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145 – Are We Sure This Is Necessary? Instructor’s Guide

Friday, September 26th, 2014

145

Instructor’s Guide – Are We Sure This Is Necessary?


Overview:
This story is about the fact that indwelling urinary catheters cause up to 80% of hospital-acquired infections, with 30% being unneeded in the first place, and how a nurse reviews a patient’s chart and challenges the catheterization.

 


Primary Learning Outcomes

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

  • Describe the importance of assessing catheter use for each patient on a daily basis.
  • Identify protocol for removing inappropriate Foley catheters.
  • Explain how to document indications for urinary catheter use.

 

 

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

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

    •   

 

Reflection Questions:

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

  1. What does this story illustrate about the importance of assessing catheter use for each patient daily?
    A: This story illustrates it is not only important to assess the catheter of every patient, but also the reason for the catheter. Nurses have a responsibility to be proactive and to discontinue indwelling urinary catheters as soon as medically possible.
  2. What are the protocols for removing inappropriate Foley catheters? Were they implemented appropriately in this story?
    A: Many facilities have protocol and standing orders to guide the healthcare team regarding urinary tract catheter removal. In this story the nurse was going to initiate a call to the doctor and the protocol to remove the indwelling catheter.
  3. How could the indications for urinary catheter use have been better documented in this story? Why?
    A: There were not any indicators for urinary catheter use in this story. This is an example of a catheter being inserted out of convenience for the staff.

Discussion Questions:

Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers

  1. What can we learn from this story?
    A: The nurse could have initiated the indwelling catheter removal much earlier in the shift. In fact, she did not initiate the catheter removal until a family member asked about it.
  2. What can we do to ensure that catheters are appropriately inserted?
    A: One way is to established guidelines and standing orders so that nurses can follow the protocol and are not reliant on their own personal judgement. This allows nurses to use evidence based practice to support their decisions and actions.
  3. What can you do to ensure that you review catheter use for each patient on a daily basis?
    A: Be proactive and remove the indwelling catheter as soon as medically possible. Documentation should be placed on the front of the chart of each patient with an indwelling catheter.

 

Suggested Classroom Mastery Activities:

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

  • Create a poster to remind others about the importance of assessing catheter use for each patient on a daily basis.
  • Work with a partner to develop a presentation to teach others how to appropriately document indications for urinary catheter use.
  • Research the consequences of the inappropriate use of Foley catheters and present your findings.



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Describe the importance of assessing catheter use for each patient on a daily basis.  Student struggles to describe the importance of assessing catheter use for each patient on a daily basis. Student can describe the importance of assessing catheter use for each patient on a daily basis, but needs further practice. Student can accurately describe the importance of assessing catheter use for each patient on a daily basis.
Identify protocol for removing inappropriate Foley catheters.   Student struggles to identify protocol for removing inappropriate Foley catheters. Student can identify protocol for removing inappropriate Foley catheters, but needs further practice. Student can accurately identify protocol for removing inappropriate Foley catheters.
Explain how to document indications for urinary catheter use.  Student struggles to explain how to document indications for urinary catheter use. Student can explain how to document indications for urinary catheter use, but needs further practice. Student can accurately explain how to document indications for urinary catheter use.

 

 

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
  • Call-Out
  • Briefs
  • Check Backs
  • Collaboration
  • Feedback
  • Debriefs
  • Handoff
  • AskMe3
  • “Speak Up”
  • 3Ws – Who I am, What I am Doing, Why I care

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

144 – Putting Safety on the Line Instructor’s Guide

Friday, September 26th, 2014

144

Instructor’s Guide – Putting Safety on the Line


Overview:
This story is about the importance of following protocols, particularly those pertaining to central venous catheters (CVCs). Prevention of CLABSI is mandated by legislation. Therefore, it is every team member’s responsibility to speak up when procedures are incorrectly performed.

 


Primary Learning Outcomes

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

  • List the five best practice components of the central line bundle for prevention of CLABSI.
  • Describe how to apply a central line bundle to prevent CLABSI.
  • Explain the importance of identifying and communicating deviations from CLABSI preventative best practices to team members using assertive language.

 

 

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

  • Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
  • Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.

