Published Back to Strategy Search Strategy Submission Quality Improvement Project for Prelicensure Nursing Students Author: Gerry Altmiller EdD, APRN, ACNS-BS, FAAN Title: Professor of Nursing Coauthors: Institution: The College of New Jersey Email: altmillg@tcnj.edu Competency Categories: Quality Improvement Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Classroom Strategy Type: Paper Assignments Learning Objectives: 1. Discuss quality improvement process in class 2. Implement a quality improvement project for 3 PDSA cycles over 3 weeks 3. Submit a 1 page essay describing quality improvement project with a graph to show data points. Strategy Overview: This teaching strategy is designed to teach prelicensure students how to implement and evaluate a quality improvement project. It can be implemented in any class but lends itself to an Introduction to Nursing Course or a Management and Leadership Course. Students are taught about quality improvement in class using the attached 15-slide powerpoint presentation. The assignment begins after the presentation and lasts for a total of 4 weeks. Students choose something about themselves or their school that they would like to improve. Ideas could include, sleeping more, studying more hours, drinking more water daily, eating healthier-whatever would be important to the student. The student conducts the improvement for three PLAN, DO, STUDY, ACT (PDSA) cycles, one cycle per week over the next 3 weeks, recording data to measure the change. On the fourth week, the student writes a 1-page essay meeting the criteria of the grading rubric and attaches a graph to demonstrate the data points. Through this assignment, the student learns how to 1) develop an aim statement, 2) implement change using the model for improvement (PDSA cycles), 3) collect data to measure change/improvement, and 4) report data using charts or graphs. The presentation includes all the information the student needs to be successful, including the Institute for Healthcare Improvement tool kit for reporting data. Submitted Materials: Quality-Improvement-and-the-Nurse.pptx - https://drive.google.com/open?id=1oDjGc2k2ti9nsL9AttO7Ck4ar2UbkPZA&usp=drive_copy Quality-Improvement-Project-Assignment.docx - https://drive.google.com/open?id=16V44XV558-g3wHZe0gTVP6vgTsHvevXH&usp=drive_copy Additional Materials: Attached is 1) 15-slide powerpoint presentation which contain samples of a student graph, and 2) assignment from syllabus and grading rubric for the assignment. Evaluation Description: The grading rubric is attached. The assignment requires the student submit a 1-page essay to describe the quality improvement project, include an aim statement, use a meaningful measure, describe the changes made with each PDSA cycle, and create a graph or run chart to illustrate the change over time. I have used this teaching strategy in Introduction to Nursing successfully. Having this assignment at the beginning of the nursing education program allows students to learn the principles of quality improvement so that they can identify and participate in quality improvement at their clinical settings throughout their nursing education.

Published Back to Strategy Search Strategy Submission Clinical Readiness Practice and Evaluation Author: Lisa Concilio MSN-ED, RN, CCRN Title: Lecturer/Clinical Instructor Coauthors: Institution: San Diego State University Email: LConcilio@sdsu.edu Competency Categories: Patient-Centered Care, Quality Improvement, Safety Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Classroom, Skills or Simulation Laboratories Strategy Type: Paper Assignments Learning Objectives: This is a non-proctored experience for novice or beginner students to combine assessment, lab interpretation, medication clinical reasoning, and become exposed to the acute care setting, virtually, at no cost. Strategy Overview: This learning strategy allows novice or beginner nursing students to simulate performing an anterior and posterior assessment. QR codes, their Smartphones, and ear buds are used to simulate a stethoscope. Students are directed to check orders, review the patient's MAR, listen to an SBAR from the previous shift, reconcile inconsistencies heard in report, use AIDET to meet their patient, perform an assessment, interpret and trend lab findings, and finally, decide patient specific nursing interventions. Submitted Materials: Clinical-Readiness-Directions-and-Findings.pdf - https://drive.google.com/open?id=1cKdSPJvhXpJX4E6Y_P_-StZeT7OiMKxO&usp=drive_copy Clinical-Readiness-Packet.docx - https://drive.google.com/open?id=1vZypYs7hnoEoCnf9qgPEPu7tlqb8-4ux&usp=drive_copy Additional Materials: Students will need their Smartphone, earbuds, black pen, and download a QR code reader (many are free and excellent quality). Evaluation Description: Students are to fill out an SBAR worksheet, assessment, QSEN medication/lab interpretation (developed from previous QSEN teaching strategies), to clinically reason and decide nursing interventions. Instructor can review in a group, students can self correct, talk through missed items and clinically reasoning. This teaching tool decreases student anxiety, maybe used as a clinical make-up, and can assist instructors to formatively evaluate clinical readiness.

