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2.  Quality and Safety Education for Nurses (QSEN) is a foundation created to be a comprehensive resource to improve and standardize quality and safety education for nurses (QSEN, 2011).  The QSEN foundation and website is a resource for nursing educators worldwide to promote quality and safety competency development in nursing (QSEN, 2011). 2

3.  The QSEN foundation was funded in 2005 by the Robert Wood Johnson Foundation.  Robert Wood Johnson founder of the Johnson & Johnson firm, felt that hospital administrators needed training which led him to work with Malcolm Thomas MacEachern, M.D to create the Robert Wood Foundation.  Robert Wood Johnson “had an intense concern for the hospital patient whom he saw as being lost in the often bewildering world of medical care. He strongly advocated improved education for both doctors and nurses, and he admired a keen medical mind that also was linked to a caring heart” (RWJF, 2011, para. 5)  Creation of the QSEN foundation was led by Dr. Linda Cronenwett and Dr. Gwen Sherwood from the University of of North Carolina (Brown, Feller & Benedict, 2010). 3

4.  The QSEN foundation was created to increase the quality of health care education and meet the goals set by the Institute of Medicine (IOM) in 2003 (Brown, Feller & Benedict, 2010).  “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” (QSEN, 2011, para. 2). 4

5.  Phase I: Nursing curricula was evaluated for quality and safety. The need for six competencies was identified. The six competencies include patient centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety and informatics (Brown, Feller, & Benedict, 2010).  Phase II: Strategies were developed to incorporated the six competencies into nursing education (Brown, Feller, & Benedict, 2010).  Phase III: Incudes an assessment of student learning, and includes a focus on development of faculty expertise, (Brown, Feller, & Benedict, 2010). 5

6.  QSEN faculty and advisory board members “outlined the KSAs appropriate for pre- licensure education” as they felt that graduating nurses did not have these core competencies (Cronenwett et al, 2007, p. 126).  KSAs developed to try and answer the question, “what should nursing promise with regards to its pre-licensure graduates’ quality and safety education” (Cronenwett et al, 2007, p. 126). 6

7.  QSEN defines patient centered care as the nurses ability to “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” (QSEN, 2011).  The proposed targets for KAS competency in this area can be found at:  http://www.qsen.org/ksas_prelicensure.php  and  http://www.qsen.org/ksas_graduate.php 7

8.  Cronenwett et al states,” the essential features of this competency include sections related to self, team, team communication and conflict resolution, effect of team on safety and quality, and the impact of systems on team functioning”(2007, p. 129).  There are several models and communication style to develop inter-professional team functioning. To develop teamwork and collaboration skills is derived from strengthening communication practices with each other (Cronenwett et al, 2007 pg. 129). 8

9.  Is more than just evidence.  EBP involves patient preference and values and the clinical expertise necessary for delivery of optimal health care ( Cronenwett et al,2007 p.129).  EBP involves collection, interpretation, integrate the evidence and evaluate the data. 9

10.  According to QSEN the definition for quality improvement is: 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 (QSEN, 2011).  Nurses who develop the KSAs for quality improvement, “would learn and use improvement methods as part of their coursework and clinical practice, and they would enter the work force prepared to participate in improvement work as a part of their daily work as health professionals” (Cronenwett et al, 2007, p. 127).  According to QSEN the definition for safety is: Minimize risk of harm to patients and providers through both system effectiveness and individual performance (QSEN, 2011).  Nurses who develop the KSAs in Safety will know about, “human factors and safety design principles, understand the importance of error reporting and safety cultures, and value vigilance and cross-monitoring among patients, families, and members of the health care team” (Cronenwett et al, 2007, p. 128). 10

11.  Cronenwett et al state that “health professionals and patients will rely increasingly on information technology to communicate, manage knowledge, mitigate error, and support decision making” (2007, p. 130).  Nurses with informatics KSAs will be prepared to “participate in design, selection and evaluation of information technologies” used in patient care (Cronenwett et al, 2007, p. 130).  KSAs include (Cronenwett et al, 2007, p. 130):  understanding why information technology is essential  familiarity with patient database contents  the ability to identify technology benefits and limitations and their impact on patient safety  To be familiar with what it takes to make these technologies available and effective). 11

12.  A core measure post open heart surgery is for blood sugar levels to be <200 through POD 2. Protocols concerning blood sugar control are continually being updated and nurses are being educated about better blood sugar control practices as new information becomes available. This is one of many examples from the CTU/CTSU that exemplifies the quality and safety measures QSEN was created to promote. 12

13.  Quality and safety should affect every nurses practice. I work in the operating room. I am the patients voice because they do not have one. My main concern is the patient’s safety. Safe positioning is a big deal in my area of expertise. A patient can be in the same position for as long as 8 or 10 hours. With pressure being on boney prominences for that long, skin break down can occur. One of my jobs is safe positioning so that it does not occur. I am also responsible for doing a timeout before surgery begins to make sure that surgery is being preformed on the correct patient and site and to make sure everyone on the team is on the same page. 13

14.  In my current practice area of medical surgical nursing the Relationship Based Practice is the model adopted to improve our teamwork and working relationships. We learned how to have caring conversations and skills to work as a team.  A EBP includes a Fall Risk Assessment to discover patients who are high risk for falling. There has been a decrease in falls since the implantation. 14

15.  According to Buckner and Gregory (2011, p. 297), “an urgent need to improve the safety and quality of care provided in our increasingly complex health care system, health information technology has taken a central role in the health care system”.  As a clinical analyst I work daily with patient care information systems. The importance of nurses having the KSAs as outlined by the QSEN foundation will be of great value. Not only will nurses be able to use the systems that are in place more effectively but they will understand the importance of the systems and the effects that correct usage can have on patient safety and quality care.  Studies have shown that nurses feel that computer systems, although they increase safety and information availability, they can be intrusive and negatively effect the nurse patient relationship (Buckner and Gregory, 2011). It is for this reason that nurses can and should play an integral role in implementing current systems and in helping to develop new systems. The art of nursing is caring for patients not computers. Nursing should play center stage in helping care providers to remember this and bring balance back into patient care (Giles, 2011). 15

16.  Brown, R., Feller, L., & Benedict, L., (2010). Reframing nursing education: the quality and safety education for nurses initiative. Teaching and Learning in Nursing, 5( 3), 115-118. doi:10.1016/j.teln.2010.02.005  Buckner, M., & Gregory, D., (2011). Point-of-care technology: preserving the caring environment. Critical Care Nursing Quarterly, 34 (4), 297-305. DOI: 10.1097/CNQ.0b013e31822bac0e  Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., … Warren, J., (2007). Quality and safety education for nurses. Nursing Outlook, 55 (3), 122-131.  Quality and Safety Education for Nurses (QSEN), (2011). Project overview, Retrieved from http://www.qsen.org/overview.php http://www.qsen.org/overview.php  Robert Wood Johnson Foundation (RWJF), (2011). Our founder, Retrieved from http://www.rwjf.org/about/founder.jsphttp://www.rwjf.org/about/founder.jsp 16