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2. Introduction to the QSEN Competencies – Gerry Altmiller, EdD

it’s now my honor to introduce Dr. Altmiller.
and Gerry has been with us, she joined us right after I came on board I came on board in July
and she came in january, so you have come up come up here two years now, as being part of TCNJ. she
is, as she said, the associate professor here at the college of new jersey, and in the School
of Nursing health and exercise science. she still maintains their clinical practice as
a clinical nurse specialist at einstein in Philadelphia, she also is very active in terms
of consultation with nurses about nursing research and evidence based practice. she’s
been a member of the quality and safety collaborative collaborative for the QSEN collaborative since 2006,
and she has served as a member of one of the pilot schools for that work. she’s currently
a national consultant for QSEN providing workshops such as this from around the country,
and serves on the QSEN Institute advisory board is the director of now the QSEN institute
regional center here at the college of new jersey which she will talk a little bit more
about that evolution or revolution. and she was invited by the National Councils of State
Boards of Nursing to develop teamwork and communication module of their transition to
practice programs designed to support nurse residencies for the new – to practice nurses.
she’s a Lindback award recipient for distinguished teaching in 2014, and she has published extensively
about quality and safety and graduate and undergraduate nursing education. she also encourages
our students to create or has created a newsletter a newsletter, a QSEN newsletter, that they are the living
experiment in terms of QSEN, to bring what they learn in the classroom and the clinical
to a newsletter that’s published on our website her research has focused on communication
challenges as well as instability in the educational and practice environment, and the negative
effects these impose on patient safety. dr. Altmiller. thank you. so today we are going to
start out by doing an introduction talking about QSEN, and and then our guests are going
to build on that going a little bit deeper into some of these concepts that i’m going
to share with you. i am a nurse educator so everything that i’m going to share with you
is about how you share it with other people. and we’re going to basically throw ideas at you all day long that you can implement into your classroom activities or into your orientations for new nurses or into your ongoing education for nurses and practice. anything that you
see here today is either on the QSEN website where you can download it for free and use
it, or you can get it from one of us by emailing us. i want to tell you that anything that you
use off the QSEN website you are allowed to make adjustments to, the only caveat is
that you make some kind of notation about the author who created it, like courtesy of
such and such a person, but you certainly can change things so that they fit into your work.
so let me start by telling you i have no conflict of interest today in this presentation. to
give you a brief overview of qsen, what I will tell you about it is that we all know
about “To Err is Human” and we know that the IOM followed that up with core competencies
that all healthcare profession.. professionals should have. so what happened around 2005, a group of Health Professions educators which were mostly nurses formed a collaboration
which was the quality and safety education for nurses collaboration, they were well funded
by robert wood johnson they created competencies that would changed the way that nurses were educated,
to move from being a task-oriented role to being this role that was about knowledge, skills, and attitudes that are focused on safety that are focused on quality improvement. so qsen developed six core competencies -they added safety as the sixth item. in the 11 years
that this has been going on, qsen has multiple faces, there was a phase where they brought
on 15 pilot schools to create teaching strategies and share them nationally and that’s what
you see on the website although now more what teaching strategies are up there is people
are doing them and sharing them, it’s a great place to publish your ideas in your work. there
was a phase 3 where AACM was part of that and they disseminated it in train to trainer sessions,
there was a phase four where they brought it in to graduate level and made core competencies
for the graduate nursing students. where does all this lead to what is the relevance? it
is relevant to nursing education and practice in a lot of ways. anybody who’s in an accredited
school, ACEN uses it as part of their accreditation criteria, it is part of the baccalaureate essentials, it is part of the Masters essentials it
is used in all transition to practice programs, so it has become relevant to practice and
to academia. so to people who think that qsen is only about education i’m going to tell
you no it is not. so a young man named Giancarlo Lyle-Edrosolo at the University of San
Francisco was doing a DNP project and he cross-walked the qsen competencies with the Joint
Commission standards with the magnet standards and he found that everything flowed beautifully
together and everything fit together so the idea is that qsen should be part of all
undergraduate or pre-licensure nursing education and then it should flow seamlessly through
into practice because it brings that person into the practice setting ready to do all
the things that they need to do to meet the Joint Commission standards and to meet magnet
