discussion post questions in the file
Submit QSEN Discussion Board posting after reading and reviewing the Cronenwett et al article. As a nurse leader, you are charged with improving quality and safety in health care systems. Describe a nursing or patient care concern or issue from your clinical practice that needs improvement. This could be a patient care issue closely related to the Safety issue that you identified included as a Joint Commission Safety goal in your previous discussion post. However, for this discussion, analyze the significance of the concern for nursing practice in relation to the Quality and Safety Education for Nurses (QSEN) competences described in the Cronenwatt article. This assignment is limited to the Evidence-based Practice (EBP) or Quality Improvement (QI) competencies. Why is it important to explore this concern or issue? Discuss fully. What would be the best or preferred practice for this concern? You should have literature to support your discussion of this. As a nurse manager or leader, how will you improve practices in your work environment related to this concern? This post requires literature that is evidence based, not simply an article providing further information on the concern. Those articles can be included for additional support, but your best or preferred practices need to come from nursing journals discussing EBP or those that discuss QI related to the concern. CONCERN IS: NURSE SHORTAGE Cronenwett et al article Quality and safety education for nurses Linda Cronenwett, PhD, RN, FAAN Gwen Sherwood, PhD, RN, FAAN Jane Barnsteiner, PhD, RN, FAAN Joanne Disch, PhD, RN, FAAN Jean Johnson, PhD, RN-C, FAAN Pamela Mitchell, PhD, CNRN, FAAN Dori Taylor Sullivan, PhD, RN, CNA, CPHQ Judith Warren, PhD, RN, BC, FAAN, FACMI Quality and Safety Education for Nurses (QSEN) ad- dresses 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 col- laboration, evidence-based practice, quality im- provement, safety, and informatics), proposing defi- nitions 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 devel- oped during pre-licensure nursing education. Quality and Safety Education for Nurses (QSEN) faculty and advisory board members invite the profession to com- ment 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. A series of national commissions have documented significant problems related to safety and quality in the US health care system.1–5 In light of these problems, reports from multiple national committees con- cluded that if health care is to improve, providers need to be prepared with a different set of competencies than are developed in educational programs today.1,6 Health pro- fessionals, using scientific evidence, need to 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 they could initiate, if necessary, to close any gaps.7 Faculties of medicine, nursing, and other health professions are challenged by the 2003 Institute of Medicine (IOM) Health Professions Education report1 to mindfully alter learning experiences that form the basis for professional identity formation so that grad- uates are educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics.1 Will, ideas, and execution are required to incorporate the development of the above competencies in nursing education. Unlike medicine, where commitment to an adapted version of the IOM competencies is now in place for the continuum from medical school to resi- dency program to certification, 8,9 nursing has no con- sensus on the competencies that could apply to all nurses—that would define what it means to be a respected and qualified nurse. At the core of nursing, however, lies incredible historical will to ensure quality and safety for patients. Evidence of valuing quality and safety competencies in nursing is evident in nursing publications, 10 –12 standards of practice, 13 and accredi- tation guidelines. 14,15 The American Association of Colleges of Nursing Task Force on the Essential Patient Safety Competencies for Professional Nurs- Table 1. Patient-centered Care Definition: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs. Knowledge Skills Attitudes Integrate understanding of multiple dimensions of patient-centered care: ● patient/family/community preferences, values ● coordination and integration of care ● information, communication, and education ● physical comfort and emotional support ● involvement of family and friends ● transition and continuity Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care Communicate patient values, preferences and expressed needs to other members of health care team Provide patient-centered care with sensitivity and respect for the diversity of human experience Value seeing health care situations “through patients’ eyes” Respect and encourage individual expression of patient values, preferences and expressed needs Value the patient’s expertise with own health and symptoms Seek learning opportunities with patients who represent all aspects of human diversity Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient, family, and community values Recognize personally held attitudes about working with patients from different ethnic, cultural and social backgrounds Willingly support patient- centered care for individuals and groups whose values differ from own Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfort Assess presence and extent of pain and suffering Assess levels of physical and emotional comfort Elicit expectations of patient & family for relief of pain, discomfort, or suffering Initiate effective treatments to relieve pain and suffering in light of patient values, preferences, and expressed needs Recognize personally held values and beliefs about the management of pain or suffering Appreciate the role of the nurse in relief of all types and sources of pain or suffering Recognize that patient expectations influence outcomes in management of pain or suffering Examine how the safety, quality, and cost-effectiveness of health care can be improved through the active involvement of patients and families Examine common barriers to active involvement of patients in their own health care processes Describe strategies to empower patients or families in all aspects of the health care process Remove barriers to presence of families and other designated surrogates based on patient preferences Assess level of patient’s decisional conflict and provide access to resources Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management Value active partnership with patients or designated surrogates in planning, implementation, and evaluation of care Respect patient preferences for degree of active engagement in care process Respect patient’s right to access to personal health records Quality and safety education for nurses Cronenwett et al 123M A Y / J U N E N U R S I N G O U T L O O K ing Care recently completed an enhancement to the Essentials of Baccalaureate Education for Profes- sional Nursing Practice to include exemplars of qual- ity and