Author: Deborah Struth, MSN, RN
Title: Associate Director
Institution: Univeristy of Pittsburgh Medical Center Shadyside School of Nursing
Coauthors: Wendeline Grbach, MSN, RN, CCRN; Lizabeth Vincent, MSN, RN; Joyce Heil, MSN, RN and Cari Simpson, MSN, RN
Safety, Teamwork and Collaboration
Clinical Setting, Skills or Simulation Laboratories
Teamwork and Collaboration:
K = Describe strategies for identifying and managing overlaps in team member roles and accountabilities.
S = Solicit input from other team members to improve individual, as well as team performance.
S = Function completely within own scope of practice as member of the health care team.
A = Value teamwork and the relationships upon which it is based.
K = Delineate general categories of errors and hazards in care.
S = Demonstrate effective use of strategies to reduce risk of harm to self or others.
A = Appreciate the cognitive and physical limits of human performance.
First level students are introduced to crew resource management (CRM) principles in all four level one nursing courses. One of these principles is situation awareness, which is taught in Introduction to Nursing Practice Strategies (N102) via the 60 Second Situational Assessment. The purpose and directions to students are outlined on the attached tool. The assessment is taught in the laboratory practice section of the course and practices during clinical and during high fidelity human patient scenarios (HFHPS) which were developed around the concept of “noticing”. The clinical faculty assigns each student one patient and gives the student up to 60 seconds to complete the Situation Assessment, at the same time the faculty completes the assessment on the patient. Findings between student and faculty are compared. After each individual assessment is completed, the instructor brings together all students, and each presents their situational assessments in SBAR format. The faculty facilitates a briefing using their assessment data to determine priorities for the student nurse “patient care team”.
Two cohorts of students (198 total) were divided into a study and a control group. The Wednesday clinical groups were not taught the situation assessment, but were given the CRM content and the Friday clinical groups were taught and practiced the 60 Second Situational Assessment over 12 weeks. In the final week (16) of the course, all students were taken to the simulation lab to participate in problem oriented HFHPS which were designed around patient/environmental observation or noticing. Students in the study groups initiated key assessments or interventions seconds to minutes faster that the control group. When N102 HPHFS data was compared to third level student nurse performance around time to assessment and intervention in the simulation lab, the third level students – who had neither CRM nor situation awareness education – did not engage or “notice” as quickly as either the control or study group.
Faculty and student satisfaction with this assessment tool is high and the tool has been adapted to the second level student and a prototype tool around Situational Assessment for Maternal Newborn Nursing is in development.
Please note this evaluation was developed as a performance improvement rapid cycle test of change using PI approaches.