TeamSTEPPS® Long-Term Care Instructor Guide
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- Advocacy and Assertion - Techniques for intervening when
your viewpoint does not match that of the decisionmaker.
- Adaptability - The ability to adjust strategies and alter
a course of action in response to changing conditions (internal or external).
- Brief - Discussion prior to start that assigns essential
roles, establishes expectations, identifies anticipated outcomes, and identifies likely contingencies.
- Call-Out - A tactic used to communicate critical information
during an emergent event. Call-outs help the team prepare for vital next
steps in resident care.
- Check-Back - A communication strategy that requires
verification of information. The sender initiates the message; the receiver
accepts it and restates the message. In return, the sender verifies that
the restatement of the original message is correct or amends it if not.
- Checklist - A list of items to be noted, checked, or
- Closed-Loop Communication/Information Exchange - The initiation
of a message by a sender, the receipt and verbal acknowledgment of the message
by the receiver, and the verification of the message by the initial sender.
- Coaching - The process of helping someone else expand
and apply his or her skills, knowledge, and abilities. Generally takes place
within a defined context, such as a specific task, skill, or responsibility.
- Collaboration - An approach to manage conflict that results
in a mutually satisfying solution that is in the resident's best interest.
- Communication - The process by which information is clearly
and accurately exchanged among team members.
- Crew Resource Management (CRM) - Encompasses a wide range
of knowledge, skills, and attitudes, including communications, situational
awareness, problem solving, decisionmaking, and teamwork, making optimum
use of all available resources (e.g., equipment, procedures, and people) to
promote and enhance efficiency of operations.
- Cross-Monitoring - The process of monitoring other team
members' actions against the standard or shared plan of care for the purpose
of sharing workload and reducing or avoiding errors.
- CUS - Signal phrases that denote "I am Concerned.
I am Uncomfortable. This is a Safety Issue." When these phrases are used, all team members
will understand clearly not only the issue but also the magnitude of the issue.
- Debrief - Brief, informal information exchange session
designed to improve team performance and effectiveness; after action review.
- DESC Script - A technique for managing and resolving conflict.
- Feedback - The transmission of evaluative or corrective
- Handoff - The transfer of information/knowledge along
with authority and responsibility among care providers at all levels of care
transitions and across the continuum of care.
- Huddle - Ad hoc planning to reestablish situation awareness;
designed to reinforce plans already in place and assess the need to adjust
- Human Factors - Human capabilities and limitations to
the design and organization of the work environment. Primarily attributed
to errors but also a consideration in the design of workflow and processes.
The study of human factors can help identify operations susceptible to human
error and improve working conditions to reduce fatigue and inattention.
- I PASS the BATON - A mnemonic used during handoffs to
facilitate a structured transition in care.
- I'M SAFE Checklist - A simple checklist that should be
used daily to determine both your co-workers' and your own ability to perform
- Leadership - The ability to coordinate the activities
of team members and teams by managing the resources available to team members
and facilitating team performance by communicating plans, providing information
about team performance through debriefs, and providing support to team members
- Mutual Support - Assessing and anticipating
other team members' needs through accurate knowledge about their responsibilities,
task load, and core capabilities and responding by shifting the workload among members
to achieve balance during high or low periods of workload or pressure.
- Mutual Trust - The shared belief that team members will
perform their roles and protect the interests of their teammates.
- Obstacles - Human behaviors that result from both personality
and attitude that prevent effective job performance. Obstacles are ever
present, requiring vigilant awareness to overcome them. Some examples of
- Excessive Professional Courtesy - Giving someone of
higher rank or status too much respect or deference so that it affects
the level of health care they receive as patients. May also occur among team members
having higher rank or status, resulting in a hesitancy of team members
to point out deficiencies in performance.
- Halo Effect - Occurs when someone else's "great" reputation
or extensive experience clouds our judgment.
- Passenger Syndrome - Team members experience "Passenger
Syndrome" ("just along for the ride") when they abdicate
responsibility, believing someone else is in charge.
- Hidden Agenda - When a team member makes suggestions
or decisions on information or desires of which the rest of the team
may be unaware. An example of hidden agenda is a strong desire to get
off work early or avoid a procedure in which they are poorly trained.
- Complacency - When individuals or teams become
comfortable with the most routine to the most difficult or critical tasks.
Becomes a hazard when individuals and teams lose their vigilance and
- High-Risk Phase - A procedure or time in which a medical
mishap is likely to happen (e.g., shift change).
