Archive for the ‘Teacher Guides’ Category
Friday, September 5th, 2014
114
Instructor’s Guide – Reaching Out
Overview:
This story focuses on care for the caregiver, sometimes referred to as resilience. The stress of caring for patients can lead to chronic fatigue, burnout, and unprofessional behaviors. All team members have a responsibility to recognize and respond when team members are overwhelmed.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Summarize the elements of the resilience self-assessment tool I’M SAFE.
- Evaluate team members’ fitness for duty by identifying cues of stress, fatigue, and burnout.
- Describe strategies and methods for encouraging open sharing among team members and leaders for early identification of individuals with severe stress.
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.
- Safety:
- Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
QSEN Evidence-Based Practice Enrichment
TeamSTEPPS® Best Practice: I’M SAFE
- 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.
- Awareness of your own condition to ensure that you are fit and ready to fulfill your duties is essential to delivering safe, quality care. Team members should assess and report if there is a personal situation affecting their ability to perform. “I’M SAFE” is a simple checklist that should be used daily (or more frequently) to determine both co-workers’ and your own ability to perform safely. I’M SAFE stands for:
I’M SAFE Technique:
- Illness: Am I feeling so bad that I cannot perform my duties?
- Medication: Is the medication I am taking affecting my ability to maintain situational awareness and perform my duties?
- Stress: Is there something (such as a life event or situation at work) that is detracting from my ability to focus and perform my duties?
- Alcohol/Drugs: Is my use of alcohol or illicit drugs affecting me so that I cannot focus on the performance of my duties?
- Fatigue: The effects of fatigue should not be ignored. Team members should alert the team regarding their state of fatigue (e.g., watch me a little closer today, I only had three hours of sleep last night).
- Eating and Elimination: Has it been 6 hours since I have eaten or used the restroom? Many times we are so focused on ensuring our patient’s basic needs that we forget to take care of our own. Not taking care of our eating or elimination needs affects our ability to concentrate and stresses us physiologically.
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
- Describe how the use of the “I’M SAFE” tool could help you. Why is it an important technique?
A: It’s important that nurses can recognize when they have limitations. The safety of the patient needs to be the first priority.
- Use the “I’M SAFE” tool to evaluate Francis’s readiness for duty, based on the background information you have about her recent stressors.
A: Stress appears to be her major concern and potentially a reason for her to be more aware of her own condition.
- What are some issues that June might need to address with her team to ensure that everyone feels safe to speak up in her team briefs?
A: She may need to review the “I’M SAFE” tool with her staff. She will also need to address how nurses interact with each other and the need to support 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
- What can we learn from this story?
A: That stress, fatigue, and burnout can happen to anyone. Every nurse to subject to burnout and they need to be aware of the signs so that patient safety remains the primary focus and not the stress of the nurse.
- What one thing could you do to improve your ability to recognize and manage stress among your team members?
A: Review the “I’M SAFE” steps and ensure team members are also aware of those steps. Another way to recognize stress is to continue to keep an open dialogue with staff members. Allow the staff to express their feelings and to state when they are overwhelmed with their assignment.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Create a presentation about the effects of one of the six conditions discussed in “I’M SAFE” and its effects on a medical professional’s ability to perform at work. Research cases to use as examples.
- Explain why patient acuity should be a consideration when assigning cases to nurses. Why is it important that June took this information into account when assessing Francis’s case load?
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Summarize the elements of the resilience self-assessment tool I’M SAFE |
Student struggles to summarize the elements of the resilience self-assessment tool “I’M SAFE.” |
Student can summarize the elements of the resilience self-assessment tool “I’M SAFE”, but needs more practice. |
Student can summarize and elaborate on the elements of the resilience self-assessment tool “I’M SAFE.” |
| Evaluate team members’ fitness for duty by identifying cues of stress, fatigue, and burnout |
Student struggles to evaluate team members’ fitness for duty by identifying cues of stress, fatigue, and burnout |
Student can evaluate team members’ fitness for duty by identifying cues of stress, fatigue, and burnout, but may be missing key indicators. |
Student can evaluate and describe team members’ fitness for duty by identifying cues of stress, fatigue, and burnout. |
| Describe strategies and methods for encouraging open sharing among team members and leaders for early identification of individuals with severe stress. |
Student struggles to describe strategies and methods for encouraging open sharing among team members and leaders for early identification of individuals with severe stress. |
Student can describe strategies and methods for encouraging open sharing among team members and leaders for early identification of individuals with severe stress, but needs more practice. |
Student can describe strategies and methods for encouraging open sharing among team members and leaders for early identification of individuals with severe stress. |
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
- Huddles
- Cross Monitoring
- Feedback
- Collaboration
- Task Assistance
- Patient Rounding
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, September 5th, 2014
113
Instructor’s Guide – Getting to the Heart of the Matter
Overview:
This story is about the importance of recognizing that performance data reports alone may not tell the whole story. Leaders must assess multiple problems and challenges on a unit face-to-face, using walk-rounds and ‘ad hoc’ informal rounding.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe the importance of being willing to speak up, question, and clarify abnormalities that could lead to patient harm.