 

Reflection Questions:

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

  1. What are the five best practice components of the central line bundle for prevention of CLABSI?
    A: Hand Hygiene, apply a sterile drape, allow the chlorhexidine to dry, use antimicrobial catheters, and disinfect hubs, connectors and injection ports.
  2. What can we do to ensure that a central line bundle is applied to all patients with central lines?
    A: One way is to apply a copy of the bundle to the front of each patient chart that is receiving a central line. Another way is to encourage all staff to use open communication when assisting or inserting a central line.
  3. What can you do to ‘stop the line’ if central line bundle protocols are not followed by any member of the team?
    A: One way is to address the person in charge of the procedure and to note if there is a break in the protocol.

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: The patient needs to be the focus of care. In this instance Corrie was looking out for the patient. She addressed her concerns with the doctor and it resulted in a positive response. Patient safety was the top priority.
  2. What do you think Corrie did well in this story? Why?
    A: Corrie demonstrated assertiveness when she addressed Dr. Winters when he had not waited to allow the chlorhexidine to dry completely before continuing with the procedure. She stood her ground and ensured the patient’s safety was a priority.

 

Suggested Classroom Mastery Activities:

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

  • Make a poster to remind your colleagues of the five best practice components of the central line bundle for prevention of CLABSI.
  • Create a step-by-step presentation describing how to apply a central line bundle to prevent CLABSI.



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
List the five best practice components of the central line bundle for prevention of CLABSI.  Student struggles to list the five best practice components of the central line bundle for prevention of CLABSI. Student can list some of the five best practice components of the central line bundle for prevention of CLABSI, but needs more practice. Student can accurately list the five best practice components of the central line bundle for prevention of CLABSI.
Describe how to apply a central line bundle to prevent CLABSI.  Student struggles to describe how to apply a central line bundle to prevent CLABSI. Student can describe how to apply a central line bundle to prevent CLABSI, but needs more practice. Student can accurately describe how to apply a central line bundle to prevent CLABSI.
Explain the importance of identifying and communicating deviations from CLABSI preventative best practices to team members using assertive language.  Student struggles to explain the importance of identifying and communicating deviations from CLABSI preventative best practices to team members using assertive language. Student can explain the importance of identifying and communicating deviations from CLABSI preventative best practices to team members using assertive language, but needs further practice. Student can accurately explain the importance of identifying and communicating deviations from CLABSI preventative best practices to team members using assertive language.

 

 

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
  • Cross Monitoring
  • CUS
  • Debriefs
  • DESC Script
  • Feedback
  • Huddles
  • STEP
  • Task Assistance
  • Two-Challenge Rule
  • “Speak Up”
  • 3Ws – Who I am, What I am Doing, and Why I Care

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

143 – Got Clutter? Instructor’s Guide

Friday, September 26th, 2014

143

Instructor’s Guide – Got Clutter?


Overview:
This story is about facility cleanliness. It is a key patient and family satisfaction performance indicator. Facilities that are cluttered, unorganized, and generally untidy form negative patient perceptions. This could also impact safety, efficiency, and organizational effectiveness.

 


Primary Learning Outcomes

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

  • Examine the effect a cluttered facility has on the patient experience.
  • Explain and adopt strategies and actions to eliminate clutter and create a consistently clean and inviting atmosphere for patients, families, and visitors.

 

 

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

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

 

Reflection Questions:

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

  1. What do you believe was the effect of the state of the facility in this story on its patients?
    A: Patients may see the clutter and assume there is a correlation been poor patient care and a cluttered and old environment. Patients may choose to seek care at another hospital because this one does not appear as nice or organized.
  2. Do you agree with Mary’s assessment of the hospital, despite Dr. Samuel’s descriptions? Why or why not?
    A: It is hard to know the quality of care that is provided at this facility. Dr. Samuel may be accurate of his account of the care provided at this hospital and he may not notice the clutter.
  3. What could the hospital do to eliminate clutter and create a consistently clean and inviting atmosphere for patients, families, and visitors?
    A: Creating a consistently clean and inviting environment is an important goal. One way to do this is to provide a storage closet for wheelchairs and other regularly used equipment. Another way is to ensure staff are responsible for keeping their work areas clean and tidy. This should be everyone’s responsibility and not just that of the cleaning crew.

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: People are aware of the environment around them and an unkempt and cluttered area can be difficult for people to work with. Mary was concerned about the care provided to the patients and that included the environment she was going to work in.
  2. What one thing can you do to de-clutter, clean, and support your team to create an inviting atmosphere for patients, the community, and ourselves?
    A: One way is to ensure that unused equipment gets put away promptly. Another way is to keep all regularly used equipment and supplies on one side of the hallway. This is not only a safety issue, but it looks more appealing to the eye.

