{"id":151,"date":"2021-09-30T16:02:50","date_gmt":"2021-09-30T16:02:50","guid":{"rendered":"https:\/\/pressbooks.ccconline.org\/accnursing2030\/chapter\/7-6-teams-and-teamwork\/"},"modified":"2025-02-18T18:43:02","modified_gmt":"2025-02-18T18:43:02","slug":"7-6-teams-and-teamwork","status":"publish","type":"chapter","link":"https:\/\/pressbooks.ccconline.org\/accnursing2030\/chapter\/7-6-teams-and-teamwork\/","title":{"raw":"7.6 Teams and Teamwork","rendered":"7.6 Teams and Teamwork"},"content":{"raw":"Now that we have reviewed the first three IPEC competencies related to valuing team members, understanding team members\u2019 roles and responsibilities, and using structured interprofessional communication strategies, let\u2019s discuss strategies that promote effective teamwork. The fourth IPEC competency states, \u201cApply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan, deliver, and evaluate client\/population-centered care and population health programs and policies that are safe, timely, efficient, effective, and equitable.\u201d<sup>[footnote]Interprofessional Education Collaborative. <em>IPEC core competencies<\/em>. <a href=\"https:\/\/www.ipecollaborative.org\/ipec-core-competencies\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ipecollaborative.org\/ipec-core-competencies<\/a>[\/footnote]<\/sup> See the following box for the components of this IPEC competency.\n<div class=\"textbox shaded \">\n\n<strong>Components of IPEC\u2019s Teams and Teamwork Competency<\/strong><sup>[footnote]Interprofessional Education Collaborative. <em>IPEC core competencies<\/em>. <a href=\"https:\/\/www.ipecollaborative.org\/ipec-core-competencies\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ipecollaborative.org\/ipec-core-competencies<\/a>[\/footnote]<\/sup>\n<ul>\n \t<li style=\"font-weight: 400\">Describe the process of team development and the roles and practices of effective teams.<\/li>\n \t<li style=\"font-weight: 400\">Develop consensus on the ethical principles to guide all aspects of teamwork.<\/li>\n \t<li style=\"font-weight: 400\">Engage health and other professionals in shared client-centered and population-focused problem-solving.<\/li>\n \t<li style=\"font-weight: 400\">Integrate the knowledge and experience of health and other professions to inform health and care decisions, while respecting client and community values and priorities\/preferences for care.<\/li>\n \t<li style=\"font-weight: 400\">Apply leadership practices that support collaborative practice and team effectiveness.<\/li>\n \t<li style=\"font-weight: 400\">Engage self and others to constructively manage disagreements about values, roles, goals, and actions that arise among health and other professionals and with clients, families, and community members.<\/li>\n \t<li style=\"font-weight: 400\">Share accountability with other professions, clients, and communities for outcomes relevant to prevention and health care.<\/li>\n \t<li style=\"font-weight: 400\">Reflect on individual and team performance for individual, as well as team, performance improvement.<\/li>\n \t<li style=\"font-weight: 400\">Use process improvement to increase effectiveness of interprofessional teamwork and team-based services, programs, and policies.<\/li>\n \t<li style=\"font-weight: 400\">Use available evidence to inform effective teamwork and team-based practices.<\/li>\n \t<li style=\"font-weight: 400\">Perform effectively on teams and in different team roles in a variety of settings.<\/li>\n<\/ul>\n<\/div>\nDeveloping effective teams is critical for providing health care that is client-centered, safe, timely, effective, efficient, and equitable.<sup>[footnote]Interprofessional Education Collaborative Expert Panel. (2011). <em>Core competencies for interprofessional collaborative practice: Report on an expert panel.<\/em> Interprofessional Education Collaborative. <a href=\"https:\/\/ipec.memberclicks.net\/assets\/2011-Original.pdf\" target=\"_blank\" rel=\"noopener\">https:\/\/ipec.memberclicks.net\/assets\/2011-Original.pdf<\/a>[\/footnote]<\/sup> See Figure 7.5<sup>[footnote]\u201c<a href=\"https:\/\/www.shutterstock.com\/image-photo\/team-multiracial-doctors-hospital-discussing-patient-400845937\" target=\"_blank\" rel=\"noopener\">400845937-huge.jpg<\/a>\u201d by<a href=\"https:\/\/www.shutterstock.com\/g\/UberImages\" target=\"_blank\" rel=\"noopener\"> Flamingo Images<\/a> is used under license from<a href=\"https:\/\/www.shutterstock.com\/\" target=\"_blank\" rel=\"noopener\"> Shutterstock.com<\/a>[\/footnote]<\/sup> for an image illustrating interprofessional teamwork.\n\n[caption id=\"attachment_150\" align=\"aligncenter\" width=\"436\"]<img class=\"wp-image-147\" title=\"&quot;400845937-huge.jpg&quot; by Flamingo Images is used under license from Shutterstock.com\" src=\"https:\/\/pressbooks.ccconline.org\/accphysicalgeology\/wp-content\/uploads\/sites\/225\/2021\/09\/400845937-huge.png\" alt=\"Image showing a simulated interprofessional medical team discussing something\" width=\"436\" height=\"291\"> Figure 7.5 Interprofessional Teamwork[\/caption]\n\nNurses collaborate with the interprofessional team by not only assigning and coordinating tasks, but also by promoting solid teamwork in a positive environment. A nursing leader, such as a charge nurse, identifies gaps in workflow, recognizes when task overload is occurring, and promotes the adaptability of the team to respond to evolving client conditions. Qualities of a successful team are described in the following box.<sup>[footnote]O\u2019Daniel, M., &amp; Rosenstein, A. H. (2011). Professional communication and team collaboration. In: Hughes R.G. (Ed.). <em>Patient safety and quality: An evidence-based handbook for nurses.<\/em> Agency for Healthcare Research and Quality (US); Chapter 33. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK2637\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK2637<\/a>[\/footnote]<\/sup>\n<div class=\"textbox shaded \">\n\n<strong>Qualities of A Successful Team<\/strong><sup>[footnote]O\u2019Daniel, M., &amp; Rosenstein, A. H. (2011). Professional communication and team collaboration. In: Hughes R.G. (Ed.). <em>Patient safety and quality: An evidence-based handbook for nurses.<\/em> Agency for Healthcare Research and Quality (US); Chapter 33. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK2637\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK2637<\/a>[\/footnote]<\/sup>\n<ul>\n \t<li style=\"font-weight: 400\">Promote a respectful atmosphere<\/li>\n \t<li style=\"font-weight: 400\">Define clear roles and responsibilities for team members<\/li>\n \t<li style=\"font-weight: 400\">Regularly and routinely share information<\/li>\n \t<li style=\"font-weight: 400\">Encourage open communication<\/li>\n \t<li style=\"font-weight: 400\">Implement a culture of safety<\/li>\n \t<li style=\"font-weight: 400\">Provide clear directions<\/li>\n \t<li style=\"font-weight: 400\">Share responsibility for team success<\/li>\n \t<li style=\"font-weight: 400\">Balance team member participation based on the current situation<\/li>\n \t<li style=\"font-weight: 400\">Acknowledge and manage conflict<\/li>\n \t<li style=\"font-weight: 400\">Enforce accountability among all team members<\/li>\n \t<li style=\"font-weight: 400\">Communicate the decision-making process<\/li>\n \t<li style=\"font-weight: 400\">Facilitate access to needed resources<\/li>\n \t<li style=\"font-weight: 400\">Evaluate team outcomes and adjust as needed<\/li>\n<\/ul>\n<\/div>\n<h2>TeamSTEPPS\u00ae<\/h2>\n<strong>[pb_glossary id=\"464\"]TeamSTEPPS\u00ae[\/pb_glossary]<\/strong> is an evidence-based framework used to optimize team performance across the health care system. It is a mnemonic standing for Team Strategies and Tools to Enhance Performance and Patient Safety. The Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense (DoD) developed the TeamSTEPPS\u00ae framework as a national initiative to improve client safety by improving teamwork skills and communication.<sup>[footnote]AHRQ. (2019, June).<em> TeamSTEPPS 2.0.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/index.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/index.html<\/a>[\/footnote]<\/sup>\n<div class=\"textbox shaded \">\n<p class=\"video\">View this video about the TeamSTEPPS\u00ae framework<sup>[footnote]AHRQ Patient Safety. (2015, April 29). <em>TeamSTEPPS overview<\/em>\u00a0[Video]. YouTube. All rights reserved. <a href=\"https:\/\/youtu.be\/p4n9xPRtSuU\" target=\"_blank\" rel=\"noopener\">https:\/\/youtu.be\/p4n9xPRtSuU<\/a>[\/footnote]<\/sup>:<\/p>\n[embed]https:\/\/youtu.be\/p4n9xPRtSuU[\/embed]\n\n<\/div>\nTeamSTEPPS\u00ae is based on establishing team structure and four teamwork skills: communication, leadership, situation monitoring, and mutual support.<sup>[footnote]AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS<\/em>. <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a>[\/footnote]<\/sup> See Figure 7.6<sup>[footnote]\u201ctslogo1med.jpg\u201d by unknown author is licensed under\u00a0<a href=\"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/deed.en\" target=\"_blank\" rel=\"noopener\">Public Domain<\/a>. Access for free at <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a>[\/footnote]<\/sup> for an image of the TeamSTEPPS\u00ae framework followed by a description of each TeamSTEPPS\u00ae skill. The components of this model are described in the following subsections.\n\n[caption id=\"attachment_150\" align=\"aligncenter\" width=\"386\"]<img class=\"wp-image-148 \" title=\" \u201ctslogo1med.jpg\u201d by unknown author is in the Public Domain. Access for free at https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html. \" src=\"https:\/\/pressbooks.ccconline.org\/accphysicalgeology\/wp-content\/uploads\/sites\/225\/2025\/02\/tslogo1med.jpg\" alt=\"Image of triangle showing Team Steps Framwork, with textual labels\" width=\"386\" height=\"311\"> Figure 7.6 TeamSTEPPS<strong>\u00ae<\/strong> Framework[\/caption]\n<h3>Team Structure<\/h3>\nA nursing leader establishes team structure by assigning or identifying team members' roles and responsibilities, holding team members accountable, and including clients and families as part of the team.\n<h3>Communication<\/h3>\nCommunication is the first skill of the TeamSTEPPS\u00ae framework. As previously discussed, it is defined as a \u201cstructured process by which information is clearly and accurately exchanged among team members.\u201d All team members should use these skills to ensure accurate interprofessional communication:\n<ul>\n \t<li style=\"font-weight: 400\">Provide brief, clear, specific, and timely information to other team members.<\/li>\n \t<li style=\"font-weight: 400\">Seek information from all available sources.<\/li>\n \t<li style=\"font-weight: 400\">Use ISBARR and handoff techniques to communicate effectively with team members.<\/li>\n \t<li style=\"font-weight: 400\">Use closed-loop communication to verify information is communicated, understood, and completed.<\/li>\n \t<li style=\"font-weight: 400\">Document appropriately to facilitate continuity of care across interprofessional team members.<\/li>\n<\/ul>\nThese communication strategies are further described in the \u201c<a href=\"https:\/\/pressbooks.ccconline.org\/accnursing2030\/chapter\/7-5-interprofessional-communication\/\" target=\"_blank\" rel=\"noopener\">Interprofessional Communication<\/a>\u201d section of this chapter.\n<h3>Leadership<\/h3>\nLeadership is the second skill of the TeamSTEPPS\u00ae framework. As previously discussed, it is defined as the \u201cability to maximize the activities of team members by ensuring that team actions are understood, changes in information are shared, and team members have the necessary resources.\u201d An example of a nursing team leader in an inpatient setting is the charge nurse.\n\nEffective team leaders demonstrate the following responsibilities<sup>[footnote]AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a>[\/footnote]<\/sup>:\n<ul>\n \t<li style=\"font-weight: 400\">Organize the team.