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QSEN

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HomeLeading InitiativesQSEN

QUALITY AND SAFETY EDUCATION FOR NURSES (QSEN)


ADN QSEN Purpose
The Associate Degree Nursing (ADN) Task Force is comprised of members who have a special interest in ADN as well as QSEN. Educators of ADN programs are tasked with the challenge of preparing future nurses with the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality and safety of the healthcare systems in which they will work. The aim of the ADN Task Force is to assist nurse educators in incorporating QSEN competencies into ADN education.

 

Task Force Goals
  • Identify current status of QSEN competencies incorporated in ADN education.
  • Identify resources to support the integration of QSEN competencies in ADN education.
  • Develop strategies to assist ADN programs with the implementation of QSEN competencies into curricula.
  • Collaborate with ADN educators regarding innovative curricular designs, evaluation tools, and teaching strategies by creating a repository showcasing how QSEN competencies can be integrated into ADN programs

QSEN Competencies

The Organization for Associate Degree Nursing (OADN) values the role of the nurse educator.  Being an effective educator can impact students and their patients for decades.  It is for this reason that we promote incorporation of Quality and Safety Education for Nurses (QSEN) into nursing curriculum at all levels.  Over the course of several months, the QSEN workgroup will post each of the six pre-licensure competencies.  These posts are brief summaries of the competency with some tips for practical application in your role as a nurse educator.

 

QSEN Competency #1:  Patient-centered Care

This content area emphasizes key patient-centered care points that the pre-licensure graduate should be competent in upon graduation.  Definition:  Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.

Recognition for the need of patient-centered care can be traced back to the Institute of Medicines (IOM) Crossing the Quality Chasm which suggested that “caregivers provide care that is respectful and responsive to patient preferences, needs, and values, and that patient values guide clinical decision making” (IOM,  2001, p. 40).  As seasoned caregivers, nurses realize that most of what we do rotates around the patient.  But, students often get caught up in daily tasks and forget the true reason they are providing care, the patient.  How do nurse educators get students to understand that if care is patient-centered, improved patient outcomes and satisfaction will follow?  Below are some examples of activities with an emphasis on patient-centered care.

Classroom

Submitted by Kimberly Silver Dunker, DNP, RN.  This is an unfolding case study designed for nursing students to learn about caring for a patient with pancreatic cancer.  This case study addresses the following competencies:  patient-centered care, teamwork and collaboration, safety, evidence-based practice, and quality improvement.  Students actively participate by answering questions as they work through the case study which includes video clips.  At the end, students could complete reflective writing on how this enhanced their knowledge, skills, and attitudes related to patient-centered care and team huddles.
 
Submitted by Karla Rodriguez, DNP, CNE, RN, co-authors include Karyn Boyar, DNP, RN, FNP-BC; James Weidel, PhD, FNP-BC, PMHNP-BC; Emerson Ea, DNP, APRN, CNE.  This classroom activity has students work in small groups to mind map the care for an older adult from a scenario focusing on safety, patient-centered care, and fall prevention.  
Developed by Laurie Simmons, MSN, RN, CNE.  This classroom activity helps students understand how healthcare providers are incorporating patient self-management and making care patient centered.
 
Clinical
Submitted by Diana Girdley, MS, RN.  This clinical activity focuses on the use of a clinical evaluation tool that students complete along with their head-to-toe assessment for safety and providing patient centered care.  During post conference the students share their results and interventions they took.
 
 
Clinical/Lab
Submitted by Robin Arends, MS, CNP.  This clinical activity has students entering a “set-up” room to identify potential errors or hazards for the patient.  Students are allowed 15 minutes to make observations and record them.  Then students debrief with the instructor and the instructor points out errors or misses that no one identified and discuss the importance.
 
Originator of competency highlight: Laurie Simmons, MSN RN CNE; Associate Professor; Kirkwood Community College; Marion, IA.

 

 

QSEN Competency #2:  Teamwork and Collaboration

This content addresses the key competencies expected in entry-level nurses to facilitate their abilities to work effectively with the other members of the healthcare team.

Definition: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.

In nursing education, it is critical that pre-licensure graduates understand their role in healthcare in relationship to the other healthcare providers. Nurses must learn to respect the value of the other disciplines recognizing where the various scopes of practices intersect or are different. In achieving this level of understanding patients will truly receive patient-centered care that fosters the provision of healthcare that is provided by the most appropriate individual or team. It is the responsibility of nurse educators to provide students with opportunities to appreciate the specific role of the other healthcare disciplines and identify how these relationships might be fostered. The following examples describe activities that were designed to meet this goal.

