Author: Esther Gravis, RN, MSN, CPN
Title: Professor of Nursing
Institution: Saddleback College
Students will be able to:
1. Identify patient-centered care either being delivered, or not, in the hospital setting
2. Demonstrate teamwork and collaboration as an active member of the healthcare team
3. Identify how communication aids in resolving conflict.
4. Differentiate between a nurse’s opinion and research or evidence.
5. Locate policies and guidelines that support nursing practice
6. Identify ways to reduce the risk of harm to the patient (knowledge).
7. Identify and describe a culture of safety (attitudes).
8. Identify how information is managed in order to provide care to patients (skills)
9. Describe ways of protecting electronic health records.
The QSEN competencies and National Patient Safety Goals are used to provide standards of care to nursing students. Both of these tools provide guidelines and examples of care for nursing students and registered nurses. These standards are widely used within a variety of hospital settings.
This teaching strategy was used with first year fundamental ADN nursing students.
Prior to the beginning of clinical, the students are taught about QSEN competencies and National Patient Safety Goals in the lecture setting. Students are presented with QSEN competencies and KSA’s needed for the graduate nurse. The students are then given examples of how nurses demonstrate each QSEN competency while caring for patients in the clinical setting (eg, focusing on providing care that is focused on the patients’ needs and not that of the nurse- patient centered care). *See table below for examples used in the lecture setting. The students are then given copies of the QSEN competencies and National Patient Safety Goals.
In the clinical setting:
In the hospital setting the QSEN competencies and National Patient Safety Goals are reviewed again in pre-conference before the students go to their assigned patient-care units. The students are assigned to groups of two or three and asked to identify and provide examples of the six QSEN competencies they see while in the hospital setting. They will provide these examples during post-conference later that day. This activity works well during periods of down-time; normally after medications have been administered and physical assessments are complete. If the students are unsure where to start they could focus on safety and patient-centered care. If the students are unable to identify a QSEN competency, the instructor can ask if the students continue to look for the competency and return to the topic in a later post conference. For example, quality improvement might be identified by the wound care nurse providing an in-service to the nursing staff regarding a new type of wound care equipment at a later date.
This is not a time to focus on the negative aspects of the nurses, doctors, and ancillary staff, but to learn from what they are observing and to decipher best practices. Moreover, this activity will help the students to identify specific QSEN competencies and National Patient Safety Goals and potentially implement those standards into their own practice.
The students found it difficult to identify Evidence-based practices in the clinical setting. This was discussed in lecture and post-conference, but it was difficult for them to identify. The competencies identified most often were safety, informatics, and teamwork. In instances where they were unable to identify a QSEN competency the instructor provided it for them. For example, patient-centered care: they were reminded this includes empowering the patient and their family members or ways the nurse helped to relieve the patient’s pain.
This is a way to get them to think about the care they provide and to reflect on their clinical practice. They will also learn from their colleagues. Post conference is a time to let them discuss their issues, concerns, worries, and feelings, but don’t let one student monopolize the group.
Questions to stimulate discussion in debriefing:
Which QSEN competencies were you able to identify today?
Were you able to identify patient-centered care either being delivered, or not, in the hospital setting?
At what points during the day were your nursing actions specifically directed toward prevention of a negative outcome?
Did you witness teamwork and collaboration as an active member of the healthcare team?
What communication strategies did you use to validate accuracy of your information or decisions with your team members (nurse, instructor)?
Were you able to differentiate between a nurse’s opinion and research or evidence? Give an example.
Were you able to locate policies and guidelines that support nursing practice?
Can you note ways to reduce the risk of harm to the patient in the clinical setting?
Can you give an example where you noted a culture of safety?
How is information managed in order to provide care to patients?
What are a few ways of protecting electronic health records?
Identify QSEN Competencies or National Patient Safety Goals:
1. The faculty member can access the 2018 National Patient Safety goals: https://www.jointcommission.org/hap_2017_npsgs/
This link will take the instructor to the National Patient Safety Goals as a downloadable document or as a simplified version. The simplified version is easy to use and most often seen in the hospital setting. The Goal number and titles are found on the left side of the form and examples of the goal are found on the right side.
2. The faculty member in the class room can bring up qsen.org/competencies/pre-licensure-ksas/
This link will lead the instructor to a table where each QSEN competency is defined and the knowledge, skills, and attitudes for the QSEN competency are identified.
This table is used in lecture to provide objectives and examples for the students to learn about QSEN competencies.
QSEN Competency Example of this competency in the hospital setting
Patient-centered care 1. The nurse views the care they provide from the patient perspective. Eg. The nurse values the patient’s opinion and ideas when planning and providing care.
2. The nurse uses critical thinking when caring for the patient. Eg. The nurse determines the patient would benefit from being discharged to a location closer to her family than in the town the live. The nurse might work with the discharge planner to communicate the desires of the patient
Teamwork and collaboration 1. The nurse demonstrates awareness of her own strengths and limitations. Eg. The nurse asks another health care provider for help when turning a patient and completing a dressing change.
2. The nurse acts as a team member. Eg. The nurse recognizes the role of each team member and speaks positively about another member of the team.
Informatics 1. Document and plan patient care in the electronic health record. Eg The nurse documents education given to the patient and care provided.
2. Identify the risk of patient privacy violations. Eg Discuss how HIPAA compliance violations can occur when using electronic health records.
Consider how social media can be used to violate patient privacy.
Quality Improvement 1. Explain that nurses are part of the system of care and they affect outcomes for patients and families. Eg. The nurses in some units of the hospital have changed the admission process to make it more streamlined for the patient and the staff. Even small local changes can improve patient care. It doesn’t always have to be an institutional change.
2. Use quality measures to understand performance. Eg. Infection control nurses are able to identify a microorganism found near a water source (handwashing station) that then leads to an infection in the intensive care unit (ICU). The use of a control chart helps the staff nurses to see the connection.
Safety 1. Discuss effective use of strategies to reduce the risk of harm to the nurse or the patient. Eg. Never re-capping a used needle, good hand hygiene and donning and doffing personal protective equipment.
2. Articulating the need for prompt reporting. Eg. The nurse who identifies a pressure ulcer documents it immediately and does not wait for someone else to find it.
Evidence-based practice 1. The nurse is able to compare evidence-based care to routine approaches that may result in less-than desired outcomes. Eg The nurse values the ethical considerations for patient’s participating in drug research.
2. The nurse consults with clinical experts before making decisions about the care of the patient. Eg. The nurse discusses patient care with the doctor and what might be best for the patient. She does not blindly provide patient care, but researches medications and procedures before administering them to the patient