Published Back to Strategy Search Strategy Submission Enhancing Medication Safety Teaching through Remediation and Reflection Author: Donna E. McCabe DNP, APRN-BC, GNP Title: Clinical Assistant Professor Coauthors: Emerson Ea Institution: New York University Meyers College of Nursing Email: donna.mccabe@nyu.edu Competency Categories: Safety Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN, Staff Development Learner Setting(s): Classroom Strategy Type: General Strategy Learning Objectives: 1)Knowledge-Examine human factors and other basic safety design principles as well as commonly used unsafe practices. 2)Skill-Participate appropriately in analyzing errors and designing system improvements. 3)Attitudes-Appreciate the cognitive and physical limits of human performance. Value own role in preventing errors Strategy Overview: Medication dosage calculation competencies has been a mandatory rite of passage through nursing school as well as practice. It is difficult to argue the importance of examining this competency in nurses who are most often the professional administering the medications and serve with the patient and family as the last chance for error prevention. Despite the enormity of the safety implications surrounding medication dosing and administration there is little evidence to guide us in best practices for teaching. Most schools require successful completion of a standard exam with a set score, and not all require a 100%. This strategy to improve acquisition of safety KSAs with medication dosage calculation has an added element of remediation and reflection. Students first complete a comprehensive on-line learning module to prepare for the test. On-line courses are available for purchase associated with commercial textbooks, can be designed by faculty, and some are available free via internet. A few examples can be found here and here. Many pharmacology texts and resources also have dosage calculation and medication administration content. Students takes “practice” tests throughout the module. Prior to being permitted to administer medications in the clinical setting students must compete a 10 question medication administration/dosage test with 100% success. Students have three attempts to achieve this competency. Students who are not successful on the first attempt are required to meet with the instructor in small groups to review the test to remediate and reflect on their errors. The guide for reflection includes; 1) How did the error occur? Was it a calculation error (math error or formula error)? Was it a “silly” error (not checking or going to fast)? 2) Consider if this error occurred in practice, describe how you would handle the issue? 3) How would you monitor the patient if this error occurred? 4) How would you feel if you were involved in this error in clinical practice? Where would you turn for support? 5) What steps could you or would you take to prevent an error of this nature from occurring again? Are you familiar with strategies used in healthcare facilities to prevent medication errors? If so, please describe the strategies. Students complete a written reflection while in the room with the instructor and small group and are encouraged to share what they learned and how they felt in the remediation and reflection. Submitted Materials: Additional Materials: 1) https://www.youtube.com/watch?v=IiP21-ZnPEg&feature=youtu.be 2) https://www.youtube.com/watch?v=zZ3M747ChrQ&feature=youtu.be Evaluation Description: Remediation and reflection are two educational models. Reflection has a great deal of evidence to support its effectiveness in fostering critical thinking in nursing education. Remediation, the act of correcting, is gaining momentum in the nursing education field. Pairing both of these models has proven to be anecdotally successful in enhancing medication dosage calculation learning. Students reported enjoying the process of reviewing and remediating their error. The comments bring forward a broad range of feelings and questions, likely not those raised by the straight forward dosage calculation exam. Examples of student response: •“My patient would have been fluid overloaded and short of breath.” •“I could have killed my patient.” •“The patient would have needed a pacemaker.” •“I would feel terrible if I made this error. Do nurses have to apologize?” •“I didn’t ever know what carvedilol was while I was taking the test?” •“Can nurses split a pill in half” •“What if I didn’t even realize I made an error? Who double checks me in real life.” The shared reflection among the small group of students is powerful. The instructor is able to set the tone for open discussion and provide a safe environment. Students were honest and humbled by ease of possible human error. Given the success of the remediation and reflection sessions, small group sessions will be held in the future for all students regardless of passing at 100%. Culleiton, A. L. (2009). Remediation: A closer look in an educational context.Teaching and Learning in Nursing, 4(1), 22-27.

Published Back to Strategy Search Strategy Submission Medication Administration Map Author: Lisa Concilio MSN-ED, RN, CCRN, PhD(c) Title: Lecturer/Clinical Instructor Coauthors: Institution: San Diego State Univesity Email: LConcilio@sdsu.edu Competency Categories: Evidence-Based Practice, Safety Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Clinical Setting Strategy Type: General Strategy Learning Objectives: Application of concept mapping as a visual thinking strategy teaches student how to use pharmacology and nursing knowledge to create clinical reasoning and decision-making as novice nursing students. By using a concept map for common medications, students are introduced to clinical decision making quickly and early in their education and gain confidence. This confidence translates to motivation and the courage to withhold or administer a medication using evidence-based rationales and assessment findings. - Students will recognize subjective, objective assessment findings and laboratory data in order to withhold or administer medications ordered. - Students will create clinical reasoning and decision-making to withhold or administer common medications found in the adult, acute care setting. Strategy Overview: The most common medications novice nursing students are administering in their first clinical experiences are: -anticoagulants -anti infectives - diuretics - opioids - mental health medications - antihypertensives - antidiabetics Submitted Materials: Medication-Administration-Form-1.docx - https://drive.google.com/open?id=1-J7D6LjWKBMn0goTbs_zoq2mYjU84yZW&usp=drive_copy Principles-of-basic-medications-V9-1-2.pdf - https://drive.google.com/open?id=1kYNfPQmp_DkvuosZpFvkXjJEvjehwHFE&usp=drive_copy Additional Materials: Evaluation Description: Based on the patient's data, the student will complete a QSEN laboratory interpretation document, attached below.

