Columbus State University Nursing Leadership Teamwork and Collaboration

Columbus State University Nursing Leadership Teamwork and Collaboration Columbus State University Nursing Leadership Teamwork and Collaboration NURSING LEADERSHIP TEAMWORK AND COLLABORATION When communication problems are analyzed, it is important to consider all of the process’s components: the sender, the message, the receiver, feedback, and the context. Assessment of communication should include these factors with the understanding that communication is rarely perfect. If you were a team leader, what might you routinely include in your assessment of the team’s communication? Develop a checklist of critical elements to assess. Explain why you chose these elements and the positive/negative impact on patient outcomes. (Use the discussion rubric located in the “Rubrics”) Must be 300 characters long. must use one citation published in the last 5 years. discussion_board_rubric_ada_approved_.pdf five_steps_to_providing_eff_ective_feedback_in_the_clinical_setting.pdf valuing_communication.pdf ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Discussion Board Rubric Criteria Criterion 1: Initial post on Wednesday by 12 MN (100 – 300 words) with critical thinking and reference. Remember Do not quote (if possible) on the discussion board. We want your analytical thoughts after reading the material. Criterion 2: Responded to at least 3 classmates by Sunday at MN (100 – 200 words) using critical thinking. No additional reference required Criterion 3: Stimulating further thought and discussion. Evidence of critical thinking (application, Level 5 25 points 25 points Level 4 20 points 20 points Level 3 15 points 15 points Level 2 10 points 10 points Level 1 0 Points 0 points Clear evidence of critical thinking (application, synthesis, and evaluation Some critical thinking evident Beginnings of critical thinking evident Poorly developed critical thinking evident Did not enter discussion 25 points 20 points 15 points 10 points 0 points Responded to 3 classmates Responded to 2 classmate Responded to 1 classmate Did not respond to any classmates Did not enter discussion 25 points 20 points 15 points 10 points 0 points Clear evidence of critical thinking (application, Some critical thinking evident Beginnings of critical thinking evident Poorly developed critical thinking evident Did not enter discussion Criteria analysis, synthesis and evaluation) Criterion 4: Properly cited reference in APA format American Psychological Association (APA) Manual Latest edition/ correct spelling and grammar Overall Score Level 5 25 points synthesis, and evaluation) Level 4 20 points Level 3 15 points Level 2 10 points Level 1 0 Points 25 points 20 points 15 points 10 points 0 points Clear evidence of APA use. Citation within 5 years. Must include at least one citation within the post and a corresponding reference at the bottom of the post in APA format. Perfect to 1 spelling and/or grammatical error Level 5 100 or more Cited in the summary and made a reference, but lacking proper format for APA. Two to four grammatical and/or spelling errors. Cited in the summary did not reference at the bottom of the summary. Five or more grammatical and/or spelling errors. Did not cite in the summary but did make reference. Ten or more grammatical and/or spelling errors. Did not cite in APA or older than 5 years Level 4 80 or more Level 3 60 or more Level 2 40 or more Level 1 0 or more Educational Innovations Five Steps to Providing Effective Feedback in the Clinical Setting: A New Approach to Promote Teamwork and Collaboration Cindy L. Motley, MSN, APRN, FNP-BC; and Mary A. Dolansky, PhD, RN ABSTRACT Background: Feedback is a major component of clinical education. Feedback reinforces or modifies behavior and helps learners to validate knowledge and feel motivated to learn. Traditionally, feedback is used by clinical educators who observe learners’ behavior and provide expert direction. Teamwork and collaboration is one of the six Quality and Safety Education for Nurses core competencies developed for prelicensure and graduate nurses. These skills are important in the current complex health care environment. Method: On the basis of the literature and prior experience, a new approach for clinical educators is using feedback to teach teamwork and collaboration skills. Results: Five steps educators can take to provide effective feedback in the clinical setting are to (a) create a culture of feedback, (b) use structured communication tools, (c) encourage dialogue, (d) acknowledge the human factor, and (e) embrace a leadership role. Conclusion: This new approach enhances feedback and teaches teamwork and collaboration. [J Nurs Educ. 2015;54(7):399-403.] Received: September 6, 2014 Accepted: March 6, 2015 Ms. Motley is Instructor of Nursing, and Dr. Dolansky is Associate Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Columbus State University Nursing Leadership Teamwork and Collaboration The authors have disclosed no potential conflicts of interest, financial or otherwise. Address correspondence to Cindy L. Motley, MSN, APRN, FNP-BC, Instructor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106-4904; e-mail: [email protected] doi:10.3928/01484834-20150617-08 Journal of Nursing Education • Vol. 54, No. 7, 2015 F eedback is a form of