Tammy Selleck, msn, rn Ferris state university Cardiovascular Medical/ Surgical Nursing: Quality and Safety Initiative and Healthcare Change Simulation Thank them for attending your presentation. Explain that they will be students. Explain that due to the assignment being a simulation, the purpose of this presentation will be to prepare them as students for the simulation and share the content that will be involved in the assignment, instead of doing an actual assignment together. Tammy Selleck, msn, rn Ferris state university

Presentation Overview Overall Goal: Prepare students for simulation assignment 1. Provide foundation/background on the quality and safety initiative (QSI) and healthcare change (HC) How do these impact nursing? 2. Review basic assignment structure and contents The main goals of this presentation are to prepare you for the simulation assignment that is at the end of the semester. Due to its complexity, two major areas will be focused on in this presentation. The first is that I will provide the foundation or background information into what the QSI and HC are and how they impact nursing. The second aspect is to review the basic assignment structure and contents before you do the simulation activity. I believe that by doing a simulation activity you will be able to integrate and apply concepts learned in this classroom to a simulated-real experience, with the mindset that you will better retain and understand the information. This presentation can serve as a guide to remind you what you need to know and do for the simulation. You can look back on the content and review as necessary for the assignment by taking notes as needed. www.clinical-innovation.com

Quality and Safety Initiative Quality and Safety Education for Nurses (QSEN) “Continuously improve patient outcomes by providing pre-licensed and graduate nursing students with the knowledge, skills, and attitudes (KSA) needed to provide safe and effective quality care” (RWJF, 2013, para. 2) Six Undergraduate/Pre-Licensure Competencies Patient-Centered Care, Quality Improvement, Teamwork and Collaboration, Safety, Evidence-Based Practice, and Informatics Impacts on Nursing Improve practice by improving education to improve student knowledge, skills, and attitudes After finding there were numerous HC errors being made per reports by the IOM and a gap between the education and practice of healthcare professionals, the quality and safety education for nurses was created. Being termed the QSEN competencies, their goal is to continuously improve patient outcomes by providing pre-licensed and graduate nursing students with the knowledge, skills, and attitudes (KSA) needed to provide safe and effective quality care. By the time nurses graduate from an accredited institution, these competencies should be achieved in programs and continually addressed and utilized throughout their practice (Pohl et al., 2010). These competencies include patient-centered care, teamwork and collaboration, evidence-based practice (EBP), quality improvement, safety, and informatics. Although there are several different QSI, QSEN will be the main one focused on for this course. To provide further clarification, Patient-centered care recognizes the patient needs to be a partner in their care, so coordination in practices needs to include the patient’s preferences, values and needs . Quality supports continually monitoring patient outcomes and by designing and testing changes to improve healthcare systems. Nurses to be involved in teamwork by collaborating in inter-professional teams, creating an environment of open communication, mutual respect and shared decision making. Safety minimizes patient harm while preforming in their own practices, either individually or within an organization. EBPs is a conglomeration of current, quality scientific research that provides nursing evidence, along with patient/family preferences and clinical experiences and judgement to deliver optimal care for patients. Informatics involves the understanding utilizing information and technology to their fullest potential in order to communication, make decisions, gain knowledge, and decrease errors. www.aacn.nche.edu (AACN, 2011; Armstrong, 2010; Croenwett et al., 2010; Dolanksy & Moore, 2013; Hunt, 2013; Manning & Frisby, 2011, Pohl et al., 2010; RWJF, 2013 )

Healthcare Change Changes to healthcare delivery and technology Telehealth/Telemedicine Amplifying at-home healthcare for patients Uses internet and cell phone applications Provides real-time nursing and medical consultations Impacts on Nursing Recent changes in healthcare affect patient care delivery methods Due to technology rapidly evolving, new ways to deliver patient care are created, in which nurses need to adapt to change and embrace being a life-long learner. Thusly, nurses need to be familiar with such methods in order to integrate the most recent changes in healthcare. By doing so, the advancement of the nursing practice and improvement of patient care outcomes are supported. Understanding and utilizing the current changes in healthcare, allows you as students to be better prepared in delivering modern patient care as practicing nurses. One piece of healthcare technology greatly impacting the current nursing practice is telehealth, or also called telemedicine. Telehealth, or also termed telemedicine, is amplifying at-home healthcare for patients instead of patients traveling and being admitted in acute-care facilities. Think of this like a virtual house call. This technology not only increases access to care, activities of daily living, and patient satisfaction, but conversely decreases rates of hospital admissions, rates of hospital-acquired infections, hospital length of stays, and mortalities. The increase in internet and cell phone applications are allowing patients use a Two-way interactive video conferencing in order to get real-time nursing and medical consultations. In order for students to be successful in their practice, they will need to possess the knowledge of this technology in order to guide patents on how to use them. They will have to understand how to utilize the telehealth system to its fullest potential by learning the application and video conferencing, in order to triage patients without being able to physically touch them. www.eweek.com (Armstrong, 2010; Grabowski & O’Malley, 2014; Kveder et al., 2014; Lazarou, 2012; Nagel, 2013; Peck, 2011; Pohl et al., 2010; Reed, 2010; Rueuch et al, 2012; Schwamm, 2014)

