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207 – Let’s STEP Back Instructor’s Guide

Friday, October 10th, 2014

207

Instructor’s Guide – Let’s STEP Back


Overview:
This story is about how training for situation awareness can prevent many serious medical errors and sentinel events. A team’s ability to maintain situation awareness depends on having good tools to use, and practicing the use of those tools.

 


Primary Learning Outcomes

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

  • Summarize the elements of the TeamSTEPPS STEP situation awareness tool.
  • Describe how situation awareness can be maintained by consistent use of the STEP tool.
  • Plan how to consistently use and practice applying the STEP tool on the unit.

 

 

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: STEP

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.

 

STEP: How do you acquire a trained eye as you “monitor the situation” on your unit? The STEP process is a mnemonic tool that can help you monitor the situation and the overall environment. The STEP process involves ongoing monitoring of the:

  • Status of the patient,
  • Team members,
  • Environment, and
  • Progress toward the goal.

 

In a healthcare setting, the most obvious element of the situation requiring constant monitoring is your patient’s status. Even minor changes in the patient’s vital signs may require dramatic changes in the team’s actions and the urgency of its response. You should also be aware of team members’ status, including fatigue and stress level, workload, and skill level. You should be aware of the environment, including triage acuity, and equipment. And finally, you should assess your progress towards goals by asking the following key questions: What is the status of the team’s patient(s)? Has the team established goals? Has the team accomplished their task/actions? Is the plan still appropriate?

 
 

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 does the STEP tool improve patient safety?
    A: TEAM STEPPS improves patient safety because good communication allows every team member to be aware of what is happening with the patient. The patient remains the focus of the team.
  2. Why is it important that this team is practicing the STEP tool?
    A: This team works in a very busy unit and by practicing the STEP tool they are preparing for safe patient care. It is good to practice the STEP tool because the team is more likely to use it in a real case situation if they also practice it in a simulation type setting.
  3. How can the TeamSTEPPS STEP tool help us maintain situation awareness at all times and in all circumstances?
    A: TeamSTEPPS provides a framework for good communication. It is a way of verbalizing what is happening and to establish common 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: We have learned the appropriate use of good communication, teamSTEPPS, and closed loop communication. It may seem awkward in the beginning, but the more this type of communication is practiced the easier it is to use.
  2. How can I use the STEP tool to help maintain situation awareness?
    A: Situation awareness can be maintained by using check backs and open communication. This may be more critical during high workload periods due to the increased stress and chaos of a situation.

 

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

  • Create a presentation for colleagues on the usefulness of the TeamSTEPPS STEP tool. Describe how it could be used.
  • Think of another scenario for using the STEP tool. Describe the scenario and write a story using the STEP tool effectively.
  • Brainstorm ways to practice the STEP tool on a regular basis. Share your ideas with the class and come up with a list of the best ways to practice using the tool.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Summarize the elements of the TeamSTEPPS STEP situation awareness tool.  Student struggles to summarize the elements of the TeamSTEPPS STEP situation awareness tool. Student can summarize the elements of the TeamSTEPPS STEP situation awareness tool, but needs further practice. Student can accurately summarize the elements of the TeamSTEPPS STEP situation awareness tool.
Describe how situation awareness can be maintained by consistent use of the STEP tool. Student struggles to describe how situation awareness can be maintained by consistent use of the STEP tool. Student can describe how situation awareness can be maintained by consistent use of the STEP tool, but needs further practice. Student can accurately describe how situation awareness can be maintained by consistent use of the STEP tool.
Plan how to consistently use and practice applying the STEP tool on the unit. Student struggles to plan how to consistently use and practice applying the STEP tool on the unit. Student can plan how to consistently use and practice applying the STEP tool on the unit, but needs further practice. Student can accurately plan how to consistently use and practice applying the STEP tool on the 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:

  • STEP

 

 

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206 – That One Little Thing Instructor’s Guide

Friday, October 10th, 2014

206

Instructor’s Guide – That One Little Thing


Overview:
Each contact with a patient in a healthcare facility creates an opportunity to satisfy or dissatisfy that patient as a consumer. If careful attention is not paid, small incidents can color the overall perception of care.

 


Primary Learning Outcomes

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

  • Describe the process patients go through when they sit down to fill out a survey of patient satisfaction.
  • Generate a list of things a unit could do that, if implemented, would increase the unit’s ability to create satisfied patients.
  • Adopt a plan to work toward eliminating dis-satisfiers of patient safety and increase the use of practices that lead to increase patient satisfaction.

