QSEN Competency #2:  Teamwork and Collaboration

This content addresses the key competencies expected in entry-level nurses to facilitate their abilities to work effectively with the other members of the healthcare team.

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

In nursing education, it is critical that pre-licensure graduates understand their role in healthcare in relationship to the other healthcare providers. Nurses must learn to respect the value of the other disciplines recognizing where the various scopes of practices intersect or are different. In achieving this level of understanding patients will truly receive patient-centered care that fosters the provision of healthcare that is provided by the most appropriate individual or team. It is the responsibility of nurse educators to provide students with opportunities to appreciate the specific role of the other healthcare disciplines and identify how these relationships might be fostered. The following examples describe activities that were designed to meet this goal.

 

Classroom/ Simulation:

In this activity, students enrolled in the respiratory care, occupational therapy assist and nursing programs participate in an inter-professional educational experience. Faculty from each of the programs begin the session with brief presentations regarding the key assessment tools used by their discipline. Students from each discipline are seated at each table to facilitate sharing. Through this didactic content students begin to appreciate where their scope of practice was similar or different.

In the next phase of the activity, a case study from the National League for Nurses (NLN) Advancing Care Excellence for Seniors (ACES) involving Henry and Ertha Williams is presented. Henry is a patient with COPD and Ertha struggles with dementia. A discussion ensues at each table with students from the various disciplines discussing how they would assess and treat the patient from their discipline’s perspective.

Phase 3 of the program involves a live simulation with standardized patients. Each discipline interacts with the patient(s). It is the responsibility of the nursing students to identify when their patient could benefit from the care of a different discipline.

Pre- and post-assessment data is gathered in terms of the students’ readiness to learn about other disciplines as well as assessment of their level of understanding the scope of practice of other disciplines.

 

Classroom/Simulation:

In this activity, students are trained to use the AHRQ TeamSTEPPS framework for collaborative practice within the simulation lab before entering the hospital setting.  Using the Simulation Exemplar #1 found in the NLN’s Guide to Effective Interprofessional Education Experiences in Nursing Education, clinical case scenarios are developed in which students learn how to implement their TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) teamwork skills.

Prior to simulation, a TeamSTEPPS presentation and handout are given to the students.  Terms such as “Briefing and Debriefing, SBAR (Situation, Background, Assessment, Recommendation), Huddles, Hand-off, Situational Monitoring, Conflict Resolution, CUS (Concerned, Uncomfortable, Safety) and Closing the Loop” (AHRQ, 2015) are explained .  The resources for this information can be found on the following  AHRQ link: https://www.ahrq.gov/teamstepps/instructor/essentials/igessentials.html

With the nursing professor acting as facilitator, a briefing is held in which students are divided into two groups: the first group as active participants in the first case scenario, while the second group serves as the observers who complete a peer evaluation tool using a TeamSTEPPS checklist.  The students’ roles are then reversed for a second case scenario.

During a de-briefing, the TeamSTEPPS checklists are reviewed with the students, feedback obtained and the student feelings about communication and the importance of teamwork and collaboration are discussed.  The students are then able to apply their knowledge in the hospital setting and understand the value of teamwork and collaboration in promoting patient safety.

 

Classroom/Clinical Experience:

In this activity, we link the information from the perioperative unit in the didactic class to a clinical experience found within second and third semester medical-surgical courses.  The information is introduced in first semester during the perioperative unit with a discussion of all interdisciplinary professions that work within the perioperative environment, from pre- to post-operative care.  During second semester, each student is assigned a day of observation within the OR.  They are able to follow a patient from the pre-operative suite to the intraoperative room and finally through the post-anesthesia care unit (PACU).  The ultimate objective is for the student nurse to then return with the patient to the nursing unit on which the patient will be admitted.  During third semester, each nursing student is again assigned a day within the perioperative unit, with the intention that they will spend this experience shadowing RN’s who are instrumental in the care of the patient, whether that is the surgical nurse or the PACU nurse.

Through the introduction prior to the experience, the students become aware of the many different interdisciplinary personnel who work within the perioperative unit. They develop an understanding of the roles of these individuals and the responsibilities assigned to each.  During the second semester, students are able to observer and interact with each of these healthcare team members, solidifying their understanding of what nurses are responsible for in the OR, but also how RN’s interact with other team members.  During the third semester, the student is able to focus more thoroughly on the role of the RN because they have developed a familiarity with the environment through their previous educational experiences.  By working with a specific nurse throughout the care of the patient undergoing an operative procedure, the student gains a better understanding of the ways the RN manages the care of the patient throughout this experience.  Additionally, the student is able to more fully comprehend the role of the nurse within the perioperative environment and the ways these roles and responsibilities intertwine with other professionals working toward the same outcome.

Developed by the OADN QSEN Task Force