standards. so with all of that in mind today, our objectives are to identify knowledge skills
and attitudes that emphasize the qsen competencies, to demonstrate strategies that can be integrated
into classroom and clinical teaching to support behavior is consistent with the qsen competencies, and to discuss resources support educational and implementation strategies
aimed in quality improvement patient safety and systems effectiveness. so we’re going to
start off with patient-centered care. that is the first qsen competency. with that
competency the patient is in control and a full partner, care is based on respect for
patient preferences values and needs. so what does that mean? that’s really about thinking
about the patient and letting them be in charge of their care, promoting self-efficacy instead
of us telling them how it’s going to be asking them how do you want it to be? really individualizing
care in a way that we have never done before. so some of the things that I would like to
show you out on the web, Barry if you can take us out there, the picker Institute this is
a great little site that is completely focused on patient-centered care. Picker principles,
there’s eight different principles of of patient-centered care, they show you a different
ideas you can take your colleagues out there or your students out there and show them
these eight principles. the principles are explained and then they are shown in short
little videos that you can embed into your presentations. so to talk a little bit about
that, each of the videos shows the presentation as an example of it, like the first picker
principle is respect, with respect you see a woman come on and she talks about how a doctor
will walk into a room and he’ll say, hi pearl i’m dr. Smith so the idea is that he is ok
with being on a first-name basis with the patient but the patient is not on a first
name basis with the doctor no matter who they are and that’s really takes us out of that
level playing field so we really need to get away from that treat people with respect when
we walk into the room hello mrs. Smith i am dr. Jones that’s that idea so it really emphasizes
the principal to our students not to call their patients by the first name to address
them by those titles another side that i wanted to show you is the Institute for patient and
family-centered care that is a website that’s really about a patient centeredness but we
has tons of resources whenever you go to one of these resources that i’m showing you the
website go across the top click on resources and all of them have a site for free downloads
on the patient-centered care site when you go to free downloads down pops a list of about
20 different items that you can implement in your classroom in your orientation to help
people focus on patient-centered care the idea is that it gives you a way to bring it
into discussions you can take it into post-conference there’s a piece on there called a patient-centered
care assessment it’s a great tool for students to think do I really do these things like
it ask questions when patients talk to I actually listened or am I thinking about the next thing
that I have to do I know if the teacher lot of times that’s what happens with me i’m hearing
them but really thinking I got this I got that so it’s really about bringing your consciousness
into thinking about patience and this all the time so one of the best resources that
you can use is IH eyes open school I don’t know how many of you have heard about that
but that is a free resource if you are faculty member or if you are a student what that is
is really excellent modules that teach about quality and safety their interactive when
you do a model it’s about an hour and a half each one has three or so lessons at the end
of the 20 minute lesson you would take a test you need to get an 80% on before you can progress
its interactive and your blog all through it so it’s a great opportunity to learn when
it’s done if you’ve done the module you earn a a a sec approved contact hours for 1.5 for
each module you get the furnace certificate it goes into your portfolio for you its faculty
it is a great aight way to learn the language of safety we have all been teaching quality
and safety for so many years but the language has changed in the way that we approach it
has changed and so for us the reef amiloride ourselves with how we are doing it in this
day and age these are a great great way for us to learn and we can put them toward our
requirement for our licensure for our students it is a great way for them to learn it is
better than anything I could ever present in the class now for a basic certificate there’s
13 modules that can be completed so here at our school we have taken those 13 models and
spread them across our curriculum in different courses so every course a student knows that
they are going to be doing one of the IHI modules to learn the basic certificate when
they graduate not only do they finish their nursing program but they have this quality
and safety certificate that they graduate with we have already seen the benefits of
it our students are telling us that employers are very impressed that they’re having them
done asking them why did you do them faculties so what I wanted i’m going to i’m not going
to go out to the site this is something that you can do on your own but i do want to show
you a couple of things so you go to IH i see at the top here where it says log on and register
you would go in and register yourself as a professor alright it’s free if you are professor
if you register as an RN there’s going to be a fee that comes with it well then when
you put it in your classroom to tell your students to register as a student and it will
