Published Back to Strategy Search Strategy Submission Coding Practice Using ICD-10 for Nurse Practitioner Students Author: Beth Vottero PhD, RN, CNE Title: Associate Professor Coauthors: Institution: Purdue University Northwest Email: bstarnes@pnw.edu Competency Categories: Informatics Learner Level(s): Graduate Students Learner Setting(s): Classroom Strategy Type: Online or Web-based Modules Learning Objectives: Value the importance of standardized terminologies in conducting searches for patient information Describe and critique taxonomic and terminology systems used in national efforts to enhance interoperability of information systems and knowledge management systems Strategy Overview: Family Nurse Practitioner students have little opportunity to work with ICD-10 coding prior to clinical experiences. Feedback from FNP students identified a need to incorporate more background information and introduction to ICD-10 coding of patient presentations. A discussion question was created for an online graduate Nursing Informatics course to introduce these students to ICD-10 coding in a non-threatening manner to help students gain insights into how to correctly code, then interpret, a patient's presentation. The discussion question is attached as a file. The instructor helps students to make the link between the ICD-10 codes and standardized nursing language (NIC/NOC, NANDA, etc.) by having student access the provided websites. The instructor can encourage students to continue the discussion using ICD-10 codes to follow-up with the patient over time and can guide students to continue coding a patient based on what they would expect to see during follow-up clinic visits. Submitted Materials: 239-RevisedCoding-Discussion-and-Rubric-Revision.docx - https://drive.google.com/open?id=1qPGlv7Ho-t7dSwosI-atfCNRunxpGFXn&usp=drive_copy Additional Materials: Evaluation Description: Students are evaluated using a standard discussion evaluation tool based on the initial response, level of engagement with classmates, number of posts and quality of posts. A rubric used for this discussion is provided with the discussion question.

Published Back to Strategy Search Strategy Submission Evidence-Based Practice Course Application Strategy Author: Elizabeth Kudzma DNSc, MPH, RNC Title: Professor, Division of Nursing Coauthors: Maureen L. Murphy Phd EdM CNM, Cathleen C. Santos MSN RN Institution: Curry College Email: ekudzma@curry.edu Competency Categories: Evidence-Based Practice Learner Level(s): Pre-Licensure BSN, RN to BSN Learner Setting(s): Classroom Strategy Type: Online or Web-based Modules Learning Objectives: Learning Objectives modified from QSEN Identify reliable sources for locating evidence reports and clinical practice guidelines. Apply pertinent evidence-based reports related to clinical coursework. Level original research and evidence reports related to coursework. Distinguish clinical opinion and consensus from research and evidence summaries. Describe how the strength of available evidence influences the choice of interventions in provision of nursing care. Strategy Overview: Students are exposed to a wide variety of evidence in their nursing classes. In many cases relevant current studies are cited and summarized in classes frequently in PowerPoint format. This simple strategy asks faculty to level the type of evidence used in the research study when discussing it in class. If PowerPoint format is used, the level of evidence can be cited at the bottom of the slide. Viewing the level of evidence with the research study summary should provide application of the information about levels of evidence to the current topic under study. Students should be exposed to exemplars in evidence-based practice, PICO format and levels of evidence early in the nursing curriculum. For later classes, only a few slides (see PowerPoint presentation attachment) at the beginning of a course may be necessary to reacquaint the student with major principles of evidence-based practice and levels of evidence. Since there are several rating guides for levels of evidence, several sources might be used. We used the following sources for evidence-based nursing conceptual content and for grading level of evidence: Melnyk, B. & Fine-Overholt, E. (2005). Evidence-Based Practice in Nursing and Healthcare. Lippincott, Williams & Wilkins. Siwek, J., Gourlay, M., Slawson, D. & Shaughnessy, A. (2002). How to write an evidence-based clinical review article. Am Fam Physician 65, 251-258. Submitted Materials: Additional Materials: Evaluation Description: This strategy increases student engagement in nursing classes where study examples are cited. Instead of viewing use of evidence-based investigation as dry and involved primarily with the nursing research course, students found that they could actually level evidence and discuss why a study would fit into a particular level or category. Through use of this strategy, students became more thoughtful about levels of evidence and were able to discriminate levels of evidence. In an introduction to vital signs and blood pressure, students were able to recognize that the Siwek et al. (2002), Level C consensus/ expert opinion, applied to the Seventh Report of the Joint National committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) statement about categories of hypertension and pre hypertension. Also, as a result of this strategy, students became more discriminating and practical about use and issues surrounding randomization in various studies. The strategy assists students to see that evidence-based practice applies in a diversity of nursing curricular areas. Evaluation of the strategy can also be accomplished through exam questions on the various studies or focused papers in which the student is asked to discuss levels of evidence and rationales.