- Explain the importance of empowering all staff members to create an outstanding patient experience.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Quality Improvement (QI):
- Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems.
- 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
- How might this story have been different if Meg had not visited the floor in question? What opportunities might she have missed if she had not visited the floor in question?
A: Had Meg not visited the floor, most if not all the issues identified would most likely have continued. Clearly the manager was uncertain how to overcome many of the barriers she was facing and may have never identified appropriate support for fear of being seen as ineffective.
A: First hand experience related to the loss of cell phone signal was key to emphasizing the communication issues being experienced by the staff.
A: Staffing models based on patient ratios is an easier model of staffing than acuity, had the frank honesty of the new employee not be share, the reality of the issue may not have been fully appreciated. In person communications allow for relationships and transparent communication to be enhanced.
- What opportunities might she have missed if she had not visited the floor?
A: The perspective of the patient was provided at the Meg’s first encounter with Nancy, the administrative clerk. The impact and reality of the situation on the patient experience was impactful.
A: The visual of “no nurses” being at the desk, demonstrated the state of business in the unit in a way that reports cannot relay or fully impress.
A: The demonstration of value and concern for the staff would not have been relayed had Meg not personally visited the unit to inquire of the concerns and issues being faced by the team.
- How did Meg’s demeanor empower Nancy to become part of the solution to fixing her floor’s problems?
A: Meg intentionally made verbal and nonverbal queues to establish a therapeutic environment for enhanced communication with Nancy.
A: Her honesty regarding the reports about the unit allowed her to ask for the same level of honesty in order to address the issues.
A: Allowing for the face to face, one on one discussion was less formal and more comfortable in order to ask real questions to identify real answers.
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: In order to get to the heart of the matter, a trusting relationship with an opportunity for transparent dialogue is a prerequisite.
A: Leadership is most effective when they demonstrate real interest in the team.
A: Issues cannot be addressed until they are identified and communicated with those in a position to change them.
- What can you do to build the necessary trust to openly share challenges and prioritize improvement?
A: Actively listen and provide an informal, yet intention mechanism to share issues or concerns.
A: Do not negatively expose those that are willing to be honest and transparent.
A: Affirm those committed to quality and excellence and encourage open dialogue with the leadership.
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 ways to build trust with your co-workers and subordinates. Which do you think are most effective and why?
- Read Using the Power of Story to Improve the Patient Experience. Why is it important to differentiate between the actual versus perceived truth? How might the patients in this story have perceived their hospital experience versus what actually happened?
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe the importance of being willing to speak up, question, and clarify abnormalities that could lead to patient harm. |
Student struggles to describe the importance of being willing to speak up, question, and clarify abnormalities that could lead to patient harm. |
Student can describe the importance of being willing to speak up, question, and clarify abnormalities that could lead to patient harm, but needs more practice. |
Student can describe and elaborate on the importance of being willing to speak up, question, and clarify abnormalities that could lead to patient harm. |
| Explain the importance of empowering all staff members to create an outstanding patient experience. |
Student struggles to describe the importance of being willing to speak up, question, and clarify abnormalities that could lead to patient harm. |
Student can describe the importance of being willing to speak up, question, and clarify abnormalities that could lead to patient harm, but needs more practice. |
Student can explain the importance of empowering all staff members to create an outstanding patient experience. |
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. (Details and definitions can be found in the Best Practices section of the website.) Some best practices to consider for improving team communication include:
- Feedback
- CUS
- Patient Rounding
- Handoffs
- “Speak Up”
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, September 5th, 2014
112
Instructor’s Guide – Trusting Enough to Do the Right Thing
Overview:
This story addresses the issue of cross monitoring as it relates to error prevention. A work environment that encourages staff to openly share concerns related to the safety of patients is necessary for optimal patient care and experience.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe the importance of reporting concerns to ensure patient safety.
