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200 – When Egos Clash, It’s the Patients Who Lose Instructor’s Guide

Friday, October 10th, 2014

200

Instructor’s Guide – When Egos Clash, It’s the Patients Who Lose


Overview:
This story is about how unprofessional conduct is a major cause of compromises in patient safety and affects the morale of the entire clinical team.  All parties, regardless of role, seniority, or skill level, need to treat each other with respect and dignity.

 


Primary Learning Outcomes

After completing this lesson, the student will be able to:

  • Define the DESC tool from TeamSTEPPS and identify how it can be used to correct incidents and patterns of unprofessional conduct.
  • Arrange the debrief process to set up DESC discussions between the participants when disruptive interpersonal conflict affects the functioning of the team.
  • Adopt the TeamSTEPPS DESC tool as the primary problem-resolution strategy for handling interpersonal conflict.

 

 

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.
  • 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 Teamwork & Collaboration Enrichment

TeamSTEPPS® Best Practice: DESC Script

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 healthcare professionals.

 

DESC: What if a conflict has become personal in nature? The DESC script can be used to communicate effectively during all types of conflict, and is most effective in resolving personal conflict. The DESC script is used in the more conflicting scenarios in which behaviors aren’t practiced, hostile or harassing behaviors are ongoing, and safe patient care is suffering.

 

DESC is a mnemonic for—

D = Describe the specific situation

E = Express your concerns about the action

S = Suggest other alternatives

C = Consequences should be stated in terms of impact on established team goals; strive for consensus

 

There are some crucial things to consider when using the DESC script:

  • Time the discussion.
  • Work on win-win.
  • Frame problems in terms of personal experience and lessons learned. Choose a private location.
  • Use “I” statements rather than blaming statements.
  • Focus on what is right, not who is right.

 

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

  1. Describe how Cindy’s behavior is detrimental to patient safety and the team’s effectiveness.
    A: There is unspoken communication used in this scenario. Cindy’s behavior and actions indicate that she is not team oriented. The team is less effective because they are not able to work together and help each other to provide quality care for each patient.
  2. How could Dr. Janney use the DESC tool to address his concerns about Cindy?
    A: He could use the DESC tool to address his concerns regarding the behavior and conditions in the operating room. He would need to describe the specific situation, express his concerns, suggest other alternatives, and discuss potential patient consequences if new goals are not established.
  3. How can we use the DESC tool to increase our ability to confront incidents and patterns of unprofessional conduct?
    A: The DESC tool is one way to keep the patient the focus of the scenario. It should not be a personal accusation, but rather a way to make patient care a priority.

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

  1. What can we learn from this story?
    A: We learned that disruptive behavior impacts more than just the team, it could also negatively impact patient care.
  2. What can I ensure that I will be confident of my ability to successfully resolve any incident or pattern of unprofessional conduct on my team?
    A: If everyone were responsible for their own behavior this situation may have turned out differently. The team did not show respect for each other and were not making the patient’s safety a priority. Each member of the team needs to take responsibility for their own actions and to be accountable to each other to provide safe patient care.

 

Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting. 

  • Create a graphic or poster to remind colleagues of the DESC tool and its uses.
  • Develop and describe a protocol for using the DESC tool in conjunction with debriefs. Describe how the DESC tool can address patient safety concerns.
  • Complete this story by writing a dialogue in which Dr. Janney addresses his concerns about Cindy with her as a supervisor, using the DESC script tool.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Define the DESC tool from TeamSTEPPS and identify how it can be used to correct incidents and patterns of unprofessional conduct. Student struggles to define the DESC tool from TeamSTEPPS and identify how it can be used to correct incidents and patterns of unprofessional conduct. Student can define the DESC tool from TeamSTEPPS and identify how it can be used to correct incidents and patterns of unprofessional conduct, but needs further practice. Student can accurately define the DESC tool from TeamSTEPPS and identify how it can be used to correct incidents and patterns of unprofessional conduct.
Arrange the debrief process to set up DESC discussions between the participants when disruptive interpersonal conflict affects the functioning of the team.  Student struggles to arrange the debrief process to set up DESC discussions between the participants when disruptive interpersonal conflict affects the functioning of the team. Student can arrange the debrief process to set up DESC discussions between the participants when disruptive interpersonal conflict affects the functioning of the team, but needs further practice. Student can accurately arrange the debrief process to set up DESC discussions between the participants when disruptive interpersonal conflict affects the functioning of the team.
Adopt the TeamSTEPPS DESC tool as the primary problem-resolution strategy for handling interpersonal conflict.  Student struggles to adopt the TeamSTEPPS DESC tool as the primary problem-resolution strategy for handling interpersonal conflict. Student can adopt the TeamSTEPPS DESC tool as the primary problem-resolution strategy for handling interpersonal conflict, but needs further practice. Student can accurately adopt the TeamSTEPPS DESC tool as the primary problem-resolution strategy for handling interpersonal conflict.

 

 

Additional Story-Specific Resources:
For additional information on improving team communication, please consult the following articles and resources in Further Reading:

 


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. Some best practices to consider for improving team communication include:

  • DESC Script
  • 4-Step Process

 

 

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199 – Don’t Look Back in Anger Instructor’s Guide

Friday, October 10th, 2014

199

Instructor’s Guide – Don’t Look Back in Anger


Overview:
This story is about how patients, justified or not, can present staff with difficult interpersonal challenges that are sometimes hostile. The story demonstrates that even in the most trying circumstances, the best choice is to listen with compassion and empathy.

