Clinical Integration of QSEN Competencies, Knowledge, Skills, and Attitudes for Clinical Instructors and Preceptors in Operating Rooms Francesca Logterman University Hospitals Case Medical Center

Objectives Upon completion of the educational offering the nurse preceptor will be able to: Describe the 6 core competencies of Quality Safety and Education in Nursing (QSEN) List one learning objective (knowledge, skill or attitude) for each of the 6 rubrics The preceptor will score a minimum of 80% on the post test

OR Nurse Today Is expected to be: An expert clinician A patient advocate Competent with informatics and technology A Problem-solver An Educator Sweeney, 2010

QSEN Project funded by Robert Wood Johnson Foundation to improve quality and safety education of nurses Identifies the core knowledge, skills, and attitudes that should be mastered by pre licensure nursing students Identification of competencies in nursing that correlates with other healthcare professionals. Reflects the call to action of the 2003 Institute of Medicine Report: Health Professions Education: A Bridge to Quality ( Read Intro 19-28)

QSEN Phases Phase 1: 2005-2007: Identified the six QSEN competencies Phase 2: 2007-2008: Developed, tested, and disseminated teaching strategies in fifteen schools of nursing Phase 3: 2008-2012: Developed and evaluated innovative methods of assessment of student learning and advancement of faculty expertise Phase 4: 2012-Present: Focused on faculty development and delivery of graduate QSEN competencies Barnstiener et al., 2012

Level of Competency Beginner: Embedding quality and safety in beginning nursing and clinical assignments Freshman and Sophomore Students Intermediate: Emphasis on system thinking and specialty populations (Reinforcement of beginner competencies) Pediatrics Obstetrics Operating Rooms Junior Students

Level of Competency Advanced Advanced courses designed to transition student to practitioner Emphasis on Quality and Safety Senior Students QSEN competencies need to be threaded throughout the students curriculum beginning freshman year

Continuum Acquisition Knowledge, Skills, Attitude (KSAs) Beginner Intermediate Advanced

Continuum of Systems Thinking Dolansky & Moore, 2013

Article To Be Reviewed Quality and Safety in Nursing: The Key is Systems Thinking (Dolansky & Moore, 2013)

Why Do We Need QSEN? Identification of KSAs nurses need to provide safe, quality care A common language and core competencies Uniform goals for environmental, educational, and cultural initiatives Components of quality and safety integrated into nursing school curriculum Cronenwett et al., 2007

QSEN and Safety QSEN provides students with tools related to patient safety and decreasing errors in healthcare Involvement in patient care and real life scenarios or simulated experiences gives students opportunities to ‘practice and rehearse’ (Siebert, 2014, p. 233) Nurse educators must provide students with learning activities Utilize systems thinking Simulate safe practice Develop a safety conscious in systems and processes through specific learning activities Siebert, 2014

QSEN Competencies Patient Centered Care Teamwork and Collaboration Evidence Based Practice Quality Improvement Safety Informatics QSEN Website

QSEN Article to be Reviewed Article discussing QSEN and competency application in the clinical area Nursing Outlook Article: Quality and Safety Education in Nursing Cronenwett et al., 2007

Intermediate Competencies and KSAs Emphasis is on teams and systems Students have a lack of exposure to teamwork and collaboration Look for ways to improve team membership and communication Assume role of team member or leader Students need increased exposure to safety and quality improvement initiatives to evaluate impact of interventions and patient outcomes Barton et al., 2009

Patient Centered Care Focus on culture and diversity Principles of communication Physical comfort/pain management Emotional support Eliciting and incorporating patient preferences and values in plan of care Shared decision making Developing expertise in managing conflict Safe medication administration Safe handoffs, timeouts, pre procedure verification Cronenwett et al., 2007