 

 

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

  1. What does this story illustrate about the importance of providing a consistent level of patient-centered care throughout the hospital?
    A: It only takes one bad experience or encounter to impact the overall patient experience and organizational perception.
  2. Describe the examples of excellent patient-centered care and poor patient-centered care in this story?
    A: The smiling, personable transporter was a positive, along with menu selections and provision of a warm blanket as an unexpected comfort measure.
    A: Clearly, leaving him in the cold basement – unattended for 25 minutes was inconsistent with the overall experience.
  3. How can you use information from patient surveys to improve care?
    A: Look for common themes to determine how to change processes or systems of care.
    A: Identify opportunities to improving communication.
    A: Identify opportunities to repeat positive behaviors.

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: One bad experience can minimize dozens of positive patient encounters.
    A: Our goal must be to have everyone striving for consistent excellence and patient centered care.

 

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

  • Think of an experience you or a loved one had in a hospital or clinic. How would you rate your stay or visit? What situations or experiences would cause you to lower your rating?
  • Research the reasons that patients rate hospitals poorly. Create a presentation that teaches your colleagues about the importance of providing a high level of patient centered care.
  • Develop a plan for using patient surveys to evaluate policies and procedures in your workplace.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Describe the process patients go through when they sit down to fill out a survey of patient satisfaction. Student struggles to describe the process patients go through when they sit down to fill out a survey of patient satisfaction. Student can describe the process patients go through when they sit down to fill out a survey of patient satisfaction, but needs further practice. Student can accurately describe the process patients go through when they sit down to fill out a survey of patient satisfaction.
Generate a list of things a unit could do that, if implemented, would increase the unit’s ability to create satisfied patients. Student struggles to generate a list of things a unit could do that, if implemented, would increase the unit’s ability to create satisfied patients. Student can generate a list of things a unit could do that, if implemented, would increase the unit’s ability to create satisfied patients, but needs further practice. Student can accurately generate a list of things a unit could do that, if implemented, would increase the unit’s ability to create satisfied patients.
Adopt a plan to work toward eliminating dis-satisfiers of patient safety and increase the use of practices that lead to increased patient satisfaction.  Student struggles to adopt a plan to work toward eliminating dis-satisfiers of patient safety and increase the use of practices that lead to increased patient satisfaction. Student can adopt a plan to work toward eliminating dis-satisfiers of patient safety and increase the use of practices that lead to increased patient satisfaction, but needs further practice. Student can accurately adopt a plan to work toward eliminating dis-satisfiers of patient safety and increase the use of practices that lead to increased patient satisfaction.

 

 

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:

  • 3Ws – Who I Am, What Am I Doing, and Why I Care
  • Bedside Handoffs
  • Patient Rounding
  • Check-Backs
  • Speak Up
  • AskMe3

 

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205 – The Sound Resounds Instructor’s Guide

Friday, October 10th, 2014

205

Instructor’s Guide – The Sound Resounds


Overview:
This story is about a very important part of the patient experience – a clean, orderly, and quiet environment. Staff members can become desensitized to noises over time that disturb and annoy patients.

 


Primary Learning Outcomes

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

  • Explain the negative effect that unnecessary noise has on patients and their satisfaction with their hospital experience.
  • Be able to define noise and list possible sources of noise affecting patients.
  • Create a plan for conducting regular noise audits and awareness-raising sessions for fellow staff members.

 

 

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

  1. What does this story illustrate about the importance of viewing all hospital decisions through patients’ eyes?
    A: Clearly, the first impression is important, however, not a priority over patient’s getting adequate for recovery
  2. What can we do to ensure that noise is controlled and has a minimal impact on the well-being and satisfaction of patients?
    A: Nurses should advocate for patient’s rest by keeping unnecessary conversation and confusion in the halls to a minimum.
    A: Identify systems of care – environmental services, etc – that could adjust their services to accommodate a peaceful environment for the patients.
  3. What can you do to eliminate unnecessary sources of noise?
    A: Most unnecessary noise in the hospital setting falls into 2 categories:
    -Human generated
    -Technology generated
    A: Communicating with staff and visitors and express that noise is disruptive to patients and their recovery and should be minimized
    A: Advocate for patients and intervene when appropriate
    A: Be sure all technology is kept “updated” and “serviced” to minimize unnecessary technology related noises.

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: When making care decisions, it is vital to see through the patient’s eyes.
    A: Providing patients and opportunity to share their concerns and perspective is vital to patient centered care.
  2. Why is it important to be sensitive to patient frustrations and irritations?
    A: Sensitivity is core to a patient centered approach. Although we cannot resolve every frustration or irritation, demonstrating compassion and interest is key to improving the quality of care we provide.