 


Primary Learning Outcomes

After completing this lesson, the student will be able to:

  • Recognize the importance of patient perspective in hostile situations.
  • Describe how empathy can be used to diffuse patient/family anger.
  • Adopt a huddle as a communication tool to support team members and enable them to manage patient/family expectations in hostile situations.

 

 

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

  1. How did Carol’s reaction to Carlota’s accusations serve to escalate the situation in this story?
    A: Carol reacted with anger and frustration. She did not foster open communication or mutual respect. Although Carlota did not approach the nurses station with an ability to use open communication, she was met with Carol’s anger and frustration. This then escalated the already tense situation.
  2. Describe how Estelle used empathy to curb Carlota’s anger and deescalate the situation.
    A: Estelle used empathy by fostering open communication and mutual respect. She listened to Carlota and her concerns regarding her mother’s lack of perceived care. Estelle defended her staff, but also acknowledged the concerns and frustrations Carlota was feeling.
  3. If you had been in Carlota’s shoes, how might you have perceived the situation?
    A: It is easy to become defensive and frustrated when a loved one is ill and in the hospital. Carlota was feeling frustrated and scared about her mother’s declining health. It is appropriate to note that family members may not perceive the situation in the same way as the nurse or other healthcare professional.

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

  1. What can we learn from this story?
    A: We have learned that disruptive behavior can negatively impact the health care team. In this situation it was appropriate to contact the nurse manager and to deescalate the situation.
  2. What tools can you adopt to diffuse patient/family anger and manage expectations?
    A: Tools that can be adopted to help diffuse anger include mutual respect and open communication. It may not be natural to respond in a way that is similar to Estelle, but it can be achieved with practice.

 

Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting. 

  • Imagine that Estelle had not been nearby to step in. Write your worst-case scenario for what happens next in this story.
  • Develop a protocol or checklist for dealing with irate patients or family members. Be sure it addresses the use of empathy in diffusing anger.
  • Create a presentation for your colleagues on the use of huddles to diffuse patient anger and support team members.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Recognize the importance of patient perspective in hostile situations.  Student struggles to recognize the importance of patient perspective in hostile situations. Student can recognize the importance of patient perspective in hostile situations, but needs further practice. Student can accurately recognize the importance of patient perspective in hostile situations.
Describe how empathy can be used to diffuse patient/family anger. Student struggles to describe how empathy can be used to diffuse patient/family anger. Student can describe how empathy can be used to diffuse patient/family anger, but needs further practice. Student can accurately describe how empathy can be used to diffuse patient/family anger.
Adopt a huddle as a communication tool to support team members and enable them to manage patient/family expectations in hostile situations.  Student struggles to adopt a huddle as a communication tool to support team members and enable them to manage patient/family expectations in hostile situations. Student can adopt a huddle as a communication tool to support team members and enable them to manage patient/family expectations in hostile situations, but needs further practice. Student can accurately adopt a huddle as a communication tool to support team members and enable them to manage patient/family expectations in hostile situations.

 

 

Additional Story-Specific Resources:
For additional information on improving team communication, please consult the following articles and resources in Further Reading:

 


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. Some best practices to consider for improving team communication include:

  • Collaboration
  • Huddles
  • SBAR
  • 3Ws – Who I Am, What I am Doing, Why I care
  • AskMe3

 

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198 – Empathize to Deescalate Instructor’s Guide

Friday, October 10th, 2014

198

Instructor’s Guide – Empathize to Deescalate


Overview:
This story is about the challenge of diffusing a patient’s upset or anger, and how important it is for every team member to maintain an even keel when dealing with conflict, find ways to empathize with patients no matter how combative, and to listen with compassion.

 


Primary Learning Outcomes

After completing this lesson, the student will be able to:

  • Identify your attitude to conflict.
  • Use empathy in situations charged with conflict to convey that you hear and understand what patients are saying.
  • Establish a common goal through collaboration.

 

 

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

  1. Describe how Mindy effectively deescalated the conflict in this story.
    A: Mindy used open communication and mutual respect to deescalate the situation. She did not ignore the issue or try to get involved with the situation, but she calmly addressed each person and the current situation.
  2. How did Mindy empathize with Carla?
    A: She shared an example of when she also came to the ER to receive care. It is not always necessary to share a personal story, but showing empathy is an important part of providing quality care.
  3. If you were in Mindy’s shoes, how might you have handled the situation differently?
    A: Mindy did a good job of deescalating the situation and still addressing the issue. She included Carla and Juan in the conversation and kept the conversation professional.

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

  1. What can we learn from this story?
    A: We learned the importance of deescalating a potentially aggressive situation. Carla was reacting from a stressful situation and Mindy approached the situation with compassion and empathy. She was successful in her approach to the situation.
  2. What can you do to reduce the potential for failed handoffs?
    A: Remember the importance of providing quality care for each patient no matter how difficult the situation may become. Sometimes it is easier to care for patients who are not angry or frustrated, but everyone deserves quality care.

 

Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting. 