Published Back to Strategy Search Strategy Submission QSEN Teaching Strategy: Sponge Relay and Cardiac Output Author: Katie Morales PhD, RN, CNE Title: Assistant Professor of Nursing Coauthors: Cindy Johnson, PhD, RN; Carrie Barr, MSN, RN Institution: Berry College Email: Kmorales@Berry.Edu Competency Categories: Evidence-Based Practice, Patient-Centered Care Learner Level(s): Pre-Licensure BSN Learner Setting(s): Classroom Strategy Type: General Strategy Learning Objectives: Learning Objectives: Evidence-based practice (EBP) and patient-centered care (PCC), and safety were the objectives for this learning activity: Knowledge: (EBP) Demonstrate knowledge of basic scientific methods and processes, explain the role of evidence in determining best available clinical practice, explain the role of best practice in clinical practice. (PCC) Integrate understanding of the dimensions of care in the patient with cardiac dysfunction while providing information, physical comfort, and emotional support. Provide safe and effective care to the client experiencing cardiac dysfunction. Skills: (EBP) Base individualized plan on patient values, clinical expertise and evidence. (PCC) Provide patient-centered care for a patient with cardiac dysfunction while considering patient values, preferences and expressed needs. Attitudes: (EBP) Value the need for continuous improvement in clinical practice. (PCC) Value the patient's expertise with own health and symptoms. Strategy Overview: This interactive hands-on learning activity was developed as part of a senior level adult-health course to provide understanding on advanced cardiac concepts such pre-load and afterload. The purpose of the activity was to engage the students and help them grasp the connection between cardiac output, heart rate, and stroke volume. The activity correlated with the didactic content (the role of heart rate and stroke volume on cardiac output) to link the activity to specific cardiac disease conditions, with a discussion of related clinical symptoms and anticipated treatment. Afterwards, the students were asked to discuss how the activity demonstrated cardiac output, stroke volume, and heart rate. In addition, students were asked to troubleshoot cardiac output issues identified in the sponge relay. Students were divided into two teams of five, with the remaining students observing. Two 2.5-gallon buckets were filled with water and two empty buckets were placed approximately 63 feet apart. Fill lines were indicated on the empty buckets. Two large sponges (9x4.5x3inches) were placed in the buckets containing water. Each team member grabbed the sponge from the full bucket, ran to the empty bucket, wrung out the sponge, and ran back to tag the next team member. The first team who filled the empty bucket to the fill line won. Winners were given a box of Swedish Fish candy. The learning activity represented how cardiac output is affected by heart rate, stroke volume, contractility, and preload. The relay participants demonstrated heart rate, as teams had to be faster running between buckets in order to fill the bucket (cardiac output) more quickly. Stroke volume was demonstrated as the volume wrung out of the sponge needed to be optimal to fill the bucket. The force used to wring the sponge represented contractility. Preload was demonstrated by the amount of fluid in the first bucket available for the sponge to absorb. The fluid, which was transferred to the second bucket (initially empty) via the sponge, represented cardiac output. Follow-up discussion addressed related concepts identified a priori as difficult for the students. For example, the leakage around the first bucket (initially full) represented incompetent valves. Inadequate sponge fill time represented inadequate cardiac fill time, which can occur in diastolic heart failure. Leakage of water from the sponge along the relay route represented decreased oncotic pressure. The effect of afterload (resistance) and the role of vasodilator and vasoconstrictor medications were discussed. Future use may include a wide mouth bucket and a narrow mouth bucket to demonstrate the effect of afterload (resistance) on cardiac output. Submitted Materials: QSEN-Relay-Revised.docx - https://drive.google.com/open?id=1pa8O6_moxC9e-Vp_ON0mNszwcIW565Df&usp=drive_copy Additional Materials: The materials required an initial investment of approximately six dollars. No funding was received for this activity. The demonstration required no special adaptation of the materials. Evaluation Description: Student feedback was obtained using a survey which included the following items: This learning activity was beneficial; I enjoyed this interactive learning activity; I learned new information related to nursing care of adults with cardiovascular disorders; In the future, I want to use more activities like the sponge relay to demonstrate key concepts; This teaching/learning activity helped me understand the cardiac process. Twenty of the 26 students submitted evaluations. Graphic 1 displays the results of student evaluation. All students either strongly agreed or agreed the learning activity met the learning objectives. Space for individual feedback was provided on the surveys for how to improve the activity in future learning activities. The three main themes identified in the summary of student feedback included: active involvement of entire class rather than passive observation, more time for collaboration, and the creation of a handout or PowerPoint slide illustrating key concepts. Student comments included the activity "brought everything together in a fun way" and the "visualization brought a better understanding of key cardiac concepts." Raw student feedback is included in Appendix 1. While the evaluation for this activity was a survey, future use may include a pre-test/post-test evaluation of concepts (Appendix 2).