- Describe the importance of applying reporting principles without fear of retribution or punishment.
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
- How did Allison put Sarah’s health and safety at risk in this story?
A: Allison needed to report these findings right away, as she was not sure how to assess the bruises appropriately.
- What conditions exist in this story that prevented Allison from reporting her concerns about Sarah’s health and safety? How could Colleen address those conditions in the future?
A: Allison was concerned about reporting the bruises because it would require a large amount of paperwork. She also didn’t think it was a serious issue.
A: Colleen could have let the staff know as soon as she dropped Sarah off for the day. The issues related with the bruises could have been avoided if Colleen would have said something first.
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: A thorough assessment of each patient is necessary and important. This could have potentially been a very serious situation.
- Why is it important to report safety concerns to a supervisor immediately?
A: The supervisor may know something the CNA does not know. Also, the supervisor is trained regarding skin care assessments and potential abuse reporting.
Suggested Classroom Mastery Activities: These activities can be tailored for individuals or groups in a face to face or online setting.
- Make a checklist that Allison could use when checking on her patients. What conditions should trigger an automatic report to Colleen? When should she use her own judgment?
- Create a presentation that Colleen could use to help Allison and the other CNAs under her direction understand the reporting process and the importance of patient safety.
- Read The Silent Treatment. Describe the problem of Organizational Silence and how it applies to this story. How could it be addressed?
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe the importance of reporting concerns to ensure patient safety. |
Student struggles to describe the importance of reporting concerns to ensure patient safety. |
Student can describe the importance of reporting concerns to ensure patient safety, but needs more practice. |
Student can accurately describe the importance of reporting concerns to ensure patient safety, and can give examples. |
| Describe the importance of applying reporting principles without fear of retribution or punishment. |
Student struggles to describe the importance of applying reporting principles without fear of retribution or punishment and its application an organization. |
Student can describe the importance of applying reporting principles without fear of retribution or punishment, but needs more practice. |
Student can describe the importance of applying reporting principles without fear of retribution or punishment and its application an organization. |
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. (Details and definitions can be found in the Best Practices section of the website.) Some best practices to consider for improving team communication include:
- Cross Monitoring
- Huddles
- STEP
- Debriefs
- Advocacy and Assertion
- Handoff
- Patient Rounding
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, September 5th, 2014
111
Instructor’s Guide – When Shared Mental Models Shatter
Overview:
This story addresses the impact disruptive behavior has on teamwork, communication, patient safety, and patient satisfaction. Each person involved in patient care, regardless of position, must conduct themselves in a professional manner.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe the importance of adopting standards of professional conduct.
- Classify individual behaviors as acceptable and unacceptable.
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.
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
- What does this story illustrate about the importance of adopting standards of professional conduct?
A: There was a great deal of unspoken communication during this scenario due to the fact that staff didn’t want to “upset” the doctor. This situation may have been avoided if there were standards of professional conduct in place.
- Describe the behavior in this story that you believe to be unprofessional. What should have been done instead?
A: Everyone in the scenario participated in unprofessional behavior. The patient should have been the focus of the scenario and not the potential problems with the surgical team and doctor.
Discussion Questions: Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: We learned that disruptive behavior impacts more than just the team, it could also impact patient care.
- What one thing can we do to show respect for each other by ensuring everyone is accountable for professional behavior?
A: If everyone were responsible for their own behavior this situation may have turned out differently. The team did not show respect to the doctor by not telling him the equipment he wanted was not available and the doctor did not show respect to the team when he blamed the patient’s condition on their inability to get him the equipment he had requested.
Suggested Classroom Mastery Activities: These activities can be tailored for individuals or groups in a face to face or online setting.
- Read the Professional Conduct Survey. Create a presentation that describes two major problems that occur between doctors and nurses (see table 6) and describe how those might be dealt with, using the solutions suggested, as well as your own ideas.