Simulation Basics Simulation goals: Understand how triage, Virtually assess, Make nursing judgements, Understand associated challenges of virtual healthcare, Collaborate among multiple disciplines, and Connect patients to appropriate care Patient-centered care, safety, quality improvement, teamwork and collaboration, and evidence-based practices will be promoted In general, nurses need to provide patient care that is held to quality standards that emanates safety. In order to ensure future nurses meet these standards of care, nursing educators need to weave these quality and safety standards and environmental changes into nursing programs, so they will prepare students for the modern nursing environment. By infusing QSEN and telehealth into a simulation, it is hoped that it improve your critical thinking by being exposed to current evidence-based nursing practices. And in so doing, you will learn to be an effective member of the healthcare team by creating innovative strategies and able to provide proper quality and safe, current nursing care, so patient outcomes are enhanced. By integrating this concept into a simulation lab, as student, it is intended that you will understand how triage, virtually assess, make nursing judgements, understand associated challenges of virtual healthcare, collaborate among multiple disciplines and connect patients to appropriate care. Also, it is intended that you will also learn the concept of how innovative healthcare changes can assist you in being life-long learners by urging you to adapt to different situations. This is needed in order to better provide care to patients and further advance the nursing profession. Because of these new changes, nurses are finding themselves in new healthcare roles frequently. Patient-centered care, safety, quality improvement, teamwork and collaboration, and evidence-based practices from QSEN competencies will be promoted and emphasized from this assignment. p20.education.uky.edu (Baltas, et al, 2014; Browning & Pont, 2014; Cant & Cooper, 2010; Chan, 2013; Friesth, 2012; Jefferies & Clochsey, 2012; Laiw, et al., 2014; Ozekin, et al., 2015; Vinales, 2015)

Simulation Specifics Understand concepts from class and integrate into simulation. Use Adobe online meeting room via webcam computers. Each student pairs takes a turn being a nurse/patient. Student 1=Patient: Act out situation Student 2=Nurse: Assess and guide patient while developing and implementing a care plan; Answers questions and provides education When in the skills laboratory, as students you will work in pairs to prepare a simulation where a patient is needing care and a nurse will provide that care via telehealth. Each member will take turns in being a patient and nurse. It is expected you will this presentation and research information on telehealth. I will be handing out cards to the student playing the patient, which will prompt this student in what to say, what condition they will have, and how to act once they are in the simulation. You all will have to access a virtual Adobe meeting site, in order to give the illusion you accessing a telehealth site from a physician’s office. Upon being at opposite ends of the lab room, the computer will open up a channel from the patient to nurse, where you both will be able to see and hear each other.   The student playing a physician office nurse will have to guide patients in how to take their own vital signs, ask pertinent questions, and obtain and relay information to the appropriate disciplines. From this information, the nurse can develop their own care plan for this patient by using ADPIE for patient treatment strategies. Being an access point of quality healthcare information, the nurse will need to guide the patient in following physician and possible hospital discharge orders, while answering their questions and providing education that could benefit, or possibly improve, their condition. I will supply the student nurse, physician and discharge orders, so they can practice how to deliver such virtual care to the patient. Answering questions and providing education will be your responsibility when you play the nurse, as you will formulate answers from content/concepts discussed/learned in class. You will have to possess and apply the knowledge of identifying abnormal results from a patient situation and take appropriate measures to promote the best outcome for the patient’s safety. www.vnahealthathome.org

Simulation Example For example, lets say we are in the simulation lab, and I was a student and Kim was my partner. If I was playing the nursing role, I would sit at one end of the lab, while kim sat at the other end. Once we logged into an Adobe meeting site, we could then see each other on computer web cams and hear one another. Kim would read the “patient card” that would indicate what type of patient she would be, then she would pretend to call me who was a nurse at a physician office that has access to the telehealth system. If, lets say she was a CHF patient who was having difficulty breathing and was gaining weight everyday with noticeable edema, I would guide her in taking her VS with the equipment provided in the lab. In some cases if patients have access to this system, they do have some of these devices at home. If her vs were abnormal, I would mention that I would be sending this information to the physician to coordinate care via the telehealth system. I would provide education about CHF and her condition and also make mention of possibly having her come into the hospital. If she did have transportation, I would say that I could summon the ambulance. I would formulate a CHF care plan for her, and ask questions in order to obtain more information from her, (which would be triaging), such as when this started, activities prior to this situation occurring, if she was adhering to the CHF regimen, such as following the diet, medications and exercise recommended for these patients. I would also answer any question she may also be having. If there were any treatments she could initiate at home I would instruct her to do those things. www.ecnmag.com