Published Back to Strategy Search Strategy Submission Patient Centered Care: Assessment of Health Literacy Author: Kimberly Dudas PhD(c), RN, ANP-BC, CNE Title: Assistant Professor Coauthors: Institution: New Jersey City University Email: kdudas@njcu.edu Competency Categories: Patient-Centered Care Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Classroom, Clinical Setting Strategy Type: Case Studies Learning Objectives: Examine common barriers to active involvement of patients in their own health care processes. Communicate patient values, preferences and expressed needs to other members of the healthcare team. Strategy Overview: The goal of this learning activity is to promote patient-centered care as it relates to health literacy and health outcomes. It has been reported nearly half of the United States population experience difficulty in understanding and using health information. The toll of low health literacy not only translates into poorer health for the population, but significantly increases healthcare costs. Evidence suggests that low health literacy is a greater factor in chronic disease management than age, socioeconomic background, education level, or health status (NNLM, 2010). An exercise in health literacy can help students gain greater understanding of health literacy and its impact on quality and safety in patient care. The Newest Vital Sign (NVS) is a screening tool for health literacy developed by Pfizer that is freely available. The instrument is available in English and Spanish. It can be administered in about three minutes. Results of the screening provide health care providers with information regarding patients’ health literacy, allowing health care professionals to adapt communication techniques to promote understanding of health issues. Prior to completing the NVS, students are assigned a reading: Weiss, B., et al. (2005). Quick assessment of literacy in primary care: The newest vital sign. Annals of Family Medicine, 3(6), 514-522, available at http://www.annfammed.org/cgi/reprint/3/6/514. The reading introduces the student to the concept of health literacy and its impact on the health of the public. The article also describes the development and testing of the NVS so that students are able to view the evidence supporting the validity and reliability of the instrument. Students are asked to administer the NVS to a patient during the clinical experience, total the score and examine health education material presented to the patient in the clinical setting. Students are also asked to report their findings to the primary nurse. In post-conference, students discuss their results. To administer the NVS, the patient is given the ice cream label (part of NVS) but is not provided the scoring sheet. The scoring sheet is retained by the student with each item read to the patient. At the conclusion of administering the NVS, the student scores the patient and sums to the total. Interpretation of scores is included on the answer sheet. Submitted Materials: 118.newest_vital_sign_assignment.docx - https://drive.google.com/open?id=1n2JkfiPECmbp6oAtiFaSwpbE23mfGPmG&usp=drive_copy nvs_flipbook_english_final.pdf - https://drive.google.com/open?id=1VNkc6OorsELE-VzVVLKntM-KyUuUPtvK&usp=drive_copy Additional Materials: Evaluation Description: This is an ungraded assignment although student participation in post-conference is an expectation. In post-conference, students are asked the following discussion questions: What barriers did you encounter in completing this assignment and how did you overcome them? Prior to completing this assignment, consider your perception of the patient’s level of health literacy. Were the results of the NVS different than you expected? Why or why not? How did you communicate your findings to the patient and primary nurse? What adjustments did you make with regard to your patient’s educational needs based on these results? What did you learn by completing this assignment? This exercise was challenging for students. It only took a few minutes to administer as the NVS instructions suggest, but the students spent much more time explaining the results and what the interpretation of the score meant. Many students were surprised to find they overestimated the patient’s understanding of health literacy. Results were mixed as to the appropriateness of written health information – some students found the material was on target for a patient with limited health literacy while others found ample material that was written at too high a level for the patient. This learning activity generated great discussion in post-conference. After completing this exercise, student feedback indicated they were more attuned to health literacy and more patient-centered with patient education. Reference: National Network of Libraries of Medicine. (2010). Health Literacy. Retrieved from http://nnlm.gov/outreach/consumer/hlthlit.html

Published Back to Strategy Search Strategy Submission Nurse-Physician Communication Exercise Author: Leslie W. Hall M.D. Title: Associate Professor of Clinical Internal Medicine Coauthors: Institution: University of Missouri - Columbia Email: HallLW@health.missouri.edu Competency Categories: Teamwork and Collaboration Learner Level(s): New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: At the completion of this exercise, you should: Understand the contribution of good communication to safe patient care Be able to concisely summarize a concern about a patient Actively listen to information communicated by the physician or other healthcare providers Assertively yet professionally communicate concerns you have about a patient that are not being adequately addressed Strategy Overview: This classroom exercise may be utilized with nurses as they near completion of their training and begin to encounter initial experiences in which communication with physicians Acquistare ora may be challenging. The accompanying Word document and PowerPoint presentation take the learner through a simulated conversation between a nurse and a physician regarding a patient who is deteriorating. The nurse is challenged to find effective means of assertively yet professionally escalating the dialogue on behalf of a patient whose condition does not allow for delay. The role play outlined in this scenario can easily be accomplished in a classroom setting by having students work in groups of two or three. The case scenario outlined in this teaching tool always provokes vigorous discussion, which can lead to a very productive dialogue about how to engage other health care workers Submitted Materials: Communication_among_Health_Care_Providers-1.doc - https://drive.google.com/open?id=1XH5-eUB2NIHl2dYAw5X68SpTwtksXcIM&usp=drive_copy Communication_Among_Health_Care_Providers-1.ppt - https://drive.google.com/open?id=1XH5-eUB2NIHl2dYAw5X68SpTwtksXcIM&usp=drive_copy Additional Materials: Evaluation Description: Evaluation of this program has been accomplished by measurement of student satisfaction with the session. This session has been delivered several times, with learners consistently reflecting that this was very useful.

