Jeannie Couper, MSN, RN-BC Seton Hall University May 2, 2012 QSEN in Practice Jeannie Couper, MSN, RN-BC Seton Hall University May 2, 2012 In 2003, the IOM report challenged health professional educators to shift the paradigm facilitating the learner to graduate as a member of the interdisciplinary healthcare team focused on patient-centered care, “emphasizing evidence-based practice, quality improvement approaches, and informatics” (IOM, 2003). The QSEN initiative, Quality and Safety Education for Nurses, attempted to address the gaps in nursing education identified in the IOM report. The 6 domains (patient-cantered care, team work & collaboration, evidence-based practice, quality improvement, safety, and informatics) were the basis for the 6 competencies required by all graduates in order to assume the role of the professional nurse. Cronenwett et al. noted the competencies were defined by the QSEN team, providing a framework for curricular development, transition to practice, continuing ed programs, and regulatory programs (setting standards for licensure, certification, and accreditation). Definitions were further clarified by the QSEN team as they outlined knowledge, skills, and attitudes (also known as KSAs) for pre-licensure.

QSEN Competency 2: Team Work and Collaboration Definition: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care (QSEN, 2012). Knowledge Skills Attributes Describe own strengths, limitations, and values in functioning as a member of a team Demonstrate awareness of own strengths and limitations as a team member Acknowledge own potential to contribute to effective team functioning Initiate plan for self- development as a team member Appreciate importance of intra- and inter-professional collaboration Act with integrity, consistency and respect for differing views In considering the 6 domains that define quality and safety content identified by the Quality and Safety Education for Nurses project team, Competency #2: team work and collaboration was explored first. Initially, the team developed competency definitions “broad enough to be used as frameworks for all educational programs” (Smith et al., 2007, p 132) to be used as beginning competencies for pre-licensure students. The QSEN project team outlined explicit goals for knowledge, skills, and attributes required by the professional nurse to facilitate team work and collaboration. (Review slide). Cronenwett et al., 2007

QSEN Competency 2: Team Work and Collaboration Program Outcome: Collaborate with members of the health care team in planning, guiding, coordinating and evaluating nursing practice . Course Objective: Utilize the critical thinking process to generate outcome oriented clinical judgment. Knowledge Skills Attitudes Analyze how personal development is affecting your function as a team member Plan for continued growth thru self-reflection and journaling Appreciate importance of intra- and inter-professional collaboration: build community and team via mutual respect and shared decision-making Evaluate personal growth and development Advocate for patient Actively assist team Delegate to CNA In an attempt to offer the students opportunities to develop this competency, the program and course design includes each area (knowledge, skills, and attitudes) as a basis for a specific assignment. The intent is to foster the growth and development of the competency. Here the student engages in reflection through journaling to evaluate their personal growth, and make connections between their nursing practice and the desired competency- team work and collaboration. In providing care to the patient, the student has opportunities to advocate on the patient’s behalf and to observe professional nurses advocating on behalf of their patients. Interprofessional collaboration is explored in terms of decision-making and communication with the team- CNA, primary care MD, residents, etc. These role models are necessary for the student nurse to grasp “how” to fulfill the competency. The student is also given opportunities to assist their team building community and to delegate appropriate tasks to nursing assistants. Mutual respect and decision-making is the fabric of the team relationships. Cronenwett et al., 2007; Sherwood & Drenkard, 2007; Zimmerman & Ramirez, 2007; Hall, et al., 2007

QSEN Competency 5: Safety Definition: Minimize risk of harm to patients and providers through both system effectiveness and individual performance (QSEN, 2012). Knowledge Skills Attitudes Delineate general categories Communicate observations Value own role of errors and hazards in or concerns related to in preventing care hazards and errors to errors patients, families, and health care team The second competency considered is Competency 5: Safety. This competency compliments team work and collaboration as together it is each individuals responsibility to ensure the safety of the patients- preventing or minimizing harm. The knowledge, skills, and attitudes are necessary for all members of the healthcare team. The team members role model this for the students throughout their relationships with the patient and their families. All members of healthcare team have a responsibility in preventing errors. Cronenwett et al. (2007)

QSEN Competency 5: Safety Program Outcome Demonstrate interpersonal, clinical, and technological skills consistent with the standards and guidelines of professional nursing practice. Course Objective: Utilize the SBAR-R approach for communication with healthcare team. Promoting and maintaining safety for patients. Knowledge Skills Attitude Explore categories of Utilize the revised SBAR *Reflect on your errors and potential approach in giving handoff practice; *List 2 hazards in providing communication with staff things learned handoff report from your patient; *Explain where and how nurses intercede to promote safety In attempting to incorporate this competency into the curriculum, the SBAR approach is introduced as a vehicle to maintain and improve safety insuring continuity of care through a thorough handoff report. The revised SBAR includes an opportunity to ask and respond to questions and requires the nurse to introduce them self. SBAR (Situation, Background, Assessment, Recommendation) is an effective and efficient way to communicate important information. SBAR offers a simple way to help standardize communication and allows parties to have common expectations related to what is to be communicated and how the communication is structured. This approach was adapted from the US Navy. S=Situation (a concise statement of the problem) B=Background (pertinent and brief information related to the situation) A=Assessment (analysis and considerations of options — what you found/think) R=Recommendation (action requested/recommended — what you want) In addition, students reflect on their practice and experience identifying specific “things they’ve learned” during post-conference. The students are encouraged to identify any breakdown in safety they.ve observed throughout the clinical day. The rich discussion affords students opportunities to identify where and how nurses intervene or intercede to promote safety. Brain-storming together facilitates the students learning from one another and perhaps experiencing something new. Cronenwett et al., 2007; Sherwood & Cronenwett et al., 2007; Sherwood & Drenkard, 2007; Zimmerman & Ramirez, 2007; Hall, et al., 2007; Grbach & Vincent, 2007)

Clinical education: Integration Required! 2. Identify a problem or need that arose during your observation in the PICU. Explain the circumstances of the problem including who, what, when, where, and how urgent the problem was. a. Identify the knowledge required by the staff nurse to solve the problem. b. Analyze steps taken by nurse to solve the problem. c. Evaluate collaborative efforts of health care team members in helping to solve the problem. d. Consider other possible solutions to the problem. 3. Discuss how the staff nurse’s participation in clinical decision making relates to improved patient outcomes and job satisfaction. Review a specific reflective assignment targeting 2 competencies: Team work & collaboration and Safety: PICU or Valerie Center Observation Assignment. See Handout.

References Cronenwett, L et al. (2007). Quality and safety education for nurses. Nursing Outlook, 55(3), 122-131. Grbach, W. & Vincent, L. (2008). Reformulating SBAR to “I-SBAR-R”. Accessed at http://www.qsen.org/teachingstrategy.php?id=33 Hall, L., Scott, S. & Cox, K. (2007). Interprofessional curriculum in patient safety and quality improvement. Accessed at http://www.qsen.org/teachingstrategy.php?id=45 Sherwood, G. & Drenkard, K. (2007). Quality and safety curricula in nursing education: Matching practice realities. Nursing Outlook, 55(3), 151-155 Smith, E. L., Cronenwett, L., & Sherwood, G. (2007). Nursing Outlook, 55(3), 132-137. Zimmerman, R. & Ramirez, Y. (2011). A universal template for designing QSEN learning activities: Setting expectations using KSAs. Accessed at http://www.qsen.org/teachingstrategy.php?id=179