  • Rewrite this story assuming that Mindy had a bad day and reacted differently to Carla and Juan’s fight and aggressiveness. Write your worst-case scenario and share it with the class.
  • What was your gut reaction to Carla’s aggressiveness and anger? Describe how you felt about the conflict in this story.
  • Create a presentation that teaches colleagues to focus on a common goal and use empathy when dealing with angry patients or families.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Identify your attitude to conflict. Student struggles to identify their attitude to conflict. Student can identify their attitude to conflict, but needs further practice. Student can accurately identify their attitude to conflict.
Use empathy in situations charged with conflict to convey that you hear and understand what patients are saying. Student struggles to use empathy in situations charged with conflict to convey that they hear and understand what patients are saying. Student can use empathy in situations charged with conflict to convey that they hear and understand what patients are saying, but needs further practice. Student can accurately use empathy in situations charged with conflict to convey that they hear and understand what patients are saying.
Establish a common goal through collaboration.  Students struggles to establish a common goal through collaboration. Students can establish a common goal through collaboration, but needs further practice. Students can accurately establish a common goal through collaboration.

 

 

Additional Story-Specific Resources:
For additional information on improving team communication, please consult the following articles and resources in Further Reading:

 


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. Some best practices to consider for improving team communication include:

  • Collaboration

 

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197 – Toxic Handoff Instructor’s Guide

Friday, October 10th, 2014

197

Instructor’s Guide – Toxic Handoff


Overview:
This story is about how a poor patient handoff can result in crucial information about the patient’s condition not being communicated, resulting in incomplete or inappropriate care decisions that can seriously endanger the patient’s safety.

 


Primary Learning Outcomes

After completing this lesson, the student will be able to:

  • Summarize the benefits for patient safety of having a structured handoff process.
  • Identify tools to support an effective handoff (e.g., checklist).
  • Develop a handoff process that ensures all relevant information is available to the team prior to discharge and that this information is shared with patients.

 

 

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.
  • 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 Teamwork & Collaboration Enrichment

TeamSTEPPS® Best Practice: Handoffs

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 healthcare professionals.

Handoffs: When a team member is temporarily or permanently relieved of duty, there is a risk that necessary information about the patient might not be communicated. The handoff strategy is designed to enhance information exchange at critical times such as transitions in care. More important, it maintains continuity of care despite changing caregivers and patients. 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.
*Following each question are some potential answers

  1. Which parts of the handoff process were most challenging for this team?
    A: It was most challenging for this team when the ER was busy and the work load continued to increase. Also – they did not have a good way to provide patient handoff care information from one healthcare professional to another. The doctor assisting with the discharge was not informed of the necessary discharge information.
  2. How could a structured handoff process have improved patient safety in this story?
    A: A structured handoff process would have helped in this situation, because the patient had tests ordered, but there was not follow-up to those tests. In this scenario it is unclear if any type of handoff was given between the healthcare professionals.
  3. How could the hospital improve its handoff process to better address patient safety?
    A: The use of SBAR could be used when transferring information from one healthcare team to another. The discharge doctor could have instructed the family to stay until all test results were received.

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

  1. What can we learn from this story?
    A: The importance of Team STEPPS handoff when patient care is transferred from one person to another. The healthcare team is responsible to provide quality care to the patient. This includes noting and following up with lab and test results prior to discharge.
  2. What can you do to reduce the potential for failed handoffs?
    A: One way is to implement bedside handoffs for every patient in the hospital. Another way to reduce the potential for failed handoffs is to identify a specific tool to be used when providing handoff, for example SBAR.

 

Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting. 

  • Develop a checklist that could help the team conduct a structured and effective handoff.
  • Create a presentation that teaches your colleagues about the importance of handoffs and their benefits for patient safety.
  • Research and describe what might have happened if Jody’s parents didn’t act so quickly in bringing him back to the emergency department. What might the consequences have been for him and for the hospital?

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Summarize the benefits for patient safety of having a structured handoff process Student struggles to summarize the benefits for patient safety of having a structured handoff process Student can summarize the benefits for patient safety of having a structured handoff process, but needs further practice. Student can accurately summarize the benefits for patient safety of having a structured handoff process
Identify tools to support an effective handoff (e.g., checklist) Student struggles to identify tools to support an effective handoff (e.g., checklist) Student can identify tools to support an effective handoff (e.g., checklist), but needs further practice. Student can accurately identify tools to support an effective handoff (e.g., checklist)
Develop a handoff process that ensures all relevant information is available to the team prior to discharge and that this information is shared with patients  Student struggles to develop a handoff process that ensures all relevant information is available to the team prior to discharge and that this information is shared with patients. Student can develop a handoff process that ensures all relevant information is available to the team prior to discharge and that this information is shared with patients, but needs further practice. Student can accurately develop a handoff process that ensures all relevant information is available to the team prior to discharge and that this information is shared with patients.

 

 

Additional Story-Specific Resources:
For additional information on improving team communication, please consult the following articles and resources in Further Reading:

 


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. Some best practices to consider for improving team communication include:

  • Collaboration
  • Handoff
  • Bedside Handoffs
  • Check-Backs
  • 3Ws – Who I am, What I am doing, and Why I care
  • AskMe3

 

 

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196 – Close the Loop Instructor’s Guide

Friday, October 10th, 2014

196

Instructor’s Guide – Close the Loop!


Overview:
This story is about patient discharge as a crucial activity to ensure their safety. It’s not enough for caregivers to simply communicate instructions—we must ensure that the patient and their family fully understand every detail using the check-back process.

