Assignment: Quality and Safety Improvement
Assignment: Quality and Safety Improvement
There are several nursing quality outcome indicators that are supposed to focus programs and plans to improve safety and quality in the patient care. Patient satisfaction is one of the main pointers when it comes to the measurement of nursing quality. In most cases, satisfaction results from the services, both medical and non-mIn quality improvement, there is always the adjustment of the operational processes to comply with the demands from the clients and the government or professional standards. In the medical setup, quality improvement usually involves collecting information and data for the management to understand where there is the need for adjustments.
QSEN Discussion Board #1 Rubric
As a nurse leader, you are responsible for improving the quality and safety of health care systems. Describe a nursing or patient care concern or issue that needs to be addressed in your clinical practice. If your clinical practice is limited, you may be able to draw on experiences gained during clinical rotations in nursing school. Analyze the significance of the nursing practice concern in relation to the Quality and Safety Education for Nurses (QSEN) competencies described in the Cronenwatt article (Cronenwatt website – http://qsen.org/competencies/pre-licensure-ksas/).
I have decided to complete my BSN for a few different reasons. One reason is to further my knowledge in the most recent evidence based practice of nursing in order to provide better patient care. Academic nursing research is crucial to providing quality nursing care because it gives the foundation for evidence-based practice (EBP) that is often the catalyst for changes that impact patient outcomes (Falkner 2018). The next reason is my place of work requires that all ADN nurses obtain a BSN or higher within 3 years of hire, and lastly the more education I achieve the higher I get paid. All three of these reasons point back to an overarching idea that I am here getting my BSN to further myself along in my career and become a better nurse. I don’t have many concerns with getting started in my bachelorette program except the sole fact that I’d rather be outside enjoying playing sports or doing activities outside rather than being on the computer. I have never been one to like sitting on a computer for any period of time really. A few strategies that I can implement is time management, using evidence based practice sources of information, and remembering to ask for help when I don’t understand or am feeling overwhelmed. Enlist your family to keep a master calendar so everyone knows when you’re working, going to class and studying. And be sure to schedule some free time for the things you like to do, whether it’s working out, reading, listening to music or spending time with your family. That balance will help you get through the rigors of nursing school (Murphy 2015).
This assignment is restricted to the competencies of Evidence-based Practice (EBP) or Quality Improvement (QI).
Why is it critical to investigate this concern or issue?
What is the best or preferred method for dealing with this issue?
How will you, as a nurse manager or leader, improve workplace practices related to this issue?
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Enhancement of Quality and Safety Discussion
Describes a nursing or patient care issue that needs to be addressed.
20 Describes the Evidence-based Practice and/or Quality Improvement QSEN competencies and links the importance of the issue to the QSEN competencies.
Why is it important to investigate this issue?
20
This section describes the best or preferred practices for this issue. At least one current nursing RESEARCH article provides support.
25
Describes strategies for improving health-care practices. Please provide at least one reference. Textbooks or current nursing literature can be used.
APA and Grammar
10\sTextbook:
E. J. Sullivan (2012). Nursing leadership and management that is effective. Pearson, Boston, ISBN-13: 978-0132814546
Discussion on Quality and Safety Improvement
Nursing education on quality and safety Dr. Linda Cronenwett, RN, FAAN PhD, RN, FAAN Gwen Sherwood PhD, RN, FAAN Jane Barnsteiner PhD, RN, FAAN Joanne Disch PhD, RN-C, FAAN Jean Johnson Dr. Pamela Mitchell, CNRN, FAAN Dori Taylor Sullivan is a PhD, RN, CNA, and CPHQ. On whether the KSAs for pre-licensure education are appropriate goals for students preparing for basic practice as a registered nurse, Judith Warren, PhD, RN, BC, FAAN, FACMI. Quality and Safety Education for Nurses (QSEN) addresses the challenge of equipping nurses with the knowledge and skills needed to continuously improve the quality and safety of the health care systems in which they work. The QSEN faculty members adapted the Institute of Medicine1 competencies for nursing (patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics), proposing definitions of what it means to be a competent and respected nurse.
The authors propose statements of knowledge, skills, and attitudes (KSAs) for each competency that should be developed during pre-licensure nursing education based on the competency definitions. Faculty and advisory board members of Quality and Safety Education for Nurses (QSEN) invite the profession to comment on the competencies and their definitions. A number of national commissions have identified significant issues with safety and quality in the US health-care system. 1–5 In light of these issues, multiple national committee reports concluded that if health care is to improve, providers must be prepared with a different set of competencies than are currently taught in educational programs. 1,6 Using scientific evidence, health professionals must be able to describe what constitutes good care, identify gaps between good care and the local care provided in their practices, and know what activities, if any, they can initiate to close any gaps. 7
The 2003 Institute of Medicine (IOM) Health Professions Education report1 challenges faculties of medicine, nursing, and other health professions to mindfully alter learning experiences that form the basis for professional identity formation so that graduates are educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics. 1 To incorporate the development of the aforementioned competencies in nursing education, will, ideas, and execution are required. In contrast to medicine, where a commitment to an adapted version of the IOM competencies has now been made for the entire continuum from medical school to residency program to certification, 8,9 There is no agreement in nursing on the competencies that could apply to all nurses and define what it means to be a respected and qualified nurse.