communication and is a crucial component of clinical education (Kaprielian & Gradison, 1998; van de Ridder, Stokking, McGaghie, & ten Cate, 2008). Indeed, feedback has been referred to as the cornerstone of effective clinical teaching, and empirical evidence has shown that it can significantly improve clinical performance (Cantillon & Sargeant, 2008; Eggen & Kauchak, 2007). Traditional clinical feedback must be expanded to meet the needs of the learner in the current complex health care environment, which demands interprofessional teamwork. The purpose of this article is to present an expanded approach to feedback that consists of the following five steps that educators can take to provide effective feedback in the clinical setting to teach teamwork and collaboration: (a) create a culture of feedback, (b) use structured communication tools, (c) encourage dialogue, (d) acknowledge the human factor, and (e) embrace a leadership role. This novel approach prepares students to effectively communicate and collaborate by providing and receiving feedback from other health care providers. Feedback is commonly described as information provided about a previous performance that is used as a basis for improvement (Archer, 2010; Dayton & Henriksen, 2007). A more comprehensive definition of clinical feedback identifies feedback as “Specific information about the comparison between a trainee’s observed performance and a standard, given with the intent to improve the trainee’s performance” (van de Ridder et al., 2008, p. 193). Both the behaviorism theory and the social learning theory emphasize the importance of positive feedback in modifying behavior and promoting learning (Eggen & Kauchak, 2007). Negative feedback is also essential for learning and is often the content of difficult conversations (Stone & Heen, 2014). For example, when feedback focuses on the individual, rather than the performance, it can be perceived as judgmental, critical, or controlling by the learner. Barriers to effective feedback in the clinical setting include unclear expectations and goals, no appropriate time or place for feedback to occur, and the tendency for a one-way flow of information from the educator to the learner (Archer, 2010). To be effective, feedback must be presented in a way that allows the learner not only to comprehend and accept feedback but also to know how to apply feedback in practice (Cantillon & Sargeant, 2008; Ramani & Krackov, 2012). Traditionally, providing feedback has been the task of the clinical educator (instructor or preceptor) who observes the 399 EDUCATIONAL INNOVATIONS learner’s (student or orientee) behavior and provides expert direction (Ramani & Krackov, 2012; van de Ridder et al., 2008). However, the current need is for both clinical faculty and students to use feedback-seeking behaviors to understand ways to improve effective teamwork and collaboration (Crommelinck & Anseel, 2013). Providing clinical instruction has become increasingly difficult for educators due to the current complex health care environment. Barriers to clinical education include diversity of settings, complexity of patient populations, limited clinical sites, and time constraints for teaching. Clinical groups may have as many as 10 students per clinical instructor, and preceptors are often undertrained (Cantillon & Sargeant, 2008; Clapper & Kong, 2012; Salas et al., 2009). The protection of professional standards, the self-esteem of students, and the rights and safety of patients must be priority considerations in any clinical learning experience (Archer, 2010). The Joint Commission recognized that breakdowns in communication were the leading root cause for sentinel events between 1995 and 2006 (World Health Organization, 2007). In response to the Joint Commission’s report, the National Patient Safety Goals were established to improve the effectiveness of communication and promote team training programs (American Society of Registered Nurses, 2008; Berg, Wong, & Vincent, 2010; Salas et al., 2009). Columbus State University Nursing Leadership Teamwork and Collaboration The Interprofessional Education Collaborative’s Expert Panel (2011) responded by recommending the continuous development of interprofessional competencies by health professions students as part of their learning. Teamwork and collaboration is one of the six Quality and Safety Education for Nurses core competencies for prelicensure and graduate nurses developed by the QSEN Institute (Barnsteiner, 2011). The provision and acceptance of feedback in the clinical educator–student dyad will help to develop the teamwork and collaboration skills needed in the current complex health care environment. Teamwork and Collaboration Skills Step 1: Create a Culture of Feedback To create a culture of feedback, educators must consciously embed feedback implicitly and explicitly into all clinical activities so that it is viewed as a normal, everyday component of the clinical experience and is conceptualized as a sequential process, instead of as a series of unrelated events (Archer, 2010). This begins with the clinical educator modeling a climate of mutual respect by ensuring that the goals and expectations of the clinical experience are clearly understood and embraced by the learner (Ramani & Krackov, 2012). The learner needs to understand