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Strategy Submission

Communication Picture Exercise


Carol F. Durham

Ed.D.(c.), RN


Director Clinical Education & Resource Center and Clinical Associate Professor



UNC-Chapel Hill School of Nursing


Competency Categories:

Safety, Teamwork and Collaboration

Learner Level(s):

Continuing Education, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN, Staff Development

Learner Setting(s):

Classroom, Skills or Simulation Laboratories

Strategy Type:

General Strategy

Learning Objectives:

This strategy is to develop the following Communication & Teamwork KSAs:

KSA category: Communication & Conflict Resolution: Knowledge: Discusses effective strategies for communication and resolving conflict Attitude: Contributes to resolution of conflict and disagreements. Skill: Initiate actions to resolve conflict.

KSA category: Effect of Team on Safety & Quality Knowledge: Understands the impact of effective team functioning on safety and quality of care. Attitudes: -Appreciated the risk associated with handoffs among providers and across transitions in care. -Discusses how authority gradients influence teamwork and patient safety. Skill: Asserts own position/perspective in discussions about patient care.

This strategy is to develop the following Safety KSAs: Knowledge: Discuss potential and actual impact of national patient safety resources, initiatives and regulations. Attitude: Value relationship between national safety campaigns and implementation in local practices and practice settings. Skills: Use of available resources Agency for Healthcare Research and Quality (AHRQ) for professional development and to focus attention on assuring safe practice.

Strategy Overview:

This exercise takes about 10 minutes, excluding debrief and is best used after the content about communication and shared mental model has been explained to the learner. It provides a cognitive break in the mist of content delivery. The exercise is helpful as an illustrative tip to drive home the key concept. Implementation Instructions: Ask the learners to pair up in dyads. Prior to the class you will have created packets of handouts. In each packet, you will need two different sets of the handout. It is important that you do not let the learners know there is a difference in the handouts. Prepare the packets and stack them in twos so that the different instructions can be handed out without the learners’ perceiving the slight of hand. Always put the picture on top, which hides that the instructions are different. Then hand one learner the instructions for picture I and the other person in the dyad instructions for picture II, each receives the same picture. Instruct them to carefully read their instructions and take a few minutes to fill out the sheet (allow approximately 2 minutes to complete this portion of the exercise). They can lay them side-by-side to identify the objects in the picture and they are not expected to be able to identify all objects listed on their list. The picture is deliberately abstract (insert picture link here). One set of instructions (insert Picture I instructions link here) directs the learner to view the picture from the point of view of a circus act and the second set of instructions directs the learner to view the picture from the point of view of ballroom dancing (insert Picture II instructions link here). Next ask them to share with each other (3 minutes each) what they have observed using SBAR as the format for communication (6 minutes total). Ask a select group of learners to share what they experienced (2 minutes). Examples of potential SBARs Situation-Background-Assessment-Recommendation (SBAR) Situation – We need a poster for advertising a circus act. Background – This is a draft. Assessment – I identify a seal, ball, trainer, etc. Recommendation – This seems to be an adequate draft. Situation-Background-Assessment-Recommendation (SBAR) Situation – We need a poster for advertising a ballroom dancing class. Background – This is a draft. Assessment – I identify a woman, a man bowing to her prior to the dance, etc. Recommendation – This seems to be an adequate draft for the poster They should then reconcile the differences they identify. They will begin to say show me where you saw a seal or a woman, etc. I did not see that. Debrief: Hone in on the dissonance experienced with two people coming from two points of view. Explain that you set this up by giving them two sets of instructions. Make the connection about how this is similar to patient care situations. One practitioner may listen to report and have one mental model of what to expect about a given patient. Another may have just completed an assessment or may be a nursing assistant who did not hear report but has other data that contributes to their mental model of the patient. Using SBAR as a communication technique they can come to a SHARED mental model which is when the patient care team shares what they know so that each of them can be on the same page as they proceed in the care of the patient avoiding errors that put the patient at risk. In isolation, it is possible for an individual team member to misinterpret cues or to place too much emphasis on one piece of information. Shared mental models are knowledge structures of the relevant facts and relationships about tasks or situation that the team is engaged in, and about the way the team members interact (Team Strategies & Tools to Enhance Performance & Patient Safety (TeamSTEPPS), Situation Monitoring p. 17).

Submitted Materials:

Additional Materials:

This file contains a jpg picture and a set of two intentionally different instructions for interpretation of the picture: Picture I and II.

You will find it helpful to order one free copy of the TeamSTEPPS multimedia curriculum kit. The Department of Defense and the Agency for Healthcare Research and Quality (AHRQ) have developed TeamSTEPPS “It is an evidenced-based program aimed at optimizing performance among teams of healthcare professionals – enabling them to respond quickly and effectively to whatever situations arise.” (TeamSTEPPS, Introduction, p.1). Order: AHRQ, PO Box 8547, Silver Spring, MD 20907 800-358-9296 ISBN 1-58763-192-X

Evaluation Description:

Evaluation – anecdotal

Learners have been expressed an “ah ha” moment when this strategy has been used. The importance of handoffs and of using SBAR when different team members have different information about the patient is highlighted. The importance of clear and concise communication is reinforced.

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