 

Suggested Classroom Mastery Activities:

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

  • Create a chart or Venn Diagram to compare and contrast Dr. Samuel and Mary’s views of the hospital. Describe where you believe the breakdown in their opinions occurred, and what could be done to remedy the situation.
  • Research why hospital cleanliness and lack of clutter is so important for patient safety. Share your findings with the class.



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Examine and describe the effect a cluttered facility has on the patient experience.  Student struggles to examine and describe the effect a cluttered facility has on the patient experience. Student can examine and describe the effect a cluttered facility has on the patient experience, but needs further instruction. Student can examine and accurately describe the effect a cluttered facility has on the patient experience.
Explain and adopt strategies and actions to eliminate clutter and create a consistently clean and inviting atmosphere for patients, families, and visitors.  Student struggles to explain and adopt strategies and actions to eliminate clutter and create a consistently clean and inviting atmosphere for patients, families, and visitors. Student can explain and adopt strategies and actions to eliminate clutter and create a consistently clean and inviting atmosphere for patients, families, and visitors, but needs further instruction. Student can accurately explain and adopt strategies and actions to eliminate clutter and create a consistently clean and inviting atmosphere for patients, families, and visitors.

 

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:

  • STEP
  • Patient Rounding

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

142 – Teamwork Starts Here Instructor’s Guide

Friday, September 26th, 2014

142

Instructor’s Guide – Teamwork Starts Here


Overview:
This story is about the role senior leadership plays in effective teamwork. A top-down and control leadership style among senior leadership teams creates a climate where members don’t feel respected or empowered to perform, whereas psychological safety creates trust among all teams.

 


Primary Learning Outcomes

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

  • Describe why establishing norms for the conduct of the leadership team so that all members are empowered to speak up about lapses in professional conduct is important to achieving quality patient care.

 

 

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

  • Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.

 

Reflection Questions:

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

  1. What can members of the leadership team do to hold each other accountable for professional conduct?
    A: Mutual respect is an important part of a leadership team. One way to hold each other accountable is to take note when it appears that mutual respect is not being maintained. Sometimes individuals need to be reminded, in private, that their behavior is not conducive to shared decision-making process.
  2. What kind of environment was created by the CEO? Why was his approach detrimental to the team?
    A: The CEO did not create an environment of mutual respect or shared decision-making. It had become a hostile environment for everyone involved. This environment needs to be changed in order to foster open communication and inter-professional teams.

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: All team members need to be able to hold each other accountable for their behavior. This should be done out of mutual respect and not out of personal interest.
  2. What can the leadership team do to role-model good teamwork behaviors for the rest of the organization?
    A: Good teamwork behaviors need to start with the CEO and those in a leadership role. Mutual respect and shared-decision making needs to be established with the senior leadership first. Once this is established on a leadership level it will be easier to role-model this behavior to the rest of the organization.

 

Suggested Classroom Mastery Activities:

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

  • Imagine you were part of this leadership team. What could you do to hold each other accountable for professional conduct in your relationships?



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Describe why establishing norms for the conduct of the leadership team so that all members are empowered to speak up about lapses in professional conduct is important to achieving quality patient care.  Student struggles to describe why establishing norms for the conduct of the leadership team so that all members are empowered to speak up about lapses in professional conduct is important to achieving quality patient care. Student can describe why establishing norms for the conduct of the leadership team so that all members are empowered to speak up about lapses in professional conduct is important to achieving quality patient care, but needs further instruction and practice. Student can describe why establishing norms for the conduct of the leadership team so that all members are empowered to speak up about lapses in professional conduct is important to achieving quality patient care.

 

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:

  • DESC Script
  • Collaboration
  • Cross Monitoring
  • I’M SAFE
  • Advocacy and Assertion
  • Task Assistance
  • Feedback
  • CUS
  • 4 Step Process
  • PEARLA

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

141 – Code of Silence Instructor’s Guide

Friday, September 26th, 2014

141

Instructor’s Guide – Code of Silence


Overview:
This story highlights the importance of a nonjudgmental culture. Every human makes mistakes or poor decisions. A culture of denial, shame, and fear of litigation prevents providers from admitting and discussing mistakes openly, or using them to learn and improve.

