Author Archive
Thursday, October 2nd, 2014
146
Instructor’s Guide – Hidden in Plain Sight
Overview:
This story is about how healthcare as seen through the patient’s eyes is often perceived as serving the staff’s needs instead of the patient’s. The cumulative effect of many small issues can make the care look disjointed and unprofessional.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe what care looks like through a patient’s eyes.
- Describe what needs to be included in the professional code of conduct to make it more patient-centered.
- Explain the importance of integrating patient-centered principles into policies and procedures.
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
- Imagine you were Sara’s mom. How would you describe the experience at this hospital to your friends and family?
A: Clinical negligence, lacking in treatment, responsive and caring.
A: Lacking in empathy
A: Lacking in advocacy
A: Lacking in communication and coordination
- How could the medical staff in this story have been more patient-centered?
A: Focus on the patient needs, chief complaint and customer service
A: Ownership of the treatment plan through a thorough and complete hand off – through the admission transition of care
A: Communicate anticipated timelines; circle back if there are unintended delays
A: Demonstrate compassion
- Why is it important to integrate patient-centered principles into policies and procedures? How could they have improved Sara’s experience?
A: Consider the targeted assessment and treatment for the fracture Sara presented with and be present during the physical assessment
A: Ask Sara what her needs were, acknowledge her pain and communicate the plan of 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: Patient centeredness should begin with the first encounter.
A: Priorities of care should be developed based on the patients needs
A: Communication is a key aspect of patient centered care.
- What one thing can you do that will send the message to your patients that your most important job is to be there for them?
A: Be more than physically present
A: Actively listen
A: Respond in a timely fashion to their needs and requests and communicate the plan of care.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Make a list of all of the opportunities to add patient-centered principles in this story, and describe how they could be implemented to improve the patient experience.
- Write a letter to the editor as Sara’s mom. Describe your experience with the hospital and your opinion on their ability to provide appropriate care.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe what care looks like through a patient’s eyes. |
Student struggles to describe what care looks like through a patient’s eyes. |
Student can describe to a degree what care looks like through a patient’s eyes, but needs further practice. |
Student can describe what care looks like through a patient’s eyes. |
| Describe what needs to be included in the professional code of conduct to make it more patient-centered.
| Student struggles to describe what needs to be included in the professional code of conduct to make it more patient-centered. |
Student can describe what needs to be included in the professional code of conduct to make it more patient-centered, but needs further practice. |
Student can describe what needs to be included in the professional code of conduct to make it more patient-centered. |
| Explain the importance of integrating patient-centered principles into policies and procedures. |
Student struggles to explain the importance of integrating patient-centered principles into policies and procedures. |
Student can explain the importance of integrating patient-centered principles into policies and procedures, but needs further practice. |
Student can explain the importance of integrating patient-centered principles into policies and procedures. |
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
- Briefs
- Collaboration
- Feedback
- 3 Ws – Who I am, What I Am Doing, and Why I Care
- Patient Rounding
Posted in Pro ED Guides, Teacher Guides | No Comments »
Thursday, October 2nd, 2014
150
Student’s Guide – See You Soon
Overview:
This story illustrates the likelihood of readmission in the absence of a coordinated care plan for the patient. Readmissions are often caused by preventable complications that occur during a transition from one care setting to another and may reflect poor coordination of care.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- List components of a coordinated discharge plan.
- Describe how to modify discharge processes to enhance communication between the hospital and discharge settings.
- Explain the importance of creating opportunities to involve patients and their families in discharge planning.
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.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- What components of a coordinated discharge plan are missing from this story?
- How could Andrea have modified her discharge process to enhance communication between the hospital and Mei Li and her family?
- What could Andrea have done to ensure that Anna was included in the discharge planning process?
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Thursday, October 2nd, 2014
149
Student’s Guide – Room for Improvement
Overview:
This story addresses patient falls. According to reports by the IHI, Robert Wood Johnson Foundation, and several studies, falls are three times more likely in hospitals and nursing homes than in the community. It is every team member’s responsibility to help prevent falls.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe strategies to assess patients at risk for fall or at risk for injury from falls.
- Explain evidence-based fall prevention best practices.
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.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- What evidence-based practices could be used to prevent falls and reduce harm from falls?
- What could have been done in this story to prevent Mrs. Shreaver’s fall?
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Thursday, October 2nd, 2014
148
Student’s Guide – One Big Team
Overview:
This story demonstrates the benefits of a care team functioning as a unified whole where everyone assumes responsibility for every job getting done when it comes to the patient’s safety and satisfaction.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Identify and summarize the problems that are caused by an “it’s not my job” attitude.
- Generate guidelines for how to respond to patients’ requests when the request is outside the staff member’s particular functional responsibilities.
- Describe the importance of the distribution of guidelines to every unit in the hospital.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
- 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.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- How did the “it’s not my job” attitude of the staff in the story affect Kathy’s care?