 

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 hospital noises that could have a negative effect on patients and their satisfaction with their hospital experience. Share your list with a partner and design solutions for the unnecessary noise.
  • Conduct a noise audit at a local hospital. Walk around and listen to the noises that might disturb patients. Share your findings with the class.
  • Create a graphic or poster to remind colleagues about the importance of reducing unnecessary noise to increase patient satisfaction.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Explain the negative effect that unnecessary noise has on patients and their satisfaction with their hospital experience. Student struggles to explain the negative effect that unnecessary noise has on patients and their satisfaction with their hospital experience. Student can explain the negative effect that unnecessary noise has on patients and their satisfaction with their hospital experience, but needs further practice. Student can accurately explain the negative effect that unnecessary noise has on patients and their satisfaction with their hospital experience.
Be able to define noise and list possible sources of noise affecting patients.  Student struggles to define noise and list possible sources of noise affecting patients. Student is able to define noise and list possible sources of noise affecting patients, but needs further practice. Student is able to accurately define noise and list possible sources of noise affecting patients.
Create a plan for conducting regular noise audits and awareness-raising sessions for fellow staff members.  Student struggles to create a plan for conducting regular noise audits and awareness-raising sessions for fellow staff members. Student can create a plan for conducting regular noise audits and awareness-raising sessions for fellow staff members, but needs further practice. Student can accurately create a plan for conducting regular noise audits and awareness-raising sessions for fellow staff members.

 

 

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:

  • 3Ws – Who I Am, What Am I Doing, and Why I Care
  • Collaboration

 

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204 – Fearing No Pain Instructor’s Guide

Friday, October 10th, 2014

204

Instructor’s Guide – Fearing No Pain


Overview:
This story is about how communication about pain medications can be just as important as the selection, dosage, timing, and administration of the medication itself. Patients need to understand pain management as well as any pain medications they may be taking.

 


Primary Learning Outcomes

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

  • Explain the role effective pain management has in overall patient satisfaction.
  • Compare effective and ineffective approaches to communicating with patients about their pain and its management.
  • Adopt a pain management strategy that includes and emphasizes complete and compassionate communication with patients.

 

 

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

  1. How did Nancy’s explanation of pain management help to put Marsha and Terry at ease?
    A: Nancy’s explanation was matter of fact, patient centered and encouraged them to communicate honestly
    A: Nancy’s approach was sensitive to their concerns
    A: Nancy’s tone and body language contributed to providing a therapeutic environment
  2. How were Nancy’s actions an example of patient-centered care?
    A: Nancy emphasized that Marsha was the only one that could communicate how well they were managing the post procedure pain
    A: Nancy’s inclusion of the husband as a focus of the dialogue, helped put Marsha at ease and demonstrated that the patient and family are our “patients”.
  3. What do we need to do to demonstrate to patients that we care about their experience of pain and that we are doing everything possible to minimize it?
    A: Active listening and being fully present when assessing pain is vital to demonstrating our commitment to patient centered care.
    A: Explain pain management, orders and the rationale for the prescribed plan of care.
    A: Advocate for individualized orders, if the patient’s needs are not met by the standardized approach.

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: This story reflects the importance of education at all levels. Marsha and her husband needed to understand the plan of care. As stated in the story,
    knowledge was power for Marsha.
  2. What can I do to make sure I convey compassion and empathy when I am interacting with patients about issues of their pain and its management?
    A: Actively listen
    A: Be fully present
    A: Educate the patient and family on the plan of care with associate rationale.
    A: Remind the patient that they are the focus of the assessment and the management success is based on the patient perception of pain management not the practitioners.

 

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

  • Research the role of effective pain management and its impact on patient satisfaction. Develop a presentation that teaches colleagues more about the connection.
  • Brainstorm a list of effective and ineffective approaches to communicating with patients about their pain and its management. Compare your list with a partner.
  • Think of another scenario in which compassionate pain management is necessary. Write a story that demonstrates your understanding of compassionate pain management.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Explain the role effective pain management has in overall patient satisfaction. Student struggles to explain the role effective pain management has in overall patient satisfaction. Student can explain the role effective pain management has in overall patient satisfaction, but needs further practice. Student can accurately explain the role effective pain management has in overall patient satisfaction.
Compare effective and ineffective approaches to communicating with patients about their pain and its management. Student struggles to compare effective and ineffective approaches to communicating with patients about their pain and its management. Student can compare effective and ineffective approaches to communicating with patients about their pain and its management, but needs further practice. Student can accurately compare effective and ineffective approaches to communicating with patients about their pain and its management.
Adopt a pain management strategy that includes and emphasizes complete and compassionate communication with patients. Student struggles to adopt a pain management strategy that includes and emphasizes complete and compassionate communication with patients. Student can adopt a pain management strategy that includes and emphasizes complete and compassionate communication with patients, but needs further practice. Student can accurately adopt a pain management strategy that includes and emphasizes complete and compassionate communication 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:

  • 3Ws – Who I Am, What Am I Doing, and Why I Care
  • Collaboration

 

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

203 – I Have Nothing More Important Than You! Instructor’s Guide

Friday, October 10th, 2014

203

Instructor’s Guide – I Have Nothing More Important Than You!


Overview:
This story is about how contact with nurses will often be the primary difference in patients being satisfied with their care or not. Consistently caring, empathetic responses are absolutely necessary for a highly satisfying patient experience.

 


Primary Learning Outcomes

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

  • Describe ways you can engage patients to make an emotional connection.
  • Adopt strategies that focus on the emotional needs of patients and families, not just clinical or administrative requirements.
  • Demonstrate empathic, caring response to patients during episodes of indecision, anxiety, and concerns about the direction of their care.

 

 

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 were Teresa’s actions an example of patient-centered care?
    A: Teresa recognized Toni’s need to ask questions.
    A: Teresa acknowledged that the doctor was busy and not available to pause and focus on the anxiety that Toni was feeling before the procedure.
    A: Teresa allowed Toni be in control of the decision making.
  • How did Teresa attempt to see Toni’s concerns through her eyes, and how did that make a difference for Toni?
    A: Teresa stopped what she was doing and focused on Toni
    A: Teresa acknowledged Toni’s fear and allowed her to verbalize her questions.
    A: Teresa affirmed that Toni was in control of the decision making and provided a therapeutic environment and comfort measures to demonstrate her compassion.
  • How can we make an emotional connection with our patients on a regular basis?
    A: Actively listen
    A: Being present
    A: Demonstrate a commitment to compassionate and coordinated care

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: Healthcare, even when engaged for relief of chronic pain, is an intimidating environment and a patient centered approach requires that patients be seen as individuals with unique perspectives, priorities and needs.
  • What one thing can you do to see care through a patient’s eyes to better anticipate and respond to their emotional needs?
    A: Slow down

 

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

  • Brainstorm ways to engage patients to make an emotional connection. Share your best with a partner and present your top three ideas to the class for discussion.
  • Create a graphic or poster that reminds colleagues to focus on the emotional needs of patients, not just clinical or administrative requirements.
  • Work with a partner to write a dialogue that demonstrates your understanding of empathic and caring responses to patients during episodes of indecision, anxiety, and concerns about the direction of their care. Act out your dialogue.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Describe ways you can engage patients to make an emotional connection. Student struggles to describe ways you can engage patients to make an emotional connection. Student can describe ways you can engage patients to make an emotional connection, but needs further practice. Student can accurately describe ways you can engage patients to make an emotional connection.
Adopt strategies that focus on the emotional needs of patients and families, not just clinical or administrative requirements.  Student struggles to adopt strategies that focus on the emotional needs of patients and families, not just clinical or administrative requirements. Student can adopt strategies that focus on the emotional needs of patients and families, not just clinical or administrative requirements, but needs further practice. Student can accurately adopt strategies that focus on the emotional needs of patients and families, not just clinical or administrative requirements.
Demonstrate empathic, caring response to patients during episodes of indecision, anxiety, and concerns about the direction of their care.  Student struggles to demonstrate empathic, caring response to patients during episodes of indecision, anxiety, and concerns about the direction of their care. Student can demonstrate empathic, caring response to patients during episodes of indecision, anxiety, and concerns about the direction of their care, but needs further practice. Student can accurately demonstrate empathic, caring response to patients during episodes of indecision, anxiety, and concerns about the direction of their care.

 

 

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:

  • 3Ws – Who I Am, What Am I Doing, and Why I Care
  • AskMe3

 

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

202 – How Could This Happen? Instructor’s Guide

Friday, October 10th, 2014

202

Instructor’s Guide – How Could This Happen?


Overview:
This story is about ensuring a safe and satisfying experience for mother and baby during the rapidly changing environment of Labor and Delivery. To prevent harm, use structured and reliable communication protocols.