be free for them now you can pay to track it online I don’t do that because it’s one
more job for me what I have my students do with when they finish the module they save
the certificate and I have them drop it into my canvas and I just check off that they all
have it done so it’s easy for me how to find it very simple you’re on the IHI paid to pick
education go to open school on campus and modules pop up for you so this is a great
resource that you can use there are many more models than 13 that are in the basic certificate
but on you can pick and choose how you want to do that we made a decision as a faculty
here at TCNJ that the basic certificate would be a good resource for our students so when
we think about patient-centeredness we really want to help people to keep their eyes focused
on the patient it’s all about the patient so things that we see happening in hospitals
whiteboards for patient goals so everyday the patient puts what’s important to them
up there and even if the patient rights get the hell out of here today that’s their goal
then let’s go with it and we need to be respectful of that and I tell my students whatever they
put up there that’s the priority go with that we need to get our students involved and helping
the patient when they go in and introduce themselves what’s your goal for the day let
me put this up on the board for you we have to think about value-added nursing these are
the things that make better value for the patient like rounding is value-added nursing
because people get together and they talk about the patient and we discovered problems
and we brainstorm we have to teach our students to look at the non-value-added nursing and
work to get rid of that like waiting for delays looking for supplies all of these things weigh
so much time that we could be with the patient so those are the things that our students
have to be focused on let’s get rid of that let’s remedy that and then of course we have
to streamline the necessary but non-value-added nursing things like getting medications together
and documenting we have to do those things but let’s streamline and make it easy so let’s
go out to this site right now Barry this is Don Berwick and he does a very good job of
describing what it means to be patient centered if you can scroll down on this page keeps
coming down here he is Don Berwick ico to be patient partly that’s here comes from what
I know about technical hazards and the lack of the liability in care today I have a bone
on bone pain and and osteoarthritis in my right knee i can no longer jog which was my
passion or even run four steps because i had an unnecessary and now fully discredited the
operation as a medical student operation had never been subjected to proper evaluation
for a condition that have never been subjected to a hands-off arm of a clinical trial my
best friend had a PBR postoperative complications from the gates a drug dosing era transition
it almost killed him my research on errors in care show these errors to be careful firing
Lee terrifyingly the norm but the honest truth for me is that the errors and unreliability
of healthcare are not the main reason that I fear that inevitable day on which I will
become a patient for inviting those enemies errors and unreliability IM aligned with the
good hearts and the fine skills of my technical caregivers i can use my own with to stand
guard against them but chills my bones is indignity it is the loss of influence on what
happens to me it is the image of myself in a hospital gown homogenized anonymous powerless
no longer myself it is the founder of a young nurse tangy Donald which is the name I never
use it done or for her maybe it’s dr. Berwick it is the voice of the doctor saying we think
instead of I think and thereby placing that small verbal which the pronoun week between
himself as a person and myself as a person it is the clerk who tells my wife for my son
to leave my room for me to leave their room without asking if we want to be apart a close
friend called the clinic for her mammogram reported she was told you have to come here
we don’t give that information out on the phone she said it’s okay you can tell me on
the phone and they said no we can’t do that of course they can do that they choose not
to do that and their choice comes her choice period that’s what scares me it scares me
to be made helpless before my time to be made ignorant when I want to know we made to sit
when I wish to stand or to be alone when I need to hold my wife’s hand or to eat what
I do not wish to eat or to be named what I do not wish to be named or to be told when
I wish to the ass or to be awoken when I wish to sleep you can call it patient-centeredness
if you choose but i suggest to you this is the court it is that property of care that
welcomes me to assert my humanity and my individuality and my uniqueness and if we be healers then
i suggest to you that that is not a route to the point it is so he does a very good
job of describing that I show that in my introduction to nursing class it is our first level of
them being introduced to the idea that they need to be a lifelong learner and I think
that’s an important concept for them to get right away that it’s all about respecting
patients dignity so some things that I’ve tried to make the students think about is
seeing through the patient’s eyes to always look for feedback and think about how does
it feel to be a patient now I’m going to save some time here this um click link here is
to the immigrant it is a six-minute vimeo really well done that describes the situation
where a medical error was made for a patient the medical error was made because the patient’s
