Chapter 22

Chapter 22
Quality and Safety in Nursing
Education: The QSEN Project
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

The New Standard for
Nursing Education
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 2

 Most technologically advanced
 Most expensive system in the world
 Failures in the system occur with some regularity
U.S. Health Care System

 Sustained the imperative to address inconsistent
outcomes and prevent errors
 Medical errors erode public confidence, increase
health care costs, and increase morbidity and
mortality
IOM’s Quality Chasm Reports

 Recommendations for health professions’ education
 Identified competencies all health care professionals
should achieve
 Education needs to allow students to form a professional
identity in preparation to deliver patient-centered care as
members of an interprofessional team, emphasizing
evidence-based practice, quality improvement, and
informatics (Cronenwett et al., 2007; Greiner and
Knebel, 2003)
 Competencies are not discrete concepts but overlap
IOM’s 2003 Health Professions
Education: A Bridge to Quality

 Funded by the Robert Wood Johnson Foundation and
created to:
• Facilitate the execution of changes in nursing education
• Offer new opportunities for faculty development
• Learn from a 15-school pilot collaborative
 IOM identified five competencies, and QSEN faculty
determined that quality and safety should be separate
because of the science supporting each
History of QSEN

 Six QSEN competencies
 Patient-centered care
 Quality improvement
 Teamwork and collaboration
 Evidence-based practice
 Safety
 Informatics
History of QSEN (cont'd)

Applying the Competencies in
Practice

 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
Patient-Centered Care

 Knowledge
 Integrate understanding of multiple dimensions of patient-centered care
 Describe how diverse cultural, ethnic, and social backgrounds function
as sources of patient, family, and community values
 Skills
 Elicit patient values, preferences, and expressed needs as part of
clinical interview
 Communicate patient values, preferences, and expressed needs to
other members of the health care team
 Attitudes
 Value seeing health care situations “through patients’ eyes”
 Respect and encourage individual expression of patient values,
preferences, and expressed needs
Patient-Centered Care (cont'd)

 Questions to ask in a patient-centered care
approach:
 What is the most important thing I could do for my
patient at this moment?
 How can the patient and/or family participate in
accurately assessing the patient’s pain and
determining the best pain management plan that
recognizes the patient’s attitudes and expectations
about pain and suffering?
 How can I assist family members with visiting hours
and access to their family member to allay anxiety
and include them as partners in care?
Patient-Centered Care (cont'd)

1. Nurses in a home health agency are implementing a
policy to include input from the patient in the patient’s
plan of care. This action by the nurses represents:
A. Evidence-based practice
B. Interprofessional teamwork
C. Patient-centered care
D. The communication technique of “call-out”

 Definition: function effectively within nursing and
interprofessional teams, fostering open
communication, mutual respect, and shared
decision making to achieve quality patient care
Teamwork and Collaboration

 Knowledge
 Describe one’s own strengths, limitations, and values in functioning as a
team member
 Describe examples of the effect of team functioning on safety and
quality of care
 Skills
 Demonstrate awareness of one’s own strengths and limitations as a
team member
 Follow communication practices that minimize risks associated with
hand-offs among providers and across transitions in care
 Attitude
 Acknowledge one’s own potential to contribute to effective team
functioning
 Appreciate the risks associated with hand-offs among providers and
across transitions in care
(cont'd)

 Up to 66% of health care errors are related to
poor working relationships and communication
 Standardized communication strategies help
team members share concerns, clarify decisions
about care, and ensure accurate and complete
information exchange (see Box 22-1 in text)
(cont'd)

2. A patient who is 1 day postop following a right knee replacement is
complaining of a pain level of 8 (on a 10-point scale) after having received
his pain medication 2 hours ago. The pain medicine is ordered every 4
hours. The nurse calls the physician and provides the following information:
“Dr. Michaels, this is Jane Stallings, RN at Fairview General. I am calling
about Mr. Stuart Phillips. Mr. Phillips is 1-day postop right knee
replacement and is reporting a pain level of 8 after receiving morphine 1
mg 2 hours ago. The medication is ordered to be given every 4 hours. His
blood pressure is 148/86; pulse 104; respirations 24; temperature 98.6.
The dressing on the right knee is clean and dry and 4+ pedal pulse. He
may need a higher dose of morphine to control the pain. How would you
like to change his orders?” What form of standardized communication is
the nurse using?
A. Critical language
B. SBAR (situation background assessment recommendation)
C. Check-back
D. Hand-off

 Definition: integrate best current evidence with
clinical expertise and patient/family preferences
and values for delivery of optimal health care
Evidence-Based Practice

 Knowledge
 Demonstrate knowledge of basic scientific methods and processes
 Discriminate between valid and invalid reasons for modifying evidence-
based clinical practice based on clinical expertise or patient/family
preference
 Skills
 Participate effectively in appropriate data collection and other research
activities
 Consult with clinical experts before deciding to deviate from evidence-
based protocols
 Attitude
 Appreciate strengths and weaknesses of scientific bases for practice
 Acknowledge own limitations in knowledge and clinical expertise before
determining when to deviate from evidence-based best practices
Evidence-Based Practice (cont'd)

 Definition: use data to monitor the outcomes of
care processes and use improvement methods
to design and test changes to continually
improve the quality and safety of health care
systems
Quality Improvement

 Knowledge
 Describe strategies for learning about the outcomes of care in
the setting in which one is engaged in clinical practice
 Describe approaches for changing processes of care
 Skills
 Seek information about outcomes of care for populations served
in a care setting
 Design a small test of change in daily work
 Attitude
 Appreciate that continual quality improvement is an essential
part of the daily work of all health professionals
 Appreciate the value of what individuals and teams can to do
improve care
Quality Improvement (cont'd)

 Definition: minimize risk of harm to patients and
providers through system effectiveness and
individual performance
Safety

 Knowledge
 Examine human factors and other basic safety design principles
as well as commonly used unsafe practices
 Discuss potential and actual effect of national patient resources,
initiatives, and regulations
 Skills
 Demonstrate effective use of technology and standardization
practices that support safety and quality
 Use national patient safety resources for own professional
development and to focus attention on safety in care settings
 Attitude
 Value the contributions of standardization/reliability to safety
 Value relationship between national safety campaigns and
implementation in local practices and practice settings
Safety (cont'd)

 Health care organizations focused on safety use
constant surveillance to manage the potential for
humans (health professionals) to make
unintentional mistakes
Safety (cont'd)

 Definition: use information and technology to
communicate, manage knowledge, mitigate
error, and support decision making
Informatics

 Knowledge
 Identify information that must be available in a common database to
support patient care
 Describe how technology and information management are related to
the quality and safety of patient care
 Skills
 Navigate the electronic health record
 Respond appropriately to clinical decision-making supports and alerts
 Attitude
 Value technologies that support clinical decision making, error
prevention, and care coordination
 Value nurses’ involvement in design, selection, implementation, and
evaluation of information technologies to support patient care
Informatics (cont'd)

 Informatics and IT are links to ensure patient
safety through improved information access and
data management
 Nurses play crucial roles to help shape design,
purchase, and implementation of technology to
match clinical needs
Informatics (cont'd)

 Continual improvement in the six competencies
allows nurses to shape the quality and safety of
health care systems
 Goal is to alter nursing’s professional identity so
that being a respected nurse means caring,
knowledge, honesty plus knowledge, and
commitment to quality and safety
Implications for Practice

Chapter 22

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Chapter 22

Similar to Chapter 22 (20)

More from stanbridge

More from stanbridge (20)

Chapter 22

Editor's Notes