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The Lewis Blackman Story
Overview
Helen Haskell is the mother of Lewis Blackman, a 15-year-old boy who died in a hospital following routine surgery. The videos featured below were part of a lecture and interviews with Ms. Haskell recorded at the UNC-Chapel Hill School of Nursing in summer 2009.
Videos Part 1 and 2 present Lewis’s story and a patient/family perspective of lessons learned from a tragic outcome. Videos 3-5 include selected segments of an interview with Linda Cronenwett and the dialogue between Ms. Haskell and the audience following her lecture.
1. More About Helen Haskell
Helen Haskell is president of Mothers Against Medical Error, a South Carolina-

based group dedicated to improving patient safety and providing support for patients who have experienced medical injury. For Helen, patient safety is a calling to which she was brought by the death of her fifteen-year-old son Lewis, who died in the hospital following routine surgery. Following Lewis’s death, Helen helped create a coalition of South Carolina health professionals and consumers to pass the Lewis Blackman Act, aimed at addressing the conditions that led to Lewis’s death. Helen is a World Health Organization Patient Safety Champion and has served on patient safety advisory panels for a number of national organizations. She regularly addresses national groups of health professionals on the consumer perspective in patient safety.
In 2007, the Health Sciences South Carolina consortium named the first Lewis Blackman Professor of Patient Safety and Simulation, an endowed chair funded
by the state of South Carolina. In 2008, the South Carolina Hospital Association initiated an annual Lewis Blackman Award for champions of patient safety in South Carolina.
Ms. Haskell was closely involved in the passage of the 2006 South Carolina Hospital Infection Disclosure Act. She sits on the Hospital Infection Disclosure Act advisory committee and on the South Carolina Hospital Association Quality Council. Nationally, Helen is involved in a variety of initiatives involving such issues as health education reform, rapid response teams, disclosure of medical error, and informed consent.
Helen holds a BA in Classical Studies from Duke University, an MA in Anthropology from Rice University, and an M Phil in Museum Studies from the University of South Carolina. Her earlier career as an archaeologist included research and fieldwork in the United States, Europe, the Near East, and Africa.
2. Additional Information for Faculty
Helen Haskell has graciously given permission to use these Lewis Blackman videos for the education of students and health professionals worldwide. To each video segment, we have added questions that can be used to stimulate discussion or structure a written assignment.
The questions for Video A are designed to elicit learning about the signs and symptoms of septic shock – something Ms. Haskell wants every nursing and medical student to learn in order to reduce the likelihood of “failure to rescue” of someone else’s loved one in the future.
The questions for Videos B-E are designed to elicit learning about the QSEN competencies of patient-centered care, teamwork and collaboration, and safety.
Potential strategies for use of the Lewis Blackman story include:
Classroom Instruction
Show video segments in a lecture class and facilitate a class discussion on selected questions. UNC faculty members used this approach with a class of 88 BSN students and received positive feedback.
If you have a room layout that allows use of breakout groups, try allowing small group reaction/discussion time prior to full group discussion following each video segment.
If students have their own computers in the classroom, small breakout groups could be assigned to view one of the Videos C-E (all will have to view A and B to get the story), and small group discussions on assigned video segments and questions sets could be followed by opportunities to share insights with the total class following breakout time.
Online Instruction
Assign students to view all or selected video clips and reflect on the questions that accompany each.
Use one or more questions as the stimulus for asynchronous or synchronous discussions.
In a module aimed at developing knowledge skills and attitudes related to a specific QSEN competency, include video segments in the assignment, and select questions that are pertinent to the competency for a student-written assignment.
Simulation Lab
Develop a simulation scenario that focuses on elements of the Lewis Blackman story. Use it with students during weeks when classroom or clinical instructors are focusing on QSEN competency development and using the Lewis Blackman video clips and questions.
Use the simulation with students prior to introducing the Lewis Blackman videos, so that they are well equipped to answer the Video A question set.
Clinical Teaching
Be alert to student exposure to health care errors, poor teamwork, or lack of patient-centeredness while practicing on the patient care unit. When such issues surface, assign students to view the Lewis Blackman story prior to the next clinical teaching day. Facilitate discussion of questions/reactions in post-clinical conferences.
Ask students to view the Lewis Blackman videos at the beginning of a clinical rotation and reflect on the culture questions as they observe the communications among health care providers on the current patient care unit. They might provide responses in reflective journals or as part of a written assignment for the course.
Many other ideas for use of these videos will occur to you and your colleagues. We hope you will share the teaching strategies you develop and test by submitting them to the QSEN strategy collection.
3. BSN Student Responses to the Lewis Blackman Story at UNC-Chapel Hill
The Lewis Blackman Story – Student Feedback
UNC-Chapel Hill School of Nursing faculty members Denise Hirst and Shielda Rodgers showed Videos A-B of the Lewis Blackman Story to a class of BSN students and facilitated a large-group discussion using questions from the associated sets plus additional questions pertaining to leadership issues.
The faculty requested written, anonymous feedback at the end of this session, focused on this learning opportunity’s impact and value. This resulted in 38 student responses, all but one of which was positive (with that response addressing worry about being a “young, new nurse” if that was viewed as part of the problem that caused Lewis’s death). We have included below a few of the anonymous student responses that represented the predominant themes:
“This video was powerful. Take home message – believe the patient and the family. It’s not about the staff – it’s all about meeting the needs of the patient.”