Published Back to Strategy Search Strategy Submission Integration of QSEN competencies when designing simulation scenarios Author: Paula Jarzemsky MS, RN Title: Clinical Professor Coauthors: Jane McCarthy, MSN, RN, Nadege Ellis, BSN, RN Institution: University of Wisconsin-Madison School of Nursing Email: pajarzem@wisc.edu Competency Categories: Evidence-Based Practice, Informatics, Patient-Centered Care, Safety, Teamwork and Collaboration Learner Level(s): Faculty Development Strategies, New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN Learner Setting(s): Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: Using this strategy, nursing faculty will be able to: 1. Develop learning outcomes for simulation scenarios that exemplify the knowledge, skills and attitudes underlying QSEN competencies 2. Create an inventory of sample events or triggers that target specific QSEN competencies before, during and after a simulation scenario. 3. Collaborate with other nursing faculty to design effective simulation scenarios. Strategy Overview: Task analysis is a detailed examination of the knowledge, skills and attitudes (KSAs) that are essential to job performance and an important first step in the process of developing learning outcomes for simulation-based training. QSEN offered a detailed list of KSAs that are critical to the nursing profession. We used this information to design learning activities and simulation events that would elicit such KSAs from students. This strategy describes a planning process which has helped our nursing faculty share ideas and craft scenarios best suited to the needs of their students. First, QSEN competencies were associated with examples of learning activities and events that might occur before, during and after simulation scenarios (see Summary). For instructors new to simulation, the summary offered a preview of possible learning outcomes and in some cases, inspiration to engage in the process. It also led to discoveries which are likely to influence our future plans for simulation scenarios. For example, we noted that KSAs related to Quality Improvement had been overlooked. In addition, we identified a need for more advanced communication challenges such as the need to consider boundaries of therapeutic relationships, barriers to active patient involvement and conflict resolution. Next, we examined key elements of our existing simulation scenarios, in relation to QSEN competencies. Five simulation scenarios serving first-year students in medical-surgical settings have been analyzed using this framework (see Table). From this analysis, we identified core features that were emphasized in every simulation, along with special features that made each scenario unique. We expect to adopt a similar approach to planning scenarios as our simulation program expands to meet the needs of more advanced students and nursing specialty courses. Submitted Materials: 109.Summary-of-Simulation-Activities-and-QSEN-Competencies.doc - https://drive.google.com/open?id=1n2JkfiPECmbp6oAtiFaSwpbE23mfGPmG&usp=drive_copy 109.Table-Mapping-QSEN-competencies.doc - https://drive.google.com/open?id=1n2JkfiPECmbp6oAtiFaSwpbE23mfGPmG&usp=drive_copy Additional Materials: Evaluation Description: No formal evaluation of the strategy has been planned.

Published Back to Strategy Search Strategy Submission Identifying QSEN competencies in the clinical setting Author: Esther Gravis RN, MSN, CPN Title: Professor of Nursing Coauthors: Institution: Saddleback College Email: egravis@saddleback.edu Competency Categories: Evidence-Based Practice, Informatics, Patient-Centered Care, Quality Improvement, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Classroom, Clinical Setting Strategy Type: General Strategy Learning Objectives: Students will be able to: 1.Identify patient-centered care either being delivered, or not, in the hospital setting 2.Demonstrate teamwork and collaboration as an active member of the healthcare team 3.Identify how communication aids in resolving conflict. 4.Differentiate between a nurse's opinion and research or evidence. 5.Locate policies and guidelines that support nursing practice 6.Identify ways to reduce the risk of harm to the patient (knowledge). 7.Identify and describe a culture of safety (attitudes). 8.Identify how information is managed in order to provide care to patients (skills) 9.Describe ways of protecting electronic health records. Strategy Overview: The QSEN competencies and National Patient Safety Goals are used to provide standards of care to nursing students. Both of these tools provide guidelines and examples of care for nursing students and registered nurses. These standards are widely used within a variety of hospital settings. Submitted Materials: grading-rubric-1.docx - https://drive.google.com/open?id=1xtTw66TUna0d6GCZv3_dY6Y7dRNFSXsP&usp=drive_copy Example-document-Esther-1.docx - https://drive.google.com/open?id=1xcDFGv9her6o9vCDrGJ5xLyTQF_vcye_&usp=drive_copy Additional Materials: Additional Materials Evaluation Description: Strategy Activity: This teaching strategy was used with first year fundamental ADN nursing students. Prior to the beginning of clinical, the students are taught about QSEN competencies and National Patient Safety Goals in the lecture setting. Students are presented with QSEN competencies and KSA's needed for the graduate nurse. The students are then given examples of how nurses demonstrate each QSEN competency while caring for patients in the clinical setting (eg, focusing on providing care that is focused on the patients' needs and not that of the nurse- patient centered care). *See table below for examples used in the lecture setting. The students are then given copies of the QSEN competencies and National Patient Safety Goals. In the clinical setting: In the hospital setting the QSEN competencies and National Patient Safety Goals are reviewed again in pre-conference before the students go to their assigned patient-care units. The students are assigned to groups of two or three and asked to identify and provide examples of the six QSEN competencies they see while in the hospital setting. They will provide these examples during post-conference later that day. This activity works well during periods of down-time; normally after medications have been administered and physical assessments are complete. If the students are unsure where to start they could focus on safety and patient-centered care. If the students are unable to identify a QSEN competency, the instructor can ask if the students continue to look for the competency and return to the topic in a later post conference. For example, quality improvement might be identified by the wound care nurse providing an in-service to the nursing staff regarding a new type of wound care equipment at a later date. This is not a time to focus on the negative aspects of the