<\/li>\n \t<li style=\"font-weight: 400\">Identify and articulate clear goals (i.e., share the plan).<\/li>\n \t<li style=\"font-weight: 400\">Assign tasks and responsibilities.<\/li>\n \t<li style=\"font-weight: 400\">Monitor and modify the plan and communicate changes.<\/li>\n \t<li style=\"font-weight: 400\">Review the team's performance and provide feedback when needed.<\/li>\n \t<li style=\"font-weight: 400\">Manage and allocate resources.<\/li>\n \t<li style=\"font-weight: 400\">Facilitate information sharing.<\/li>\n \t<li style=\"font-weight: 400\">Encourage team members to assist one another.<\/li>\n \t<li style=\"font-weight: 400\">Facilitate conflict resolution in a learning environment.<\/li>\n \t<li style=\"font-weight: 400\">Model effective teamwork.<\/li>\n<\/ul>\nThree major leadership tasks include sharing a plan, monitoring and modifying the plan according to situations that occur, and reviewing team performance. Tools to perform these tasks are discussed in the following subsections.\n<h4>Sharing the Plan<\/h4>\nNursing team leaders identify and articulate clear goals to the team at the start of the shift during inpatient care using a \u201cbrief.\u201d The <strong>[pb_glossary id=\"497\"]brief[\/pb_glossary]<\/strong> is a short session to share a plan, discuss team formation, assign roles and responsibilities, establish expectations and climate, and anticipate outcomes and contingencies. See a Brief Checklist in the following box with questions based on TeamSTEPPS\u00ae.<sup>[footnote]AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a>[\/footnote]<\/sup>\n<div class=\"textbox shaded \">\n\n<strong>Brief Checklist<\/strong>\n\nDuring the brief, the team should address the following questions<sup>[footnote]AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a>[\/footnote]<\/sup>:\n\n___ Who is on the team?\n\n___ Do all members understand and agree upon goals?\n\n___ Are roles and responsibilities understood?\n\n___ What is our plan of care?\n\n___ What are staff and provider's availability throughout the shift?\n\n___ How is workload shared among team members?\n\n___ Who are the sickest clients on the unit?\n\n___ Which clients have a high fall risk or require 1:1?\n\n___ Do any clients have behavioral issues requiring consistent approaches by the team?\n\n___ What resources are available?\n\n<\/div>\n<h4>Monitoring and Modifying the Plan<\/h4>\nThroughout the shift, it is often necessary for the nurse leader to modify the initial plan as client situations change on the unit. A <strong>[pb_glossary id=\"498\"]huddle[\/pb_glossary]<\/strong> is a brief meeting before and\/or during a shift to establish situational awareness, reinforce plans already in place, and adjust the teamwork plan as needed. Read more about situational awareness in the \u201cSituation Monitoring\u201d subsection below.\n<h4>Reviewing the Team's Performance<\/h4>\nWhen a significant or emergent event occurs during a shift, such as a \u201ccode,\u201d it is important to later review the team\u2019s performance and reflect on lessons learned by holding a \u201cdebrief\u201d session. A<strong> [pb_glossary id=\"499\"]debrief[\/pb_glossary]<\/strong> is an informal information exchange session designed to improve team performance and effectiveness through reinforcement of positive behaviors and reflection on lessons learned.<sup>[footnote]AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a>[\/footnote]<\/sup> See the following box for a Debrief Checklist.\n<div class=\"textbox shaded \">\n\n<strong>Debrief Checklist<\/strong><sup>[footnote]AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a>[\/footnote]<\/sup>\n\nThe team should address the following questions during a debrief:\n\n___ Was communication clear?\n\n___ Were roles and responsibilities understood?\n\n___ Was situation awareness maintained?\n\n___ Was workload distribution equitable?\n\n___ Was task assistance requested or offered?\n\n___ Were errors made or avoided?\n\n___ Were resources available?\n\n___ What went well?\n\n___ What should be improved?\n\n<\/div>\n<h3>Situation Monitoring<\/h3>\nSituation monitoring is the third skill of the TeamSTEPPS\u00ae framework and defined as the \u201cprocess of actively scanning and assessing situational elements to gain information or understanding, or to maintain awareness to support team functioning.\u201d <strong>[pb_glossary id=\"504\"]Situation monitoring[\/pb_glossary] <\/strong>refers to the process of continually scanning and assessing the situation to gain and maintain an understanding of what is going on around you. <strong>[pb_glossary id=\"505\"]Situation awareness[\/pb_glossary]<\/strong> refers to a team member knowing what is going on around them. The team leader creates a <strong>[pb_glossary id=\"506\"]shared mental model[\/pb_glossary]<\/strong> to ensure all team members have situation awareness and know what is going on as situations evolve. The STEP tool is used by team leaders to assist with situation monitoring.<sup>[footnote]AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a>[\/footnote]<\/sup>\n<h4>STEP<\/h4>\nThe <strong>[pb_glossary id=\"500\"]STEP tool[\/pb_glossary]<\/strong> is a situation monitoring tool used to know what is going on with you, your clients, your team, and your environment. <strong>STEP<\/strong> stands for<strong> S<\/strong>tatus of the clients, <strong>T<\/strong>eam members,<strong> E<\/strong>nvironment, and<strong> P<\/strong>rogress toward goal. See an illustration of STEP in Figure 7.7.<sup>[footnote]\u201cstepfig1.jpg\u201d by unknown author is licensed under\u00a0<a href=\"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/deed.en\" target=\"_blank\" rel=\"noopener\">Public Domain<\/a>. Access for free at <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a>[\/footnote] <\/sup>The components of the STEP tool are described in the following box.<sup>[footnote]AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a>[\/footnote]<\/sup>\n\n[caption id=\"attachment_150\" align=\"aligncenter\" width=\"437\"]<img class=\"wp-image-149 \" title=\"\u201cstepfig1.jpg\u201d by unknown author is in the Public Domain. Access for free at https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" src=\"https:\/\/pressbooks.ccconline.org\/accphysicalgeology\/wp-content\/uploads\/sites\/225\/2025\/02\/stepfig1.jpg\" alt=\"Illustration of stair shape to demonstrate step accronymn\" width=\"437\" height=\"283\"> Figure 7.7 STEP Tool[\/caption]\n\n<div class=\"textbox shaded \">\n\n<strong>STEP Tool<\/strong><sup>[footnote]AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a>[\/footnote]<\/sup>\n\n<strong>Status of Clients:<\/strong> \u201cWhat is going on with your clients?\u201d\n\n__ Patient History\n\n__ Vital Signs\n\n__ Medications\n\n__ Physical Exam\n\n__ Plan of Care\n\n__ Psychosocial Issues\n\n<strong>Team Members:<\/strong> \u201cWhat is going on with you and your team?\u201d(See the \u201cI\u2019M SAFE Checklist\u201d below.)\n\n__ Fatigue\n\n__ Workload\n\n__ Task Performance\n\n__ Skill\n\n__ Stress\n\n<strong>Environment:<\/strong> Knowing Your Resources\n\n__ Facility Information\n\n__ Administrative Information\n\n__ Human Resources\n\n__ Triage Acuity\n\n__ Equipment\n\n<strong>Progression Towards Goal:<\/strong>\n\n__ Status of the Team's Clients\n\n__ Established Goals of the Team\n\n__ Tasks\/Actions of the Team\n\n__ Appropriateness of the Plan and are Modifications Needed?\n\n<\/div>\n<h4>Cross-Monitoring<\/h4>\nAs the STEP tool is implemented, the team leader continues to cross monitor to reduce the incidence of errors. Cross-monitoring includes the following<sup>[footnote]AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a>[\/footnote]<\/sup>:\n<ul>\n \t<li style=\"font-weight: 400\">Monitoring the actions of other team members.<\/li>\n \t<li style=\"font-weight: 400\">Providing a safety net within the team.<\/li>\n \t<li style=\"font-weight: 400\">Ensuring that mistakes or oversights are caught quickly and easily.<\/li>\n \t<li style=\"font-weight: 400\">Supporting each other as needed.<\/li>\n<\/ul>\n<h4>I\u2019M SAFE Checklist<\/h4>\nThe<strong> [pb_glossary id=\"501\"]I\u2019M SAFE[\/pb_glossary] <\/strong>mnemonic is a tool used to assess one\u2019s own safety status, as well as that of other team members in their ability to provide safe client care. See the I\u2019M SAFE Checklist in the following box.<sup>[footnote]AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a>[\/footnote]<\/sup> If a team member feels their ability to provide safe care is diminished because of one of these factors, they should notify the charge nurse or other nursing supervisor. In a similar manner, if a nurse notices that another member of the team is impaired or providing care in an unsafe manner, it is an ethical imperative to protect clients and report their concerns according to agency policy.<sup>[footnote]AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a>[\/footnote]<\/sup>\n<div class=\"textbox shaded \">\n\n<strong>I\u2019m SAFE Checklist<\/strong><sup>[footnote]AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a>[\/footnote]<\/sup>\n\n__ <strong>I<\/strong>: Illness\n\n__<strong>M<\/strong>: Medication\n\n__<strong>S<\/strong>: Stress\n\n__<strong>A<\/strong>: Alcohol and Drugs\n\n__<strong>F<\/strong>: Fatigue\n\n__<strong>E<\/strong>: Eating and Elimination\n\n<\/div>\nRead an example of a nursing team leader performing situation monitoring using the STEP tool in the following box.\n<div class=\"textbox shaded \">\n\n<strong>Example of Situation Monitoring<\/strong>\n\nTwo emergent situations occur simultaneously on a busy medical-surgical hospital unit as one client codes and another develops a postoperative hemorrhage. The charge nurse is performing situation monitoring by continually scanning and assessing the status of all clients on the unit and directing additional assistance where it is needed. Each nursing team member maintains situation awareness by being aware of what is happening on the unit, in addition to caring for the clients they have been assigned. The charge nurse creates a shared mental model by ensuring all team members are aware of their evolving responsibilities as the situation changes. The charge nurse directs additional assistance to the emergent clients while also ensuring appropriate coverage for the other clients on the unit to ensure all clients receive safe and effective care.\n\nFor example, as the \u201ccode\u201d is called, the charge nurse directs two additional nurses and two additional assistive personnel to assist with the emergent clients while the other nurses and unlicensed assistive personnel are directed to \u201ccover\u201d the remaining clients, answer call lights, and assist clients to the bathroom to prevent falls. Additionally, the charge nurse is aware that after performing a few rounds of CPR for the coding client, the unlicensed assistive personnel must be switched with another team member to maintain effective chest compressions. As the situation progresses, the charge nurse evaluates the status of all clients and makes adjustments to the plan as needed.\n\n<\/div>\n<h3>Mutual Support<\/h3>\n<strong>[pb_glossary id=\"525\"]Mutual support[\/pb_glossary]<\/strong> is the fourth skill of the TeamSTEPPS\u00ae framework and defined as the \u201cability to anticipate and support team members' needs through accurate knowledge about their responsibilities and workload.\u201d Mutual support includes providing task assistance, giving feedback, and advocating for client safety by using assertive statements to correct a safety concern. Managing conflict is also a component of supporting team members\u2019 needs.