safety competencies.16 But the ideas for what to teach, how to teach, and how to assess learning of the competencies are sorely lacking, and there are few, if any, examples of schools claiming to execute a com- prehensive quality and safety curriculum. DEFINING THE COMPETENCIES Quality and Safety Education for Nurses (QSEN), funded by the Robert Wood Johnson Foundation, was designed to address these gaps—to build on the will, to develop the ideas, and to facilitate execution of changes in nursing education. Before teaching strategies could be developed, however, the QSEN faculty needed to identify specifically what was to be achieved. Working with an Advisory Board of thought leaders in nursing and medicine (see acknowledgments), the authors re- viewed the relevant literatures and adapted the IOM 1 competencies for nursing. The goal was to describe competencies that would apply to all registered nurses. In Tables 1– 6, the definitions are shared with the profession with the hope that nursing, through its professional organizations, can benefit from the work. If nursing constituencies find these competency defini- tions clear and compelling, over time the competencies can serve as guides to curricular development for formal academic programs, transition to practice, and continuing education programs. In addition, the defini- tions can provide a framework for regulatory bodies that set standards for licensure, certification, and ac- creditation of nursing education programs. PRE-LICENSURE NURSING EDUCATION The competency definitions provided a broad frame- work for QSEN’s work to define pedagogical strategies for quality and safety education; however, as is evident in the accompanying article in this issue, 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 com- petencies in their curricula. 17 Relying on the respondent to interpret the general definitions of the QSEN com- petencies, levels of satisfaction with the extent to which students developed these competencies were high, and program leaders believed that faculty possessed the necessary expertise to teach these competencies. The QSEN faculty and advisory board members did not share the view that pre-licensure nursing students were graduating with these competencies. We knew that many students graduated without ever communi- cating a recommendation for a change in patient care to a physician. Many of us knew that students learned the “five rights” of medication administration but lacked the language of common concepts related to safety sciences or quality improvement methods. With the Table 1. Continued Definition: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs. Knowledge Skills Attitudes Explore ethical and legal implications of patient-centered care Describe the limits and boundaries of therapeutic patient-centered care Recognize the boundaries of therapeutic relationships Facilitate informed patient consent for care Acknowledge the tension that may exist between patient rights and the organizational responsibility for professional, ethical care Appreciate shared decision- making with empowered patients and families, even when conflicts occur Discuss principles of effective communication Describe basic principles of consensus building and conflict resolution Examine nursing roles in assuring coordination, integration, and continuity of care Assess own level of communication skill in encounters with patients and families Participate in building consensus or resolving conflict in the context of patient care Communicate care provided and needed at each transition in care Value continuous improvement of own communication and conflict resolution skills Quality and safety education for nurses Cronenwett et al 124 V O L U M E 5 5 ● N U M B E R 3 N U R S I N G O U T L O O K Table 2. Teamwork 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. Knowledge Skills Attitudes 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 Initiate plan for self-development as a team member Act with integrity, consistency and respect for differing views Acknowledge own potential to contribute to effective team functioning Appreciate importance of intra- and inter-professional collaboration Describe scopes of practice and roles of health care team members Describe strategies for identifying and managing overlaps in team member roles and accountabilities Recognize contributions of other individuals and groups in helping patient/family achieve health goals Function competently within own scope of practice as a member of the health care team Assume role of team member or leader based on the situation Initiate requests for help when appropriate to situation Clarify roles and accountabilities under conditions of potential overlap in team-member functioning Integrate the contributions of others who play a role in helping patient/family achieve health goals Value the perspectives and expertise of all health team members Respect the centrality of the patient/family as core members of any health care team Respect the unique attributes that members bring to a team, including variations in professional orientations and accountabilities Analyze differences in communication style preferences among patients and families, nurses, and other members of the health team Describe impact of own communication style on others Discuss effective strategies for communicating and resolving conflict Communicate with team members, adapting own style of communicating to needs of the team and situation Demonstrate commitment to team goals Solicit input from other team members to improve individual, as well as team, performance Initiate actions to resolve conflict Value teamwork and the relationships upon which it is based Value different styles of communication used by patients, families, and health care providers Contribute to resolution of conflict and disagreement Describe examples of the impact of team functioning on safety and quality of care Explain how authority gradients influence teamwork and patient safety Follow communication practices that minimize risks associated with handoffs among providers and across transitions in care Assert own position/perspective in discussions about patient care Choose communication styles that diminish the risks associated with authority gradients among team members Appreciate the risks associated with handoffs among providers and across transitions in care Identify system barriers and facilitators of effective team functioning Examine strategies for improving systems to support team functioning Participate in designing systems that support effective teamwork Value the influence of system solutions in achieving effective team functioning Quality and safety education for nurses Cronenwett et al 125M A Y / J U N E N U R S I N G O U T L O O K goal of clarifying rather than prescribing current mean- ings of the competency definitions, we outlined the knowledge, skills, and attitudes (KSAs) appropriate for pre-licensure education. During 2 workshops