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127 – Caution for CAUTI Student’s Guide

Thursday, September 25th, 2014

127

Student’s Guide – Caution for CAUTI


Overview:
This story describes the importance of following best practice protocols, such as the IHI bundle, to prevent urinary catheter associated infections. Use of a daily checklist ensures appropriate practices and guidelines are followed to decrease potential for infection.

 

 

Primary Learning Outcomes

After completing this lesson, you will be able to:

  • Describe and apply safe guidelines for placement, care, and removal of urinary tract catheters.
  • Generate strategies to ensure urinary tract catheter safe practices are strictly followed.
  • Explain and adopt methods for challenging team members when safety protocols are not followed for any reason.

 

 

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 the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.

 

Reflection Questions:

  1. Describe commonly accepted safe guidelines for the placement, care, and removal of urinary tract catheters. How were these Evidence-Based Practices not utilized in this story?
  2. What strategies could be used in this hospital to ensure that preventable CAUTIs do not continue to occur?
  3. How does this story demonstrate the importance of teamwork and communication that is focused on patient safety?

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125 – These Things Happen Student’s Guide

Thursday, September 25th, 2014

125

Student’s Guide – These Things Happen


Overview:
This story is about how human error is common during ‘workload spikes’ due to monitoring failures, multitasking, distractions, deviations, or interruptions. Cross monitoring and team ‘backup behaviors’ are essential safety practices for managing such workload threats.

 

 

Primary Learning Outcomes

After completing this lesson, you will be able to:

  • Describe safe practices and processes related to accurate lab specimen labeling.
  • Identify and explain potential risks associated with mislabeled lab specimens including high workload periods.
  • Describe team-based strategies and systems to ensure accurate labeling of lab specimens.

 

 

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

  • Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
  • Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
  • Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.

 

 

QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS Best Practice: 3 Ws & Bedside Handoffs

Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals.

  • A check-back is a closed-loop communication strategy used to verify and validate information exchanged. The strategy involves the sender initiating a message, the receiver accepting the message and confirming what was communicated, and the sender verifying that the message was received. Typically, information is called out anticipating a response on any order which must be checked.

 

Story Directions: 

As you listen to and read the story, think about the things that the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.

 

Reflection Questions:

  1. Describe safe practices and processes related to accurate lab specimen labeling that you have previously encountered.
  2. What safety errors occurred in this story? Describe each and their causes.
  3. How could the use of check-backs helped to avert the errors in this story?

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125 – These Things Happen Instructor’s Guide

Thursday, September 25th, 2014

125

Instructor’s Guide – These Things Happen


Overview:
This story is about how human error is common during ‘workload spikes’ due to monitoring failures, multitasking, distractions, deviations, or interruptions. Cross monitoring and team ‘backup behaviors’ are essential safety practices for managing such workload threats.

 


Primary Learning Outcomes

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

  • Describe safe practices and processes related to accurate lab specimen labeling.
  • Identify and explain potential risks associated with mislabeled lab specimens including high workload periods.
  • Describe team-based strategies and systems to ensure accurate labeling of lab specimens.

 

 

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

  • Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
  • Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
  • Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.

 


QSEN Teamwork & Collaboration Enrichment

TeamSTEPPS® Best Practice: Check-Backs

Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals.

  • A check-back is a closed-loop communication strategy used to verify and validate information exchanged. The strategy involves the sender initiating a message, the receiver accepting the message and confirming what was communicated, and the sender verifying that the message was received. Typically, information is called out anticipating a response on any order which must be checked.

 

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 safe practices and processes related to accurate lab specimen labeling that you have previously encountered.
    A: It is imperative that accurate lab specimen labeling occurs every time a lab is drawn. This is why it is important to have the labels ready when someone draws the labs.
  2. What safety errors occurred in this story? Describe each and their causes.
    A: Here are a few errors that occurred during this story: Check-Backs, Cross Monitoring, and SBAR.
    A: Safety errors occurred in this story because the nurse was cutting corners when she felt overwhelmed by the number of patients she was taking care of.
  3. How could the use of check-backs helped to avert the errors in this story?
    A: Check-backs are used to prevent error because they are a closed-loop communication system. At no time was closed-loop communication used in this story.

