Archive for the ‘Teacher Guides’ Category
Friday, October 3rd, 2014
155
Instructor’s Guide – No Shortcuts to Risk Reduction
Overview:
This story is about surgical site infections (SSIs). According to the CDC, SSIs are the second most common healthcare-acquired infection. Following evidence-based perioperative practices such as using precautions to prevent contamination of sterile equipment can prevent the risk of SSI.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- List evidence-based perioperative practices that prevent SSIs.
- Demonstrate awareness of techniques to resolve conflict when team members take shortcuts in perioperative practices.
- Describe a strategy to improve SSI preventative practices, such as implementation of the WHO SSI checklist.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Patient-Centered Care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
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 healthcare professionals.
CUS: 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
- What evidence-based perioperative practices were ignored in this story? Why are they important to follow?
A: The practices that were ignored in this story are related to surgical asepsis. Surgical equipment should stay in the sterile packaging until it is opened in the surgical suite.
- What barriers did Celeste face in addressing the breaks in evidence-based practice that she witnessed? What does this say about the norms of the unit?
A: She was concerned about speaking up because she is new to this unit. The surgical nurses had been preparing surgical equipment in this way for an extended amount of time. Due to the fact this was not a new occurrence may make it even more difficult to discuss.
- How could the use of the CUS Technique have helped Celeste address her concerns?
A: First, she would need to state her concern regarding the sterile equipment being opened in the storage unit. Then she would need to stay why she was uncomfortable. Then if the conflict were not resolved, she would need to state their was a patient safety issue related to the equipment.
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 although the staff knew the right thing to do they had become accustomed to doing it a different way. It is not always wrong to change how things are done, but they still must comply with safety standards. In this case the staff were no longer complying by the necessary perioperative practices.
- What steps can the team take to ensure we feel able to intervene if another team member takes a safety-compromising shortcut?
A: One way is to encourage open communication and regular dialogue regarding patient care and safety.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Write a dialogue in which Celeste utilizes the CUS Technique to address the breach of evidence-based practice that she has witnessed. How do you think the others might react, and what might she need to do to ensure patient safety?
- Make a poster to remind team members about the importance of following evidence-based perioperative practices that prevent SSIs.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| List evidence-based perioperative practices that prevent SSI. |
Student struggles to list evidence-based perioperative practices that prevent SSIs. |
Student can list evidence-based perioperative practices that prevent SSIs, but needs further practice and instruction. |
Student can accurately list evidence-based perioperative practices that prevent SSIs. |
| Demonstrate awareness of techniques to resolve conflict when team members take shortcuts in perioperative practices. |
Student struggles to demonstrate awareness of techniques to resolve conflict when team members take shortcuts in perioperative practices. |
Student can demonstrate awareness of techniques to resolve conflict when team members take shortcuts in perioperative practices, but needs further practice and instruction. |
Student can accurately demonstrate awareness of techniques to resolve conflict when team members take shortcuts in perioperative practices. |
| Describe a strategy to improve SSI preventative practices, such as implementation of the WHO SSI checklist. |
Student struggles to describe a strategy to improve SSI preventative practices, such as implementation of the WHO SSI checklist. |
Student can describe a strategy to improve SSI preventative practices, such as implementation of the WHO SSI checklist, but needs further practice and instruction. |
Student can accurately describe a strategy to improve SSI preventative practices, such as implementation of the WHO SSI checklist. |
Story-Specific Best Practices and Proven Tools:
In addition to the ideas generated by students and mentioned in the activities, there are established best practices that may be appropriate to introduce or reference during this lesson to support communication. Some best practices to consider for improving team communication include:
- Advocacy and Assertion
- Check-Backs
- STEP
- Call-Out
- AskMe3
- Cross Monitoring
- SBAR
- “Speak Up”
- Task Assistance
- Huddles
- 4 Step Process
- Two-Challenge Rule
- DESC Script
- PEARLA
- CUS
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Friday, October 3rd, 2014
154
Instructor’s Guide – Patients are People Too
Overview:
This story illustrates how knowing about being patient-centered, and actually doing it, are two different things, and that staff must be intentional and self-aware about engaging the patient.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Identify the core components of patient-centered behavior.
