Minimizing Miscommunication: Using Simulation to Strengthen Communication in Nursing Education

Hilary Gamblin:

Hello, everyone. Thank you for joining today’s workshop about Using Simulation to Strengthen Communication Skills in Nursing Education. My name’s Hilary Gamblin. I’m a GoReact employee. And today I’ll be chatting with Dr. Stacie Hunsaker from Brigham Young University. Stacie, do you want to introduce yourself?

Dr. Stacie Hunsaker:

Yes. Thanks, Hilary. As Hilary mentioned, my name is Stacie. I have been a nurse for 34 years, this coming May, and 27 of those years have been as an emergency department nurse. So I’ve had my share of learning about communication and miscommunication and decided to move into the education world about nine years ago. I’ve been teaching full-time in a baccalaureate nursing program, but I continue to work at the bedside. My passion is simulation and I’m able to teach in our simulation lab and direct our simulation lab here at BYU. And I continue to work in our simulation lab at Intermountain Healthcare, where I continue to work as a nurse. And I love teaching students, and I feel that my ability to continue to practice just brings current real-life information to help my students prepare better. So I hope to share today some really valuable and valid information that’s will help you in real-life.

Hilary Gamblin:

Well, we are so excited that you’re joining us. Miscommunication is one of the number one causes for errors in nursing. So this is a crucial topic, and we’re just so pleased that you’re here with us today to discuss it. Before we dig in, let me kind of overview how we do these virtual events, how we do our GoReact workshops.

Hilary Gamblin:

So for the first 30 minutes or so, I will discuss with Stacie how she addresses miscommunication head on through simulation. And then after that, we’ll do a live Q&A session for about 10 to 15 minutes. So please submit any questions that you have to the Q&A feature on Chat in Zoom, the little feature there that says Q&A. And if you see a question that someone else has posted and you’d like that answered as well, you can actually vote for it.

Hilary Gamblin:

I’d also like to draw your attention to the Chat feature in Zoom. You actually have to click on it to in order for it to pop out. And so you can see everybody talking. I would suggest doing that because this is where attendees can discuss and share resources, ideas, personal information to connect after the workshop. A lot always happens in the Chat, so please be a part of that and get that to pop out so you can be part of it too.

Hilary Gamblin:

I think that is all of the basics for the event. We actually like to start off today’s workshop with a quick poll, just to get to know everyone a little bit better. The poll question is, do you use a communication framework like TeamSTEPPS in your nursing program? Oh, it looks like that question was cut off at the end. It was supposed to be nursing program. So we have, yes, we reinforce the framework throughout the program. Yes, we only introduce it, but don’t reinforce it throughout the program and then no. So those are the options. If you could go ahead and select that. And Fortunately, I don’t know if I can see the results. Stacie, can you see the results?

Dr. Stacie Hunsaker:

I cannot, I see the poll. It might be a surprise. Oh, somebody said they’re not seeing the poll clearly.

Hilary Gamblin:

Okay. Oh, I’m seeing [crosstalk 00:03:45].

Dr. Stacie Hunsaker:

Thank you.

Hilary Gamblin:

Okay. Yes. So 50% are saying no. So we have some people that are starting that have some structure to how they’re addressing this issue. And then about half of them really don’t have a framework to start with. So that’s perfect to understand where everybody’s coming from so we can tailor the information today to our audience better.

Hilary Gamblin:

The ultimate goal is that by the end of today’s workshop, you’ll leave with at least one new resource, idea or SIM scenario to strengthen communication and teamwork skills in your nursing program. So with that in mind, let’s get started.

Hilary Gamblin:

Stacie, speaking of TeamSTEPPS, your program decided to use TeamSTEPPS to provide a communication framework for your students. Just to set the stage here, especially for those who don’t have a framework or methodology like this. Could you explain why you decided to use TeamSTEPPS?

Dr. Stacie Hunsaker:

Yes, I will. Next slide please. This came about in our program approximately six years ago, and I was a fairly new faculty member and the deans and some leadership had determined there was a gap in our program related to consistency of teaching community, and it was problematic that it was being taught in some courses not ever reinforced. And there was not anything taught the same way throughout each semester. So students of course were getting communication foundation, but we were not measuring anything. And we noticed on surveys when students graduated, there was a big gap and students didn’t feel prepared to enter the clinical setting. So one of our leaders had been trained in TeamSTEPPS training.

