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Cortés-Rodríguez AE, Roman P, López-Rodríguez MM, Fernández-Medina IM, Fernández-Sola C, Hernández-Padilla JM. Role-Play versus Standardised Patient Simulation for Teaching Interprofessional Communication in Care of the Elderly for Nursing Students. Healthcare (Basel) 2021; 10:healthcare10010046. [PMID: 35052210 PMCID: PMC8775804 DOI: 10.3390/healthcare10010046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/17/2021] [Accepted: 12/23/2021] [Indexed: 01/08/2023] Open
Abstract
This study aims to describe and compare the effects of standardised patient simulation and role-play in the acquisition and retention of interprofessional communication in elderly care competence amongst nursing students. In this controlled clustered randomised trial, 121 nursing students attended a workshop on interprofessional communication in elderly care using role-play or standardised patient simulation. The study was conducted between September 2017 and February 2018. Participants’ knowledge, self-efficacy and communication skills were assessed using a simulated scenario at pre-test, post-test and 6-week follow-up points. Between-subject and within-subject differences were measured using counts and proportions of participants who achieved competence. Regardless of the strategy applied, a significant improvement in knowledge, skills, self-efficacy and overall interprofessional communication competence was found between pre-test and post-test. Moreover, there were significant differences between pre-test and follow-up for all the studied variables, but no differences were found between post-test and follow-up. Lastly, when comparing the success rates of both strategies, no significant differences were observed (p > 0.05). In conclusion, standardised patient simulation and role-play have been shown to promote an improvement on knowledge, self-efficacy and interprofessional communication skills in nursing students, although it is not possible to state which strategy is the most adequate for teaching this competency.
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Affiliation(s)
- Alda Elena Cortés-Rodríguez
- Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (A.E.C.-R.); (M.M.L.-R.); (I.M.F.-M.); (C.F.-S.); (J.M.H.-P.)
- Health Sciences Research Centre, University of Almería, 04120 Almería, Spain
| | - Pablo Roman
- Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (A.E.C.-R.); (M.M.L.-R.); (I.M.F.-M.); (C.F.-S.); (J.M.H.-P.)
- Health Sciences Research Centre, University of Almería, 04120 Almería, Spain
- Correspondence: ; Tel.: +34-950214563
| | - María Mar López-Rodríguez
- Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (A.E.C.-R.); (M.M.L.-R.); (I.M.F.-M.); (C.F.-S.); (J.M.H.-P.)
- Health Sciences Research Centre, University of Almería, 04120 Almería, Spain
| | - Isabel María Fernández-Medina
- Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (A.E.C.-R.); (M.M.L.-R.); (I.M.F.-M.); (C.F.-S.); (J.M.H.-P.)
- Health Sciences Research Centre, University of Almería, 04120 Almería, Spain
| | - Cayetano Fernández-Sola
- Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (A.E.C.-R.); (M.M.L.-R.); (I.M.F.-M.); (C.F.-S.); (J.M.H.-P.)
- Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco 4810101, Chile
| | - José Manuel Hernández-Padilla
- Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (A.E.C.-R.); (M.M.L.-R.); (I.M.F.-M.); (C.F.-S.); (J.M.H.-P.)
- Adult, Child and Midwifery Department, School of Health and Education, Middlesex University, The Burroughs, London NW4 4BT, UK
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Guttman OT, Lazzara EH, Keebler JR, Webster KLW, Gisick LM, Baker AL. Dissecting Communication Barriers in Healthcare: A Path to Enhancing Communication Resiliency, Reliability, and Patient Safety. J Patient Saf 2021; 17:e1465-e1471. [PMID: 30418425 DOI: 10.1097/pts.0000000000000541] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Suboptimal exchange of information can have tragic consequences to patient's safety and survival. To this end, the Joint Commission lists communication error among the most common attributable causes of sentinel events. The risk management literature further supports this finding, ascribing communication error as a major factor (70%) in adverse events. Despite numerous strategies to improve patient safety, which are rooted in other high reliability industries (e.g., commercial aviation and naval aviation), communication remains an adaptive challenge that has proven difficult to overcome in the sociotechnical landscape that defines healthcare. Attributing a breakdown in information exchange to simply a generic "communication error" without further specification is ineffective and a gross oversimplification of a complex phenomenon. Further dissection of the communication error using root cause analysis, a failure modes and effects analysis, or through an event reporting system is needed. Generalizing rather than categorizing is an oversimplification that clouds clear pattern recognition and thereby prevents focused interventions to improve process reliability. We propose that being more precise when describing communication error is a valid mechanism to learn from these errors. We assert that by deconstructing communication in healthcare into its elemental parts, a more effective organizational learning strategy emerges to enable more focused patient safety improvement efforts. After defining the barriers to effective communication, we then map evidence-based recovery strategies and tools specific to each barrier as a tactic to enhance the reliability and validity of information exchange within healthcare.