- Make a list of the behaviors exhibited by all of the professionals in this story and classify them as acceptable or unacceptable. Discuss your reasoning for your classification with a classmate.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe the importance of adopting standards of professional conduct. |
Student struggles to describe the importance of adopting standards of professional conduct. |
Student can describe the importance of adopting standards of professional conduct, but needs more practice. |
Student can accurately describe the importance of adopting standards of professional conduct. |
| Classify individual behaviors as acceptable and unacceptable. |
Student struggles to classify individual behaviors as acceptable and unacceptable. |
Student can classify individual behaviors as acceptable and unacceptable, but needs more practice. |
Student can accurately classify individual behaviors as acceptable and unacceptable, and provide explanations. |
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. (Details and definitions can be found in the Best Practices section of the website.) Some best practices to consider for improving team communication include:
- CUS
- Huddles
- STEP
- Briefs
- Debriefs
- I’M SAFE
- DESC Script
- Feedback
- “Speak Up”
- 4 Step Process
- PEARLA
- Collaboration
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, September 5th, 2014
110
Instructor’s Guide – Double Check Three Times
Overview:
This story addresses the issue of double checking and verifying patient identification before administering medication while dealing with fatigue, and simultaneously anticipating family needs when moving a patient to a new room. Adding fatigue to the situation suddenly opens up the possibility for serious error.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe strategies to assess and manage the effects of fatigue on individual and team performance.
- Explain the importance of developing and maintaining communications systems for signaling team members, patients, and family members when changes occur in the plan of care.
- Describe methods for ‘double checking’ high risk patient care practices such as medication administration.
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.
- 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
- What does this story illustrate about the importance of communicating with team members, especially when fatigue becomes an issue at the end of a shift?
A: Mistakes or the potential for a mistake can easily be made, especially when a health care professional becomes tired.
- What could this team have done to alleviate the stress and safety concerns caused by Mr. Pappas’ move to a new room?
A: The nurse, Diane, could have been notified of the move prior to it happening.
- What were some ways that Diane employed “double-checking” during this story? What might the consequences have been if she hadn’t?
A: She asked the patient to state their name and date of birth while she “double-checked” the name band. She also noted the name of the patient on the medication bag did not match that of her patient.
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: New orders must be checked before any medication is administered. Diane should have double checked the orders and medication before bringing them into the patient’s room.
A: As we get tired it may be more difficult to adjust to changes. Mr. Pappas was moved to another room, but Diane did not realize this until after it had been done.
- What is something you can do to improve your ability to manage the effects of fatigue to prevent errors?
A: Double check all medication orders before administering the medication. Be sure to check on your patients regularly, as well as the chart, to determine if any changes have been made.
Suggested Classroom Mastery Activities: These activities can be tailored for individuals or groups in a face to face or online setting.
- Brainstorm ways you could and your team could manage the effects of fatigue to prevent errors. Compare your ideas with those of another classmate, and discuss the ones that you feel are the most effective or innovative.
- Develop a checklist that this team could use for signaling team members, patients, and family members when changes occur in the plan of care.
- Describe some other situations in which double-checking could be used to ensure patient safety.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe strategies to assess and manage the effects of fatigue on individual and team performance |
Student struggles to describe strategies to assess and manage the effects of fatigue on individual and team performance. |
Student can describe strategies to assess and manage the effects of fatigue on individual and team performance, but needs more practice. |
Student is able to accurately describe strategies to assess and manage the effects of fatigue on individual and team performance. |
| Explain the importance of developing and maintaining communications systems for signaling team members, patients, and family members when changes occur in the plan of care. |
The student struggles to explain the importance of developing and maintaining communications systems for signaling team members, patients and family members when changes occur in the plan of care. |
The student can explain the importance of developing and maintaining communications systems for signaling team members, patients and family members when changes occur in the plan of care, but needs more practice. |
The student can accurately explain and elaborate on the importance of developing and maintaining communications systems for signaling team members, patients and family members when changes occur in the plan of care. |
| Describe methods for ‘double checking’ high risk patient care practices such as medication administration. |
Student struggles to describe methods for ‘double checking’ high risk patient care practices such as medication administration. |
Student can describe methods for ‘double checking’ high risk patient care practices such as medication administration, but needs more practice or cannot provide relevant examples. |
Student can describe methods for ‘double checking’ high risk patient care practices such as medication administration and provide relevant examples. |
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. (Details and definitions can be found in the Best Practices section of the website.) Some best practices to consider for improving team communication include:
- STEP
- Huddles
- Check-Backs
- 3 Ws—Who Am I, What Am I Doing, and Why Do I Care
- I’M SAFE
- Cross Monitoring
- Task Assistance
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, September 5th, 2014
109
Instructor’s Guide – Seize the Moment
Overview:
This story is about how every staff member’s job is to recognize that what we experience as routine is for the patient a journey that is filled with fear and concern. It emphasizes the positive impact staff members have on patients when they provide reassurance and support.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe how going beyond your role to address the emotional needs of patients can positively impact their experience.
- Describe strategies that can be used by individuals and team members to help deliver an exceptional patient experience regardless of position, role, or status.