Dr. Stacie Hunsaker:

And advantages of TeamSTEPPS, some of you may already know this, but it’s always a good reminder is it’s a free resource that’s available. It’s online. It was developed by the Agency for Healthcare Research and Quality and the Department of Defense. So if you will ever need information on TeamSTEPPS, it’s ahrq.gov is where you can find the information. So it’s a free online resources that provide training for you, training that you can share. The only limitation is that it’s not for any monetary gain. Nobody presents this and sells it as a way to enhance communication.

Dr. Stacie Hunsaker:

So we thought, “Well, it’s already there, it’s free.” Education is expensive and many of us don’t have large budgets. And it’s easily transferable. So for example, in our healthcare setting, I’m in Utah. One of our largest healthcare organizations uses a TeamSTEPPS platform called Zero Harm. But TeamSTEPPS is so transferable. It will work across many platforms. The concepts are the same. The communication principles are the same with some wording changes. So we felt like it would prepare our students wherever they practice throughout the United States. These concepts are sound, they’re pretty consistent, and it was really easy to transfer and all of the training resources and really the curriculum as much, or as little as you want to use is available free. The challenge is just your time to develop and make it fit for your program. So it seemed like a good fit. We had a small team that started, and that’s where the seed was planted.

Hilary Gamblin:

And your students complete a TeamSTEPPS course, but to really make those principles stick, reinforce and revisit them throughout the other courses, how do you thread TeamSTEPPS techniques and framework into the rest of the curriculum?

Dr. Stacie Hunsaker:

Yeah, next slide. So we learned that early on and I’ll share a little bit about the foundational course that our students learn about TeamSTEPPS. They’re introduced, we have a six semester program. Of course, this can be adjusted to any length of program that you have. I’ve seen it used ADM programs, undergraduate LPM programs, et cetera. So we learned that we couldn’t just teach these concepts first semester and then, “Good luck, you’re on your own.” There is so much depth in the materials that are provided by the AHRQ that we became master trainers, that helps some of the team become experts.

Dr. Stacie Hunsaker:

And then we developed the content based on what was already prepared. So you can see here, and I’m happy to share this with anybody who needs it. I know a slide’s sometimes difficult to read with the small writing, but we determined that we would fit the TeamSTEPPS curriculum that was available online into our program because there are phenomenal videos, games, interactive case studies that are already developed. So the educator doesn’t need to spend a lot of time putting this together. But we didn’t want them to have them say in second semester. And then they moved to third semester and they’re like, “Well, Dr. Himes already taught this. Why am I learning this exact same case study again?”

Dr. Stacie Hunsaker:

So this curriculum map that we created helped us determine where we were teaching what, which pieces of the curriculum we were using and where we would reinforce it. So really essential. We’ve learned that we need to revisit this every so often. This was developed a few years ago, and we have already learned now that some of it slides off as new faculty come in and faculty retire. So we need to work together as a faculty to ensure that we are teaching these concepts. And then it’s being threaded throughout our curriculum and not lost or not faded away because there’s so much content available, but communication is just foundational. That is so essential. We didn’t want to lose it just with regular curricular drift.

Hilary Gamblin:

Stacie, I know that you said that the slide looks small. For those of you that are participating, we will be sending out an email after the workshop is completed with a link to the recording and all the slides that we’re using today. So you can pull those up and start to analyze them and really dig in. So don’t worry. You will get those slides.

Hilary Gamblin:

Also, I want to stress right now that you do not have to use TeamSTEPPS as your program’s framework. It’s a great resource, but there are other methodologies and frameworks you can use. Today we just to talk about how she’s using TeamSTEPPS, but the real focus is on how she’s using simulation. Stacie’s using simulation to reinforce communication and teamwork skills. So Stacie, can you outline how you set up your communications lab course?

Dr. Stacie Hunsaker:

Yeah. Next slide please. So this is where it all began. We had a Communication Lab, fortunately, that was set up to be taught early on in our six semester program, a half credit course, and it was called Communication Lab. And this will be changing, so I want to reinforce that this is adaptable. We’ve had to fit some other things in our program but we are not going to lose TeamSTEPPS because it’s so essential.

