South Dakota State University Integrates TeamSTEPPS® Into College of Nursing Curriculum

Senior nursing students at South Dakota State University (SDSU) are using TeamSTEPPS® to learn how leadership and team skills can be relevant to clinical practice and how those skills affect patient safety and quality of care.

Haifa A. Samra, PhD, Assistant Professor of Nursing at SDSU, is trained as a TeamSTEPPS Master Trainer. She began using TeamSTEPPS in the classroom in 2008. Since then, she has introduced the concepts to approximately 950 students and 10 faculty members at the university. Students are introduced to and encouraged to use the AHRQ Web site throughout the semester to learn about other AHRQ resources and tools.

A modified TeamSTEPPS framework was used to organize the content of the leadership course, which is a capstone course taught to fifth-semester students at SDSU's College of Nursing. The course focuses on the four TeamSTEPPS competencies: leadership, situation monitoring, mutual support, and communication.

Samra says, "I refine the course every semester to reflect the current updates and student needs. The TeamSTEPPS video vignettes are used to teach students effective handoffs using a standardized format, including the mnemonic 'SBAR' (Situation-Background-Assessment-Recommendation) and 'I PASS the BATON.' A copy of 'I PASS the BATON' is posted on the course Web page, and students are encouraged to use it when practicing handoffs during their clinical experiences."

The three-credit course includes lectures, unfolding case studies, discussion, video vignettes and analysis, and simulation exercises. Students shadow a clinical leader in a practice setting and complete a reflection paper and a quality improvement project. The course helps students to:

• Incorporate patient preferences in managing high-quality care.
• Use practical and evidence-based strategies to build, lead, and sustain effective teams.
• Understand the relationship between effective leadership, teamwork, conflict management, communication, safety, and quality of care.

Students participate in a simulation exercise to apply what they learn using both a standardized patient and mannequins. TeamSTEPPS tools and strategies used in the simulation include briefing, huddle, debriefing, and "CUS" (I am Concerned; I am Uncomfortable; this is a Safety issue). The focus is on providing task assistance and managing conflict related to care decisions.

Unfolding case studies a teaching strategy in which a case is presented over a period of time are also used in the exercise. Students work in groups analyzing the case studies. The focus of the case studies is to manage personal conflict by using the "DESC" (D Describe the specific situation, E Express your concerns about the action, S Suggest other alternatives, and C Consequences should be stated) tool. Students learn to differentiate between personal conflict and decision-related conflict and how to advocate for a patient.

Feedback from students has been very positive, according to Samra. The majority of the students agree that using the simulation exercise enhances their understanding of their role and responsibilities as a leader/member of the health care team. Students are also more confident using standardized communication and reporting a patient situation or change in status to a physician after the activity. Students think the exercise is an excellent way of practicing leadership and teamwork and highly recommend the activity for future students.

The following is a summary of student feedback and quotes:

• Exercise taught me how to communicate in a critical situation, use SBAR, and be assertive while staying calm.
• Learned how to delegate and use team members appropriately in a critical situation.
• Helped me appreciate the importance of the leadership role and taking charge.
• Gave me an opportunity to practice critical thinking skills and problem solving.
• Helped me know my strengths and weaknesses.
• Learned how to use available resources.

Samra says, "My intention is to enhance students' understanding of the impact of their actions and decisions on patient safety. Those actions and decisions have far-reaching effects on patient outcomes and the overall quality of health care."