\n<h4>Task Assistance<\/h4>\nHelping other team members with tasks builds a strong team. Task assistance includes the following components<sup>[footnote]AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a>[\/footnote]<\/sup>:\n<ul>\n \t<li style=\"font-weight: 400\">Team members protect each other from work-overload situations.<\/li>\n \t<li style=\"font-weight: 400\">Effective teams place all offers and requests for assistance in the context of client safety.<\/li>\n \t<li style=\"font-weight: 400\">Team members foster a climate where it is expected that assistance will be actively sought and offered.<\/li>\n<\/ul>\n<div class=\"textbox shaded \">\n\n<strong>Example of Task Assistance<\/strong>\n\nIn a previous example, one client on the unit was coding while another was experiencing a postoperative hemorrhage. After the emergent care was provided and the hemorrhaging client was stabilized, Sue, the nurse caring for the hemorrhaging client, finds many scheduled medications for her other clients are past due. Sue reaches out to Sam, another nurse on the team, and requests assistance. Sam agrees to administer a scheduled IV antibiotic to a stable third client so Sue can administer oral medications to her remaining clients. Sam knows that on an upcoming shift, he may need to request assistance from Sue when unexpected situations occur. In this manner, team members foster a climate where assistance is actively sought and offered to maintain client safety.\n\n<\/div>\n<h4>Feedback<\/h4>\nFeedback is provided to a team member for the purpose of improving team performance. Effective feedback should follow these parameters<sup>[footnote]AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a>[\/footnote]<\/sup>:\n<ul>\n \t<li style=\"font-weight: 400\"><em>Timely:<\/em> Provided soon after the target behavior has occurred.<\/li>\n \t<li style=\"font-weight: 400\"><em>Respectful:<\/em> Focused on behaviors, not personal attributes.<\/li>\n \t<li style=\"font-weight: 400\"><em>Specific:<\/em> Related to a specific task or behavior that requires correction or improvement.<\/li>\n \t<li style=\"font-weight: 400\"><em>Directed towards improvement:<\/em> Suggestions are made for future improvement.<\/li>\n \t<li style=\"font-weight: 400\"><em>Considerate:<\/em> Team members\u2019 feelings should be considered and privacy provided. Negative information should be delivered with fairness and respect.<\/li>\n<\/ul>\n<h4>Advocating for Safety with Assertive Statements<\/h4>\nWhen a team member perceives a potential client safety concern, they should assertively communicate with the decision-maker to protect client safety. This strategy holds true for ALL team members, no matter their position within the hierarchy of the health care environment. The message should be communicated to the decision-maker in a firm and respectful manner using the following steps<sup>[footnote]AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a>[\/footnote]<\/sup>:\n<ul>\n \t<li style=\"font-weight: 400\">Make an opening.<\/li>\n \t<li style=\"font-weight: 400\">State the concern.<\/li>\n \t<li style=\"font-weight: 400\">State the problem (real or perceived).<\/li>\n \t<li style=\"font-weight: 400\">Offer a solution.<\/li>\n \t<li style=\"font-weight: 400\">Reach agreement on next steps.<\/li>\n<\/ul>\n<div class=\"textbox shaded \">\n\n<strong>Examples of Using Assertive Statements to Promote Client Safety<\/strong>\n\nA nurse notices that a team member did not properly wash their hands during client care. Feedback is provided immediately in a private area after the team member left the client room: <em>\u201cI noticed you didn\u2019t wash your hands when you entered the client\u2019s room. Can you help me understand why that didn\u2019t occur?\u201d (Wait for an answer.) \u201cPerforming hand hygiene is essential for protecting our clients from infection. It is also hospital policy, and we are audited for compliance to this policy. Let me know if you have any questions and I will check back with you later in the shift.\u201d (Monitor the team member for appropriate hand hygiene for the remainder of the shift.)<\/em>\n\n<\/div>\n<h5>Two-Challenge Rule<\/h5>\nWhen an assertive statement is ignored by the decision-maker, the team member should assertively voice their concern at least two times to ensure that it has been heard by the decision-maker. This strategy is referred to as the <strong>[pb_glossary id=\"502\"]two-challenge rule[\/pb_glossary]<\/strong>. When this rule is adopted as a policy by a health care organization, it empowers all team members to pause care if they sense or discover an essential safety breach. The decision-maker being challenged is expected to acknowledge the concern has been heard.<sup>[footnote]AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a>[\/footnote]<\/sup>\n<h5><strong>[pb_glossary id=\"503\"]CUS Assertive Statements[\/pb_glossary]<\/strong><\/h5>\nDuring emergent situations, when stress levels are high or when situations are charged with emotion, the decision-maker may not \u201chear\u201d the message being communicated, even when the two-challenge rule is implemented. It is helpful for agencies to establish assertive statements that are well-recognized by all staff as implementation of the two-challenge rule. These assertive statements are referred to as the CUS mnemonic: \u201cI am <strong>C<\/strong>oncerned - I am <strong>U<\/strong>ncomfortable - This is a <strong>S<\/strong>afety issue!\u201d<sup>[footnote]AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a>[\/footnote]<\/sup> See Figure 7.8<sup>[footnote]\u201ccusfig1.jpg\u201d by unknown author is licensed under\u00a0<a href=\"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/deed.en\" target=\"_blank\" rel=\"noopener\">Public Domain<\/a>. Access for free at <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a>[\/footnote]<\/sup> for an illustration of CUS assertive statements.\n\n[caption id=\"attachment_150\" align=\"aligncenter\" width=\"443\"]<img class=\"wp-image-150 size-full\" title=\"\u201ccusfig1.jpg\u201d by unknown author is in the Public Domain.\u00a0 Access for free at\u00a0 https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html.\" src=\"https:\/\/pressbooks.ccconline.org\/accphysicalgeology\/wp-content\/uploads\/sites\/225\/2025\/02\/cusfig1.jpg\" alt=\"Illustration showing CUS acronym for assertive statements\" width=\"443\" height=\"216\"> Figure 7.8 CUS Assertive Statements[\/caption]\n\nUsing these scripted messages may effectively catch the attention of the decision-maker. However, if the safety issue still isn\u2019t addressed after the second statement or the use of \u201cCUS\u201d assertive statements, the team member should take a stronger course of action and utilize the agency\u2019s chain of command. For the two-challenge rule and CUS assertive statements to be effective within an agency, administrators must support a culture of safety and emphasize the importance of these initiatives to promote client safety.\n\nRead an example of a nurse using assertive statements in the following box.\n<div class=\"textbox shaded \">\n\n<strong>Assertive Statement Example<\/strong>\n\nA nurse observes a new physician resident preparing to insert a central line at a client\u2019s bedside. The nurse notes the resident has inadvertently contaminated the right sterile glove prior to insertion.\n\n<strong>Nurse:<\/strong> \u201cDr. Smith, I noticed that you contaminated your sterile gloves when preparing the sterile field for central line insertion. I will get a new set of sterile gloves for you.\u201d\n\n<strong>Dr. Smith:<\/strong> (Ignores nurse and continues procedure.)\n\n<strong>Nurse:<\/strong> \u201cDr. Smith, please pause the procedure. I noticed that you contaminated your right sterile glove by touching outside the sterile field. I will get a new set of sterile gloves for you.\u201d\n\n<strong>Dr. Smith:<\/strong> \u201cMy gloves are fine.\u201d (Prepares to initiate insertion.)\n\n<strong>Nurse:<\/strong> \u201cDr. Smith - I am concerned! I am uncomfortable! This is a safety issue!\u201d\n\n<strong>Dr. Smith:<\/strong> (Stops procedure, looks up, and listens to the nurse.) \u201cI\u2019ll wait for that second pair of gloves.\u201d\n\n<\/div>\n<h4>Managing Conflict<\/h4>\nConflict is not uncommon on interprofessional teams, especially when there are diverse perspectives from multiple staff regarding client care. Nurse leaders must be prepared to manage conflict to support the needs of their team members.\n\nWhen conflict occurs, the <strong>[pb_glossary id=\"507\"]DESC tool[\/pb_glossary] <\/strong>can be used to help resolve conflict by using \u201cI statements.\u201d DESC is a mnemonic that stands for the following<sup>[footnote]AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a>[\/footnote]<\/sup>:\n<ul>\n \t<li style=\"font-weight: 400\"><strong>D:<\/strong> Describe the specific situation or behavior; provide concrete data.<\/li>\n \t<li style=\"font-weight: 400\"><strong>E:<\/strong> Express how the situation makes you feel\/what your concerns are using \u201cI\u201d statements.<\/li>\n \t<li style=\"font-weight: 400\"><strong>S:<\/strong> Suggest other alternatives and seek agreement.<\/li>\n \t<li style=\"font-weight: 400\"><strong>C:<\/strong> Consequences stated in terms of impact on established team goals while striving for consensus.<\/li>\n<\/ul>\nThe DESC tool should be implemented in a private area with a focus on WHAT is right, not WHO is right. Read an example of a nurse using the DESC tool in the following box.\n<div class=\"textbox shaded \">\n\n<strong>Example of Using the DESC Tool<\/strong><sup>[footnote]AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a>[\/footnote]<\/sup>\n\n<strong>Situation:<\/strong> A physician became angry at a nurse who was inserting a client\u2019s Foley catheter and yelled at the nurse in front of the client and other team members. The nurse later addressed the physician in a private area outside the client\u2019s room using the DESC tool and \u201cI statements\u201d:\n\n<strong>D:<\/strong> \u201cI noticed you got angry at me when I inserted the client\u2019s Foley catheter.\u201d\n\n<strong>E:<\/strong> \u201cI\u2019m concerned how you addressed that issue in front of the client and three other staff members. It made me feel bad in front of the client and my colleagues.\u201d\n\n<strong>S:<\/strong> \u201cIn the future, if you have an issue with how I do things, please pull me aside privately to discuss your concern.\u201d\n\n<strong>C:<\/strong> \u201cOur organization has a policy for managing communication challenges among team members if we can\u2019t agree on this alternative.\u201d\n\n<\/div>\nManaging interpersonal conflict resolution is described further in the \u201c<a href=\"https:\/\/pressbooks.ccconline.org\/accnursing2030\/chapter\/7-7-conflict-resolution\/\" target=\"_blank\" rel=\"noopener\">Conflict Resolution<\/a>\u201d section.\n<div class=\"textbox shaded \">\n<p class=\"video\">View a supplementary detailed video webinar from AHRQ describing the TeamSTEPPS<strong>\u00ae<\/strong> principles at <a href=\"https:\/\/youtu.be\/fxlRtpzsUug\" target=\"_blank\" rel=\"noopener\">youtu.be\/fxlRtpzsUug<\/a>.<sup>[footnote]AHRQ Patient Safety. (2017, July 26). <em>Introduction to the fundamentals of TeamSTEPPS<\/em><span style=\"color: #000000\"><em>\u00ae concepts and tools<\/em>\u00a0[Video]. YouTube. Video in the Public Domain. <a href=\"https:\/\/youtu.be\/fxlRtpzsUug\" target=\"_blank\" rel=\"noopener\">https:\/\/youtu.be\/fxlRtpzsUug<\/a>[\/footnote]<\/span><\/sup><\/p>\n\n<\/div>\n<div class=\"textbox shaded \">\n\n<strong>Team Qualitities Case Application (<\/strong><em>Answers can be found at the end of book)<\/em>\n\nMary is recovering from a stroke and requires comprehensive care involving multiple disciplines. Her care team has scheduled interdisciplinary team meetings twice a week to discussion Mary's progress, adjust her care plan, and address any concerns. Dr. Patel is Mary's primary physician and consults with Chris (physical therapist) and Emily (speech therapist) before making any changes to Mary's medication that might affect her therapy sessions. Chris and Emily coordinate their therapy schedules to help maximize Mary's participation and avoid conflicting sessions and fatigue. Laura is Mary's social worker and has a large roster of clients. Laura struggles to include Mary's family in the discharge planning discussions but feels that she has identified an appropriate facility that Mary and her family will be receptive to for discharge. She moves forward with the client placement paperwork. Lisa is Mary's dietician, and she has identified a dietary plan that will best contribute to Mary's nutritional needs and healing. She acknowledges that Mary's dietary preferences are much different than what she has selected in her dietary plan, but Lisa knows that she has identified the best dietary plan to meet Mary's energy needs.