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?
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 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.
- 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.
- 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
- 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.
- 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.
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. |
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