Quality and Safety Education for Nurses

Quality and Safety Education for Nurses (QSEN) addresses the challenge of preparing nurses with the competencies necessary to continuously improve the quality and safety of the health care systems in which they work. The QSEN faculty members adapted the Institute of Medicine(1) competencies for nursing (patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics), proposing definitions that could describe essential features of what it means to be a competent and respected nurse. Using the competency definitions, the authors propose statements of the knowledge, skills, and attitudes (KSAs) for each competency that should be developed during pre-licensure nursing education. Quality and Safety Education for Nurses (QSEN) faculty and advisory board members invite the profession to comment on the competencies and their definitions and on whether the KSAs for pre-licensure education are appropriate goals for students preparing for basic practice as a registered nurse.     

Patient safety competence for final-year health professional students: Perceptions of effectiveness of an interprofessional education course

As final-year medical and nursing students will soon play key roles in frontline patient care, their preparedness for safe, reliable care provision is of special importance. We assessed patient safety competencies of final-year health profession students, and the effect of a 1-day patient safety education programme on these competencies. A cross-sectional survey was conducted with 233 students in three colleges of medicine, nursing, and traditional medicine in Seoul. A before-and-after study followed to evaluate the effectiveness of the curriculum. Patient safety competency was measured using the Health-Professional Education for Patients Safety Survey (H-PEPSS) and an objective patient safety knowledge test. The mean scores were 3.4 and 1.7 out of 5.0, respectively. The communication domain was rated the highest and the teamwork domain was rated the lowest. H-PEPSS scores significantly differed between the students from three colleges. The 1-day patient safety education curriculum significantly improved H-PEPSS and knowledge test scores. These results indicated that strengthening patient safety competencies, especially teamwork, of students is required in undergraduate healthcare curricula. A 1-day interprofessional patient safety education programme may be a promising strategy. The findings suggest that interprofessional patient safety education needs to be implemented as a core undergraduate course to improve students’ safety competence.     

Efficacy and safety of procedural sedation and analgesia for burn wound care

The study aim was to quantify efficacy and patient safety of registered nurse-administered procedural sedation and analgesia in a regional burn center. The investigators conducted a review of procedural sedation forms for all pediatric and adult patients admitted to this burn center from January 1, 2005, through December 31, 2005, for demographic and clinical data including patient age, gender, body weight, TBSA, dates of burn injury and wound care procedures, length of procedure, pre- and postprocedural pain assessment, procedural sedation/analgesia medications and doses, adverse drug events, and related interventions. During the 12-month study period, a total of 328 burn patients received 1293 procedural sedation procedures; child subjects (≤ 18 years) received 356 procedures and adult subjects (19-87 years) received 937 procedures. The mean (SD) length of the procedure was 60.1 (22.49) minutes with a range of 10 to 170 minutes. The mean subject age was 34.2 years (range: 6 weeks to 87 years), 67% were male, and the mean TBSA was 17% (0.5-68%). Ninety-four percent received fentanyl for analgesia and 85% received midazolam for anxiolysis and amnesia. The mean preprocedural pain score was 3.2 and the mean postprocedural pain score was 2 (t = 14.795; df = 1243; P < .001). Ten adverse events, all respiratory related, were documented in eight patients, two of whom experienced a second adverse event for an overall adverse event rate of 0.77%. No patient required intubation. Procedural sedation administered by a registered nurse competent in administration and monitoring in a burn center provided safe and effective pain management during wound care.     

Procedural Sedation by Registered Nurses in the Interventional Radiology Setting: Incorporating Evidence-Based Practice Regarding Medication Selection, Fasting, and Mitigating Cardiorespiratory Complications

Registered nurses administer procedural sedation in the interventional radiology setting to manage a patient's pain and anxiety to facilitate the performance of unpleasant but necessary procedural interventions in a safe, effective, and humane fashion. The nurse who is administering procedural sedation should maintain competency regarding knowledge of the medications being administered for procedural sedation, knowledge of the drugs required to reverse the effects of procedural sedation medications, ability to assess the patient's response to procedural sedation, and the knowledge and ability to respond appropriately in the event of an adverse reaction to procedural sedation medications. The nurse should be a part of the facility's policymaking team with respect to procedural sedation. The nurse should bring evidence-based information to the policymaking process to assist him/her to be an effective patient advocate. This article examines the available scientific data related to medications for procedural sedation, appropriate fasting considerations, and mitigation of cardiorespiratory complications.     

