Incorporating Quality and Safety Case Studies, problem-based learning assignments and reflective practice exercises into Geriatric Practicum Setting

Submitter Information

Author: Jill Gaffney Valde, PhD, RN
Title: Associate Professor
Institution: University of Iowa; College of Nursing

Competency Category(s)
Evidence-Based Practice, Informatics, Patient-Centered Care, Quality Improvement, Safety, Teamwork and Collaboration

Learner Level(s)
Pre-Licensure BSN

Learner Setting(s)
Clinical Setting

Strategy Type
Case Studies

Learning Objectives

1.Communicate patient values, preferences and expressed needs to other members of health care team. (PCC )

2. Recognize contributions of other individuals and groups in helping patient/family achieve health goals. (T&C)

3. Locate evidence reports related to clinical practice topics and guidelines. (EBP)

4. Identify gaps between local and best practice. (QI)

5. Communicate observations or concerns related to hazards and errors to patients, families and the health care team. (Safety)

6. Use high quality electronic sources of healthcare information. (Informatics)

Strategy Overview

The purpose of this teaching strategy is to incorporate the six QSEN competencies into a series of geriatric practicum seminars. Using a variety of interactive teaching techniques, including the unfolding case study and problem-based learning, students increase their awareness and assessment of quality and safety issues specific to older adults.

Seminar A:

Students listen to the unfolding case study of an elderly man named Sherman “Red” Yoder, who is an 80 year old widower with multiple health care needs. The case study is available free at the National League of Nursing (NLN) website

Students divide into pairs and identify and prioritize care needs of the client focusing on individual preferences and values revealed in the tape. They are also asked to discuss what other members of the health care team would be appropriate to collaborate with based on the team member’s role and education, and what referrals they would make. (PCC and T&C)

Seminar B:

Students interview a client the week before and bring a comprehensive medication list (both prescribed and over the counter) of their client to this week’s seminar.  Students then draw from a list of pre-selected websites by the instructor and look up medication information and interactions.  The students critique the credibility of the sites selected using the critique developed by the University of Minnesota. (Informatics)

Seminar C:

Students research and present articles on evidence based practice for one of the 3 D’s- (Delirium, Dementia or Depression) comparing their literature findings to the current practice and policies in their assigned facility. Students are then expected to share their findings with their assigned preceptors. (EBP)

Seminar D:

Students are asked to select an assigned client and to go into the client’s room and time and conduct the “One Minute Safety Checklist” developed by K. Amer and found under Submitted Materials. Students need to quickly assess six categories of safety risks, (e.g. weight and age, assessment of airway) and based on the findings develop a prioritization of concerns and a plan of care (POC). The student is expected to involve the client, family and preceptor in the discussion of possible risks and interventions. (Safety and PCC)

Seminar E:

Students do a quality assessment of a long term care facility where they have a client and develop plans for improvement based on identified needs and opportunities using the “Observable Indicators of Nursing Home Care Quality Instrument” found under Submitted Materials. Students are instructed to spend 30 minutes walking around the long term care facility and making observations, focusing on what they see, hear and smell. Following the observation walk, students answer the 30 questions and compute a score. The results of their findings are shared with the preceptor and or administrator. In seminar students share findings, looking for common themes and identifying opportunities for quality improvement. (QI)

Submitted Materials

Additional Materials

• Evaluating Web Resources ( University of Minnesota. Accessed August 16, 2012.

• National League for Nurses. ( Accessed August 16, 2012.

• Rantz, M., Zwygart-Stauffacher, M., Mehr, D., Petroski, G., Owen, S., & Madsen, R. (2006). Field testing, refinement and psychometric evaluation of a new measure of nursing home care quality. Journal of Nursing Measurement, 14(2), 129-148(20).* PMCID: PMC3254215

Evaluation Description

The clinical practicum seminar activities have not yet been formally evaluated. The plan is to revise the existing clinical evaluation tool to include successful demonstration of the six identified learning objectives. I welcome further implementation and evaluation of these activities and would be interested in receiving feedback.