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: By slowing down and using appropriate safety measures patient care and safety will not be jeopardized.
  2. What is one thing you could do to improve the accuracy of labeling, especially during high workload periods?
    A: One way is to keep the labs in your hand until they are labeled. Another way is to print the labels ahead of time and have them ready to apply to the specimens once they are collected.

 

Suggested Classroom Mastery Activities:

These activities can be tailored for individuals or groups in a face to face or online setting. 

  • Make a poster to help remind your colleagues of safe procedures for accurately labeling lab specimens, and the consequences for not doing so.
  • Make a checklist for submitting lab specimens that helps to remind medical professionals to walk through all safety procedures before administering treatments.
  • Write a short dialogue of a check-back that could have been used in this story.

 



Measuring Student Mastery: 

Learning Outcome Level 1 Level 2 Level 3
Describe safe practices and processes related to accurate lab specimen labeling.  Student struggles to describe safe practices and processes related to accurate lab specimen labeling. Student can describe some safe practices and processes related to accurate lab specimen labeling, but needs more practice. Student can accurately describe safe practices and processes related to accurate lab specimen labeling.
Identify and explain potential risks associated with mislabeled lab specimens including high workload periods. Student struggles to identify and explain potential risks associated with mislabeled lab specimens including high workload periods. Student can identify and explain some potential risks associated with mislabeled lab specimens including high workload periods. Student can accurately identify and explain potential risks associated with mislabeled lab specimens including high workload periods.
Describe team-based strategies and systems to ensure accurate labeling of lab specimens.  Student struggles to describe team-based strategies and systems to ensure accurate labeling of lab specimens. Student can describe some team-based strategies and systems to ensure accurate labeling of lab specimens, but needs more practice with the skill. Student can accurately describe team-based strategies and systems to ensure accurate labeling of lab specimens.

Additional Story-Specific Resources:

For additional information on improving team communication, please consult the following articles and resources in Further Reading:

 

 


Story-Specific Best Practices and Proven Tools:

In addition to the ideas generated by students and mentioned in the activities, there are established best practices that may be appropriate to introduce or reference during this lesson to support communication. Some best practices to consider for improving team communication include:

  • Check-Backs
  • Cross Monitoring
  • SBAR
  • Call-Out
  • Handoff

 

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

124 – No One Thing Killed Elias Smith Student’s Guide

Friday, September 19th, 2014

124

Student’s Guide – No One Thing Killed Elias Smith


Overview:
This story is about how healthcare organizations are often ill-equipped to respond to the crisis following unexpected death or harm to a patient due to medical errors, and how an organization can establish an effective crisis management team to transparently respond to the family.

 

 

Primary Learning Outcomes

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

  • Describe and apply family-centered principles to respectfully disclose medical errors.
  • Describe a crisis management response to medical errors that considers the caregivers.
  • Explain how to convey medical error information to families in lay terms using transparency and empathy.

 

 

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

  • Patient-Centered Care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
  • Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.

 

Story Directions: 

As you listen to and read the story, underline the things that you think the team members did well, and circle the things you think that could lead to errors. Also, think about the questions below as you listen.

 

Reflection Questions:

  1. Describe the actions of the CEO that you felt demonstrated his application of family-centered principles to respectfully disclose the medical errors in Elias’ case.
  2. What safety errors occurred in this story? How did the hospital system fail Elias?
  3. Why is empathy important in responding to the family? How was empathy used effectively in this story?

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

126 – Almost Routine Student’s Guide

Friday, September 19th, 2014

126

Student’s Guide – Almost Routine


Overview:
Central Line-Associated Blood Stream Infections (CLABSIs) cause up to 60,000 preventable deaths in the U.S. each year. This story highlights how deviation from evidence-based protocols and checklists can place the patient at risk for CLABSI, and how the CUS technique can help improve team member collaboration and patient safety.