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Affiliation(s)
| | - Elizabeth H Lazzara
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, Florida
| | - Joseph R Keebler
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, Florida
| | - Kristen L W Webster
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Logan M Gisick
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, Florida
| | - Anthony L Baker
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, Florida
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Neville B, Miltner RS, Shirey MR. Clinical Team Training and a Structured Handoff Tool to Improve Teamwork, Communication, and Patient Safety. J Healthc Qual 2021; 43:365-373. [PMID: 34734920 DOI: 10.1097/jhq.0000000000000291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Effective communication among healthcare teams is essential for ensuring handoff-related safety and quality care outcomes. PURPOSE The aim of this project was to improve patient safety through the reduction of communication-related errors on an acute hemodialysis unit (AHU) in an academic medical center. A target was set to reduce by 50 percent the communication-related errors using strategies to improve teamwork and communication. METHODS Acute hemodialysis unit team members attended Clinical Team Training (CTT) informational sessions on teamwork and communication. A structured handoff tool was implemented in the AHU to improve nurse communication and reduce communication-related patient safety events. Descriptive statistics and comparison of means were conducted to assess the differences between preimplementation and postimplementation audit and safety event data. RESULTS There was a statistically significant difference between the preintervention and postintervention groups of handoff tool usage and completion as well as a consistent decrease in handoff-related safety events after implementation. CONCLUSIONS/IMPLICATIONS Findings suggest that CTT and a structured handoff tool used to guide nurse-to-nurse care transitions lead to a reduction in communication-related safety events during handoffs in an AHU.
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Jakonen A, Mänty M, Nordquist H. Safety Checklists for Emergency Response Driving and Patient Transport: Experiences from Emergency Medical Services. Jt Comm J Qual Patient Saf 2021; 47:572-580. [PMID: 34183282 DOI: 10.1016/j.jcjq.2021.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Emergency response driving (ERD) is considered one of the most significant occupational risk factors affecting both patient and traffic safety in emergency medical services (EMS). The majority of the risk factors in ERD are crew related and could be affected positively with crew resource management (CRM). The aim of this study was to examine how the safety checklists developed for ERD and patient transport are experienced in practical work in EMS by paramedics. METHODS Safety checklists for ERD and patient transport were developed and then piloted in practical work among 30 paramedics in five different EMS areas around Finland for a two-month period in fall 2019. Afterward, semistructured thematic interviews were performed with the pilot participants, and the material was analyzed using inductive content analysis. RESULTS Paramedics experienced that use of ERD and patient transport safety checklists improved safety, and deployment of the checklists required systematic planning. Use of the safety checklists was seen as changing the mindset of the ERD drivers to a more safety critical stance and increasing a systematic approach to ERD. Paramedics also stated that when deploying the checklists in EMS, their use should be standardized as a nationwide operating model and that service-dependent fine-tuning is required. CONCLUSION This study's findings support the use of ERD and patient transport safety checklists in practical work in EMS for promoting safety. In addition to safety checklists, other sections of CRM and its applications to EMS should also be studied.