family speaks Spanish and for some reason they disregarded their ability to describe
what they needed because of their speaking Spanish instead of speaking English the vimeo
does a great job where the one patient says just because I speak at another end language
doesn’t mean I’m an alien from outer space i still live in take care of myself and can
think and I think that a lot of people have that bias and it’s important for students
to things right away that just because people are different from you doesn’t mean that they’re
not smart and can take care of themselves so it’s a beautiful little vimeo on that you
can access that on youtube I do want to tell you that everything that i’m showing you today
is on that listing that’s in your packet so you’ll be able to find these resources but
we’ll skip this one just to save a little time and catch up here the whole idea is that
you want to teach your students to build relationships solve problems at the point-of-care involved
the patient in everything you do and some of the ways that we’re doing that it’s situational
awareness knowing everything that’s going on in the unit instead of just knowing what’s
going on with your patient and thinking about rapid response teams which are only useful
if the people who come to the rapid response are supportive instead of condescending I
had a student tell me a story non dead serious i had a student tell me a story works as a
nurse aide said she was up on the floor the patient was having a lot of trouble breathing
she went out and told the nurse and the nurse said I’m not calling a rapid response to the
last time the resident ridiculed me and the woman continue to have trouble so she called
her husband who was an ICU nurse and told him and he said go in the room and i’ll come
up to visit you and that’s what they did and he came up to visit me one out and he told
the nurses at the station you should call the rapid response that patients have until
the patient was transferred down the ICU like that’s not the way it was meant to be it’s
really meant to be you show up at a rapid response and say what can I do to help you
not why are you calling me what do you need now so we really need to impress upon people
that whole idea of Rapid Response someday you’re going to be the person answering that
rapid response you need to come with a what can I do for you attitude personal accountability
thinking about reducing admission the only way to do that is to make sure people go out
the door they’re ready to be going out the door medication reconciliation this is huge
this is a big part of the patient safety goals we need to make sure that our students have
a very good understanding of it so something that you can do there is a exercise up on
the q some website called medication reconciliation exercise it was created by pam Ironside and
her gang out at Indiana University and i use it in every every semester in my med surg
class and we do a med reconciliation on the first day of class so that students understand
what it is and it’s an unfolding case which is a great strategy for you to teach with
so I dropped it into here this morning just so i can show you the slides so you can get
an idea and unfolding cases where you introduce a patient to your students and then you follow
that patients when they have to make decisions along the way to learn how to take care of
that patient so this unfolding case actually works with students because it’s got a little
bit of drugs and a little bit of alcohol and a little bit of sex in it so all of those
things help them all the stay tuned in so on how this works out and we’re not going
to run through the whole thing but i’m just going to tell you the gentleman who had heart
failure comes in having trouble breathing and as the nurse goes on to find out more
he takes something that starts with an L and they get excited all that’s lasix and he takes
the doctrine and medicine something and they’re excited because they know that’s metoprolol
and they can talk about all this seven thank God he takes a multibyte like we wee lass
the whole time through and then we get to the crux of the problems he’s not telling
you anything and he doesn’t know anything and what they come to discover he needs serious
patient education and we talk about what how you gonna find all this stuff out and then
we find out more about him that he drinks occasionally one drink at lunch to have to
work and one before bed and oh by the way you use cocaine sometimes and then he barred
by agri from his body and people know people bar biography from there buddy so I’m on we
go and they put it all together to understand that he went into heart failure what are you
worried about and what do we know and we run through it and this is how it all works and
then here we see Bob nice normal-looking guy right but somebody who really needed a med
reconciliation could be a lot of stuff ordered and really had a lack of knowledge then to
carry that over you know how you do clinical paperwork for your students that they have
to do things each week with their patients to write out you know information to learn
it well most of us have them list their meds and do the classic you know classification
mode rationale for this patient will I go one step forward their meds list is actually
a med reconciliation so at the very bottom it says who did you talk to and when did you
talk to them now I’m careful this Helen don’t ever put the patient’s name in there but you’re
going to put I talk to the patient at twelve-fifteen on this steak I talked to the patient’s daughter
but this makes them have to have a conversation with the patient or somebody who’s caring