Published Back to Strategy Search Strategy Submission End-of-life Simulation Author: Carla Hunt RN, MSN Title: Clinical Instructor Coauthors: Institution: Mercy College of Nursing Health Sciences Southwest Baptist University Email: carla.hunt@mercy.net Competency Categories: Patient-Centered Care, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure ADN/Diploma Learner Setting(s): Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: At the completion of this end-of-life simulation, the learner will be able to: 1. Perform a physical assessment and analyze the findings to manage end-of-life symptoms; 2. Practice therapeutic support and compassionate end-of-life communication; 3. Assess spiritual needs and provide culturally sensitive nursing care; 4. Demonstrate a patient and family-centered approach to care; 5. Analyze the completed advanced directive and advocate to uphold the patient’s wishes; 6. Utilize nursing process to develop an individualized plan of care; 7. Evaluate personal beliefs and values that influence a nurse’s ability to provide care to the dying; 8. Perform the nurse-to-nurse death verification and death documentation utilizing a standardized expiration checklist. 9. Demonstrate post mortem care and safe handling precautions; 10. Practice interdisciplinary collaboration as death approaches and at the time of death. Strategy Overview: The End-of-Life (EOL) simulation occurs in a simulation lab and is intended to facilitate clinical correlation to oncology, palliative, and end-of-life content presented in the third semester classroom. Required pre-assignments are EOL lecture attendance or power point review, completion of Caring Conversations of Young Adults (2012), and review of the journal article, Preparation and care at the time of death: Content of the ELNEC curriculum and teaching strategies by Sherman, Matzo, Ferrell, and Malloy (2005). In the EOL simulation, student groups of two rotate in and out of the simulation to perform a physical assessment, compassionate comfort care, effective communication, interdisciplinary collaboration, and post-mortem care. Students demonstrate physical assessment for a non-responsive patient and perform post mortem care on the female Sim Man manikin. Students demonstrate compassionate comfort care and effective communication through interaction with the Sim Man manikin and a live patient’s mother that is role played by a faculty member. Communication with the live patient’s mother is scripted to facilitate confidence and competence in EOL skills. Students demonstrate interdisciplinary collaboration through telephonic communication with a second faculty member acting out the role of interdisciplinary team members. An observer faculty member remains with the students to takes notes and be present for the debriefing session. The simulation is intended to run 45 minutes and then a 15 minute emotional break is provided before students proceed to the 60 minute debriefing session. Submitted Materials: 134.LIVING-WILL-DECLARATION-OF-Doris-Says.docx - https://drive.google.com/open?id=1DW-ATih3eQFchaIqI-_rWk6bw6q6uAj2&usp=drive_copy 134.Sim-Doris-Say.docx - https://drive.google.com/open?id=1DW-ATih3eQFchaIqI-_rWk6bw6q6uAj2&usp=drive_copy 134.Sim-Doris-Say-CAT-scan.docx - https://drive.google.com/open?id=1EJYxaxw_-OaMizWD_FnpAxGW-e8xMedG&usp=drive_copy 134.Sim-Doris-Say-H-and-P.docx - https://drive.google.com/open?id=1EIr0EmocjRw2h7BMlnfwr-wa7KvsDOyp&usp=drive_copy Additional Materials: Read the journal article: Sherman, D. W., Matzo, M. L., Pitorak, E., Ferrell, B. R., & Malloy, P. (2005). Preparation and care at the time of death: Content of the ELNEC curriculum and teaching strategies. Journal for Nurses in Staff Development, 21(3), 93-100. Complete the Caring Conversations for Young Adults available via web link http://www.practicalbioethics.org Read the Missouri Advance Directive available via web link http://www.caringinfo.org/files/public/ad/missouri.pdf Evaluation Description: This simulation was utilized during the Spring 2013 semester with third semester students after presentation of the oncology course content. Nine clinical groups participated in the EOL simulation. Student feedback indicated the simulation fostered a positive learning experience through an interactive approach to EOL communication. A live faculty member used to role play a grieving mother was positively received by students. Faculty observers and the debriefing faculty member reported the simulation was well organized, had good flow, and facilitated the necessary end-of-life competencies. The final page of the simulation includes an evaluation tool for students to complete following the simulation.

