Healthcare Team Communication and Support

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Questions and Answers

What is the purpose of using critical language in a medical team setting?

To discourage team members from speaking up

To foster an environment where concerns can be communicated (correct)

To find fault in team members' actions

To challenge the authority of the lead physician

What should the endoscopy nurse do when she suspects a possible lesion during a procedure?

Ignore her concern since it may upset the physician

Wait until the procedure is over to mention her observation

Reassure the patient that everything is fine

Open the discussion using an assertive statement (correct)

Which is the correct order of the five-step process for mutual support?

Open the discussion, State the concern, State the problem, Offer a solution, Obtain an agreement (correct)

State the concern, Offer a solution, Open the discussion, State the problem, Obtain an agreement

Obtain an agreement, Open the discussion, State the problem, State the concern, Offer a solution

Open the discussion, State the problem, Obtain an agreement, Offer a solution, State the concern

What does it mean to 'advocate for the patient' within a healthcare team?

Speak up when you disagree with the decisions being made Signup and view all the answers

How should concerns be stated in the context of mutual support?

With clarity and respect, avoiding any confrontation Signup and view all the answers

What is a key benefit of maintaining a shared mental model within a team?

It helps ensure everyone is on the same page regarding the task. Signup and view all the answers

Which of the following is NOT a condition that undermines situational awareness?

Sharing information with the team Signup and view all the answers

What is the primary purpose of team briefs prior to a procedure?

To establish team roles and responsibilities. Signup and view all the answers

When should a huddle be convened?

When a plan changes due to patient or team needs. Signup and view all the answers

What is the focus of a debrief at the completion of an event?

To evaluate what went well and what could be improved. Signup and view all the answers

What does the check back or repeat back communication strategy ensure?

That information exchanged is verified and validated. Signup and view all the answers

Which of the following is a relevant condition to assess for situational awareness?

Status of the patient. Signup and view all the answers

Including the patient or family in communication is important because:

It allows for fewer misunderstandings. Signup and view all the answers

What is the nature of conflict as described?

It is a disagreement that arises due to perceived threats. Signup and view all the answers

Which of the following is a positive effect of conflict?

Greater patient safety. Signup and view all the answers

What does conflict management aim to achieve?

To peacefully resolve disagreements through compromise. Signup and view all the answers

Which conflict style involves withdrawing from the conflict passively?

Avoidance Signup and view all the answers

What is an effective approach to resolving the issue of a messy room?

Suggesting both parties clean it together. Signup and view all the answers

Which conflict style does not satisfy the needs of either party?

Avoidance or Obliging Signup and view all the answers

What style involves setting aside one’s goals to satisfy the other person’s desires?

Accommodation Signup and view all the answers

Which scenario depicts a collaborative conflict style?

Both parties discuss solutions to the issue. Signup and view all the answers

What is a key characteristic of a culture of safety?

People treat each other with respect Signup and view all the answers

What approach do strong leaders in healthcare take to promote a culture of safety?

Make themselves approachable and invite conversations Signup and view all the answers

Which behavior exemplifies a lack of transparency in the operating room?

The surgeon plays loud music and does not communicate with the team Signup and view all the answers

What was a significant issue with the surgical procedure described?

The surgeon removed the wrong ovary as per the consent Signup and view all the answers

What is an example of fairness in a culture of safety?

Encouraging open discussions about mistakes Signup and view all the answers

Which characteristic is essential for creating psychological safety in a team?

Open communication and trust among members Signup and view all the answers

What behavior did the surgeon exhibit that shows a lack of active leadership?

Ignoring team input and focusing on music Signup and view all the answers

What is one outcome of not promoting transparency within a team?

Team members may develop mistrust and fear Signup and view all the answers

What type of violence describes incivility that occurs between peers?

Lateral Violence Signup and view all the answers

Which of the following is considered an example of incivility?

Gossiping about a colleague Signup and view all the answers

How does incivility adversely affect healthcare outcomes?

Leads to an increase in medical errors Signup and view all the answers

What is a key component of a ZERO Tolerance Policy?

Consistent application of conduct policies Signup and view all the answers

What distinguishes bullying from incivility?

Bullying involves a pattern of harmful behavior Signup and view all the answers

Which of the following strategies promotes collaboration in the workplace?