for the patient about the meds so it’s taking something we’ve always done but just putting
a new twist on it so that they learn this new important patient safety aspect alright
so this is a wonderful movie this is escape fire has anybody seen asst this is this is
an awesome video and I show this in my senior nursing class you have to put it further back
so that people have some kind of experiencing the clinical setting this is a great video
i bought it for fourteen dollars on amazon it’s really a beautiful look at our healthcare
system but after I was here I didn’t want to show it in class so I asked the librarian
to buy it for three hundred dollars they were able to buy the streaming rights for it so
now I’ve embedded into my canvas if you have canvas blackboard mood or whatever it is you
you can embed it in there I assignments in my students as a work-at-home day with today
enjoy because then they can do class on their own timeframe for one day out of the semester
they watch the video the question that i asked them is what are you going to do tomorrow
and all of them have to post on the discussion boards so if you can cue that up and run this
we’re just going to watch the trailer the American healthcare system is badly broken
the present system doesn’t work and it’s going to take us down we need a whole new kind of
medicine we’re in the grip of a very big industry and it doesn’t want to stop making money if
i spend five minutes with you and then put in one of these tents have it your case $1,500
for me to spend 45 minutes with the patience to figure out what their true problem is probably
get paid 50 now it’s a completely irrational system we don’t have health care in this country
we have a disease management system were spending almost twice as much in America and other
country on Earth but our lifetime isn’t even in the top twenty thirty thousand Medicare
recipients die each year from care they didn’t need that’s the equivalent of a jumbo jet
crashing every single week the aviation industry killed as many people would be up in our the
administration is you’ll be on how many patients you see all right who’s next she trying to
buck the system components what can we do to get your productivity up i’m not interested
in getting my productivity of i’m interested in helping patients receiving the military
just being a microcosm of the problems besides him soldiers use of prescription drugs has
tripled in the past five years this medication i was on any by accepting that the American
healthcare system is badly broken we be able to speak out escape fires the potential solutions
there are answers one company has figured out how to lower health care costs more than
forty percent we provided says for people to engage in healthy behaviors the Army Surgeon
General directed that we established the pain management task force to take a look at alternatives
to narcotics our skeptical hoes get gotten a lot of inspiration and different perspective
there’s a different way of doing things that is possible if I think about what healthcare
could be like it would have a lot 1 care the healthcare system is unsustainable we’re really
marketing the future not just the health of health care coordination so this is a great
learning opportunity for students and i will tell you the things that they’ve posted after
it our i’m going to spend more time with my patient i’m going to make sure they understand
what they need to do i’m going to teach them it’s a 90-minute movie and very very worth
the time that you invested into it so we’ll move now to teamwork and collaboration so
teamwork and collaboration is to achieve quality and patient outcomes by effectively communicating
with nurses and interprofessional teams and having mutual respect and shared decision-making
so teams are very important to everything that we do when we know that but you need
to have a team where people work together regarding each other treat each other with
respect John Nance who is always on the television whenever there is some kind of terrible aviation
accident he on has written a lot of books about teamwork he says teams provide a safety
net so an individual no matter how professional or experience is never as reliable as 15 so
Barry if you can go after this site with Lucien leaps Lucien leave i’m going to show you this
way he actually talks 48 minutes very packed for many faces an error and errors made while
like most doctors I recall every one of you individually seriously never forget i’m having
a practice for 22 years but I clearly remember the serious mistakes I made you make a whole
lot of them that you remember them a one that time would be helpful to talk about i think
we said I was a pediatric surgeon so I operating on children and one serious mistakes i made
was failing operate on a child who had bleeding from the intestinal tract and I delayed surgery
so long that she ended up dying from this and as far as I was concerned it was entirely
a judgmental error on my part on the teaching and my experience I was I was fairly experienced
that a lot of residency for 10 years or more the teaching and my experience was that I’m
bleeding from the stomach and children always stops you don’t need to operate on and in
fact there’s a fair amount and the literature about how it was long to operate on these
people because you didn’t need to and so I believe that and and so we treat the child
and get for institutions of what and finally became apparent that it wasn’t stopping and
at that time that means enough damage that we weren’t able to savor I of course was devastated
by this as your family and we all cried together no question about it and I visit I did explain