\n\nIdentify which team members are demonstrating team success strategies and how they are demonstrated?\n\nWhich team members are not demonstrating team success strategies? How could these team members modify their approach?\n\n<\/div>","rendered":"<p>Now that we have reviewed the first three IPEC competencies related to valuing team members, understanding team members\u2019 roles and responsibilities, and using structured interprofessional communication strategies, let\u2019s discuss strategies that promote effective teamwork. The fourth IPEC competency states, \u201cApply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan, deliver, and evaluate client\/population-centered care and population health programs and policies that are safe, timely, efficient, effective, and equitable.\u201d<sup><a class=\"footnote\" title=\"Interprofessional Education Collaborative. IPEC core competencies. https:\/\/www.ipecollaborative.org\/ipec-core-competencies\" id=\"return-footnote-151-1\" href=\"#footnote-151-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a><\/sup> See the following box for the components of this IPEC competency.<\/p>\n<div class=\"textbox shaded\">\n<p><strong>Components of IPEC\u2019s Teams and Teamwork Competency<\/strong><sup><a class=\"footnote\" title=\"Interprofessional Education Collaborative. IPEC core competencies. https:\/\/www.ipecollaborative.org\/ipec-core-competencies\" id=\"return-footnote-151-2\" href=\"#footnote-151-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a><\/sup><\/p>\n<ul>\n<li style=\"font-weight: 400\">Describe the process of team development and the roles and practices of effective teams.<\/li>\n<li style=\"font-weight: 400\">Develop consensus on the ethical principles to guide all aspects of teamwork.<\/li>\n<li style=\"font-weight: 400\">Engage health and other professionals in shared client-centered and population-focused problem-solving.<\/li>\n<li style=\"font-weight: 400\">Integrate the knowledge and experience of health and other professions to inform health and care decisions, while respecting client and community values and priorities\/preferences for care.<\/li>\n<li style=\"font-weight: 400\">Apply leadership practices that support collaborative practice and team effectiveness.<\/li>\n<li style=\"font-weight: 400\">Engage self and others to constructively manage disagreements about values, roles, goals, and actions that arise among health and other professionals and with clients, families, and community members.<\/li>\n<li style=\"font-weight: 400\">Share accountability with other professions, clients, and communities for outcomes relevant to prevention and health care.<\/li>\n<li style=\"font-weight: 400\">Reflect on individual and team performance for individual, as well as team, performance improvement.<\/li>\n<li style=\"font-weight: 400\">Use process improvement to increase effectiveness of interprofessional teamwork and team-based services, programs, and policies.<\/li>\n<li style=\"font-weight: 400\">Use available evidence to inform effective teamwork and team-based practices.<\/li>\n<li style=\"font-weight: 400\">Perform effectively on teams and in different team roles in a variety of settings.<\/li>\n<\/ul>\n<\/div>\n<p>Developing effective teams is critical for providing health care that is client-centered, safe, timely, effective, efficient, and equitable.<sup><a class=\"footnote\" title=\"Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report on an expert panel. Interprofessional Education Collaborative. https:\/\/ipec.memberclicks.net\/assets\/2011-Original.pdf\" id=\"return-footnote-151-3\" href=\"#footnote-151-3\" aria-label=\"Footnote 3\"><sup class=\"footnote\">[3]<\/sup><\/a><\/sup> See Figure 7.5<sup><a class=\"footnote\" title=\"\u201c400845937-huge.jpg\u201d by Flamingo Images is used under license from Shutterstock.com\" id=\"return-footnote-151-4\" href=\"#footnote-151-4\" aria-label=\"Footnote 4\"><sup class=\"footnote\">[4]<\/sup><\/a><\/sup> for an image illustrating interprofessional teamwork.<\/p>\n<figure id=\"attachment_150\" aria-describedby=\"caption-attachment-150\" style=\"width: 436px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-147\" title=\"&quot;400845937-huge.jpg&quot; by Flamingo Images is used under license from Shutterstock.com\" src=\"https:\/\/pressbooks.ccconline.org\/accphysicalgeology\/wp-content\/uploads\/sites\/225\/2021\/09\/400845937-huge.png\" alt=\"Image showing a simulated interprofessional medical team discussing something\" width=\"436\" height=\"291\" srcset=\"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2021\/09\/400845937-huge.png 512w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2021\/09\/400845937-huge-300x200.png 300w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2021\/09\/400845937-huge-65x43.png 65w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2021\/09\/400845937-huge-225x150.png 225w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2021\/09\/400845937-huge-350x234.png 350w\" sizes=\"auto, (max-width: 436px) 100vw, 436px\" \/><figcaption id=\"caption-attachment-150\" class=\"wp-caption-text\">Figure 7.5 Interprofessional Teamwork<\/figcaption><\/figure>\n<p>Nurses collaborate with the interprofessional team by not only assigning and coordinating tasks, but also by promoting solid teamwork in a positive environment. A nursing leader, such as a charge nurse, identifies gaps in workflow, recognizes when task overload is occurring, and promotes the adaptability of the team to respond to evolving client conditions. Qualities of a successful team are described in the following box.<sup><a class=\"footnote\" title=\"O\u2019Daniel, M., &amp; Rosenstein, A. H. (2011). Professional communication and team collaboration. In: Hughes R.G. (Ed.). Patient safety and quality: An evidence-based handbook for nurses. Agency for Healthcare Research and Quality (US); Chapter 33. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK2637\" id=\"return-footnote-151-5\" href=\"#footnote-151-5\" aria-label=\"Footnote 5\"><sup class=\"footnote\">[5]<\/sup><\/a><\/sup><\/p>\n<div class=\"textbox shaded\">\n<p><strong>Qualities of A Successful Team<\/strong><sup><a class=\"footnote\" title=\"O\u2019Daniel, M., &amp; Rosenstein, A. H. (2011). Professional communication and team collaboration. In: Hughes R.G. (Ed.). Patient safety and quality: An evidence-based handbook for nurses. Agency for Healthcare Research and Quality (US); Chapter 33. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK2637\" id=\"return-footnote-151-6\" href=\"#footnote-151-6\" aria-label=\"Footnote 6\"><sup class=\"footnote\">[6]<\/sup><\/a><\/sup><\/p>\n<ul>\n<li style=\"font-weight: 400\">Promote a respectful atmosphere<\/li>\n<li style=\"font-weight: 400\">Define clear roles and responsibilities for team members<\/li>\n<li style=\"font-weight: 400\">Regularly and routinely share information<\/li>\n<li style=\"font-weight: 400\">Encourage open communication<\/li>\n<li style=\"font-weight: 400\">Implement a culture of safety<\/li>\n<li style=\"font-weight: 400\">Provide clear directions<\/li>\n<li style=\"font-weight: 400\">Share responsibility for team success<\/li>\n<li style=\"font-weight: 400\">Balance team member participation based on the current situation<\/li>\n<li style=\"font-weight: 400\">Acknowledge and manage conflict<\/li>\n<li style=\"font-weight: 400\">Enforce accountability among all team members<\/li>\n<li style=\"font-weight: 400\">Communicate the decision-making process<\/li>\n<li style=\"font-weight: 400\">Facilitate access to needed resources<\/li>\n<li style=\"font-weight: 400\">Evaluate team outcomes and adjust as needed<\/li>\n<\/ul>\n<\/div>\n<h2>TeamSTEPPS\u00ae<\/h2>\n<p><strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_151_464\">TeamSTEPPS\u00ae<\/a><\/strong> is an evidence-based framework used to optimize team performance across the health care system. It is a mnemonic standing for Team Strategies and Tools to Enhance Performance and Patient Safety. The Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense (DoD) developed the TeamSTEPPS\u00ae framework as a national initiative to improve client safety by improving teamwork skills and communication.<sup><a class=\"footnote\" title=\"AHRQ. (2019, June). TeamSTEPPS 2.0. https:\/\/www.ahrq.gov\/teamstepps\/instructor\/index.html\" id=\"return-footnote-151-7\" href=\"#footnote-151-7\" aria-label=\"Footnote 7\"><sup class=\"footnote\">[7]<\/sup><\/a><\/sup><\/p>\n<div class=\"textbox shaded\">\n<p class=\"video\">View this video about the TeamSTEPPS\u00ae framework<sup><a class=\"footnote\" title=\"AHRQ Patient Safety. (2015, April 29). TeamSTEPPS overview\u00a0[Video]. YouTube. All rights reserved. https:\/\/youtu.be\/p4n9xPRtSuU\" id=\"return-footnote-151-8\" href=\"#footnote-151-8\" aria-label=\"Footnote 8\"><sup class=\"footnote\">[8]<\/sup><\/a><\/sup>:<\/p>\n<p><iframe loading=\"lazy\" id=\"oembed-1\" title=\"TeamSTEPPS Overview\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/p4n9xPRtSuU?feature=oembed&#38;rel=0&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<\/div>\n<p>TeamSTEPPS\u00ae is based on establishing team structure and four teamwork skills: communication, leadership, situation monitoring, and mutual support.<sup><a class=\"footnote\" title=\"AHRQ. (2020, January). Pocket guide: TeamSTEPPS. https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" id=\"return-footnote-151-9\" href=\"#footnote-151-9\" aria-label=\"Footnote 9\"><sup class=\"footnote\">[9]<\/sup><\/a><\/sup> See Figure 7.6<sup><a class=\"footnote\" title=\"\u201ctslogo1med.jpg\u201d by unknown author is licensed under\u00a0Public Domain. Access for free at https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" id=\"return-footnote-151-10\" href=\"#footnote-151-10\" aria-label=\"Footnote 10\"><sup class=\"footnote\">[10]<\/sup><\/a><\/sup> for an image of the TeamSTEPPS\u00ae framework followed by a description of each TeamSTEPPS\u00ae skill. The components of this model are described in the following subsections.<\/p>\n<figure id=\"attachment_150\" aria-describedby=\"caption-attachment-150\" style=\"width: 386px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-148\" title=\"\u201ctslogo1med.jpg\u201d by unknown author is in the Public Domain. Access for free at https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html.\" src=\"https:\/\/pressbooks.ccconline.org\/accphysicalgeology\/wp-content\/uploads\/sites\/225\/2025\/02\/tslogo1med.jpg\" alt=\"Image of triangle showing Team Steps Framwork, with textual labels\" width=\"386\" height=\"311\" srcset=\"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/tslogo1med.jpg 407w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/tslogo1med-300x242.jpg 300w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/tslogo1med-65x52.jpg 65w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/tslogo1med-225x181.jpg 225w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/tslogo1med-350x282.jpg 350w\" sizes=\"auto, (max-width: 386px) 100vw, 386px\" \/><figcaption id=\"caption-attachment-150\" class=\"wp-caption-text\">Figure 7.6 TeamSTEPPS<strong>\u00ae<\/strong> Framework<\/figcaption><\/figure>\n<h3>Team Structure<\/h3>\n<p>A nursing leader establishes team structure by assigning or identifying team members&#8217; roles and responsibilities, holding team members accountable, and including clients and families as part of the team.