However, at the heart of nursing is an incredible historical will to ensure patient quality and safety. Nursing publications,10 -12 standards of practice,13 and accreditation guidelines all show a value for quality and safety competencies. 14,15 The Task Force on the Essential Patient Safety Competencies for Professional Nurses of the American Association of Colleges of Nursing Linda Cronenwett is a Professor and Dean at the University of North Carolina at Chapel Hill’s School of Nursing. Gwen Sherwood is a Professor and Associate Dean for Academic Affairs at the University of North Carolina at Chapel Hill’s School of Nursing. Jane Barnsteiner is a Professor and the Director of Translational Research at the University of Pennsylvania School of Nursing and Hospital in Philadelphia, PA. Joanne Disch is the Kathyrn R. and C. Walton Lillehei Professor and Director of the Densford International Center for Nursing Leadership at the University of Minnesota School of Nursing in Minneapolis, Minnesota.
Jean Johnson is a Professor of Health Sciences and Senior Associate Dean at The George Washington University in Washington, DC. Pamela Mitchell is the Elizabeth S. Soule Professor and Associate Dean for Research at the University of Washington School of Nursing in Seattle, Washington. Dori Taylor Sullivan is an Associate Professor and Chair of the Nursing Department at Sacred Heart University in Fairfield, Connecticut. Judith Warren is an Associate Professor of Nursing at the University of Kansas and the Director of Nursing Informatics at the Kansas University Center for Healthcare Informatics in Kansas City, Kansas. Requests for reprints should be addressed to Linda Cronenwett, PhD, RN, FAAN, Dean and Professor, School of Nursing, University of North Carolina at Chapel Hill, Carrington Hall, CB #7460, Chapel Hill, NC 27599-7460. Contact: lcronenwett@unc.edu 0029-6554/07/$-see front matter. Nurs Outlook 2007;55:122-131. Copyright Mosby, Inc., 2007. Every right is reserved. http://dx.doi.org/10.1016/j.outlook.2007.02.006 122 V O L U M E 5 5 N U M B E R 3 N U R S L O O K I N G O U T Nursing education on quality and safety Cronenwett and colleagues Table 1.
Definition of Patient-Centered Care: Recognize the patient or designee as the source of control and a full partner in providing compassionate and coordinated care that is based on the patient’s preferences, values, and needs. Knowledge Integrate knowledge of multiple aspects of patient-centered care: Preferences and values of patients/families/communities coordination and integration of care information, communication, and education physical comfort and emotional support family and friend involvement transition and continuity Skills Attitudes Elicit patient values, preferences, and expressed needs as part of the clinical interview, care plan implementation, and care evaluation. Communicate to other members of the health care team the patient’s values, preferences, and expressed needs. Give patient-centered care while being sensitive to and respectful of the diversity of human experience. Describe how different cultural, ethnic, and social backgrounds contribute to patient, family, and community values. Consider seeing health-care situations “through the eyes of the patients.” Individual expression of patient values, preferences, and expressed needs should be respected and encouraged. Consider the patient’s knowledge of his or her own health and symptoms. Seek out opportunities to learn from patients who represent all aspects of human diversity.
Recognize personal attitudes toward working with patients from various ethnic, cultural, and social backgrounds. Willingly support patient-centered care for individuals and groups with values that differ from one’s own Demonstrate a thorough understanding of pain and suffering concepts, including physiologic models of pain and comfort Determine the presence and extent of pain and suffering. Recognize personal values and beliefs about pain or suffering management. Determine your level of physical and emotional comfort. Recognize the nurse’s role in the relief of all types and sources of pain or suffering. Elicit the patient’s and family’s expectations for pain, discomfort, or suffering relief. Recognize that patient expectations influence pain or suffering management outcomes. Initiate effective pain and suffering relief treatments based on patient values, preferences, and expressed needs. Investigate how the active participation of patients and families can improve the safety, quality, and cost-effectiveness of health care. Examine common barriers to patients’ active participation in their own health care processes.
