What is the quality and safety education for nurses?

What is the quality and safety education for nurses?

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  • Dedication
  • Contributors
  • Foreword by Mary A. Dolansky, PhD, RN, FAAN
  • Foreword by Ronda G. Hughes, PhD, MHS, RN, CLNC, FAAN
  • Preface
  • Acknowledgments
  • Unit I: Introduction to Quality and Safety Education for Nurses: Core Competencies for Nursing Leadership and Management
  • Unit II: The Use of Quality and Safety Education Concepts by Nursing Leaders and Managers
  • Unit III: Nurse Leadership and Management for Quality Improvement
  • Appendix A: Selected Reports of the National Academies of Sciences, Engineering, and Medicine, Formerly the Institute of Medicine (IOM)
  • Appendix B: Prelicensure Knowledge, Skills, and Attitudes
  • Appendix C: Critical Thinking Extras
  • Glossary

  • What is the quality and safety education for nurses?
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What is the quality and safety education for nurses?

Volume 55, Issue 3, May–June 2007, Pages 122-131

What is the quality and safety education for nurses?

https://doi.org/10.1016/j.outlook.2007.02.006Get rights and content

Quality and Safety Education for Nurses (QSEN), funded by the Robert Wood Johnson Foundation, was designed to address these gaps—to build on the will, to develop the ideas, and to facilitate execution of changes in nursing education. Before teaching strategies could be developed, however, the QSEN faculty needed to identify specifically what was to be achieved. Working with an Advisory Board of thought leaders in nursing and medicine (see acknowledgments), the authors reviewed the relevant

The competency definitions provided a broad framework for QSEN’s work to define pedagogical strategies for quality and safety education; however, as is evident in the accompanying article in this issue, when the competency names and definitions were used alone, the vast majority of pre-licensure program leaders stated that they already included content related to the competencies in their curricula.17 Relying on the respondent to interpret the general definitions of the QSEN competencies,

The essential features of this competency were derived from work by Bezold,18 the Picker Institute,19 and Lorig.20 Educators have worked hard on the issues related to diversity during the last years, and curricula generally address principles of communication, physical comfort, emotional support, and education. The QSEN faculty and advisory board members believed greater attention might be needed to KSAs that are concerned with eliciting and incorporating patient preferences and values in the

At the core of nursing lies incredible historical will to ensure quality and safety for patients. Many current endeavors such as the work occurring in the Robert Wood Johnson Foundation-sponsored project, Transforming Care at the Bedside, demonstrate how quality/safety/improvement work attracts the hearts of nurses, resulting in the “joy in work”7 that retains the health care workforce. Attending to the development of QSEN competencies may help nurses—who love the basic work of nursing—love

Linda Cronenwett is a Professor and Dean at the School of Nursing, University of North Carolina at Chapel Hill.

  • S. Bakken et al.
  • H. Marin
  • Z.R. Wolf et al.
  • H.K. Burns et al.
  • D. Ciliska
  • K.M. Haig et al.
  • E.L. Smith et al.
  • L. Arnold et al.
  • P.J. Maddox et al.

  • J.B. VanGeest et al.
  • Batalden P. Developing health professionals capable of continually improving health care quality, safety and value: The...
  • K. Regnier et al.
  • D. Leach
  • L. Cronenwett
    • The aim was to explore collaboration between first year undergraduate nursing students in a three-year bachelor program during clinical skills lab practices.

      The ability to collaborate is important in the nursing profession to ensure patient safety. Thus, efforts supporting nursing students with learning activities emphasizing this ability is crucial in nurse education as a preparation for the requirements of the nursing profession. Collaborative learning models are described as ways that support the students’ interaction during education. However, collaboration between students has shown to have challenges such as negative competition and confrontations. This stresses the need to explore the collaboration between students to find ways to support the interaction.

      The study was conducted with a focused ethnographic approach.

      Data were generated by participant observations during one semester, involving 70 h observation of 87 first year nursing students for 6 months and 24 training sessions in clinical skills lab practices. Two focus group discussions were used to elaborate students’ views of collaboration and to provide an opportunity for follow up questions and interpretations from the observations. Field notes and focus group discussions were interpreted as one unit of analysis conducted with thematic network analysis. A global theme were synthesized from organizational and additional basic themes presenting the overall metaphor of the students’ collaboration.