Published Back to Strategy Search Strategy Submission A template for simulation scenario development that incorporates QSEN competencies Author: Paula Jarzemsky MS, RN Title: Clinical Professor Coauthors: Institution: University of Wisconsin-Madison Email: pajarzem@wisc.edu Competency Categories: Evidence-Based Practice, Informatics, Patient-Centered Care, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN Learner Setting(s): Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: Communicate patient values, preferences and expressed needs to other members of health care team Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care Communicate with team members, adapting own style of communicating to needs of the team and situation Respect the centrality of the patient/family as core members of any health care team Follow communication practices that minimize risks associated with handoffs among providers and across transitions in care Value the concept of EBP as integral to determining best clinical practice Describe reliable sources for locating evidence reports and clinical practice guidelines Demonstrate effective use of technology and standardized practices that support safety and quality Navigate the electronic health record Document and plan patient care in an electronic health record Use high quality electronic sources of healthcare information Strategy Overview: Effective simulations engage students in realistic problems that require clinical data and decision-making, along with the opportunity to reflect on their practice. As interest in building simulation cases started to increase across our nursing faculty, it was felt that a design template would be useful to guide development and encourage incorporation of QSEN competencies. In future scenarios, an effort will be made to thread elements of patient-centered care, teamwork and collaboration, evidence-based practice, safety, and informatics. Submitted Materials: 100.QSEN_Simulation.doc - https://drive.google.com/open?id=1n2JkfiPECmbp6oAtiFaSwpbE23mfGPmG&usp=drive_copy Additional Materials: Evaluation Description: Two simulation scenarios have been developed with this template in mind: DVT/PE and Neutropenic Fever – contact author to send specific scenarios if interested. Both scenarios were well-received by students. Clinical faculty will begin using this template when planning additional scenarios next semester.

Published Back to Strategy Search Strategy Submission Simulation of Skills Fair Day Author: Deborah Wood MSN, RN Title: Associate Professor of Nursing Coauthors: Dr. Sarita James, PhD, RN-BC, CNE, Amie Starks, MSN, RN, Julie Bordelon, MSN, RN, Laurie Pittman, MSN, RN, Alexandra Deasis, MSN, RN Institution: Louisiana State University of Alexandria Email: dwood@lsua.edu Competency Categories: Evidence-Based Practice, Patient-Centered Care, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN, Quality and Safety Learner Setting(s): Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: 1. Perform accurate reconciliation of oral and parenteral medications followed by the appropriate medication administration for safe patient-centered care. 2. Perform complete head-to-toe assessment or focused assessment for medical surgical, obstetric, and pediatric patients while following prescribed client orders to safely deliver patient care. 3. Demonstrate accurate dosage calculation of insulin followed by safe medication administration. 4. Demonstrate appropriate intravenous therapy set up according to prescribed orders followed by fluid calculation for the safe administration of intravenous fluids and medications. 5. Demonstrate appropriate sterile technique while delivering care that requires sterile procedure following safe infection control protocols for patient safety (insertion of indwelling catheter, central line dressing change). 6. Demonstrate how to maintain patient safety for the insertion and maintenance of nasogastric tube with enteral feedings and medication administration. 7. Identify nursing implications to promote patient safety and patient-centered care for clients diagnosed with mental health disorders. 8. Demonstrate therapeutic communication techniques in the delivery of safe patient-centered care. 8. Follow appropriate infection control processes for safe patient-centered care. Strategy Overview: Each clinical semester, beginning in semester 2 of this concept-based curriculum, students learn skills that complement exemplars learned through didactic lecture and the clinical experience. The simulation of skills day (SOS) is designed to be a progressive clinical activity using patient care scenarios and situations with low fidelity simulation. These activities allow students at levels 2, 3, and 4 an opportunity to review the skills learned in previous semesters and provide faculty with an opportunity to identify deficits prior to students entering the clinical sites. The first semester student does not participate in simulation of skills day as this semester is reserved for skills lab learning basic skills before entering clinical sites. Second semester students for simulation of skills day are expected to complete stations in Medication Administration with Reconciliation, Barcode medication administration, sterile gloving, physical assessment, and infection control practices, including standard precautions. Third semester students are expected to go through each of the stations referenced above with the addition of insertion of indwelling catheter following sterile technique. The fourth semester students are to complete all stations referenced above with the addition of intravenous therapy which includes safe cannulation, performance of an IV push, and IV piggyback. REMOVED THIS STATEMENT … and completion of a simulation for mental health content entitled "Hearing Voices." (this activity accomplishes a mental health component of the course and was a mistake in original submission) Submitted Materials: TS-323-Attachment-A.docx - https://drive.google.com/open?id=1AtAEa2vHmZ83yPvcjuQVx9jdLkcn1OOq&usp=drive_copy TS-323.Attachment-B.docx - https://drive.google.com/open?id=1B-ZFuuUUFe1WraFwV-9mAqrimmOd-SW2&usp=drive_copy TS-323.Simulation-of-Skills-Fair-Quiz-CN3.docx - https://drive.google.com/open?id=1AtAEa2vHmZ83yPvcjuQVx9jdLkcn1OOq&usp=drive_copy 323.