that feedback will be given throughout the clinical day in multiple venues and from a variety of sources. Feedback can be provided in a reciprocal one-to-one method between the educator and the learner, but it can also be provided during facilitated group discussion or dialogue sessions with students, nursing staff, other health care providers, or patients. Effective feedback is a two-way interaction, and the learner is encouraged to provide feedback to the educator as well (Archer, 2010; Ramani & Krackov, 2012; van de Ridder et al., 2008). Surveys of learners’ preferences indicate that learners want feedback, but, although educators believe they are providing adequate feedback, it is often not what the learners themselves 400 perceive (Cantillon & Sargeant, 2008; Ramani & Krackov, 2012). Many educators find that providing feedback is an uncomfortable responsibility because they find it difficult to separate the task or performance from the individual learner (Cantillon & Sargeant, 2008). The educators may not know how to respond to the emotional reactions that can result when feedback is perceived by the learner as being negative or critical. Most individuals do not take kindly to criticism, even when it is offered as constructive criticism, because criticism in any form often comes across as being evaluative and judgmental, even if it is meant to be helpful. The key to providing feedback is to encourage the development of self-reflection, sometimes used interchangeably with self-assessment and self-efficacy, to help the learner understand certain events and accept feedback, with the aim of self-improvement (Stone & Heen, 2014). It is time for educators to take a cue from the current health care paradigm shift from a culture of error and blame to a culture of safety and encourage learners to review their experiences in a climate of shared learning, instead of shame, guilt, and punishment. This culture of safety creates an environment where it is more likely that good practice will be reinforced and poor practice will be corrected (Bates, n.d.; Cantillon & Sargeant, 2008). Students assigned to clinical groups are in the ideal position to learn team-building skills. A team is defined as two or more individuals who work toward a common goal and whose behaviors, cognitions, and attitudes combine to create an adaptive and interdependent performance (Weaver et al., 2010). The team becomes the structure for providing feedback and support. A team attribute is that no one particular person has all the answers, but through effective communication and collaboration, team performance can be improved and goals can be met. The team approach establishes a culture of feedback that encourages continual learning and improvement. For example, a student is given the opportunity to place a nasogastric tube in a patient. After reviewing the procedure and collecting the appropriate equipment, the student attempts to place the tube, but on the first few attempts it curls up in the patient’s mouth. The instructor makes several suggestions, and on the next attempt, the tube goes down the trachea instead of the esophagus. By this time the student is anxious, but the instructor facilitates the placement. Columbus State University Nursing Leadership Teamwork and Collaboration Afterwards, in a private setting, the student is encouraged to critique the experience from his or her perspective. The instructor then reviews the procedure and reinforces learning. However, feedback has only just begun. The next step is for the student to share the experience in the postclinical conference (debriefing). This gives the student an opportunity to acknowledge his or her feelings about what happened and share what was learned. In return, other students are able to share their experiences, ask questions, and provide support. The instructor’s role is to facilitate the team’s learning. Step 2: Use Structured Communication Tools Structured forms of communication used to provide feedback can enhance clarity, reduce ambiguity, and signal when action is required (Dayton & Henriksen, 2007). TeamSTEPPS® Copyright © SLACK Incorporated EDUCATIONAL INNOVATIONS is an evidence-based program developed in 2006 by the U.S. Department of Defense in collaboration with the Agency for Healthcare Research and Quality to improve communication and teamwork skills among health care professionals (Salas et al., 2009; U.S. Department of Health and Human Services, n.d.). It consists of four competencies—leadership, situation monitoring, communication, and mutual support. The program provides communication tools such as SBAR (Situation, Background, Assessment, Recommendation), call out, check back, briefing, debriefing, and huddle, which provide a standardized structure to improve the way health care providers communicate and function as part of a team (Clapper & Kong, 2012). The use of briefings, debriefings, and huddles ensures that appropriate time is provided for the feedback process to occur. For example, a morning briefing (traditionally referred to as the preclinical conference) provides an opportunity for educator and student alike to clarify questions such as, “What is the goal of the day?” “What is my role?” and “What are the expectations?” A student who is having difficulty interpreting a blood gas analysis for a patient