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
- Explain how this story demonstrates the effect of going beyond your role on the patient’s total experience.
A: Olivia did not have to volunteer to stay with Mrs. Ferren, but she made the commitment to stay.
A: Terrell did a nice job of explaining what he was doing and what to expect during the transfer to the radiology department.
- Describe how Terrell and Olivia’s teamwork helped make Mrs. Ferren’s experience more pleasant and safe.
A: Mrs. Ferren was treated with respect and dignity during this experience. Terrell and Olivia included Mrs. Ferren in their discussion and made it known they were there to help her.
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 learned that someone may have a specific job, like housekeeping, but they can still fill a vital role in comforting patients.
A: We must also remember that every job is important and they each aid in the support of the patient.
- How does this story illustrate the importance of all roles in the hospital for consistent patient-centered care, regardless of hierarchy?
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 ways to go beyond your role when working with patients. What could you do to make their everyday experiences more pleasant? Compare your list with a partner’s, and share your top three most interesting or innovative ideas with the class for discussion.
- Think of an everyday scenario you will encounter in your job. Write a short story that reflects how you could work with your team to make that scenario more pleasant for your patients, and address both their emotional and physical needs.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe how going beyond your role to address the emotional needs of patients can positively impact their experience. |
Student struggles to describe how going beyond their role to address the emotional needs of patients can positively impact their experience. |
Student can describe how going beyond their role to address the emotional needs of patients can positively impact their experience, through innovative ideas. |
Student can accurately describe and apply assertive statements or signal phrases to express safety concerns using the CUS technique. |
| Describe strategies that can be used by individuals and team members to help deliver an exceptional patient experience regardless of position, role, or status. |
Student struggles to generate and describe innovative strategies that can be used by individuals and team members to help deliver an exceptional patient experience. |
Student can generate and describe some strategies that can be used by individuals and team members to help deliver an exceptional patient experience, but needs more practice. |
Student can generate and describe innovative strategies that can be used by individuals and team members to help deliver an exceptional patient experience. |
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. (Details and definitions can be found in the Best Practices section of the website.) Some best practices to consider for improving team communication include:
- STEP
- Huddles
- Cross Monitoring
- 3 Ws—Who Am I, What Am I Doing, and Why Do I Care
- Collaboration
- Handoff
- Task Assistance
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, September 5th, 2014
108
Instructor’s Guide – Decision to Indecision
Overview:
This story addresses the importance of effective and consistent forms of team communication. Staff should feel empowered to speak up, assert, and advocate on behalf of the patient and the team regardless of perceived organizational hierarchies.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe and apply assertive statements or signal phrases to express safety concerns among team members regardless of hierarchy, using the CUS Technique.
- Describe the importance of adopting 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:
- 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 Evidence-Based Practice Enrichment
TeamSTEPPS® Best Practice: CUSTeam 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.
- CUS Technique:
- First, state your Concern.
- Then state why you are Uncomfortable.
- 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.
*Following each question are some potential answers
- Describe how breaks in Evidence-Based Practice (EBP) put the patient and her baby in danger in this story.
A: The nurse knew the fetal heart monitor indicated there was a potential problem, but she did not make that clear to the OBGYN.
- What do you believe Beth did well in the story?
A: She continued to monitor the baby and mother. She also began to prepare the family for potential issues.
- Describe the barriers that Beth faced in her attempt to advocate for her patient with other team members. How could use of the CUS Technique have helped her overcome those barriers?
A: She only hinted suggestions to the Dr. She did not state her concern or that she was uncomfortable with the situation.
Discussion Questions: Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: Being proactive and noting a concern is an important part of patient care. Nurse Beth could have used ‘CUS’ earlier in the shift when she noted the potential problem with the fetal heart tones.
- What one thing can you do as a team member to improve your communication with your team during emergent situations while including patients and families?
A: Be direct and state the actual concern with the Dr. Do not assume the doctor or other health care professions see the same thing you do.
Suggested Classroom Mastery Activities: These activities can be tailored for individuals or groups in a face to face or online setting.
- Rewrite Beth’s initial interaction with Dr. Pappas, demonstrating how she could have used the CUS technique to better advocate for Tracy.