-Department-of-Nursing_Simulation-of-Skills-Day.docx - https://drive.google.com/open?id=1YFTvxXzLZd9eH0F9LB_lEiFdFbDR1zmY&usp=drive_copy Additional Materials: Attached is the faculty agenda with summaries and explanations. Other materials utilized for the charts for the med admin, etc. are available upon request. Also attached are the evaluations to be completed at each level and samples of the Moodle quizzes. Since completion of the Simulation of Skills Day is required before the student enters the clinical setting, for something different and ease of document archival, students complete the Simulation of Skills Day quiz by scanning a QR code, using their phone, and linking them to a Moodle Quiz. This quiz is non-punitive but provides a method of confirming attendance and key “takeaways” from the activity. Evaluation Description: Students who have participated in the Simulation of Skills Day have stated that the opportunity of being able to review patient skills learned prior to going back to clinical helped reduce their anxiety and helped them to remember how to perform skills safely in a non-threatening, non-punitive environment. Using the innovation of low-fidelity simulation with simple patient scenarios and situations is an evidence-based method to safely provide students with the opportunity to practice and demonstrate skills already learned. Faculty satisfaction was positive, reporting that conducting the simulation of skills day enabled them to identify student deficits in knowledge or competencies prior to clinical, enabling them to correct and direct students within the skills lab setting, prior to entering actual patient care settings. The evaluation students are asked to complete is a self-evaluation to capture both quantitative and qualitative data to evaluate the if the student felt that learning outcomes were met by participation in the learning activity. This evaluation is collected during the simulation of skills day debriefing session. The quantitative data is collected from students answers to questions on each learning outcome, whether the learning outcome was “Met” or “Not Met”. For each “Not Met”, students are requested to provide further comments. Qualitative data is collected from students answering a series of self-reflective questions relative to the activity and their clinical level. 100% (n=124) of the participants answered the student learning outcomes were “Met”. A Simulation of Skills Day Quiz was required at the completion of the activity at each level providing a “non-graded” assessment of important “takeaways” from the activity and an electronic archival of attendance. Students scanned the QR code provided to complete the online quiz through Moodle, confirming that they had completed Simulation of Skills day prior to going to clinical.

Published Back to Strategy Search Strategy Submission An Interprofessional Simulation of Opioid Overdose in the Community and Acute Care Setting Author: Jamie Hunsicker DNP, MS, RN Title: Associate Professor of Nursing Coauthors: Megan Lieb, DNP, RN Institution: Ohio Northern University Email: j-hunsicker@onu.edu Competency Categories: Patient-Centered Care, Teamwork and Collaboration Learner Level(s): Interprofessional, New Graduates/Transition to Practice, Pre-Licensure BSN Learner Setting(s): Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: The learner will provide simulated patient-centered care acknowledging the patient as the source of control and full partner (Patient-centered Care, Attitude). The learner will value the perspectives and expertise of all health team members including community partners (Teamwork and Collaboration, Attitude). The learner will describe scopes of practice and the role of health care team members related to the care of vulnerable populations (Teamwork and Collaboration, Knowledge). Strategy Overview: This simulation utilizes a standardized patient to promote interprofessional collaboration between nursing and forensic biology students, the county sheriff, and community emergency medical personnel including a sexual assault nurse examiner. The simulation bridges an outpatient emergency response in a mock home crime scene to an inpatient hospital setting allowing for 1) exchange of information and expertise of health team members, 2) understanding scopes of practice and roles of emergency and health care team members, 3) provision of patient-centered care during an unfolding clinical situation involving opioid overdose with components of sexual violence 4) recognition of the patient as the source of control and full partner. Submitted Materials: QSEN-324-Overdose-Attitudes-Scale.pdf - https://drive.google.com/open?id=1lh30OCdf3KDXgPZU-nsGiQ-eyadtr8NG&usp=drive_copy QSEN-324.Evaluation-of-simulation.docx - https://drive.google.com/open?id=13PrTl-bLgTAwSccAI6FhYSWMf0srngL8&usp=drive_copy Additional Materials: Please see attached: Provider orders Simulation overview Evaluation Evaluation Description: The effectiveness of this learning experience is evaluated through focused debriefing and comparison of pre-and post-simulation Opioid Overdose Attitudes Scale results. Participation in an opioid overdose simulation that incorporates sexual violence supports the development of student knowledge, skills, and attitudes related to patient-centered care delivered utilizing an interprofessional team. The Opioid Overdose Attitudes Scale demonstrates significant results indicating students feel more comfortable in their role as part of the health care team. Additional student exemplar statements, including “The main focus is the patient… giving the power back to them” and “I didn’t realize all of the interprofessional communication that goes into these situations” demonstrates achievement of simulation objectives.

