QSEN Presented by Jean Eden, Kristi Evans, Morrehea Hardman, Valerie McGouldrick, Ashton Merchant, Katelyn Peper

QSEN: Quality and Safety Education for Nurses

Includes: Patient Centered Care Teamwork and Collaboration Evidence-based Practice Quality Improvement Safety Informatics

Patient Centered Care: Recognizing the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient's preference, values, and needs. In patient centered care, patient and families participate in nursing and medical decision making and in care coordination with all members of the health care team.

Patient Centered Care requires nurses to seek out and apply interventions learned from the abundance of information to the individual patient receiving the care. A nurse has to have the knowledge, skills, and attitude to properly care for a patient.

Patient-Centered Care Knowledge Skills Attitudes Integrate understanding if multiple dimensions of patient centered care Elicit patient values , preferences, and expressed needs as part of clinical interview Value seeing health care situations “through patient's eyes” Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient, family, and community values Communicate patient values, preferences, and expressed needs to other members of the health care team Respect and encourage the individual expression of patient values, preferences, and expressed needs Sources: http://qsen.org/competencies/pre-licensure-ksas/ Cherry, B. (2014). Contemporary Nursing (6th ed.). St. Louis, MO: Elsevier Patient-Centered Care

Example: A 28 year old female was admitted to the hospital.  During her assessment with the nurse, the patient stated, “ I would like to try more holistic methods in treating my pain before taking any pain medication.”  The nurse noted as such in the patient's chart.  Later in the day, the patient was complaining of pain.  The nurse immediately administers pain medication before asking patient if she wanted to try any holistic methods first.  Is this an example of patient-centered care? Why?

No, the patient specifically stated she wanted to try holistic methods before any pain medication was administered.  The nurse should have asked the patient if she had tried or wanted to try some deep breathing exercises, meditation, distraction, or other non-pharmacological treatments first. The ultimate goal in patient-centered care is to involve the patient in the care for themselves.

Competency of Teamwork and Collaboration Nursing personnel must be able to competently interact with physicians, pharmacists, respiratory care therapists, dieticians, physical and occupational therapists, nurse practitioners, clinical nurse specialists, physician assistants, social workers and care managers, licensed practical nurses and unlicensed assistants. Effective teamwork and positive interdisciplinary collaboration among and between healthcare providers are seen as important contributors to improved patient outcomes (http://scholarworks.gvsu.edu, 2012).

Patient-Centered Care Knowledge Skills Attitudes Describe impact of own communication style on others. Clarify roles and accountabilities under conditions of potential overlap in team member functioning. Respect the centrality of the patient/family as core members of any health care team. Recognize contributions of other individuals and groups in helping patient/family achieve health goals. Solicit input from other team members to improve individual, as well as team, performance. Appreciate the risks associated with handoffs among providers and across transitions in care. Sources: http://qsen.org/competencies/pre-licensure-ksas/ Patient-Centered Care

The QSEN project contributes to this competency by offering a database of educational strategies that have been submitted to the project on the merits of being helpful to healthcare educators on the baccalaureate program and associate degree level as well as for continuing education and staff development.

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

Patient-Centered Care Knowledge Skills Attitudes Differentiate clinical opinion from research and evidence summaries. Participate in structuring the work environment to facilitate integration of new evidence into standards of practice. Value the concept of EBP as integral to determining best clinical practice Explain the role of evidence in determining best clinical practice Question rationale for routine approaches to care that result in less-than-desired outcomes or adverse events Appreciate the importance of regularly reading relevant professional journals Sources: http://qsen.org/competencies/pre-licensure-ksas/ http://www.asatonline.org/treatment/articles/evidencebasedpractice Patient-Centered Care

Evidence-based practice means that clinicians use evaluation and treatment procedures for particular disorders and populations. Evidence-based practice also takes into account current understanding of the patho-physiology of the disorder(s) being treated, clinical expertise, and the client’s preferences for treatment. -- Jeri A. Logemann

Quality improvement: Nurses are in a greater demand for increasing the quality improvement according to a new study by the Center of Studying Health System Change (HSC). There are tools used to help with the competencies being completed and improved in the hospital setting. These tools would include flowcharts, cause-effect diagrams, control charts and run chart. These tools help to analyze events and understand the different variations of why the negative events occurred and their root cause. Hospitals need supportive leadership, a philosophy of quality as everyone’s responsibility, individual accountability, and effective feedback that would offer greater promise for successful improvement activities.