 


Primary Learning Outcomes

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

  • Identify existing norms and beliefs within a culture related to organizational response to errors.
  • Generate strategies, methods, and practices for open sharing, resolution, and learning from errors.
  • Describe the importance of adopting organizational practices to care for the caregiver who has made a mistake or medical error.

 

 

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.

 

Reflection Questions:
Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
*Following each question are some potential answers

  1. How did Emily’s existing internalized norms and beliefs influence her decisions in the story? What could the hospital do to change them?
    A: She didn’t want to bother the resident and she wanted to “prove” that she could do her job without any help from any physician. One way to change that is to develop protocols for common admissions. This would allow physicians to do their work and to take the guess work out of an admission or discharging the patient home.
  2. How does this story illustrate the importance of fostering open communication in the healthcare workplace?
    A: Fostering open communication is an important part of providing care to patients. The doctor asked a nurse on the floor for advise however, she is not an expert in the field and should not have been asked to consult on the case.
  3. Why is it important to reach out to caregivers who have made a mistake or medical error?
    A: One reason is in order to correct the issue and to ensure it does not occur again. It should not be used as punishment but as a way to make improvements for the future.

 

Discussion Questions:

Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers

  1. What can we learn from this story?
    A: That it is important to practice within your scope of practice. This is true for everyone working within the healthcare field.
  2. What one thing can you do that will increase transparency and trust through open sharing, team learning, and healing after an error occurs?
    A: One way is to meet with the people involved in the error and to emphasize the need to learn and grow from the situation. It is then a good idea to reflect on what happened and potential options to take in the future. This should not be used as a punishment, but as a way to learn a different way of providing care to the patient.

 

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 barriers that might exist within a team that prevent members from openly sharing, discussing, and learning from their mistakes. Then, work on your own or with a partner to develop solutions to overcome each barrier.
  • Research the effects of medical errors and mistakes on healthcare providers. Use the internet, journals, and the article “Psychological Safety in Healthcare Teams” as a starting point. Present your findings in a paper, presentation, or PSA.



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Identify existing norms and beliefs within a culture related to organizational response to errors.  Student struggles to identify existing norms and beliefs within a culture related to organizational response to errors. Student can identify existing norms and beliefs within a culture related to organizational response to errors, but needs further practice. Student can accurately identify existing norms and beliefs within a culture related to organizational response to errors.
Generate strategies, methods, and practices for open sharing, resolution, and learning from errors.  Student struggles to generate strategies, methods, and practices for open sharing, resolution, and learning from errors. Student can generate strategies, methods, and practices for open sharing, resolution, and learning from errors, but needs further instruction. Student can generate strategies, methods, and practices for open sharing, resolution, and learning from errors.
Describe the importance of adopting organizational practices to care for the caregiver who has made a mistake or medical error.  Student struggles to describe the importance of adopting organizational practices to care for the caregiver who has made a mistake or medical error. Student can describe the importance of adopting organizational practices to care for the caregiver who has made a mistake or medical error, but needs further instruction. Student can describe the importance of adopting organizational practices to care for the caregiver who has made a mistake or medical error.
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
  • I’M SAFE
  • Debriefs
  • Feedback
  • AskMe3
  • “Speak Up”

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

140 – Sailing on a Healing Tide Instructor’s Guide

Friday, September 26th, 2014

140

Instructor’s Guide – Sailing on a Healing Tide


Overview:
This story is about the importance of listening for understanding. The messages we communicate come across in both verbal and non-verbal ways. We must be aware of the messages we are sending, and must decide if those are the ones we want to be sending.

 


Primary Learning Outcomes

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

  • Identify and describe the inadvertent or non-verbal messages we may be sending to patients through our behavior.
  • Describe the importance of adopting a set of team norms and behaviors for the positive messages we want to be sending to our patients and families.

 

 

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

  1. What kinds of messages was Carl receiving from Dr. Samuels and Smitty? How did they affect his recovery?
    A: Smitty lacked in the ability to reach Carl’s non-verbal grimaces, as signs of pain.
    A: Dr. Samuels didn’t fully appreciate the patient’s concern over his pain during therapy, his ability to fully recover, his ability to be free from narcotic addiction.
  2. What’s one specific thing you could do to make sure you are sending a caring and compassionate message to your patients and families?
    A: Be fully present when listening.