<\/p>\n<h3>Communication<\/h3>\n<p>Communication is the first skill of the TeamSTEPPS\u00ae framework. As previously discussed, it is defined as a \u201cstructured process by which information is clearly and accurately exchanged among team members.\u201d All team members should use these skills to ensure accurate interprofessional communication:<\/p>\n<ul>\n<li style=\"font-weight: 400\">Provide brief, clear, specific, and timely information to other team members.<\/li>\n<li style=\"font-weight: 400\">Seek information from all available sources.<\/li>\n<li style=\"font-weight: 400\">Use ISBARR and handoff techniques to communicate effectively with team members.<\/li>\n<li style=\"font-weight: 400\">Use closed-loop communication to verify information is communicated, understood, and completed.<\/li>\n<li style=\"font-weight: 400\">Document appropriately to facilitate continuity of care across interprofessional team members.<\/li>\n<\/ul>\n<p>These communication strategies are further described in the \u201c<a href=\"https:\/\/pressbooks.ccconline.org\/accnursing2030\/chapter\/7-5-interprofessional-communication\/\" target=\"_blank\" rel=\"noopener\">Interprofessional Communication<\/a>\u201d section of this chapter.<\/p>\n<h3>Leadership<\/h3>\n<p>Leadership is the second skill of the TeamSTEPPS\u00ae framework. As previously discussed, it is defined as the \u201cability to maximize the activities of team members by ensuring that team actions are understood, changes in information are shared, and team members have the necessary resources.\u201d An example of a nursing team leader in an inpatient setting is the charge nurse.<\/p>\n<p>Effective team leaders demonstrate the following responsibilities<sup><a class=\"footnote\" title=\"AHRQ. (2020, January). Pocket guide: TeamSTEPPS. https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" id=\"return-footnote-151-11\" href=\"#footnote-151-11\" aria-label=\"Footnote 11\"><sup class=\"footnote\">[11]<\/sup><\/a><\/sup>:<\/p>\n<ul>\n<li style=\"font-weight: 400\">Organize the team.<\/li>\n<li style=\"font-weight: 400\">Identify and articulate clear goals (i.e., share the plan).<\/li>\n<li style=\"font-weight: 400\">Assign tasks and responsibilities.<\/li>\n<li style=\"font-weight: 400\">Monitor and modify the plan and communicate changes.<\/li>\n<li style=\"font-weight: 400\">Review the team&#8217;s performance and provide feedback when needed.<\/li>\n<li style=\"font-weight: 400\">Manage and allocate resources.<\/li>\n<li style=\"font-weight: 400\">Facilitate information sharing.<\/li>\n<li style=\"font-weight: 400\">Encourage team members to assist one another.<\/li>\n<li style=\"font-weight: 400\">Facilitate conflict resolution in a learning environment.<\/li>\n<li style=\"font-weight: 400\">Model effective teamwork.<\/li>\n<\/ul>\n<p>Three major leadership tasks include sharing a plan, monitoring and modifying the plan according to situations that occur, and reviewing team performance. Tools to perform these tasks are discussed in the following subsections.<\/p>\n<h4>Sharing the Plan<\/h4>\n<p>Nursing team leaders identify and articulate clear goals to the team at the start of the shift during inpatient care using a \u201cbrief.\u201d The <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_151_497\">brief<\/a><\/strong> is a short session to share a plan, discuss team formation, assign roles and responsibilities, establish expectations and climate, and anticipate outcomes and contingencies. See a Brief Checklist in the following box with questions based on TeamSTEPPS\u00ae.<sup><a class=\"footnote\" title=\"AHRQ. (2020, January). Pocket guide: TeamSTEPPS. https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" id=\"return-footnote-151-12\" href=\"#footnote-151-12\" aria-label=\"Footnote 12\"><sup class=\"footnote\">[12]<\/sup><\/a><\/sup><\/p>\n<div class=\"textbox shaded\">\n<p><strong>Brief Checklist<\/strong><\/p>\n<p>During the brief, the team should address the following questions<sup><a class=\"footnote\" title=\"AHRQ. (2020, January). Pocket guide: TeamSTEPPS. https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" id=\"return-footnote-151-13\" href=\"#footnote-151-13\" aria-label=\"Footnote 13\"><sup class=\"footnote\">[13]<\/sup><\/a><\/sup>:<\/p>\n<p>___ Who is on the team?<\/p>\n<p>___ Do all members understand and agree upon goals?<\/p>\n<p>___ Are roles and responsibilities understood?<\/p>\n<p>___ What is our plan of care?<\/p>\n<p>___ What are staff and provider&#8217;s availability throughout the shift?<\/p>\n<p>___ How is workload shared among team members?<\/p>\n<p>___ Who are the sickest clients on the unit?<\/p>\n<p>___ Which clients have a high fall risk or require 1:1?<\/p>\n<p>___ Do any clients have behavioral issues requiring consistent approaches by the team?<\/p>\n<p>___ What resources are available?<\/p>\n<\/div>\n<h4>Monitoring and Modifying the Plan<\/h4>\n<p>Throughout the shift, it is often necessary for the nurse leader to modify the initial plan as client situations change on the unit. A <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_151_498\">huddle<\/a><\/strong> is a brief meeting before and\/or during a shift to establish situational awareness, reinforce plans already in place, and adjust the teamwork plan as needed. Read more about situational awareness in the \u201cSituation Monitoring\u201d subsection below.<\/p>\n<h4>Reviewing the Team&#8217;s Performance<\/h4>\n<p>When a significant or emergent event occurs during a shift, such as a \u201ccode,\u201d it is important to later review the team\u2019s performance and reflect on lessons learned by holding a \u201cdebrief\u201d session. A<strong> <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_151_499\">debrief<\/a><\/strong> is an informal information exchange session designed to improve team performance and effectiveness through reinforcement of positive behaviors and reflection on lessons learned.<sup><a class=\"footnote\" title=\"AHRQ. (2020, January). Pocket guide: TeamSTEPPS. https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" id=\"return-footnote-151-14\" href=\"#footnote-151-14\" aria-label=\"Footnote 14\"><sup class=\"footnote\">[14]<\/sup><\/a><\/sup> See the following box for a Debrief Checklist.<\/p>\n<div class=\"textbox shaded\">\n<p><strong>Debrief Checklist<\/strong><sup><a class=\"footnote\" title=\"AHRQ. (2020, January). Pocket guide: TeamSTEPPS. https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" id=\"return-footnote-151-15\" href=\"#footnote-151-15\" aria-label=\"Footnote 15\"><sup class=\"footnote\">[15]<\/sup><\/a><\/sup><\/p>\n<p>The team should address the following questions during a debrief:<\/p>\n<p>___ Was communication clear?<\/p>\n<p>___ Were roles and responsibilities understood?<\/p>\n<p>___ Was situation awareness maintained?<\/p>\n<p>___ Was workload distribution equitable?<\/p>\n<p>___ Was task assistance requested or offered?<\/p>\n<p>___ Were errors made or avoided?<\/p>\n<p>___ Were resources available?<\/p>\n<p>___ What went well?<\/p>\n<p>___ What should be improved?<\/p>\n<\/div>\n<h3>Situation Monitoring<\/h3>\n<p>Situation monitoring is the third skill of the TeamSTEPPS\u00ae framework and defined as the \u201cprocess of actively scanning and assessing situational elements to gain information or understanding, or to maintain awareness to support team functioning.\u201d <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_151_504\">Situation monitoring<\/a> <\/strong>refers to the process of continually scanning and assessing the situation to gain and maintain an understanding of what is going on around you. <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_151_505\">Situation awareness<\/a><\/strong> refers to a team member knowing what is going on around them. The team leader creates a <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_151_506\">shared mental model<\/a><\/strong> to ensure all team members have situation awareness and know what is going on as situations evolve. The STEP tool is used by team leaders to assist with situation monitoring.<sup><a class=\"footnote\" title=\"AHRQ. (2020, January). Pocket guide: TeamSTEPPS. https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" id=\"return-footnote-151-16\" href=\"#footnote-151-16\" aria-label=\"Footnote 16\"><sup class=\"footnote\">[16]<\/sup><\/a><\/sup><\/p>\n<h4>STEP<\/h4>\n<p>The <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_151_500\">STEP tool<\/a><\/strong> is a situation monitoring tool used to know what is going on with you, your clients, your team, and your environment. <strong>STEP<\/strong> stands for<strong> S<\/strong>tatus of the clients, <strong>T<\/strong>eam members,<strong> E<\/strong>nvironment, and<strong> P<\/strong>rogress toward goal. See an illustration of STEP in Figure 7.7.<sup><a class=\"footnote\" title=\"\u201cstepfig1.jpg\u201d by unknown author is licensed under\u00a0Public Domain. Access for free at https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" id=\"return-footnote-151-17\" href=\"#footnote-151-17\" aria-label=\"Footnote 17\"><sup class=\"footnote\">[17]<\/sup><\/a> <\/sup>The components of the STEP tool are described in the following box.<sup><a class=\"footnote\" title=\"AHRQ. (2020, January). Pocket guide: TeamSTEPPS. https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" id=\"return-footnote-151-18\" href=\"#footnote-151-18\" aria-label=\"Footnote 18\"><sup class=\"footnote\">[18]<\/sup><\/a><\/sup><\/p>\n<figure id=\"attachment_150\" aria-describedby=\"caption-attachment-150\" style=\"width: 437px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-149\" title=\"\u201cstepfig1.jpg\u201d by unknown author is in the Public Domain. Access for free at https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" src=\"https:\/\/pressbooks.ccconline.org\/accphysicalgeology\/wp-content\/uploads\/sites\/225\/2025\/02\/stepfig1.jpg\" alt=\"Illustration of stair shape to demonstrate step accronymn\" width=\"437\" height=\"283\" srcset=\"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/stepfig1.jpg 396w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/stepfig1-300x195.jpg 300w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/stepfig1-65x42.jpg 65w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/stepfig1-225x146.jpg 225w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/stepfig1-350x227.jpg 350w\" sizes=\"auto, (max-width: 437px) 100vw, 437px\" \/><figcaption id=\"caption-attachment-150\" class=\"wp-caption-text\">Figure 7.7 STEP Tool<\/figcaption><\/figure>\n<div class=\"textbox shaded\">\n<p><strong>STEP Tool<\/strong><sup><a class=\"footnote\" title=\"AHRQ. (2020, January). Pocket guide: TeamSTEPPS. https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" id=\"return-footnote-151-19\" href=\"#footnote-151-19\" aria-label=\"Footnote 19\"><sup class=\"footnote\">[19]<\/sup><\/a><\/sup><\/p>\n<p><strong>Status of Clients:<\/strong> \u201cWhat is going on with your clients?\u201d<\/p>\n<p>__ Patient History<\/p>\n<p>__ Vital Signs<\/p>\n<p>__ Medications<\/p>\n<p>__ Physical Exam<\/p>\n<p>__ Plan of Care<\/p>\n<p>__ Psychosocial Issues<\/p>\n<p><strong>Team Members:<\/strong> \u201cWhat is going on with you and your team?\u201d(See the \u201cI\u2019M SAFE Checklist\u201d below.)<\/p>\n<p>__ Fatigue<\/p>\n<p>__ Workload<\/p>\n<p>__ Task Performance<\/p>\n<p>__ Skill<\/p>\n<p>__ Stress<\/p>\n<p><strong>Environment:<\/strong> Knowing Your Resources<\/p>\n<p>__ Facility Information<\/p>\n<p>__ Administrative Information<\/p>\n<p>__ Human Resources<\/p>\n<p>__ Triage Acuity<\/p>\n<p>__ Equipment<\/p>\n<p><strong>Progression Towards Goal:<\/strong><\/p>\n<p>__ Status of the Team&#8217;s Clients<\/p>\n<p>__ Established Goals of the Team<\/p>\n<p>__ Tasks\/Actions of the Team<\/p>\n<p>__ Appropriateness of the Plan and are Modifications Needed?