nurses, doctors, and ancillary staff, but to learn from what they are observing and to decipher best practices. Moreover, this activity will help the students to identify specific QSEN competencies and National Patient Safety Goals and potentially implement those standards into their own practice. Exploratory: The students found it difficult to identify Evidence-based practices in the clinical setting. This was discussed in lecture and post-conference, but it was difficult for them to identify. The competencies identified most often were safety, informatics, and teamwork. In instances where they were unable to identify a QSEN competency the instructor provided it for them. For example, patient-centered care: they were reminded this includes empowering the patient and their family members or ways the nurse helped to relieve the patient's pain. Debriefing This is a way to get them to think about the care they provide and to reflect on their clinical practice. They will also learn from their colleagues. Post conference is a time to let them discuss their issues, concerns, worries, and feelings, but don't let one student monopolize the group. Questions to stimulate discussion in debriefing: Which QSEN competencies were you able to identify today? Were you able to identify patient-centered care either being delivered, or not, in the hospital setting? At what points during the day were your nursing actions specifically directed toward prevention of a negative outcome? Did you witness teamwork and collaboration as an active member of the healthcare team? What communication strategies did you use to validate accuracy of your information or decisions with your team members (nurse, instructor)? Were you able to differentiate between a nurse's opinion and research or evidence? Give an example. Were you able to locate policies and guidelines that support nursing practice? Can you note ways to reduce the risk of harm to the patient in the clinical setting? Can you give an example where you noted a culture of safety? How is information managed in order to provide care to patients? What are a few ways of protecting electronic health records? Links: Identify QSEN Competencies or National Patient Safety Goals: 1.The faculty member can access the 2018 National Patient Safety goals: https://www.jointcommission.org/hap_2017_npsgs/ This link will take the instructor to the National Patient Safety Goals as a downloadable document or as a simplified version. The simplified version is easy to use and most often seen in the hospital setting. The Goal number and titles are found on the left side of the form and examples of the goal are found on the right side. 2. The faculty member in the class room can bring up qsen.org/competencies/pre-licensure-ksas/ This link will lead the instructor to a table where each QSEN competency is defined and the knowledge, skills, and attitudes for the QSEN competency are identified. This table is used in lecture to provide objectives and examples for the students to learn about QSEN competencies. QSEN CompetencyExample of this competency in the hospital setting Patient-centered care1. The nurse views the care they provide from the patient perspective. Eg. The nurse values the patient's opinion and ideas when planning and providing care. 2. The nurse uses critical thinking when caring for the patient. Eg. The nurse determines the patient would benefit from being discharged to a location closer to her family than in the town the live. The nurse might work with the discharge planner to communicate the desires of the patient Teamwork and collaboration1. The nurse demonstrates awareness of her own strengths and limitations. Eg. The nurse asks another health care provider for help when turning a patient and completing a dressing change. 2. The nurse acts as a team member. Eg. The nurse recognizes the role of each team member and speaks positively about another member of the team. Informatics1. Document and plan patient care in the electronic health record. Eg The nurse documents education given to the patient and care provided. 2. Identify the risk of patient privacy violations. Eg Discuss how HIPAA compliance violations can occur when using electronic health records. Consider how social media can be used to violate patient privacy. Quality Improvement1. Explain that nurses are part of the system of care and they affect outcomes for patients and families. Eg. The nurses in some units of the hospital have changed the admission process to make it more streamlined for the patient and the staff. Even small local changes can improve patient care. It doesn't always have to be an institutional change. 2. Use quality measures to understand performance. Eg. Infection control nurses are able to identify a microorganism found near a water source (handwashing station) that then leads to an infection in the intensive care unit (ICU). The use of a control chart helps the staff nurses to see the connection. Safety1. Discuss effective use of strategies to reduce the risk of harm to the nurse or the patient. Eg. Never re-capping a used needle, good hand hygiene and donning and doffing personal protective equipment. 2. Articulating the need for prompt reporting. Eg. The nurse who identifies a pressure ulcer documents it immediately and does not wait for someone else to find it. Evidence-based practice1. The nurse is able to compare evidence-based care to routine approaches that may result in less-than desired outcomes. Eg The nurse values the ethical considerations for patient's participating in drug research. 2. The nurse consults with clinical experts before making decisions about the care of the patient. Eg. The nurse discusses patient care with the doctor and what might be best for the patient. She does not blindly provide patient care, but researches medications and procedures before administering them to the patient