in respiratory distress performs a call out, which is when the student asks the team (the clinical educator and other students) for help and identifies that the process of feedback needs to occur. A debriefing at the end of the shift (traditionally referred to as the postclinical conference) allows team members to reflect on the day’s challenges, acquire feedback from the other team members and educator, and answer the question, “What did I learn today?” (Shunk, Dulay, Chou, Janson, & O’Brien, 2014). By introducing students to structured communication tools and providing opportunities for practice, clinical educators can provide feedback and foster team building and a feeling of mutual support among students. Students must learn to give and receive feedback because it is essential for learning, adapting, and providing safe patient care (Dayton & Henriksen, 2007; Jones, Skinner, High, & Reiter-Palmon, 2013). Step 3: Encourage Dialogue Traditional clinical learning emphasizes skills checklists and summative evaluations, even though the American Nurses Association’s standards of nursing practice require that nurses solve problems, anticipate problems, analyze situations, and apply information (American Nurses Association, 2010). One of the responsibilities of an educator is to promote those higher order cognitive skills (Davidson, 2009). This requires a more complex interaction than what the sender-message receiverback to sender communication model depicts (van de Ridder et al., 2008). As a facilitator of feedback, the educator engages the learner in team discussion, leading to dialogue. No longer is feedback a one- or two-way flow of information, but it becomes multidirectional (Cantillon & Sargeant, 2008; Sargeant et al., 2011). Columbus State University Nursing Leadership Teamwork and Collaboration Dialogue occurs when individuals freely and creatively explore experiences, actively listen to each other, and set aside their own opinions and biases to explore options and find solutions to problems (Cowan & Arsenault, 2008). The educator leads the dialogue, following a format using the basic elements of feedback—describe what was observed (who, what, when, where, and how); relate how the behavior or scenario made them feel, being as specific as possible and avoid judgJournal of Nursing Education • Vol. 54, No. 7, 2015 ing or generalizing; and suggest alternative options or another action, behavior, or response based on evidence-based practice (Swihart, 2007). As a team, learners have access to a larger pool of knowledge, have a chance to ask questions and clarify what others are saying, and can reinforce their own knowledge or performance (Arnold, 2010). The next level of team communication is collaboration, which is a process of communication and joint decision making based on shared goals. Collaboration provides a basis and structure on which professional relationships develop (Cowan & Arsenault, 2008). For successful collaboration to occur, dialogue must first take place. Step 4: Acknowledge the Human Factor Again, it is time for nurse educators to take another cue from the current health care environment and recognize how human factors affect the safety and performance of students (Institute for Healthcare Improvement, n.d.). The concept of human factors in health care recognizes the relationship between human beings and the systems in which they function. It focuses on efficiency, creativity, productivity, and job satisfaction, with the goal of minimizing errors (World Health Organization, n.d.). The fundamental basis of human factors is that individuals observe and learn information through a process that is complex and influenced by many factors—both intrinsic and extrinsic. Intrinsic factors for the learner may include pride in work, self-motivation, and interest. Extrinsic factors may include grades, expectations of teachers, and the number of clinical hours required (Nasrin, Soroor, & Soodabeh, 2012; Vanderbilt University, n.d.). When providing or receiving effective feedback, the learner’s personality and temperament cannot be left out of the equation. It is equally important to consider the learner’s background and readiness to change behavior. Experienced clinical educators make the effort to learn the student’s perspectives and their reasons for a specific behavior (Ramani & Krackov, 2012). The emotions, content, and outcomes model takes into account the human factor in the feedback process, which was developed to help raise learners’ insight and self-awareness of their clinical and professional abilities (Krackov & Pohl, 2011). Step one focuses on acknowledging and exploring the emotional reaction to the feedback received. Step two aims to clarify the specific content of the feedback as it relates to the student’s actual performance. Step three seeks to confirm the student’s identified learning and development of an outcome plan to improve performance (Sargeant et al., 2011). Educators must recognize that students work within a complex health care system that co … Purchase answer to see full attachment Student has agreed that all tutoring, explanations, and answers provided by the tutor will be used to help in the learning process and in accordance with Studypool’s honor code & terms of service . 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Columbus State University Nursing Leadership Teamwork and Collaboration