Teamwork and Collaboration Team membership and communication skills Conflict resolution Team competence Self awareness of strengths and limitations as team member Respect for differing views Knowledge of roles, accountability, and scope of practice Description of factors that enhance or deter communication Identification of factors and systems that enhance teamwork Identification of system support or hindrance of teamwork Identification of risks and benefits of handoffs Cronenwett et al., 2007

Evidence Based Practice Understanding and recognition of scientific process and method Recognition of difference between clinical opinion and scientific evidence Involvement of patient preferences and values Adherence to Internal Review Board protocols Identication of clinical practice deviations from evidence based practices Acknowledgement of limitations of knowledge and clinical expertise Identication professional practice guidelines and standards available for reference Cronenwett et al., 2007

Quality Improvement Participate in root cause analysis of sentinel events Identification of sentinel events Use of Electronic Health Records Perioperative Nursing Data Set Knowledge and use of Surgical Care Improvement (SCIP) measures Select link and download file Unit based procedures, practice guidelines, and resources Scope of Practice 2014 National Patient Safety Goals Cronenwett et al., 2007

Safety Pre-procedure verification Informed consent Time out Hand offs Identification of ways to minimize risk Teams Information technology Simulated experiences Event reporting Use of checklists Universal Protocol Crononenwett et al., 2007

Informatics Advantages of electronic health record Use of on-line reference sites AORN Joint Commission Agency for Research and Quality in Healthcare Event reporting Perioperative Nursing Data Set Perioperative computer charting

QSEN Intermediate KSAs QSEN in the Perioperative Setting Select content and review perioperative power point on QSEN website Click on the link or use the following: http://www.qsen.org/modules/module11/files/qsen_module11_part2

The Goal Patient Safety Assure new graduate nurse competency in complex healthcare systems Use the following rubric to enhance the clinical preceptor evaluation of QSEN competency of nursing students (A PDF of the competencies is available in this teaching strategy tool kit).

Safety Rubric

Safety 3 Points 2 Points 1 Point Zero Points The student VERBALIZED recognition of potential 3 safety issues in the operating room The student needed the preceptors assistance to identify of 3 potential safety issues The student had basic knowledge of safety issues in the operating room documented in reflective journaling The student could not identify potential safety issues in the operating room The student participated in the universal protocol including pre procedure verification, and marking of the surgical site. Able to identify missing information The student displayed knowledge of the universal protocol including all three aspects: procedure verification, marking of the surgical site, and time out Student displayed knowledge of two of the aspects in reflective journaling Student unable to identify universal protocol component in the clinical setting or reflective journaling The student participated in the completion of the time out and surgical safety checklists including the post op handoff The student was prompted to participate in the timeout The student documented knowledge of the surgical safety checklist and time out protocol in reflective journal The student did not demonstrate knowledge of the surgical safety checklist and time out protocol The student identified National Patient Safety Goals in 2014: especially those specific to surgical environment. The student displayed knowledge of safety goals to preceptor The student documented identified safety goals in reflective journal The student did not demonstrate knowledge of safety issues The student identified an idea for improving safety and shared with preceptor/team The student was able to identify safety issues with preceptor The student documented identified safety concerns in reflective journal The student did not demonstrate knowledge of ways to improve safety in the clinical setting or reflective journaling Safety