Dr. Stacie Hunsaker:

So there was this course that was set up and with TeamSTEPPS, we didn’t have an extra full-time faculty member to take on this half credit course. So what we did that was really unique is we utilized peer teachers. So the faculty member who leads this course actually hires, it’s taught in the second semester. After he teaches a semester, he’ll hire third, fourth, fifth, and sixth semester students. And it’s just a rotating group of just one student from each semester. So he’s the faculty lead, but he allows them almost full control of the class. It’s pass, fail. The students love interacting with their peers and hearing from the students who are just a little bit older or more advanced than them, the realities of not just nursing school, but the realities of communication in healthcare.

Dr. Stacie Hunsaker:

So as you can see here, it’s set up as a 10-week course. They have a lot of lab time. Hilary mentioned, we use simulation to reinforce and teach this. And it’s essential because we put these students in small groups and they practice all of the concepts related to TeamSTEPPS and they learn it over and over. So by the time they move on from this found course, we don’t really revisit it. We expect them to use them. We review the names and the terminology, et cetera, but we expect them to know this and then just build upon this every semester.

Dr. Stacie Hunsaker:

So it’s an online class with lab sections and lab time, a lot of simulation. We use standardized patients who will come in and kind of push these students a little bit on their communication and the ability to have difficult conversations. We use the TeamSTEPPS online learning modules and case studies that are also enhanced with some of the faculty’s videos that built in are built-in, and a lot of just low-fidelity communication modules. So that peer teacher will have those interactions with those students, act as the provider and have a difficult conversation where the students have to respond to them. We also use reflective journals for their simulation post-simulation assignments, and they have an actual skills pass software. They have to be recorded and they’re reviewed by their peers themselves, and it’s all related to communication and TeamSTEPPS concepts.

Hilary Gamblin:

So specifically, I actually wanted to ask about this because research shows that miscommunication errors often occurs during Handoffs, particularly Handoffs. So you specifically created a simulation scenario that addresses Handoff communication. Could you share that scenario with us and the accompanying observation and reflection exercises?

Dr. Stacie Hunsaker:

Yes. Next slide please. So I’ll tell you… Well, this is the introduction slide about how important simulation is. So I’ll have you go to the next slide please.

Dr. Stacie Hunsaker:

When we began, and this has just been an ever evolving process. We started with a communication course, and we determined we have simulation labs throughout our entire curriculum. And we’d had almost no consistency, which seems ridiculous now, reviewing on how we used to do it. Everybody thought they were doing really well in their own course, but we realized, “We’re not using any consistent tools.” We know that our hospitals and our clinical partners have Handoff tools. They don’t all look alike. And Hilary, as you mentioned, they don’t have to look alike. The key is that you are using a consistent format for passing on information. So if I’m leaving shift, I’m giving report to the next nurse.

Dr. Stacie Hunsaker:

I have a consistent tool that will show me all the information that needs to be shared. And we learned that our students were not comfortable with this, and they didn’t have a tool. One instructor had a handmade tool. One student was using one they got from a preceptor at the hospital. We were all over the place. So we did a little digging. We found this tool, it’s called the SHARQ tool. So S-H-A-R-Q on the slides here, you can see what that stands for. It was developed for the American Association of Operating Room Nurses, and we just tweaked it a little bit to fit our needs. You can see this is pretty generic, but when the students move into labor and delivery simulations, there are a few little tweaks that we have made to that. We keep the same format, but they are then familiar with using a Handoff tool, so they don’t delete information in the report.

Dr. Stacie Hunsaker:

And on the back of that, we have the [inaudible 00:15:37] tool, which I think all of us are familiar with just to remind them those key concepts when communicating information to a provider, or a condition change. But it’s different than a Handoff report. So we learned something I thought was fascinating. We did a little pilot study with our students and students are new. Giving report is not second nature to them. And they of course, were a little nervous. However, we did a study where we recorded our simulations. We had student permission, we had an IRB protocol, et cetera, but the students were giving report to their fellow students. We had them pass off in a report in our regular simulation scenarios.