- Pretend you are evaluating Dr. Pappas’ handling of the situation in the story. Describe what he could have done to better connect with his patients and team.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe and apply assertive statements or signal phrases to express safety concerns among team members regardless of hierarchy, using the CUS Technique. |
Student struggles to describe and apply assertive statements or signal phrases to express safety concerns using the CUS technique. |
Student can describe and apply some assertive statements or signal phrases to express safety concerns using the CUS technique, but needs more practice. |
Student can accurately describe and apply assertive statements or signal phrases to express safety concerns using the CUS technique. |
| Describe the importance of adopting communication methods and strategies for improving team decision-making during emergent situations that include the patient and family. |
Student struggles to describe the importance of adopting communication methods and strategies for improving team decision-making during emergent situations that include the patient and family. |
Student can describe the importance of adopting communication methods and strategies for improving team decision-making during emergent situations that include the patient and family, but needs more practice. |
Student can accurately describe the importance of adopting communication methods and strategies for improving team decision-making during emergent situations that include the patient and family. |
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. (Details and definitions can be found in the Best Practices section of the website.) Some best practices to consider for improving team communication include:
- CUS
- STEP
- Two-Challenge Rule
- Huddles
- Briefs
- Debriefs
- Feedback
- Advocacy and Assertion
- Collaboration
- Call-Out
- Cross Monitoring
- “Speak Up”
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Thursday, September 4th, 2014
107
Instructor’s Guide – Anything Else You Want to Tell Us
Overview:
This story is about bedside handoffs and the opportunities they present to share and receive information with the patient and the family. When done well, trust and connections will be established, resulting in staff members meeting the patient’s needs more efficiently.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Recall and describe ways to engage patients to make an emotional connection.
- Describe the importance of examining the accuracy of patient information across the care continuum by including the patient and family members in the assessment and handoff process.
- Demonstrate the ability to articulate a patient-centered approach to bedside handoffs to establish personal connections with patients and families, using the I PASS the BATON technique.
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.
- 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 Evidence-Based Practice Enrichment
Evidence-Based Best Practice: I PASS the BATON
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.
- I PASS the BATON is a powerful tool that can be used for handoff of care anytime the complete responsibility for the patient from one entity to another, i.e., department to department or facility to facility. I PASS the BATON is a long acronym and usually the caregivers who adopt this tool build a checklist that uses the acronym as its foundation. The letters stand for:
- I PASS the BATON Technique:
- I (Introduction) Introduce yourself and your role/job
- P (Patient) Name, identifiers, age, sex, location
- A (Assessment) Present vital signs, chief complaint, symptoms and diagnosis
- S (Situation) Current status/circumstances
- S (Safety Concerns) Critical lab values/reports, allergies, alerts
- B (Background) Co-morbidities, previous episodes, current medications, family history
- A (Actions) What actions were taken or are required
- T (Timing) Level of urgency and timing/prioritization of actions
- O (Ownership) Who is responsible for care going forward, including patient and family
- N (Next) What will happen next? What is the plan?
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
- What do you believe were the most critical safety concerns revealed in the story? How could they be prevented in the future?
A: Getting an accurate medication history of the patient is a top priority. There may be other priorities, but with an accurate history the patient cannot be prepared for surgery.
- How does this story illustrate the importance of making a personal connection with the patient and family? What were some things that Teresa and Cathy did to ensure that they had the patient’s trust and full attention?
A: They communicated clearly with the patient and his wife. They also did not say anything negative about the E.R. in front of the patient.
- How could a checklist based on the “I PASS the BATON” technique have alleviated some of the issues in this story? What procedures do you think this hospital needs to address and why?
A: A checklist could have been started in the E.R. or when the patient was admitted to the unit. The nurse was being proactive in her work, however this could have easily turned into a devastating error.
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: Good communication, thinking ahead, and making observations is an important part of nursing work.
- What other things can we do to ensure we have the most accurate patient information during handoffs, especially at shift changes?
A: One way is to verbalize the things that are missing or that have not been previously discussed. The oncoming nurse should never assume a checklist has been completed or that previous work has been done by another department.
- What one thing could you do in your role to make a personal connection with patients and families during shift changes?
A: It works well if a nurse can start the shift change process about 30-45 minutes before the actual change of shift. Let the patient know you will be leaving at a certain time. Let them know you will be giving report to another nurse and that they will be well cared for in the coming hours. This is a good time to ask if they have any questions or concerns before the actual change of shift.
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 ways to better engage patients and families during shift change handoffs to make more personal connections. Compare your list with a classmate’s and share your three best ideas with the class.
- Research what complications for Antwon’s surgery he might have experienced had his pre-existing heart conditions and diabetes not been discovered by Teresa and Cathy. Develop a presentation to demonstrate why it is so important to examine the accuracy of patient information, based on what might have happened if Antwon’s surgery had proceeded without this information.