to him when I apologize and so worth the no apologies going to bring back your child and
I just thought it was not the worst thing I’ve ever done in my life what did you learn
from it well i think is very simple lesson that is decisions that are really critical
to like best were nearby knew that I should never be made by one person if we working
the equal teams i wouldn’t be able to get away with that I was like people challenge
nobody ever nobody challenged my judgment no no resident or other person around ever
asked any questions about it because it was my decision was respected and so it wasn’t
challenged that should have been challenged children challenge should have been discussed
in like in the open manner and if we had another pair of eyes looking that child she would
you like today like my classroom and I make it clear the students that there’s a very
respected man harvard medical school this is something that he talked about happening
50 years ago it’s still happening today that people make decisions without consulting the
team and without talking and I felt and you are a voice so you need to speak up in and
take a chance if you think that something is wrong and make make your voice heard be
part of a meaningful team so I think that gives them as a good idea of even a well-respected
man seeing how important it is so this whole idea of speaking up we really need to help
students understand how to do that the synergistic effect of having collaboration between all
the disciplines is so good for the patient they need to have system based solutions for
safety and off so that you can speak to another person and tell them what needs to be done
and not worry about whether they’re judging what you haven’t done we need to acknowledge
everybody’s contribution a dietitian bring something the housekeeper bring something
the pharmacist bring something everybody is bringing something that’s so important so
acknowledge the expertise of all people we tell our students that you need to speak up
advocate advocate advocate but we can not send them out there without a tool to do it
so a great tool for them to assert and speak up is cut it is an acronym for the words I’m
concerned among comfortable I don’t think this is safe so see us I tell my students
you can cuss all day in clinical which they do anyways right so here you go so an example
would be dr. Smith I’m concerned with this vancomycin order among comfortable because
the patient’s creatinine is 1.4 i don’t think it’s safe to give it all I didn’t know it
was 1.4 ok that kind of thing so speak up how about the two challenges rule I tell students
just because you tell somebody something is wrong if they don’t do anything about it then
they haven’t heard you and you have an obligation as a nurse to say it again and again and again
and this is what we need to do in practice I know as an ICU nurse for many years you
could say something and people just ignore it like it was not important you have an obligation
to challenge it again and again we stayed to challenge but it might be for challenge
before someone hears it how about the idea of critical language the literature says that
in the o.r that is the most difficult place to communicate and that people are most afraid
to speak up there because it is behind closed doors and there are no patients so how do
you speak up to somebody who enough chain is way up here in your way down here a critical
language like I need some clarity stops it so when you see a surgeon who is doing surgery
on the right arm instead of the left and you want to stop it before the cut is made you
would say I need some clarity and then everybody needs to review what is it we did wrong site
surgery left we absolutely do not last year 1600 wrong site surgeries in the United States
so all the things that we’re doing has decreased it but we still don’t have it stop so we need
to teach students you could do this at a bedside somebody’s giving a transfusion or starting
a transfusion for somebody that they shouldn’t be but it’s the charge nurse and your new
nurse and your income to I need some clarity we are supposed to be giving packed red blood
cells to so-and-so in bed so-and-so and help everybody to stop what they’re doing and think
about what it is we’re doing so that they can correct themselves before they make an
error we need to have uniforms communication so as far as a great framework it came from
aviation many hospitals are using it in practice we need to make sure all our students are
doing it so one of the ways that you can do that is make them FR report in the classroom
I keep the telephone in the classroom occasionally they have to call the physician with the problems
so if they were if we were doing pulmonary edema dr. Smith I’m calling about mrs. Jones
in 304 she’s your patient you admit in pulmonary edema yesterday and we’ve been managing her
on six leaders and 40 milligrams of lasix ID push toys today this morning I came in
she’s got crackles up one-third two-thirds of her back her respiratory base32 and her
pulse ox is 92 think she needs more lasix and let them practice how to do an sfr communication
i make them handoff to different places as you move your patient through different areas
of the hospital handoff and use as far and make them run through it so think about leadership
things that we can teach them in a leadership course there should be a pre-breathing anybody
can be the pre briefer it can be the person who’s taking care of the patient think about
that when a patient codes doesn’t the nurse caring for the patient lay it out as people
arrive this is what it is going on this is the patient’s problem and this is what we’re