Dr. Stacie Hunsaker:

And then I had a student research assistant who actually went through and reviewed all of those simulations. We also provided the students with the questionnaire and we had students who gave report with the SHARQ Handoff tool, students who gave just writing notes down. And we learned really fascinating that students perceived that they were giving a quality Handoff report the same way without a written report, as well as with report. So these two groups of students who aren’t experts at giving report thought they were doing a great job. And then we showed the data and there were so many items missed. As you can see, we gave all of this information. And this is just common sense, but those who use the SHARQ tool hit many more of these items than those who did not. However, they both thought they did really, really well.

Dr. Stacie Hunsaker:

This is kind of eye opening because we know that omitting patient information in report jeopardizes safe patient care. And we feel that that’s so important to really ingrain in them during nursing school. So we provide these with every simulation. We ask them to please use this, and we also educate them, “This isn’t the only tool out there. You will see multiple tools. Ask your nurse, when you’re in the clinical setting to see what they use. Ask to use it with them.” So we want to expose this over and over, but it was pretty eye opening. Students just don’t know what they don’t know. And you think of the ramifications and the important information that could be missed by just leaving one of these items off. It was quite alarming to us.

Dr. Stacie Hunsaker:

So we like the tool. Is it the best tool out there? Not necessarily. There is a tool that is provided in the TeamSTEPPS curricula that is called I PASS the BATON. It’s another report format. It was a little long for our students. We trialed that. This just worked for us, but the suggestion is that you use a tool and you use it consistently throughout your program, so your students become comfortable with using a tool for Handoff communication.

Hilary Gamblin:

Fantastic. Along with the Handoff communication, you also created a TeamSTEPPS assignment that let students practice speaking up in a clinical setting. Can you share why you did this and what the scenario looks like?

Dr. Stacie Hunsaker:

Yeah, sure. Next slide please. Well, as we progressed in our journey with TeamSTEPPS, we learned a huge gap was that we were teaching these concepts, but we weren’t asking students to look for them in real-life. I think we were, but it also depended very much upon the comfort of their clinical faculty member. We hire adjuncts and we do try and train our adjuncts to TeamSTEPPS, but some weren’t really comfortable. So we learned that this was kind of falling off in the clinical setting and we thought, “Oh my gosh, this is low hanging fruit. We need to reinforce this in the clinical setting.” And we want to be consistent throughout their clinical rotations and have a similar assignment. So we already had the students use reflective journals, which is really common. I’m sure many of you use that.

Dr. Stacie Hunsaker:

We had a set up with prompts that they use for their regular reflective journaling. And then we asked them to please observe for TeamSTEPPS, communication, or lack thereof during their clinical shift. We asked them to do their regular reflective journal and just have line item. There is no minimum requirement. They can write two sentences if they want, but some really expanded. And we learned so much and I want to share a couple of those experiences. So we will give them prompts. As I mentioned, we teach that foundation of TeamSTEPPS principles in that first semester. But if there are a lot of prompts and there’s a lot of terminology, and this is my plug for the… There’s a TeamSTEPPS app. You can just search in your app store. It’s free, TeamSTEPPS 2.0. And we have our students have those apps on their phone. And you can just scroll through really quickly and it’ll remind you of the prompts.

Dr. Stacie Hunsaker:

So for example, we’ll put journal prompts. Watch for Call-Outs when you’re caring for your patient. Watch for SBAR, Handoffs, Check-Backs. Did anybody have to use the CUS tool? Are they briefing? Are they debriefing? They can write on any one of these multiple concepts.

Dr. Stacie Hunsaker:

I’ve had students who have written at the end of the day, “I didn’t notice anything.” And I thought, “No, no, no, it’s everywhere.” Whether it’s a lack thereof or it’s a good example. So we don’t let them get away that easily. But I want to share a couple of journal examples that are really meaningful. And I think we should expect more of our students and what they are able to do in the clinical setting. So one student wrote, and I’m going to provide two examples.

Dr. Stacie Hunsaker:

This one is pretty common where the students are scared, they’re nervous. They don’t consider themselves expert communicators, and they don’t feel knowledgeable enough to speak up, but TeamSTEPPS provides them with that foundation and those skills to know what to say and how to say it.