 

 

Primary Learning Outcomes

After completing this lesson, you should be able to:

  • Describe safe, evidence-based practices related to central line insertions
  • Develop a checklist that includes proper protocols for a central line insertion scenario
  • Understand and adopt critical language to ‘stop the line’ when deviation from protocols occurs, regardless of professional hierarchies.

 

 

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

  • Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
  • Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
  • Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.

 

 

QSEN Teamwork & Collaboration Enrichment

TeamSTEPPS Best Practice: CUS

  • Using the CUS technique provides another framework for conflict resolution, advocacy, and mutual support. Signal words, such as “danger,” “warning,” and “caution” are common in the medical arena. They catch the reader’s attention. “CUS” and several other signal phrases have a similar effect in verbal communication. When they are spoken, all team members will understand clearly not only the issue, but also the magnitude of the issue.

 

  • CUS Technique:
    1. First, state your Concern.
    2. Then state why you are Uncomfortable.
    3. If the conflict is not resolved, state that there is a Safety issue.

 

Story Directions: 

As you listen to and read the story, think about what you think the team members did well, and the things you think that could lead to errors. Also, keep the questions below in mind as you listen.

 

Reflection Questions:

  • What safety protocols that can help prevent the risk of CLABSI were violated in this scenario?
  • QSEN requires you to discriminate between valid and invalid reasons for modifying evidence-based clinical practice based on clinical expertise or patient/family preferences. Do you think Dr. Long’s deviations from EBP in this scenario were valid or invalid? Explain your reasoning.
  • Thinking about the TeamSTEPPS best practice “CUS” described earlier, when and how could Carly have employed this technique to better advocate for her patient’s safety?

 

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

126 – Almost Routine Instructor’s Guide

Friday, September 19th, 2014

126

Instructor’s Guide – Almost Routine


Overview:
Central Line-Associated Blood Stream Infections (CLABSIs) cause up to 60,000 preventable deaths in the U.S. each year. This story highlights how deviation from evidence-based protocols and checklists can place the patient at risk for CLABSI, and how the CUS technique can help improve team member collaboration and patient safety.

 


Primary Learning Outcomes

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

  • Describe safe, evidence-based practices related to central line insertions
  • Develop a checklist that includes proper protocols for a central line insertion scenario
  • Understand and adopt critical language to ‘stop the line’ when deviation from protocols occurs, regardless of professional hierarchies using the CUS technique.

 

 

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

  • Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
  • Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
  • Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.

 


QSEN Teamwork & Collaboration Enrichment

TeamSTEPPS® Best Practice: CUS

  • Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals.

 

  • The CUS technique provides a framework for conflict resolution, advocacy, and mutual support. Signal words, such as “danger,” “warning,” and “caution” are common in the medical arena. They catch the reader’s attention. “CUS” and several other signal phrases have a similar effect in verbal communication. When they are spoken, all team members will understand clearly not only the issue, but also the magnitude of the issue.
    1. CUS Technique:
    2. First, state your Concern.
    3. Then state why you are Uncomfortable.
    4. If the conflict is not resolved, state that there is a Safety issue.

 

Reflection Questions:

Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.

  • What safety protocols that can help prevent the risk of CLABSI were violated in this scenario?
  • QSEN requires you to discriminate between valid and invalid reasons for modifying evidence-based clinical practice based on clinical expertise or patient/family preferences. Do you think Dr. Long’s deviations from EBP in this scenario were valid or invalid? Explain your reasoning.
  • Thinking about the TeamSTEPPS best practice “CUS” described earlier, when and how could Carly have employed this technique to better advocate for her patient’s safety?

 

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.

  • What can we learn from this story?
  • What other issues regarding patient care and advocacy need to be addressed in this scenario?
  • How could this scenario have been prevented?

