By: Bethany Robertson (@bdrclo), Rebekah Chance-Revels (https://www.linkedin.com/in/rebekah-chance-revels-a81391208/) and Deena Gilland (@DeenaGilland)
I had the privilege of creating a nursing doctoral-level course from scratch this semester entitled “Interprofessional Partnerships”. The overall course objectives were handed to me, but I was tasked with creating course modules with objectives, readings, and assignments. I was joined by two amazing co-faculty, who were, like me, more grounded in practice than academia. While I have had two distinctive and long careers in both academia and practice, my co-faculty have spent most of their professional years in the practice setting.
Why that matters?
We wanted the course to be more about practical application versus academic theory. While we included theory, specifically the science behind teamwork from noteworthy articles by Edward Salas (include article link), we also infused some very practical application readings and assignments that mapped nicely to the new AACN Essentials and IPEC Competencies. The other reason “this matters” is because of the movement towards competency-based education. In CBE, you begin with the end in mind, asking what I want this person to be able to do. It is “behavior-based forward” and is an entirely new way of approaching education. Once you determine the desired outcome you back into assignments, readings, and objectives. Then you crosswalk the course to the AACN Essentials. This is called backward design. I will share a few of our assignments and how they support this model. I will then show how one assignment met our intended goals.
Crucial Conversations.
As seasoned practitioners and leaders, we now understand one of the most challenging activities is having a high-stakes conversation. While we have the topic of communication thread throughout our entire curriculum, we wanted to focus on a particular type of communication—one that has been self-identified as a difficult one. Below is our mapping based on our “end in mind”.
Behaviors we wanted to see:
Learners can use an evidence-based framework, construct and deliver a crucial conversation.
Objectives of the module:
- Appreciate the role of feedback in individual development.
- Utilize techniques to conduct crucial conversations and provide feedback.
Course Objective:
- Evaluate communication tools and techniques that facilitate discussion and interactions to enhance team function grounded in team dynamics and culture change.
Assignments:
- Read the Crucial Conversations Book
Identify a crucial conversation you need to have or could have, write an outlined your approach and then record a short (5-7 minute) video recording of yourself having the conversation. Video can be with a partner simulating what your actual conversation would be or with the actual stakeholder(s). Submit both your outline and your video.
Video should include:
- Stated topic of crucial conversation and key stakeholder(s) you will be talking with (de-identify actual names).
- Utilization of crucial conversation key principles and techniques.
- Move to Action identified.
- Summary of your own self-reflection and critique of the conversation (can use domains from Style Under Stress Test and Coaching for Crucial Conversations table in text).
AACN Essentials Domain/Competencies:
- Domain 6: Interprofessional Partnerships
- 6.1 Communicate in a manner that facilitates a partnership approach to quality care delivery.
- 6.1l Demonstrate capacity to resolve interprofessional conflict
- 6.1 Communicate in a manner that facilitates a partnership approach to quality care delivery.
- Domain 2: Person-Centered Care Descriptor
- 2.2 Communicate effectively with individuals.
- 2.2g Demonstrate advanced communication skills and techniques using a variety of modalities with diverse audiences.
- 2.2j Facilitate difficult conversations and disclosure of sensitive information
- 2.2 Communicate effectively with individuals.
IPEC Competencies:
Domain: Communication
- C2. Use communication tools, techniques, and technologies to enhance team function, well-being, and health outcomes.
- C4. Promote common understanding of shared goals.
- C5. Practice active listening that encourages ideas and opinions of other team members.
- C6. Use constructive feedback to connect, align, and accomplish team goals.
- C7. Examine one’s position, power, role, unique experience, expertise, and culture towards improving communication and managing conflicts.
Evaluation:
We have created a rubric to evaluate not only the write up but the performance as it relates to the simulated conversation in the video submission. The rubric is linked to the behaviors we want to see as well as the objectives.
Organizational Team Analysis
As individuals in our doctoral program matriculate to their new roles, they will be expected to interface in teams in different ways. Of course, being part of a team is crucial to their clinical practice, but they will also find themselves in leadership positions and will need to objectively evaluate how well the team is performing and develop plans to strengthen teams. Therefore, we utilized backward design to create an assignment.
