QSEN Quality and Safety and Education for Nurses Practice Standards Melanie Guikema Rene Larson Steve Rich Amanda Roberts

QSEN- What is it? Quality and Safety Education for Nurses QSEN is a project of the American Association of College of Nursing (AACN) and the Robert Wood Johnson Foundation initiative to ensure that nurses and nursing students are educated in quality and safe nursing practice. The Robert Wood Johnson Foundation awarded a grant to fund a national study to educate nursing students on patient safety and health care quality. The lead investigator is Linda Cronenwett, PhD, FAAN and Dean at University of Carolina at Chapel Hill School of Nursing. The study is broken into four phases.

Goal of QSEN “The overall goal through all phases of QSEN has been to address the challenge of preparing future nurses with the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality and safety of the health care systems in which they work” (QSEN, 2013).

Phases of QSEN Phase One: Outline of the core knowledge, skills, and attitudes (KSA’s) that should be mastered by prelicensure nursing students. QSEN adopted six competency standards. Phase Two: QSEN works with programs that support advanced practice nurses to define a program to enhance education in the KSA’s for graduate study nurses. They also worked with 15 pilot schools to change curriculum to include education on quality and safe nursing practices (QSEN, 2013). Phase Three: Focuses on training faculty on quality and safe healthcare practices and incorporating the information in texts (QSEN, 2013). Phase Four: Supporting the IOM’s campaign to encourage nurses to further their education and become advanced practice nurses (QSEN, 2013).

QSEN Practice Competency Standards 1. Patient-Centered Care 2. Teamwork & Collaboration 3. Evidence Based Practice 4. Quality Improvement 5. Safety 6. Informatics In addition to the six competencies, sets of KSA’s were created for each competency. (QSEN, 2013)

Patient-Centered Care “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” (American Association of Colleges of Nursing, 2012). Knowledge associated with patient centered care includes the ability to: ●Analyze multiple dimensions of patient centered care ●Describe the limits and boundaries of therapeutic patient-centered care ●Analyze strategies that empower patients in all aspects of the healthcare process ●Integrate principles of effective communication with knowledge of quality and safety competencies (QSEN, 2013)

Patient-Centered Care Skills associated with patient centered care include: Providing patient centered care with “sensitivity, empathy, and respect for the diversity of human experience” (QSEN, 2013). Respecting the boundaries of therapeutic relationships Encourage patients to be active partners in their own health care Continuously improve own communication and problem solving skills (QSEN, 2013) Attitudes include: “Value seeing health care situations ‘through patients’ eyes’” (QSEN, 2013) Value shared decision making with patients, even if there is conflict Respect patient preference for engagement in their own health care (QSEN, 2013)

Teamwork Important? Teamwork is the reason for success for healthcare facilities and their patients. There needs to be communication through the whole process of care through staff. Team work does not only apply to staff to staff but also staff to patient. This is imperative for the success of the patient and the healthcare facility.

Informatics Definition: “Use information and technology to communicate, manage knowledge, mitigate error, and support decision making” (QSEN, 2013).

Why is Informatics Important? Informatics is huge in providing high quality of care to our patients. Informatics allows healthcare professionals to record and document on patient outcomes. These documentations will provide good learning material for the future. A huge part of informatics is technology. Technology allows communication through electronic medical records, bar-code scanning systems, and through other electronic sources. Informatics are so important because technology is taking over healthcare.

Evidence Based Practice “Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care” (American Association of Colleges of Nursing, 2012). Knowledge associated with evidence based practice (EBP) includes the ability to: Describe EVP to include the components of research evidence, clinical expertise, and patient/family values Ability to critically appraise current research and identify any gaps in current EBP Evaluate current EBP in the health care environment (QSEN, 2013).

Evidence Based Practice Skills include: Modeling clinical skills based on current EBP Initiate changes in care when new evidence shows ways to improve outcomes and/or decrease adverse events (QSEN, 2013) Attitudes associated with Evidence Based Practice include: Value knowing and understanding EBP for one’s practice specialty Value the need for continuous improvement in clinical practice based on new knowledge (QSEN, 2013).

Quality Improvement Definition: using 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 healthcare systems” (QSEN, 2013).

Quality Improvement Examples of knowledge: Explanation of strategies that enhance patient outcomes. Distinguishing which quality measures are nationally approved. Evaluating the importance of quality indicators and the necessity of change. Examples of skills: Interpreting quality improvement goals. Using multiple data sources, such as flow charts and cause-effect diagrams to evaluate various aspects of care.

Safety Definition: minimizing the “risk of harm to patients and providers through both system effectiveness and individual performance” (QSEN, 2013).