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Turkelson C, Yorke AM, Keiser M, Smith L, Gilbert GE. Promoting Interprofessional Communication with Virtual Simulation and Deliberate Practice. Clin Simul Nurs 2020. [DOI: 10.1016/j.ecns.2020.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Malcom DR, Pate AN, Rowe AS. Applying safety lessons from aviation to pre-licensure health professions education: A narrative critical review. CURRENTS IN PHARMACY TEACHING & LEARNING 2020; 12:1028-1035. [PMID: 32564990 DOI: 10.1016/j.cptl.2020.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 01/22/2020] [Accepted: 04/04/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Significant numbers of patients continue to be harmed annually by healthcare systems in the United States (US) and around the world. Through a lens of safety, the fields of aviation and healthcare share many similarities in the non-technical skills required by team members, including situational awareness, communication, problem-solving, and leadership. Despite these links and evidence of effective interventions in the clinical setting, there is a lack of a guidance on how to incorporate non-technical skills training into pre-licensure health professions curricula. METHODS Following guidance for a narrative critical review, a comprehensive literature search was conducted looking for studies incorporating non-technical skills training including crew resource management (CRM) and human factors and ergonomics (HFE) into pre-licensure health professions curricula. RESULTS Eleven example articles were organized into three broad themes: (1) changing the teaching paradigm around errors, (2) targeted curricular interventions, and (3) interprofessional team training. Several useful tools for evaluating training effectiveness were highlighted, but consistent measures of efficacy for CRM/HFE training are lacking. Interprofessional team training may have the most tangible and broadly applicable link to pre-licensure curricula. IMPLICATIONS Additional research is needed to identify best practices for consistent incorporation of non-technical skills into pre-licensure curricula. A cultural shift to focus on error management (vs. solely error avoidance) is also needed early in training with development of a common language to discuss patient safety issues and opportunities for improvement across various healthcare settings.
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Affiliation(s)
- Daniel R Malcom
- Sullivan University College of Pharmacy and Health Sciences, 2100 Gardiner Ln, Louisville, KY 40205, United States.
| | - Adam N Pate
- University of Mississippi School of Pharmacy, Faser Hall 221, Oxford, MS 38677, United States.
| | - A Shaun Rowe
- University of Tennessee Health Science Center College of Pharmacy, 1924 Alcoa Hwy, Knoxville, TN 37920, United States.
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Rosengarten L. Teamwork in nursing: essential elements for practice. Nurs Manag (Harrow) 2019; 26:36-43. [PMID: 31468828 DOI: 10.7748/nm.2019.e1850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2019] [Indexed: 11/09/2022]
Abstract
As any nurse working in the NHS knows, teamwork can be powerful. Successful teamwork can make a huge workload of unmanageable tasks manageable. However, unsuccessful teamwork can leave people struggling to cope. This article explores readers' knowledge and skills related to teamwork and provides them with new skills and techniques to improve practice.
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Affiliation(s)
- Leah Rosengarten
- School of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, England
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Son HK, Hee Kim D. Effect of SEGUE-based communication education on nursing simulation practice: a quasi-experimental design. Contemp Nurse 2019; 55:330-340. [PMID: 31280701 DOI: 10.1080/10376178.2019.1641421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Effective educational approaches are required to enhance nursing students' communication competency.Objectives: To evaluate the effectiveness of SEGUE ('set the stage,' 'elicit information,' 'give information,' 'understand the patient's perspective,' and 'end the encounter')-based communication education.Design: A non-equivalent control group pretest-posttest design.Methods: Students were randomized into the control group (n = 41) and experimental group (n = 57). Communication competency and efficacy were measured via a self-report questionnaire and via ratings of the students from professor and standardized patient.Results: Scores by students (self-evaluations; p < .001), professor (p < .001), and standardized patient (p < .042) showed higher communication competency in the experimental group. Compared with the control group, the pre-post difference in communication efficacy in the experimental group was increased (p = .004).Conclusions: Simulation practice to reflect the various clinical situation is recommended to improve students' communication.Impact statement: SEGUE-based communication education in nursing simulation practice with the standardized patient was an effective strategy for improving nursing students' communication.