Teamwork and Collaboration

Teamwork and Collaboration 3 Points 2 Points 1 Point Zero Points The student displayed two effective communication strategies which improved communication within the surgical team The student required the preceptors assistance to identify communication strategies which improve teamwork The student displayed basic knowledge of effective communication strategies used to improve teamwork documented in reflective journaling The student did not identify effective communication strategies to enhance teamwork in the clinical setting or reflective journaling The student identified the different surgical team members and their roles and responsibilities The student verbalized knowledge of different surgical team members and their roles and responsibilities The student displayed knowledge differing team members roles and responsibilities in reflective journaling Student did not identify roles and responsibilities of team members in the clinical setting or reflective journaling The student follows a patient through pre, intra, post op experience and is able to identify positive and negative behaviors impacting communication of team members The student utilized the preceptor to identify positive and negative behaviors impacting communication The student displayed knowledge of positive and negative behaviors of team members by documentation in reflective journal. The student did not display knowledge of of positive and negative behaviors of team members in the clinical setting or reflective journaling The student participated in the team as a circulating or scrub nurse. This includes responsibilities for the time out, perioperative briefings, relief reports, handoffs, and surgical checklists The student verbalized knowledge/findings with the preceptor who shared information with the surgical team in the presence of the student The student displayed knowledge of the responsibilities of the scrub and circulating nurse in reflective journaling The student did not display knowledge of scrub and circulating nurse roles in the clinical setting or reflective journaling Teamwork and Collaboration

Evidence Base Practice Rubric

Evidence Based Practice 3 Points 2 Points 1 Point Zero Points The student obtains sterilization and disinfection policies from the clinical setting and can verbalize differences between the two to the preceptor The student demonstrates a basic knowledge of sterilization and disinfection in the operating room to the preceptor The student demonstrates basic knowledge of sterilization and disinfection in reflective journaling The student does not display knowledge of disinfection and sterilization in the clinical setting or reflective journaling The student can demonstrates knowledge of event related sterility in the OR when opening sterile supplies The student verbalizes concepts of event related sterility in operating rooms to preceptors The student demonstrates knowledge of event related sterility in reflective journaling The student did not demonstrate knowledge of event related sterility in the clinical setting or reflective journaling The student researches and presents one research article associated with best evidence based practice in perioperative setting to classmates in lab The student discussed a research article related to perioperative experience and identified one implication for perioperative clinical practice The student demonstrates findings and observations regarding research article in reflective journal The student did not display knowledge of evidence based practice related to perioperative nursing in the clinical setting or reflective journaling The student displays knowledge of 2013 AORN Recommendations for sterile packaging and is able to identify correct packaging to preceptor in clinical setting before opening supplies onto the sterile field The student inspects packages for integrity before delivering items to the sterile field and is able to identify unsterile supplies The student demonstrates knowledge of 2013 sterile packaging recommendations in reflective journaling The student did not display knowledge of recommendations for sterile packaging in the clinical setting or reflective journaling Evidence Based Practice

Patient Centered Care Rubric

Patient Centered Care 3 Points 2 Points 1 Point Zero Points The student described the patients or coworkers/team member values, beliefs, and attitudes in cultural assessment assignment. Cultural sensitivity displayed in interactions The student identified values, attitudes and beliefs that may affect cultural awareness, but needed preceptor support when interacting with the patient The student displayed knowledge of values, attitudes, and beliefs that may impact patient care in reflective journaling The student did not identify potential attitudes, values, and beliefs regarding cultural assessment assignment in the clinical setting or reflective journaling The student documented personal cultural values, beliefs, and attitudes in reflective journal. The student described how impact of interactions with patients and co workers The student is able to describe the impact cultural values, attitudes and beliefs may have on patients/co-workers, or team members Student displayed insight of personal cultural assessment in in reflective journaling Student did not display knowledge of personal cultural assessment in clinical setting or reflective journaling The student used information from the patient/co-worker/team member cultural assessment to design and implement education specific to the person. Student shows transfer of knowledge and skills from patient to patient The student shared information with preceptor or was prompted by the preceptor to include cultural assessment in plans, actions, and patient education The student displayed knowledge of how to change plans of care and educational opportunities related to findings from cultural assessment The student did not display knowledge of the cultural assessment of patient/co-worker, or team member in the clinical setting or reflective journaling Patient Centered Care