 


Primary Learning Outcomes

After completing this lesson, the student will be able to:

  • Identify at least 3 points in this story where staff should have verified that the patient or her son understood the message.
  • Describe how check backs close the communication loop when exchanging information with patients and their families.
  • Adopt check backs as a tool to effectively exchange information with patients and their families.

 

 

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.
  • 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 Teamwork & Collaboration Enrichment

TeamSTEPPS® 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 healthcare professionals.

 

Check-Back: 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.
*Following each question are some potential answers

  1. Identify at least 3 points in this story where staff should have verified that the patient or her son understood the message.
    A: This could have been done when the patient was still in the hospital, during discharge, or when the follow-up phone call was made to the patient’s home. In fact, it should have been done at all three of these times. This would have provided the patient and her son with multiple opportunities to ask for clarification.
  2. Describe how check backs could have helped to close the communication loop with this family.
    A: Good communication, thinking ahead, and asking questions are an important part of nursing work. There was not a time during this scenario that anyone asked the family questions regarding the need to make an upcoming appointment or for filling the medication prescription.
  3. What do team members need to be able to do in order to effectively close the communication loop when exchanging information with patients about their care?
    A: One way is to verbalize the things that are missing or that have not been previously discussed. The discharge nurse could have made a checklist to be completed by the family upon discharge. The nurse that made the follow-up phone call could have asked open ended questions about the care of the patient and direct questions related to the dialysis appointment and medication administration.

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

  1. What can we learn from this story?
    A: Good communication, thinking ahead, and making observations is an important part of nursing work.
  2. How can you ensure that you close the communication loop with patients and their families when you are talking with them about their care?
    A: One way is for a nurse to start the discharge information process much earlier than the actual discharge time. Let the patient know they can ask questions at any time and to repeat necessary information as needed. The nurse should provide information and then ask the patient to restate what was said in their own words. Once the discharge information has been given it is a good time to ask if they have any questions or concerns before the actual discharge.

 

Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting. 

  • Describe the 3 points in this story where staff should have verified that the patient or her son understood the message. Explain how the staff could have better handled each of these points.
  • Create a presentation that teaches your colleagues about Check-Backs and their importance.
  • Develop a protocol and checklist for the staff in this story that helps them ensure that patients and their families are actively involved in the discharge process.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Identify at least 3 points in this story where staff should have verified that the patient or her son understood the message.  Student struggles to identify at least 3 points in this story where staff should have verified that the patient or her son understood the message. Student can identify at least 3 points in this story where staff should have verified that the patient or her son understood the message, but needs further practice. Student can accurately identify at least 3 points in this story where staff should have verified that the patient or her son understood the message.
Describe how check backs close the communication loop when exchanging information with patients and their families.  Student struggles to describe how check backs close the communication loop when exchanging information with patients and their families. Student can describe how check backs close the communication loop when exchanging information with patients and their families, but needs further practice. Student can accurately describe how check backs close the communication loop when exchanging information with patients and their families.
Adopt check backs as a tool to effectively exchange information with patients and their families.  Student struggles to adopt check backs as a tool to effectively exchange information with patients and their families. Student can adopt check backs as a tool to effectively exchange information with patients and their families, but needs further practice. Student can accurately adopt check backs as a tool to effectively exchange information with patients and their families.

 

 

Additional Story-Specific Resources:
For additional information on improving team communication, please consult the following articles and resources in Further Reading:

 


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. Some best practices to consider for improving team communication include:

  • Check-Backs
  • I PASS the BATON
  • 3Ws – Who I am, What I am doing, and Why I care
  • AskMe3

 

 

Posted in Pro ED Guides, Teacher Guides | No Comments »

195 – Question Everything! Instructor’s Guide

Friday, October 10th, 2014

195

Instructor’s Guide – Question Everything!


Overview:
This story is about a patient who is prescribed an inappropriate and dangerous dose of a drug, and how no one from the nurse carrying out the order to the pharmacist filling the order challenged the dosage that could have resulted in patient harm.

 


Primary Learning Outcomes

After completing this lesson, the student will be able to:

  • Describe how situation monitoring supports team functioning.
  • Identify tools that enable team members to assertively voice concerns over patient care.
  • Apply the Two-Challenge rule in situations where there are conflicting perspectives on patient care.

 

 

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 Teamwork & Collaboration Enrichment

TeamSTEPPS® Best Practice: “Two Challenge Rule”

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 healthcare professionals.

 

Two Challenge Rule: It is important to voice your concern by advocating and asserting your statement at least twice if the initial assertion is ignored (thus the name, “Two-Challenge rule”). These two attempts may come from the same person or two different team members. The first challenge should be in the form of a question. The second challenge should provide some support for your concern. Remember this is about advocating for the patient. The Two-Challenge tactic ensures that an expressed concern has been heard, understood, and acknowledged.

 

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

  1. How could the two-challenge rule have helped improve patient safety in this story?
    A: In this story no one challenged the Thorazine order or dosage. The two-challenge rule may have helped in this case due to the use of the medication and the high dosage. The pharmacist and the nurse could have questioned the order before administering the medication.
  2. What barriers were present in this story that prevented Alice from questioning Dr. Racinelli’s orders?
    A: She did not question the order because she was not familiar with Thorazine being used for hiccups. She also did not double check the amount of medication ordered. She did not speak up when she thought it may be an incorrect order.
  3. What skills do team members in this story need to develop to enable them to effectively advocate for patients?
    A: Team staff members could develop “Speak Up” or work on more advocacy and assertion. Assertion was not demonstrated in this story in regards to the new medication order.

