In the November issue of The Journal of Continuing Education in Nursing, part one of this article outlined the background, literature review, and development of this academic partnership using TeamSTEPPS® training. In part two, the focus will be detailing the implementation, results, and implications of this resident safety academic collaboration in long-term care (LTC).
Starting in 2015, the course was taught to an interdisciplinary group of LTC staff composed of managers or supervisors, nurses, nursing assistants, social workers, secretaries, activity staff, environmental service workers, and therapists. The 6-hour training was held on the college campus. Six modules were implemented, including an introduction to LTC TeamSTEPPS, team leadership, team communication, situational monitoring, mutual support, and a synthesis component geared toward problem-solving teamwork and communication issues in their individual facilities. Each of the modules were presented in a coteaching format that encouraged collaboration among participants and modeled a teamwork approach to problem solving.
To begin, an ice breaker exercise was used to demonstrate the importance of team leadership and team communication as participants were instructed to create a chain using paper circles. First, the participants were placed into random groups and told to create a paper chain. After several minutes passed, the participants were allowed to pause and take a few moments to develop a plan before beginning again, introducing the TeamSTEPPS strategies of briefings and huddles. After a few more minutes, they were stopped again and allowed more time to modify their plan before proceeding. It was apparent through both the first and second pause that their effectiveness with the task at hand improved as evidenced by the creation of longer chains. The remainder of the training session included content and role-playing activities that reinforced various other communication strategies, situational monitoring techniques, and methods to promote task assistance through the use of mutual support. At the end of the training module, the group had learned communication tools for the LTC setting, reviewed tools to eliminate obstacles as identified at the onset of the class, and brainstormed opportunities for improvement to resident safety in their specific organizations.
From September to December 2015, the Academy for Leadership in Long-Term Care offered five TeamSTEPPS training modules for a total of 41 nursing and non-nursing staff from area LTC facilities. After each training class, attendees completed a qualitative survey that included identifying strategies that could be implemented in their facilities. The survey results identified an increased awareness of the need for open and improved communication, including providing feedback, listening through huddles, briefings, and SBAR (Situation, Background, Assessment, and Recommendation usage. In addition, most attendees indicated with enthusiasm that the staff huddle, briefings, and use of the SBAR can be immediately initiated in their respective workplaces.
In addition, an online retrospective pre- and post–5-point Likert survey was used starting in December 2015 (n = 10) to capture participants' responses to 16 questions. The questions focused on the Team-STEPPS strategies and were categorized into five subscales (Table). For each subscale, pre- and posttest mean scores were calculated. Due to the mean scores on the subscales not being normally distributed, the Wilcoxon signed rank test was used to test for changes in responses from the pretest to the posttest. The results of the Wilcoxon signed rank test indicated there were significant changes in all five subscales (Table). The changes were such that post-test self-report ratings of knowledge were higher than the pretest ratings, indicating change in the intended direction.
Results of the Wilcoxon Signed Rank Test Pre- and Postmedian Scores
This academic collaboration between a school of nursing and the Academy has resulted in a mutually beneficial training program that has the potential to impact resident safety. Seasoned nursing faculty who are familiar with both LTC and acute care and have experience teaching the TeamSTEPPS program, have been able to create a learning environment that facilitates a smooth transition of this new material. Many local LTC facilities already have in-place resident-care planning teams; however, the strategies learned while attending the 1-day workshop encourage all team members to improve their dialogue in a more effective way. This collaboration provided interdisciplinary staff with a scaffolding method to incorporate these important concepts into daily practice by encouraging an intentional, rehearsed response to resident safety situations.
It is essential to identify several champions utilizing the combination of a top-down-and-bottom-up approach to ensure that the work environment supports the TeamSTEPPS caring approach (Stewart, Manges, & Ward, 2015). An additional benefit to team training is when the staff has a voice and their ideas are recognized, retention and job satisfaction improve, resulting in a positive influence on residents (Tourangeau, Cranley, Spence, Laschinger, & Pachis, 2010). However, the key limitations of this study were the challenges in providing comprehensive training to all staff from one LTC facility. Due to budget constraints and staffing needs, not all staff from an LTC facility or organization were available to attend. Yet, the focus of each class was the dissemination of these strategies to all care team members to improve resident safety.
When considering the increase in the number of older adults, it is essential that we retain quality health care professionals who are trained and motivated to promote resident safety. The enthusiasm of participants to begin implementing the TeamSTEPPS tools and strategies in their facilities was evident and was a positive outcome for the training. In addition to the resident safety benefits of TeamSTEPPS in LTC, the program itself is also a readily available and cost-effective strategy for these facilities to use. In addition, the added benefit of having a professional collaboration with a local nursing college allows for the pooling of resources and a seamless educational initiative that has the potential to influence resident safety in one region of the United States.
- Stewart, G.L., Manges, K.A. & Ward, M.M. (2015). Empowering sustained patient safety: The benefits of combining top-down and bottom-up approaches. Journal of Nursing Care Quality, 30, 240–246. doi:10.1097/NCQ.0000000000000103 [CrossRef]
- Tourangeau, A., Cranley, L., Spence Laschinger, H.K. & Pachis, J. (2010). Relationships among leadership practices, work environments, staff communication and outcomes in long-term care. Journal of Nursing Management, 18, 1060–1072. doi:10.1111/j.1365-2834.2010.01125.x [CrossRef]
Results of the Wilcoxon Signed Rank Test Pre- and Postmedian Scores
|Subscale||Pretest Median||Posttest Median||p Value|
|Roles and responsibilities||3.00||4.50||.007|
|Assessment and monitoring||3.00||4.00||.005|