Published Back to Strategy Search Strategy Submission Patient Safety Teaching Case - Hyperkalemia 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: Safety Learner Level(s): Continuing Education, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN, Staff Development Learner Setting(s): Classroom Strategy Type: Online or Web-based Modules Learning Objectives: Knowledge: Examine human factors and basic safety design principles as well as commonly used unsafe practices as they relate to an adverse event in health care. Describe the benefits and limitations of information systems in the improvement of health care quality. Discuss effective strategies to improve medication safety. Attitudes: Value the balance between professional autonomy and standardization or reliability. Appreciate the cognitive and physical limits of human performance. Recognize the value of engaging in root cause analysis rather than blaming when error or near misses occur. Value relationship between national patient safety campaigns and implementation in local practices settings. Skills: Use appropriate strategies to reduce reliance on memory. Demonstrate an effective use of strategies to reduce risk of harm to others. Participate appropriately in analyzing errors and designing systems improvements. Strategy Overview: The attached case describes an adverse event in which an infant received a potentially lethal overdose of potassium via intravenous infusion. Although the infant fortunately suffered no permanent harm from this event, this case affords students an opportunity to review the many factors that contributed to this serious error. In reviewing this case, nursing students are challenged to look beyond blaming one or more health care workers for this mistake, and instead identify system issues (latent factors) that led to the environment where such an event could occur. They are then challenged to identify possible system interventions that might lead to safer systems of care in the future. We have utilized this primarily in small group settings (some single-specialty, some interprofessional), usually in the format of a simulated root cause analysis. However, this case could also be utilized for computer-based training. Submitted Materials: Additional Materials: Evaluation Description: Learner evaluations of sessions in which this teaching case has been utilized have indicated that the case was felt to be helpful in learning important patient safety principles.

Published Back to Strategy Search Strategy Submission High-Fidelity Simulation to Teach the Role of the Advanced Practice Nurse in Palliative Communication Author: Adrienne Markiewicz MSN, RN, AGACNP-BC Title: Clinical Instructor Coauthors: Natalie McAndrew PhD, RN, ACNS-BC, CCRN-K Institution: University of Wisconsin-Milwaukee Email: markiewi@uwm.edu Competency Categories: Evidence-Based Practice, Patient-Centered Care Learner Level(s): Graduate Students Learner Setting(s): Skills or Simulation Laboratories Strategy Type: Case Studies Learning Objectives: 1. Conduct assessments appropriate for care of patient in an organized and systematic manner. 2. Assess and treat pain and suffering in light of patient values, preferences, and expressed needs 3. Value and uphold shared decision-making with empowered patients and families 4. Make clinical judgments, decisions and recommendations that are evidence-based. 5. Demonstrate knowledge of legal and ethical obligations related to patient-centered care. QSEN Graduate Patient Centered Care Competency Knowledge Analyze multiple dimensions of patient-centered care: • patient/family/community preferences, values • coordination and integration of care • information, communication, and education • physical comfort and emotional support • involvement of family and friends • transition and continuity Skills Elicit patient values, preferences, and expressed needs as part of clinical interview, diagnosis, implementation of care plan, and evaluation of care Communicate patient values, preferences, and expressed needs to other members of healthcare team Provide patient-centered care with sensitivity, empathy, and respect for the diversity of human experience Assess and treat pain and suffering in light of patient values, preferences, and expressed needs Attitude Value seeing health care situations ‘through patients’ eyes’ Respect and encourage individual expression of patient values, preferences, and expressed needs Value the patient’s expertise with own health and symptoms Honor learning opportunities with patients who represent all aspects of human diversity Willingly support patient-centered care for individuals whose values differ from own Seek to understand one’s personally held values and beliefs about the management of pain or suffering Strategy Overview: This strategy allows graduate APRN students to practice principles of palliative communication for patients with chronic illness disease trajectory through an unfolding, two-scenario high fidelity simulation of the same patient. By extending the same patient case through two scenarios, students can see a realistic illness trajectory and simulate their role as the APRN in goals of care discussions with both the patient and her family. Pre-briefing materials provide didactic instruction on palliative communication, patient-centered care, and shared decision making. Structured debriefing allows the student to analyze the experience through the lens of patient centered care, affirming the necessity of valuing and upholding shared decision-making, even when disagreements occur. The scenario also examines the legal and ethical implications of shared decision-making in the incapacitated patient. Submitted Materials: PalliativeSimulationDesignPlan-1.docx - https://drive.google.com/open?id=10AjmQUEtKlL7xtWTemA651vtfEKgLcA9&usp=drive_copy Handout-for-Students-for-Simulation-1-2.docx - https://drive.google.com/open?id=1yJXHwGfKgjeQrT6y2_Yz1WckdWq7SbsT&usp=drive_copy Handout-for-Students-for-Simulation-2-1.docx - https://drive.google.com/open?id=1ykDP5y2-U6BtJsWgf1jmbNNl1_nvGSbC&usp=drive_copy Worksheet-for-Students-to-Complete-During-Sim.docx - https://drive.google.com/open?id=1BYX6dxI1KulZMIg-yxkRrudbk7oqTJf-&usp=drive_copy Additional Materials: Attached to this submission, author can be contacted at markiewi@uwm.edu for additional information. Evaluation Description: Simulation debriefing was conducted after each scenario with the graduate nurse learners using the debriefing questions found in the simulation progression outline document.