Examining the implementation of collaborative competencies in a critical care setting: Key challenges for enacting competency-based education

Interprofessional collaboration is recognised as an important factor in improving patient care in intensive care units (ICUs). Competency frameworks, and more specifically interprofessional competency frameworks, are a key strategy being used to support the development of attitudes, knowledge, skills, and behaviours needed for an interprofessional approach to care. However, evidence for the application of competencies is limited. This study aimed to extend our empirically based understanding of the significance of interprofessional competencies to actual clinical practice in an ICU. An ethnographic approach was employed to obtain an in-depth insight into healthcare providers’ perspectives, behaviours, and interactions of interprofessional collaboration in a medical surgical ICU in a community teaching hospital in Canada. Approximately 160 hours of observations were undertaken and 24 semi-structured interviews with healthcare workers were conducted over a period of 6 months. Data were analysed using a directed content approach where two national competency frameworks were used to help generate an understanding of the practice of interprofessional collaboration. Healthcare professionals demonstrated numerous instances of interprofessional communication, role understandings, and teamwork in the ICU setting, which supported a number of key collaborative competencies. However, organisational factors such as pressures for discharge and patient flow, staffing, and lack of prioritisation for interprofessional learning undermined competencies designed to improve collaboration and teamwork. The findings demonstrate that interprofessional competencies can play an important role in promoting knowledge, attitudes, skills, and behaviours needed. However, competencies that promote interprofessional collaboration are dependent on a range of contextual factors that enable (or impede) individuals to actually enact these competencies.     

Current assessments of quality and safety education in nursing

Concerns about the quality and safety of health care have changed practice expectations and created a mandate for change in the preparation of health care professionals. The Quality and Safety Education for Nurses project team conducted a survey to assess current levels of integration of quality and safety content in pre-licensure nursing curricula. Views of 195 nursing program leaders are presented, including information about satisfaction with faculty expertise and student competency development related to 6 domains that define quality and safety content: patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. With competency definitions as the sole reference point, survey respondents indicated that quality and safety content was embedded in current curricula, and they were generally satisfied that students were developing the desired competencies. These data are contrasted with work reported elsewhere in this issue of Nursing Outlook and readers are invited to consider a variety of interpretations of the differences.     

Superior Cluneal Nerve Block for Treatment of Buttock Abscesses in the Emergency Department

Background: The buttock is a common location for cutaneous abscesses among patients presenting for emergency department care. Procedural pain management sufficient to permit adequate incision and drainage often requires moderate sedation or general anesthesia. Discussion: We describe a patient with a buttock abscess who successfully underwent incision and drainage with a regional superior cluneal nerve blockade instead of moderate sedation. Conclusions: Our experience suggests that superior cluneal nerve blockade may reduce the need for procedural sedation, expedite care, and reduce costs for some patients presenting with buttock abscesses.     

A necessity not a luxury: preparing advanced practice nurses to care for older adults.

Of today's 2.7 million registered nurses, less than 1% are certified in gerontological nursing and only 3% of advanced practice nurses (APNs) have specialized training in this area. These statistics indicate that there are not enough gerontological nurse practitioners or geriatric clinical nurse specialists to care for the burgeoning older adult population. Relying solely on certified geriatric APNs to care for older adults is not a viable solution. Educating all APNs with grounding in gerontological nursing care may well be the answer to expanding our nation's capacity to competently care for our rapidly aging population. As part of the 4-year Enhancing Geriatric Nursing Education in Baccalaureate and Advanced Practice Nursing Grant, the American Association of Colleges of Nursing developed a set of core gerontological competencies for graduate APN programs. These competencies, entitled Nurse Practitioner and Clinical Nurse Specialist Competencies for Older Adult Care, delineate guidelines for APNs who are not specialists in gerontology but provide care to older adults. This article describes the competency development process, provides an overview of broad categories and examples of competency statements, and highlights model case studies for integrating gerontological content throughout APN curricula to ensure that graduates are equipped to provide competent care to older adults.     

Supporting Emergency Care Delivery Through Updated Emergency Nurse Practitioner Competencies

As multidisciplinary emergency care becomes increasingly complex, all team members must be aware of their respective roles and responsibilities. In the emergency department, nurse practitioners are integral members of the team. They possess a wide range of clinical and leadership competencies that allow them to perform specific and differentiated tasks within the emergency department. A well-defined competency not only contributes to the promotion of a positive work culture but also clarifies performance expectations, identifies skill gaps, and supports team development. Furthermore, it allows the nurse practitioner to adapt to changing conditions while maintaining patient safety. The competencies of emergency nurse practitioners have evolved over the past 2 decades. The authors discuss the importance of establishing clear expectations for emergency nurse practitioner practice in this article and the alignment of competencies with organizational culture and objectives.     