Published Back to Strategy Search Strategy Submission TouchPoint: Undergraduate Senior Immersion Activity Author: Linda Macera-DiClemente DNP, BA, RN Title: Assistant Director of Educational Excellence and Coordination - Clinical Instructor - Undergraduate Program Coauthors: Peggy Ann Ursuy PhD, RN PPCNP-BC, Clinical Assistant Professor Institution: University of Michigan - Ann Arbor, MI Email: lmdiclem@umich.edu Competency Categories: Patient-Centered Care, Teamwork and Collaboration Learner Level(s): New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN Learner Setting(s): Classroom, Clinical Setting Strategy Type: General Strategy Learning Objectives: The learner will • Recognize patient is the center in the delivery of care and the coordination of care. (Knowledge) • Identify a trust relationship between patient, family, and nurse to effectively coordinate care. (Skill) • Practice in reflecting on a patient’s point of view in relation to the nurse-patient relationship (Attitude). • Demonstrate awareness of personal strengths and limitations as a team member while recognizing the therapeutic relationship that exists between patient and nurse. (Skill). • Describe own strengths, limitations, and values in functioning as a member of a team (Knowledge). • Acknowledge own potential to contribute to effective team functioning (Attitude). • Appreciate the importance of intra- and inter-professional collaboration (Attitude). Strategy Overview: Strategy Overview TouchPoint is an innovative approach to the face-to-face clinical post-conference for pre-licensure BSN nursing students in an immersion experience. The design and purpose of these faculty-moderated sessions are to engage students in an elevated, deep, and meaningful reflection. Unlike a traditional faculty-student clinical conference, which is the typical standard for faculty and students to meet and engage at the end of a clinical day or experience, TouchPoint elevates the experience to deep reflection. TouchPoint builds relationships between faculty and students by connecting and exploring feelings, emotions, fears, and anxieties in this unscripted method of deep reflective sharing. By aligning the QSEN competencies of Patient-Centered Care and Teamwork and Collaboration, the sessions build a sense of safety in reflective sharing and transparency, with the outcome of building resilience and strengthening resiliency practices. Touchpoint’s aim is to explore the deep levels of students' experiences in relation to clinical reasoning and critical thinking thought processes. TouchPoint creates a safe and enriching environment where the sharing of student experiences builds on a community reflection technique to support students during intense immersion experiences. Macera-DiClemente and Smith’s (2018) work on mentoring noted a supportive environment is crucial to deep reflections that produce deep thought. It is imperative to contend that with an intense degree of deep thought and disclosure, vulnerability exists. Ursuy(2015) demonstrated the dimensions of trust, support, and respect were the most important factors in understanding progress toward independent nursing practice. Hudson (2016) further supports the trust relationship as the center of any supportive and close relationship. Koole, Christiaens, Cosyn, and Bruyn (2016) identify deep reflection in terms of single-loop, double-loop, and triple-loop learning by the use of mentor groups, to explore deep reflection for dental students. TouchPoint digs deeper into reflection by using triple loop learning which includes the practice of how the structure relates to the problem, in that students connect experiences to clinical reasoning practices through examples and experiences. In this deep reflective state, students recognize the patient as the center point in the delivery of care, and that effective delivery and coordination of care happen through teamwork and collaboration. Using the QSEN competencies of Patient Centered Care and Teamwork and Collaboration, Touchpoint’s reflective learning practices and deep exploration of student experiences frames discussion on the importance of formulating a holistic approach to healing and a building a trust relationship for patients and families. This deep reflective state aligns with Patient Centered Care as students relate examples of sensitivity, diversity, and respect for the human experience as it relates to the particular unit experience. Emphasizing the importance of Teamwork and Collaboration, students begin to realize the importance of quality patient care as role transition takes place from the perspective of a student individual to a functioning member of the inter- and intra-professional healthcare team member. Strategy Method TouchPoint is a two-part experience: (1) The focus of Session One is Patient Centered Care and the immediate and professional relationship between patient, nurse, and family; and (2) Session Two addresses Teamwork and Collaboration, the importance of inter- and intra-professional relationships for the institution of quality care. The method for both sessions includes a faculty moderator meeting with a small group of students, 10-12 students maximum. The sessions last 1-1/2 hours to 2-hours, depending on the number of students, in either a face-to-face format or synchronous online format. Session One content on Patient Centered Care is a reflective question card clinical game (TouchPoint Session One: Clinical Game, see attachment). There is no preparation necessary for students or faculty, as the initial first response generates deep reflective thought. A randomly selected student begins by drawing a card. The student shares a response aloud to the group related to the clinical experience. After the sharing, all students can reflect on the experience or discuss their own experience elicited by the discussion. After this deep dialogue, the next student draws a card and the same process occurs. This can continue until all students have the opportunity to participate in the game with an original question drawn by a card. Be prepared for deep reflective thought about death, dying, the good and bad of a clinical experience, fears, struggles, shared tough moments, and the support and comfort in knowing that others have the same feeling and emotions. TouchPoint Session Two content on Teamwork and Collaboration occurs approximately four-to-six weeks after the TouchPoint Session One. The focus of Session Two is the professional socialization and role identity transition of senior students nearing graduation. The preparation necessary for this TouchPoint is that the students receive and complete, after reflective thought, the TouchPoint Behavioral Questions (TouchPoint Session Two: Behavioral Questions, see attachment) prior to the face-to-face meeting. The behavioral questions include the following topics: a) teamwork/collaboration, b) leadership, c) problem solving, d) communication/handling conflict, and e) initiative “self-starter” (https://www.indeed.com/career-advice/interviewing/most-common-behavioral-interview-questions-and-answers). Each of these topics have four-to-six sub-statements or questions for follow-up. The sub-statements are randomly distributed and assigned to an initial student, and then moving in a round-robin fashion as students reflect on one to two questions in each group, in a simulated interview panel experience. At the end of each student share, the moderator summarizes the share by an affirming statement for the student that states, “Your story is inspiring and you inspire me by the way you....” The TouchPoint senior immersion activity is a synthesis of moving stories presented by nursing students following a reflective question prompt. TouchPoint sessions are valuable for students as they share about witnessing death, experiencing independence and autonomy, practicing anticipation, and applying new knowledge acquisition with critical thinking at the bedside. Submitted Materials: TouchPoint-Session-One285_Clinical-game.docx - https://drive.google.com/open?id=1BSkLFeAAiThXPItKjo-G1aoiMAVyCChF&usp=drive_copy TouchPoint-Session-Two_Behavioral-Questions.pdf - https://drive.google.com/open?id=1mwmV-CxcRxQDPRy7hReoW3EBafle5IvU&usp=drive_copy TouchPoint-Teaching-Strategy1.pdf - https://drive.google.com/open?id=1mtSlap3OFoCYWxuiSjNwK0HsH64CowV_&usp=drive_copy Additional Materials: References Hudson, P. (2016). Forming the mentor-mentee relationship. Mentoring and Tutoring: Partnership in Learning. 