<\/p>\n<\/div>\n<h4>Cross-Monitoring<\/h4>\n<p>As the STEP tool is implemented, the team leader continues to cross monitor to reduce the incidence of errors. Cross-monitoring includes the following<sup><a class=\"footnote\" title=\"AHRQ. (2020, January). Pocket guide: TeamSTEPPS. https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" id=\"return-footnote-151-20\" href=\"#footnote-151-20\" aria-label=\"Footnote 20\"><sup class=\"footnote\">[20]<\/sup><\/a><\/sup>:<\/p>\n<ul>\n<li style=\"font-weight: 400\">Monitoring the actions of other team members.<\/li>\n<li style=\"font-weight: 400\">Providing a safety net within the team.<\/li>\n<li style=\"font-weight: 400\">Ensuring that mistakes or oversights are caught quickly and easily.<\/li>\n<li style=\"font-weight: 400\">Supporting each other as needed.<\/li>\n<\/ul>\n<h4>I\u2019M SAFE Checklist<\/h4>\n<p>The<strong> <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_151_501\">I\u2019M SAFE<\/a> <\/strong>mnemonic is a tool used to assess one\u2019s own safety status, as well as that of other team members in their ability to provide safe client care. See the I\u2019M SAFE Checklist in the following box.<sup><a class=\"footnote\" title=\"AHRQ. (2020, January). Pocket guide: TeamSTEPPS. https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" id=\"return-footnote-151-21\" href=\"#footnote-151-21\" aria-label=\"Footnote 21\"><sup class=\"footnote\">[21]<\/sup><\/a><\/sup> If a team member feels their ability to provide safe care is diminished because of one of these factors, they should notify the charge nurse or other nursing supervisor. In a similar manner, if a nurse notices that another member of the team is impaired or providing care in an unsafe manner, it is an ethical imperative to protect clients and report their concerns according to agency policy.<sup><a class=\"footnote\" title=\"AHRQ. (2020, January). Pocket guide: TeamSTEPPS. https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" id=\"return-footnote-151-22\" href=\"#footnote-151-22\" aria-label=\"Footnote 22\"><sup class=\"footnote\">[22]<\/sup><\/a><\/sup><\/p>\n<div class=\"textbox shaded\">\n<p><strong>I\u2019m SAFE Checklist<\/strong><sup><a class=\"footnote\" title=\"AHRQ. (2020, January). Pocket guide: TeamSTEPPS. https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" id=\"return-footnote-151-23\" href=\"#footnote-151-23\" aria-label=\"Footnote 23\"><sup class=\"footnote\">[23]<\/sup><\/a><\/sup><\/p>\n<p>__ <strong>I<\/strong>: Illness<\/p>\n<p>__<strong>M<\/strong>: Medication<\/p>\n<p>__<strong>S<\/strong>: Stress<\/p>\n<p>__<strong>A<\/strong>: Alcohol and Drugs<\/p>\n<p>__<strong>F<\/strong>: Fatigue<\/p>\n<p>__<strong>E<\/strong>: Eating and Elimination<\/p>\n<\/div>\n<p>Read an example of a nursing team leader performing situation monitoring using the STEP tool in the following box.<\/p>\n<div class=\"textbox shaded\">\n<p><strong>Example of Situation Monitoring<\/strong><\/p>\n<p>Two emergent situations occur simultaneously on a busy medical-surgical hospital unit as one client codes and another develops a postoperative hemorrhage. The charge nurse is performing situation monitoring by continually scanning and assessing the status of all clients on the unit and directing additional assistance where it is needed. Each nursing team member maintains situation awareness by being aware of what is happening on the unit, in addition to caring for the clients they have been assigned. The charge nurse creates a shared mental model by ensuring all team members are aware of their evolving responsibilities as the situation changes. The charge nurse directs additional assistance to the emergent clients while also ensuring appropriate coverage for the other clients on the unit to ensure all clients receive safe and effective care.<\/p>\n<p>For example, as the \u201ccode\u201d is called, the charge nurse directs two additional nurses and two additional assistive personnel to assist with the emergent clients while the other nurses and unlicensed assistive personnel are directed to \u201ccover\u201d the remaining clients, answer call lights, and assist clients to the bathroom to prevent falls. Additionally, the charge nurse is aware that after performing a few rounds of CPR for the coding client, the unlicensed assistive personnel must be switched with another team member to maintain effective chest compressions. As the situation progresses, the charge nurse evaluates the status of all clients and makes adjustments to the plan as needed.<\/p>\n<\/div>\n<h3>Mutual Support<\/h3>\n<p><strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_151_525\">Mutual support<\/a><\/strong> is the fourth skill of the TeamSTEPPS\u00ae framework and defined as the \u201cability to anticipate and support team members&#8217; needs through accurate knowledge about their responsibilities and workload.\u201d Mutual support includes providing task assistance, giving feedback, and advocating for client safety by using assertive statements to correct a safety concern. Managing conflict is also a component of supporting team members\u2019 needs.<\/p>\n<h4>Task Assistance<\/h4>\n<p>Helping other team members with tasks builds a strong team. Task assistance includes the following components<sup><a class=\"footnote\" title=\"AHRQ. (2020, January). Pocket guide: TeamSTEPPS. https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" id=\"return-footnote-151-24\" href=\"#footnote-151-24\" aria-label=\"Footnote 24\"><sup class=\"footnote\">[24]<\/sup><\/a><\/sup>:<\/p>\n<ul>\n<li style=\"font-weight: 400\">Team members protect each other from work-overload situations.<\/li>\n<li style=\"font-weight: 400\">Effective teams place all offers and requests for assistance in the context of client safety.<\/li>\n<li style=\"font-weight: 400\">Team members foster a climate where it is expected that assistance will be actively sought and offered.<\/li>\n<\/ul>\n<div class=\"textbox shaded\">\n<p><strong>Example of Task Assistance<\/strong><\/p>\n<p>In a previous example, one client on the unit was coding while another was experiencing a postoperative hemorrhage. After the emergent care was provided and the hemorrhaging client was stabilized, Sue, the nurse caring for the hemorrhaging client, finds many scheduled medications for her other clients are past due. Sue reaches out to Sam, another nurse on the team, and requests assistance. Sam agrees to administer a scheduled IV antibiotic to a stable third client so Sue can administer oral medications to her remaining clients. Sam knows that on an upcoming shift, he may need to request assistance from Sue when unexpected situations occur. In this manner, team members foster a climate where assistance is actively sought and offered to maintain client safety.<\/p>\n<\/div>\n<h4>Feedback<\/h4>\n<p>Feedback is provided to a team member for the purpose of improving team performance. Effective feedback should follow these parameters<sup><a class=\"footnote\" title=\"AHRQ. (2020, January). Pocket guide: TeamSTEPPS. https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" id=\"return-footnote-151-25\" href=\"#footnote-151-25\" aria-label=\"Footnote 25\"><sup class=\"footnote\">[25]<\/sup><\/a><\/sup>:<\/p>\n<ul>\n<li style=\"font-weight: 400\"><em>Timely:<\/em> Provided soon after the target behavior has occurred.<\/li>\n<li style=\"font-weight: 400\"><em>Respectful:<\/em> Focused on behaviors, not personal attributes.<\/li>\n<li style=\"font-weight: 400\"><em>Specific:<\/em> Related to a specific task or behavior that requires correction or improvement.<\/li>\n<li style=\"font-weight: 400\"><em>Directed towards improvement:<\/em> Suggestions are made for future improvement.<\/li>\n<li style=\"font-weight: 400\"><em>Considerate:<\/em> Team members\u2019 feelings should be considered and privacy provided. Negative information should be delivered with fairness and respect.<\/li>\n<\/ul>\n<h4>Advocating for Safety with Assertive Statements<\/h4>\n<p>When a team member perceives a potential client safety concern, they should assertively communicate with the decision-maker to protect client safety. This strategy holds true for ALL team members, no matter their position within the hierarchy of the health care environment. The message should be communicated to the decision-maker in a firm and respectful manner using the following steps<sup><a class=\"footnote\" title=\"AHRQ. (2020, January). Pocket guide: TeamSTEPPS. https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" id=\"return-footnote-151-26\" href=\"#footnote-151-26\" aria-label=\"Footnote 26\"><sup class=\"footnote\">[26]<\/sup><\/a><\/sup>:<\/p>\n<ul>\n<li style=\"font-weight: 400\">Make an opening.<\/li>\n<li style=\"font-weight: 400\">State the concern.<\/li>\n<li style=\"font-weight: 400\">State the problem (real or perceived).<\/li>\n<li style=\"font-weight: 400\">Offer a solution.<\/li>\n<li style=\"font-weight: 400\">Reach agreement on next steps.<\/li>\n<\/ul>\n<div class=\"textbox shaded\">\n<p><strong>Examples of Using Assertive Statements to Promote Client Safety<\/strong><\/p>\n<p>A nurse notices that a team member did not properly wash their hands during client care. Feedback is provided immediately in a private area after the team member left the client room: <em>\u201cI noticed you didn\u2019t wash your hands when you entered the client\u2019s room. Can you help me understand why that didn\u2019t occur?\u201d (Wait for an answer.) \u201cPerforming hand hygiene is essential for protecting our clients from infection. It is also hospital policy, and we are audited for compliance to this policy. Let me know if you have any questions and I will check back with you later in the shift.\u201d (Monitor the team member for appropriate hand hygiene for the remainder of the shift.)<\/em><\/p>\n<\/div>\n<h5>Two-Challenge Rule<\/h5>\n<p>When an assertive statement is ignored by the decision-maker, the team member should assertively voice their concern at least two times to ensure that it has been heard by the decision-maker. This strategy is referred to as the <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_151_502\">two-challenge rule<\/a><\/strong>. When this rule is adopted as a policy by a health care organization, it empowers all team members to pause care if they sense or discover an essential safety breach. The decision-maker being challenged is expected to acknowledge the concern has been heard.<sup><a class=\"footnote\" title=\"AHRQ. (2020, January). Pocket guide: TeamSTEPPS. https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" id=\"return-footnote-151-27\" href=\"#footnote-151-27\" aria-label=\"Footnote 27\"><sup class=\"footnote\">[27]<\/sup><\/a><\/sup><\/p>\n<h5><strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_151_503\">CUS Assertive Statements<\/a><\/strong><\/h5>\n<p>During emergent situations, when stress levels are high or when situations are charged with emotion, the decision-maker may not \u201chear\u201d the message being communicated, even when the two-challenge rule is implemented. It is helpful for agencies to establish assertive statements that are well-recognized by all staff as implementation of the two-challenge rule. These assertive statements are referred to as the CUS mnemonic: \u201cI am <strong>C<\/strong>oncerned &#8211; I am <strong>U<\/strong>ncomfortable &#8211; This is a <strong>S<\/strong>afety issue!\u201d<sup><a class=\"footnote\" title=\"AHRQ. (2020, January). Pocket guide: TeamSTEPPS. https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" id=\"return-footnote-151-28\" href=\"#footnote-151-28\" aria-label=\"Footnote 28\"><sup class=\"footnote\">[28]<\/sup><\/a><\/sup> See Figure 7.8<sup><a class=\"footnote\" title=\"\u201ccusfig1.jpg\u201d by unknown author is licensed under\u00a0Public Domain. Access for free at https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" id=\"return-footnote-151-29\" href=\"#footnote-151-29\" aria-label=\"Footnote 29\"><sup class=\"footnote\">[29]<\/sup><\/a><\/sup> for an illustration of CUS assertive statements.