- Make a checklist for a shift change handoff using the I PASS the BATON technique. Go back through the story and evaluate Teresa and Cathy’s performance in this handoff on your checklist.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Recall and articulate ways to engage patients and make an emotional connection |
Student struggles to recall and articulate ways to engage patients and make an emotional connection. |
Student can recall and articulate some ways to engage patients and make an emotional connection, but needs more practice |
Student can accurately recall and articulate ways to engage patients and make an emotional connection. |
| Describe the importance of examining the accuracy of patient information across the care continuum by including the patient and family members in the assessment and handoff process. |
Student struggles to describe the importance of examining the accuracy of patient information and including the patient and family in assessment and handoff procedures. |
Student can describe the importance of examining the accuracy of patient information and including the patient and family in assessment and handoff procedures, but lacks authority on the subject. |
Student can accurately describe the importance of examining the accuracy of patient information and including the patient and family in assessment and handoff procedures. |
| Demonstrate the ability to articulate a patient-centered approach to bedside handoffs to establish personal connections with patients and families, using the I PASS the BATON technique. |
Student struggles to demonstrate the ability to professionally articulate a patient-centered approach to bedside handoffs through the use of I PASS the BATON. |
Student can demonstrate some ability to articulate a patient-centered approach to bedside handoffs through the use of I PASS the BATON, but needs more practice with the technique. |
Student can demonstrate the ability to professionally articulate a patient-centered approach to bedside handoffs through the use of I PASS the BATON. |
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Thursday, September 4th, 2014
106
Instructor’s Guide – Missed Our Chat Today
Overview:
This story is about making a human connection with a patient and how small personal touches and recognizing the needs of others are the key to an exceptional patient experience.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Recall and describe ways to engage patients to make an emotional connection.
- Discover and explain techniques for seeing care through the patient’s eyes.
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 might you make an emotional connection with a patient on a regular basis in your role?
A: Human connectedness is an important aspect of care giving. Active listening and episodes of demonstrating being “present” are ways to support a connectedness with your patients that will allow for you to have an emotional connection.
- What is one thing you could do to see through the patient’s eyes to better anticipate their emotional needs?
A: Provide an environment that encourages your patient be transparent with you regarding their needs. With the national trend toward shared decision-making, the importance of therapeutic communication is increasingly emphasized and supports meeting the emotional needs of our patients.
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: The emotional needs of our patients can be met by all members of the team, including those in non-clinical positions. Supporting a culture of patient centeredness encourages this therapeutic environment.
- Describe how Helen made a difference for Mr. Lafleur during his hospital stay.
A: Helen should be commended for her attention to detail and contribution to his care. Her taking note of the “crushed” nature of his pillows, demonstrates that she was able to truly put herself in his position and say what would help me with my leg swelling? What would I want if I were in his shoes?
- What does this story illustrate about the importance of communicating with the entire hospital staff about patient care, not just the medical team?
A: Having a culture of patient centeredness and teamwork requires intentional effort and should be infused into all communications at all levels of the organization. As nurses at the bedside, we can establish that the non-clinical team members, contributing and interacting with our patients, are expected to consider them as their patients as well.
Suggested Classroom Mastery Activities: These activities can be tailored for individuals or groups in a face to face or online setting.
- Describe a time you experienced excellent care as a patient in a medical setting, where the staff (regardless of role) reached out to you as a person. Why was it important to you? If you don’t have a personal experience, ask your friends or loved ones to share their experience.
- Brainstorm a list of ways to make an emotional connection with patients on a regular basis in your role. Compare your list with a classmate’s and discuss your ideas. Present the three that you deem to be the most innovative and effective.
- Write the end of this story from Mr. LaFleur’s perspective. How do you think he might have reacted to Helen’s note?
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Recall and describe ways to engage patients to make an emotional connection. |
The student struggles to recall and describe ways to engage patients to make an emotional connection. |
The student can recall and describe some ways to engage patients to make an emotional connection. |
The student can recall and describe personal and innovative ways to engage patients to make an emotional connection. |
| Discover and explain techniques for seeing care through the patient’s eyes. |
The student struggles to articulate techniques for seeing care through the patient’s eyes. |
The student can articulate some techniques for seeing care through the patient’s eyes, but needs more practice. |
The student can articulate innovative techniques for seeing care through the patient’s eyes. |
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Thursday, September 4th, 2014
105
Instructor’s Guide – The Courage to Make the Call
Overview:
This story is about how a nurse questions a written physician order that doesn’t seem to make sense clinically. The physician is contacted immediately and the order is changed preventing a medication error. It is a prime example of the value of cross monitoring.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe the importance of comparing written orders in the context of the entire patient care plan to ensure accuracy and patient safety.