 

Classroom/ Simulation:

In this activity, students enrolled in the respiratory care, occupational therapy assist and nursing programs participate in an inter-professional educational experience. Faculty from each of the programs begin the session with brief presentations regarding the key assessment tools used by their discipline. Students from each discipline are seated at each table to facilitate sharing. Through this didactic content students begin to appreciate where their scope of practice was similar or different.

In the next phase of the activity, a case study from the National League for Nurses (NLN) Advancing Care Excellence for Seniors (ACES) involving Henry and Ertha Williams is presented. Henry is a patient with COPD and Ertha struggles with dementia. A discussion ensues at each table with students from the various disciplines discussing how they would assess and treat the patient from their discipline’s perspective.

Phase 3 of the program involves a live simulation with standardized patients. Each discipline interacts with the patient(s). It is the responsibility of the nursing students to identify when their patient could benefit from the care of a different discipline.

Pre- and post-assessment data is gathered in terms of the students’ readiness to learn about other disciplines as well as assessment of their level of understanding the scope of practice of other disciplines.

 

Classroom/Simulation:

In this activity, students are trained to use the AHRQ TeamSTEPPS framework for collaborative practice within the simulation lab before entering the hospital setting.  Using the Simulation Exemplar #1 found in the NLN’s Guide to Effective Interprofessional Education Experiences in Nursing Education via the following link: http://www.nln.org/docs/default-source/default-document.../ipe-toolkit-krk-012716.pdf?, clinical case scenarios are developed in which students learn how to implement their TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) teamwork skills.

 Prior to simulation, a TeamSTEPPS presentation and handout are given to the students.  Terms such as “Briefing and Debriefing, SBAR (Situation, Background, Assessment, Recommendation), Huddles, Hand-off, Situational Monitoring, Conflict Resolution, CUS (Concerned, Uncomfortable, Safety) and Closing the Loop” (AHRQ, 2015) are explained .  The resources for this information can be found on the following  AHRQ link: https://www.ahrq.gov/teamstepps/instructor/essentials/igessentials.html 

With the nursing professor acting as facilitator, a briefing is held in which students are divided into two groups: the first group as active participants in the first case scenario, while the second group serves as the observers who complete a peer evaluation tool using a TeamSTEPPS checklist.  The students’ roles are then reversed for a second case scenario.

During a de-briefing, the TeamSTEPPS checklists are reviewed with the students, feedback obtained and the student feelings about communication and the importance of teamwork and collaboration are discussed.  The students are then able to apply their knowledge in the hospital setting and understand the value of teamwork and collaboration in promoting patient safety.

 

Classroom/Clinical Experience:

In this activity, we link the information from the perioperative unit in the didactic class to a clinical experience found within second and third semester medical-surgical courses.  The information is introduced in first semester during the perioperative unit with a discussion of all interdisciplinary professions that work within the perioperative environment, from pre- to post-operative care.  During second semester, each student is assigned a day of observation within the OR.  They are able to follow a patient from the pre-operative suite to the intraoperative room and finally through the post-anesthesia care unit (PACU).  The ultimate objective is for the student nurse to then return with the patient to the nursing unit on which the patient will be admitted.  During third semester, each nursing student is again assigned a day within the perioperative unit, with the intention that they will spend this experience shadowing RN’s who are instrumental in the care of the patient, whether that is the surgical nurse or the PACU nurse. 

Through the introduction prior to the experience, the students become aware of the many different interdisciplinary personnel who work within the perioperative unit. They develop an understanding of the roles of these individuals and the responsibilities assigned to each.  During the second semester, students are able to observer and interact with each of these healthcare team members, solidifying their understanding of what nurses are responsible for in the OR, but also how RN’s interact with other team members.  During the third semester, the student is able to focus more thoroughly on the role of the RN because they have developed a familiarity with the environment through their previous educational experiences.  By working with a specific nurse throughout the care of the patient undergoing an operative procedure, the student gains a better understanding of the ways the RN manages the care of the patient throughout this experience.  Additionally, the student is able to more fully comprehend the role of the nurse within the perioperative environment and the ways these roles and responsibilities intertwine with other professionals working toward the same outcome.

Developed by the OADN QSEN Task Force

 

QSEN Competency #3: Safety

This content area emphasizes the key elements of safety that the pre-licensure graduate should be competent in upon graduation.  

QSEN Definition:  Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.