 

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: Having a repertoire with our patients is important in order to develop a patient centered plan of care.
    A: Patient’s often have needs beyond the primary diagnosis or treatment.
    A: Actively listening is invaluable to assess patient preferences, values and needs.
  2. What caring and compassionate messages (verbal and non-verbal) are our patients receiving from us on a routine basis?
    A: Patients read our non-verbal messages with every encounter.
    A: Intentionally being “present” when listenting to our patients is a demonstration of our caring and compassion.

 

Suggested Classroom Mastery Activities:

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

  • Read “Principles of Motivational Interviewing”, and describe how some of these tactics were employed in the story, or could improve the interaction in the story.
  • Imagine this story if Dr. Samuels had not developed a personal relationship with Carl. What might be different? Why?



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Identify and describe the inadvertent or non-verbal messages we may be sending to patients through our behavior.  Student struggles to identify and describe the inadvertent or non-verbal messages we may be sending to patients through our behavior. Student can identify and describe some inadvertent or non-verbal messages we may be sending to patients through our behavior, but needs more practice. Student can accurately identify and describe the inadvertent or non-verbal messages we may be sending to patients through our behavior.
Describe the importance of adopting a set of team norms and behaviors for the positive messages we want to be sending to our patients and families.  Student struggles to describe the importance of adopting a set of team norms and behaviors for the positive messages we want to be sending to our patients and families. Student can describe the importance of adopting a set of team norms and behaviors for the positive messages we want to be sending to our patients and families, but needs more practice. Student can accurately describe the importance of adopting a set of team norms and behaviors for the positive messages we want to be sending to our patients and families.

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
  • Check Backs
  • Collaboration
  • STEP
  • Huddles
  • I’M SAFE
  • STEP
  • AskMe3
  • Bedside Handoffs
  • “Speak Up”
  • 3 Ws – Who I Am, What Am I Doing, and Why I Care
  • Patient Rounding

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

139 – Nature to Nurture Instructor’s Guide

Friday, September 26th, 2014

139

Instructor’s Guide – Nature to Nurture


Overview:
This story is about bullying and hazing practices often associated with a healthcare worker’s indoctrination. These practices cause both unnecessary stress and premature abandonment of the field, and often compromise both the satisfaction and safety of patients.

 


Primary Learning Outcomes

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

  • Evaluate and explain on-boarding practices that ensure proper supervision for safe, competent, and quality patient care.
  • Describe the importance of adopting “no bullying, no hazing” policies and protocols.
  • Clarify the responsibility of each team member in creating a climate of respect and professionalism for new team members.

 

 

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

  1. What does this story illustrate about the importance of shared on-boarding practices?
    A: Cheryl was not put in a position to succeed. This not only put her in danger, but also the other patients.
  2. Explain how Karen and Alice failed to create a climate of respect and professionalism in this story.
    A: Kyrie and Alice spoke negatively about having a new nurse in their department and that attitude was made known to Cheryl. She was not oriented to the unit or welcomed to the department.
  3. How did Kyrie and Alice, and the procedures in place at the hospital, fail to minimize the risk of harm to patients in this story? What should have been done instead?
    A: Alice should have learned more about Susie’s clinical skills, strengths and weaknesses. Alice is responsible for the care that Susie provides to each of the patients and needs to know the scope of Alice’s training.
    A: Alice should have been oriented to the unit and her surroundings. She should have then been placed with a nurse that would demonstrate the proper way to do things on that unit. She should have been given more simple tasks in the beginning and then guided through the more complicated tasks.

 

Discussion Questions:

Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers

  1. What can we learn from this story?
    A: That bullying and hazing can come in different forms and does not always look the same. Alice might not think she is being a bully, but she needs to know her behavior is not acceptable.
  2. What one thing can you do to ensure all team members are treated with respect, regardless of rank, position, or role?
    A: One way is to “talk up” a colleague. Kyrie could have discussed how nice it is to have a new member to their team. Cheryl may be able to contribute in ways Kyrie and Alice did not realize.
  3. Have you witnessed or been a victim of hazing or bullying from other colleagues, classmates, or staff members? How did it make you feel?
    A: It becomes a negative environment when nurses speak negatively about each other. Lateral violence, bullying, and hazing are all too common in the healthcare field. One way to stop this is to use open communication and learn to collaborate with all healthcare team members.