Dr. Stacie Hunsaker:

The student wrote, “I can be better at having confidence and also using TeamSTEPPS skills to speak up when necessary. Sometimes I lack the courage to be assertive during difficult times because I am intimidated as a student. I think I’ve improved as speaking up and doing patient teaching, but I can improve on my confidence. I shouldn’t doubt some of the training that I know and not be afraid to be assertive if something doesn’t look right, or if I’ve been taught something different. For example, I initially felt awkward asking my nurse when they said that the patient’s fluid IV drip rate was a certain number. I looked at the printed safety sheet by the patient’s bed, and I saw it was a different number. I felt silly bringing it up and wondered if somehow I was wrong. So I asked my nurse why the number was different on the safety card than what they had given us in report. My nurse was then able to call the physician and we were able to correct an error that entered into the computer. We were also able to make sure our patient had the right amount of fluid given. This was a powerful experience that showed me that it is important to speak up and be confident when something doesn’t look right.”

Dr. Stacie Hunsaker:

So just learning that it’s okay to speak up was a really important element for this student. And we have multiple journal entries. This was just a really simple one. But I want to share this second one because this was a brave student. Now I told you I’ve been a nurse for 34 years, and I still find it challenging to speak up sometimes, especially in certain environments. So I read this and I was so proud of a student. So TeamSTEPPS teaches multiple elements of miscommunication, but it also teaches students to be brave and be the patient advocate.

Dr. Stacie Hunsaker:

And this student wrote, “As the anesthesia team,” I will preface this patient was on labor and delivery. So the anesthesia team was placing an epidural for a laboring mother. She stated, “As the anesthesia team was packing up to leave, the husband started crying and asked why they wasted 30 minutes arguing with him while his wife was in pain the whole time. That really bothered me because I felt that rather than interrupting the husband and talking down to him for 30 minutes, they could have asked him why he was concerned about having an interpreter present. I followed the anesthesiologist into the hallway and asked if I could speak with him for a moment. I used the CUS strategy.” C-U-S, and if you know TeamSTEPPS, you know that. If not, I’ll ask you to look it up.

Dr. Stacie Hunsaker:

“I used the CUS strategy,” and she wrote in parentheses, “I cursed out the anesthesiologist! And I told him that I was concerned because of the way he spoke to my patient and her husband made me feel uncomfortable and that I felt it was handled in a very disrespectful manner. I told him that I understood he was frustrated by the couple’s resistance to using an interpreter, but instead of raising his voice and interrupting them, he could have asked them to clarify their concerns. And it would not have led to a long argument. I asked him to use that strategy in the future and try to speak more respectfully to people from other cultures. He thanked me for my feedback and I went back into the patient room and explained to them that he was not trying to be disrespectful, but he was legally obligated to have an interpreter present. And I apologized for the situation. And I promised that we would do all we could to make sure they had a comfortable and safe birth that fit within their cultural norms.”

Dr. Stacie Hunsaker:

I just wanted to applaud that student and these concepts were learned and practiced in simulation and learned throughout our course. So I thought that was a good success story.

Hilary Gamblin:

Those were fantastic. Thank you so much for sharing those. That’s really powerful that your students felt comfortable enough to advocate for their patients and to say something, that they thought something didn’t look right. Another passion that you have is immunization and it inspired another simulation scenario for you. Could you share the resources and SIM scenarios you use to help students discuss difficult topics with patients like vaccine hesitancy, which is a relevant topic?

Dr. Stacie Hunsaker:

Yes. Slightly, right? Next slide please. Well, yes. Thanks, Hilary. So this just springboards from that communication because as we have all been made painfully aware in the last two years, there have been more questions than ever, and probably more hesitancy than I don’t know ever. I’m not totally an expert, but it seems like very dramatic distrust in medical professions related to immunized.

Dr. Stacie Hunsaker:

So we actually started using this before the pandemic hit and it’s more important than ever now. So related to communication, nurses have such a key role in improving immunization rights, in educating the public. You can see here, a few key roles I listed, which are very minimal. We use our immunization simulation scenarios, not only for enhancing communication with families, with patients themselves, but also just practicing those skills. Do they know how to handle a vaccine? Do they know the proper administration? So we use it obviously for hands-on skills.