The patient safety movement was spurred forth following the 1999 publication of the Institute of Medicine’s To Err is Human. The report shockingly noted that as many as 98,000 people were dying in hospitals each year as a result of preventable medical errors (IOM, 1999, p. 1). Despite efforts to improve these statistics, the BMJ recently reported that medical error is the third leading cause of death in the US (The BMJ, 2016). Nurses, who have the opportunity and challenge to work at the “sharp end of care”, must begin to develop the competencies necessary to promote a culture of safety early in their nursing educational journey. Below are some examples of curricular activities with an emphasis on safety.

 

Classroom

http://qsen.org/enhancing-medication-safety-teaching-through-remediation-and-reflection/

Enhancing Medication Safety through remediation and reflection submitted by Donna McCabe, DNP, APRN-BC, GNP. This strategy seeks to improve acquisition of safety KSAs with medication dosage calculation through remediation and reflection.

 

http://qsen.org/courses/learning-modules/module-seventeen/

A learning module contributed by Carol F. Durham, EdD, RN, ANEF and Jennifer Dwyer, MS, RN, BC, CNRN, FNP BC, entitled “Learning Module 17- Patient Safety: Our Intent Is To Do No Harm- So Why Do Errors Happen?”, highlights QSEN competencies which promote safe patient care and provides video, handout, and tools for classroom use.

 

https://drive.google.com/open?id=0B6FwEbBhzK9iRTF3VGozOC0wSEk

A Just Culture Safety Exercise for faculty and/or students: Contributed by Mary Anne Tagulinao RN, BSN, MN, CRH and Joanne Iverson RN, BSN, MN. This exercise provides a case study approach and discussion around Just Culture.

 

https://www.youtube.com/watch?v=uBSc80puIMU&feature=youtu.be

This ANA video, “Nursing: The Infrastructure of Safety (Reducing Nurse Fatigue)”, provides an excellent background to spur student discussion of the role of nurse fatigue on the provision of safe care.

 

http://webcls.utmb.edu/neat/about.asp

The Nursing Education and Technology Project (NEAT) repository was developed as a collaborative effort between 10 schools of nursing across the U.S. as a means to address common teaching and learning needs related to Patient Safety and Health Disparities. To view the learning modules, users must first create a free account. To view the lessons below, once logged in, click on “preview this learning object”.

 

Beyond the Five Rights: Medication Administration Safety

http://webcls.utmb.edu/neat/loprop.asp?loid=587

Culture of Safety: Part One- Moving Beyond Blame

http://tlcprojects.org/NEAT/CultureSafety_P1.swf

Culture of Safety: Part Two-Culture Change

http://webcls.utmb.edu/neat/loprop.asp?loid=668

Culture of Safety: Why Do Things Go Wrong

http://webcls.utmb.edu/neat/loprop.asp?loid=960

Culture of Safety: The Role of Nurses

http://webcls.utmb.edu/neat/loprop.asp?loid=961

Raising a Red Flag: Reporting Near Misses in Health Care

http://webcls.utmb.edu/neat/loprop.asp?loid=986

 

Clinical

http://qsen.org/quality-and-safety-monitor-assignment-2/

The Quality and Safety Monitor Assignment submitted by Laurie J. Palmer, MS, RN, AOCN provides a structured checklist which allows the student nurse an opportunity to analyze potential and actual risks which affect the provision of safe care, communicate observations related to safety hazards, and to value one’s role in preventing error.

 

QSEN - An Interactive Teaching Strategy Using I-SBAR-R to Improve Communication, Quality and Safety

https://nursetimtube.com/qsen_i_sbar_r

This video is located on the NurseTim site, created by Karen Rotolo, MSN, RN and Debbie Riggs, MSN, RN, CCRN who are on the faculty at the Mercy College of Nursing and the University of Pittsburgh Medical Center. They collaborated on the development of the QSEN strategy expanding SBAR as a communication strategy. This activity, created for medical surgical nursing students, can be completed in the conference setting.

 

Just Culture

http://ncbon.socrateslive.com/discipline-compliance-employer-complaints-just-culture-overview-general-information

The North Carolina Board of Nursing has extensive training regarding the concept of a “Just Culture”. The site has a list of concepts and definitions, in addition to a “Compliant Evaluation Tool”.