doing right now always should be a debriefing debriefing should follow events and really
be focused on learning and here’s what i want to say to you about that it’s really about
feedback and we got to think this is a whole other day of talking to talk about feedback
but in a nutshell when we give feedback to people it needs to be focused on objective
things that can be measured and not just our opinion for instance lisa weir escos your
compressions really weren’t affected they were pretty weak that’s judgmental but if
I said please that when you were giving compressions the doctor couldn’t feel the femoral pulse
so i just think we need to all think about you got to push down an inch and a half so
it’s an objective data this is what happened this is what he saw but it always leads to
a conversation about evidence-based practice what should it be so that way Lisa doesn’t
feel inadequate was just reviewing I couldn’t feel your pulse I couldn’t feel the pulse
now we have to change how we do this let’s all think about it what is it tools that you
can use can we go out to this on Barry teamstepps are everyone is everyone familiar with teamstepps
so teamstepps is a long program it’s a two-day but I’m going to tell you we’re going to cut
to the case here when you teaching in the classroom or your teaching in the hospital
you can load this link up onto your desktop this gives you an opportunity to show all
of these different safety strategies in little vimeos so wherever you’re teaching about you
have the ER patient who comes in with chest pain and how the nurse managers that gets
the doctor’s attention and all the states handoff piece you have a situation on where
the patients and inpatient and gets confused and the person who picks that up it’s the
phlebotomist to reports empathic the videos always show it done really poorly where the
patient crumbs and then they show you the next where you use all these safety strategies
and the patient does really well so it’s a great opportunity for our students to see
the before-and-after if you can just click on here Barry could we talked about cost and
I’ll just demonstrate how these mirrors come up and you can make them full screen and just
drop them into your presentations around so just scroll up a little bit in the picture
should come up download failed okay well you know it is what it is today we can skip out
of him but it comes up as a small screen you can enlarge it and it’s just seeing that that
on safety strategy in effect other things that are on here labor and delivery of patient
with the c-section who needs to go emergently and that’s a before-and-after where you see
really poor communication and better and then the out in the community giving feedback when
somebody falls through the cracks and somebody who gives feedback really poorly in an angry
State and somebody who gives it much better 15 steps is a great tool all of that is free
for you to sew a couple of things to talk about that are up on acuson website we have
giving and receiving constructive feedback this is an important thing for all of us to
learn and as a faculty member i will tell you it’s easy to get angry and get upset especially
when you have eight students out on the clinical floor and you’re really pressed we really
need to think about the way that we talked to students and we need to have them think
about when we talk to them what is our motivation in studying this whole thing with students
and nurses i have come to find out that when people get feedback they really feel on that
you’re offending them and a lot of times it’s a trigger for instability so we really need
to think about how we deliver which I don’t want to go into a lot of detail with that
today but this is a teaching strategies that supplementation site is an 18 minute presentation
is narrated i have my students in fact next monday first day of class they have to watch
this at home and if the post on the discussion board a significant idea and what it talks
about is how you should view feedback as an opportunity to improve its a chance to get
better at what I’m doing and how important that is for patient safety and to make me
a better nurse and most of them when they post that’s what they write i used to get
really mad at feedback but now i’m going to think about this differently by the time i
get through them they’ve been through fundamentals and mother baby and they’ve already got that
attitude like the teacher wants me out of here and it’s kind of changes the way it is
another way to start that I heard Susan looper else speak and she’s wonderful she said on
the first day of class just say alright who when he wants to be mediocre who wants to
be mediocre and of course no one raises their hand and she says okay so if you don’t want
to be mediocre you want me to give you feedback is that it and everyone smiles they get it
like that’s the idea that’s the only way that you become better this down here is all the
difficult communications our students are going to come in contact with and our nurses
do come in contact with i will tell you that I did this one with nurses favor of great
stories in the or where they told doctors account was off and the doctor said that I
took one sponge and I took one sponge out that’s the end of it close the patient up
two days later fully infected so students i showed them i have them write about an instance
where they sell communication be a problem for the patient risk then we run through all
the slides which when you go to these q sins teaching strategies all the slides and everything
you need is there we run through the slides to teach him how to communicate when there’s
