“Building a Quality House” Using an Interdependent QSEN Competency Model

Submitter Information

Author: Ann Hook, RN, MSN
Title: Nursing Lecturer
Institution: Berry College
Email: ahook@berry.edu
Coauthors: Pam Dunagan, RN, PhD

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)
Classroom, Clinical Setting, Skills or Simulation Laboratories

Strategy Type
General Strategy

Learning Objectives

Following implementation of the teaching strategy, students will be able to:

1. Identify clinical issues/situations surrounding each individual QSEN competency within the clinical practice setting.

2. Demonstrate knowledge of the interdependency of competencies as revealed in the Interdependent QSEN Competency Model.

3. Value the interdependency of the QSEN competencies and how each competency influences the other competencies in the pursuit of safe, quality outcomes.

4. Apply the Interdependent QSEN Competency Model to clinical problem solving when striving for safe, quality outcomes.

Strategy Overview

Integrating the Quality and Safety for Education of Nursing (QSEN) competencies as individual concepts or “silos” of knowledge into existing nursing curricula limits the student’s ability to apply the concepts in clinical decision making.  Nursing academia is obligated to instill knowledge, skills, and attitudes in clinical decision making that promote a culture of safety and quality outcomes (IOM, 2003; QSEN, 2012).  The Institute of Medicine (2003) suggested an interdependent relationship between competencies for the clinical education of healthcare professionals.  It is believed that the competencies are not relevant to the students unless they see a use for them in clinical decision-making.  Illustrating the interdependency of the competencies through practical clinical application encourages the need for and use of all the competencies throughout the decision-making process.

Using the theories of Problem-based Learning (Savery & Duffy, 1995) and Mezirow’s (1995) Transformative Learning Theory, an Interdependent QSEN Competency Model was developed (Hook & Dunagan, 2013).  The “Quality House” model illustrates Safety and Quality Improvement as overarching or “roof” competencies supported by the “pillars”: Patient-centered Care, Teamwork and Collaboration, Evidence-based Practice, and Informatics. The nurse at the bedside acts as the “foundation” and “general contractor” of the house. Each component of the house is interdependent and structurally sound only when all parts are equally valued and maintained.  A holistic and interdependent view of the competencies is promoted with continual and early application of the model to theory, clinical problem solving, and simulated laboratory experiences. One way to apply the interdependent QSEN competency model is using the following strategy in the clinical setting or simulation laboratory. 

An innovative teaching strategy which integrates interdependent QSEN competencies has been developed to prepare nursing students to actively participate as collaborative partners in a transforming health care system. After learning about the Interdependent QSEN Competency Model in the classroom, faculty will implement a teaching strategy in the clinical setting which applies real life healthcare problems to the model.  In addition to their patient care assignments, each student will be assigned one of the six QSEN competencies. Students will be instructed to identify issues/situations illustrating use or lack of use of a specific competency in the clinical setting for the day. In post conference, faculty will ask students to share their findings with the group.  Faculty will guide discussion with the students to aid them in identifying how an issue with one competency is affected by other competencies. For example, one student may be asked to identify issues/situations surrounding Team-Work and Collaboration. Faculty will assist the student in identifying how an issue with Team-Work and Collaboration may compromise Safety and Quality Improvement; as well as how Informatics and Patient-Centered Care could be a part of the solution.

Changing healthcare systems demand that nurses participate in collaborative partnerships to promote safe, quality care.  Within these collaborative partnerships, bedside nurses must be comfortable advocating for a culture of safety and quality (Rutherford, Lee, & Greiner, 2004; Rutherford, Phillips, Coughlan, Lee, Moen, Peck, & Taylor, 2008). To support competencies of safety and quality improvement, students should continually assess for factors that increase patient risk and be willing and able to assume a nursing identity that demonstrates efforts to promote quality outcomes (IOM, 2011).  A culture of safety and quality is dependent on the nurse’s ability to apply knowledge, skills, and attitudes associated with each competency both separately and interdependently to clinical problem solving.

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Additional Materials

Evaluation Description

The student’s ability to identify a clinical issue/situation surrounding a competency indicates knowledge about the individual competency and its value to clinical practice. Evaluation of the student’s ability to meet each individual competency is also accomplished through the clinical evaluation tools (QSEN, 2013).  Following this teaching strategy, learning related to the competency’s interdependency will be assessed in post conference by the faculty. Learning is realized when the nursing student is able to identify interdependent relationships among the competencies when problem solving in the clinical setting.

No current researched evaluation method exists to assess students for knowledge about the interdependency of the competencies in the clinical setting.  Prior to the development of the model, clinical instructors have determined a lack of student insight into clinical reasoning using QSEN competencies in an interdependent manner. Students had limited ability to see the relationship between the competencies when applied to real life clinical problem solving. It was observed that student insight was enhanced when current quality improvement projects in the clinical setting were used to demonstrate the interdependency of the competencies.  In order for students to appreciate the interdependency of the model, they must first value the professional nurse’s foundational role and contributions to the quality improvement process.  Research is needed to explore the benefits of teaching students to value the competencies, their interdependent relationship, and their contribution to safe, quality outcomes.