handoffs between units.
|
| Describe strategies to improve communication between team members, patients and families. |
Student struggles to describe, or cannot describe, relevant strategies to improve communication between team members and patients. |
Student can describe some strategies to improve communication between team members and patients, but needs some improvement. |
Student can describe relevant strategies to improve communication between team members and patients. |
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Friday, August 29th, 2014
102
Instructor’s Guide – The Hard Way
Overview:
This story addresses the issue of hand hygiene, as well as the importance of including patients and family members as valued members of the care team. Hand hygiene is critical to preventing infections. Anyone on the healthcare team should feel comfortable questioning another team member’s hand hygiene practices to ensure patient safety.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe proper procedures for safe hand hygiene practices during all patient interactions.
- Recognize and describe the importance of providing patient-centered care and engaging family members as partners in patient care and safety.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Safety:
- Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
- Patient-Centered Care:
- Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
Reflection Questions: Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
- What procedures should medical professionals observe in regards to hand hygiene when interacting with a patient?
- What do you believe were the three most critical errors made by Dr. Patterson in the story, and how could he have better handled his interaction with Mr. and Mrs. Foster?
- The QSEN competencies require you to recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for the patient’s preferences, values, and needs. How did the medical professionals in this story fail to provide this level of care, and what could they have done instead?
Discussion Questions: Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: Hand hygiene is a fundamental skill that is learned in nursing school, but the general public may not be aware of the importance of hand hygiene. In this case Carmen had to learn about it in the hospital, after her husband was hospitalized.
A: Carmen wants the best care provided for her husband and that means being knowledgeable about his condition, including him in his care, and conducting appropriate hand hygiene.
A: Dr. Patterson may have had the right intentions in his care for Harold, but he did not include the patient in the conversation.
- How could Betty have intervened earlier in this story?
A: She could have introduced the Dr. to Carmen when he entered the room.
A: She could have gently reminded the Dr. to wash his hands before touching the patient.
A: She could have led by example and spoken to Harold and Carmen when Dr. Patterson was in the room.
Suggested Classroom Mastery Activities: These activities can be tailored for individuals or groups in a face to face or online setting.
- Create a family/caregiver guide to hand hygiene and safety for families to learn about protecting their loved one.
- Create a presentation on common issues or complications that can arise from poor or improper hand hygiene by medical professionals.
- Imagine you are in charge of developing and implementing a plan for promoting better hand hygiene among medical professionals on a floor of this hospital. Develop a presentation for your team and a checklist for ensuring proper hand hygiene on your floor.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Student can describe proper procedures for safe hand hygiene practices during all patient interactions. |
Student demonstrates little understanding of safe hand hygiene practices. |
Student demonstrates some understanding of safe hand hygiene practices. |
Student demonstrates full understanding of safe hand hygiene practices. |
| Student can recognize and describe the importance of providing patient-centered care and engaging family members as partners in patient care and safety. |
Student struggles to explain the importance of providing patient-centered care and engaging family members. |
Student explains the importance of providing patient-centered care and engaging family members, but may leave out important points. |
Student fully explains the importance of providing patient-centered care and engaging family members. |
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