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

  1. What can we learn from this story?
    A: New orders need to be checked before any medication is administered to the patient. It is important to double check orders, and also to determine if they are appropriate for the patient.
  2. What tools can I use to effectively advocate for patient safety?
    A: Patient safety needs to be a priority for every health care provider. In this situation advocacy and assertion could be more established within the health care team. The nurse did not speak up when she received the order and the pharmacist did not question the order or the dosage for this patient.

 

Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting. 

  • Research what adverse effects might have come from Dr. Racinelli’s overdose of Thorazine. Present your findings.
  • Create a presentation for colleagues on the Two-Challenge Rule, and its importance in protecting patient safety.
  • Write a dialogue in which Alice uses the Two Challenge Rule to question Dr. Racinelli’s decision to prescribe such a large dose of Thorazine for Shane’s hiccups.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Describe how situation monitoring supports team functioning. Student struggles to describe how situation monitoring supports team functioning. Student can describe how situation monitoring supports team functioning, but needs further practice. Student can accurately describe how situation monitoring supports team functioning.
Identify tools that enable team members to assertively voice concerns over patient care. Student struggles to identify tools that enable team members to assertively voice concerns over patient care. Student can identify tools that enable team members to assertively voice concerns over patient care, but needs further practice. Student can accurately identify tools that enable team members to assertively voice concerns over patient care.
Apply the Two-Challenge rule in situations where there are conflicting perspectives on patient care outcomes.     Student struggles to apply the Two-Challenge rule in situations where there are conflicting perspectives on patient care outcomes. Student can apply the Two-Challenge rule in situations where there are conflicting perspectives on patient care outcomes, but needs further practice. Student can accurately apply the Two-Challenge rule in situations where there are conflicting perspectives on patient care outcomes.

 

 

Additional Story-Specific Resources:
For additional information on improving team communication, please consult the following articles and resources in Further Reading:

 

 


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. Some best practices to consider for improving team communication include:

  • Advocacy and Assertion
  • Collaboration
  • I’M SAFE
  • SBAR
  • Two Challenge Rule
  • 3Ws – Who I am, What I am doing, and Why I care
  • AskMe3
  • “Speak Up”

 

 

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194 – When There’s a Conflict, DESC It! Instructor’s Guide

Friday, October 10th, 2014

194

Instructor’s Guide – When There’s a Conflict, DESC It!


Overview:
This story is about dealing with difficult interpersonal conflicts that can often become personal if not properly managed. Using the DESC tool, even difficult situations that have the potential to become inflamed can be appropriately managed in a manner that is respectful, yet still assertive.

 


Primary Learning Outcomes

After completing this lesson, the student will be able to:

  • Identify and describe early elective C-section delivery (EED) scheduling protocol.
  • Explain how you can use a DESC script to express concerns about non-compliance with your unit’s EED scheduling protocol.
  • Develop a DESC script for reducing conflict around EED scheduling that includes information about the impact and consequences of EEDs on team goals and patient outcomes.

 

 

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 Teamwork & Collaboration Enrichment

TeamSTEPPS® Best Practice: DESC Script

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 healthcare professionals.

 

DESC Script: What if a conflict has become personal in nature? The DESC script can be used to communicate effectively during all types of conflict, and is most effective in resolving personal conflict. The DESC script is used in the more conflicting scenarios in which behaviors aren’t practiced, hostile or harassing behaviors are ongoing, and safe patient care is suffering.

 

DESC is a mnemonic:

D = Describe the specific situation;

E = Express your concerns about the action;

S = Suggest other alternatives; and,

C = Consequences should be stated. Ultimately, consensus should be reached.

 

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

  1. What changes in practices and protocols were causing concern in this story? Why were they important for patient safety?
    A: The change in practice was related to delivering babies that were less than 40 weeks gestation. The change in practice and protocol were put into place in order to improve patient outcomes. Babies that are delivered closer to their due date do better than those who are delivered early.
  2. What barriers did Dr. Dorsey perceive in following the new protocol?
    A: He felt that patient satisfaction scores would go down because patients would not be able to make their own C-section date. He stated that patient satisfaction was just as important as patient safety.
  3. How can we use DESC to reduce conflict related to changes in practices and protocols?
    A: DESC can be used to reduce conflict because the focus is on the patient and reaching positive outcomes. It is not about achieving personal goals.

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

  1. What can we learn from this story?
    A: Being proactive and confronting the doctor was necessary in this situation. Patient safety was the primary concern and the nurse emphasized this information. It may be hard to confront a doctor or another nurse, but there may be times when it is necessary.
  2. What can I do to practice using DESC?
    A: One way to practice DESC is to think of a scenario and practice working through DESC with another co-worker. They can objectively hear your approach and give you pointers or corrections, if needed. It may also help to write down the necessary information. This will help you to stay focused and on track during the potentially uncomfortable conversation.

 

Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.  