 


Primary Learning Outcomes

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

  • Apply strategies and methods to ensure safe and timely closed-loop hand-offs between care providers.
  • Apply assertive statements or signal phrases to express safety concerns among team members regardless of hierarchy.
  • Adopt new 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:

  • 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

 

 

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 poor communication jeopardize patient safety in this story?
    A: Due to poor communication the patient did not receive the best care possible. The doctor was also not able to provide the best care and alter patient care related to patient safety because he was not informed of the patient’s prior situation.
  2. What could have been done in this story to ensure better communications when Jessica’s care was handed off to Dr. Travers?
    A: Dr. Travers could have been given Jessica’s chart which documented her prior third degree tear after her episiotomy. She could have also used a birth plan which documented her desire to avoid another third degree tear.
  3. If you were Susan, the nurse with a concern about Dr. Traver’s directions, what could you have said or done to better advocate for Jessica?
    A: The two challenge rule could have been used in this situation. Susan felt concerned about Dr. Travers directions, but she did not say anything to introject. She could have advocated for Jessica by using a “huddle” or the “two challenge” rule.

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 is a vital part of providing quality care to each patient and keeping the patient safe. There may be information that is unknown about the patient or the situation if good communication is not present.
  2. What can I do when I have a concern that the direction of care during a delivery could cause an unsafe condition or unsatisfying experience for the patient or family member?
    A: One way to ensure patient safety is to have a team huddle. This allows all team members to communicate any concerns, but also to clarify any issues that may be occurring. It is important for all team members to be able to voice their concerns regarding patient care and safety.

 

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 importance of using timely closed-loop handoffs between care providers to ensure patient safety.
  • Develop an assertive statement and a signal phrase you could use with your team to express safety concerns. Explain why this is important to do prior to emergent situations.
  • Design a protocol or checklist for improving team decision-making and communication in emergent situations that include the care team and the patient/family.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Apply strategies and methods to ensure safe and timely closed-loop hand-offs between care providers. Student struggles to apply strategies and methods to ensure safe and timely closed-loop hand-offs between care providers. Student can apply strategies and methods to ensure safe and timely closed-loop hand-offs between care providers, but needs further practice. Student can accurately apply strategies and methods to ensure safe and timely closed-loop hand-offs between care providers.
Apply assertive statements or signal phrases to express safety concerns among team members regardless of hierarchy.  Student struggles to apply assertive statements or signal phrases to express safety concerns among team members regardless of hierarchy. Student can apply assertive statements or signal phrases to express safety concerns among team members regardless of hierarchy, but needs further practice. Student can accurately apply assertive statements or signal phrases to express safety concerns among team members regardless of hierarchy.
Adopt new communication methods and strategies for improving team decision making during emergent situations that include the patient and family.  Student struggles to adopt new communication methods and strategies for improving team decision making during emergent situations that include the patient and family. Student can adopt new communication methods and strategies for improving team decision making during emergent situations that include the patient and family, but needs further practice. Student can accurately adopt new communication methods and strategies for improving team decision making during emergent situations that include the patient and family.

 

 

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:

  • Handoff
  • Huddles
  • Two-Challenge Rule

 

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

201 – Conduct Unbecoming Instructor’s Guide

Friday, October 10th, 2014

201

Instructor’s Guide – Conduct Unbecoming


Overview:
This story is about what happens when an incidence of unprofessional behavior happens. If team members aren’t equipped with the tools to diffuse conflict or the ability to deal with unprofessional conduct effectively and quickly, the consequences for staff and patients can be harmful in more ways than one.

 


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 Dr. Gonzalez’s behavior is detrimental to patient safety and the team’s effectiveness.
    A: Dr. Gonzalez behavior is detrimental to patient safety because he is not communicating in a way that fosters open communication or respect. In fact, he is blocking opening communication or any further discussion about his patient.
  2. How could Grace use the DESC tool to address her concerns about Dr. Gonzalez?
    A: She would need to describe the specific situation, express her concerns, suggest another alternatives, and state and consequences if the terms were not met. Grace did a good job of stating why she needed to know more about the patient. She stated this would allow her to staff according to the needs on the floor.
  3. How can we use the DESC tool to increase our ability to confront incidents and patterns of unprofessional conduct?
    A: This allows the focus of the conversation to stay on the patient and not on the frustrations of the staff or doctor. There was a potential for negative patient consequences if the doctor and nurse are unable to communicate with each other.

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 the doctor was so angry at the nurse he was no longer able to have a conversation regarding 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: Tools can be adopted to help diffuse anger, include mutual respect and open communication. It is not easy to respond in a calm and professional manner when someone else is acting irrational, but it will foster conflict resolution and professional conduct.

 

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 Grace addresses her concerns about Dr. Gonzalez with 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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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

 

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

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