Situation Monitoring: Classroom Slides

TeamSTEPPS Long-Term Care Version: Module 4

The Long-Term Care version of TeamSTEPPS adapts the core concepts of the TeamSTEPPS program to reflect the environment of nursing homes and other other long-term care settings such as assisted living and continuing care retirement communities. The examples, discussions, and exercises below are tailored to the long-term care environment.

Contents


 

Slide 1: Situation Monitoring

Text Description is below the image.

Image: A seal is trying to catch a penguin using fish as bait. The seal is thinking about eating the penguin, and the penguin is thinking about eating the fish.

"Attention to detail is one of the most important details ..."

—Author Unknown

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Slide 2: Objectives

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  • Define situation monitoring.
  • Define cross-monitoring.
  • Discuss the components of the STEP process.
  • Define situation awareness (SA), and identify conditions that undermine SA.
  • Discuss the importance of a shared mental model.
  • Discuss when to share information.
  • Recognize the barriers, tools, strategies, and outcomes of situation monitoring.

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Slide 3: Scenario

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  • Mary, a nursing home resident, falls while attempting to ambulate independently. She suffers a head laceration and a possible fractured hip. The nursing assistant, charge nurse, and supervisor all respond to Mary's call for help.
  • Diane, the supervisor, completes her assessment. She directs Ann, the nursing assistant, to retrieve 4x4 gauze from the treatment cart and Jerri, the charge nurse, to maintain c-spine precautions until EMS arrives. Noticing her confused expression, Diane tells Jerri, "Place one hand on each side of Mary's head and keep it in straight alignment with her spine."

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Slide 4: TeamSTEPPS

TeamSTEPPS logo. For details, go to [D] Text Description.

[D] Select for Text Description

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Slide 5: A Continuous Process

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Image: A circular process moves from Situation Monitoring (Individual Skill) to Situation Awareness (Individual Outcome), to Shared Mental Model (Team Outcome), and back to Situation Monitoring (Individual Skill).

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Slide 6: Situation Monitoring (Individual Skill)

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Process of actively scanning behaviors and actions to assess elements of the situation or environment.

  • Fosters mutual respect and team accountability.
  • Provides safety net for team and resident.
  • Includes cross-monitoring.

Remember, engage the resident whenever possible.

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Slide 7: Cross-Monitoring Is...

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Process of monitoring the actions of other team members for the purpose of sharing the workload and reducing or avoiding errors

  • Mechanism to help maintain accurate situation awareness.
  • Way of "watching each other's back".
  • Ability of team members to monitor each other's task execution and give feedback during task execution.

Mutual performance monitoring has been shown to be an important team competency.
(McIntyre and Salas, 1995)

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Slide 8: Cross-Monitoring

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Images: A penguin wearing scrub top says, “Hi, I’m here to change the dressing on your buttock.” A second penguin in scrub top is thinking, " That resident has C diff. The treatment nurse should be wearing precaution gear. Should I say something?" A photograph shows three female nurses with a male patient.

Select the penguin director icon below to access the video.

'Roll 'Em!' Play Video (icon: penguin film director)
Cross Monitoring (Flash video, 28 sec.; 5.7 MB) (Download Flash)

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Slide 9: STEP

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Image: The STEP diagram shows stacked ice blocks to show the components of situation monitoring on ascending levels.

Components of Situation Monitoring:

  • Status of the Resident.
  • Team Members.
  • Environment.
  • Progress Toward Goal.

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Slide 10: Status of the Resident

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Image: The STEP diagram shows stacked ice blocks to show the components of situation monitoring on ascending levels. The top level is Status of the Resident.

Status of the Resident

  • Resident History.
  • Vital Signs.
  • Medications.
  • Physical Exam.
  • Plan of Care.
  • Psychosocial Condition.

Select the penguin director icon below to access the video.

'Roll 'Em!' Play Video (icon: penguin film director)
STEP (Flash video, 49 sec.; 9.7 MB) (Plugin Software Help)

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Slide 11: Team Members

Text Description is below the image.

Image: The STEP diagram shows stacked ice blocks to show the components of situation monitoring on ascending levels. The second level is Team Members.

Team Members

  • Fatigue.
  • Workload.
  • Task Performance.
  • Skill Level.
  • Stress Level.

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Slide 12: I'M SAFE Checklist

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I = Illness

M = Medication

S = Stress

A = Alcohol and Drugs

F = Fatigue

E = Eating and Elimination

An individual team member's responsibility.

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Slide 13: Environment

Text Description is below the image.