- Task (Target) Fixation - A condition in which an individual's
or team's focus on a task may impair their decisionmaking or make
them oblivious to "the big picture." It is generally precipitated
by real or perceived pressure to perform or by workload or stress-related
- Strength of an Idea - An unconscious attempt to make
available evidence fit a preconceived situation. Once people get a
certain idea in their head, it can be difficult or impossible for them
to alter that idea no matter how much conflicting information is received.
- Hazardous Attitudes - Ways of thinking and viewing
the world (e.g., antiauthority, impulsiveness, invulnerability, machismo,
- Performance Monitoring - The ability of team members to
monitor each other's task execution and give feedback during task execution.
- Resident Care Team - Composed of the resident, caregivers,
and all staff within the nursing home.
- Resident-Centered Care - Also known as person-centered care, a philosophy that puts the needs, interests, and choices of residents at the center of care. It allows residents to exercise control and autonomy over their own lives, to the fullest extent possible. Evidence shows that giving residents a greater role in their care can improve their health.
- Root Cause Analysis (RCA) - A structured approach to investigation of undesirable events or outcomes to determine all the underlying causes of the event so that effective corrective or preventive actions may be developed. RCA focuses on weaknesses in systems and processes that may have diminished human performance.
- SBAR - A framework for team members to structure information
when communicating with each other (physician to physician, nurse to physician,
nurse to nurse, nurse to staff, nurse to resident).
- Shared Mental Model - An organizing knowledge structure
of relevant facts and relationships about a task or situation that are commonly
held by members of a team.
- Situation Awareness - The ability to identify, process,
and comprehend the critical elements of information about what is happening
to the team with regard to the mission (plan of care). Simply put, it is knowing
what is going on around you and what is likely to happen next—maintaining
mindfulness at all times.
- Situation Monitoring - The process of actively scanning
and assessing elements of the situation to gain information or maintain an
accurate awareness or understanding of the situation in which the team functions.
- STEP - A tool for monitoring the following elements of
the situation: Status of the resident, Team members, Environment, and Progress
toward the goal.
- Task Assistance - A form of mutual support, a team
behavior that protects individual members from work overload situations that may
reduce effectiveness and increase the risk of error.
- Team (Multi-Team System) - Each team within a multi-team
system is responsible for various aspects of resident care, requiring coordination
among them all to ensure quality resident care. A multi-team system is composed
of the following teams:
- Core Team - A group of caregivers who work interdependently
to manage a set of assigned residents from point of assessment to disposition.
- Coordinating Team - Members of a department/unit responsible
for managing the operational environment that supports the Core Team.
- Contingency Team - A time-limited team formed for
emergent or specific events and composed of members from various teams.
- Ancillary Services - Primarily a service delivery
team whose mission is to support the core team (e.g., lab, pharmacy).
- Support Services - Primarily a service-focused team
whose mission is to create efficient, safe, comfortable, and clean health care
environment (e.g., housekeeping).
- Administration - Includes executive leadership of
a unit or facility. They have overall responsibility and accountability
for the nursing home. They create the climate and culture in which a
teamwork system functions.
- Team Competencies - The attributes team members need to
perform successfully as a team. The three types of competencies that are
critical for effective teamwork include:
- Team Knowledge Competencies - The principles and concepts
that underlie a team's effective task performance. To function effectively
in a team, team members should know what team skills are required, when
particular team behaviors are appropriate, and how to manifest these
skills and behaviors in a team setting. Team members should also know
the team's mission and goals and be aware of one another's roles and
responsibilities in achieving them.
- Team Skill Competencies - A learned capacity to interact
with other team members at some minimal proficiency.
- Team Attitude Competencies - Internal states that
influence a team member's choices or decisions to act in a particular
way. Positive attitudes toward teamwork, a collective orientation, and
mutual trust among team members are critical to a successful team process.
- Team Orientation - The propensity to take others' behavior
into account during group interaction and the belief in the importance of
team goals over individual member goals.
- Team Self Correction - The process in which team members
engage in evaluating their performance and in determining the strategies
after task execution.
- Team Structure - The delineation of fundamentals (e.g.,
team size, team membership, team leadership, team identification, and team
- Transformational Change - The movement to place the needs, interests, and choices of residents at the center of care practices, which is also known as “culture change,” “resident-centered care,” “resident-directed care,” and “person-centered care.”
- Two-Challenge Rule - A strategy for asserting a concern
that results when clinical actions or a course of care differ from the agreed-on plan or usual procedure for the presenting event. The Two-Challenge rule
involves asserting the concern at least two times to ensure that it has been
heard. State the concern (first challenge), and if no response or discussion
occurs, rephrase and restate the concern (second challenge) to be certain
the challenge has been both heard and understood.
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