“Extremely eye-opening, great video for nursing students to watch.”
“The video was very moving and a wake-up call for us new nurses to keep our eye on the ball: the patient’s condition. It was also very convincing in its plea for nurses to listen to their patients’ and families’ concerns and take them seriously and speak up and be assertive when necessary.”
“This video made me think and analyze how nurses need to really be attentive to what they are doing.”
“Movie makes me angry that all the child’s signs were missed and so many errors could error. The parents were lied to!”
“Had a major impact on me. Excellent video.”
“Had a very big impact. Great message.”
“How side effects of medicine are often treated casually by healthcare members when they are so important to patients really made me think and appreciate the perception of the patient. It was good to hear the perception of the patient’s family.”
“I think it’s very powerful and haunting and this should be shown to all nursing students.”
“Very helpful and memorable. I will never forget this.”
“I thought this was a very powerful video.”
“Great video! It had a huge impact on me!”
“Video-this was an excellent video that should be shown to all nursing students @ UNC.”
“Why did it take days to get new orders? Absolutely awful what happened to her son and the lack of care the one nurse provided!”
“Very powerful! Could be turned into a more interactive case studies with students working in groups and analysis of the case.”
“Wonderful; sad/ informative. More clips of patient presented cases will be helpful for improving quality of care.”
For suggested strategies on using these videos in your own teaching, see our section of information for faculty.
Videos
Each of the following videos includes a list of questions that can be used to stimulate discussion or structure a written assignment.
1. The Lewis Blackman Story
2. A Mother’s View of ‘Lessons Learned’
3. Patient-centered Care and Teamwork/ Collaboration
4. Disclosing Error and Accountability
5. Transparency and Courage
Part One: The Lewis Blackman Story
Why does Helen Haskell start her story by talking about Lewis?
What is Ketorolac (indications, side effects, normal dosages for 15 year old, risks and benefits)?
What was the significance of lack of urine output (to underlying problem, amount of Ketorolac, and need for fluids)?
What are possible reasons why health care providers dismissed implications of undetectable blood pressure? Why would they think it was equipment failure?
Do you agree that it was significant that Lewis’s crises developed on the weekend? Explain why or why not.
Lewis died from septic shock. Describe the incidence, signs/symptoms, and appropriate interventions for this problem.
Part Two: A Mother’s View of ‘Lessons Learned’
Create a list of the characteristics Helen Haskell ascribes to a “good” or professional nurse/physician.
When Helen Haskell says “patients need to be empowered and nurses need to embrace it”, how do you react to her suggestion?
What does Helen Haskell mean by “misplaced professionalism”?
In her story, did you think of other examples of “misplaced professionalism”?
What is professionalism in your view?
What is your reaction to Helen Haskell’s view that nurses need policy-level help to be empowered with respect to communications with physicians?
Part Three: Patient-centered Care and Teamwork / Collaboration
What factors in this hospital’s “teamwork” culture might have contributed to the lack of response to Lewis’s parents concerns?
How might this story have changed if patients and families were considered part of the health care team?
When Helen Haskell says she saw almost no evidence of teamwork, would you agree or not, and why?
How does the culture in hospitals in which you’ve worked compare to the culture described in Helen Haskell’s story?
What can health care professionals do to create a hospital culture that supports effective teamwork and patient-centered care?
Part Four: Disclosing Error and Accountability
What does professional accountability mean to you?
How do health professionals demonstrate:
A feeling of accountability for the reliability of the system in which they work
Lack of accountability for the reliability of the system in which they work
Helen Haskell describes nurses focused on task completion (including documentation of a plan of care) rather than on accurate assessment, application of knowledge, listening to patient and family, and action on the patient’s behalf. How accurate is her depiction of nursing care you have observed? In instances where you have made similar observations, what contributes to this “misplaced” work focus?
Describe what happens in your current health care setting if someone is involved in an error?
What errors happened in Lewis’s story?
Which of the errors you described were “system” errors? Which were errors that individuals committed? What distinguishes these categories in your view?
If you were a patient or family member in Helen Haskell’s situation, what would you have wanted to say to or hear from the “frontline” nurses and residents who provided Lewis’s care?
Part Five: Transparency and Courage
What is it about being a learner that can help prevent errors and adverse events?
What is it about being a learner that can increase the risk of errors/adverse events for patients?
What policies or safeguards could help protect patients and families from a health care team’s inability to recognize a developing problem?
Patients enter hospitals assuming that health professionals are watching for complications so that they can “rescue” patients. What factors detract from our effectiveness in making that true – reliably true – for every patient?
Helen Haskell has stated elsewhere, “We were in the only place in this country where Lewis’s father and I could not get help for our son…a hospital.” In any other location, she could have called “911”. How do health professionals justify this reality? What policies could eliminate the problem?
What are your ideas about patient empowerment and nurse empowerment in terms of the overall safety of our health care systems? When are the interests of patients and nurses in alignment? When are they not?
What kind of courage do you think Helen Haskell believes we need to prevent Lewis’s story from happening again?
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