- Describe the importance of planning for all care providers to demonstrate patient-centered behaviors in all interactions with patients and family members.
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
- What important elements of patient-centered care did Tiana and Javier miss in this story?
A: The patient should be the source of control and full partner in the care team
A: The tasks should not prevent active listening
A: Explaining the rationale for each step and speaking to NOT around the patient involves them in the care process
- Why is it important to view events from the patient’s perspective when evaluating the efficacy of patient-centered care?
A: Safe and quality care requires that the patient be actively involved in the plan of care
A: Understanding that hospital sounds and otherwise simple cryptic comments can be fear inducing if not thoroughly explained and put into context
A: Being actively present and engaging is key to effective communication
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: Verbalizes that the patients experience is important does not demonstrate an understanding of patient centered care.
A: Following protocols and procedures does not demonstrate that the patient is the focus of the care
A: Enhancing the patient experience requires a patient centered approach
- How can we as a team make sure our patient-centered principles translate consistently into patient-centered behaviors?
A: Mentors should demonstrate consistent patient centered competency
A: Patient centered understanding cannot be evaluated via testing or verbalizing alone, but must be demonstrated over time
A: Holding one another accountable and have a culture of transparent communication is key to be a highly effective team
- How can I make sure I use good patient-centered behavior in every interaction with my patients?
A: Assess verbal and non-verbal queues with each interaction to better under that patients preferences, values and needs.
A: Find dedicated time to be present.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Write Mrs. Tillman’s review of her care on her patient survey. What do you think she would say about her experience with her nurses?
- Make a quick-reference chart or checklist that reminds nurses and other medical professionals to think about patient-centered care as they work through their normal procedures.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Identify the core components of patient-centered behavior. |
Student struggles to identify the core components of patient-centered behavior. |
Student can identify the core components of patient-centered behavior, but needs further instruction. |
Student can accurately identify the core components of patient-centered behavior. |
| Describe the importance of planning for all care providers to demonstrate patient-centered behaviors in all interactions with patients and family members. |
Student struggles to describe the importance of planning for all care providers to demonstrate patient-centered behaviors in all interactions with patients and family members. |
Student can describe the importance of planning for all care providers to demonstrate patient-centered behaviors in all interactions with patients and family members, but needs further instruction. |
Student can accurately describe the importance of planning for all care providers to demonstrate patient-centered behaviors in all interactions with patients and 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. Some best practices to consider for improving team communication include:
- Collaboration
- Feedback
- 3Ws – Who I am, What I am Doing, Why I Care
- DESC Script
- I’M SAFE
- STEP
- Bedside Handoffs
- Patient Rounding
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, October 3rd, 2014
153
Instructor’s Guide – No One Sits Until Everyone Sits
Overview:
This story is about mutual support and task assistance, and how offering assistance to other team members when your workload permits promotes safety, mutual trust, efficiency, productivity, and service excellence.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe the importance of adopting task sharing norms across team members to effectively manage workload.
- Identify high threat practices or protocols requiring increased shared vigilance.
- Generate team norms for engaging non-supportive team members to provide consistent mutual support.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
- Patient-Centered Care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS Best Practice: Task Assistance
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.
Task Assistance is guided by situation monitoring because situation awareness allows team members to effectively identify the need for assistance by others on the team. To a certain degree, some of us have been conditioned to avoid asking for help because of the fear of suggesting lack of knowledge or confidence. Many people refuse to seek assistance when overwhelmed by tasks. In support of patient safety, however, task assistance is expected. One of the most important concepts to remember with regard to Task Assistance is that assistance should be actively given and offered whenever there is a concern for patient safety related to workload. Task assistance may involve asking for assistance when overwhelmed or unsure; helping team members to perform their tasks, shifting workload by redistributing tasks to other team members, delaying/rerouting work so the overburdened member can recover, and/or filling in for overburdened team members when necessary.
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 task assistance across the unit and hospital?
A: It is important that nurses can recognize when they have limitations. The safety of the patient needs to be the first priority
- What high threat practices and protocols were occurring in this story?
A: Individual preferences and negative behaviors had caused a decline in safe patient care on this unit. The negative progression had continued until a potentially deadly occurrence happened on the floor.