Published Back to Strategy Search Strategy Submission Critical Care Guidelines and Values: The Basics for Nursing Students Author: Savana Eaton Student Nurse Title: Coauthors: Angela D. Jones, DNP, RN; Joy Shupak, MSN, RN Institution: Stephen F. Austin State University Email: savanaeaton1@gmail.com Competency Categories: Patient-Centered Care, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Clinical Setting, Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: 1) Patient-Centered Care: a. Skills- i. Assess the presence and extent of pain and suffering. b. Attitudes - i. Recognize the role of the nurse in relief of all types and sources of pain and suffering. ii. Value the patient’s expertise with health and symptoms. 2) Teamwork and Collaboration: a. Skills – i. Demonstrate awareness of own strengths and limitations as a team member. 3) Safety: a. Skills – i. Demonstrate effective use of strategies to reduce the risk of harm to self or others. ii. Use appropriate strategies to reduce reliance on memory. b. Attitudes – i. Value own role in preventing errors. Strategy Overview: The Critical Care Guidelines and Values: The Basics for Nursing Students pocket card is a clinical tool for use with prelicensure nursing students. Incorporating the card in the clinical setting allows the student to focus on patient-centered care to assess the presence and extent of pain and suffering in his/her patient(s). It also promotes the recognition of the role of the nurse in relief of pain and suffering encouraging the student to value the patient’s experience and expertise with their health and associated symptoms. The pocket card promotes safety as it reduces reliance on memory, aids the pre-licensure student in prioritizing care, and offers insight in applying critical care concepts to patients with complex problems. This promotes teamwork and collaboration as the student identifies and communicates his/her assessment findings, interpretation of laboratory and electrocardiogram (EKG/ECG), and the needs of the patient. Directions for use: The Critical Care Guidelines and Values: The Basics for Nursing Students pocket card is printed and laminated for use in all clinical settings. The card is provided to students at the beginning of the critical care (advanced medical-surgical) course. Students are instructed to keep the card with them to help guide their patient assessment focusing on agitation and sedation, and interpretation of the electrocardiogram (EKG/ECG) and laboratory data. The students are encouraged to communicate their assessment findings with the primary nurse and their clinical instructor. Additionally, the students are reminded to evaluate and communicate all patient and/or family concerns, requests, and/or needs. Directions for use: The Critical Care Guidelines and Values: The Basics for Nursing Students pocket card is printed and laminated for use in all clinical settings. The card is provided to students at the beginning of the critical care (advanced medical-surgical) course. Students are instructed to keep the card with them to help guide their patient assessment focusing on agitation and sedation, and interpretation of electrocardiogram (EKG/ECG) and laboratory data. The students are encouraged to communicate their assessment findings with the primary nurse and their clinical instructor. Additionally, the students are reminded to evaluate and communicate all patient and/or family concerns, requests, and/or needs. Submitted Materials: Critical-Care-Guidelines-and-Values-Feb.-22019-2.pdf - https://drive.google.com/open?id=1d9jXqRpx9UNGHWO28CXftlhAk4W9nNv4&usp=drive_copy Additional Materials: Evaluation Description: Evaluation of student performance in laboratory, simulation, and clinical settings offers insight as to the efficacy of the pocket card to enhance clinical knowledge and patient care. Formative evaluation of student learning in the clinical setting allows for immediate feedback and intervention by nursing faculty to facilitate safe, effective patient-centered care. Encouraging open dialogue between the student, nursing faculty, and members of the health care team fosters teamwork and collaboration further promoting quality health care.

Published Back to Strategy Search Strategy Submission Patient Safety Teaching Case - Wrong Patient Procedure Author: Leslie W. Hall M.D. Title: Associate Professor of Clinical Internal Medicine Coauthors: Kathryn J. Nelson, MHA; Director of Quality and Patient Safety; SSM St. Mary’s Health Care Institution: University of Missouri - Columbia Email: HallLW@health.missouri.edu Competency Categories: Safety Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Clinical Setting Strategy Type: Online or Web-based Modules Learning Objectives: Knowledge: Examine human factors and basic safety design principles as well as commonly used unsafe practices as they relate to an adverse event in health care. Describe the benefits and limitations of information systems in the improvement of health care quality. Discuss effective strategies to improve reliability of patient identification in delivery of health care. Attitudes: Value the balance between professional autonomy and standardization or reliability. Appreciate the cognitive and physical limits of human performance. Recognize the value of engaging in root cause analysis rather than blaming when error or near misses occur. Value relationship between national patients safety campaigns and implementation in local practices settings. Skills: Use appropriate strategies to reduce reliance on memory. Demonstrate an effective use of strategies to reduce risk of harm to others. Participate appropriately in analyzing errors and designing systems improvements. Strategy Overview: The attached case describes an adverse event in which the wrong patient with a similar sounding name was contacted and asked to come to the hospital for a procedure. Although the patient did not suffer any permanent harm from this event, the patient did experience inconvenience and minor discomfort, and the involved health care workers and system suffered significant embarrassment. In reviewing this case, nursing students are challenged to look beyond blaming one or more health care workers for this mistake, and instead identify system issues (latent factors) that led to the environment where such an event could occur. They are then challenged to identify possible system interventions that might lead to safer systems of care in the future. We have utilized this primarily in small group settings (some single-specialty, some interprofessional), usually in the format of a simulated root cause analysis. However, this case could also be utilized for computer-based training. Submitted Materials: Additional Materials: Evaluation Description: Learner evaluations of sessions in which this teaching case has been utilized have indicated that the case was felt to be helpful in learning important patient safety principles.