      The global theme, Between adaptation and non-conformity, revealed a field of tension in the nursing students’ collaboration. One the one hand, the global theme involved the students’ ability to adopt to new knowledge and to being a nursing student in a clinical skills lab and to others’ perspective. On the other hand, non-conformity creates a collaboration with less reflection between the students and non-synchronized and time-consuming laboratory work.

      Collaborative activities in nurse education fosters and challenges nursing students’ collaboration required for clinical practices and later in the nursing profession. By the presented scaffolding efforts, nurse educators can arrange a learning environment that can support the collaboration between students and facilitate the transition into the profession.

    • Graduate nursing education strives to promote collaborative practice on interprofessional teams. However, measuring collaboration during formative stages of professional development is rare. Few assessments are available to determine whether graduates of nursing education programs have met the required accreditation benchmarks. This project evaluates two performance standards for assessing collaboration during formative assessments.

      Formative assessment of communication and collaboration skills was explored for 62 entry-level Master's students in nursing, using a team-based objective structured clinical examination (OSCE) involving two patient simulations and assessment checklists, and comparing normative (relative standard) and criterion-referenced (absolute standard) methods.

      Mean percentages of behaviors using the normative approach indicated a range of performance levels for particular communication and collaboration behaviors. Criterion-referenced standards were higher than normative standards from actual student performance.

      This method improves assessment of collaboration through OSCEs using normative and criterion-referenced standards. We recommend using both methods jointly when setting standards or qualifying scores.

    • This study aimed to evaluate student perception of knowledge gained and intent to apply perioperative safety concepts.

      A mixed-method design analyzed themes from student reflections as well as frequencies of student survey responses after a one day, 10-hour, perioperative observational experience.

      Students participated in a one day, 10-hour, observational clinical experience following patients from the preoperative area to the operating room, postanesthesia care unit, and discharge from a surgery center or admission to a hospital room. After the experience, students completed a survey and a reflection assignment. A modified Delphi method was used for thematic analysis. Frequencies and averages were used to analyze the survey items.

      Students gained knowledge of and reported intent to apply perioperative safety concepts within their nursing practice. Some students noted an interest in perioperative nursing as a career choice.

      These findings provide evidence to support implementation of perioperative experiences in nursing programs and reinforce the role of the registered nurse (RN) to ensure safe and quality care. In addition, the perioperative experience may be a recruitment tool for enhancing the perioperative workforce.

    • This review aimed to synthesise evidence from experimental studies of the application of digital serious games in developing nursing clinical competence.

      Systematic review and meta-analysis.

      Eight databases were searched for randomized controlled trials and quasi-experimental studies published in English from 2000 to 2021.

      Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adopted in this review. Quality appraisal was conducted using Cochrane's Risk of Bias tool and the Joanna Brigg's Institute Critical Appraisal Tool for Quasi-Experimental Designs. A narrative synthesis of studies, and a meta-analysis and subgroup analysis, was performed on the study outcomes.

      22 experimental studies including 13 randomized controlled trials and nine quasi-experimental studies were included. Of these, 19 studies examined nursing students and three examined qualified nurses. These studies applied serious games to develop nursing competencies in management of nursing care, clinical reasoning skills, procedural skills, legal practice and quality improvement. Compared with control groups, serious games improved knowledge (SMD = 1.30, 95% CI [0.75, 1.86]) and skills (SMD = 0.38, 95% CI [0.17, 0.60]). Subgroup analysis for both knowledge and skills outcomes demonstrated that serious games were more effective than control groups with either no intervention or other educational interventions. A large effect size (SMD = 1.13, 95% CI [0.91, 1.34]) was found in favour of serious games for improving knowledge scores in management of nursing care.

      The reviewed studies identified a broad application of digital serious games for developing nursing competencies. The knowledge and skills performance outcomes supported the use of serious games, which were found to be superior to conventional educational interventions. More serious games are required to be incorporated into undergraduate and continuing nursing education for workplace training, with more rigorous studies examining the effect of serious games in improving the quality and safety of clinical nursing practice.