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Affiliation(s)
- Hae Kyoung Son
- College of Nursing, Eulji University, 553, Sanseong-daero, Sujeong-gu, Seongnam-si, Gyeonggi-do 13135, Korea
| | - Dong Hee Kim
- College of Nursing, Sungshin University, 76 Ga-gil 55 Dobong-ro, Kangbuk-gu, Seoul 01133, Korea
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Barton G, Bruce A, Schreiber R. Teaching nurses teamwork: Integrative review of competency-based team training in nursing education. Nurse Educ Pract 2018; 32:129-137. [DOI: 10.1016/j.nepr.2017.11.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 11/29/2017] [Indexed: 12/29/2022]
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Gordon M, Hill E, Stojan JN, Daniel M. Educational Interventions to Improve Handover in Health Care: An Updated Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:1234-1244. [PMID: 29620675 PMCID: PMC6092095 DOI: 10.1097/acm.0000000000002236] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
PURPOSE Effective handovers (handoffs) are vital to patient safety. Medical educators investigated educational interventions to improve handovers in a 2011 systematic review. The number of publications on handover education has increased since then, so authors undertook this updated review. METHOD The authors considered studies involving educational interventions to improve handover amongst undergraduate or postgraduate health professionals in acute care settings. In September 2016, two authors independently conducted a standardized search of online databases and completed a data extraction and quality assessment of the articles included. They conducted a content analysis of and extracted key themes from the interventions described. RESULTS Eighteen reports met the inclusion criteria. All but two were based in the United States. Interventions most commonly involved single-patient exercises based on simulation and role-play. Many studies mentioned multiprofessional education or practice, but interventions occurred largely in single-professional contexts. Analysis of interventions revealed three major themes: facilitating information management, reducing the potential for errors, and improving confidence. The majority of studies assessed Kirkpatrick's outcomes of satisfaction and knowledge/skill improvement (Levels 1 and 2). The strength of conclusions was generally weak. CONCLUSIONS Despite increased interest in and publications on handover, the quality of published research remains poor. Inadequate reporting of interventions, especially as they relate to educational theory, pedagogy, curricula, and resource requirements, continues to impede replication. Weaknesses in methodologies, length of follow-up, and scope of outcomes evaluation (Kirkpatrick levels) persist. Future work to address these issues, and to consider the role of multiprofessional and multiple-patient handovers, is vital.
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Affiliation(s)
- Morris Gordon
- M. Gordon is professor of evidence synthesis and systematic review, University of Central Lancashire, Preston, United Kingdom; ORCID: https://orcid.org/0000-0002-1216-5158
| | - Elaine Hill
- E. Hill is senior lecturer, School of Health Sciences, University of Central Lancashire, Preston, United Kingdom; ORCID: http://orcid.org/0000-0003-4984-9446
| | - Jennifer N. Stojan
- J.N. Stojan is assistant professor, Department of Internal Medicine and Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Michelle Daniel
- M. Daniel is assistant dean for curriculum and assistant professor, Department of Emergency Medicine and Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: http://orcid.org/0000-0001-8961-7119
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Mahajan R, Mohammed CA, Sharma M, Gupta P, Singh T. Interprofessional Education: An Approach to Improve Healthcare Outcomes. Indian Pediatr 2018. [DOI: 10.1007/s13312-018-1326-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tschannen D, Dorn R, Tedesco C. Improving knowledge and behavior of leadership and followership among the interprofessional team. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2018; 9:182-188. [PMID: 29965798 PMCID: PMC6129167 DOI: 10.5116/ijme.5b30.9a84] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 06/25/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To examine virtual training on Crew Resource Management (CRM) principles of effective leadership and followership on participants' knowledge, applicability, and intended behaviors. METHODS Graduate students (n=41) from four health disciplines participated in the training, which included a self-learning module (e.g., didactic content and video vignettes) and an optional virtual simulation exercise. Knowledge was examined via a 10-item pre/post knowledge test. Applicability of the training and intended behaviors was measured post-training via an 11-item survey. T-test and Analysis of variance were applied to compare knowledge scores, as well as to determine variation in discipline responses. RESULTS Knowledge improved significantly post-training (t(40)=10.47, p<0.001). Pharmacy students scored significantly lower on the post-knowledge test than medicine and nursing students [F(2,36)=5.99, p=0.006]. On average, participants completing the module reported learning new skills and knowledge (M=4.17, SD=0.54) and intended to use skills/knowledge gained from the training in clinical practice (M=4.29, SD=0.56). No differences were noted among responses from the various disciplines. Those completing the simulation exercise (n=10) found value in the experience, again noting strong application to practice (M=4.9, SD=0.32) and intended use in practice (M=4.9, SD=0.32). CONCLUSIONS The CRM training was valuable and applicable to practice. Use of a virtual platform may provide an avenue for minimizing current barriers to successful interprofessional education by allowing participants to connect in various geographical locations. The module is ready for widespread use in health professional education.