  • Create a presentation or brochure describing early elective C-section delivery and its possible consequences.
  • Think of another scenario where an EED is scheduled. Write a dialogue that uses a DESC script to express your concerns about non-compliance with EED scheduling protocol.
  • Develop a presentation that teaches the DESC Script tool to your colleagues as a way to avoid medical errors and lapses in safety. Use an EED situation as an example in your presentation.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Identify and describe early elective C-section delivery (EED) scheduling protocol.   Student struggles to identify and describe early elective C-section delivery (EED) scheduling protocol. Student can identify and describe early elective C-section delivery (EED) scheduling protocol, but needs further practice. Student can accurately identify and describe early elective C-section delivery (EED) scheduling protocol.
Explain how you can use a DESC script to express concerns about non-compliance with your unit’s EED scheduling protocol. Student struggles to explain how you can use a DESC script to express concerns about non-compliance with your unit’s EED scheduling protocol. Student can explain how you can use a DESC script to express concerns about non-compliance with your unit’s EED scheduling protocol, but needs further practice. Student can accurately explain how you can use a DESC script to express concerns about non-compliance with your unit’s EED scheduling protocol.
Develop a DESC script for reducing conflict around EED scheduling that includes information about the impact and consequences of EEDs on team goals and patient outcomes.      Student struggles to develop a DESC script for reducing conflict around EED scheduling that includes information about the impact and consequences of EEDs on team goals and patient outcomes. Student can develop a DESC script for reducing conflict around EED scheduling that includes information about the impact and consequences of EEDs on team goals and patient outcomes, but needs further practice. Student can accurately develop a DESC script for reducing conflict around EED scheduling that includes information about the impact and consequences of EEDs on team goals and patient outcomes.

 

 

Additional Story-Specific Resources:
For additional information on improving team communication, please consult the following articles and resources in Further Reading:

 


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. Some best practices to consider for improving team communication include:

  • Advocacy and Assertion
  • Cross Monitoring
  • Collaboration
  • DESC Script
  • Feedback
  • PEARLA

 

 

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193 – Safety Depends on Feedback Instructor’s Guide

Friday, October 10th, 2014

193

Instructor’s Guide – Safety Depends on Feedback


Overview:
This story is about how patient safety is everyone’s responsibility, and how all staff members are accountable for giving fellow team members feedback when their practices diverge from accepted safety norms and practices that have been adopted by the unit or the hospital.

 


Primary Learning Outcomes

After completing this lesson, the student will be able to:

  • Recognize situations in which it is important to advocate for patient safety even if it may lead to a conflict or differing positions.
  • Identify how situation awareness can help you identify problems that undermine patient safety.
  • Use Feedback as a tool to challenge team members and advocate for patients.

 

 

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 Teamwork & Collaboration Enrichment

TeamSTEPPS® Best Practice: Feedback

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 healthcare professionals.

 

Feedback: Another type of mutual support is feedback. Feedback is information provided for the purpose of improving team performance. The ability to communicate self-improvement information in a useful way is an important skill in the team improvement process. Feedback can be given by any team member at any time. It is not limited to management roles or formal evaluation mechanisms. Rules of effective feedback include the following:

  1. Timely—Feedback is most effective when the behavior being discussed is still fresh in the mind of the receiver;
  2. Respectful—The feedback should not be personal, and it should not be about personality. It should be about behavior;
  3. Specific—The feedback should relate to a specific situation or task;
  4. Directed—Goals should be set for improvement;
  5. Considerate—Be considerate of team members’ feelings when delivering feedback, and remember to praise good 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

  1. How was the feedback tool utilized in this story?
    A: In this situation Bridget was direct, timely, respectful, and specific. She focused on the patient and patient safety and not on herself and her own feelings.
  2. Why is it so important to always abide by evidence-based practices regarding patient safety?
    A: Evidence based practice is the standard of care each patient should be receiving.
    A: There should never be a time when Evidence-Based Practices should be ignored or altered.
  3. How did you feel about Dr. Walter’s reaction to Bridget’s questions?
    A: Bridget was appropriate when she spoke to Dr. Walters regarding his lack of hand hygiene. She provided necessary feedback to the doctor and ensured that patient safety was the top priority. Dr. Walters received this information and agreed with Bridget. He treated her with respect and agreed that hand hygiene should be more of a priority.

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

  1. What can we learn from this story?
    A: The importance of providing feedback to other health care professionals. It would have been very easy for Bridget to wait a few weeks or more before saying anything to the doctor, but she did not. Patient safety should be the priority for all health care providers. It may be hard to receive feedback at times, but it is important to remember it is for the safety of the patient.
  2. How can I use Feedback to advocate for patient safety?
    A: Feedback can be difficult to use if you are new to a hospital or clinic. However, it is important to advocate for the patient. Many times it is difficult to bring up a difficult subject, but by using the feedback tool it is possible. By being timely, respectful, specific, direct and considerate you are able to focus on the needs of the patient. The priority of the healthcare team should focus on the patient and not on feeling hurt or offended by the feedback.

 

Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting. 