Dr. Stacie Hunsaker:

But we learned that we had a gap in our curriculum. We were teaching very isolated pediatrics simulation. We will teach about immunization schedules and you know there’s no way you can ever member all of those. We were teaching how to find them, but I don’t know that anybody ever felt an expert. And we realized we were not ever reinforcing or bringing immunization education to the adult setting. And that of course has been more important than ever recently. So we added immunization education to certain scenarios that were our already existing. I know, I would say all of us in our curriculum will say, “We don’t have enough time. How can I add one more thing?” So we actually added these to existing scenarios. We just plugged in an immunization piece.

Dr. Stacie Hunsaker:

The adult one for example, is in my course, my simulated patient is in the hospital setting, was admitted with congestive heart failure and is being discharged. So it’s an appropriate time to ask him about receiving an influenza vaccine. And of course the patient says, “No, I will never get that. I always get the flu from the vaccine.” So it provides the students an opportunity to do some really important teaching.

Dr. Stacie Hunsaker:

We provide them with prep SIM work. So they have this all learned in their head, how to respond to the patient, how to talk to the patient and family about vaccine hesitancy. And it really does prepare them for the real world because it’s… In our setting in Utah, most hospitals are offering immunizations upon discharge for adults. And so these students never had an opportunity to really learn how to talk to patients about it. As you can see, we do infant and adult also, and we enhanced family communication questions about immunization.

Dr. Stacie Hunsaker:

When we learned that we had a gap, it was like, “Okay, how do we fit one more thing into our program?” So I fortunately happened to be on a team and I’ll have you slip to the next slide here. I want to give you this slide that has a wealth of resources. So I’m on a committee that is joint with the Centers for Disease Control. It’s called the IRUN committee. You can see it stands for Immunization Resources for Undergraduate Nursing. These are free resources that these scenarios I told you, we have three simulation scenarios that are already laid out for you. There are case studies. There are questions. There are resources for faculty members, as well as students. If you know that you have a gap related to immunization education, communication scenarios, et cetera, this is already there for you. It’s continually updated by a team of nursing experts in conjunction with the Centers for Disease Control.

Dr. Stacie Hunsaker:

We’re trying to just get the word out to nursing faculty, in particular, that it’s available. Use it. You can use a little piece. There’s no guideline as far as what you use it for, but we developed the scenarios. We piloted them at Brigham Young University and they’ve been very successful. So those scenarios I told you about are on this website and feel free to use whatever you want from there. It’s an amazing resource and reduces your time creating education.

Hilary Gamblin:

Fantastic. Now I’m about to ask my last question. So if you’d like to submit a question for the live Q&A, now is a great time to go ahead and start doing that. Stacie, I’ve just been so impressed with all the resources. This is a great example, the IRUN, and technology that your program uses to prepare nursing students for clinical practice. Are there any other resources or tools that you would like to mention?

Dr. Stacie Hunsaker:

Yeah. Next slide please. Oh, I’m sorry. I didn’t have a slide for this. This is just the statistic. You can still look at that last slide because this is the why behind what we are doing here. We use, as I mentioned, the IRUN. In fact, I’ll have you flip back to that last slide. That’s the one I really wanted you to get. So the two free resources for you today are the IRUN scenarios, and I jumped a little bit ahead on this slide. I apologize. But this is the wealth of resources for you in addition to the ahrq.gov resources that have the TeamSTEPPS.

Dr. Stacie Hunsaker:

So two very different resources, but I know you educators are creative and flexible and you can look there and don’t get overwhelmed by the amount of information. Just know that you can use pieces that are helpful for you. I’m available for questions or email response any time too, if you have questions about how to use them. But I know you’re all really wise and probably very skilled educators. So two large banks of resources for you. And I’m sorry that slide’s a little funky. We can go to the next slide. It’s a better picture just to give you the why behind it while Hilary and I, are we waiting for your questions.

Dr. Stacie Hunsaker:

We are there to help our patients improve and get better and get healthy. Medical errors, this is just a statistic for a five-year period, but you can look anywhere online and find the medical error statistics are huge. And so we need to do our part and not scaring our students, but just preparing them to be safe and provide the best quality care and reducing medical errors. So these are just two helps. Two resources today, and hopefully some of the things I talked to you about will also help you.