 

Suggested Classroom Mastery Activities:

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

  • Continue this story from Cheryl’s perspective. How do you think Kyrie and Alice’s actions in this story might affect her future in the profession?
  • Create a presentation to educate others on the effects of bullying and hazing in the medical profession. Use the Professional Conduct Survey to learn more about issues in the medical workplace, and do other research on your own.



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Evaluate and explain on-boarding practices that ensure proper supervision for safe, competent, and quality patient care. Student struggles to evaluate and explain on-boarding practices that ensure proper supervision for safe, competent, and quality patient care. Student can evaluate and explain on-boarding practices that ensure proper supervision for safe, competent, and quality patient care, but needs further practice. Student can evaluate and accurately explain on-boarding practices that ensure proper supervision for safe, competent, and quality patient care.
Describe the importance of adopting “no bullying, no hazing” policies and protocols. Student struggles to describe the importance of adopting “no bullying, no hazing” policies and protocols. Student can describe the importance of adopting “no bullying, no hazing” policies and protocols, but needs further practice. Student can accurately describe the importance of adopting “no bullying, no hazing” policies and protocols.
Clarify the responsibility of each team member in creating a climate of respect and professionalism for new team members.  Student struggles to clarify the responsibility of each team member in creating a climate of respect and professionalism for new team members. Student can clarify the responsibility of each team member in creating a climate of respect and professionalism for new team members, but needs further practice and instruction. Student can accurately clarify the responsibility of each team member in creating a climate of respect and professionalism for new team 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:

  • DESC Script
  • Collaboration
  • Cross Monitoring
  • I’M SAFE
  • STEP
  • Task Assistance
  • CUS
  • “Speak Up”
  • 4 Step Process
  • PEARLA

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

138 – The Pressure’s On Instructor’s Guide

Friday, September 26th, 2014

138

Instructor’s Guide – The Pressure’s On


Overview:
Pressure ulcers are common in patients with spinal cord injuries due to lack of mobility. Evidence-based protocols for pressure ulcer prevention must be developed, trained, and followed across teams to prevent patient harm. Effective handoffs are essential to ensure continuity of care.

 


Primary Learning Outcomes

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

  • Describe the role of the nurse in pressure ulcer surveillance and skin assessment.
  • Recognize and explain the importance of documenting and communicating steps to prevent pressure ulcers, especially during handoffs.
  • Explain how to apply evidence-based measures to prevent the development of pressure ulcers.

 

 

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.

 

Reflection Questions:
Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
*Following each question are some potential answers

  1. What is the role of the nurse in pressure ulcer surveillance and skin assessment?
    A: It is the nurse’s responsibility to assess for ulcers and skin breakdown every shift, or more often if needed.
  2. What did this team do well in documenting and communicating their efforts to prevent Trevon’s pressure ulcers? What could they improve?
    A: They did a good job of documenting and communicating their efforts, however the LVN was not notified of the potential issue for skin breakdown and she did not understand the abbreviated letters written on the front of the chart.
  3. What can we do to ensure that a pressure ulcer prevention plan is consistently documented, practiced and communicated, including the ‘why’ for patients and families?
    A: There may be a need to place pressure ulcer prevention plans in the front of every patients chart. It is not acceptable for patients to develop a pressure ulcer once they are in the hospital and insurance companies will no longer pay for the care of that pressure ulcer if one were to develop.

 

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: The importance of vigilant skin assessments is vital to safe patient care. With good assessments and turning procedures skin breakdown is preventable.
  2. What can we do to ensure that all members of the healthcare team receive timely, clear communication about pressure ulcer prevention plans tailored to patient needs?
    A: The charge nurse is a good person to start the communication about pressure ulcer prevention. It is also effective to have a “super user” or a champion who will lead the healthcare team in communicating the pressure ulcer prevention plans for each patient.

 

Suggested Classroom Mastery Activities:

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

  • Create a poster that reminds team members of the importance of documenting and communicating steps to prevent pressure ulcers, especially during handoff.
  • Research the consequences of pressure ulcers, and share your findings with the class.