Safety Examples of ways to incorporate safety into patient care: Establishing routines in all areas of care, as well as modifying any behaviors that could lead to injuries and/or errors. Potential hazards should be promptly reported to patients, families and/or staff members. Acknowledging human performance limitations and accepting assistance from others when needed, as well as identifying successful methods to decrease reliance upon memory.

Rene Larson In my current practice area of neuro/med-surg nursing, QSEN competencies affect my practice in the following ways: 1.Patient-Centered Care: This is the heart of nursing at my facility, and something we try to excel at daily. I am my patient’s best advocate, have learned to work with people from many different cultures, and strive to communicate effectively every day. 2.Team Work: One person can not do it all. I work with many different disciplines in order to achieve the best possible care for my patients. 3.Evidence Based Practice: I follow policies and procedures that are backed up by current EBP. This allows for better patient outcomes. It is my responsibility to know current practice and how to access policies. 4.Quality Improvement: Providing the best possible care and maintaining quality indicators. These include answering call lights in an appropriate time frame, managing pain, maintaining a quiet environment, preventing infections, and being able to detect problems. 5.Safety: I maintain a culture of safety in my practice in many ways, including screening patients for being a high fall risk and implementing a fall bundle (red socks, yellow bracelet, falling star on the door, bed/tab alarm) 6.Informatics: Technology is an important part of my practice. All of our charting/documentation is now done on the computer. We carry individual phones so that we can be easily reached.

Steve Rich The QSEN standards affect how I will work as a team. Teamwork is very important in the healthcare world. Many different people are working to make a patient better and there should be good communication and effort from everyone. These standards will help me become a better nurse. I also take safety very seriously. I think that making sure that the patients are in good hands is very important. Making sure that my nursing aids are going their jobs and doing them properly. I want to know that they know how to use the lifts correctly. I also maintain my patients safety by completing assessments to tell me if they are a fall risk or at risk for skin breakdown. Also following the policies and procedures is very important to be. I want to be doing my best to be an advocate for my patients and educate them so they can make the best decision as possible. Also the informatics is a great tool. Having computers to help keep things on track is beneficial to everyone in the healthcare field. QSEN set many great standards for us nurses.

Melanie Guikema A few ways that I incorporate safety into my nursing duties while working is to ➔ complete a fall assessment on a new admission and to make sure that those at risk for falls are being closely monitored with alarms, red star on their door, etc. ➔ Reminding aides to always use a gait belt when transporting patients, reminding myself to always use proper body mechanics (ie: bending at the knees when lifting, raising the bed to a working height when completing dressing changes, etc.) ➔ Never recapping needles, wearing gloves during direct patient contact and properly washing my hands between patients.

Amanda Roberts I incorporate practice standards in my nursing care by utilizing the practice standards outlined by QSEN. 1. Patient-Centered Care- When providing care for patients I strive to be attentive to their mental, physical, emotional, and spiritual needs. Ensuring patients and their families fully understand and are in agreement with their plan of care. 2. Team Work: Working as a team in a 24 hour care facility is extremely important. At times we have to finish what other nurses have started and share the workload in order to provide quality care. 3. Evidenced Based Practice: Utilizing educational opportunities available for CEU’s and education offered by my place of work I am able to learn and keep up on current practices and utilize them in my care. Michigan requires 25 CEU’s to be completed every two years with one credit in pain and symptom relief, I have kept up on these requirements every year. 4. Quality Improvement: Where I work there are monthly quality improvement meetings and the nurses take turns attending the meetings. This allows the facility to work together to resolve problems to improve patient care. For instance, we discussed recurrent urinary tract infections and opted to have someone come in to educate the staff on proper assignment and fitting of incontinence products and products to use for proper perineal care. We also elected to educate staff on proper bladder training programs to decrease incidence of catheterizations. 5. Safety: I am constantly thinking about safety when I am working by ensuring that I am utilizing the five rights of medication administration, providing safety measures for patients who need assistance with safe transferring, ensuring patients are free from neglect and abuse, and proper monitoring of patients. 6. Informatics: Where I currently work we do not utilize computers for medical charting and medication administration, but we use computers for education and communication through . They are also working on installing a program that we text on-call physicians instead of the paging system.

References American Association of Colleges of Nursing. (2012). Graduate-level QSEN competencies: Knowledge, skills and attitudes. Retrieved from Quality and Safety Education for Nurses. (2013). Evidence based practice. Retrieved from Quality and Safety Education for Nurses. (2013). Graduate ksas. Retrieved from Quality and Safety Education for Nurses. (2013) Project overview. Retrieved from Quality and Safety Education for Nurses. (2013). Patient centered care. Retrieved from