Informatics and Technology

Informatics and Technology 3 Points 2 Points 1 Point Zero Points The student identified 3 patient circumstances which require reporting via the patient event reporting system The student was assisted by the preceptor in identification of adverse patient events The student documented 3 adverse reportable patient events in reflective journaling The student did not demonstrate knowledge of potential adverse events in the operating room in clinical setting or reflective journaling The student accessed the Patient Event Reporting system on the computer The student displayed knowledge of need for patient event reporting and could identify three events which require reporting Student displayed knowledge of two adverse events and how to report patient events in reflective journaling The student did not demonstrate knowledge of patient event reporting in the clinical setting or reflective journaling The student verbalized how data from Patient Nursing Data Set (PNDS) informatics systems impacts care of surgical patients and identified what data was collected The student displayed knowledge of PNDS and one use of data collection in the perioperative setting to the preceptor The student demonstrated knowledge of PNDS and one use of data collection in the perioperative setting in reflective journal The student did not display knowledge of PNDS data collection in the perioperative setting in the clinical setting or reflective journaling The student accessed the electronic health record of the patient during the preoperative assessment The student was assisted by the preceptor in accessing the electronic health record of the patient The student displayed knowledge of the benefits of the electronic health record in reflective journaling The student did not display knowledge of the benefits of the electronic health record in the clinical setting or reflective journaling Informatics and Technology

Quality Improvement Rubric

Quality Improvement 3 Points 2 Points 1 Point Zero Points The student seeks out information regarding outcomes of care for surgical population The student verbalizes knowledge of outcomes of care (positive and negative) of surgical population to preceptor Student displays knowledge of outcomes of care for surgical population in reflective journal The student did not identify outcomes of care for surgical population in clinical setting or reflective journaling The student has knowledge of SCIP initiatives or participated in SCIP division rounds The student shared findings with preceptor who shared information with the surgical team in the presence of the student on SCIP initiatives The student displayed knowledge of SCIP initiatives in reflective journaling. The student did not display knowledge information regarding safety issues in the clinical setting or reflective journaling The student assessed quality improvement initiatives of clinical environment and uses the preceptor to identify one current quality improvement initiative in the clinical setting The student asks the preceptor to identify quality improvement initiatives for surgical environments The student displayed knowledge of two quality improvement initiatives related to operating rooms and surgical teams in reflective journaling The student did not display knowledge of quality improvement initiatives in the clinical setting or reflective journaling The student identified one potential adverse event in the operating room and utilizes the preceptor to assist them in identifying the resolution of the adverse event The student asks the preceptor to assist with identification of potential adverse events in the clinical environment The student documented potential adverse events and solutions in reflective journaling The student does not demonstrate knowledge of adverse events in the clinical setting or reflective journaling Quality Improvement

References Barnsteiner, J., Disch, J., Johnson, J., McGuinn, K., Chappell, K., & Swartwout, E. (2013). Diffusing QSEN competencies across schools of nursing: the AACN/RWJF Faculty Development Institutes. Journal of Professional Nursing, 29(2), 68-74. Barton, A. J., Armstrong, G., Preheim, G., Gelmon, S. B., & Andrus, L. C. (2009). A national Delphi to determine developmental progression of quality and safety competencies in nursing education. Nursing outlook, 57(6), 313-322. Dolansky, M. A., & Moore, S. M. (2013). Quality and Safety Education for Nurses (QSEN): The Key is Systems Thinking. Online Journal of Issues in Nursing, 18(3). Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, Johnson, J., Mitchell, P., Sullivan, D., & Warren, J. (2007). Quality and safety education for nurses. Nursing Outlook 55, 122-131 Patton, R. (2014). NUR 339 Perioperative Care of the Adult and Geriatric Patient (Course Syllabus). Sherwood, G., & Drenkard, K. (2007). Quality and safety curricula in nursing education: Matching practice realities. Nursing Outlook 55, 151-155 Seibert, S. A. (2014). Safety consciousness: Assignments that expand focus beyond the bedside. Nurse Education Today, 34(2), 233-236. Sweeney, P. (2010). The Effects of Information Technology on Perioperative Nursing. AORN Journal 92, 528-540