  • Create a presentation to teach others about the concept of “Feedback”. Create your own situation in which to demonstrate the concept.
  • Describe another situation where situation awareness could help improve patient safety. Write a dialogue or act out a scene where feedback is employed to help improve the patient’s experience and safety.
  • Imagine if Dr. Walters had a different reaction. Write out a dialogue in which Dr. Walters responds to Bridget’s criticism defensively, and think of a response that could respectfully drive her point home.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Recognize situations in which it is important to advocate for patient safety even if it may lead to a conflict or differing positions. Student struggles to recognize situations in which it is important to advocate for patient safety even if it may lead to a conflict or differing positions. Student can recognize situations in which it is important to advocate for patient safety even if it may lead to a conflict or differing positions, but needs further practice. Student can accurately recognize situations in which it is important to advocate for patient safety even if it may lead to a conflict or differing positions.
Identify how situation awareness can help you identify problems that undermine patient safety.  Student struggles to identify how situation awareness can help you identify problems that undermine patient safety. Student can identify how situation awareness can help you identify problems that undermine patient safety, but needs further practice. Student can accurately identify how situation awareness can help you identify problems that undermine patient safety.
Use Feedback as a tool to challenge team members and advocate for patients.    Student struggles to use Feedback as a tool to challenge team members and advocate for patients. Student can use Feedback as a tool to challenge team members and advocate for patients, but needs further practice. Student can accurately use Feedback as a tool to challenge team members and advocate for patients.

 

 

Additional Story-Specific Resources:
For additional information on improving team communication, please consult the following articles and resources in Further Reading:

 


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. Some best practices to consider for improving team communication include:

  • Advocacy and Assertion
  • Cross Monitoring
  • Check-Backs
  • STEP
  • SBAR
  • “Speak Up”

 

 

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191 – Cross Monitor to Address Adverse Drug Events Instructor’s Guide

Friday, October 10th, 2014

191

Instructor’s Guide – Cross Monitor to Address Adverse Drug Events


Overview:
This story addresses the issue of cross monitoring as it relates to adverse drug events (ADEs). Proper communication protocols between physicians and nursing staff are essential to prevent patient ADEs.

 


Primary Learning Outcomes

After completing this lesson, the student will be able to:

  • Describe challenges in ensuring medication safety.
  • Identify steps to improve medication safety, including empowering patients to be aware of the medications they are taking.
  • Explain the importance of using evidence-based communication measures to improve medication safety in a unit.

 

 

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 Teamwork & Collaboration Enrichment

TeamSTEPPS® Best Practice: Cross Monitoring

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 healthcare professionals.

Cross Monitoring: Cross monitoring is used by fellow team members to help maintain situation awareness and prevent errors. Commonly referred to as “watching each other’s back,” it is the action of monitoring the behavior of other team members by providing feedback and keeping track of fellow team members’ behaviors to ensure that procedures are being followed appropriately. It allows team members to self-correct their actions if necessary. Cross monitoring is not a way to “spy” on other team members, rather it is a way to provide a safety net or error-prevention mechanism for the team, ensuring that mistakes or oversights are caught early. When all members of the team trust the intentions of their fellow team members, a strong sense of team orientation and a high degree of psychological safety result.

 

 

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

  1. What evidence-based practices were violated in this story? Were the violations warranted?
    A: The violation noted in this scenario is related to an adverse drug event. This patient had been prescribed a sulfonamide and warfarin at the same time. This in turn created an adverse drug even.
  2. What assumptions about patient safety did the nurses in this story make? Why were they detrimental?
    A: The nurse assumed the doctor new about the Coumadin and wanted to continue with the antibiotic. Her assumptions were detrimental because the patient had an adverse drug reaction and that in turn affected the patient.
  3. How could cross monitoring help this unit provide better patient care and safety?
    A: Cross monitoring would have alerted the doctor to the potential adverse drug event. It would have also given the nurse a chance to discuss her concerns with the 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

  1. What can we learn from this story?
    A: The nurse could have discussed this potential adverse drug event with the doctor. It is also important to note that nurses are responsible for the side effects of medications that are given to the patient. The doctor may have prescribed the medication, but the nurse is responsible for monitoring the effects of the medications and to anticipate potential problems that may occur.
  2. What can I do to ensure that I monitor situations to ensure medication safety?
    A: The nurse must be proactive and advocate for the patient first. The doctor may not change the medication order, but the nurse needs to advocate for the patient. Also, if the medication regime was not altered then the nurse should be monitoring for potential adverse side effects.

 

Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting. 

  • What challenges exist when trying to ensure medication safety? Make a list of the challenges and their possible solutions.
  • Develop a step-by-step protocol for improving medication safety, which includes the empowerment of patients.
  • Create a presentation that could help teach a team about cross monitoring and other evidence based communication tools to help ensure patient safety during medication administration.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Describe challenges in ensuring medication safety. Student struggles to describe challenges in ensuring medication safety. Student can describe challenges in ensuring medication safety, but needs further practice. Student can accurately describe challenges in ensuring medication safety.
Identify steps to improve medication safety, including empowering patients to be aware of the medications they are taking. Student struggles to identify steps to improve medication safety, including empowering patients to be aware of the medications they are taking. Student can identify steps to improve medication safety, including empowering patients to be aware of the medications they are taking, but needs further practice. Student can accurately identify steps to improve medication safety, including empowering patients to be aware of the medications they are taking.
Explain the importance of using evidence-based communication measures to improve medication safety in a unit.  Student struggles to explain the importance of using evidence-based communication measures to improve medication safety in a unit. Student can explain the importance of using evidence-based communication measures to improve medication safety in a unit, but needs further practice. Student can accurately explain the importance of using evidence-based communication measures to improve medication safety in a unit.