 

Suggested Classroom Mastery Activities:

These activities can be tailored for individuals or groups in a face to face or online setting. Use one or more to help expand and measure your students’ understanding of the primary learning outcomes for this lesson.

  • Develop a graphic or poster checklist that details the safe practices related to central line insertions
  • Identify what you believe to be the three most critical errors committed by the staff in the story, and describe how they should have been handled
  • How could Carly have used the TeamSTEPPS “CUS” tool to better advocate for Mrs. Sturgis? Write out the dialogue and/or act it out for the class.

 



Measuring Student Mastery: 

Learning Outcome Level 1 Level 2 Level 3
Describe safe, evidence-based practices related to central line insertions Student had difficulty describing EBPs related to central line insertion and requires some remediation in the topic. Student described some EBPs, but lacked detail or omitted some EBPs related to central line insertion. Student described evidence-based practices related to central line insertion in detail in writing and/or orally.
Develop a checklist that includes proper protocols for a central line insertion scenario Student’s checklist did not include proper protocols and requires additional instruction. Student’s checklist omitted some proper protocols or lacked detail. Student’s checklist included all proper protocols.
Understand and adopt critical language to ‘stop the line’ when deviation from protocols occurs, regardless of professional hierarchies using the CUS technique. Student struggled with applying the CUS technique to the scenario and requires remediation on the topic of critical language. Student demonstrated some understanding of critical language and the CUS technique, but lacked detail or omitted some critical details. Student demonstrated understanding of critical language and the CUS technique in writing and/or through re-enactment.

 


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:

  • CUS
  • 3Ws- Who I am, What I am Doing, and Why I Care
  • Advocacy and Assertion
  • More

 

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

124 – No One Thing Killed Elias Smith Instructor’s Guide

Friday, September 19th, 2014

124

Instructor’s Guide – No One Thing Killed Elias Smith


Overview:
This story is about how healthcare organizations are often ill-equipped to respond to the crisis following unexpected death or harm to a patient due to medical errors, and how an organization can establish an effective crisis management team to transparently respond to the family.

 


Primary Learning Outcomes

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

  • Describe and apply family-centered principles to respectfully disclose medical errors.
  • Describe a crisis management response to medical errors that considers the caregivers.
  • Explain how to convey medical error information to families in lay terms using transparency and empathy.

 

 

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

  • Patient-Centered Care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
  • Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.

 

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 the actions of the CEO that you felt demonstrated his application of family-centered principles to respectfully disclose the medical errors in Elias’s case.
    A: He listened to the family and showed empathy to them. He also stated he would investigate the situation and gather all of the information before contacting the family. He did not try to cover up or hide any information.
  2. What safety errors occurred in this story? How did the hospital system fail Elias?
    A: Each nurse noticed a slight change in the patient condition, but did not aggressively pursue the issues. For example, the nurse that called the one of the doctors did not follow through with the call.
  3. Why is empathy important in responding to the family? How was empathy used effectively in this story?
    A: By using empathy the CEO of the hospital was able to communicate clearly with the family. By using empathy and therapeutic communication the family felt welcome to continue their dialogue with the CEO, doctors and medical staff.

 

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: That empathy and therapeutic communication allow for open dialogue and continued communication.
  2. What could I do to improve my crisis management response to show empathy for families, demonstrate transparency, and consider care for the caregiver?
    A: Try not to become defensive when family members are discussing their pain or disappointment. Allow them to state their frustrations and acknowledge their pain and frustration.

 

 

Suggested Classroom Mastery Activities:

These activities can be tailored for individuals or groups in a face to face or online setting. 

  • List each of the safety errors that occurred in this story, and describe how each could have been prevented.
  • What do you think Robert’s next steps should be to address the issues related to Elias’ death? Design a plan for his staff to ensure the mistakes made in this case are addressed in the future.