Columbus State University Nursing Leadership Teamwork and Collaboration Columbus State University Nursing Leadership Teamwork and Collaboration NURSING LEADERSHIP TEAMWORK AND COLLABORATION When communication problems are analyzed, it is important to consider all of the process’s components: the sender, the message, the receiver, feedback, and the context. Assessment of communication should include these factors with the understanding that communication is rarely perfect. If you were a team leader, what might you routinely include in your assessment of the team’s communication? Develop a checklist of critical elements to assess. Explain why you chose these elements and the positive/negative impact on patient outcomes. (Use the discussion rubric located in the “Rubrics”) Must be 300 characters long. must use one citation published in the last 5 years. discussion_board_rubric_ada_approved_.pdf five_steps_to_providing_eff_ective_feedback_in_the_clinical_setting.pdf valuing_communication.pdf ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Discussion Board Rubric Criteria Criterion 1: Initial post on Wednesday by 12 MN (100 – 300 words) with critical thinking and reference. Remember Do not quote (if possible) on the discussion board. We want your analytical thoughts after reading the material. Criterion 2: Responded to at least 3 classmates by Sunday at MN (100 – 200 words) using critical thinking. No additional reference required Criterion 3: Stimulating further thought and discussion. Evidence of critical thinking (application, Level 5 25 points 25 points Level 4 20 points 20 points Level 3 15 points 15 points Level 2 10 points 10 points Level 1 0 Points 0 points Clear evidence of critical thinking (application, synthesis, and evaluation Some critical thinking evident Beginnings of critical thinking evident Poorly developed critical thinking evident Did not enter discussion 25 points 20 points 15 points 10 points 0 points Responded to 3 classmates Responded to 2 classmate Responded to 1 classmate Did not respond to any classmates Did not enter discussion 25 points 20 points 15 points 10 points 0 points Clear evidence of critical thinking (application, Some critical thinking evident Beginnings of critical thinking evident Poorly developed critical thinking evident Did not enter discussion Criteria analysis, synthesis and evaluation) Criterion 4: Properly cited reference in APA format American Psychological Association (APA) Manual Latest edition/ correct spelling and grammar Overall Score Level 5 25 points synthesis, and evaluation) Level 4 20 points Level 3 15 points Level 2 10 points Level 1 0 Points 25 points 20 points 15 points 10 points 0 points Clear evidence of APA use. Citation within 5 years. Must include at least one citation within the post and a corresponding reference at the bottom of the post in APA format. Perfect to 1 spelling and/or grammatical error Level 5 100 or more Cited in the summary and made a reference, but lacking proper format for APA. Two to four grammatical and/or spelling errors. Cited in the summary did not reference at the bottom of the summary. Five or more grammatical and/or spelling errors. Did not cite in the summary but did make reference. Ten or more grammatical and/or spelling errors. Did not cite in APA or older than 5 years Level 4 80 or more Level 3 60 or more Level 2 40 or more Level 1 0 or more Educational Innovations Five Steps to Providing Effective Feedback in the Clinical Setting: A New Approach to Promote Teamwork and Collaboration Cindy L. Motley, MSN, APRN, FNP-BC; and Mary A. Dolansky, PhD, RN ABSTRACT Background: Feedback is a major component of clinical education. Feedback reinforces or modifies behavior and helps learners to validate knowledge and feel motivated to learn. Traditionally, feedback is used by clinical educators who observe learners’ behavior and provide expert direction. Teamwork and collaboration is one of the six Quality and Safety Education for Nurses core competencies developed for prelicensure and graduate nurses. These skills are important in the current complex health care environment. Method: On the basis of the literature and prior experience, a new approach for clinical educators is using feedback to teach teamwork and collaboration skills. Results: Five steps educators can take to provide effective feedback in the clinical setting are to (a) create a culture of feedback, (b) use structured communication tools, (c) encourage dialogue, (d) acknowledge the human factor, and (e) embrace a leadership role. Conclusion: This new approach enhances feedback and teaches teamwork and collaboration. [J Nurs Educ. 2015;54(7):399-403.] Received: September 6, 2014 Accepted: March 6, 2015 Ms. Motley is Instructor of Nursing, and Dr. Dolansky is Associate Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Columbus State University Nursing Leadership Teamwork and Collaboration The authors have disclosed no potential conflicts of interest, financial or otherwise. Address correspondence to Cindy L. Motley, MSN, APRN, FNP-BC, Instructor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106-4904; e-mail: [email protected] doi:10.3928/01484834-20150617-08 Journal of Nursing Education • Vol. 54, No. 7, 2015 F eedback is a form of