Conflict management through compromise Signup and view all the answers

What is a potential consequence of incivility in a healthcare setting?

Increased operational costs Signup and view all the answers

What does Cognitive Rehearsal aim to achieve?

Promoting visualization of anxiety-provoking situations Signup and view all the answers

What is one reason Laura feels upset about the cluttered room?

She is concerned about patient safety. Signup and view all the answers

Which action illustrates a form of lateral violence?

Gossiping about another nurse on the unit. Signup and view all the answers

What does Donald express regret over in the conflict resolution?

The condition of room 103. Signup and view all the answers

Which of the following actions is considered vertical violence?

Yelling at the assistive personnel. Signup and view all the answers

What does Laura propose to do to address the issues with room tidiness?

Discuss solutions at the QI council meeting. Signup and view all the answers

Which statement best describes Laura's perspective during the resolution of the conflict?

She acknowledges the circumstances but feels her concerns are valid. Signup and view all the answers

Identify the type of violence exemplified by a supervisor yelling at a staff nurse.

Vertical violence. Signup and view all the answers

What is a common misconception regarding the behavior of refusing to help a coworker?

It's a definitive form of lateral violence. Signup and view all the answers

Study Notes

Teamwork and Collaboration

Teamwork and collaboration are essential for quality patient care.
Teamwork is more than just cooperation, it also involves clearly defined roles, open communication, mutual respect, and shared decision-making.
QSEN (Quality and Safety Education for Nurses) defines teamwork as functioning effectively in nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.

Objectives

Describe the TeamSTEPPS framework.
Identify barriers to effective teamwork.
Define teamwork and collaboration.
Describe roles and functions of the nurse.
Explain how individual behavior and team dynamics affect safety.
Define a safety culture and describe its features.
Differentiate TeamSTEPPS basic tools and strategies.
Describe situational monitoring, situational awareness, and shared mental model.
Describe strategies for mutual support.
Demonstrate conflict resolution methods in a team setting.

Paper Chain Exercise #1

Divide into teams of 3-4 students.
The goal is to create the longest paper chain.
Teams will have 2 minutes to form their chain.

Debrief Checklist

Was communication clear?
Were roles and responsibilities understood?
Was situation awareness maintained?
Was workload distribution equitable?
Was task assistance requested or offered?
Were errors made or avoided?
Were resources available?
What went well?
What one thing should improve?

TeamSTEPPS

Based on over 30 years of research and evidence.
Team training programs enhance attitudes, increase knowledge, and improve behavioral skills.
A meta-analysis by Salas, et al. (2008) determined that team training has a moderate, positive effect on team outcomes (p = .38).

Intentional Tools and Strategies of TeamSTEPPS

Teams should focus on tools and strategies to avoid barriers like: inconsistency in team membership, lack of time, lack of information sharing, hierarchy, defensiveness, conventional thinking, complacency, varying communication styles, conflict, lack of coordination, distractions, fatigue, workload, misinterpretation of cues, and lack of role clarity.

Teamwork and Collaboration (QSEN Definition)

Function effectively within nursing and interprofessional teams.
Foster open communication, mutual respect, and shared decision-making to achieve quality patient care.

Interprofessional Team Roles and Functions

Scope of practice may overlap with other professions.
Collaborative practice is used to provide holistic care.
Nurses often manage care but should also understand other team members' roles and functions to make appropriate referrals and consults.
Intraprofessional refers to roles within the profession (e.g., nurse aids).
Interprofessional refers to roles outside the specific professions.

Interprofessional Team Role Matching (Page 9)

A list of team members matched with patient-care roles (e.g., Spiritual Support, Speech Pathologist, Social Worker, etc.).

Why is Teamwork Important?

One person cannot provide all the expertise needed to care for a patient.
80% of serious adverse events are linked to miscommunication.
Adequate communication between team members can prevent wrong-site surgeries or other mistakes.

Culture of Safety Characteristics

Psychological Safety: Treat each other with respect.
Active Leadership: Encourage speaking up about safety concerns.
Fairness: Avoid unfairly blaming people.
Transparency: Foster a safe space to discuss mistakes.
Learning from errors and using them as opportunities for improvement.

Psychological Safety vs. Danger

Psychological safety and danger are visualized as opposed concepts.
Danger is characterized by fear of admitting mistakes, blaming and less likely to share diverse viewpoints.
Safety is characterized by comfort admitting mistakes, better decision-making and better innovation through active sharing of ideas.