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Tschannen D. Development of a Virtual Crew Resource Management Training Program to Improve Communication. J Contin Educ Nurs 2017; 48:525-532. [PMID: 29083461 DOI: 10.3928/00220124-20171017-11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 08/23/2017] [Indexed: 11/20/2022]
Abstract
Crew Resource Management (CRM), a method focused on the management of human error and risk reduction, has shown promise in reducing communication failure in health care. The purpose of this project was to develop a virtual training program in CRM principles of effective leadership and followership, and evaluate the applicability to nurses working in the hospital setting. The intervention included the development of a virtual CRM training program consisting of a self-learning module and virtual simulation. Beta testing of the module was conducted by six nurses, followed by an evaluation of the training program by nurses (n = 5) in a general medicine department. Nurses reported the overall program to be worthwhile (X̄= 5; SD = 0.5), with great applicability to nursing care (X̄= 4.5, SD = 0.5). Nurses completing the simulation activity reported strong agreement to CRM applicability and training effectiveness. The CRM training module proved to be applicable to nursing care and is ready for widespread use to improve patient care and communication. J Contin Educ Nurs. 2017;48(11):525-532.
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Nelson S, White CF, Hodges BD, Tassone M. Interprofessional Team Training at the Prelicensure Level: A Review of the Literature. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:709-716. [PMID: 27782914 DOI: 10.1097/acm.0000000000001435] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE The authors undertook a descriptive analysis review to gain a better understanding of the various approaches to and outcomes of team training initiatives in prelicensure curricula since 2000. METHOD In July and August 2014, the authors searched the MEDLINE, PsycINFO, Embase, Business Source Premier, and CINAHL databases to identify evaluative studies of team training programs' effects on the team knowledge, communication, and skills of prelicensure students published from 2000 to August 2014. The authors identified 2,568 articles, with 17 studies meeting the selection criteria for full text review. RESULTS The most common study designs were single-group, pre/posttest studies (n = 7), followed by randomized controlled or comparison trials (n = 6). The Situation, Background, Assessment, Recommendation communication tool (n = 5); crisis resource management principles (n = 6); and high-fidelity simulation (n = 4) were the most common curriculum bases used. Over half of the studies (n = 9) performed training with students from more than one health professions program. All but three used team performance assessments, with most (n = 8) using observed behavior checklists created for that specific study. The majority of studies (n = 16) found improvements in team knowledge, communication, and skills. CONCLUSIONS Team training appears effective in improving team knowledge, communication, and skills in prelicensure learners. Continued exploration of the best method of team training is necessary to determine the most effective way to move forward in prelicensure interprofessional team education.
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Affiliation(s)
- Sioban Nelson
- S. Nelson is vice provost, academic, and professor, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada. C.F. White is a registered nurse, University Health Network, Toronto, Ontario, Canada. B.D. Hodges is executive vice president, University Health Network, and professor, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. M. Tassone is senior director, Collaborative and Transformative Learning, University Health Network, director, Centre for Interprofessional Education, University of Toronto, and assistant professor, Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Speaking up behaviours (safety voices) of healthcare workers: A metasynthesis of qualitative research studies. Int J Nurs Stud 2016; 64:42-51. [PMID: 27684321 DOI: 10.1016/j.ijnurstu.2016.09.014] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/14/2016] [Accepted: 09/19/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND A critical characteristic of effective teams in any setting is when each member is willing to speak up to share thoughts and ideas to improve processes. In spite of attempts by healthcare systems to encourage employees to speak up, employee silence remains a common cause of communication breakdowns, contributing to errors and suboptimal care delivery. Nurses in particular have reported low confidence in their communication abilities, and cite the belief that speaking up will not make a difference. OBJECTIVE To develop an understanding of how nurses and other healthcare workers relate to safety voice behaviors and how this might influence clinical practice. DATA SOURCES A search of the PubMed, CINAHL, and Academic Search Premier databases was conducted using keywords employee, nurse, qualitative, speak up, silence, safety, voice, and safety voice identified 372 articles with 11 retained after a review of the abstracts. Studies took place in Australia, Bulgaria, Canada, Hong Kong, East Africa, Ireland, Korea, New Zealand, Sweden, Switzerland, and the United States representing 504 healthcare workers including 354 nurses. METHODS This interpretive meta-synthesis of 11 qualitative articles published from 2005 to 2015 was conducted using a social constructivist approach with thematic analysis. RESULTS The four themes identified are: 1) hierarchies and power dynamics negatively affect safety voice, 2) open communication is unsafe and ineffective, 3) embedded expectations of nurse behavior affect safety voice, and 4) nurse managers have a powerful positive or negative affect on safety voice. CONCLUSIONS Healthcare workers worldwide report multiple social and hierarchy related fears surrounding the utilization of safety voice behaviors. Hesitance to speak up is pervasive among nurses, as is low self-efficacy related to safety voice. The presence of caring leaders, peer support, and an organizational commitment to safe, open cultures, may improve safety voice utilization among nurses and other healthcare workers.