24(1), 30-43. http://doi.org/10.1080/13611267.2016.1163637 Koole, S., Christianens, V., Cosyn, J., & De Bruyn, H. (2016). Facilitating dental student reflections: Using mentor groups to discuss clinical experiences and personal development. Journal of Dental Education, 80(10), 1212-1218. Macera-DiClemente, L. M. & Smith, C. (2018). The Impact of Nurse-to-Nurse Mentoring In Leadership Skills Development - RNMentor2Mentor. Virginia Henderson Global Nursing e- Repository. http://hdl.handle.net/10755/20572 QSEN competencies. (n.d.). QSEN Institute. https://qsen.org/competencies/pre-licensure-ksas/ Ursuy, P. A. (2015). The journey within: Discovering the sense of becoming (Order No. 3728897). Available from ProQuest Dissertations & Theses Global. (1733970259). https://proxy.lib.umich.edu/login?url=https://www-proquestcom. proxy.lib.umich.edu/docview/1733970259?accountid=14667 Evaluation Description: Strategy Evaluation The design and purpose of these faculty-moderated sessions are to engage students in an elevated, deep, and meaningful reflection. Student participants complete an evaluation of TouchPoint after each session. The student responses assist faculty in evaluating the deep reflection that is taking place individually. The TouchPoint evaluation is an important gauge for faculty to assess student engagement in this deep reflective experience. Did the exploration of the students’ experiences create a deeper level of discussion in relation to clinical reasoning and critical thinking? The evaluation questions addressed after each session include: - As a participant in TouchPoint, share your thoughts/feelings on the session you recently attended. - How did TouchPoint help you reflect on your experiences in the clinical unit? - Any other comments or feedback you would like to share. What would you change? The magic of TouchPoint is the creation of a safe space that optimizes a structured learning activity that opens a discussion of sensitive topics such as death, dying, gossip, loss, unsupportive nursing staff, joy and happiness as the patient goes home, and the supportive nature of nurse mentors throughout these positive and negative experiences. It is an opportunity for nursing students to learn about their peers' clinical experiences, especially those in high-risk specialty areas. In experiencing TouchPoint, students feel safe in a confidential environment that is necessary for deep reflection. The trusting relationship built allows for an exchange that talks about challenges seek support, and shares advice. These essentials will help faculty ensure TouchPoint sessions adhere to the foundations of trust, respect, and support. In summary, the keys to success for TouchPoint include the following: - Keep the student groups’ small, no more than 12 students per session is recommended. - Provide a safe and confidential environment. This is critical to the project’s success. - Clearly stating the ground rules prior to starting TouchPoint, with emphasis on confidentiality. Confidentiality is imperative for reflective practice. The essentials noted above will help faculty ensure their TouchPoint sessions adhere to the foundations of trust, respect, and support

Published Back to Strategy Search Strategy Submission Incorporation of QSEN Competencies in Clinical Author: Kristen Doughty EdD, MSN, RN Title: Nursing Faculty Coauthors: Lynda Kopishke DL, MSN, RN; Kristine Gawrych MSN, RN; Kathy Sokola EdD, MSN, RN, CNE Institution: Delaware Technical and Community College Email: kristen.doughty@dtcc.edu Competency Categories: Evidence-Based Practice, Patient-Centered Care, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure ADN/Diploma Learner Setting(s): Clinical Setting Strategy Type: Paper Assignments Learning Objectives: Examine common barriers to active involvement of patients in their own health care processes Describe strategies to empower patients or families in all aspects of the health care process Describe examples of the impact of team functioning on safety and quality of care Base individualized care plan on patient values, clinical expertise and evidence Recognize that nursing and other health professions students are parts of systems of care and care processes that affect outcomes for patients and families Strategy Overview: The QSEN project provides direction for the nursing faculty to transform students’ critical thinking and clinical reasoning. Incorporating QSEN competencies into an ADN clinical project fosters awareness for positive outcomes in safe nursing practice Students are assigned weekly journal questions and challenged to reflect on their clinical observations and experiences (attached). These journal questions link to QSEN Competencies: Patient-Centered Care, Teamwork & Collaboration, Evidence-based Practice, and Safety. In the final clinical week, students are assigned a journal topic and tasked with finding evidence-based literature relative to their topic. Students are placed in groups based on their topic and tasked with the collaboration of resources and experiences in creating a presentation addressing outlined key talking points (attached). Students increased their understanding of the role of the professional nurse and identify necessary behaviors and actions in preparation for the transition to practice. Submitted Materials: QSEN-TS-219-Incorporation-of-QSEN-Competencies-in-Clinical2.8.19.docx - https://drive.google.com/open?id=15qbgxWAfCXWPMKenAo54SrAZFgFMn89x&usp=drive_copy Additional Materials: Analysis of post project effectiveness demonstrated 75 of 77 (97%) of students found this excellent/great/very effective as a teaching method for QSEN concepts; 2 students were unsure. Evaluation Description: Evaluation of objectives was completed through the evaluation of weekly journal submissions and the final presentations. Journal questions and presentation guidelines attached. Weekly journals included key questions for students to address. Guideline provided for final presentations included key talking points. Student’s completed a survey post-presentation, to gather feedback. Students were able to establish professional behaviors that were characteristic of the QSEN competencies and were able to specify how those behaviors would lead to improved patient outcomes.