 



Measuring Student Mastery: 

Learning Outcome Level 1 Level 2 Level 3
Describe and apply family-centered principles to respectfully disclose medical errors.  Student struggles to describe and apply family-centered principles to respectfully disclose medical errors. Student can describe and apply family-centered principles to respectfully disclose medical errors, but needs further practice. Student can accurately describe and apply family-centered principles to respectfully disclose medical errors.
Describe a crisis management response to medical errors that considers the caregivers.  Student struggles to describe a crisis management response to medical errors that considers the caregivers. Student can describe a crisis management response to medical errors that considers the caregivers, but needs further practice. Student can accurately describe a crisis management response to medical errors that considers the caregivers.
Explain how to convey medical error information to families in lay terms using transparency and empathy. Student struggles to explain how to convey medical error information to families in lay terms using transparency and empathy. Student can explain how to convey medical error information to families in lay terms using transparency and empathy, but needs further practice. Student can accurately explain how to convey medical error information to families in lay terms using transparency and empathy.
 



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
  • CUS
  • Two-Challenge Rule
  • Huddles
  • STEP
  • Collaboration
  • SBAR
  • Handoff
  • I PASS the BATON

 

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

123 – A Tale of Two Patients Student’s Guide

Friday, September 19th, 2014

123

Student’s Guide – A Tale of Two Patients


Overview:
This is a story about how excellence in healthcare delivery requires attending to the needs, wants, feelings, insecurities, and anxieties of each and every patient and their families in addition to treating their medical problem.

 

 

Primary Learning Outcomes

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

  • Explain and adopt the 3Ws when interacting with patients and families.
  • Describe the importance of monitoring and modifying staff conversations, actions and norms regarding non-patient centered ‘chit chat’ in the presence of patients and families.
  • Explain how to integrate patient and family members in conversations during care transitions (handoffs) whenever practical.

 

 

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.

 

 

QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS Best Practice: 3 Ws & Bedside Handoffs

Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals.

  • 3 Ws- Who I Am, What I am Doing, and Why I Care was originated by the Florida Hospital System as a simple, yet effective way to reliably greet, engage, and activate patients and families.

    •  

  • Bedside Handoffs: Change of shift report occurring at the patient’s bedside with these essential components:

    • A standardized nursing report handoff tool
    • Bedside shift-to-shift report
    • Inclusion of the patient and family in the discussion of plans and goals of care including introductions.
    • Two-person medical record check



Story Directions: 

As you listen to and read the story, underline the things that you think the team members did well, and circle the things you think that could lead to errors. Also, think about the questions below as you listen.

 

Reflection Questions:

  1. How did the use of the 3Ws improve Sheila’s experience?
  2. What effect did the staff conversations, actions, and norms have on Betty’s perception of their competence and her overall impression of the hospital?
  3. How did the use of bedside handoffs at Sheila’s hospital impact her experience?

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

123 – A Tale of Two Patients Instructor’s Guide

Friday, September 19th, 2014

123

Instructor’s Guide – A Tale of Two Patients


Overview:
This is a story about how excellence in healthcare delivery requires attending to the needs, wants, feelings, insecurities, and anxieties of each and every patient and their families in addition to treating their medical problem.

 


Primary Learning Outcomes

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

  • Explain and adopt the 3Ws when interacting with patients and families.
  • Describe the importance of monitoring and modifying staff conversations, actions and norms regarding non-patient centered ‘chit chat’ in the presence of patients and families.
  • Explain how to integrate patient and family members in conversations during care transitions (handoffs) whenever practical.

 

 

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.

 


QSEN Teamwork & Collaboration Enrichment

TeamSTEPPS® Best Practice: 3 Ws & Bedside Handoffs

Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals.