- What team norms did Jane establish for engaging non-supportive team members to provide consistent mutual support across the unit? Why was this important?
A: Jane established a supportive environment where all team members supported each other. Even to the point of saying no one sits until everyone can sit down.
A: This is important because it builds a sense of support for all of the team members, but also keeps the patient the focus of care.
Discussion Questions:
Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: That psychological safety is important for health care team members. 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 individual behaviors are often permitted that do not enhance team mutual support and may be placing patients at risk?
A: Individual behaviors such as trying to do work alone or having poor communication puts patients at risk and does not support a team environment.
- What one thing can you do to promote mutual support and encourage task assistance across the team?
A: By promoting task assistance is one way to promote mutual support. Another way to promote mutual support is to continue to keep an open dialogue with staff members. This can be done by allowing 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 that describes the practice of task assistance, its importance, and the benefits for the unit and its patients.
- Brainstorm a list of high threat practices and protocols that require shared vigilance, and describe how the use of task assistance could address each.
- Write a script for the conversation you imagine Jane had with one of the less compliant members of her team. Illustrate how you think she won them over, or how she handled letting them go.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe the importance of adopting task sharing norms across team members to effectively manage workload. |
Student struggles to describe the importance of adopting task sharing norms across team members to effectively manage workload. |
Student can describe the importance of adopting task sharing norms across team members to effectively manage workload, but needs further practice. |
Student can accurately describe the importance of adopting task sharing norms across team members to effectively manage workload. |
| Identify high threat practices or protocols requiring increased shared vigilance. |
Student struggles to identify high threat practices or protocols requiring increased shared vigilance. |
Student can identify high threat practices or protocols requiring increased shared vigilance, but needs further practice. |
Student can accurately identify high threat practices or protocols requiring increased shared vigilance. |
| Generate team norms for engaging non-supportive team members to provide consistent mutual support. |
Student struggles to generate team norms for engaging non-supportive team members to provide consistent mutual support. |
Student can generate team norms for engaging non-supportive team members to provide consistent mutual support, but needs further practice. |
Student can accurately generate team norms for engaging non-supportive team members to provide consistent mutual support. |
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:
- Task Assistance
- Collaboration
- Cross Monitoring
- Feedback
- Huddles
- I’M SAFE
- STEP
- Patient Rounding
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, October 3rd, 2014
152
Instructor’s Guide – Let’s Huddle Up Here
Overview:
This story illustrates the importance of the TeamSTEPPS® “huddle” tool to keep everyone on the same page and allow for brief problem-solving before continuing the treatment plan as a patient’s condition changes.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Identify the types of situations where huddles could be advantageous in coordinating patient care.
- Explain how and when huddles should be conducted.
- Describe how to adopt huddles as a normal problem-solving event for improved patient care.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Patient-Centered Care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS Best Practice: Huddles
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.
Huddles: A huddle is a tool for reinforcing the plans already in place for the treatment of patients and for assessing the need to change plans. It can also help develop a shared understanding between team members of the plan of care and provides team leaders with the opportunity to informally monitor patient and unit-level situations. Huddles are particularly useful because information and patient status change over time, requiring ongoing monitoring and updating of the team. It may just be a matter of a sudden increase in the activity level of an individual or the team needing to reevaluate workload status. Workload distribution may have to be adjusted as a result. Information updates within the team should occur as often as necessary, and can take the form of a huddle at the status board or can occur between individual team members whenever new information needs to be shared.
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 would a huddle have been useful in this story?
A: It would have given the rest of the team more information regarding the conversation Jan had with Sarah’s mother.
- How could the use of huddles help a team better coordinate patient care?
A: Huddle allows each team member to know and understand what is expected regarding care to be provided for a patient. It also allows team members to know if there is a new situation they previously didn’t know.
- What were the barriers to using huddles in this story? How could they have been overcome?
A: One barrier was the increased deterioration of the patient. Jan believed that because the patient continued to have an increased need for medical attention that took away the opportunity of using a huddle.
A: This could have been overcome by implementing a team huddle. This could have been done by contacting the social worker or charge nurse in order to initiate a team huddle.