Published Back to Strategy Search Strategy Submission Exploring the Complexity of Advocacy: Balancing Patient-Centered Care and Safety Author: Pamela M. Ironside PhD, RN, FAAN Title: Associate Professor Coauthors: Institution: Indiana University School of Nursing Email: pamirons@iupui.edu Competency Categories: Patient-Centered Care, Safety Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Classroom Strategy Type: Online or Web-based Modules Learning Objectives: Integrate understanding of multiple dimensions of patient centered care: Patient/family preferences, values Coordination and integration of care Involvement of family and friends Provide patient-centered care with sensitivity and respect for the diversity of human experience Acknowledge the tension that may exist between patient rights and the organizational responsibility for professional, ethical care Act with integrity, consistency and respect for differing views Initiate requests for help when appropriate to situation Explore ethical and legal implications of patient-centered care Describe basic principles of consensus building and conflict resolution Value vigilance and monitoring (even of own performance of care activities) by patients and families Strategy Overview: I have been a diabetic for 33 years of my life. I am 43-years-old, a divorced father of two, a grandfather of one, and a brother to three. I sell cars for a living and most months barely make ends meet. I don’t have the best health insurance so I have to pay for most of my diabetic supplies and office visits out of pocket. I had seen my doctor 3 times in the last six months for chest pain and he said I was having panic attacks. Then one night I had my fiancé take me to the emergency department at our local hospital because I was more short of breath than “usual” with these panicky feelings I was having. Well, come to find out I was having a heart attack. I am not ready to die and don’t want to be a cardiac cripple like my dad. I am too young! I am finally in love again and things are getting good in my life. Well, I ended up being transferred to a large hospital about an hour away from my home because I needed bypassing of four of my major arteries that supply blood to my heart. Because I am a diabetic I live with my insulin pump and have very strong feelings about managing my blood sugar. Despite what they tell me “normal range” is, I know exactly where my sugar needs to be at exactly what time of the day in order for me to feel good and stay healthy. So, of course my chief concern in facing this heart surgery was how I was going to run my pump (bolusing myself or changing the basal rate) if I was “out of it” after surgery. The nurses were insistent about stopping the pump and putting me on an insulin drip because that is their routine for caring for diabetic patients post-op. But I know myself and that really messes my blood sugars up! Wasn’t my body going through enough stress the way it is? I was really steamed and I was worried that I would not recover like I should if they messed with my sugar so I pressed the issue. Besides, my mother is a nurse and would be at my beside and more than capable of monitoring my pump while I was zoned out. Well, the nurse manager finally came in and told me that the nurses weren’t comfortable with my pump because it is different than what they usually see. She suggested I purchase a new pump so they could manage it better—it was the only way she could keep me safe. If you were the nurse assigned to care for this patient, what would you do at this point and why? As you formulate your answer to the above question, also reflect Topics to discuss with a Cougar on the following: Whose interests are being served by “standard post-op orders?” What is the relationship between nurses having control of patient care and patients being safe? How is “safety” determined? How do nurses account for patients’ experience and embodied knowing? What is the meaning and significance of a patient’s experience of illness? How exactly would you include the patient as a co-collaborator in his care? When patient safety and patient wishes conflict, how do nurses decide what approach to take in each particular case? If this patient was your brother or father, how would you intercede to influence the staff in respecting his requests? What does it mean to patients’ and their care to have an advocate? Submitted Materials: Additional Materials: Evaluation Description: This exercise is intended for discussion, creating the opportunity for students to explore the complexities of advocacy in light of commitments to both patient-centered care and safety. In my experience, students initially tend to “side” with either the patient or the nurses and argue for the ascendancy of their perspective rather than exploring issues such as: a) the common concerns patients/families and nurses share, b) how common routines and practices inadvertently curtail communication and the consideration of workable alternatives, and c) how nurses, “with their hearts in the right place,” may use power over patients when conflicts arise. Alternatively, you can ask students to share experiences wherein they experienced being “discounted” or ignored or when their own actions or decisions were deemed unsafe by others who disagreed with them. Again, the point of these discussions is to engage students to exploring advocacy and the difficulty of being a patient advocate in situations that are new, unfamiliar, contentious or potentially dangerous. In most cases, this is an ungraded exercise or, alternatively, students may be marked with a pass/fail (passing for participating in the discussion). If you are asking students to journal in your course, this may also be something students reflect on further and create a journal entry describing their thinking related to this case. This will allow you to evaluate the extent to which students are becoming more adept at thinking through difficult clinical quandaries.