     

  • 3 Ws- Who I Am, What I am Doing, and Why I Care was originated by the Florida Hospital System as a simple, yet effective way to reliably greet, engage, and activate patients and families

 

  • Bedside Handoffs: Change of shift report occurring at the patient’s bedside with these essential components:
    • A standardized nursing report handoff tool
    • Bedside shift-to-shift report
    • Inclusion of the patient and family in the discussion of plans and goals of care including introductions.
    • Two-person medical record check

 

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 the use of the 3Ws improve Sheila’s experience?
    A: She was informed regarding who was present and what to expect. She felt like she was a part of the health care team.
  2. What effect did the staff conversations, actions, and norms have on Betty’s perception of their competence and her overall impression of the hospital?
    A: Betty felt as if she was a nuisance or a problem for the staff. She did not feel involved in her own care. Her husband was also made to feel as if he was in the way.
  3. How did the use of bedside handoffs at Sheila’s hospital impact her experience?
    A: She felt that the staff were interested in her needs and concerns. She also believed they cared about her and her wishes.

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 this story?
    A: That patients are always listening, even if we don’t think they are. They are very aware of the attitudes and actions made by the health care team members.
  2. What one or two things could you personally do to ensure patients feel included and not an object of care?
    A: One was is to use the 3W’s and to include the patient in their own care. Patient-centered care means that health care professionals need to keep the patient informed of what they are doing, why they are doing it and that they care.

 

Suggested Classroom Mastery Activities:

These activities can be tailored for individuals or groups in a face to face or online setting. 

  • Create a Venn Diagram to compare and contrast Betty and Sheila’s patient care experiences. Write a paragraph to summarize your findings.
  • Practice using the 3Ws in a variety of scenarios. Work with a partner to write five short patient care scenarios and explain how you would use the 3Ws to help put the patient at ease.
  • Make a poster that could remind you co-workers to focus on patient-centered care. Include some of the techniques from this story that you found useful or effective.

 



Measuring Student Mastery: 

Learning Outcome Level 1 Level 2 Level 3
Explain and adopt the 3Ws when interacting with patients and families. Student struggles to explain and adopt the 3Ws when interacting with patients and families. Student can explain some use of the 3Ws when interacting with patients and families, but needs more practice. Student can accurately explain and adopt the 3Ws when interacting with patients and families.
Describe the importance of monitoring and modifying staff conversations, actions and norms regarding non-patient centered ‘chit chat’ in the presence of patients and families. Student struggles to describe the importance of monitoring and modifying staff conversations, actions and norms regarding non-patient centered ‘chit chat’ in the presence of patients and families. Student can describe the importance of monitoring and modifying staff conversations, actions and norms regarding non-patient centered ‘chit chat’ in the presence of patients and families, but needs more practice. Student can accurately describe the importance of monitoring and modifying staff conversations, actions and norms regarding non-patient centered ‘chit chat’ in the presence of patients and families.
Explain how to integrate patient and family members in conversations during care transitions (handoffs) whenever practical. Student struggles to explain how to integrate patient and family members in conversations during care transitions (handoffs) whenever practical. Student can explain how to integrate patient and family members in conversations during care transitions (handoffs) whenever practical, but needs more practice. Student can explain how to integrate patient and family members in conversations during care transitions (handoffs) whenever practical. 

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 I am Doing, and Why I Care
  • Bedside Handoffs

 

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122 – The Rule of Six Student’s Guide

Friday, September 19th, 2014

122

Student’s Guide – The Rule of Six


Overview:
This story is about a patient being discharged following a readmission for pneumonia. A Care Transitions nurse uses patient coaching skills and motivational interviewing techniques with the patient to focus on important aspects of caring for himself at home to prevent readmission.

 

 

Primary Learning Outcomes

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

  • Explain the need for effectiveness of patient coaching in helping patients at risk of readmission.
  • Distinguish the difference in aftercare patient coaching from traditional patient education.
  • Describe patient coaching techniques suitable for use during patient discharge sessions.

 

 

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, underline the things that you think the team members did well, and circle the things you think that could lead to errors. Also, think about the questions below as you listen.

 

Reflection Questions:

  1. What can we learn from this story about the limits of teaching and the value of coaching?
  2. Describe the ways that Peggy worked with Mr. Falcone to overcome obstacles that might put him at higher risk for readmission?
  3. What coaching techniques did you learn from this story that you might be able to use in your role?

 

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