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: Jan had specific information regarding Sarah’s wishes however she was unable to get that information to the rest of the medical team.
- What barriers might you face in using the concept of huddling? How can you overcome those barriers?
A: Some barriers include feeling unsure of one’s own decisions or doubting the seriousness of a situation. You can overcome these barriers by focusing on the patient as the priority. If patient care is the focus then the focus is no longer on our insecurities or pride, but on the patient receiving quality care.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Make a list of all of the players in this story. Explain how a huddle would have helped them all be on the same page about Sarah’s care.
- Create a poster reminding your team of the importance of huddles and their benefits.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Identify the types of situations where huddles could be advantageous in coordinating patient care. |
Student struggles to identify the types of situations where huddles could be advantageous in coordinating patient care. |
Student can identify the types of situations where huddles could be advantageous in coordinating patient care, but needs further practice. |
Student can accurately identify the types of situations where huddles could be advantageous in coordinating patient care. |
| Explain how and when huddles should be conducted. |
Student struggles to explain how and when huddles should be conducted. |
Student can explain how and when huddles should be conducted, but needs further practice. |
Student can accurately explain how and when huddles should be conducted. |
| Describe how to adopt huddles as a normal problem-solving event for improved patient care. |
Student struggles to describe how to adopt huddles as a normal problem-solving event for improved patient care. |
Student can describe how to adopt huddles as a normal problem-solving event for improved patient care, but needs further practice. |
Student can accurately describe how to adopt huddles as a normal problem-solving event for improved patient care. |
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:
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, October 3rd, 2014
151
Instructor’s Guide – CUS-sing for Safety’s Sake
Overview:
This story is about CUS, a TeamSTEPPS® tool that helps care providers find the right words to express their concerns when they become aware of something they think will compromise patient safety.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe situations where the TeamSTEPPS® CUS tool would be appropriate to use to advocate for patient safety.
- Generate a plan for and practice using the TeamSTEPPS® CUS tool among providers and staff where there are unexpressed concerns about patient 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.
- 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 Technique
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.
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
- Why was the use of CUS so important in this story? What might have happened if it had not been employed?
A: It is highly likely that Marylou would have administered the incorrect amount of medication if she would not have used the CUS technique. She was looking out for the safety of the patient in this situation.
- Why is it important to express your concerns, regardless of hierarchy?
A: It is important because every patient deserves to receive the best care possible and thought would not have happened if this situation were handled differently. Hierarchy should not play a role in the care provided to the patient.
- What barriers did Marylou have to overcome in order to successfully use the CUS strategy?
A: She had to overcome her own feels and past experiences related to dealing with this pharmacist in the past. Although it is an uncomfortable conversation she knew it was the right decision.
Discussion Questions:
Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: Patient safety needs to be the first priority. It is not safe to try to administer a partial dose of an adult medication to a pediatric patient. It would not have been safe for Marylou to administer the medication as it was delivered to her. She was assertive and kept her patient the focus of the conversation.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Create a presentation explaining CUS to your team members as a way to confront differences of opinion regarding patient safety.
- Think of other scenarios where the use of CUS is appropriate.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe situations where the TeamSTEPPS® CUS tool would be appropriate to use to advocate for patient safety. |
Student struggles to describe situations where the TeamSTEPPS® CUS tool would be appropriate to use to advocate for patient safety. |
Student can describe situations where the TeamSTEPPS® CUS tool would be appropriate to use to advocate for patient safety, but needs further instruction. |
Student can accurately describe situations where the TeamSTEPPS® CUS tool would be appropriate to use to advocate for patient safety. |
| Generate a plan for and practice using the TeamSTEPPS® CUS tool among providers and staff where there are unexpressed concerns about patient safety. |
Student struggles to generate a plan for and practice using the TeamSTEPPS® CUS tool among providers and staff where there are unexpressed concerns about patient safety. |
Student can generate a plan for and practice using the TeamSTEPPS® CUS tool among providers and staff where there are unexpressed concerns about patient safety, but needs further practice. |
Student can accurately generate a plan for and practice using the TeamSTEPPS® CUS tool among providers and staff where there are unexpressed concerns about patient safety. |
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
- Advocacy and Assertion
- CUS
- Handoff
- STEP
- Two-Challenge Rule
- Cross Monitoring
- 3Ws – Who I Am, What I am Doing, and Why I Care
- “Speak Up”
Posted in Pro ED Guides, Teacher Guides | No Comments »
Thursday, October 2nd, 2014
150
Instructor’s Guide – See You Soon
Overview:
This story illustrates the likelihood of readmission in the absence of a coordinated care plan for the patient. Readmissions are often caused by preventable complications that occur during a transition from one care setting to another and may reflect poor coordination of care.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- List components of a coordinated discharge plan.