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Foronda C, MacWilliams B, McArthur E. Interprofessional communication in healthcare: An integrative review. Nurse Educ Pract 2016; 19:36-40. [DOI: 10.1016/j.nepr.2016.04.005] [Citation(s) in RCA: 251] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 02/04/2016] [Accepted: 04/28/2016] [Indexed: 11/25/2022]
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Lim F, Pajarillo EJY. Standardized handoff report form in clinical nursing education: An educational tool for patient safety and quality of care. NURSE EDUCATION TODAY 2016; 37:3-7. [PMID: 26573150 DOI: 10.1016/j.nedt.2015.10.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 10/19/2015] [Accepted: 10/26/2015] [Indexed: 06/05/2023]
Abstract
Effective change-of-shift handoff communication is a core competency in the generalist education of nurses. The use of a standardized handoff tool that fosters higher order thinking and clinical reasoning is fundamental in clinical education and nursing practice (AACN, 2008). A checklist that prompts students to implement evidence-based safety alerts will increase students' confidence and autonomy, prevent errors, promote patient safety, and successfully transform theoretical learning into competent practice. High-quality handoffs and contextualized post-conference debriefing using key items in the handoff form will help increase students' feelings of precision, accuracy, improve their self-image, and enhance their sense of professional belonging.
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Affiliation(s)
- Fidelindo Lim
- New York University College of Nursing, New York, NY 10010, United States.
| | - Edmund J Y Pajarillo
- Adelphi University, College of Nursing & Public Health, Alumnae Hall, Room 207, Department of Graduate Studies in Nursing, One South Avenue, Garden City, NY 11530, United States.
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Smith SW, Farmer BM. Toxicology in the Service of Patient and Medication Safety: a Selected Glance at Past and Present Innovations. J Med Toxicol 2015; 11:245-52. [PMID: 25804670 PMCID: PMC4469728 DOI: 10.1007/s13181-015-0470-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Medical and medication errors remain definite threats to patients in US health care. Medical toxicologists frequently encounter patients either harmed by or at risk for harm from adverse drug events, including medication errors and inadvertent exposures. An historical perspective, as viewed through the lens of specific disciplines, can be useful to trace systemic responses to safety threats. Early efforts to address anesthesia perioperative risks and recent actions in medicine, surgery, and obstetrics to introduce checklists, communication tools, and systems approaches are reviewed. Patient safety concepts can be utilized and disseminated by toxicologists to improve medication safety and drive innovative approaches to confront patient harm. Various approaches include simulation of high-risk scenarios which might predispose to medication error, assembling multidisciplinary groups of health care providers to review events and implement mitigation strategies, and proactive patient safety rounds in clinical areas to allow frontline staff to voice concerns and introduce solutions for administration, evaluation, and implementation. We review selected lessons from the past and current innovations to achieve safe medication practice.
