1. Integrating QSEN in Nursing Orientation : Can It Be All Fun and Games? Kenneth M. Miller MSN, RN, CCRN Professional Role Development Specialist Simulation Program Coordinator Department of Nursing Practice, Research, and Education May 2016

2. 2 Disclosures

3. Objectives 3 Describe the integration and evidence that supports the use of learning games as a strategy in nursing orientation. Describes the games “The Big Picture” and “The Diversity Game/Chainlinks” and applies the QSEN competencies to the game’s outcome. Participates in the game “Lifeboat and applies the QSEN competencies to the game’s outcome. Analyzes evaluation feedback and the potential implications for other QSEN competencies.

4. Games The QSEN Competencies in Nursing Orientation

5. UCLA Health Rank #3 in U.S. News & World Report 2015 One Magnet-Designated Hospital Two hospitals on the Magnet Journey Transplant Center of Excellence Employs over 3,000 RNs In 2015, 600 Nurses attended the orientation program. 5

6. Orientation History Guest Speakers on Nurse Sensitive Indicators Power Point Presentations Analyzing Orientation Evaluations 6

7. Re-imagining Orientation with QSEN and Adult-Learning Evidence Based Program Games Joseph & Diack (2015) Using games in IPE indicated that the pariticapants felt improvement in learning other professional roles. Boctor (2012) Study results show that students want to increase in use of games. Baker (2012) Games motivate and alleviate stress. Baid & Lambert (2009) Less hierarchy, fosters passing of information amongst peers. 7

8. The Big Picture Putting Together the Big Picture

9. Putting the Big Picture Together Objective of the game is to place a series of pictures together that are related and tell a story. Each participant is given a picture. Each participant must describe their picture to the group, without the group actually seeing the picture. Following first debriefing, the participants are allowed to show each other the pictures. Final debriefing. QSEN competencies stressed are teamwork and collaboration along with quality. 9

10. 10 Place Video Here

11. Debriefing Questions How does it feel when you cannot see the big picture clearly? Did anyone see the picture differently? Did you speak up? How did you work together as team to accomplish the goal? What problems did you encounter? Do you see a relationship with any nurse sensitive indicator? How do you see the “big picture” influencing the quality of patient care? 11

12. The Diversity/Chain Links Game Building the Most Expensive Chain

13. Diversity Game/Chain Links Objective of the game is for one group to build the most expensive chain with construction paper. The end product of this activity is a rich and organic discussion concerning diversity, society hierarchy, and its nursing implications. QSEN Competencies stressed are patient centered care, and team work/collaboration. 13

14. The Game Each group (groups of 5 or 4 will work) Each group has a specific color of construction paper and tools Green paper is worth the most and yellow is the least. The green group will have 2 pair of siccors and tape, the rest will have one pair, but the yellow paper group will have none. They may barter colored paper between groups. All strips must be cut, not torn. Rules Green group makes three rules and every group must abide by these new rules. Yellow group members must immigrate to new group. 14

15. 15 Insert Video Here

16. 16 Debriefing Allow the participants to “Shake off” the game. Game can be exhausting for some. Let them share their feelings before moving forward. Was there a team that was at an advantage? Was there a team at a total disadvantage? How does the other teams feel about this? Looking back at the game, what implications did we discover that could be applied to your practice/ What will you take away from this game. 16

17. Lifeboat Who would you save?

18. 18 Who would you save? Priest Rabbi Minister 12 Year old boy 29 year old pregnant woman 35 year old sailor 55 year old cook 60 year old steward 80 year old physician

19. Who would you save? Priest Has 5 days of food RabbiHas 5 days of fresh H2O MinisterHas 6 life-jackets 12 Year old boyHas Cerebral Palsy 29 year old pregnant womanHaving a breech birth 35 year old sailorIs blind. 55 year old cookIs a professional fisherman 60 year old stewardIs a professional rower 80 year old physicianIs a psychiatrist 19

20. The Evaluations and Outcomes

21. – Agree–Somewhat Agree– Neutral–Somewhat Disagree– Disagree–N/A–Total–Weighted Average– –Did you find the games insightful with team building? 88.73% 244 8.73% 24 1.45% 4 0.36% 1 0.36% 1 0.36% 1 275 1.14 –Did you find the games useful in role developement/ delegation? 86.18% 237 9.82% 27 2.91% 8 0.36% 1 0.36% 1 0.36% 1 275 1.18 –Did you find the games useful in development of leadership skills? 85.09% 234 9.82% 27 4.00% 11 0.36% 1 0.36% 1 0.36% 1 275 1.20 –Did you find the games applicable to your practice as a RN? 81.92% 222 7.75% 21 4.43% 12 1.11% 3 0.74% 2 4.06% 11 271 1.24 –Did you find the games enjoyable? 85.66% 233 9.56% 26 2.21% 6 1.47% 4 0.74% 2 0.37% 1 272 1.21 Outcomes 2015

22. – Agree–Somewhat Agree– Neutral–Somewhat Disagree– Disagree–N/A–Total–Weighted Average– – Did you find the games insightful with team building? 87.30% 110 11.11% 14 0.00% 0 0.79% 1 0.79% 1 0.00% 0 126 1.17 – Did you find the games useful in role developement/ delegation? 84.13% 106 12.70% 16 1.59% 2 0.79% 1 0.79% 1 0.00% 0 126 1.21 – Did you find the games useful in development of leadership skills ? 85.48% 106 12.10% 15 0.81% 1 0.81% 1 0.81% 1 0.00% 0 124 1.19 –Did you find the games applicable to your practice as a RN? 71.20% 89 14.40% 18 4.00% 5 0.00% 0 1.60% 2 8.80% 11 125 1.32 –Did you find the games enjoyable? 83.33% 105 12.70% 16 0.79% 1 0.79% 1 2.38% 3 0.00% 0 126 1.26 22 Outcomes 2016

23. 23 Answer Choices–Responses– –strongly agree75.00% 462 –agree23.38% 144 –neutral0.97% 6 –disagree0.16% 1 –strongly disagree0.49% 3 Total616 Do you have a clear understanding of evidenced-based practice at UCLA Health?

24. 24 Summary Closing the gaps between previous practice and the expected practice of the new facility can be challenging. Games are a fun and interactive method to learn the concepts of the QSEN competencies. Nurse educators can use these games as a catalyst for rich discussion of the concepts of QSEN competencies and application to clinical practice.

25. References Baid, H & Lambert, N. (2009). Enjoyable learning: The role of humour, games, and fun activities in nursing and midwifery education. Nurse Education Today, 30(0), 548-552. Baker, L.M. (2012). Fun and games: Connecting for learning. International Journal of Disability, Development and Education, 59(1), 119-123. Boctor, L. (2012). Active-learning strategies: The use of a game to reinforce learning in nursing education A case study. Nurse Education in Practice, 13(0), 96-100. Joseph, S & Diack, L. (2015). Playing interprofessional games: Reflections on using the interprofessional education game. Journal of Interprofessional Care, 29(3), 260-262. http://www.teampedia.net/wiki/index.php?title=Main_Page 25