Quality improvement Nurses are in a greater demand for increasing the quality improvement according to a new study by the Center of Studying Health System Change (HSC).

Patient-Centered Care Knowledge Skills Attitudes Describe approaches for changing processes of care. Practice aligning the aims, measures and changes involved in improving care. Appreciate the value of what individuals and teams can to do to improve care. Explain the importance of variation and measurement in assessing quality of care. Use tools (such as control charts and run charts) that are helpful for understanding variation. Appreciate how unwanted variation affects care. Sources: Qsen.org/competencies/2013 www.hschange.com/CONTENT/972/2006 Patient-Centered Care

There are tools used to help with the competencies being completed and improved in the hospital setting. These tools would include flowcharts, cause-effect diagrams, control charts and run chart. These tools help to analyze events and understand the different variations of why the negative events occurred and their root cause. Hospitals need supportive leadership, a philosophy of quality as everyone’s responsibility, individual accountability, and effective feedback that would offer greater promise for successful improvement activities.

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

In 2000 there was an alarming report by the institute of medicine (IOM) titled To Err Is Human: Building a safer Health System, authors extrapolated and summarized data from two major studies and concluded that up to 98,000 patients are killed each year from medical errors, confirming that poor quality of care is a major problem in the United States. Contributing factors: Overuse of expensive invasive technology Underuse of inexpensive care services Error-prone implantation of care that could harm patients and waste money :

Patient-Centered Care Knowledge Skills Attitudes Discuss potential and actual impact of national patient safety resources, initiatives and regulations Use national patient safety resources for own professional development and to focus attention on safety in care settings Value relationship between national safety campaigns and implementation in local practices and practice settings Delineate general categories of errors and hazards in care Communicate observations or concerns related to hazards and errors to patients, families and the health care team Value own role in preventing errors Sources: Qsen.org/competencies/2013 www.hschange.com/CONTENT/972/2006 Patient-Centered Care

2012 National Patient Safety Goals Improve the accuracy of patient identification. Improve the effectiveness of communication among caregivers Improve the safety of using medications. Reduce the risk of health-care association Reduce the risk of patient harm resulting in from falls. Prevent health-care associated pressure ulcers The organization identifies safety risks inherent in its patient population Universal protocol for preventing wrong site, wrong procedure, wrong person surgery. :

Informatics: the use of information and technology to communicate, manage knowledge, mitigate error, and support decision making.

“Current nursing students may present with more advanced knowledge of informatics, be it a social networking skill, word processing skill, surfing the internet and so on than faculty or staff.” --Cherry. Page 401.

Patient-Centered Care Knowledge Skills Attitudes Identify essential information that must be available in a common database to support patient care. Navigate the electronic health record Value technologies that support clinical decision making, error prevention, and care coordination Describe examples of how technology and information management are related to the quality and safety of patient care Respond appropriately to clinical decision-making supports and alerts Value nurses’ involvement in design, selection, implementation, and evaluation of information technologies to support patient care Cherry Page 402 Table 22-6 Patient-Centered Care

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Works Cited Cherry, B. (2014). Contemporary nursing: issues, trends, & management (6th ed.). St. Louis, Mo.: Elsevier. Qsen.org/competencies/2013 www.hschange.com/CONTENT/972/2006 http://qsen.org/competencies/pre-licensure-ksas/ http://scholarworks.gvsu.edu, 2012