- Explain and apply evidence-based strategies that can limit distractions, interruptions, and multitasking during critical care activities.
- Recognize the importance of cross monitoring skills across the medical care team, regardless of position, status, or hierarchy to create trust and prevent errors.
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.
- Evidence-Based Practice (EBP):
- Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
- 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 Evidence-Based Practice Enrichment
Evidence-Based Best Practice: Handoffs
Handoffs include the transfer of knowledge and information about the degree of uncertainty (or certainty about diagnoses, etc.), response to treatment, recent changes in condition and circumstances, and the plan (including contingencies). In addition, both authority and responsibility are transferred. Lack of clarity about who is responsible for care and for decision-making has often been a major contributor to medical error (as identified in root cause analyses of sentinel events and poor outcomes).
Reflection Questions: Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
- What systemic errors or lack of procedures put Mr. Carlson in danger in this story? What individual errors could have caused him harm?
- Proper handoffs are an evidence-based practice (EBP) that help ensure patient safety. What went well in the handoff of Mr. Carlson from Diane to Carol? What could have been improved?
- What might have been the consequences for Mr. Carlson had Carol and Diane not called Dr. Jackson? What does this story illustrate about the need to communicate, regardless of hierarchy?
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: That change of shift report can be a chaotic time, even if there isn’t a code at the same time.
A: It’s important to have a good handoff even when other things are occurring in the hospital.
A: Nurses are responsible for the care given to each patient, even if the doctor or another health care professional has not done the right thing in a previous situation.
- What one thing can you do to improve mutual trust among a team so you always ‘have each other’s back’ regardless of individual personalities?
A: It was important that Diane did not leave until the current situation was handled. She stayed until the handoff was complete.
A: It was appropriate for Carol to call Diane at home. Diane may have known some information about the change in medication dosage and avoided a call to the doctor.
A: Diane made it clear that she was willing to call the Dr., even if he was going to become upset. The patient needs to be the first priority.
- How can you improve your ability to manage distractions, interruptions, and multitasking to prevent errors?
A: Be sure to deliver a proper handoff when giving report to another health care professional.
A: Check for new orders and be sure they are appropriate for the patient.
A: Don’t hesitate to ask for clarification on an order if you are unsure. This may be to another nurse, the charge nurse, or a Dr.
A: Stay focused on the task at hand and try not to get distracted and behind in patient care, charting, or daily tasks.
Suggested Classroom Mastery Activities: These activities can be tailored for individuals or groups in a face to face or online setting.
- Research cases where common dosage errors resulted in harm to a patient. Present a case to the class and describe how the error could have been prevented.
- Create a list of techniques you might be able to use that can limit distractions, interruptions, and multitasking during critical care activities. Compare your list with a classmate and discuss which you think would work for you.
- Rewrite an ending to this story in which Carol and Diane decide not to call Dr. Jackson with the consequences that you believe Mr. Carlson might have faced if they had followed Dr. Jackson’s orders.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe the importance of comparing written orders in the context of the entire patient care plan to ensure accuracy and patient safety. |
Student struggles to describe patient-centered principles that can be applied to routine patient and family interactions. |
Student can describe some of the importance of comparing written orders in the context of the entire patient care plan, but lacks essential elements. |
Student can accurately describe the importance of comparing written orders in the context of the entire patient care plan. |
| Explain and apply evidence-based strategies that can limit distractions, interruptions, and multitasking during critical care activities. |
Student struggles to explain and apply evidence-based strategies that can limit distractions, interruptions, and multi-tasking during critical care activities. |
Student can explain and apply some evidence-based strategies that can limit distractions, interruptions, and multi-tasking during critical care activities, but lacks essential elements. |
Student can accurately explain and apply evidence-based strategies that can limit distractions, interruptions, and multi-tasking during critical care activities. |
| Recognize the importance of cross monitoring skills across the medical care team, regardless of position, status, or hierarchy to create trust and prevent errors. |
Student struggles to recognize and articulate the importance of cross monitoring skills across the medical care team. |
Student can recognize and articulate some of the importance of cross monitoring skills across the medical care team, but lacks essential elements. |
Student can recognize and articulate the importance of cross monitoring skills across the medical care team. |
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