Case Study: Focus on Teamwork/Collaboration, Quality Improvement, and Safety in Caring for a Newly-Diagnosed Schizophrenic Patient

Submitter Information

Author: David Foley, PhD, MSN, RN-BC, CNE, MPA
Title: Research Associate
Institution: Case Western Reserve University

Competency Category(s)
Quality Improvement, Safety, Teamwork and Collaboration

Learner Level(s)
Advanced Practice Providers, Continuing Education, Faculty Development Strategies, Graduate Students, Interprofessional, New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN, Staff Development

Learner Setting(s)
Classroom, Clinical Setting

Strategy Type
Case Studies

Learning Objectives

Global QSEN Competency Objective (GQCO): The purpose of analyzing this case study is to provide nurse educators (clinical/classroom faculty, practice-based nurse educators, and staff development personnel) with an immersive situation to promote critical/analytical thinking regarding the QSEN competencies of Teamwork/Collaboration, Quality Improvement, and Safety. The questions that follow the case study should thus be used to provide learners with opportunities to demonstrate a
practical understanding of these QSEN competencies.

Unit Learning Objectives:
As an immersive exercise, this scenario thus promotes affective development by placing leaders within a low-incidence/high-risk clinical scenario involving a serious breach of safety during the initial assessment of a young male patient experiencing his
noted episode of psychosis and subsequent transfer from the primary care to the Emergency Room settings. Three key QSEN Competencies (Teamwork and Collaboration, Quality Improvement, and Safety) provide the framework for the development of
analytical skills through reflective thought and ensuing discussion:

1. Through analysis, reflective thought, and discussion the learner will affirm the importance of safety for patients and caregivers in the acute phase of mental illness.
2. Through analysis, reflective thought, and discussion the learner will identify opportunities to enhance effective teamwork/collaboration during a low-incidence/high-risk psychiatric patient care scenario.
3. Through analysis, reflective thought, and discussion the learner will identify rapid-cycle quality improvement as a top priority following low-incidence/high-risk situations involving acutely ill psychiatric patients.

Strategy Overview

The QSEN competencies provide an ideal framework to promote opportunities for analysis, reflective thought, and discussion. In the case of this scenario, the lead characters in a primary are setting perceive their performance as competent as they provide appropriate care to a newly-arrived psychotic patient. Despite finding themselves in a low-incidence/high-risk scenario, they engaged in Teamwork/Collaboration to promote safety throughout the initial assessment and subsequent transfer to the Emergency Room. After the transfer, however, it appears that the narrative of safety may have been a fallacy, as a serious breach in safety is observed and the need for rapid-cycle quality improvement. In short, while many nurses are highly clinically competent, opportunities for analytical/critical thinking skills may be evident. This scenario thus focuses on promoting critical thinking and reflective thought to prevent such a highly dangerous scenario from reoccurring.

As for tips for educators, the mechanics of this unit thus provide opportunities to review the scenario within the framework of three key QSEN competencies (Teamwork/collaboration, quality improvement, and safety in that:

o Questions for group discussion are strategically inserted at the end of the case study and are intended to be discussed—with corresponding instructor/peer feedback—in a synchronous manner.

o Whether in the classroom or clinical setting, learners should be granted no prior access to the scenario but given approximately one-half hour to read it independently, with peer interaction followed by instructor-facilitated discussion immediately following.

o Following robust discussion, a written Reflective Journal assignment follows the exercise’s conclusion and should be prepared and submitted to the instructor prior to the next classroom/clinical, or staff development session. The Reflective Journal is completed asynchronously and thus gives students a more discrete format to present the thoughts they might not have felt comfortable sharing in a public forum.

Submitted Materials


Additional Materials

1). “Snitch, Snitch, Witch” Case study
2). Critical Reflection Journal Template
3). Faculty Tips Sheet: Therapeutic Communication
4). Psychotic Disorders: A Brief Overview

Evaluation Description

Post-Scenario Evaluative Questions

All involved ER staff are interviewed the next week as part of a Root Cause Analysis (RCA) performed by Quality Management.
Please project into this situation and imagine you are one of the ER nurses being interviewed. How would you respond to the following questions?
• How often do you receive patients from an individual provider’s office? Is this a relatively novel occurrence?
• Given the patient arrived undressed and wearing a gown, would you assume he had already been ‘wanded’ and his belongings searched/inventoried? (Obj. 1)
• Given the opportunity to review the entire scenario, is there a breakdown of teamwork/collaboration that ultimately impacted patient safety? (Obj. 1 and 2)
• What recommendations would you have for quality improvement to prevent this scenario from happening in the future? (Obj. 3)


Evaluation Description
1. Written instructor feedback as to evidence of analytical/critical thinking in Reflective Journal questions, each of which is tied to a learning objective/QSEN competency.
2. Student to peer and instructor to peer verbal feedback regarding evidence of affective development as tied to learning objectives/QSEN competencies in classroom sessions, clinical pre- or post-conference discussion, staff development, or any other group as facilitated by a nurse educator.