What Makes Someone a Leader?

Leaders exist at all levels and in all groups, not just in specific roles or positions.
Strong leaders promote a culture of safety by making themselves approachable, establishing shared goals, and inviting everyone into the conversation.

Team Horrors

Teams in the operating room/surgery demonstrate negative examples of communication, teamwork, and decision making.
The examples highlight failures in teamwork, communication, and conflict management that can lead to errors.

Team Harmony

Teams in the operating room/surgery demonstrate positive examples of communication, teamwork, and decision-making.
The positive example highlights efficient teamwork, open communication, and a safe approach to operating room care.

TeamSTEPPS Basic Tools and Strategies

Situational Monitoring: Awareness of the patient, team members, environment, and progress towards goals.
Leading Teams: Includes briefs, huddles, debriefs, communication (ISBARR, call-out, check-back, handoff), and mutual support (task assistance, feedback, assertive statements, two-challenge rule, CUUS, DESC script).

Situation Monitoring, Awareness, Mental Model

The process of actively scanning and assessing the situation to maintain an accurate understanding.
Identifying potential problems or minor deviations allows for timely correction before they become harm to the patient.

Situations Awareness (an individual outcome)

The state of knowing the current conditions that affect a person's work.
Key factors for situational awareness include the patient's status, teammates' statuses, and the environment, as well as progress toward the goal.

Conditions That Undermine Situational Awareness

Failure to: share information; request information; direct information to specific team members; include patients/family; utilize resources; maintain documentation; know and understand the plan; inform team members when the plan has changed.

Shared Mental Model (a team outcome)

Each team member maintains situational awareness and shares relevant facts with the entire team.
This ensures everyone is on the same team, preventing errors.

Leading Teams: Briefs

Team briefings outline the plan before a procedure.
They should involve forming the team, designating roles, establishing goals, establishing plans, identifying workload and resources, and providing time-outs (e.g., prior to surgery).

Leading Teams: Huddles

Huddles (ad hoc meetings) allow for communicating immediate adjustments to an existing plan, updating on changes in the patient or the team, and reestablishing situational awareness.

Leading Teams: Debriefs

Debriefs occur at the end of an event to improve outcomes.
Teams decompress and reflect on what went well, what could have been improved, and what lessons were learned.

Communication: Check back or Repeat Back

This is a closed-loop communication strategy used to verify information.
The sender states information to the receiver, receiver repeats back, sender confirms, or corrects the information. The cycle continues until shared understanding is reached.

Communication: Call-Out

Used for critical information during emergencies.
This strategy helps all team members be aware of the situation simultaneously and be prepared for the next steps; It is best used for directing information to specific individuals.

Communication: SBARR Technique

Used for communicating a patient's condition to another team member.
Crucial elements include: Situation, Background, Assessment, Recommendation, and Read-back.

Example 1: SBAR Report to Physician about a Critical Situation

A structured example of an SBAR report for a critical patient situation

Communication: Handoffs

Standardized strategies for enhancing information exchange during transitions in care provide clarity for a smooth transition of responsibility between caregivers.
Handoffs occur in the emergency department, between hospital units for continued care, or before patient discharge home or to a long-term care facility.
Patient care is maintained throughout transitions in care.

What percent of adverse events are due to faulty transitions (handoffs)?

80% of adverse events are due to communication failures in transitions.

Mutual Support (back up behavior)

Essential for effective teamwork, it involves task assistance, providing and receiving feedback, giving assertive statements, Two Challenge Rule, CUUS, and DESC Script.

Mutual Support: Task Assistance

Team members proactively assist each other by offering and seeking help.
Team members communicate clearly and specifically to ensure that tasks are completed correctly, considering the different experience levels in the team.

Mutual Support: Feedback

Feedback is used to improve team performance.
This includes different types such as formal (retrospective, scheduled, and evaluative), or informal (real-time), to improve knowledge and practical skills.

Mutual Support: Two Challenge Rule

Allows all team members to safely stop the process and identify essential breaches in safety.
If a safety issue cannot be addressed, a stronger course of action is required.

Example of two-challenge rule

A real-world example outlining how the "two-challenge rule" helps identify errors before harm is caused.