Published Back to Strategy Search Strategy Submission Creating a Climate of Safety in the Clinical Setting Author: JoAnn Mulready-Shick EdD, RN, CNE Title: Undergraduate Program Director Coauthors: Institution: College of Nursing and Health Sciences University of Massachusetts Boston Email: joann.mulreadyshick@umb.edu Competency Categories: Evidence-Based Practice, Patient-Centered Care, Safety, Teamwork and Collaboration Learner Level(s): Continuing Education Learner Setting(s): Clinical Setting Strategy Type: Online or Web-based Modules Learning Objectives: Professional Development Learning Objectives for new Parttime Clinical or Lab Faculty Examine a guide for reflection and questioning for use in a setting (clinical or lab) for student learning. Utilize Tanner’s model for clinical judgment in nursing for reflection and questioning. Apply evidence-based teaching practices to a clinical scenario. related QSEN KSA (Evidence Based Practices, Safety, Pt Centered Care Case Scenario- Spiritual Care QSEN Competency- Patient Centered Care Integrate understanding of multiple dimensions of patient-centered care:patient/family/community preferences, values; information, communication, and education; involvement of family; provide patient-centered care with sensitivity and respect for the diversity of human experience; respect and encourage individual expression of patient values, preferences and expressed needs Case Scenario- Medication Error QSEN Competency- Safety Delineate general categories of errors and hazards in care; describe and demonstrate use of open communication strategies that create a culture of safety; value own role in preventing medication errors through open communication strategies Strategy Overview: Provide a three hour faculty development session for part-time clinical faculty (and lab faculty) who are clinical experts but novices to clinical instruction and teaching strategies which promote the practice of questioning for reflection. Title: Creating a Climate of Safety: Enhancing Clinical Judgment Development and Communication Distribute and discuss Tanner's Model of Clinical Judgment Development (Journal of Nursing Education 2006 vol 45) and Guide for Reflection and Questioning (Nielsen, Stragnell, and Jester article Journal of Nursing Education 2007 vol 46) with permission. Discuss how learning reflection and questioning skills (noticing, interpreting, responding, and reflecting related to QSEN competency development. In small groups, apply reflection and questioning strategies with an Evidence Based Practices for Teaching Strategies- the University of Portlane OR, Case Scenarios CD-ROM (med. error, spiritual care, EBP teaching strategies) Order via Clinical Faculty Development Scenarios & Teaching Guide Order Form on website http://nursing.up.edu Go to News and Events to July 2007 symposium Submitted Materials: 92.Program_Evaluation_Form_Jan_23_2008.doc - https://drive.google.com/open?id=1YFTvxXzLZd9eH0F9LB_lEiFdFbDR1zmY&usp=drive_copy Additional Materials: Evaluation Description: Evaluation form for evaluating learning objectives and providing Continuing Education Units/contact hours included as an attachment.

Published Back to Strategy Search Strategy Submission Pediatric Simulation and Unfolding Case Study Author: Anne McShane MSN, RN Title: Assistant Professor Coauthors: Sheila Berkemeyer, MSN, RN Institution: Lewis University College of Nursing and Health Professions Email: mcshanan@lewis.edu Competency Categories: Evidence-Based Practice, Patient-Centered Care, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure BSN Learner Setting(s): Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: Core-Competency: Patient-Centered Care This teaching strategy is designed to evaluate the following: Knowledge: Integrates understanding of family-centered care for the pediatric population and involving parents/siblings in all aspects of patient care including plans of care, communication, education, and emotional support. Attitude: Encourages parental involvement in patient care. Recognizes the need for emotional support of family members. Skills: Acknowledges family as a part of patient care and outcomes through effective communication and evaluation of parental involvement and knowledge of care. Core-Competency: Safety This teaching strategy is designed to evaluate the following: Knowledge: Describes the nurse’s role in providing safe, effective patient care and the impact of Joint Commission standards on nursing care. Attitude: Seeks to educate the mother about safety throughout the hospital stay. Skills: Implements Joint Commission standards of safe patient care through the use of medication reconciliation, communication, error reporting, patient identifiers, medication safe doses, abbreviations, I-SBAR-R technique during patient transfer, and the six rights of medication administration. Core Competency: Team and Collaboration This teaching strategy is designed to evaluate the following: Knowledge: Demonstrates the importance of effective communication and delegation among different healthcare providers (nurses, physician, and Certified Nursing Assistant). Attitude: Implements the importance of effective communication with physicians and other members of the healthcare team to ensure patient safety and positive outcomes. Skills: Gives report for a patient using I-SBAR-R technique. Communicates safety threats to the physician prescribing medication orders. Uses the American Nurses Association delegation principles. Core Competency: Evidence-Based Practice This teaching strategy is designed to evaluate the following: Knowledge: Differentiates between clinical opinion and scientific evidence while performing specific diagnostic tests and assessments. Attitude: Values the use of evidence-based practice to make decisions in the clinical setting. Skills: Identifies potential medical errors and possible conflicts with other health care providers. Strategy Overview: The simulation can be used as an evolving scenario or it could be divided into separate activities based on the various clinical areas. The students have received the lecture on fluid and electrolyte and respiratory content prior to the simulation. Submitted Materials: Additional Materials: Evaluation Description: Students participate in the simulation as part of the pediatric nursing course. It is a pass / fail activity with formative and summative evaluation by the faculty during debriefing. We have received positive feedback from the students following the simulation. They express how much they learned and recognize how much they need to learn. We have used our simulation in a variety of ways. Most often, we have three students per clinical area in the roles of Staff Nurse, Certified Nursing Assistant, and Charge Nurse. The other students serve as participant observers. It is possible to have students participate in one setting or to have the various settings used in case study vignettes. We utilize high- or low-fidelity simulation, depending on the availability of the simulation lab on campus. While the skills component is valuable, we have found that the simulation primarily addresses the critical inquiry aspect of the course goals for the students. We have a faculty-led discussion following the completion of activities in each setting arena for the formative evaluation. The student participant observers are asked to identify areas of strength and areas for improvement related to each of the listed objectives (e.g., infection control practices, communication, delegation, etc.). Recommendations are identified for the subsequent participants. The summative evaluation consists of having the students identify progress related each of our listed objectives. In addition, the group is asked what they have learned about themselves and their nursing practice related their performance. They identify areas they recognize need improvement moving forward. The faculty at our institution decided not to formally evaluate the students' simulation with a grade. If we do so in the future, we will develop a skills checklist and outline for formal evaluation.