Image: The STEP diagram shows stacked ice blocks to show the components of situation monitoring on ascending levels. The third level is Environment.

Environment

  • Facility Information.
  • Administrative Information.
  • Human Resources.
  • Acuity of Residents and Team Members’ Assignments.
  • Equipment.

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Slide 14: Progress Toward Goal

Text Description is below the image.

Image: The STEP diagram shows stacked ice blocks to show the components of situation monitoring on ascending levels. The fourth level is Progress Toward Goal.

Progress Toward Goal

  • Status of team's resident(s)?
  • Goal of team?
  • Tasks/actions that are completed or that need to be done?
  • Plan still appropriate?

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Slide 15: Situation Monitoring

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  • Recollect examples of situation monitoring, in which you needed to—
    • Be aware of what was going on.
    • Prioritize and focus on different elements of the situation.
    • Share this information with others.
  • Select one or two that best represent the concept of situation monitoring.
  • Share.

Exercise icon: Penguin on a stationary exercise bicycle.

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Slide 16: Situation Awareness Is...

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The state of knowing the current conditions affecting the team's work

  • Knowing the status of a particular event.
  • Knowing the status of the team's residents.
  • Understanding the operational issues affecting the team.
  • Maintaining mindfulness.

Image: A seal is trying to catch a penguin using fish as bait. The seal is thinking about eating the penguin, and the penguin is thinking about eating the fish.

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Slide 17: Conditions That Undermine Situation Awareness (SA)

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Failure to—

  • Share information with the team.
  • Request information from others.
  • Direct information to specific team members.
  • Include resident or family in communication.
  • Use resources fully (e.g., status board, automation).
  • Document.

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Slide 18: A Shared Mental Model Is...

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The perception of, understanding of, or knowledge about a situation or process that is shared among team members through communication.

"Teams that perform well hold shared mental models."
(Rouse, Cannon-Bowers, and Salas, 1992)

Image: Four penguins are standing around all talking about fish.

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Slide 19: Shared Mental Model?

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Image: Four people in a group are wearing hazard suits and masks and searching the ground. A fifth person in shorts and polo shirt stands by apparently unconcerned.

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Slide 20: Practical Exercise

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  • Gloria Valdez:
    • New admission.
    • 87 years old.
    • Dementia diagnosis.
    • Confused, anxious since admission.
    • Involved daughter.

Exercise icon: Penguin on a stationary exercise bicycle.

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Slide 21: How Shared Mental Models Help Teams

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  • Help ensure that teams know what to expect, so if necessary, can regroup to get on the "same page."
  • Foster communication to ensure care is synchronized.
  • Ensure that everyone on the team has a picture of what it should look like.
  • Enable team members to predict and anticipate better.
  • Create commonality of effort and purpose.

"Shared mental models help teams avoid errors that place patients at risk."

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Slide 22: What Do You See?

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Images: Three images of optical illusions with multiple interpretations are shown: an Indian chief�s face/standing Eskimo, an old woman/young girl, and a duck/rabbit.

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Slide 23: When to Share?

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  • Briefs.
  • Huddles.
  • Debriefs.
  • Transitions in Care.

... Share information as soon as possible when a change occurs in the resident's status.

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Slide 24: Situation Monitoring


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BARRIERSTOOLS and STRATEGIESOUTCOMES
  • Hierarchical Culture.
  • Lack of Resources or Information.
  • Ineffective Communication.
  • Conflict.
  • Time.
  • Distractions.
  • Workload.
  • Fatigue.
  • Misinterpretation of Data.
  • Failure To Share Information.
  • Brief.
  • Huddle.
  • Debrief.
  • STEP.
  • Cross-Monitoring.
  • Situation Awareness.
  • Shared Mental Model.
  • Adaptability.
  • Team Orientation.
  • Mutual Trust.

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Slide 25: Teamwork Actions

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  • Conduct team exercises to increase situation monitoring skills.
  • Share information in a timely fashion.
  • Include resident and/or family in communication.
  • Use cross-monitoring.
  • Apply the STEP process when monitoring the situation.
  • Foster communication to ensure that all members of the team have a shared mental model.
  • Share information during briefs, team huddles, debriefs, and transitions in care.

"Teams do not seek consensus; they seek the best answer."
—Katzenbach and Smith

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Page last reviewed November 2012
Internet Citation: Situation Monitoring: Classroom Slides: TeamSTEPPS Long-Term Care Version: Module 4. November 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/longtermcare/module4/slltcsitmonitor.html