References for HC and QSI American Association of Colleges of Nursing [AACN]. (2011). About QSEN. Retrieved from http://www.aacn.nche.edu/qsen/about-qsen Armstrong, G. (2010). Leader to leader: Quality and safety education for nurses. Retrieved from https://www.ncsbn.org/L2L_Fall2010.pdf Croenwett, L., Sherwood, G., Barsteiner, J., Disch, J., Sullivan, D., & Warren, J. (2010). Quality and Safety education for nurses. Nursing Outlook, 55(3), 122-131. Dolansky, M., & Moore, S. (2013). Quality and safety education for nurses (QSEN): The key is systems thinking. Online Journal of Issues in Nursing, 18(3), 1-11. Grabowski, D., & O’Malley. (2014). Use of telemedicine can reduce hospitalizations of nursing home residents and generate savings for Medicare. Journal of Health Affairs, 33(2), 244-250. Hunt, D. (2012). QSEN competencies: A bridge to practice. Retrieved from http://journals.lww.com/nursingmadeincrediblyeasy/Fulltext /2012/09000/QSEN_competencies__A_bridge_to_practice.1.aspx Kvedar, J., Coye, M., & Everett, W. (2014). Connected health: A review of technologies and strategies to improve patient care with telemedicine and telehealth. Journal of Health Affairs, 33(2), 194-199. Lazarou, J. (2012). Johns Hopkins’ Hospital at home program improves patient outcomes while lowering health care costs. Retrieved from http://www.hopkinsmedicine.org/news/media/releases/johns_hopkins_hospital_at_home_program_improves _patient_outcomes_while_lowering_health_care_costs This is a basic run through of telehealth, QSEN, and the simulation activity, more information will be further discussed at a later time. If there are any questions please let me know. This concludes my presentation References Thank you for considering me for this position.

References for HC/QSI (Cont.) Leff, B., Burton, L., Mader, S., Naughton, B., Frick, K. (2010). Home is where the hospital is. Retrieved from http://www.jhsph.edu/news/news- releases/2010/burton-hospital-home.html Manning, M., & Frisby, A. (2011). Multi-method teaching strategies to integrate selected QSEN competencies in a DNP distance education program. Nursing Outlook, 59(3), 166-173. Nagel, D., Pomerleau, S., & Penner, J. (2013). Knowing, caring, and telehealth technology. Journal of Holistic Nursing, 31(2), 104-111. Peck, A. (2011). Changing the face of standard nursing practice through telehealth and telenursing. Nursing Administration and Quality, 29(4), 339-343. Reed, K. (2010). Telemedicine: Benefits to advanced practice nursing and the communities they serve. Journal of the American Academy of Nurse Practitioners, 17(3), 176-180. Robert Wood Johnson Foundation [RWJF]. (2013). Diffusing QSEN competencies across schools of nursing. Retrieved from http://www.rwjf.org/en/library/research/2013/04/diffusing-qsen-competencies-across- schools-of-nursing.html Rueuch, C., Mossakowski, J., Forrest, J., Hayes, M., Jahrsdoerfer, M., Comeau, E, … Singleton, M. (2012). Using nursing expertise and telemedicine to increase nursing collaboration and improve patient outcomes. Telemedicine Journal of Health, 18(8), 591-595. Pohl, J., Savrin, C., Flandt, K., Beauchesne, M., Drayton-Brooks, S., & Werner, K. (2010). Quality and safety in graduate nursing education: Cross-mapping QSEN graduate competencies with NONPF’s NP core and practice doctorate competencies Nursing Outlook, 57, 349-354. Schwamm, L. (2014). Telehelath: Seven strategies to successfully implement disruptive technology and transform health care. Journal of Health Affairs, 33(2), 200-205.

References for Simulation Teaching Method Baltas, M., Hassler, M., Ercole, P., & Rea, G. (2014). Effectiveness of high fidelity simulation for pediatric staff nursing education. Journal of Pediatric Nursing, 40(1), 27-32. Browning, L., & Pont, J. (2014). Supporting nursing student supervision: An assessment of an innovative approach to supervisor support. Nursing Education Today, 25(2), 73-79. Cant, R., & Cooper, S. (2010). Simulation-based learning in nursing education. Journal of Advanced Nursing Practice, 66(1), 3-15. Chan, Z. (2013). Critical thinking strategies in nursing education. Nursing Education Today, 33(5), 558-563. Friesth, R. (2012). Teaching and learning from a distance. In D. Billings, & J. Halstead (Eds.), Teaching in Nursing: A guide for faculty, (pp. 386-400). St. Louis, MS: Elsevier. Jefferies, P., & Clochsey, J. (2012). Clinical Simulations: A student centered pedagogical approach. In D. Billings, & J. Halstead (Eds.), Teaching in Nursing: A guide for faculty, (pp. 352-367). St. Louis, MS: Elsevier. Laiw, S., Siau, C., & Lau, T. (2014). Interprofessional simulation-based education program. Applied Nursing Research, 27(4), 258-268. Ozekin, L., Tiute, P, Willner, K., & Hranick, M. (2015). Simulation education: Early identification of patient physiologic deterioration by acute care nurses. Clinical Nursing Specialty, 29(3), 166-173. Vinales, J. (2015). Exploring the differences in nursing education environments. British Journal of Nursing, 25(5), 284-288. (Baltas, et al, 2014; Browning & Pont, 2014; Cant & Cooper, 2010; Chan, 2013; Friesth, 2012; Jefferies & Clochsey, 2012; Laiw, et al., 2014; Ozekin, et al., 2015; Vinales, 2015)