<\/p>\n<figure id=\"attachment_150\" aria-describedby=\"caption-attachment-150\" style=\"width: 443px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-150 size-full\" title=\"\u201ccusfig1.jpg\u201d by unknown author is in the Public Domain.\u00a0 Access for free at\u00a0 https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html.\" src=\"https:\/\/pressbooks.ccconline.org\/accphysicalgeology\/wp-content\/uploads\/sites\/225\/2025\/02\/cusfig1.jpg\" alt=\"Illustration showing CUS acronym for assertive statements\" width=\"443\" height=\"216\" srcset=\"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/cusfig1.jpg 443w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/cusfig1-300x146.jpg 300w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/cusfig1-65x32.jpg 65w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/cusfig1-225x110.jpg 225w, https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-content\/uploads\/sites\/225\/2025\/02\/cusfig1-350x171.jpg 350w\" sizes=\"auto, (max-width: 443px) 100vw, 443px\" \/><figcaption id=\"caption-attachment-150\" class=\"wp-caption-text\">Figure 7.8 CUS Assertive Statements<\/figcaption><\/figure>\n<p>Using these scripted messages may effectively catch the attention of the decision-maker. However, if the safety issue still isn\u2019t addressed after the second statement or the use of \u201cCUS\u201d assertive statements, the team member should take a stronger course of action and utilize the agency\u2019s chain of command. For the two-challenge rule and CUS assertive statements to be effective within an agency, administrators must support a culture of safety and emphasize the importance of these initiatives to promote client safety.<\/p>\n<p>Read an example of a nurse using assertive statements in the following box.<\/p>\n<div class=\"textbox shaded\">\n<p><strong>Assertive Statement Example<\/strong><\/p>\n<p>A nurse observes a new physician resident preparing to insert a central line at a client\u2019s bedside. The nurse notes the resident has inadvertently contaminated the right sterile glove prior to insertion.<\/p>\n<p><strong>Nurse:<\/strong> \u201cDr. Smith, I noticed that you contaminated your sterile gloves when preparing the sterile field for central line insertion. I will get a new set of sterile gloves for you.\u201d<\/p>\n<p><strong>Dr. Smith:<\/strong> (Ignores nurse and continues procedure.)<\/p>\n<p><strong>Nurse:<\/strong> \u201cDr. Smith, please pause the procedure. I noticed that you contaminated your right sterile glove by touching outside the sterile field. I will get a new set of sterile gloves for you.\u201d<\/p>\n<p><strong>Dr. Smith:<\/strong> \u201cMy gloves are fine.\u201d (Prepares to initiate insertion.)<\/p>\n<p><strong>Nurse:<\/strong> \u201cDr. Smith &#8211; I am concerned! I am uncomfortable! This is a safety issue!\u201d<\/p>\n<p><strong>Dr. Smith:<\/strong> (Stops procedure, looks up, and listens to the nurse.) \u201cI\u2019ll wait for that second pair of gloves.\u201d<\/p>\n<\/div>\n<h4>Managing Conflict<\/h4>\n<p>Conflict is not uncommon on interprofessional teams, especially when there are diverse perspectives from multiple staff regarding client care. Nurse leaders must be prepared to manage conflict to support the needs of their team members.<\/p>\n<p>When conflict occurs, the <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_151_507\">DESC tool<\/a> <\/strong>can be used to help resolve conflict by using \u201cI statements.\u201d DESC is a mnemonic that stands for the following<sup><a class=\"footnote\" title=\"AHRQ. (2020, January). Pocket guide: TeamSTEPPS. https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" id=\"return-footnote-151-30\" href=\"#footnote-151-30\" aria-label=\"Footnote 30\"><sup class=\"footnote\">[30]<\/sup><\/a><\/sup>:<\/p>\n<ul>\n<li style=\"font-weight: 400\"><strong>D:<\/strong> Describe the specific situation or behavior; provide concrete data.<\/li>\n<li style=\"font-weight: 400\"><strong>E:<\/strong> Express how the situation makes you feel\/what your concerns are using \u201cI\u201d statements.<\/li>\n<li style=\"font-weight: 400\"><strong>S:<\/strong> Suggest other alternatives and seek agreement.<\/li>\n<li style=\"font-weight: 400\"><strong>C:<\/strong> Consequences stated in terms of impact on established team goals while striving for consensus.<\/li>\n<\/ul>\n<p>The DESC tool should be implemented in a private area with a focus on WHAT is right, not WHO is right. Read an example of a nurse using the DESC tool in the following box.<\/p>\n<div class=\"textbox shaded\">\n<p><strong>Example of Using the DESC Tool<\/strong><sup><a class=\"footnote\" title=\"AHRQ. (2020, January). Pocket guide: TeamSTEPPS. https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" id=\"return-footnote-151-31\" href=\"#footnote-151-31\" aria-label=\"Footnote 31\"><sup class=\"footnote\">[31]<\/sup><\/a><\/sup><\/p>\n<p><strong>Situation:<\/strong> A physician became angry at a nurse who was inserting a client\u2019s Foley catheter and yelled at the nurse in front of the client and other team members. The nurse later addressed the physician in a private area outside the client\u2019s room using the DESC tool and \u201cI statements\u201d:<\/p>\n<p><strong>D:<\/strong> \u201cI noticed you got angry at me when I inserted the client\u2019s Foley catheter.\u201d<\/p>\n<p><strong>E:<\/strong> \u201cI\u2019m concerned how you addressed that issue in front of the client and three other staff members. It made me feel bad in front of the client and my colleagues.\u201d<\/p>\n<p><strong>S:<\/strong> \u201cIn the future, if you have an issue with how I do things, please pull me aside privately to discuss your concern.\u201d<\/p>\n<p><strong>C:<\/strong> \u201cOur organization has a policy for managing communication challenges among team members if we can\u2019t agree on this alternative.\u201d<\/p>\n<\/div>\n<p>Managing interpersonal conflict resolution is described further in the \u201c<a href=\"https:\/\/pressbooks.ccconline.org\/accnursing2030\/chapter\/7-7-conflict-resolution\/\" target=\"_blank\" rel=\"noopener\">Conflict Resolution<\/a>\u201d section.<\/p>\n<div class=\"textbox shaded\">\n<p class=\"video\">View a supplementary detailed video webinar from AHRQ describing the TeamSTEPPS<strong>\u00ae<\/strong> principles at <a href=\"https:\/\/youtu.be\/fxlRtpzsUug\" target=\"_blank\" rel=\"noopener\">youtu.be\/fxlRtpzsUug<\/a>.<sup><a class=\"footnote\" title=\"AHRQ Patient Safety. (2017, July 26). Introduction to the fundamentals of TeamSTEPPS\u00ae concepts and tools\u00a0[Video]. YouTube. Video in the Public Domain. https:\/\/youtu.be\/fxlRtpzsUug\" id=\"return-footnote-151-32\" href=\"#footnote-151-32\" aria-label=\"Footnote 32\"><sup class=\"footnote\">[32]<\/sup><\/a><\/span><\/sup><\/p>\n<\/div>\n<div class=\"textbox shaded\">\n<p><strong>Team Qualitities Case Application (<\/strong><em>Answers can be found at the end of book)<\/em><\/p>\n<p>Mary is recovering from a stroke and requires comprehensive care involving multiple disciplines. Her care team has scheduled interdisciplinary team meetings twice a week to discussion Mary&#8217;s progress, adjust her care plan, and address any concerns. Dr. Patel is Mary&#8217;s primary physician and consults with Chris (physical therapist) and Emily (speech therapist) before making any changes to Mary&#8217;s medication that might affect her therapy sessions. Chris and Emily coordinate their therapy schedules to help maximize Mary&#8217;s participation and avoid conflicting sessions and fatigue. Laura is Mary&#8217;s social worker and has a large roster of clients. Laura struggles to include Mary&#8217;s family in the discharge planning discussions but feels that she has identified an appropriate facility that Mary and her family will be receptive to for discharge. She moves forward with the client placement paperwork. Lisa is Mary&#8217;s dietician, and she has identified a dietary plan that will best contribute to Mary&#8217;s nutritional needs and healing. She acknowledges that Mary&#8217;s dietary preferences are much different than what she has selected in her dietary plan, but Lisa knows that she has identified the best dietary plan to meet Mary&#8217;s energy needs.<\/p>\n<p>Identify which team members are demonstrating team success strategies and how they are demonstrated?<\/p>\n<p>Which team members are not demonstrating team success strategies? How could these team members modify their approach?<\/p>\n<\/div>\n<hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-151-1\">Interprofessional Education Collaborative. <em>IPEC core competencies<\/em>. <a href=\"https:\/\/www.ipecollaborative.org\/ipec-core-competencies\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ipecollaborative.org\/ipec-core-competencies<\/a> <a href=\"#return-footnote-151-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-151-2\">Interprofessional Education Collaborative. <em>IPEC core competencies<\/em>. <a href=\"https:\/\/www.ipecollaborative.org\/ipec-core-competencies\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ipecollaborative.org\/ipec-core-competencies<\/a> <a href=\"#return-footnote-151-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><li id=\"footnote-151-3\">Interprofessional Education Collaborative Expert Panel. (2011). <em>Core competencies for interprofessional collaborative practice: Report on an expert panel.<\/em> Interprofessional Education Collaborative. <a href=\"https:\/\/ipec.memberclicks.net\/assets\/2011-Original.pdf\" target=\"_blank\" rel=\"noopener\">https:\/\/ipec.memberclicks.net\/assets\/2011-Original.pdf<\/a> <a href=\"#return-footnote-151-3\" class=\"return-footnote\" aria-label=\"Return to footnote 3\">&crarr;<\/a><\/li><li id=\"footnote-151-4\">\u201c<a href=\"https:\/\/www.shutterstock.com\/image-photo\/team-multiracial-doctors-hospital-discussing-patient-400845937\" target=\"_blank\" rel=\"noopener\">400845937-huge.jpg<\/a>\u201d by<a href=\"https:\/\/www.shutterstock.com\/g\/UberImages\" target=\"_blank\" rel=\"noopener\"> Flamingo Images<\/a> is used under license from<a href=\"https:\/\/www.shutterstock.com\/\" target=\"_blank\" rel=\"noopener\"> Shutterstock.com<\/a> <a href=\"#return-footnote-151-4\" class=\"return-footnote\" aria-label=\"Return to footnote 4\">&crarr;<\/a><\/li><li id=\"footnote-151-5\">O\u2019Daniel, M., &amp; Rosenstein, A. H. (2011). Professional communication and team collaboration. In: Hughes R.G. (Ed.). <em>Patient safety and quality: An evidence-based handbook for nurses.<\/em> Agency for Healthcare Research and Quality (US); Chapter 33. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK2637\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK2637<\/a> <a href=\"#return-footnote-151-5\" class=\"return-footnote\" aria-label=\"Return to footnote 5\">&crarr;<\/a><\/li><li id=\"footnote-151-6\">O\u2019Daniel, M., &amp; Rosenstein, A. H. (2011). Professional communication and team collaboration. In: Hughes R.G. (Ed.). <em>Patient safety and quality: An evidence-based handbook for nurses.<\/em> Agency for Healthcare Research and Quality (US); Chapter 33. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK2637\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK2637<\/a> <a href=\"#return-footnote-151-6\" class=\"return-footnote\" aria-label=\"Return to footnote 6\">&crarr;<\/a><\/li><li id=\"footnote-151-7\">AHRQ. (2019, June).<em> TeamSTEPPS 2.0.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/index.