- Describe how to modify discharge processes to enhance communication between the hospital and discharge settings.
- Explain the importance of creating opportunities to involve patients and their families in discharge planning.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Patient-Centered Care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
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 components of a coordinated discharge plan are missing from this story?
A: It is unclear if the patient understood the discharge instructions. She repeated some of the words the nurse said, but it does not appear as if the patient had a good understanding of the discharge instructions.
- How could Andrea have modified her discharge process to enhance communication between the hospital and Mei Li and her family?
A: She could have waited until the family was present to provide the discharge information. She also could have provided information in a manner that was more understandable for Mei Li.
- What could Andrea have done to ensure that Anna was included in the discharge planning process?
A: She could have waited to provide the discharge information until Anna was present. She also could have provided a check off sheet with important information for the family.
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 patients want to learn more about their disease process and how to care for themselves, but it may be difficult for them. Sometimes health care providers provide a great deal of information to the patient, but the patient does not understand the information. Therefore, it is not helpful for the patient.
- What can you do to ensure patients and their caregivers actively participate in discharge planning?
A: One way is to ask the patient if they would like someone specific with them when the information is provided. Another way is to ask questions that require more than a “yes” or “no” response. Providing valuable information at the time of discharge is an important part of providing quality care for the patient.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- List the components of a coordinated discharge plan. Be sure to include who should be involved and why. Discuss your components with others and compare.
- Write out a discharge plan for Mei Li that better meets her needs.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| List components of a coordinated discharge plan. |
Student struggles to list components of a coordinated discharge plan. |
Student can list components of a coordinated discharge plan, but needs further practice. |
Student can accurately list components of a coordinated discharge plan. |
| Describe how to modify discharge processes to enhance communication between the hospital and discharge settings. |
Student struggles to describe how to modify discharge processes to enhance communication between the hospital and discharge settings. |
Student can describe how to modify discharge processes to enhance communication between the hospital and discharge settings, but needs further practice. |
Student can accurately describe how to modify discharge processes to enhance communication between the hospital and discharge settings. |
| Explain the importance of creating opportunities to involve patients and their families in discharge planning. |
Student struggles to explain the importance of creating opportunities to involve patients and their families in discharge planning. |
Student can explain the importance of creating opportunities to involve patients and their families in discharge planning, but needs further practice. |
Student can accurately explain the importance of creating opportunities to involve patients and their families in discharge planning. |
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:
- Handoff
- Check-Backs
- Collaboration
- Bedside Handoffs
- SBAR
- Advocacy and Assertion
- I PASS the BATON
- Debriefs
- “Speak Up”
- 3Ws – Who I am, What I am Doing, and Why I Care
- Patient Rounding
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Thursday, October 2nd, 2014
149
Instructor’s Guide – Room for Improvement
Overview:
This story addresses patient falls. According to reports by the IHI, Robert Wood Johnson Foundation, and several studies, falls are three times more likely in hospitals and nursing homes than in the community. It is every team member’s responsibility to help prevent falls.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe strategies to assess patients at risk for fall or at risk for injury from falls.
- Explain evidence-based fall prevention best practices.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
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 evidence-based practices could be used to prevent falls and reduce harm from falls?
A: One way is to investigate what the most common falls are, and work to reduce common falls in a hospital. The IHI, along with other resources, have a variety of resources to help identify common falls.
- What could have been done in this story to prevent Mrs. Shreaver’s fall?
A: One way is to attach a bed alarm to the patient. This can either be something that is attached to the patient or the bed and it makes a loud noise when the patient gets out of the bed.
