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104-You Tell Me All About It Instructor’s Guide

Friday, August 29th, 2014

104

Instructor’s Guide – You Tell Me All About It

Overview:
This story is about a staff member who goes beyond her role to deliver an excellent patient experience.  Seeing the person, not just the patient, is essential to making personal connections leading to outstanding care from the patient perspective. 


Primary Learning Outcomes

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

  • Describe patient-centered principles that can be applied to routine patient and family interactions, and the importance of valuing all members of the team.
  • Describe patient needs beyond immediate clinical tasks by seeing the person, not just the patient.


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.

  1. As a member of the housekeeping department, Ernestine might not be considered part of the patient care team by some medical staff. What does this story demonstrate about the need to value all members of the team, regardless of their role?
  2. What do you believe Ernestine did in this story that demonstrated her ability to see the person, not just the patient? How could you apply that thinking to your role?
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: It is important to realize that many aspects of communication are non-verbal. Listening between the lines to the tone, body language and non-verbal ques were essential to understanding this patient’s need for meaningful presence.
    A: Meeting the physical needs of a patient on bedrest are foundational, but the emotional and spiritual aspects of care should not be underestimated.
    A: Listening to what is important to the patient, should be the focus of our assessment and care planning for a patient centered approach to care.
  2. What’s one thing you could do to see through the patient’s eyes and go beyond your role to deliver exceptional care?
    A: Being a therapeutic presence, as modeled by Ernestine in the story, can allow patient’s time to feel safe enough to share beyond the structure of direct questions or task related interactions.

 

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

  • Imagine you are presenting the importance of patient-centered care to your team. Develop a presentation that highlights the importance of applying patient-centered care principles to routine patient and family interactions.
  • Think of a time when a medical professional looked beyond your status as a patient and saw the person? Share your story and why it was important to you.

 



Measuring Student Mastery: 

Learning Outcome Level 1 Level 2 Level 3
Describe patient-centered principles that can be applied to routine patient and family interactions, and the importance of valuing all members of the team. Student struggles to describe patient-centered principles that can be applied to routine patient and family interactions. Student can describe some patient-centered principles that can be applied to routine patient and family interactions, but needs improvement. Student can accurately describe patient-centered principles that can be applied to routine patient and family interactions.
Describe patient needs beyond immediate clinical tasks by seeing the person, not just the patient. Student struggles to describe patient needs beyond immediate clinical tasks by seeing the person, not just the patient. Student can describe some patient needs beyond immediate clinical tasks by seeing the person, not just the patient, but needs improvement. Student can accurately describe patient needs beyond immediate clinical tasks by seeing the person, not just the patient.

 


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. (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
  • 3Ws– Who Am I, What Am I Doing, and Why Do I Care

 

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103-You’re Part of Our Care Team Now Instructor’s Guide

Friday, August 29th, 2014

103

Instructor’s Guide – You’re Part of Our Care Team Now

Overview:
During a routine delivery, the baby is unresponsive requiring resuscitation and a transfer to the neonatal intensive care unit. Prior planning and coordination are essential for successful handoffs in emergent situations.


Primary Learning Outcomes

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

  • Summarize information that should be included in a pre-delivery team briefing for staff, the patient, and family.
  • Describe strategies and methods to ensure safe, timely, and closed-loop handoffs between units especially during emergent situations.
  • Describe strategies to improve communication between team members, patients and families.


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.
  • Evidence-Based Practice (EBP):
    • Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.

QSEN Evidence-Based Practice Enrichment
Evidence-Based 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 back.

 

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.

  1. Describe the information that could have been included in a pre-delivery briefing for the team, patient and family that could have alleviated some stress in this story?
  2. How were check-backs used appropriately in this story to ensure safe, timely, and closed-loop handoffs between units? How could they have been used more effectively?
  3. Which staff member do you believe was the most responsive to the needs of the patients and in this story? Why?
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: Javier and Elisa heard what was happening in the delivery room, but could not fully understand what was happening with their baby.
    A: Javier and Elisa had to make assumptions about the health of the new born baby.
    A: There did not appear to be a good check-back dialogue as the delivery nurse had not finished her assessment of the baby and the NICU then took the baby to the NICU.
  2. What are some things this team could have done to improve the way they communicated and to ‘stay on the same page’?
    A: Javier and Elisa could have been informed from the moment the baby was born that the NICU was being notified and why.
    A: A better check-back dialogue could have been initiated. It appeared as if the nurses knew what to do, but they were not communicating that information back.
  3. Which staff member do you believe was the least response to the needs of the patients in the story? Why?
    A: The Dr. delivering the baby appears to be the least responsive to the patient. Elisa was not informed of what the APGAR numbers meant or why the NICU nurse was being called. The Dr. could have kept Elisa and Javier informed of the situation.