The role of the nurse sedationist

Aim and objectives

This paper aims to provide a quality improvement review to identify the benefits and level of satisfaction for the role of the nurse sedationists.

Background

Traditionally procedural sedation was only administered by an anaesthetist or dentist and it was not until the early 1990s that nurses in America commenced administering procedural sedation. A literature review on the role of the nurse sedationist undertaken identified no documented evidence of such a role in Australia. The role of the nurse sedationist was pursued as a strategy to meet the increased demand for anaesthetic services, manage the shortage of anaesthetists and address concerns associated with the administration of procedural sedation by healthcare workers untrained in this area.

Method

Evaluation of the role of the nurse sedationist was essential to ensure that the role met both the needs of the organisation, patients and key stakeholders. Due to the variety of stakeholders and associated expectations a variety of evaluation methods were used.

Results

Results indicate that the introduction of the nurse sedationist role has been recognised as value adding through increases in patient safety, a more collaborative approach to patient care, improved work environments for all staff groups and strengthened multi disciplinary relationships. Patients also indicate a very high level of patient satisfaction with the service.

Conclusion

The role of nurse sedationist has been successfully introduced in an Australian acute public hospital. The introduction of the role has assisted to address an increased demand for anaesthetic services and to address patient safety concerns.

Relevance to clinical practice

Recent years have seen an expansion of advanced practice nursing roles throughout Australia. This expansion of roles has resulted in an increase in nursing expertise, high quality patient outcomes and an improved multidisciplinary approach to healthcare. The role of the nurse sedationist has been a result of expansion in this area.     

Ergonomics in healthcare facility design, part 1: patient care areas

There are many ergonomic considerations during design that can enhance nurse and other provider safety in the built healthcare environment. This facility design department aims to expand nurse leaders' knowledge and competencies in health facility design and enables them to take leadership roles in design efforts. Part 1 in this 2-part series focuses on ergonomic designs for patient care areas to enhance patient and nurse safety. Part 2 discusses ergonomic designs for centralized and decentralized nursing stations.     

Interprofessional education: Lessons learned from conducting an electronic health record assignment

Abstract

Ineffective collaboration and communication contribute to fragmented patient care and potentially increase adverse events, clinical errors, and poor patient outcomes. Improving collaboration and communication is essential; however, interprofessional education (IPE) supporting this cause is not a common practice. Most often healthcare profession students are educated in profession-centered silos limiting opportunities to develop effective communication and collaboration practices. Students from nursing, health informatics, and radiologic technology collaboratively populated an academic electronic health record (AEHR) using fictitious case study data. The assignment was designed to address the Quality and Safety Education for Nurses and IPE Collaborative competencies. The objective was to evaluate students’ informatics competency, teamwork behaviors, and communication skills while exploring the different roles and responsibilities for collaborative practice after participating in an interprofessional case study assignment. Students gained experience using the AEHR for data entry, analysis, and application increasing their informatics competency. The assignment required students to communicate and actively collaborate as an interprofessional team to achieve the assignment objectives. Clinical errors often occur during care transitions, so simulating this process in the assignment was essential. Nursing and radiologic technology students had to analyze patient data and develop a hand-off communication template supporting patient safety and optimizing outcomes. The assignment required students to work as an interprofessional team and demonstrate how communication and collaboration is an essential component to quality and safe patient care.     

A nurse residency program for competency development using human patient simulation.

A new graduate registered nurse residency program integrating human patient simulation was developed at an academic medical center. The program focused on orientation through skill-based learning, critical thinking, human factors engineering, and patient safety using simulated experiences for a wide variety of high-risk, low-frequency, as well as high-frequency, commonly occurring clinical events and situations. Structured evaluations demonstrated that simulation serves as a highly effective strategy for developing competency, confidence, and readiness for entry-into-practice. It strengthened assessment and clinical skills, and enhanced nurse residents' ability to apply critical thinking to simulated patient scenarios. The time and cost of orientation decreased while recent graduate nurse satisfaction with orientation was high.     