Hilary Gamblin:

I also, and we’re going to add a couple links from GoReact to there. So you have those resources too. I know Stacie’s program mainly primarily just go after skills, checkoffs, but many nursing programs use GoReact for simulation and soft skills, and it’s a really helpful tool. And so since that’s been the topic of today, if you’re interested in how that works, we’ve provided a few links in the chat that show you, if you are GoReact users, how you can use GoReact to reinforce communication skills with simulation. So those are available as well.

Hilary Gamblin:

Okay. Again, Stacie, thank you so much for answering my questions. I’m sure your ideas have sparked some questions. So let’s take the next 10 or 15 minutes to do that live Q&A again, if you like to spin a question, it’s not too late. You can do it right now. It looks like we don’t have any questions right at the moment.

Dr. Stacie Hunsaker:

Comments, thoughts, ideas.

Hilary Gamblin:

Yeah, yeah. There were some that were answered that we were able to answer. Let’s see. Yeah, we have a lot of participants. I’m actually surprised that we don’t have any questions. Please, please discuss.

Dr. Stacie Hunsaker:

Don’t be shy.

Hilary Gamblin:

We’ll wait a few seconds here to see if anything pops up. Because normally we have some really great questions about the content that’s presented.

Dr. Stacie Hunsaker:

Yeah. Just my little plugin while we’re waiting for GoReact for using it for even these communication scenarios. It’s so helpful for students to be able to interact with each other, give pointers, review and learn from each other with the system. We use it in many ways, but we decided to use it for the ease of student use and student preference. They can just record things on their phone and submit it into our online system and then interact with each other or have a faculty member. It’s so easy. And there’s nothing like watching yourself communicate or not communicate very well as someone that you really learn a whole lot. We found that with our students.

Hilary Gamblin:

It looks like some of the questions are happening in the chat.

Dr. Stacie Hunsaker:

Oh, I see.

Hilary Gamblin:

One question is from Warren Crow and he says, “Do you use rubrics to evaluate your students communication skills?”

Dr. Stacie Hunsaker:

Good point. Thank you for that question. So I don’t teach the communication class, but yes they do, and I’m happy to share. When they get to my semester, I’m kind of midway through their program. When they are in a simulation group, we have half of the group watching them. We actually have an observation form. You could call it a rubric, but they’re watching for specific TeamSTEPPS concepts that are being taught. We don’t use it as a summative evaluation, but more a formative evaluation. So we use it for feedback in the debriefing. So it’s not a really formal tool after they get past that communications class. But yes, early on, they do have a rubric. And then we do evaluate it, but more for summative. I hope that answers your question. I can clarify if you need more.

Hilary Gamblin:

Fantastic. Looks like you answered that perfectly.

Dr. Stacie Hunsaker:

Teaching them how to speak up assertively. Yeah. And it’s not a once and done as hopefully that’s the message you’ve received is they have to practice this over and over. And I’m on the other end of the phone as the provider in that simulation many times. And I have been not treated well on the phone by providers sometimes. So I don’t want to scare them, but I ask them difficult questions and they have to respond appropriately. So we allow them to use those communication skills during their simulation scenarios. And then we all talk about it after in our debriefing, students watch each other and give each other feedback, which is also very helpful.

Hilary Gamblin:

Okay. This is a very quiet group. I actually have one follow-up question about reflections. How do you use reflections because your emphasis is simulation and I know simulation standards, while they’re set, they vary from program to program as far as how people are implementing it. How do you use reflection with your simulation?

Dr. Stacie Hunsaker:

Yeah, and this is good. And this is where I think educators can be creative. So in addition to TeamSTEPPS, we also want students to enhance and improve their critical thinking, their clinical judgment. So we use, in our program, a model called Tanner’s Clinical Judgment Model. So when students are debriefing and performing that scenario, we’re asking them not only TeamSTEPPS concepts, we have a little and again, I’m willing to share. We have on their observation form where they’re watching for TeamSTEPPS concepts, but they’re also using that clinical judgment piece and recording on that. So they have those that they’re actively using in the debriefing.