 

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

  • Create (and optionally deliver to the class orally) a pre-delivery briefing that could have been given to the team, the patient and her husband prior to this delivery.
  • Develop a check-back dialogue between the delivery team and the transport team to demonstrate a successful closed-loop handoff in a similar delivery scenario.
  • Create a list of effective ways to improve communication with team members and patients in the delivery ward.

 



Measuring Student Mastery: 

Learning Outcome Level 1 Level 2 Level 3
Summarize information that should be included in a pre-delivery team briefing for staff, the patient, and family Student does not include adequate relevant information in a mock pre-delivery team briefing that includes the team and patient. Student includes some relevant information in a mock pre-delivery team briefing that includes the team and patient. Student includes relevant information in a mock pre-delivery team briefing that includes the team and patient.
Describe strategies and methods to ensure safe, timely, and closed-loop handoffs between units especially during emergent situations Student struggles to describe strategies and methods to ensure safe, timely, and closed-loop handoffs between units. Student can describe some strategies and methods to ensure safe, timely, and closed-loop handoffs between units, but information is incomplete. Student can accurately describe strategies and methods to ensure safe, timely, and closed-loop handoffs between units.
Describe strategies to improve communication between team members, patients and families. Student struggles to describe, or cannot describe, relevant strategies to improve communication between team members and patients. Student can describe some strategies to improve communication between team members and patients, but needs some improvement. Student can describe relevant strategies to improve communication between team members and patients.

 


Additional Story-Specific Resources: For additional information on improving team communication, please consult the following articles and resources in Further Reading:

 


Story-Specific Best Practices and Proven Tools:

In addition to the ideas generated by students and mentioned in the activities, there are established best practices that may be appropriate to introduce or reference during this lesson to support communication. (Details and definitions can be found in the Best Practices section of the website.) Some best practices to consider for improving team communication include:

  • Briefs
  • Handoffs
  • SBAR
  • Check-backs
  • Huddles
  • 3Ws– Who Am I, What Am I Doing, and Why Do I Care

 

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102-The Hard Way Instructor’s Guide

Friday, August 29th, 2014

102

Instructor’s Guide – The Hard Way

Overview:
This story addresses the issue of hand hygiene, as well as the importance of including patients and family members as valued members of the care team. Hand hygiene is critical to preventing infections. Anyone on the healthcare team should feel comfortable questioning another team member’s hand hygiene practices to ensure patient safety.


Primary Learning Outcomes

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

  • Describe proper procedures for safe hand hygiene practices during all patient interactions.
  • Recognize and describe the importance of providing patient-centered care and engaging family members as partners in patient care and safety.


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.

 

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.

  1. What procedures should medical professionals observe in regards to hand hygiene when interacting with a patient?
  2. What do you believe were the three most critical errors made by Dr. Patterson in the story, and how could he have better handled his interaction with Mr. and Mrs. Foster?
  3. The QSEN competencies require you to recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for the patient’s preferences, values, and needs. How did the medical professionals in this story fail to provide this level of care, and what could they have done instead?
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: Hand hygiene is a fundamental skill that is learned in nursing school, but the general public may not be aware of the importance of hand hygiene. In this case Carmen had to learn about it in the hospital, after her husband was hospitalized.
    A: Carmen wants the best care provided for her husband and that means being knowledgeable about his condition, including him in his care, and conducting appropriate hand hygiene.
    A: Dr. Patterson may have had the right intentions in his care for Harold, but he did not include the patient in the conversation.
  2. How could Betty have intervened earlier in this story?
    A: She could have introduced the Dr. to Carmen when he entered the room.
    A: She could have gently reminded the Dr. to wash his hands before touching the patient.
    A: She could have led by example and spoken to Harold and Carmen when Dr. Patterson was in the room.

 

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

  • Create a family/caregiver guide to hand hygiene and safety for families to learn about protecting their loved one.
  • Create a presentation on common issues or complications that can arise from poor or improper hand hygiene by medical professionals.
  • Imagine you are in charge of developing and implementing a plan for promoting better hand hygiene among medical professionals on a floor of this hospital. Develop a presentation for your team and a checklist for ensuring proper hand hygiene on your floor.

 



Measuring Student Mastery: 

Learning Outcome Level 1 Level 2 Level 3
Student can describe proper procedures for safe hand hygiene practices during all patient interactions. Student demonstrates little understanding of safe hand hygiene practices. Student demonstrates some understanding of safe hand hygiene practices. Student demonstrates full understanding of safe hand hygiene practices.
Student can recognize and describe the importance of providing patient-centered care and engaging family members as partners in patient care and safety. Student struggles to explain the importance of providing patient-centered care and engaging family members. Student explains the importance of providing patient-centered care and engaging family members, but may leave out important points. Student fully explains the importance of providing patient-centered care and engaging family members.