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Describe the role of the nurse in pressure ulcer surveillance and skin assessment.  Student struggles describe the role of the nurse in pressure ulcer surveillance and skin assessment. Student can describe the role of the nurse in pressure ulcer surveillance and skin assessment, but needs further instruction and practice. Student can accurately describe the role of the nurse in pressure ulcer surveillance and skin assessment.
Recognize and explain the importance of documenting and communicating steps to prevent pressure ulcers, especially during handoffs.  Student struggles to recognize and explain the importance of documenting and communicating steps to prevent pressure ulcers, especially during handoffs. Student can recognize and explain the importance of documenting and communicating steps to prevent pressure ulcers, especially during handoffs, but needs more practice. Student can recognize and accurately explain the importance of documenting and communicating steps to prevent pressure ulcers, especially during handoffs.
Explain how to apply evidence-based measures to prevent the development of pressure ulcers.  Student struggles to explain how to apply evidence-based measures to prevent the development of pressure ulcers. Student can explain how to apply evidence-based measures to prevent the development of pressure ulcers, but needs more practice. Student can accurately explain how to apply evidence-based measures to prevent the development of pressure ulcers.

 

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:

  • Briefs
  • Check-Backs
  • Debriefs
  • Collaboration
  • Handoff
  • Cross Monitoring
  • Huddles
  • I PASS the BATON
  • SBAR
  • Task Assistance
  • Patient Rounding
  • Bedside Handoffs

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

137 – Vigilance is Never In Vain Instructor’s Guide

Friday, September 26th, 2014

137

Instructor’s Guide – Vigilance is Never In Vain


Overview:
This story highlights the importance of Venous Thrombosis Embolism (VTE) prevention protocols. Signs and symptoms of VTE are frequently silent and can lead to fatal pulmonary embolism. All team members are responsible for VTE.

 


Primary Learning Outcomes

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

  • Explain the importance of ensuring that patient order sets include a plan for VTE prophylaxis.
  • Describe the necessity of re-assessing patients for VTE risk when their conditions or circumstances change (e.g. moving into post-operative phase).
  • Develop a plan to communicate patient goals including VTE prophylaxis to all members of the multidisciplinary team.

 

 

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 Teamwork & Collaboration Enrichment

TeamSTEPPS Best Practice: Two Challenge Rule

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.

 

Two Challenge Rule

It is important to voice your concern by advocating and asserting your statement at least twice if the initial assertion is ignored (thus the name, “Two-Challenge rule”). These two attempts may come from the same person or two different team members. The first challenge should be in the form of a question. The second challenge should provide some support for your concern. Remember this is about advocating for the patient. The Two-Challenge tactic ensures that an expressed concern has been heard, understood, and acknowledged.

 

Reflection Questions:
Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
*Following each question are some potential answers

  1. Why is it important to ensure that patient order sets include a plan for VTE prophylaxis?
    A: This is one way to ensure the patient does not get a DVT after surgery. The order sets are put into place for a reason and they reflect Evidence Based Practice.
  2. How could Sally have applied the Two-Challenge Rule when she discovered Dr. Hamdi’s orders?
    A: She could have called the doctor right away and asked if he would like to implement the VTE protocol. If the doctor does not agree then the nurse can suggest they implement the VTE protocol.
  3. What does this story illustrate about the importance of fostering and maintaining open communication, mutual respect, and shared decision-making among the team, regardless of roles or hierarchy?
    A: The nurse did not call the doctor because she was nervous about how he would respond. The hospitalist also did not want to contact Dr Hamdi because she did not think he would respond well. Therefore, because the nurse was nervous about speak to the doctor then the patient did not receive the appropriate medication.

 

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: The patient needs to be the priority for the nurse and not the concern over what the doctor will say. The patient should have received different medication and the nurse knew that, but she did not feel comfortable calling the doctor.
  2. What could you do to ensure daily review of VTE risk factors for all patients?
    A: All surgical patients should be provided with VTE standards of care. A daily check could be made by the change nurse to ensure this is done.

 

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 VTE risk, and the precautions that can help prevent fatal errors. Share your work with your classmates.
  • Create a VTE prophylaxis protocol/checklist that members of this unit could follow when re-assessing patients.
  • Write a dialogue between Sally and Dr. Hamdi where Sally employs the Two-Challenge Rule to advocate for Dina.