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/index.html<\/a> <a href=\"#return-footnote-151-7\" class=\"return-footnote\" aria-label=\"Return to footnote 7\">&crarr;<\/a><\/li><li id=\"footnote-151-8\">AHRQ Patient Safety. (2015, April 29). <em>TeamSTEPPS overview<\/em>\u00a0[Video]. YouTube. All rights reserved. <a href=\"https:\/\/youtu.be\/p4n9xPRtSuU\" target=\"_blank\" rel=\"noopener\">https:\/\/youtu.be\/p4n9xPRtSuU<\/a> <a href=\"#return-footnote-151-8\" class=\"return-footnote\" aria-label=\"Return to footnote 8\">&crarr;<\/a><\/li><li id=\"footnote-151-9\">AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS<\/em>. <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a> <a href=\"#return-footnote-151-9\" class=\"return-footnote\" aria-label=\"Return to footnote 9\">&crarr;<\/a><\/li><li id=\"footnote-151-10\">\u201ctslogo1med.jpg\u201d by unknown author is licensed under\u00a0<a href=\"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/deed.en\" target=\"_blank\" rel=\"noopener\">Public Domain<\/a>. Access for free at <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a> <a href=\"#return-footnote-151-10\" class=\"return-footnote\" aria-label=\"Return to footnote 10\">&crarr;<\/a><\/li><li id=\"footnote-151-11\">AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a> <a href=\"#return-footnote-151-11\" class=\"return-footnote\" aria-label=\"Return to footnote 11\">&crarr;<\/a><\/li><li id=\"footnote-151-12\">AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a> <a href=\"#return-footnote-151-12\" class=\"return-footnote\" aria-label=\"Return to footnote 12\">&crarr;<\/a><\/li><li id=\"footnote-151-13\">AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a> <a href=\"#return-footnote-151-13\" class=\"return-footnote\" aria-label=\"Return to footnote 13\">&crarr;<\/a><\/li><li id=\"footnote-151-14\">AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a> <a href=\"#return-footnote-151-14\" class=\"return-footnote\" aria-label=\"Return to footnote 14\">&crarr;<\/a><\/li><li id=\"footnote-151-15\">AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a> <a href=\"#return-footnote-151-15\" class=\"return-footnote\" aria-label=\"Return to footnote 15\">&crarr;<\/a><\/li><li id=\"footnote-151-16\">AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a> <a href=\"#return-footnote-151-16\" class=\"return-footnote\" aria-label=\"Return to footnote 16\">&crarr;<\/a><\/li><li id=\"footnote-151-17\">\u201cstepfig1.jpg\u201d by unknown author is licensed under\u00a0<a href=\"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/deed.en\" target=\"_blank\" rel=\"noopener\">Public Domain<\/a>. Access for free at <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a> <a href=\"#return-footnote-151-17\" class=\"return-footnote\" aria-label=\"Return to footnote 17\">&crarr;<\/a><\/li><li id=\"footnote-151-18\">AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a> <a href=\"#return-footnote-151-18\" class=\"return-footnote\" aria-label=\"Return to footnote 18\">&crarr;<\/a><\/li><li id=\"footnote-151-19\">AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a> <a href=\"#return-footnote-151-19\" class=\"return-footnote\" aria-label=\"Return to footnote 19\">&crarr;<\/a><\/li><li id=\"footnote-151-20\">AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a> <a href=\"#return-footnote-151-20\" class=\"return-footnote\" aria-label=\"Return to footnote 20\">&crarr;<\/a><\/li><li id=\"footnote-151-21\">AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a> <a href=\"#return-footnote-151-21\" class=\"return-footnote\" aria-label=\"Return to footnote 21\">&crarr;<\/a><\/li><li id=\"footnote-151-22\">AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a> <a href=\"#return-footnote-151-22\" class=\"return-footnote\" aria-label=\"Return to footnote 22\">&crarr;<\/a><\/li><li id=\"footnote-151-23\">AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a> <a href=\"#return-footnote-151-23\" class=\"return-footnote\" aria-label=\"Return to footnote 23\">&crarr;<\/a><\/li><li id=\"footnote-151-24\">AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a> <a href=\"#return-footnote-151-24\" class=\"return-footnote\" aria-label=\"Return to footnote 24\">&crarr;<\/a><\/li><li id=\"footnote-151-25\">AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a> <a href=\"#return-footnote-151-25\" class=\"return-footnote\" aria-label=\"Return to footnote 25\">&crarr;<\/a><\/li><li id=\"footnote-151-26\">AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a> <a href=\"#return-footnote-151-26\" class=\"return-footnote\" aria-label=\"Return to footnote 26\">&crarr;<\/a><\/li><li id=\"footnote-151-27\">AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a> <a href=\"#return-footnote-151-27\" class=\"return-footnote\" aria-label=\"Return to footnote 27\">&crarr;<\/a><\/li><li id=\"footnote-151-28\">AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a> <a href=\"#return-footnote-151-28\" class=\"return-footnote\" aria-label=\"Return to footnote 28\">&crarr;<\/a><\/li><li id=\"footnote-151-29\">\u201ccusfig1.jpg\u201d by unknown author is licensed under\u00a0<a href=\"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/deed.en\" target=\"_blank\" rel=\"noopener\">Public Domain<\/a>. Access for free at <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a> <a href=\"#return-footnote-151-29\" class=\"return-footnote\" aria-label=\"Return to footnote 29\">&crarr;<\/a><\/li><li id=\"footnote-151-30\">AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a> <a href=\"#return-footnote-151-30\" class=\"return-footnote\" aria-label=\"Return to footnote 30\">&crarr;<\/a><\/li><li id=\"footnote-151-31\">AHRQ. (2020, January). <em>Pocket guide: TeamSTEPPS.<\/em> <a href=\"https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahrq.gov\/teamstepps\/instructor\/essentials\/pocketguide.html<\/a> <a href=\"#return-footnote-151-31\" class=\"return-footnote\" aria-label=\"Return to footnote 31\">&crarr;<\/a><\/li><li id=\"footnote-151-32\">AHRQ Patient Safety. (2017, July 26). <em>Introduction to the fundamentals of TeamSTEPPS<\/em><span style=\"color: #000000\"><em>\u00ae concepts and tools<\/em>\u00a0[Video]. YouTube. Video in the Public Domain. <a href=\"https:\/\/youtu.be\/fxlRtpzsUug\" target=\"_blank\" rel=\"noopener\">https:\/\/youtu.be\/fxlRtpzsUug<\/a> <a href=\"#return-footnote-151-32\" class=\"return-footnote\" aria-label=\"Return to footnote 32\">&crarr;<\/a><\/li><\/ol><\/div><div class=\"glossary\"><span class=\"screen-reader-text\" id=\"definition\">definition<\/span><template id=\"term_151_464\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_151_464\"><div tabindex=\"-1\"><p>An evidence-based framework to improve client safety through effective communication in health care environments consisting of four core competencies: communication, leadership, situation monitoring, and mutual support.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_151_497\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_151_497\"><div tabindex=\"-1\"><p>A short session to share a plan, discuss team formation, assign roles and responsibilities, establish expectations and climate, and anticipate outcomes and contingencies.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_151_498\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_151_498\"><div tabindex=\"-1\"><p>A brief meeting during a shift to reestablish situational awareness, reinforce plans already in place, and adjust the teamwork plan as needed.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_151_499\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_151_499\"><div tabindex=\"-1\"><p>An informal information exchange session designed to improve team performance and effectiveness through reinforcement of positive behaviors and reflecting on lessons learned after a significant event occurs.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_151_504\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_151_504\"><div tabindex=\"-1\"><p>The process of continually scanning and assessing the situation to gain and maintain an understanding of what is going on around you.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_151_505\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_151_505\"><div tabindex=\"-1\"><p>The awareness of a team member knowing what is going on around them.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_151_506\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_151_506\"><div tabindex=\"-1\"><p>The actions of a team leader that ensure all team members have situation awareness and are \"on the same page\" as situations evolve on the unit.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_151_500\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_151_500\"><div tabindex=\"-1\"><p>A situation monitoring tool used to know what is going on with you, your patients, your team, and your environment. STEP stands for Status of the patients, Team members, Environment, and Progress Toward Goal.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_151_501\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_151_501\"><div tabindex=\"-1\"><p>A tool used to assess one\u2019s own safety status, as well as that of other team members in their ability to provide safe patient care.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_151_525\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_151_525\"><div tabindex=\"-1\"><p>Ability to anticipate and support team members' needs through accurate knowledge about their responsibilities and workload.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_151_502\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_151_502\"><div tabindex=\"-1\"><p>A strategy for advocating for patient safety that includes a team member assertively voicing their concern at least two times to ensure that it has been heard by the decision-maker.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_151_503\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_151_503\"><div tabindex=\"-1\"><p>Assertive statements that are well-recognized by all staff across a health care agency as implementation of the two-challenge rule.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_151_507\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_151_507\"><div tabindex=\"-1\"><p>A tool used to help resolve conflict. DESC is a mnemonic that stands for Describe the specific situation or behavior and provide concrete data, Express how the situation makes you feel\/what your concerns are using \u201cI\u201d messages, Suggest other alternatives and seek agreement, and Consequences are stated in terms of impact on established team goals while striving for consensus.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><\/div>","protected":false},"author":32,"menu_order":6,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[48],"contributor":[],"license":[],"class_list":["post-151","chapter","type-chapter","status-publish","hentry","chapter-type-numberless"],"part":132,"_links":{"self":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-json\/pressbooks\/v2\/chapters\/151","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-json\/wp\/v2\/users\/32"}],"version-history":[{"count":2,"href":"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-json\/pressbooks\/v2\/chapters\/151\/revisions"}],"predecessor-version":[{"id":561,"href":"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-json\/pressbooks\/v2\/chapters\/151\/revisions\/561"}],"part":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-json\/pressbooks\/v2\/parts\/132"}],"metadata":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-json\/pressbooks\/v2\/chapters\/151\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-json\/wp\/v2\/media?parent=151"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-json\/pressbooks\/v2\/chapter-type?post=151"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-json\/wp\/v2\/contributor?post=151"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accnursing2030\/wp-json\/wp\/v2\/license?post=151"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}