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Affiliation(s)
- Silas W Smith
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, 462 First Avenue, Room A345-A, New York, NY, 10016, USA,
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Sculli GL, Fore AM, Sine DM, Paull DE, Tschannen D, Aebersold M, Seagull FJ, Bagian JP. Effective followership: A standardized algorithm to resolve clinical conflicts and improve teamwork. J Healthc Risk Manag 2015; 35:21-30. [PMID: 26227290 DOI: 10.1002/jhrm.21174] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In healthcare, the sustained presence of hierarchy between team members has been cited as a common contributor to communication breakdowns. Hierarchy serves to accentuate either actual or perceived chains of command, which may result in team members failing to challenge decisions made by leaders, despite concerns about adverse patient outcomes. While other tools suggest improved communication, none focus specifically on communication skills for team followers, nor do they provide techniques to immediately challenge authority and escalate assertiveness at a given moment in real time. This article presents data that show one such strategy, called the Effective Followership Algorithm, offering statistically significant improvements in team communication across the professional continuum from students and residents to experienced clinicians.
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O'Dea A, O'Connor P, Keogh I. A meta-analysis of the effectiveness of crew resource management training in acute care domains. Postgrad Med J 2014; 90:699-708. [PMID: 25370080 DOI: 10.1136/postgradmedj-2014-132800] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The healthcare industry has seen an increase in the adoption of team training, such as crew resource management (CRM), to improve teamwork and coordination within acute care medical teams. A meta-analysis was carried out in order to quantify the effects of CRM training on reactions, learning, behaviour and clinical care outcomes. Biases in the research evidence are identified and recommendations for training development and evaluation are presented. PUBMED, EMBASE and PsychInfo were systematically searched for all relevant papers. Peer reviewed papers published in English between January 1985 and September 2013, which present empirically based studies focusing on interventions to improve team effectiveness in acute health care domains, were included. A total of 20 CRM-type team training evaluation studies were found to fulfil the a priori criteria for inclusion in the meta-analysis. Overall, CRM trained participants responded positively to CRM (mean score 4.25 out of a maximum of 5), the training had large effects on participants' knowledge (d=1.05), a small effect on attitudes (d=0.22) and a large effect on behaviours (d=1.25). There was insufficient evidence to support an effect on clinical care outcomes or long term impacts. The findings support the premise that CRM training can positively impact teamwork in healthcare and provide estimates of the expected effects of training. However, there is a need for greater precision in outcome assessment, improved standardisation of methods and measures, and more robust research design. Stronger evidence of effectiveness will require multi-level, multicentre, multispecialty and longitudinal studies.
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Affiliation(s)
- Angela O'Dea
- Department of General Practice, National University of Ireland, Galway, Ireland
| | - Paul O'Connor
- Department of General Practice, National University of Ireland, Galway, Ireland
| | - Ivan Keogh
- Academic Department of Otolaryngology, National University of Ireland, Galway, Ireland
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Ashley J, Stamp K. Learning to think like a nurse: the development of clinical judgment in nursing students. J Nurs Educ 2014; 53:519-25. [PMID: 25199107 DOI: 10.3928/01484834-20140821-14] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 06/02/2014] [Indexed: 11/20/2022]
Abstract
The purpose of this project was to examine the clinical judgment and reasoning skills of nursing students in high-fidelity simulation. Two levels of students (N = 104), novices and those who are slightly more advanced, participated in individual videotaped simulations. Afterward, interviews were conducted to explore what the student was thinking and feeling during simulation. Five themes emerged from the interviews: thinking like a nurse, assessment, looking for answers, communication, and magical or reflective thinking. There was a clear distinction in the reasoning skills of the novice students compared with students with more clinical experience. Tanner's model of clinical judgment in nursing is used to understand the findings of the study.
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Pollard CL, Wild C. Nursing leadership competencies: low-fidelity simulation as a teaching strategy. Nurse Educ Pract 2014; 14:620-6. [PMID: 25017299 DOI: 10.1016/j.nepr.2014.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 04/17/2014] [Accepted: 06/16/2014] [Indexed: 11/30/2022]
Abstract
Nurses must demonstrate leadership and followership competencies within complex adaptive team environments to ensure patient and staff safety, effective use of resources, and an adaptive health care system. These competencies are demonstrated through the use of communication strategies that are embedded within a relational practice. Health care professionals, regardless of formal position, need to assert their opinions and perspectives using a communication style that demonstrates value of all team members in open discussions about quality patient care, appropriate access, and stewardship. Challenges to effective communication and relational practice are the individual and organizational patterns of behavior, and the subsequent impact that these behaviors have on others. Students articulate situational awareness when they conduct a critical analysis of individual, team, and organizational functioning, and then use this information and evidence gained from a critical literature review to develop recommendations to improve individual, team, and/or organizational performance. Leadership and followership simulation exercises, inclusive of public feedback and debriefing, are used as a pedagogical/andragogical strategy in a nursing baccalaureate senior leadership course to facilitate learning of team communication skills and improve situational awareness. We view this strategy as an alternative to traditional classroom learning activities which provide little opportunity for recursive learning.