communication and is a crucial component of clinical education (Kaprielian & Gradison, 1998; van de Ridder, Stokking, McGaghie, & ten Cate, 2008). Indeed, feedback has been referred to as the cornerstone of effective clinical teaching, and empirical evidence has shown that it can significantly improve clinical performance (Cantillon & Sargeant, 2008; Eggen & Kauchak, 2007). Traditional clinical feedback must be expanded to meet the needs of the learner in the current complex health care environment, which demands interprofessional teamwork. The purpose of this article is to present an expanded approach to feedback that consists of the following five steps that educators can take to provide effective feedback in the clinical setting to teach teamwork and collaboration: (a) create a culture of feedback, (b) use structured communication tools, (c) encourage dialogue, (d) acknowledge the human factor, and (e) embrace a leadership role. This novel approach prepares students to effectively communicate and collaborate by providing and receiving feedback from other health care providers. Feedback is commonly described as information provided about a previous performance that is used as a basis for improvement (Archer, 2010; Dayton & Henriksen, 2007). A more comprehensive definition of clinical feedback identifies feedback as “Specific information about the comparison between a trainee’s observed performance and a standard, given with the intent to improve the trainee’s performance” (van de Ridder et al., 2008, p. 193). Both the behaviorism theory and the social learning theory emphasize the importance of positive feedback in modifying behavior and promoting learning (Eggen & Kauchak, 2007). Negative feedback is also essential for learning and is often the content of difficult conversations (Stone & Heen, 2014). For example, when feedback focuses on the individual, rather than the performance, it can be perceived as judgmental, critical, or controlling by the learner. Barriers to effective feedback in the clinical setting include unclear expectations and goals, no appropriate time or place for feedback to occur, and the tendency for a one-way flow of information from the educator to the learner (Archer, 2010). To be effective, feedback must be presented in a way that allows the learner not only to comprehend and accept feedback but also to know how to apply feedback in practice (Cantillon & Sargeant, 2008; Ramani & Krackov, 2012). Traditionally, providing feedback has been the task of the clinical educator (instructor or preceptor) who observes the 399 EDUCATIONAL INNOVATIONS learner’s (student or orientee) behavior and provides expert direction (Ramani & Krackov, 2012; van de Ridder et al., 2008). However, the current need is for both clinical faculty and students to use feedback-seeking behaviors to understand ways to improve effective teamwork and collaboration (Crommelinck & Anseel, 2013). Providing clinical instruction has become increasingly difficult for educators due to the current complex health care environment. Barriers to clinical education include diversity of settings, complexity of patient populations, limited clinical sites, and time constraints for teaching. Clinical groups may have as many as 10 students per clinical instructor, and preceptors are often undertrained (Cantillon & Sargeant, 2008; Clapper & Kong, 2012; Salas et al., 2009). The protection of professional standards, the self-esteem of students, and the rights and safety of patients must be priority considerations in any clinical learning experience (Archer, 2010). The Joint Commission recognized that breakdowns in communication were the leading root cause for sentinel events between 1995 and 2006 (World Health Organization, 2007). In response to the Joint Commission’s report, the National Patient Safety Goals were established to improve the effectiveness of communication and promote team training programs (American Society of Registered Nurses, 2008; Berg, Wong, & Vincent, 2010; Salas et al., 2009). Columbus State University Nursing Leadership Teamwork and Collaboration The Interprofessional Education Collaborative’s Expert Panel (2011) responded by recommending the continuous development of interprofessional competencies by health professions students as part of their learning. Teamwork and collaboration is one of the six Quality and Safety Education for Nurses core competencies for prelicensure and graduate nurses developed by the QSEN Institute (Barnsteiner, 2011). The provision and acceptance of feedback in the clinical educator–student dyad will help to develop the teamwork and collaboration skills needed in the current complex health care environment. Teamwork and Collaboration Skills Step 1: Create a Culture of Feedback To create a culture of feedback, educators must consciously embed feedback implicitly and explicitly into all clinical activities so that it is viewed as a normal, everyday component of the clinical experience and is conceptualized as a sequential process, instead of as a series of unrelated events (Archer, 2010). This begins with the clinical educator modeling a climate of mutual respect by ensuring that the goals and expectations of the clinical experience are clearly understood and embraced by the learner (Ramani & Krackov, 2012). The learner needs to understand