- How could guidelines that help staff members respond to patient requests outside of their responsibilities have helped Kathy?
- Why is it important that all staff members are on the same page regarding policies about patient-centered care?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
147
Student’s Guide – Can You Suggest A Solution?
Overview:
This story is about how you can put the emphasis on respectful problem-solving and building buy-in and responsibility-taking when disruptive or unprofessional behavior affects patients by slowing their care, thereby increasing the risk of error or omission.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Summarize the tools and techniques used in an engagement approach to resolving unprofessional conduct issues.
- Evaluate the appropriateness of an engagement approach versus a disciplinary approach for any given example of unprofessional conduct.
- Plan for an engagement-approach discussion with a peer or subordinate who is exhibiting unprofessional conduct.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- What tools and techniques were used in this story to resolve unprofessional conduct issues?
- Do you think Kim would have had a different reaction from Bob if she had taken a disciplinary approach to the problem? Why?
- What do you think Kim did well in this story to begin building the kind of teamwork she wants to see in her unit?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
146
Student’s Guide – Hidden in Plain Sight
Overview:
This story is about how healthcare as seen through the patient’s eyes is often perceived as serving the staff’s needs instead of the patient’s. The cumulative effect of many small issues can make the care look disjointed and unprofessional.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe what care looks like through a patient’s eyes.
- Describe what needs to be included in the professional code of conduct to make it more patient-centered.
- Explain the importance of integrating patient-centered principles into policies and procedures.
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.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- Imagine you were Sara’s mom. How would you describe the experience at this hospital to your friends and family?
- How could the medical staff in this story have been more patient-centered?
- Why is it important to integrate patient-centered principles into policies and procedures? How could they have improved Sara’s experience?
Posted in Pro ED Guides, Student Guides | No Comments »
Friday, September 26th, 2014
145
Student’s Guide – Are We Sure This Is Necessary?
Overview:
This story is about the fact that indwelling urinary catheters cause up to 80% of hospital-acquired infections, with 30% being unneeded in the first place, and how a nurse reviews a patient’s chart and challenges the catheterization.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe the importance of assessing catheter use for each patient on a daily basis.
- Identify protocol for removing inappropriate Foley catheters.
- Explain how to document indications for urinary catheter use.
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.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- What does this story illustrate about the importance of assessing catheter use for each patient daily?
- What are the protocols for removing inappropriate Foley catheters? Were they implemented appropriately in this story?
- How could the indications for urinary catheter use have been better documented in this story? Why?
Posted in Pro ED Guides, Student Guides | No Comments »
Friday, September 26th, 2014
144
Student’s Guide – Putting Safety on the Line
Overview:
This story is about the importance of following protocols, particularly those pertaining to central venous catheters (CVCs). Prevention of CLABSI is mandated by legislation. Therefore, it is every team member’s responsibility to speak up when procedures are incorrectly performed.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- List the five best practice components of the central line bundle for prevention of CLABSI.
- Describe how to apply a central line bundle to prevent CLABSI.
- Explain the importance of identifying and communicating deviations from CLABSI preventative best practices to team members using assertive language.
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.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- What are the five best practice components of the central line bundle for prevention of CLABSI?
- What can we do to ensure that a central line bundle is applied to all patients with central lines?
- What can you do to ‘stop the line’ if central line bundle protocols are not followed by any member of the team?
Posted in Pro ED Guides, Student Guides | No Comments »
Friday, September 26th, 2014
143
Student’s Guide – Got Clutter?
Overview:
This story is about facility cleanliness. It is a key patient and family satisfaction performance indicator. Facilities that are cluttered, unorganized, and generally untidy form negative patient perceptions. This could also impact safety, efficiency, and organizational effectiveness.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Examine the effect a cluttered facility has on the patient experience.
- Explain and adopt strategies and actions to eliminate clutter and create a consistently clean and inviting atmosphere for patients, families, and visitors.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
- Patient-Centered Care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- What do you believe was the effect of the state of the facility in this story on its patients?
- Do you agree with Mary’s assessment of the hospital, despite Dr. Samuel’s descriptions? Why or why not?
- What could the hospital do to eliminate clutter and create a consistently clean and inviting atmosphere for patients, families, and visitors?
Posted in Pro ED Guides, Student Guides | No Comments »
Friday, September 26th, 2014
142
Student’s Guide – Teamwork Starts Here
Overview:
This story is about the role senior leadership plays in effective teamwork. A top-down and control leadership style among senior leadership teams creates a climate where members don’t feel respected or empowered to perform, whereas psychological safety creates trust among all teams.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Describe why establishing norms for the conduct of the leadership team so that all members are empowered to speak up about lapses in professional conduct is important to achieving quality patient care.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- What can members of the leadership team do to hold each other accountable for professional conduct?
- What kind of environment was created by the CEO? Why was his approach detrimental to the team?
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