Behaviors we wanted to see:
Learner can reflect on team dynamics, assess functionality of the team, and create a plan to address dysfunctions.
Objectives of the module:
Outline the key components to a successful team.
Course Objective: Design interprofessional partnerships across stakeholder groups using best practices and performance-based models for structuring and sustaining partnerships.
Assignments:
- Read The Five Dysfunctions of a Team
- Identify a team, you have recently been a part of; it can be within your work environment, sports, or related to your academic program. Us the Team Assessment on page 191 in the book to evaluate your team. Using Professional APA format in a 3-page paper address the following:
- Describe the team: purpose/goal, context, individuals, number, and any other characteristics that helps provide the reader with a clear understanding of the team.
- Describe the dysfunctions you identified within the team relative to the Five Dysfunctions of a Team Model. Address how these dysfunctions impacted performance. Give examples.
- Select one dysfunction and describe strategies you’d use to address the dysfunction.
- Describe how you’d anticipate this intervention would positively affect the team’s dynamics.
AACN Essentials Domain/Competencies:
- Domain 6: Interprofessional Partnerships
- 6.2g Integrate evidence-based strategies and processes to improve team effectiveness and outcomes.
- 6.2h Evaluate the impact of team dynamics and performance on desired outcomes.
- 6.2i Reflect on how one’s role and expertise influences team performance.
- 6.2j Foster positive team dynamics to strengthen desired outcomes.
IPEC Competencies:
- Domain: Communication
- TT1. Describe evidence-informed processes of team development and team practices.
- TT2. Appreciate team members’ diverse experiences, expertise, cultures, positions, power, and roles towards improving team function.
- TT3. Practice team reasoning, problem-solving, and decision-making.
- TT4. Use shared leadership practices to support team effectiveness.
- TT5. Apply interprofessional conflict management methods, including identifying conflict cause and addressing divergent perspectives.
- TT6. Reflect on self and team performance to inform and improve team effectiveness.
- TT7. Share team accountability for outcomes.
- TT8. Facilitate team coordination to achieve safe, effective care and health outcomes.
Evaluation:
We have a rubric to evaluate to the extent to which the student was able to successfully analyze the team and create an improvement strategy. Below is an excerpt that shows the analysis aspect.
In grading this assignment, the issue that seems to be most frequently addressed is fear of engaging in conflict. At that heart of this is the team’s lack of trust which hinders their ability to participate in constructive conflict. Here is an excerpt from a student’s assignment illustrating the point.
Our team communication is limited due to strong fears of offending or displeasing other
members. Specifically, our ineffective communication patterns have reduced our team cohesion,
and had negative impacts on our team morale. These are issues because effective communication
is essential to ensure patient safety….When our team avoids conflict, our members are withholding
important patient care concerns that can lead to errors or gaps that compromise patient care.
Furthermore, fear of conflict has, at times, created an extremely stressful work environment. This
is because I have often felt that I cannot express my thoughts openly or honestly, leading to
stress, burnout, and dissatisfaction with the job. Ultimately, if these communication issues are
not addressed, our team is at an increased risk for critical patient care issues like risks for adverse
events or complications within the procedure room, or medical errors afterwards.
While taking a backward design approach initially feels very different, when you think about it, it is exactly the way we should be thinking about educating the next generation of healthcare professionals: start with “what do we want them to be able to do” when they are in practice.
“To begin with the end in mind means to start with a clear understanding of your destination. It means to know where you’re going so that you better understand where you are now and so that the steps you take are always in the right direction.”
photo courtesy of IStock
Authors:
Bethany Robertson, DNP, CNM, FNAP, Clinical Professor, Nell Hodgson Woodruff School of Nursing, Emory University
Rebekah Chance-Revels, DNP, WHNP-BC, CPH, CPPS, CPHQ, Senior Instructor, Nell Hodgson Woodruff School of Nursing, Emory University
Deena Gilland, DNP, RN, NEA-BC, FAAN, Senior Instructor, Nell Hodgson Woodruff School of Nursing, Emory University