 

 

Additional Story-Specific Resources:
For additional information on improving team communication, please consult the following articles and resources in Further Reading:

 


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. Some best practices to consider for improving team communication include:

  • Advocacy and Assertion
  • Cross Monitoring
  • Check-Backs
  • STEP
  • SBAR
  • “Speak Up”

 

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190 – Safety Practices Depend on Advocacy and Assertion Instructor’s Guide

Friday, October 10th, 2014

190

Instructor’s Guide – Advocate for a Smooth Delivery


Overview:
This story is about when we witness team members depart from evidence-based safety practices designed to minimize risk, and how we can best intervene when it’s often difficult or uncomfortable to speak up assertively to confront unsafe practices.

 


Primary Learning Outcomes

After completing this lesson, the student will be able to:

  • Identify the responsibilities of each team member under the Advocacy and Assertion strategy in TeamSTEPPS.
  • Explain and apply the strategy of advocacy for the patient and expressing concerns assertively when shortcuts are being taken that compromise patient safety.
  • Describe and adopt an assertive statement or a signal phrase to be used by team members to voice concerns when shortcuts are being taken.

 

 

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 Teamwork & Collaboration Enrichment

TeamSTEPPS® Best Practice: Advocacy and Assertion

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 healthcare professionals.

Advocacy and Assertion: Advocacy and assertion interventions are invoked when a team member’s viewpoint does not coincide with that of a decision maker. In advocating for the patient and asserting a corrective action, the team member has an opportunity to correct errors or the loss of situation awareness. Failure to employ advocacy and assertion has been frequently identified as a primary contributor to the clinical errors found in malpractice cases and sentinel events. You should advocate for the patient even when your viewpoint is unpopular, is in opposition to another person’s view, or questions authority. When advocating, assert your viewpoint in a firm and respectful manner. You should also be persistent and persuasive, providing evidence or data for your concerns.

 

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

  1. What evidence-based practices were violated in this story? Were the violations warranted?
    A: The violations noted in this story are related to evidence based practice and maintaining a sterile field.
    A: The violations in this story do not appear to be an intentional violation, but rather a change in practice. However, the current practice is not acceptable and breaches the standards of care.
  2. What barriers to patient advocacy did Celeste face?
    A: She was new to the role and did not know how much she could say. She also did not know enough about the culture of the operating room. She did not know if this was an intentional violation of sterility or something that had been in practice for a long time.
  3. How might she have overcome them to better advocate for the patient in this story?
    A: Celeste needs to remember that patient care is the priority. It may be difficult at times to speak up in a new situation, but the safety of the patient needs to be more important than feeling uncomfortable about 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

  1. What can we learn from this story?
    A: All team members need to be able to hold each other accountable for their behavior. This should be done out of mutual respect and not out of personal interest.
    A: There may be times when small changes over time are not best for the patient. The nurses did not intend to cause harm to the patient, but because they contaminated the sterile field, patient care was compromised.
  2. What steps can you take to ensure you feel able to assert yourself and advocate for the patient if another team member takes a safety-compromising shortcut?
    A: Good teamwork needs to be demonstrated by everyone on the team. Mutual respect and shared-decision making needs to be established by the senior leadership. However, if this is not the case, then everyone needs to be able to speak up and advocate for the patient.

 

Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting. 

  • What are some of the barriers we experience when we attempt to advocate for a patient or assert a concern when we see shortcuts being taken? Develop a list of barriers and possible solutions for overcoming them.
  • Think of an assertive statement that Celeste could have used in this story. Share your statement with the class and work to decide which statements would be most effective.
  • Develop a protocol that could be used by a team when a team member takes a shortcut. Include an assertive statement and steps to maintain the team’s progress and the team member’s dignity without compromising patient safety.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Identify the responsibilities of each team member under the Advocacy and Assertion strategy in TeamSTEPPS. Student struggles to identify the responsibilities of each team member under the Advocacy and Assertion strategy in TeamSTEPPS. Student can identify the responsibilities of each team member under the Advocacy and Assertion strategy in TeamSTEPPS, but needs further practice. Student can accurately identify the responsibilities of each team member under the Advocacy and Assertion strategy in TeamSTEPPS.
Explain and apply the strategy of advocacy for the patient and expressing concerns assertively when shortcuts are being taken that compromise patient safety.   Student struggles to explain and apply the strategy of advocacy for the patient and expressing concerns assertively when shortcuts are being taken that compromise patient safety. Student can explain and apply the strategy of advocacy for the patient and expressing concerns assertively when shortcuts are being taken that compromise patient safety, but needs further practice. Student can accurately explain and apply the strategy of advocacy for the patient and expressing concerns assertively when shortcuts are being taken that compromise patient safety.
Describe and adopt an assertive statement or a signal phrase to be used by team members to voice concerns when shortcuts are being taken.  Student struggles to describe and adopt an assertive statement or a signal phrase to be used by team members to voice concerns when shortcuts are being taken. Student can describe and adopt an assertive statement or a signal phrase to be used by team members to voice concerns when shortcuts are being taken, but needs further practice. Student can accurately describe and adopt an assertive statement or a signal phrase to be used by team members to voice concerns when shortcuts are being taken.

 

 

Additional Story-Specific Resources:
For additional information on improving team communication, please consult the following articles and resources in Further Reading:

 


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. Some best practices to consider for improving team communication include:

  • Advocacy and Assertion
  • Cross Monitoring
  • CUS
  • Two-Challenge Rule

 

Posted in Pro ED Guides, Teacher Guides | No Comments »

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