that feedback will be given throughout the clinical day in multiple venues and from a variety of sources. Feedback can be provided in a reciprocal one-to-one method between the educator and the learner, but it can also be provided during facilitated group discussion or dialogue sessions with students, nursing staff, other health care providers, or patients. Effective feedback is a two-way interaction, and the learner is encouraged to provide feedback to the educator as well (Archer, 2010; Ramani & Krackov, 2012; van de Ridder et al., 2008). Surveys of learners’ preferences indicate that learners want feedback, but, although educators believe they are providing adequate feedback, it is often not what the learners themselves 400 perceive (Cantillon & Sargeant, 2008; Ramani & Krackov, 2012). Many educators find that providing feedback is an uncomfortable responsibility because they find it difficult to separate the task or performance from the individual learner (Cantillon & Sargeant, 2008). The educators may not know how to respond to the emotional reactions that can result when feedback is perceived by the learner as being negative or critical. Most individuals do not take kindly to criticism, even when it is offered as constructive criticism, because criticism in any form often comes across as being evaluative and judgmental, even if it is meant to be helpful. The key to providing feedback is to encourage the development of self-reflection, sometimes used interchangeably with self-assessment and self-efficacy, to help the learner understand certain events and accept feedback, with the aim of self-improvement (Stone & Heen, 2014). It is time for educators to take a cue from the current health care paradigm shift from a culture of error and blame to a culture of safety and encourage learners to review their experiences in a climate of shared learning, instead of shame, guilt, and punishment. This culture of safety creates an environment where it is more likely that good practice will be reinforced and poor practice will be corrected (Bates, n.d.; Cantillon & Sargeant, 2008). Students assigned to clinical groups are in the ideal position to learn team-building skills. A team is defined as two or more individuals who work toward a common goal and whose behaviors, cognitions, and attitudes combine to create an adaptive and interdependent performance (Weaver et al., 2010). The team becomes the structure for providing feedback and support. A team attribute is that no one particular person has all the answers, but through effective communication and collaboration, team performance can be improved and goals can be met. The team approach establishes a culture of feedback that encourages continual learning and improvement. For example, a student is given the opportunity to place a nasogastric tube in a patient. After reviewing the procedure and collecting the appropriate equipment, the student attempts to place the tube, but on the first few attempts it curls up in the patient’s mouth. The instructor makes several suggestions, and on the next attempt, the tube goes down the trachea instead of the esophagus. By this time the student is anxious, but the instructor facilitates the placement. Columbus State University Nursing Leadership Teamwork and Collaboration Afterwards, in a private setting, the student is encouraged to critique the experience from his or her perspective. The instructor then reviews the procedure and reinforces learning. However, feedback has only just begun. The next step is for the student to share the experience in the postclinical conference (debriefing). This gives the student an opportunity to acknowledge his or her feelings about what happened and share what was learned. In return, other students are able to share their experiences, ask questions, and provide support. The instructor’s role is to facilitate the team’s learning. Step 2: Use Structured Communication Tools Structured forms of communication used to provide feedback can enhance clarity, reduce ambiguity, and signal when action is required (Dayton & Henriksen, 2007). TeamSTEPPS® Copyright © SLACK Incorporated EDUCATIONAL INNOVATIONS is an evidence-based program developed in 2006 by the U.S. Department of Defense in collaboration with the Agency for Healthcare Research and Quality to improve communication and teamwork skills among health care professionals (Salas et al., 2009; U.S. Department of Health and Human Services, n.d.). It consists of four competencies—leadership, situation monitoring, communication, and mutual support. The program provides communication tools such as SBAR (Situation, Background, Assessment, Recommendation), call out, check back, briefing, debriefing, and huddle, which provide a standardized structure to improve the way health care providers communicate and function as part of a team (Clapper & Kong, 2012). The use of briefings, debriefings, and huddles ensures that appropriate time is provided for the feedback process to occur. For example, a morning briefing (traditionally referred to as the preclinical conference) provides an opportunity for educator and student alike to clarify questions such as, “What is the goal of the day?” “What is my role?” and “What are the expectations?” A student who is having difficulty interpreting a blood gas analysis for a patient