    • As nursing education shifts toward competency-based education, valid and reliable tools to assess student competencies at both entry-level and advanced-level nursing education are needed. The Creighton Simulation Evaluation Instrument (C-SEI) and the Creighton Competency Evaluation Instrument (C-CEI) have been used to evaluate undergraduate student competency over the past decade. A comprehensive review of the literature associated with the C-SEI and the C-CEI was completed to lay the foundation for future revision of the instrument consistent with the updated AACN Essentials (2021). Both the C-SEI and the C-CEI have demonstrated validity and reliability when used to evaluate students, new graduate nurses, and professional nurses in both the clinical and simulated learning environments. The instruments have been used to evaluate competency in student nurses, professional nurses, and new resident nurses, as well as in peer evaluation. The tools have also been adapted to assess interprofessional competence, and have been used nationally and internationally. Valid and reliable instruments are essential as nursing education shifts to competency-based education.

    • Telehealth has become a staple form of healthcare delivery, yet training is lacking in nursing curricula. The purpose of this study is to assess undergraduate nursing students’ learning outcomes and experience with a novel telehealth simulation.

      A descriptive, mixed-methods design was used with 59 undergraduate nursing students.

      Based on the quantitative data, all of the students indicated that the simulation experience improved their knowledge about telehealth. Major categories emerging from the qualitative analysis were (a) importance of assessing home environment, (b) importance of therapeutic communication, (c) benefits of telehealth visits, (d) awareness of the challenges associated with telehealth encounters, (e) role of the telehealth nurse, and (f) importance of detailed assessment by asking questions.

      The telehealth simulation contributed to nursing students’ clinical growth and should be integrated into nursing curricula.

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    • Leadership to improve quality and safety is a core component of care delivery. The article presents a crosswalk of the core competencies of the VA Centers of Excellence in Primary Care Education nurse practitioner residency programs with the Quality and Safety Education for Nurses competencies for graduate education to identify areas to enhance leadership in quality and safety in the curriculum.

    • This article details a nurse-led, interprofessional collaborative practice (IPCP) model that was developed to provide primary care to a medically indigent population in Birmingham, Alabama. Funding to develop and implement this project came from a federal Nurse Education, Practice, Quality and Retention award to the University of Alabama at Birmingham (UAB) School of Nursing, with additional support coming from the UAB Hospital and Health System. The clinic is housed within a local community-based, non-profit organization and all services, including supplies and pharmaceuticals, are provided free of charge to this vulnerable population.

      The IPCP model that was developed includes three primary care teams and incorporates faculty clinicians from a variety of disciplines, including nursing, medicine, optometry, nutrition, mental health, social work and informatics. Evaluation of the project has included annual structured interviews of project personnel, a variety of survey instruments completed electronically at various intervals, and assessments by students as well as patients experiencing team-based care.

      The focus of this article is the qualitative data collected from structured interviews of clinician faculty annually over the three years of the funded project. The learning, understanding and growth that have taken place by the experienced clinicians from multiple disciplines regarding IPCP are detailed.

    • In this article we ask our profession to consider whether something is rotten at the core of modern nursing. We will use our own experiences as patients, together with published literature, to ask questions of our profession in perpetrating what one of our colleagues recently, and with great embarrassment, referred to as ‘shitty nursing’.

      Our intention is most certainly not to offend any readers, for this term has been used in literature for more than one hundred years to describe bad situations, including those where events or people’s behaviour are of a low standard. Our intention instead, is to challenge ourselves, the profession and you the reader by raising a measured debate which seems at present to be missing within the profession.

      We examine the potential idea that poor nursing care may not be the exception, but horrifyingly, may be the new normal. We are particularly concerned that patients’ fundamental care needs may be falling into an ever widening gap between assistant and registered nurses. Whilst we acknowledge the potential causes of poor nursing care, causes that are often cited by nurses themselves, we come to the conclusion that a mature profession including clinicians, educators, administrators, researchers and regulators cannot continually blame contextual factors for its failings. A mature profession with an intact contract between itself and society must shoulder some of the responsibility for its own problems.

      We do suggest a way forward, including a mix of reconciliation, refocus and research, underpinned by what we argue is a much needed dose of professional humility. Readers may take us to task for potentially overstating the problem, ignoring non-nursing drivers, and downplaying other significant factors. You may think that there is much in nursing to glory in. However, we make no apology for presenting our views. Our lived experiences tell us something different. As professional nurses our main aim is to ensure that our adverse experiences as patients are statistical anomalies, and our future encounters with nursing care represent all that we know to be excellent in our profession. We leave you to judge and comment.

