OVERVIEW

The overall goal for the Quality and Safety Education for Nurses (QSEN) project is to meet the challenge of preparing future nurses who will have the knowledge, skills and attitudes (KSAs) necessary to continuously improve the quality and safety of the healthcare systems within which they work.

Using the Institute of Medicine1 competencies, QSEN faculty and a National Advisory Board have defined quality and safety competencies for nursing and proposed targets for the knowledge, skills, and attitudes to be developed in nursing pre-licensure programs for each competency. These definitions are shared in the six tables below as a resource to serve as guides to curricular development for formal academic programs, transition to practice and continuing education programs 2.

For information on applying the competencies at a graduate level, see the Graduate KSAs page.

Note: This content is reprinted with permission from the “Quality and Safety Education for Nurses” article originally printed in Nursing Outlook Special Issue: Quality and Safety Education. For guidelines on use of this material, please read our terms and conditions.

DEFINITIONS AND PRE-LICENSURE KSAS

 

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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

Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values

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

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

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

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

EVIDENCE-BASED PRACTICE (EBP)

Definition: Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
Knowledge Skills Attitudes
Demonstrate knowledge of basic scientific methods and processes

Describe EBP to include the components of research evidence, clinical expertise and patient/family values.

Participate effectively in appropriate data collection and other research activities

Adhere to Institutional Review Board (IRB) guidelines

Base individualized care plan on patient values, clinical expertise and evidence

Appreciate strengths and weaknesses of scientific bases for practice

Value the need for ethical conduct of research and quality improvement

Value the concept of EBP as integral to determining best clinical practice

Differentiate clinical opinion from research and evidence summaries

Describe reliable sources for locating evidence reports and clinical practice guidelines

Read original research and evidence reports related to area of practice

Locate evidence reports related to clinical practice topics and guidelines

Appreciate the importance of regularly reading relevant professional journals
Explain the role of evidence in determining best clinical practice

Describe how the strength and relevance of available evidence influences the choice of interventions in provision of patient-centered care

Participate in structuring the work environment to facilitate integration of new evidence into standards of practice

Question rationale for routine approaches to care that result in less-than-desired outcomes or adverse events

Value the need for continuous improvement in clinical practice based on new knowledge
Discriminate between valid and invalid reasons for modifying evidence-based clinical practice based on clinical expertise or patient/family preferences Consult with clinical experts before deciding to deviate from evidence-based protocols Acknowledge own limitations in knowledge and clinical expertise before determining when to deviate from evidence-based best practices

QUALITY IMPROVEMENT (QI)

Definition: Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems.
Knowledge Skills Attitudes
Describe strategies for learning about the outcomes of care in the setting in which one is engaged in clinical practice Seek information about outcomes of care for populations served in care setting

Seek information about quality improvement projects in the care setting

Appreciate that continuous quality improvement is an essential part of the daily work of all health professionals
Recognize that nursing and other health professions students are parts of systems of care and care processes that affect outcomes for patients and families

Give examples of the tension between professional autonomy and system functioning

Use tools (such as flow charts, cause-effect diagrams) to make processes of care explicit

Participate in a root cause analysis of a sentinel event

Value own and others’ contributions to outcomes of care in local care settings
Explain the importance of variation and measurement in assessing quality of care Use quality measures to understand performance

Use tools (such as control charts and run charts) that are helpful for understanding variation

Identify gaps between local and best practice

Appreciate how unwanted variation affects care

Value measurement and its role in good patient care

Describe approaches for changing processes of care Design a small test of change in daily work (using an experiential learning method such as Plan-Do-Study-Act)

Practice aligning the aims, measures and changes involved in improving care

Use measures to evaluate the effect of change

Value local change (in individual practice or team practice on a unit) and its role in creating joy in work

Appreciate the value of what individuals and teams can to do to improve care

SAFETY

Definition: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
Knowledge Skills Attitudes
Examine human factors and other basic safety design principles as well as commonly used unsafe practices (such as, work-arounds and dangerous abbreviations)

Describe the benefits and limitations of selected safety-enhancing technologies (such as, barcodes, Computer Provider Order Entry, medication pumps, and automatic alerts/alarms)

Discuss effective strategies to reduce reliance on memory

Demonstrate effective use of technology and standardized practices that support safety and quality

Demonstrate effective use of strategies to reduce risk of harm to self or others

Use appropriate strategies to reduce reliance on memory (such as, forcing functions, checklists)

Value the contributions of standardization/reliability to safety

Appreciate the cognitive and physical limits of human performance

Delineate general categories of errors and hazards in care

Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems)

Communicate observations or concerns related to hazards and errors to patients, families and the health care team

Use organizational error reporting systems for near miss and error reporting

Value own role in preventing errors
Describe processes used in understanding causes of error and allocation of responsibility and accountability (such as, root cause analysis and failure mode effects analysis) Participate appropriately in analyzing errors and designing system improvements

Engage in root cause analysis rather than blaming when errors or near misses occur

Value vigilance and monitoring (even of own performance of care activities) by patients, families, and other members of the health care team
Discuss potential and actual impact of national patient safety resources, initiatives and regulations Use national patient safety resources for own professional development and to focus attention on safety in care settings Value relationship between national safety campaigns and implementation in local practices and practice settings

INFORMATICS

Definition: Use information and technology to communicate, manage knowledge, mitigate error, and support decision making.
Knowledge Skills Attitudes
Explain why information and technology skills are essential for safe patient care Seek education about how information is managed in care settings before providing care

Apply technology and information management tools to support safe processes of care

Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills
Identify essential information that must be available in a common database to support patient care

Contrast benefits and limitations of different communication technologies and their impact on safety and quality

Navigate the electronic health record

Document and plan patient care in an electronic health record

Employ communication technologies to coordinate care for patients

Value technologies that support clinical decision-making, error prevention, and care coordination

Protect confidentiality of protected health information in electronic health records

Describe examples of how technology and information management are related to the quality and safety of patient care

Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care

Respond appropriately to clinical decision-making supports and alerts

Use information management tools to monitor outcomes of care processes

Use high quality electronic sources of healthcare information

Value nurses’ involvement in design, selection, implementation, and evaluation of information technologies to support patient care

REFERENCES

1 Institute of Medicine. Health professions education: A bridge to quality. Washington DC: National Academies Press; 2003.

2 Cronenwett, L., Sherwood, G., Barnsteiner J., Disch, J., Johnson, J., Mitchell, P., Sullivan, D., Warren, J. (2007). Quality and safety education for nurses. Nursing Outlook, 55(3)122-131.