Describe strategies for empowering patients or families in all aspects of the health-care process. Remove obstacles to the presence of families and other designated surrogates based on patient preferences. Assess the level of decisional conflict in the patient and provide resources. Participate in active partnerships with patients or designated surrogates to promote health, safety, and well-being, as well as self-care management. J U N E / M A Y Value active collaboration with patients or designated surrogates in care planning, implementation, and evaluation. Respect the patient’s preferences for the level of active participation in the care process. Respect the right of patients to access their personal health records. 123 N U R S I N G O U T L O O K Nursing education on quality and safety Cronenwett and colleagues Table 1. Continued Definition: Recognize the patient or designee as the source of control and a full partner in providing compassionate and coordinated care that is based on the patient’s preferences, values, and needs.
Knowledge Abilities Investigate the ethical and legal ramifications of patient-centered care. Recognize therapeutic relationship boundaries Describe the limits and boundaries of therapeutic patient-centered care Encourage informed patient consent for treatment. Attitudes Recognize the potential conflict between patient rights and organizational responsibility for professional, ethical care. Even when conflicts arise, appreciate shared decisionmaking with empowered patients and families. Discuss principles of effective communication. Assess own level of communication skill in encounters with patients and families. Explain the fundamental principles of consensus building and conflict resolution. Participate in the formation of consensus or the resolution of conflict in the context of patient care. Examine the roles of nurses in ensuring care coordination, integration, and continuity. At each transition in care, communicate care provided and needed. Care recently updated the Essentials of Baccalaureate Education for Professional Nursing Practice to include quality and safety competency exemplars. 16 However, ideas for what to teach, how to teach, and how to assess competency learning are severely lacking, and there are few, if any, examples of schools claiming to implement a comprehensive quality and safety curriculum. Programs for continuing education Furthermore, the definitions can serve as a framework for regulatory bodies that set standards for nursing education program licensure, certification, and accreditation.
NURSING PRE-LICENSURE EDUCATION Enhancement of Quality and Safety Discussion. The competency definitions provided a broad framework for QSEN’s work to define pedagogical strategies for quality and safety education; however, when the competency names and definitions were used alone, the vast majority of pre-licensure program leaders stated that they already included content related to the competencies in their curricula, as shown in the accompanying article in this issue. 17 Using the respondent to interpret the general definitions of the QSEN competencies, program leaders were pleased with the extent to which students developed these competencies, and faculty believed they possessed the necessary expertise to teach these competencies. The QSEN faculty and advisory board members disagreed that pre-licensure nursing students graduated with these competencies. We were aware that many students graduated without ever recommending a change in patient care to a physician. Many of us were aware that students were taught the “five rights” of medication administration but lacked a common language for concepts related to safety sciences or quality improvement methods. With the COMPETENCIES DEFINED The Robert Wood Johnson Foundation-funded Quality and Safety Education for Nurses (QSEN) program was created to fill these gaps—to strengthen the will, develop ideas, and facilitate the implementation of changes in nursing education. However, before developing teaching strategies, the QSEN faculty needed to define precisely what was to be accomplished.
The authors reviewed the relevant literatures and adapted the IOM1 competencies for nursing in collaboration with an Advisory Board of thought leaders in nursing and medicine (see acknowledgements). The goal was to define competencies that all registered nurses should have. The definitions in Tables 1–6 are shared with the profession in the hope that nursing, through its professional organizations, will benefit from the work. If nursing constituents find these competency definitions clear and compelling, the competencies can eventually serve as guides to curricular development for formal academic programs, transition to practice, and professional development. 124 5 5 N U M B E R V O L U M E Consider yourself to be constantly improving your communication and conflict resolution skills. N U R S I N G O U T L O O K 3 N U R S I N G O U T L O O K Nursing education on quality and safety Cronenwett and colleagues Table 2: Improving Quality and Safety Discussion. Collaboration and teamwork Definition: Work effectively within nursing and inter-professional teams to achieve quality patient care by fostering open communication, mutual respect, and shared decision-making.
Knowledge Describe your own strengths, limitations, and values in teamwork Skills Attitudes Show that you are aware of your own strengths. Recognize your own abilities and limitations as a team member to contribute to effective team functioning. Create a plan for self-development as a team member Recognize the value of intra- and inter-professional collaboration Act with integrity, consistency, and respect for opposing viewpoints. Describe practice scopes and function competently within one’s own scope Value the perspectives and roles of health care team members as members of the health expertise of all health team members. Describe methods for locating Assume the role of a team member or leader, and manage overlaps in team member roles based on the situation. When accountabilities are appropriate for the situation, initiate requests for assistance.
Recognize others’ contributions Clarify roles and responsibilities for individuals and groups in situations where there may be overlap in order to assist patients/families in achieving team-member functioning health goals. Include the contributions of others who help the patient/family achieve their health goals. Respect the patient/family as essential members of any health care team. Consider differences in communication style preferences among patients and families, nurses, and other members of the health care team. Communicate with team members, adapting your communication style to the needs of the team and the situation. Respect the distinct characteristics that team members bring to the table, including differences in professional orientations and accountability. Show dedication to team goals. Consider the various communication styles used by Solicit feedback from other team members to describe the impact of one’s own patients, families, and health on the performance of other care providers.