Discussion Questions:
Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: We have learned that no one was intentionally trying to hurt the patient, however harm still occurred. It is important to have every member of the team aware of any patient that may be at risk for fall or injury.
- How can I monitor patients in order to reduce the risk of falls and injury?
A: One way is to keep those patients at risk for falls closer to the nurse’s station. Another way is to attach a bed alarm to the patient. Another way to reduce harm is to ensure all team members are aware of those at risk for falls and to check on those patients more often.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Create a guide for medical staff to remind them of evidence-based practices for preventing falls.
- Make a list of best practices for preventing falls to share with your classmates. Create a top ten list of the best ideas.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe strategies to assess patients at risk for fall or at risk for injury from falls. |
Student struggles to describe strategies to assess patients at risk for fall or at risk for injury from falls. |
Student can describe strategies to assess patients at risk for fall or at risk for injury from falls, but needs further practice. |
Student can accurately describe strategies to assess patients at risk for fall or at risk for injury from falls. |
| Explain evidence-based fall prevention best practices. |
Student struggles to explain evidence-based fall prevention best practices. |
Student can explain evidence-based fall prevention best practices, but needs further practice. |
Student can accurately explain evidence-based fall prevention best practices. |
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:
- Feedback
- Check-Backs
- Collaboration
- Handoff
- “Speak Up”
- SBAR
- I’M SAFE
- AskMe3
- Advocacy and Assertion
- Patient Rounding
- 3Ws – Who I am, What I am Doing, and Why I Care
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Thursday, October 2nd, 2014
148
Instructor’s Guide – One Big Team
Overview:
This story demonstrates the benefits of a care team functioning as a unified whole where everyone assumes responsibility for every job getting done when it comes to the patient’s safety and satisfaction.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Identify and summarize the problems that are caused by an “it’s not my job” attitude.
- Generate guidelines for how to respond to patients’ requests when the request is outside the staff member’s particular functional responsibilities.
- Describe the importance of the distribution of guidelines to every unit in the hospital.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
- Patient-Centered Care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
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 the “it’s not my job” attitude of the staff in the story affect Kathy’s care?
A: Kathy may have felt less confident in the skills of the staff when they continued to focus on their other work and not on her question. Kathy was no longer the center of care, but rather the tasks that everyone needed to complete became the focus of care.
- How could guidelines that help staff members respond to patient requests outside of their responsibilities have helped Kathy?
A: Guidelines to help staff with requests outside of their responsibilities would have helped Kathy to feel more included in the care provided. It would have also allowed other members of the health care team to assist in the situation. Sometimes other healthcare members are not given the opportunity to help out, even if they wanted to.
- Why is it important that all staff members are on the same page regarding policies about patient-centered care?
A: It is very easy for health care providers to get “caught up” in their own work and forget about the needs of the patient. If all staff members are on the same page it is easier to reach the goal of quality patient care.
Discussion Questions:
Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: She wanted to comply with the diet order set out by her doctor, but she was unsure if the meal tray she had received was correct. She was asking a rather simple question, however no one that she spoke to was able to assist her.
- What can I do to encourage everyone in every function to look at ourselves and behave as one, well-functioning team?
A: One way is to facilitate open communication between all team members. The responsibility in this scenario was left to the primary nurse, however it could have been handled by another nurse. Also, the other team members could have done a better job of keeping Kathy the focus of the care and not the numerous tasks they were trying to accomplish.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Generate guidelines for how to respond to patients’ requests when the request is outside the staff member’s particular functional responsibilities.
- Describe how you might distribute your guidelines for patient-centered care to all units and staff in the hospital?