Mutual Support: Critical Language (CUUS)

Specific words to signal escalating concern.
Includes the phrases: "I'm concerned", "I'm uncomfortable", "I feel it's unsafe", and "I'm scared."
Clear and defined language helps individuals to express concern in the workplace without feeling pressured, embarrassed or unsafe.

Critical Language Example (CUUS)

Real work situation showing successful use of critical language in a stressful situation.

Mutual Support: Advocacy and Assertion

Addresses instances where team members' viewpoints differ from a decision-maker.
A five-step process for asserting safely and respectfully includes: Opening a discussion, stating the concern, stating the problem (real or perceived), offering a solution, and obtaining agreement.

Example of Assertive Statement

Real-life scenario illustrating the use of assertive statements concerning an issue in a clinical setting.

TeamSTEPP Video Analysis

Provide debrief on a analyzed video on teamwork situations in order to identify barriers, tools and strategies to use and achieve outcomes.

Paper Chain Exercise #2

Teams create the longest paper chain possible.
Teams identify and apply at least 6 TeamSTEPPS tools and strategies during the exercise.

Team Concepts

Includes a discussion on culture of safety, team structure, communication, leadership, and situation monitoring from the perspective of the team members, which helps improve their communication, teamwork and patient care delivery.

Debrief Checklist (Page 44)

Checklist of questions to reflect on after a teamwork exercise.

Mutual Support: Conflict in Teams

Discusses informational conflicts (different information) and interpersonal conflicts (hostile and harassing behavior) in teams.
It uses the "Two-Challenge Rule" and "DESC Script" to address conflict in a calm and respectful manner.

Incivility

Defined as actions that are rude, intimidating, dismissive, or lead to problems in both physiological and psychological health.
Includes lateral violence (peer-to-peer) and vertical violence (e.g., supervisor-to-subordinate).
These behaviors negatively influence communication, performance, and outcomes, affecting the safety culture.

Relationship Between Incivility and Bullying

Incivility, if repeated can turn into bullying.

Negative effects of Incivility

Medical errors, poor patient satisfaction, increased preventable adverse outcomes and costs, and decreased retention of health workers, are all consequences of incivility.

Strategies to Promote Collaboration

Zero Tolerance policy for ensuring conduct is uniformly applied.
Using conflict management to peacefully resolve disagreements with respect, compromise, and accommodation.
Applying Cognitive Rehearsal as a problem-solving technique.

Conflict: Neither Good or Bad

Conflict can involve individuals or groups with differing viewpoints.
Conflicts can affect the working environment.
Important to note that conflict can have both positive and negative effects on a team.

Positive effects of conflict

Positive effects of conflict include stronger working relationships, improved staff retention, increased creativity, improved decision making, increased patient safety, and a better workplace environment.

Conflict Management

Conflict management is a method to resolve disputes peacefully and respectfully by utilizing compromise and accommodation to meet the needs of all involved parties; it's important that parties keep goal-setting and communication clear.

You are starting out your day shift by obtaining... (Page 53,54)

A scenario describing a messy work environment.
A discussion on how to approach a messy work environment and what conflict style to use to improve relations and address the root cause of the problem.

What's your conflict style?

There are different approaches for managing conflict; including Avoidance/Obliging, Accommodation, Force/Competition/Domination, Compromise, and Collaboration/Integrating.

Conflict Management Styles

Different methods for approaching and resolving conflict.

Cognitive Rehearsal

Envisioning or visualizing an overwhelming or anxiety-producing situation, to help prepare for difficult situations and build confidence.

Key Points of Conflict Resolution

Steps for identifying, addressing and resolving conflicts within the workplace or group.

Conflict Resolution: DESC Script

A structured and constructive approach used to manage and resolve issues through Describing, Expressing, Suggesting, Consequences.

Example of a conflict (page 61)

Case example of a conflict

Conflict Resolution (page 62)

Case example illustrating conflict resolution.

Question: Determine whether each of the following... (page 63,64)

A series of examples of actions that may be horizontal and/or vertical violence.

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Description

This quiz evaluates key concepts related to effective communication, mutual support, and situational awareness within healthcare teams. It covers critical language use, advocating for patients, and the importance of team debriefs and huddles. Test your understanding of team dynamics and strategies that enhance patient care.