Disclosure Statement Deb Tauber, Stephanie Teets and Katherine Weibel have no financial or commercial interest in this content.
Objectives Learner will be able to describe the process of using this methodology to integrate QSEN into the hospital setting, by incorporating QSEN into the hospital orientation process. Demonstrate how teams of healthcare professionals can integrate the competencies of the QSEN process into “Rapid Response Mock Training.” Participant will be able to compare this opportunity to current needs in their organization or nursing school and construct a similar opportunity to meet their specific challenges.
Call From Above Adventist Hospital Leaders recognized QSEN as a potential opportunity for improving patient safety. The first principle for designing safe systems in health care organizations is – according to the IOM report To Err is Human — to provide leadership from the top-most level of the organization. The need to create a safe and effective nursing environment clearly parallels, and indeed overlaps, this IOM dictum. (The Joint Commission, 2012)
What Exactly is a Competency? The IOM defined competency as “the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values and reflection in daily practice” (Brady, 2011). 5
6 Quality and Safety Education for Nurse (QSEN) QSEN Competency Categories Patient Centered Care Teamwork and Collaboration Evidence-Based Practice Quality Improvement Safety Informatics The purpose of the QSEN competencies is to meet the challenge of preparing nurses to improve the knowledge, skills and attitudes (KSA’s) necessary to continuously improve the quality and safety of healthcare systems within which they work (Adapted from QSEN, 2009).
Evidence Based Practice (EBP) Implement each competency with evidence Gather best practices Review current healthcare education, nursing and patient safety literature 7
Addressing Disruptive Behaviors Incivility in Healthcare A summary of relevant sources of literature support the findings that the problems of incivility in healthcare are both harmful and costly. Replacement of one nurse can cost an organization between $46,932 - $145,000 (Kennedy, Michols, Halamek, & Arafeh, 2012). “Workplace incivility may be subtle but it creates a heavy financial burden estimated at $24 billion dollars annually” (Spence, Laschinger, Cummings, Wong, & Grau,2014). 8
Summary Graph Data (Tauber, 2014) 9
Safety It is well documented in many initiatives leading healthcare organizations driving improved outcomes (AACN), World Health Organization (WHO), QSEN, The Joint Commission, that the benefit of Interprofessionality will improve patient outcomes and decrease sentinel events. 10
What is Simulation? “A technique, not a technology, to replace or amplify real experiences with guided experiences, often immersive in nature, that evoke or replicate substantial aspects of the real world in a fully interactive fashion” (Gaba, 2004,p 2). Gaba, D. (2004) The future vision of simulation in health care. Quality and Safety in Health Care, 13 (Suppl 1),
The Value of Simulation Safe environment Learn from mistakes Repetition Enhance teamwork and collaboration 12 Improve -Critical Thinking -Judgment -Organization -Prioritization -Communication Controlled environment
Three Phases of Debriefing (Harvard Model - CMS) Reactions - Clear the air and set the stage for discussion -Feelings (normalize) -Facts Understanding -Exploring - explore trainees perspectives on scenario events -Discussion and teaching Summary - distill lessons learned for future use -What worked well -What should be changed next time -Major take always 14
15 Evaluation Tools
Integrating QSEN into Clinical Practice 16 Socializing QSEN Introduction to the CNOs with commitment Presentation to nursing leadership, education team, Advanced Practice Nurses Discussions at Patient Care Division Meetings Introduction at orientation
17 Revised curriculum for the New Grad Residency Program integrating QSEN competencies into each cohort meeting. Integrating QSEN
18 Example Curriculum
As a Beta testing group – we piloted the use of this onboarding checklist with 16 New Graduate Nurses and their preceptors. 21
Feedback from Beta Testing Group Overall the feedback from the group has been very positive. We are using process improvement for evaluating and improving for the next groups. One of the gaps identified has been getting the behavior portion documented for fear of possible consequences. We hope to improve this. The hope is as the "culture" within the organization changes and people become more comfortable with behavioral expectations it will be easier to hold people accountable for their behavior. 22
Next Steps We will evaluate the orientation model and modify as needed from our BETA testing group We intend to submit this information for publication Compare HCAPHS, Press Ganey, Core Measures in one specific unit for one year and see if any measurable differences are noted 23
Gaba, D. (2004) The future vision of simulation in health care. Quality and Safety in Health Care, 13 (Suppl 1), INACSL,(2011). Standards of Best Practice: Simulation. Clinical Simulation in Nursing, 7(4), S3-S7. Fero, L., Wesmiller, S., Witsberger, C., Zullo, T., Hoffman, L., Critical Thinking Ability of New Graduate and Experienced Nurses, Journal of Advanced Nursing, 65(1) Brady, D. S. (2011). Using Quality and Safety Education for Nurses (QSEN) as a Pedagogical Structure for Course Redesign and Content. International Journal Of Nursing Education Scholarship, 8(1), doi: / X.2147 References 24
References Continued Spence Laschinger, H. K., Cummings, G. G., Wong, C. A., & Grau, A. L. (2014). Resonant Leadership and Workplace Empowerment: The Value of Positive Organizational Cultures in Reducing Workplace Incivility. Nursing Economics, Tauber, D. A. (2014). [Simulation respectful caring assertive communication evaluation tool]. Unpublished raw data 25