 

Lab/Simulation

http://sirc.nln.org/file.php/1/Supplemental_Materials_for_Integrating_QSEN_and_ACES.pdf

An NLN created resource, entitled, “Supplemental Materials for Integrating QSEN and ACES: An NLN Simulation Leader Initiative”, that incorporates QSEN competencies into the "Millie” unfolding case study that was developed for the NLN's Advancing Care Excellence for Seniors (ACE.S) project. Tables that correlate the KSAs for each QSEN competency with the learning activities suggested in each scenario are provided, along with enhanced simulation templates for the three scenarios. Access to the ACES “Millie” unfolding case study can be found here: http://www.nln.org/professional-development-programs/teaching-resources/ace-s/unfolding-cases/millie-larsen

 

Enhancing Patient Safety in Nursing Education through Patient Simulation

https://www.ncbi.nlm.nih.gov/books/NBK2628/

This chapter in Patient Safety and Quality: An Evidence-based Handbook for Nurses (2008) (see Additional Resources below) specifically addresses the use of simulation as a teaching tool for patient safety.  A sample simulation scenario is included.

 

NurseTim presents...NCLEX ® Nuggets: Safety as an Emphasis in Lab and Simulation

https://nursetimtube.com/nclex-nuggets-safety-lab-sim

This is a short video that provides a strategy that can be used in the simulation/lab setting that links the use of the NCLEX blueprint to what is being taught in the lab/simulation setting.

 

Additional Resources

Agency for Healthcare Research and Quality

  • Patient Safety and Quality: An Evidence-based Handbook for Nurses (2008)

https://archive.ahrq.gov/professionals/clinicians-providers/resources/nursing/resources/nurseshdbk/index.html

The Agency for Healthcare Research and Quality (AHRQ), with additional funding from the Robert Wood Johnson Foundation, prepared this handbook for nurses on patient safety and quality.  The Handbook also includes a section on nurses’ work environment and working conditions.

 

  • Patient Safety Primers

https://psnet.ahrq.gov/primers

This site offers definitions of commonly used patient safety terms and additional information about the source and context of the term.

 

  • AHRQ Health Literacy Universal Precautions Toolkit

https://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/index.html

The AHRQ Health Literacy Universal Precautions Toolkit, 2nd edition, can help primary care practices reduce the complexity of health care, increase patient understanding of health information, and enhance support for patients of all health literacy levels.

 

  • Patient Safety Measure Tools & Resources

https://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/index.html

 

  • Web M&M: Web Morbidity & Mortality

https://psnet.ahrq.gov/webmm

Features the Patient Safety Network case reports of safety errors from a variety of settings.  Each case study includes expert commentary, take home points, and references.

 

  • TeamSTEPPS

https://www.ahrq.gov/teamstepps/instructor/index.html

TeamSTEPPS is an evidence-based teamwork system aimed at optimizing patient care by improving communication and teamwork skills among health care professionals, including frontline staff. It includes a comprehensive set of ready-to-use materials, including video clips and scenarios for discussion, and a training curriculum to successfully integrate teamwork principles into a variety of settings. Topics addressed include traits for effective leadership, situation awareness, protecting the team with mutual support, and effective communication.

 

  • CUSP: The Comprehensive Unit-based Safety Program

https://www.ahrq.gov/professionals/education/curriculum-tools/cusptoolkit/index.html

CUSP contains a series of modules which can be modified for individual needs. Each module contains training tools and resources to make care safer by improving the foundation of how your physicians, nurses, and other clinical team members work together. It builds the capacity to address safety issues by combining clinical best practices and the science of safety for the goal of quality improvement.  The CUSP Toolkit module “Implement Teamwork and Communication” helps learners understand the importance of effective communication and transparency, identify barriers to communication, and isolate and apply the effective teamwork and communication tools.

https://www.ahrq.gov/professionals/education/curriculum-tools/cusptoolkit/modules/implement/index.html 

 

The Joint Commission:

  • National Patient Safety Goals: Daily Safety Briefings

https://www.jointcommission.org/assets/1/23/Quick_Safety_Issue_34_2017_Safety_briefings_FINAL.pdf

Shares the importance, benefits, and safety actions of daily safety briefings, also known as safety huddles.

 

  • Patient Safety

https://www.jointcommission.org/topics/patient_safety.aspx

Learn about the Joint Commission’s patient safety focused initiatives.

             

World Health Organization:

  • Patient Safety Curriculum

http://www.who.int/patientsafety/education/curriculum/who_mc_topic-1.pdf

Resources from WHO to aid in the implementation of a patient safety curriculum.

 

References

The BMJ. (2016). Medical error is the third biggest cause of death in the US, say experts. [Press release]. Retrieved from http://www.bmj.com/company/wp-content/uploads/2016/05/medical-errors.pdf)

IOM (Institute of Medicine). 2000. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press.

 

Originators of competency highlight: Laurie Palmer, MSN, RN, AOCN; Madelyn Danner, MSN, RN, CCRN, CEN, CNE; Julie Benson, MHA, MN, CNE, ARNP; Mary Adams, MSN, RN, CNE