Dr. Stacie Hunsaker:

And then we have learned if we just let it go, it’s gone. But we ask them to write a little reflection piece. Students don’t love writing a lot. They want to just be done, but that reflecting on what they learned in simulation and that noticing, interpreting and communication, if they’ll just write about it, one paragraph or two paragraphs after that’s where we have that deeper learning. As you can see from our clinical piece, we also ask them to reflect just a little bit, not too much after, but after their simulation performance.

Dr. Stacie Hunsaker:

Whereas we use it as summative, not… Excuse me, formative. I keep interchanging those. Our graduate program uses more summative for simulation. We try to keep it really low stakes and a safe environment and maybe that’ll change someday, but right now it’s working for us.

Hilary Gamblin:

Now that we’ve answered those questions. I like to ask our guests to share with us three takeaways. So what would the three takeaways be for these people that are participating and that are watching in four months, in a year? What would you want them to remember, the three things you would want them to remember to improve communication and teamwork in their nursing program?

Dr. Stacie Hunsaker:

Well, can I answer a question really quickly, Hilary?

Hilary Gamblin:

Oh, yeah.

Dr. Stacie Hunsaker:

Somebody asked about the NCSBN’s CJMM as part of observation forms. Yes. We just did that this year. I don’t think our forms are perfect. We started to tie it in, but we’re going to keep that in our forms and adjust those and I can share what we have too. I’m happy to share. Yeah.

Hilary Gamblin:

Okay. Just to go back to that question. So what would be those three takeaways that people should think about if they want to improve communication and teamwork in their nursing programs?

Dr. Stacie Hunsaker:

Well, I hope and somebody has touched on this is using a structured program such as TeamSTEPPS really simplifies your work as a faculty member because the information is there, it’s a tool for you. You can use it in whatever way works for your program. It also helps to have a couple of different champions and just you writing this out throughout your program.

Dr. Stacie Hunsaker:

Number two, it doesn’t have to be difficult. We had some courses, we just implemented it into the course, but use what you have, use the elements that are already there to put into your existing curriculum. And simulation is a natural place to teach communication and speaking up and a safe place. So use that to reinforce and teach your communication skills.

Dr. Stacie Hunsaker:

And then third was, don’t assume that communication is being taught by someone else or somewhere else in your program. Encourage your program to analyze where it is being taught. Our map really helped us learn that where there were gaps, where we needed to push it in to certain areas. And it helps you determine where to initiate the teaching and where to reinforce it and really gives you more organized format. And everybody’s then consistent throughout your program.

Hilary Gamblin:

Stacie, thank you very much for sharing your expertise with us today. You did this workshop voluntarily and your schedule is crazy. You’re preparing to go out of the country for a project for a couple of weeks. And so we just are so grateful that you took the time to chat with us. And as a thank you for everyone that joined us live to show our appreciation, we have randomly selected one participant joining us live at the moment to win a pair of AirPod Pros. So congratulations to, I think we’ll probably put the winner in the chat here, Rose Harding. Rose Harding.

Dr. Stacie Hunsaker:

Awesome.

Hilary Gamblin:

We will be reaching out to you rose to get your AirPod Pros. We do these drawings in our workshops. So if you want a chance to win, just join us live. And we know, as I mentioned before, that these resources will be particularly valuable for you. So everyone that signed up will get an email with a link to today’s recording as well as the slide deck. So you can watch for those tools in your inbox.

Hilary Gamblin:

And then also if you enjoyed today’s workshop, we are hosting a free virtual conference for skills-based learning on April 20th and 21st. It will feature opening and closing keynote speakers, thought leadership breakout and sessions specifically for nurse educators on topics like competency-based and interprofessional education, AACN Essentials and more. So register now to be the first to hear about our speakers in the sessions when they’re announced in April. We are posting a link so you can register for that in the chat, but that is it for today. Thank you to our participants. Thank you to those who are working behind the scenes and making those slides work for us. And of course thank you to our guest, Dr. Stacie Hunsaker.

Dr. Stacie Hunsaker:

Thank you.

Hilary Gamblin:

We will see you next time.

Dr. Stacie Hunsaker:

Thank you. Thanks everyone.