 

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Explain the importance of ensuring that patient order sets include a plan for VTE prophylaxis. Student struggles to explain the importance of ensuring that patient order sets include a plan for VTE prophylaxis. Student can explain the importance of ensuring that patient order sets include a plan for VTE prophylaxis, but needs improvement. Student can accurately explain the importance of ensuring that patient order sets include a plan for VTE prophylaxis.
Describe the necessity of re-assessing patients for VTE risk when their conditions or circumstances change (e.g. moving into post-operative phase). Student struggles to describe the necessity of re-assessing patients for VTE risk when their conditions or circumstances change. Student can describe the necessity of re-assessing patients for VTE risk when their conditions or circumstances change, but needs improvement. Student can accurately describe the necessity of re-assessing patients for VTE risk when their conditions or circumstances change.
Develop a plan to communicate patient goals including VTE prophylaxis to all members of the multidisciplinary team.  Student struggles to develop a plan to communicate patient goals including VTE prophylaxis to all members of the multidisciplinary team. Student is able to develop a plan to communicate patient goals including VTE prophylaxis to all members of the multidisciplinary team, but needs improvement. Student is able to develop an accurate and complete plan to communicate patient goals including VTE prophylaxis to all members of the multidisciplinary team.
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
  • Check Backs
  • Bedside Handoffs
  • Collaboration
  • Cross Monitoring
  • STEP
  • Handoff
  • I PASS the BATON
  • Two-Challenge Rule
  • Debriefs
  • SBAR
  • AskMe3
  • CUS
  • Feedback
  • Patient Rounding
  • Huddles
  • Task Assistance

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

136 – Heading in the Right Direction Instructor’s Guide

Thursday, September 25th, 2014

136

Instructor’s Guide – Heading in the Right Direction


Overview:
Lack of clear roles and responsibilities for Head of Bed (HoB) elevation reduces the likelihood that HoB is elevated to recommended angle to prevent ventilator associated pneumonia (VAP). All members of the team are responsible for initiating HoB elevation.

 


Primary Learning Outcomes

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

  • Describe the rationale for using a VAP bundle.
  • Identify tools for reminding healthcare team members to elevate HoB in ventilated patients
  • Describe the importance of establishing which team members are responsible for initiating HoB elevation.

 

 

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.
  • 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

  1. Explain the importance of developing checklists to ensure proper use of a VAP bundle.
    A: Checklists ensure that patients receive appropriate care based on Evidence Based Practice. The doctor may not write all of the specific orders related to VAP care and a checklist will ensure the patient still receives the best care.
  2. How can we help remind members of the team to elevate HoB in patients who are being ventilated?
    A: Sometimes it may be as simple as reminding a team member to elevate the HOB or to apply a checklist to the front of the chart.
  3. How does this story illustrate the importance of including family members as full partners in providing compassionate and coordinated care?
    A: If the family members are aware of the appropriate care for the patient they can be a apart of the care team. Often times family members feel empowered when they are made a part of the health care team.

 

Discussion Questions:

Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers

  1. What can we learn from this story?
    A: That standards and protocols are developed to guide the nurse in providing care for the patient.
  2. What can you do to clarify your responsibility for HoB elevation?
    A: One way is to determine if standards have been set and to follow those standards. If there are not any standards, then it is best to clarify with the doctor.

 

Suggested Classroom Mastery Activities:

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

  • Research the consequences of improper HoB elevation in ventilated patients. Create a presentation for your classmates.
  • Develop a list of tools that could help healthcare teams remember to elevate HoB in ventilated patients (wall tape to mark height, documentation, etc.).
  • How could this team better delineate responsibility for HoB elevation in their ventilated patients? Create a plan that helps them to be sure they know who is responsible for all aspects of their patients’ care.

 

 



Measuring Student Mastery: 

Learning Outcome Level 1 Level 2 Level 3
Describe the rationale for using a VAP bundle. Student struggles to describe the rationale for using a VAP bundle. Student can describe some of the rationale for using a VAP bundle. Student can accurately describe the rationale for using a VAP bundle.
Identify tools for reminding healthcare team members to elevate HoB in ventilated patients Student struggles to identify tools for reminding healthcare team members to elevate HoB in ventilated patients Student can identify some tools for reminding healthcare team members to elevate HoB in ventilated patients, but needs more practice. Student can accurately identify tools for reminding healthcare team members to elevate HoB in ventilated patients
Describe the importance of establishing which team members are responsible for initiating HoB elevation. Student struggles to describe the importance of establishing which team members are responsible for initiating HoB elevation. Student can describe some of the importance of establishing which team members are responsible for initiating HoB elevation, but needs further practice. Student can accurately describe the importance of establishing which team members are responsible for initiating HoB elevation.
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
  • Bedside Handoffs
  • Collaboration
  • Cross Monitoring
  • STEP
  • Handoff
  • I PASS the BATON
  • Task Assistance

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

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