Defining and integrating informatics competencies into a hospital nursing department

Expanding use of complex patient information management systems and communication technology in healthcare organizations requires nurses to possess core competencies that until recently were not considered as integral to practice as those of a strictly clinical nature. Organizational changes necessary to formally integrate informatics competencies into nursing practice require strong partnerships among facility nursing leaders, educators, and informaticists. The authors describe a strategic initiative one acute care organization used to develop nursing practice that ensures use of system tools to manage patient information, support clinical decision making, optimize workflow, and communicate with members of the care team. The initiative involved defining nursing computer and informatics management skills for the clinical system applications and technologies utilized in the organization and integrating the introduction, evaluation, and on going professional development of the defined informatics competencies into organizational processes and tools to support the bedside nurse.     

亚专业化护理模式对护士核心能力的影响

目的探讨亚专业化护理模式对护士核心能力的影响,分析和评价新模式的临床应用效果。方法采用“注册护士核心能力量表”评估我科31名护士在亚专业护理模式实施前后核心能力的情况,使用SPSS13．0统计学软件进行配对t检验,以分析护士核心能力的差异,评价新模式的临床应用效果。结果亚专业护理模式前后我科护士核心能力总分差异有显著意义（P=0．004）;批判性思维／科研、临床护理、领导能力、人际关系、专业发展及教育／咨询等各个能力得分的差异有显著意义（P〈0．05）,法律／伦理能力得分的差异无显著意义（P=0．173）。结论亚专业化护理模式促进了护士核心能力的培养,改进了科室医疗护理质量。     

Using quality and safety education for nurses to guide clinical teaching on a new dedicated education unit

Gaps exist in health professional education versus the demands of current practice. Leveraging front-line nurses to teach students exemplary practice in a Dedicated Education Unit (DEU) may narrow this gap. The DEU is an innovative model for experiential learning, capitalizing on the expertise of staff nurses as clinical teachers. This study evaluated the effectiveness of a new academic-practice DEU in facilitating quality and safety competency achievement among students. Six clinical teachers received education in clinical teaching and use of Quality and Safety Education for Nurses (QSEN) competencies to guide acquisition of essential knowledge, skills, and attitudes for continuous health care improvement. Twelve students assigned to the six teachers completed daily logs for the 10-week practicum. Findings suggest that DEU students achieved QSEN competencies through clinical teacher mentoring in interdisciplinary collaboration, using electronic information for best practice and patient teaching, patient/family decision making, quality improvement, and resolution of safety issues.     

Ergonomics in healthcare facility design, part 2: support areas

There are many factors to consider during design including a balance between patient-centered features and ergonomic considerations that can prevent workplace injuries. This facility design department aims to expand nurse leaders' knowledge and competencies in health facility design and enables them to take leadership roles in design efforts. Part 1 in this 2-part series focused on ergonomic designs for patient care areas to enhance patient and nurse safety. The focus of part 2 is ergonomic designs for nursing stations and support areas that can prevent worker injury.     

Integrating quality and safety content into clinical teaching in the acute care setting

Teaching the highest quality and safest practice has long been a goal of faculty members in pre-licensure nursing education programs. This article will describe innovative approaches to integrating quality and safety content into existing clinical practica. The core competencies identified by the Quality and Safety Education for Nurses project--patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics--serve as the framework for the teaching/learning exercises. The strategies described require a shift in attention rather than changes in course content and can be included in any clinical rotation in an acute care setting.     

Engaging students in a QI/QM presentation to enhance QSEN concept learning

The Quality and Safety Education for Nurses (QSEN) Initiative addresses goals to better prepare future nurses by proposing and defining 6 competencies addressing knowledge, skills, and attitudes (KSA) needed for undergraduate, pre-licensure nursing students to be successful, competent, and qualified registered nurses. Educators maintain the responsibility to bridge education and clinical preparation to enable nursing students to practice at a level that projects quality and safety. This article introduces and explains a guided Quality Indicator/Quality Measure (QI/QM) teaching-learning strategy aimed at the promotion of learning about QSEN competencies, in which students identify a clinical QI/QM issue, gather data, collaborate, apply research techniques, create a presentation, and report their findings. Specific QSEN competency sub-scores from an NCLEX test preparation strategy were used to measure students’ learning, and improvements on these sub-scores were observed. Introducing QSEN concepts sets the stage for competent nursing care in the future and this valuable teaching-learning strategy suggests how to infuse QSEN competencies into an undergraduate nursing curriculum.