a problem and then I have them reframed their story and retell it i could have cussed at
him I could have done a to challenge rule those kind of things to try to fix it if we
can go out to hear Barry and hopefully this will show up in leadership class we tell students
to be leaders have that if we tell them be followers get on board with quality and safety
education and all the things that go with being safe practitioner i’m going to show
you just a short video that entertains them but certainly teaches them how important it
is if you’ve learned a lot about leadership and making a movie then let’s watch movement
happens start to finish in under three minutes and dissect some lessons first of course a
leader needs the guts to stand alone and look ridiculous but what he’s doing is so simple
it’s normal construction this is key you must be easy to follow now here comes the first
follower with the crucial role he publicly shows everyone else how to follow notice how
the leader in braces him as an equal so it’s not about the leader anymore it’s about them
claro notice that was calling to his friends to join in it takes guts to be a first follower
you stand out grave ridicule yourself being a first follower is an underappreciated form
of leadership the first follower transform a lone nut into a leader if the leader is
the Flint the first follower is parked it really makes fine now here’s the second followers
this is a turning point it’s proof the first have done well now it’s not a lone nut and
it’s not tuna three is a crowd and the crowd is new a movement must be public make sure
outsiders see more than just the leader everyone needs to see the followers because new followers
emulate follow not the leader now here come two more people than three more immediately
now we’ve got momentum this is the tipping point and now we have a movement as more people
jump in it’s no longer risky if they were on the fence before there’s no reason not
to join in now they won’t stand down they won’t be ridiculed and they will be part of
the in crowd if they vary over the next minute you’ll see the rest who prefer to stay part
of the crowd because eventually they ridiculed for not joining and ladies and gentlemen that
is the house movement is made so let’s recap what we learned if you are a version of the
shirtless dancing guy all alone remember the importance of nurturing your first few followers
that equals making everything clearly about the movie not you the public be easy to follow
but the biggest lesson here if you catch it leadership get it started with the shirtless
guy and he’ll get all the credit but you saw what were the captain it was the first follower
that transformed a lone nut into a leader there’s no movement without the first problem
we were told that we all need to be leader that would be really ineffective the best
way to make a move night if you really care its courageously follow and show other had
a problem when you find a lone nut doing something great have the guts to be the first person
to stand up enjoying it but i’ll tell you about that if you are the lone nut at your
school trying to put cuse in place just keep pushing and person gently and get people to
come on board piece by piece and you’ll see that it will spread I think it’s a good lesson
for our students to learn that they need to be followers and they need to you know not
always follows but they need to think about on when they find something good get on board
with it so this next thing I’m going to show you will do this and then we’ll take a break
on is I think this is the end of the teamwork piece anyway I’m can my for volunteers come
on up these are my colleagues at einstein so on is m 2 BR volunteers today i would like
to show you what a healthy team looks like I go to summer camp every year for health
professionals educators we learned lots of good stuff so this is something that I learned
there alright so we think about teams and we think everybody’s got to get along and
everybody’s gotta work together and we see that person is always difficult bigger why
are they on our team but I want to tell you that everybody needs to be there to make a
good team alright Lorraine come on you’re here this is Laraine Marines job you’re the
mover you’re shaking it up i want you to stand like this you go girl hurry so Lorraine is
the mover she makes things happen she brings all the ideas Denise you’re the supporter
get in there and support Lorraine however you cannot right here right here supporter
oh well that’s very nursing and caring all right support however you want to support
so everybody who’s moving it needs to have somebody who’s supporting the work because
they go yeah that’s a great idea for months so you’re the role we hate all right I want
you to stand here like this guess what her role is you know she’s the resistor alright
so you got the movie that supported the resistor Priscilla come here its priscilla job good
job facility you just standing there doing nothing we always have somebody on the team
who looks like they’re standing there doing nothing right but here’s the thing you need
to stand there doing nothing you know what they’re doing CC observer she’s going to give
feedback you know why because he’s not bought into this one she’s not bought into this one
she’s not bought into this one so she can give effective feedback to this this and this
so you need all of these people otherwise your eyes don’t get dotted UT don’t get across
this person but what about but how about but what if you need that person so that you prepare
for all of that stuff so this is actually what an effective team looks like thank you
very much ladies

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