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Identify and summarize the problems that are caused by an “it’s not my job” attitude. |
Student struggles to identify and summarize the problems that are caused by an “it’s not my job” attitude. |
Student can identify and summarize the problems that are caused by an “it’s not my job” attitude, but needs further practice. |
Student can accurately identify and summarize the problems that are caused by an “it’s not my job” attitude. |
| Generate guidelines for how to respond to patients’ requests when the request is outside the staff member’s particular functional responsibilities. |
Student struggles to generate guidelines for how to respond to patients’ requests when the request is outside the staff member’s particular functional responsibilities. |
Student can generate guidelines for how to respond to patients’ requests when the request is outside the staff member’s particular functional responsibilities, but needs further practice. |
Student can accurately generate guidelines for how to respond to patients’ requests when the request is outside the staff member’s particular functional responsibilities. |
| Describe the importance of the distribution of guidelines to every unit in the hospital. |
Student struggles to describe the importance of the distribution of guidelines to every unit in the hospital. |
Student can describe the importance of the distribution of guidelines to every unit in the hospital, but needs further practice. |
Student can accurately describe the importance of the distribution of guidelines to every unit in the hospital. |
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:
- Huddles
- Check-Backs
- Collaboration
- 4 Step Process
- Cross Monitoring
- 3Ws – Who I am, What I am Doing, and Why I Care
- Task Assistance
- AskMe3
- “Speak Up”
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Thursday, October 2nd, 2014
147
Instructor’s Guide – Can You Suggest A Solution?
Overview:
This story is about how you can put the emphasis on respectful problem-solving and building buy-in and responsibility-taking when disruptive or unprofessional behavior affects patients by slowing their care, thereby increasing the risk of error or omission.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Summarize the tools and techniques used in an engagement approach to resolving unprofessional conduct issues.
- Evaluate the appropriateness of an engagement approach versus a disciplinary approach for any given example of unprofessional conduct.
- Plan for an engagement-approach discussion with a peer or subordinate who is exhibiting unprofessional conduct.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
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 tools and techniques were used in this story to resolve unprofessional conduct issues?
A: An engagement approach was used in this situation. Bob was treated with respect when he was spoken to by Kim. She let him know what was expected of him, but did not make him feel that he was not part of the team.
- Do you think Kim would have had a different reaction from Bob if she had taken a disciplinary approach to the problem? Why?
A: Yes, Bob would have most likely become defensive and angry if she would have used a disciplinary approach. It is important that Bob feels he has respect and is part of the decision-making process.
- What do you think Kim did well in this story to begin building the kind of teamwork she wants to see in her unit?
A: She kept the patient the focus of the conversation and not the other staff. She made patient safety the priority and did not focus on the dispute between the two staff members.
Discussion Questions:
Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: We have learned that patients are always listening, even if we don’t think they are. They are very aware of the attitudes and actions made by the health care team members.
- What can I do to engage colleagues and subordinates in discussions to resolve unprofessional conduct issues?
A: One was is to keep the patient the focus of the discussion. Patient-centered care means that health care professionals need to keep the patient the focus of care. Another way is to use shared-decision making. When staff feel they are a part of the solution they are more likely to join in the change process.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Create and write a script for an engagement-approach discussion with a peer or subordinate who is exhibiting unprofessional conduct.
- Develop a presentation to help your colleagues access tools and techniques that would allow them to use the engagement approach for dealing with conflict with subordinates or peers.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Summarize the tools and techniques used in an engagement approach to resolving unprofessional conduct issues. |
Student struggles to summarize the tools and techniques used in an engagement approach to resolving unprofessional conduct issues. |
Student can summarize the tools and techniques used in an engagement approach to resolving unprofessional conduct issues, but needs further practice. |
Student can summarize accurately the tools and techniques used in an engagement approach to resolving unprofessional conduct issues. |
| Evaluate the appropriateness of an engagement approach versus a disciplinary approach for any given example of unprofessional conduct.