Discuss effective methods for Contribute to the resolution of communicating and resolving Conflict Conflict and Disagreement Conflict Give examples of the Adhere to communication practices that Recognize the risks associated with team functioning on reducing risks associated with handoffs with handoffs among providers and across transitions in care providers and across transitions in care Explain how authority levels affect teamwork and In patient safety discussions about patient care, assert your own position/perspective. Select communication styles that reduce the risks associated with power imbalances among team members. Determine the system barriers and facilitators of effective teamwork. Participate in the development of systems that promote effective teamwork. Consider the role of system solutions in achieving effective teamwork. Investigate strategies for improving systems to aid teamwork. M 125 A Y / J U N E N U R S I N G O U T L O O K Nursing education on quality and safety Cronenwett and colleagues Table 3. Practice Based on Evidence (EBP) Definition: To provide optimal health care, integrate the best current evidence with clinical expertise and patient/family preferences and values.
Knowledge Abilities Demonstrate understanding of fundamental scientific methods and processes. Explain EBP in terms of research evidence, clinical expertise, and patient/family values. Participate in effective data collection and other research activities. Recognize the strengths and weaknesses of scientific foundations for practice. Follow the guidelines of the Institutional Review Board (IRB). Recognize the importance of ethical research and quality improvement. Individualized care plans should be based on patient values, clinical expertise, and evidence. Distinguish between clinical opinion and research and evidence summaries. Read original research and evidence reports relevant to your practice area. Describe trustworthy sources for finding evidence reports and clinical practice guidelines. Find evidence reports on clinical practice topics and guidelines. Explain how evidence is used to determine best clinical practice. Participate in the organization of the workplace to facilitate the incorporation of new evidence into standards of practice. Explain how the strength and relevance of available evidence influences intervention selection in patient-centered care. Examine the rationale for routine care approaches that result in less-than-desired outcomes or adverse events.
Distinguish between legitimate and illegitimate reasons for changing evidence-based clinical practice based on clinical expertise or patient/family preferences. Before deviating from evidence-based protocols, consult with clinical experts. We outlined the knowledge, skills, and attitudes (KSAs) appropriate for pre-licensure education with the goal of clarifying rather than prescribing current meanings of competency definitions. The authors guided the KSA development process through two workshops and numerous email communications. We concentrated on all levels of pre-licensure education (associate, diploma, baccalaureate, and master’s) because the ultimate goal is to ensure that all patients are cared for by nurses who have developed KSAs for each competency. Enhancement of Quality and Safety Discussion. We attempted to answer the question, “What should nursing promise in terms of quality and safety education for pre-licensure graduates?” We solicited feedback from nursing faculty at each stage. In contrast to the survey results, when nursing 126 Attitudes V O L U M E 5 5 N U M B E R 3 N U R S I N G N U R S I N G N U R S I N G N U Consider EBP to be essential in determining best clinical practice. Recognize the significance of reading relevant professional journals on a regular basis. Recognize the importance of continuous improvement in clinical practice based on new knowledge. Recognize your own knowledge and clinical expertise limitations before deciding when to deviate from evidence-based best practices. The Institute for Healthcare Improvement includes faculty from 16 universities. When the draft KSAs were reviewed by the Health Professions Education Collaborative, they unanimously reported that nursing students were not developing these KSAs.
Additional focus groups were held with faculty who taught pre-licensure students in the schools of QSEN faculty members, and the responses were consistent. Although the faculty agreed that they should and had thought they were teaching these competencies, focus group participants did not understand fundamental concepts related to the competencies and could not identify pedagogical strategies used to teach the KSAs. A focus group of new graduates was led by a chief nurse executive who serves on the QSEN advisory board. Not only did these nurses report a lack of learning experience Nursing education on quality and safety Cronenwett and colleagues Table 4. Quality Enhancement (QI) Definition: Continuously improve the quality and safety of health care systems by using data to monitor the outcomes of care processes and using improvement methods to design and test changes. Attitudes and Knowledge Describe strategies for learning about the outcomes of care in the clinical setting in which you work. Discussion on Quality and Safety Improvement
You should proofread your paper. However, do not rely solely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part, and your grade will suffer as a result. Papers with a high number of misspelled words and grammatical errors will be penalized. Before submitting your paper, go over it in silence and then aloud, and make any necessary changes. It is often beneficial to have a friend proofread your paper for obvious errors. Uncorrected mistakes are preferable to handwritten corrections.