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Affiliation(s)
- Cheryl L Pollard
- Bachelor of Science in Nursing Program, Faculty of Health and Community Studies, MacEwan University, 10910-104 Avenue, Edmonton AB T5J 2P2, Canada.
| | - Carol Wild
- Bachelor of Science in Nursing Program, Faculty of Health and Community Studies, MacEwan University, 10910-104 Avenue, Edmonton AB T5J 2P2, Canada.
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Yoo MS, Park HR. Effects of case-based learning on communication skills, problem-solving ability, and learning motivation in nursing students. Nurs Health Sci 2014; 17:166-72. [DOI: 10.1111/nhs.12151] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 04/18/2014] [Accepted: 04/22/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Moon-Sook Yoo
- Ajou University College of Nursing; Suwon South Korea
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Orgun F, Karaoz B. Epistemological beliefs and the Self-efficacy Scale in nursing students. NURSE EDUCATION TODAY 2014; 34:e37-e40. [PMID: 24315533 DOI: 10.1016/j.nedt.2013.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 11/07/2013] [Accepted: 11/18/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Epistemological beliefs in their most general form define an individual's subjective beliefs about what knowledge is and how knowing and learning occur. OBJECTIVES To investigate epistemological beliefs and the Self-efficacy Scale in nursing students. DESIGN Prospective survey study. SETTINGS University School of Nursing. PARTICIPANTS Nursing students. METHODS Outcome parameters included Nurses' Descriptive Characteristics Data Form, Epistemological Beliefs Questionnaire and Self-efficacy Scale. RESULTS As for the subscales of epistemological beliefs, Effort Subscale was 38.89 ± 11.62, Ability Subscale was 24.02 ± 6.19 and Unchanging Truth Subscale was 30.65 ± 5.74. Total score of the self-efficacy subscales was 74.39 ± 13.59. It has been determined that the majority (60.8%) of nursing students have chosen the nursing profession willingly, 82.8% of them like the nursing profession and 59.8% of students have a good perception of their own academic achievements. CONCLUSIONS Understanding student's epistemological beliefs, trying to improve them and creating suitable learning environments for the development of self-efficacy should be the aim of an education that values individual differences.
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Affiliation(s)
- Fatma Orgun
- Department of Education Nursing, Ege University Faculty of Nursing, Izmir, Turkey
| | - Banu Karaoz
- Department of Nursing, Trakya University Faculty of Health Sciences, Edirne, Turkey.
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Garbee DD, Paige J, Barrier K, Kozmenko V, Kozmenko L, Zamjahn J, Bonanno L, Cefalu J. Interprofessional teamwork among students in simulated codes: a quasi-experimental study. Nurs Educ Perspect 2014; 34:339-44. [PMID: 24245386 DOI: 10.5480/1536-5026-34.5.339] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIM The purpose of this study was to evaluate the efficacy of using crisis resource management (CRM) principles and high-fidelity human patient simulation (HFHPS) for interprofessional (IP) team training of students from undergraduate nursing, nurse anesthesia, medical, and respiratory therapy. BACKGROUND IP education using simulation-based training has the potential to transform education by improving teamwork and communication and breaking down silos in education. METHOD This one-year study used a quasi-experimental design to evaluate students' acquisition and retention of teamwork and communication skills. A convenience sample consisted of 52 students in the fall semester, with 40 students returning in the spring. RESULTS Mean scores increased after training, and skills were retained fairly well. Any loss was regained with repeat training in the spring. CONCLUSION The results suggest that using CRM and HFHPS is an effective pedagogy for teaching communication and teamwork skills to IP student teams.
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Affiliation(s)
- Deborah D Garbee
- Louisiana State University Health Sciences Center, New Orleans, USA.
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