in respiratory distress performs a call out, which is when the student asks the team (the clinical educator and other students) for help and identifies that the process of feedback needs to occur. A debriefing at the end of the shift (traditionally referred to as the postclinical conference) allows team members to reflect on the day’s challenges, acquire feedback from the other team members and educator, and answer the question, “What did I learn today?” (Shunk, Dulay, Chou, Janson, & O’Brien, 2014). By introducing students to structured communication tools and providing opportunities for practice, clinical educators can provide feedback and foster team building and a feeling of mutual support among students. Students must learn to give and receive feedback because it is essential for learning, adapting, and providing safe patient care (Dayton & Henriksen, 2007; Jones, Skinner, High, & Reiter-Palmon, 2013). Step 3: Encourage Dialogue Traditional clinical learning emphasizes skills checklists and summative evaluations, even though the American Nurses Association’s standards of nursing practice require that nurses solve problems, anticipate problems, analyze situations, and apply information (American Nurses Association, 2010). One of the responsibilities of an educator is to promote those higher order cognitive skills (Davidson, 2009). This requires a more complex interaction than what the sender-message receiverback to sender communication model depicts (van de Ridder et al., 2008). As a facilitator of feedback, the educator engages the learner in team discussion, leading to dialogue. No longer is feedback a one- or two-way flow of information, but it becomes multidirectional (Cantillon & Sargeant, 2008; Sargeant et al., 2011). Columbus State University Nursing Leadership Teamwork and Collaboration Dialogue occurs when individuals freely and creatively explore experiences, actively listen to each other, and set aside their own opinions and biases to explore options and find solutions to problems (Cowan & Arsenault, 2008). The educator leads the dialogue, following a format using the basic elements of feedback—describe what was observed (who, what, when, where, and how); relate how the behavior or scenario made them feel, being as specific as possible and avoid judgJournal of Nursing Education • Vol. 54, No. 7, 2015 ing or generalizing; and suggest alternative options or another action, behavior, or response based on evidence-based practice (Swihart, 2007). As a team, learners have access to a larger pool of knowledge, have a chance to ask questions and clarify what others are saying, and can reinforce their own knowledge or performance (Arnold, 2010). The next level of team communication is collaboration, which is a process of communication and joint decision making based on shared goals. Collaboration provides a basis and structure on which professional relationships develop (Cowan & Arsenault, 2008). For successful collaboration to occur, dialogue must first take place. Step 4: Acknowledge the Human Factor Again, it is time for nurse educators to take another cue from the current health care environment and recognize how human factors affect the safety and performance of students (Institute for Healthcare Improvement, n.d.). The concept of human factors in health care recognizes the relationship between human beings and the systems in which they function. It focuses on efficiency, creativity, productivity, and job satisfaction, with the goal of minimizing errors (World Health Organization, n.d.). The fundamental basis of human factors is that individuals observe and learn information through a process that is complex and influenced by many factors—both intrinsic and extrinsic. Intrinsic factors for the learner may include pride in work, self-motivation, and interest. Extrinsic factors may include grades, expectations of teachers, and the number of clinical hours required (Nasrin, Soroor, & Soodabeh, 2012; Vanderbilt University, n.d.). When providing or receiving effective feedback, the learner’s personality and temperament cannot be left out of the equation. It is equally important to consider the learner’s background and readiness to change behavior. Experienced clinical educators make the effort to learn the student’s perspectives and their reasons for a specific behavior (Ramani & Krackov, 2012). The emotions, content, and outcomes model takes into account the human factor in the feedback process, which was developed to help raise learners’ insight and self-awareness of their clinical and professional abilities (Krackov & Pohl, 2011). Step one focuses on acknowledging and exploring the emotional reaction to the feedback received. Step two aims to clarify the specific content of the feedback as it relates to the student’s actual performance. Step three seeks to confirm the student’s identified learning and development of an outcome plan to improve performance (Sargeant et al., 2011). Educators must recognize that students work within a complex health care system that co … Purchase answer to see full attachment Student has agreed that all tutoring, explanations, and answers provided by the tutor will be used to help in the learning process and in accordance with Studypool’s honor code & terms of service . 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