    • The study sought to validate the Italian version of the Health Professional Education in Patient Safety Survey (H-PEPSS), an instrument used to assess the perceptions of health professionals regarding patient safety competence. The H-PEPSS was administered to a sample of 574 bachelor degree nursing students in two north-eastern Italian universities. Its factor structure, validity and reliability were examined using explorative factor analysis. The internal consistency of the Italian version of H-PEPSS (H-PEPSSIta) measured with Cronbach's alpha (α) was higher for both classroom (.938) and clinical training (.942) dimensions. The six factors that emerged from the analysis were composed of three to five items loading ≥.55 and explaining 69.344% of the classroom total variance and 70.425% of the clinical training total variance of the H-PEPSSIta. The H-PEPSSIta is a valid tool capable of evaluating the self-perception of nursing students regarding patient safety knowledge and competence. Therefore, the instrument could be adopted in educational settings as a periodic nursing student report. This may help students reflect on PS related-issues, and evaluate gaps in knowledge and competences; furthermore, data emerging from periodic self-reports may offer the opportunity to tailor educational strategies to fill the gaps in PS knowledge and competences that emerge.

    • Education is crucial to how nurses practice, talk and write about keeping patients safe. The aim of this multisite study was to explore the formal and informal ways the pre-registration medical, nursing, pharmacy and physiotherapy students learn about patient safety. This paper focuses on findings from nursing.

      A multi-method design underpinned by the concept of knowledge contexts and illuminative evaluation was employed. Scoping of nursing curricula from four UK university programmes was followed by in-depth case studies of two programmes.

      Scoping involved analysing curriculum documents and interviews with 8 programme leaders. Case-study data collection included focus groups (24 students, 12 qualified nurses, 6 service users); practice placement observation (4 episodes = 19 hrs) and interviews (4 Health Service managers).

      Within academic contexts patient safety was not visible as a curricular theme: programme leaders struggled to define it and some felt labelling to be problematic. Litigation and the risk of losing authorisation to practise were drivers to update safety in the programmes. Students reported being taught idealised skills in university with an emphasis on ‘what not to do’.

      In organisational contexts patient safety was conceptualised as a complicated problem, addressed via strategies, systems and procedures. A tension emerged between creating a ‘no blame’ culture and performance management. Few formal mechanisms appeared to exist for students to learn about organisational systems and procedures.

      In practice, students learnt by observing staff who acted as variable role models; challenging practice was problematic, since they needed to ‘fit in’ and mentors were viewed as deciding whether they passed or failed their placements. The study highlights tensions both between and across contexts, which link to formal and informal patient safety education and impact negatively on students' feelings of emotional safety in their learning.

    • Graduate nursing competencies in quality and patient safety should be integrated into theoretical and experiential learning using active, student-centered methodologies, and threaded through multiple nursing courses. A series of workshops designed to provide quality and safety content and innovative teaching techniques to faculty based on goals of the Quality and Safety Education for Nurses (QSEN) Faculty Development Institute were developed. Post-workshop survey results found a significant self-reported change in course design with a focus on the integration of QSEN competencies.

    Linda Cronenwett is a Professor and Dean at the School of Nursing, University of North Carolina at Chapel Hill.

    Gwen Sherwood is a Professor and Associate Dean for Academic Affairs at the School of Nursing, University of North Carolina at Chapel Hill.

    Jane Barnsteiner is a Professor and Director of Translational Research at the School of Nursing and Hospital of the University of Pennysylvania, Philadelphia, PA.

    Joanne Disch is Kathyrn R. and C. Walton Lillehei Professor and Director of the Densford International Center for Nursing Leadership at the School of Nursing, University of Minnesota, Minneapolis, MN.

    Jean Johnson is a Professor and Senior Associate Dean for Health Sciences at The George Washington University, Washington, DC.

    Pamela Mitchell is Elizabeth S. Soule Professor and Associate Dean for Research at the School of Nursing, University of Washington, Seattle, WA.

    Dori Taylor Sullivan is an Associate Professor and Chair, Department of Nursing at Sacred Heart University, Fairfield, CT.

    Judith Warren is an Associate Professor at the University of Kansas School of Nursing and Director of Nursing Informatics at Kansas University Center for Healthcare Informatics, Kansas City, KS.

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