Enhancing Patient Safety and Professional Communication: Integration of Teamstepps Concepts in the Undergraduate Nursing Curriculum

This descriptive study involves the use of the principles of TeamSTEPPS® as a new and innovative method for teaching professional communication and teamwork skills to undergraduate nursing students in a baccalaureate nursing degree program.  TeamSTEPPS® (Strategies and Tools to Enhance Performance and Patient Safety) is an evidenced-based teaching/learning strategy aimed at healthcare providers and healthcare students.  TeamSTEPPS® education enhances the development of communication, leadership, and teamwork skills which are increasing needed in a complex healthcare system in which communication failures are associated with the majority of medical errors which often results in negative consequences for patients.  Improvement in these skills is linked to improved patient outcomes and enhanced safety in healthcare environments. The TeamSTEPPS® program is a national implementation model supported and advanced the U.S. Department of Health and Human Services Agency for Healthcare Research and Quality (AHRQ).  Increasingly, health professional education programs have been challenged to improve how they are preparing graduates for interprofessional collaboration in which communication and teamwork skills are essential for patient safety.  A number of studies have suggested that new graduate nurses lack effective interprofessional communication skills particularly with regard to communicating with physician and residents, managing conflict and delegation (Casey, Fink, Krugman & Propst, 2004; Dyess & Sherman 2009; Hartigan, Murphy, Flynn,& Walshe,2010; Theisen & Sandau, 2013).  

In order to better prepare new graduate nurses the traditional method of teaching communication skills was replaced with the TeamSTEPPS strategies and tools in order to heighten program focus on communication skills and to build teamwork skills needed for professional practice.  As part of this new initiative IRB approval was sought and received in order to study both the process and outcomes of the curricular integration in a systematic way. A descriptive design was employed to determine if using the TeamSTEPPS method enhanced nursing student competency in professional communication and teamwork and to monitor and assess the effectiveness of the curricular integration and the teaching/learning strategies employed.

A total of four cohorts of students are enrolled in the study (N = 250) with approximately 40-80 students per cohort. Cohorts were assembled based upon start date in the program with the goal of following each cohort from their first clinical course to graduation.  As part of the educational process students are asked to complete pre and post-assessment tools to measure attitudes towards collaboration and perceptions of inter-professional communication, knowledge of key concepts, and motivation to collaborate.  Students are also asked to self-report opportunities to participate in team communication in the clinical setting and are engaged in clinical simulations to build and evaluate skills. Faculty observes students in the clinical area and assesses their skill in implementing the TeamSTEPPS concepts in practice.

In order to effectively implement TeamSTEPPS faculty completed TeamSTEPPS training with some accomplishing master trainer status.  TeamSTEPPS constructs and tools were then mapped into the existing curriculum dividing the content across the four semesters of the program to ensure students were receiving content that was appropriate for their knowledge and experience level.  TeamSTEPPS education occurs in the classroom, laboratory, and clinical settings utilizing lecture, case study, video vignettes, discussion, role play, simulation with video-taping and journaling.   

Results from the TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ) pre-test suggest that students enter the nursing program with very positive attitudes towards teamwork and recognize the importance of communication to effective team functioning.   Over ninety- percent (90%) of students to date have achieved 100% on exam questions targeting TeamSTEPPs content  across various levels of the program suggesting that the teaching strategies employed have been effective in promoting student acquisition of TeamSTEPPS knowledge.  Faculty evaluation of student performance of TeamSTEPPS skills in the practice setting suggests that students have both opportunity to practice TeamSTEPPS skills and also are able to effectively utilize when opportunities arise.  Simulated activities in which TeamSTEPPS use is evaluated suggests that students excel in utilizing the communication tools of SBAR, Call-out and Check-Back but need further opportunities to practice being assertive and using the Two-Challenge Rule and CUS (Concerned, Uncomfortable, Safety-Issue) tools.  Students have reported examples of using TeamSTEPPS tools in the clinical setting and in many cases appear to have internalized the importance of interprofessional communication to patient safety.  For example, a first semester nursing student shared that while caring for her patient she realized that the attending physician was unaware of the patient’s history of chronic pain related to a back injury and was incorrectly associating the patient pain with a recent surgical procedure. The student related that she thought of her TeamSTEPPS training and realized she needed to share what she knew about the patient’s condition in order for the patient to receive the most appropriate care. 

This study is ongoing with additional cohorts in process; however our experience to date and the preliminary result of our study suggest that TeamSTEPPS enhances communication and teamwork skills in undergraduate nursing students.  We believe it is a model worthy of consideration for nursing programs searching for strategies to enhance student confidence, skill, and competence in interprofessional communication and collaboration skills.