| Student struggles to evaluate the appropriateness of an engagement approach versus a disciplinary approach for any given example of unprofessional conduct. |
Student can evaluate the appropriateness of an engagement approach versus a disciplinary approach for any given example of unprofessional conduct, but needs further practice. |
Student can evaluate accurately the appropriateness of an engagement approach versus a disciplinary approach for any given example of unprofessional conduct. |
| Plan for an engagement-approach discussion with a peer or subordinate who is exhibiting unprofessional conduct. |
Student struggles to plan for an engagement-approach discussion with a peer or subordinate who is exhibiting unprofessional conduct. |
Student can plan for an engagement-approach discussion with a peer or subordinate who is exhibiting unprofessional conduct, but needs further practice. |
Student can plan accurately for an engagement-approach discussion with a peer or subordinate who is exhibiting unprofessional conduct. |
Additional Story-Specific Resources:
For additional information on improving team communication, please consult the following articles and resources in Further Reading:
Story-Specific Best Practices and Proven Tools:
In addition to the ideas generated by students and mentioned in the activities, there are established best practices that may be appropriate to introduce or reference during this lesson to support communication. Some best practices to consider for improving team communication include:
- Advocacy and Assertion
- Collaboration
- Cross Monitoring
- CUS
- DESC Script
- Feedback
- I’M SAFE
- STEP
- Task Assistance
- Two-Challenge Rule
- 4 Step Process
- PEARLA
Posted in Pro ED Guides, Teacher Guides | No Comments »
Thursday, October 2nd, 2014
146
Instructor’s Guide – Hidden in Plain Sight
Overview:
This story is about how healthcare as seen through the patient’s eyes is often perceived as serving the staff’s needs instead of the patient’s. The cumulative effect of many small issues can make the care look disjointed and unprofessional.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe what care looks like through a patient’s eyes.
- Describe what needs to be included in the professional code of conduct to make it more patient-centered.
- Explain the importance of integrating patient-centered principles into policies and procedures.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Patient-Centered Care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
Reflection Questions:
Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
*Following each question are some potential answers
- Imagine you were Sara’s mom. How would you describe the experience at this hospital to your friends and family?
A: Clinical negligence, lacking in treatment, responsive and caring.
A: Lacking in empathy
A: Lacking in advocacy
A: Lacking in communication and coordination
- How could the medical staff in this story have been more patient-centered?
A: Focus on the patient needs, chief complaint and customer service
A: Ownership of the treatment plan through a thorough and complete hand off – through the admission transition of care
A: Communicate anticipated timelines; circle back if there are unintended delays
A: Demonstrate compassion
- Why is it important to integrate patient-centered principles into policies and procedures? How could they have improved Sara’s experience?
A: Consider the targeted assessment and treatment for the fracture Sara presented with and be present during the physical assessment
A: Ask Sara what her needs were, acknowledge her pain and communicate the plan of care
Discussion Questions:
Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: Patient centeredness should begin with the first encounter.
A: Priorities of care should be developed based on the patients needs
A: Communication is a key aspect of patient centered care.
- What one thing can you do that will send the message to your patients that your most important job is to be there for them?
A: Be more than physically present
A: Actively listen
A: Respond in a timely fashion to their needs and requests and communicate the plan of care.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Make a list of all of the opportunities to add patient-centered principles in this story, and describe how they could be implemented to improve the patient experience.
- Write a letter to the editor as Sara’s mom. Describe your experience with the hospital and your opinion on their ability to provide appropriate care.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe what care looks like through a patient’s eyes. |
Student struggles to describe what care looks like through a patient’s eyes. |
Student can describe to a degree what care looks like through a patient’s eyes, but needs further practice. |
Student can describe what care looks like through a patient’s eyes. |
| Describe what needs to be included in the professional code of conduct to make it more patient-centered.
| Student struggles to describe what needs to be included in the professional code of conduct to make it more patient-centered. |
Student can describe what needs to be included in the professional code of conduct to make it more patient-centered, but needs further practice. |
Student can describe what needs to be included in the professional code of conduct to make it more patient-centered. |
| Explain the importance of integrating patient-centered principles into policies and procedures. |
Student struggles to explain the importance of integrating patient-centered principles into policies and procedures. |
Student can explain the importance of integrating patient-centered principles into policies and procedures, but needs further practice. |
Student can explain the importance of integrating patient-centered principles into policies and procedures. |
Additional Story-Specific Resources:
For additional information on improving team communication, please consult the following articles and resources in Further Reading:
Story-Specific Best Practices and Proven Tools:
In addition to the ideas generated by students and mentioned in the activities, there are established best practices that may be appropriate to introduce or reference during this lesson to support communication. Some best practices to consider for improving team communication include:
- Advocacy and Assertion
- Briefs
- Collaboration
- Feedback
- 3 Ws – Who I am, What I Am Doing, and Why I Care
- Patient Rounding
Posted in Pro ED Guides, Teacher Guides | No Comments »
