1. QSEN competencies: Degree of visibility in clinical education assessment tools in Sweden
Annette Nygårdh, PhD, RN, CRNA, Sweden
Gwen Sherwood, PhD, RN, FAAN, USA
QSEN Forum 2017

2. Objectives Patient centered care Teamwork and collaboration
Evidence based practice
Quality improvement
Safety
Informatics
Describe the Audit Tool used to examine visibility of the QSEN competencies in Swedish nursing schools
Report the visibility of the six QSEN competencies in clinical evaluation tools in Swedish nursing education

3. Nursing education in Sweden
Laws and regulations
Higher Education Act, Högskolelag (1992:1434)
Higher Education Ordinance, Swedish Code of Statutes (SFS) 1993:100 that govern the operations of higher education institutions in Sweden.
UKÄ (Swedish Higher Education Authority) exercises supervision of the HEIs, which means ensuring their compliance with the statutes and regulations that apply to higher education

4. QSEN competencies applied in Swedish nursing education
The Swedish Society of Nursing Association, a non profit organization, has developed competence descriptions for nurses with specialization in different areas
Swedish Association of Local Authorities and Regions
Quality and Safety Education: A Competency Approach to Improve Outcomes translated into Swedish
At Jönköping University, QSEN competencies, as a concept, have been integrated in the nursing education since 2015

5. Bachelor of Science in Nursing,180 credits at Jönköping University
Theory
Practice

6. QSEN competencies: Degree of visibility in clinical education assessment tools in Swedish nursing schools
Annette Nygårdh RN, CRNA, PhD, Assistant Professor, Department of Nursing, School of Health and Welfare, Improvement, innovation, and leadership in health and welfare, Jönköping University, Sweden
Gwen Sherwood, PhD, RN, FAAN, ANEF, Professor and Associate Dean for Practice and Global Initiatives University of North Carolina at Chapel Hill School of Nursing, USA
Susanne Knutsson RN, PhD, Assistant Professor Department of Nursing, School of Health and Welfare, CHILD research Group, Jönköping University Sweden
Students: Jeanette Rehn RN, MSc and Therese Sandberg RN, MSc

7. Background and Aim
The QSEN competencies should be visible in clinical assessment tools to demonstrate their significance in providing good and safe care
Prospective nurses should have sufficient knowledge to give good care, ensure safety and quality in the nursing process and promote health and wellbeing of the patient
Swedish nursing schools use a range of assessment tools
Aim: to examine the visibility of QSEN competencies in clinical assessment tools used during the last semester in Swedish clinical nursing education

8. An empirical quantitative investigation
Design
An empirical quantitative investigation
All Swedish universities (n = 25), with a nursing program were invited to participate by sending their clinical assessment tool to the research team.
Audit Template to determine visibility: developed from review of previous research (Swedish Society of Nursing, 2010; AACN QSEN Education Consortium, 2012).

9. Data Analysis
Audit Template: 3 key characteristics for each competency
Researchers coded data from the clinical assessment tools of the 23 participating nursing schools
Scoring:
one point if competency identified (6 points total possible score),
one point for each visible key characteristic (3x6=18 total for key characteristics)

10. Total possible score per competency=4
Competency: (one point) Patient centered care: Work for patient involvement in their own care be based on empathy and respect for the patient or a family preferences, values and needs.
One point for each key characteristics identified:
Creates a good care relationship through active communication that supports and strengthens the patient/relative participation.
Shows empathy and respect and care based on the patient/relative ethical and cultural needs and values.
Teaches patient/relatives.
Total possible score per competency=4
Total possible score for all competencies 4x6=24

11. Scoring 0 points Not Visible 1-6 points Visible to a low extent
Visible low extent
2 points
Visible
3 points
Visible to large extent
4 points
Very visible
Competency not referred to by name and no key characteristic listed
Competency referred to by name but no key characteristic listed
Competency referrred to by name + 1 essentail characteristic listed or not referred to by name but lists 2 key characteristics
Competency referred to by name + 2 key characteristics listed or not referred to by name but lists 3 key characteristics
Competency referred to by name + 3 key characteristics are listed
0 points Not Visible
1-6 points Visible to a low extent
7-12 points Visible
13-18 points Visible to a large extent
19-24 points Visible to a very large extent

12. Results
Few schools named the QSEN competencies in their assessment tools and visibility of the competencies varied widely.
No tools named all six QSEN competencies.
Teamwork and collaboration, the only competency named in all 23 tools, was most visible
Person-centered care received the highest audit points (68) but was named in only 3 tools.

13. Results cont.
Safety was named in four assessment tools with 63 audit points.
Evidence-based practice was named in eight tools with 45 audit points.
Quality improvement was named in five assessment tools and received 43 audit points.
Informatics was the least visible and was not called by name in any tool

14. Conclusion and Implications
The first study to review QSEN competencies in assessment tools used in Sweden
Results help inform clinical assessment and indicates the need for common elements for assessing QSEN competencies in clinical learning
Informatics, critical in current nursing, should receive more attention
It raises questions how other countries are assuring student assessment of these critical competencies for improving quality and safety