 


Additional Story-Specific Resources: For additional information on improving team communication, please consult the following articles and resources in Further Reading:

 


Story-Specific Best Practices and Proven Tools:

In addition to the ideas generated by students and mentioned in the activities, there are established best practices that may be appropriate to introduce or reference during this lesson to support communication. (Details and definitions can be found in the Best Practices section of the website.) Some best practices to consider for improving team communication include:

  • Two-Challenge Rule
  • STEP
  • Cross-Monitoring
  • “Speak Up”
  • More

 

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101-Lead or Follow, But Don’t Interrupt Instructor’s Guide

Friday, August 22nd, 2014

101

Instructor’s Guide – Lead or Follow, But Don’t Interrupt

Overview:
This story highlights the importance of communication to build cohesive teams sharing the same mental model regarding each of the patients in their care. The team brief at the start of each day can prevent errors and ensure that patients’ needs are anticipated.


Primary Learning Outcomes

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

  • Demonstrate an understanding of the importance of team briefs and team communication at the beginning of a shift.


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.
  • 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: Briefs

Briefs serve the following purposes:

  • They clarify who will be leading the team so that others know to whom to look for guidance.
  • They open lines of communication among team members, ensuring that everyone can contribute their unique knowledge base to the task, and thereby set the tone for the upcoming procedure or shift. Protocols, responsibilities, and expected behaviors are discussed and reinforced so that possible misunderstanding are avoided.
  • They prepare the team for the flow of the procedure or shift, contingency plans, and the means for resolving any unusual circumstances.
  • By delineating expectations, they reduce disruptive or unexpected behaviors.

 

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.

  1. After reading the story and the description of the EBP procedure for team briefs, evaluate Porscia’s pre-shift brief. Do you think she covered all of the necessary information? Why or why not?
  2. Do you believe Porscia’s reaction to David’s disruption of her brief was handled appropriately? Why or why not? What might you have done differently in her 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

  1. What can we learn from this story?
    A: It is important to remember the discussion does not have to only reflect what Porscia or David said, but their non-verbal communication can also be discussed.
    A: Listening to David’s concerns, along with the staff members, is an important part of Porscia’s role in keeping all team members involved in patient care.
    A: Every team member is responsible for the care of the patients and not just Porscia. Each team member should be engaged in the patient care process.
  2. What systems could have been in place to better prepare David to enter his new workplace
    A: He could have had an orientation program, to include the daily morning “huddle” with Porscia.
    A: He could have been given an email reminder of “important things to know” before beginning the shift.
    A: He could have been included, by another staff member, when he entered the room.
  3. Did Porscia handle the situation correctly? Why or why not?
    A: She did a nice job of acknowledging David and addressing the current issue, however she may have come across as too assertive.
    A: She may have embarrassed David and subsequently made the situation worse.
  4. What could David have done to better handle the situation?
    A: David could have kept the negative comment to himself and tried to find out what the meeting was about.
    A: He could have asked Porscia what the meeting was about at a later time.

 

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

  • Imagine that this team did not have a pre-shift brief. What kinds of issue could arise if the team were not on the same page? Create a list of the possible consequences of not holding team briefs. Share your list with a classmate and discuss the possible outcomes. Create a poster reminding your team members of the importance of team briefs and their benefits.
    A: It will foster future communication within the team.
    A: Specific issues can be addressed earlier in the day.
    A: Porscia is able to “check-in” with the team to determine if there are any issues she does not know about.



Instructor Tips: If the students are having trouble with the scenario suggest to the students to imagine they are sitting in on the team meeting, but as a team member and answer the questions. Then have them then re-listen to the scenario and break them into two groups. One group will imagine they are Porscia and try to determine how they would respond and the other half will try to determine how David would respond.

Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Demonstrate an understanding of the importance of team briefs at the beginning of a shift. Student struggles to articulate an understanding of the importance of team briefs and team communication at the beginning of a shift. Student can articulate some understanding of the importance of team briefs and team communication at the beginning of a shift. Student can articulate a professional understanding of the importance of team briefs and team communication at the beginning of a shift.

 


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
  • Briefs
  • Cross-Monitoring
  • Task Assistance
  • Bedside Handoffs
  • More

 

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126-Almost Routine Instructor’s Guide

Wednesday, July 9th, 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.

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.

 

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 EBP 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 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

 

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