Published Back to Strategy Search Strategy Submission Giving and Receiving Constructive Feedback Author: Gerry Altmiller EdD, APRN, ACNS-BC Title: Associate Professor Coauthors: Institution: The College of New Jersey Email: Altmillg@TCNJ.edu Competency Categories: Quality Improvement, Safety, Teamwork and Collaboration Learner Level(s): New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN, Staff Development Learner Setting(s): Classroom, Clinical Setting Strategy Type: Online or Web-based Modules Learning Objectives: This is a narrated presentation focused on helping students to understand the importance of learning to give and to receive constructive feedback. Key points include understanding constructive feedback's role in quality improvement and patient safety, and learning to view constructive feedback as an opportunity for improvement. It addresses the following KSAs: Teamwork and Collaboration, Describe impact of own communication style on others; Discuss effective strategies for communicating and resolving conflict; Explain how authority gradients influence teamwork and patient safety, S-Communicate with team members, adopting own style of communicating to needs of the team and situation; Solicit input from other team members to improve individual, as well as team performance; Assert own position/perspective in discussions about patient care; Choose communication styles that diminish the risks associated with authority gradients among team members, A-Value teamwork and the relationships upon which it is based; Contribute to the resolution of conflict and disagreement; Quality Improvement; Recognize that nursing and other health professions students are parts of systems of care and care processes that affect outcomes for patients and families; A-Value own and others' contributions to outcomes of care in local care settings. Safety: Describe factors that create a culture of safety (such as open communication strategies and organizational error reporting; S-Communicate observations or concerns related to hazards and errors to patients, families, and the health care team; A-Value vigilance and monitoring (even of own performance of care activities) by patients, families, and other members of the health care team. Strategy Overview: This is a narrated presentation. Students may listen to it on-line, at home, or in the classroom with a faculty member. The presentation can be loaded into Electronic Course Frameworks and assigned. If assigned as an out of class activity, faculty can have students blog or post in discussions about what they gained from the presentation. Submitted Materials: Giving-and-Receiving-Constructive-Feedback-2.pptx - https://drive.google.com/open?id=113AUP_VmsfZ0EADOqkDsKxWpTn_hIn8m&usp=drive_copy Additional Materials: Evaluation Description: Evaluation strategies can include a blog or discussion post to determine what students gained from listening to the presentation. Faculty can initiate a classroom discussion focused on the value of feedback and strategies students learned from the presentation to help them give and receive constructive feedback.

Published Back to Strategy Search Strategy Submission Test Taking Strategies Author: Janine Messer BSN, RN Title: MSN graduate student Coauthors: Institution: Ohio University Email: jmesser@hondros.edu Competency Categories: Evidence-Based Practice, Patient-Centered Care, Safety, Teamwork and Collaboration Learner Level(s): New Graduates/Transition to Practice Learner Setting(s): Classroom Strategy Type: Online or Web-based Modules Learning Objectives: The student will develop a basic understanding of nursing skills while reviewing rationales for approaches to care that result in appropriate patient outcomes. Discussion regarding the importance of choice of intervention is highly integrated into this strategy. Students learn to base care plans on patient values, clinical expertise and evidence-based practice. The student will recognize that patient-centered care is developed through integration of knowledge related to coordination and integration of care and interventions necessary to provide to patients, family and community members. This strategy includes exploration of legal and ethical issues, examination of safe practice, and demonstration of understanding of therapeutic interventions and the role of the nurse in practice. 3. The student will analyze the process of teamwork and collaboration. This skill is enhanced through a vast knowledge base, which reviews the concepts of effective communication with members of the interdisciplinary team. This includes development of the nursing roles of delegation and prioritization. 4. The student will develop recognition of safety as a major priority in nursing care. In building the knowledge base of the new nurse, it is essential to integrate safe practice and be proficient in identifying potential errors. Discussing the errors and hazards in the patient care setting is a theme that is presented through question and answer sessions and review of rationales showing safe care techniques and interventions that potentially put the patient at risk. Strategy Overview: It is apparent that there is a continual necessity to develop strategies to help engage the online learner and promote successful progression of their learning needs. For the purpose of this project, test-taking strategies are utilized in specific relation to becoming proficient in NCLEX style questions. The NCLEX review course is presented in either the classroom or online forum. Sessions are two hours in length and for the purpose of this project were held via the Adobe Connect system. This can be an effective avenue for study in preparation for the HESI exit examination and for alumni students wishing to review material in preparation of their Ohio Board of Nursing examination. A two-hour session consists of NCLEX review questions and detailed power point presentations teaching students the strategies of test taking. Several topics are covered such as study techniques, anxiety reduction strategies, and specific tools to be a successful test taker. Students are able to participate via a chat room and they can hear the instructor via audio. Students can respond and interact by typing into the chat room. In utilizing the following test taking strategies, students can increase their success as a test-taker specifically concentrating on NCLEX style questions. The major strategies implemented are: POW-put it in your own words (rewording the question) KEY WORDS-pick out key words to prioritize responses (best, most, first, initial) ELIMINATION-using the process of elimination to take out the incorrect responses and derive the correct answer MASLOW’S HEIRARCHY OF NEEDS-utilization of Maslow’s Hierarchy of Needs to determine priority questions (What does the nurse do first?) ERIKSONS STAGES OF PSYCHOSOCIAL DEVELOPMENT-to determine age specific questions based on developmental milestones ADPIE-deriving the correct response by using the nursing process (we assess before we implement) ABC’s-determining the appropriate answer to a priority question by using Airway-Breathing-Circulation (we protect the airway first) PHAN-Priority-Hierarchy-ABC’s-Nursing Process (the order in which we use the strategies in a priority question) Submitted Materials: Additional Materials: For additional resources, please feel free to contact me via email at jmesser@hondros.edu Evaluation Description: This review course has been developed to include both the practical and associate degree-nursing students. There is an attached the power point with respective data showing that the first cohort of students who were active participants in the review sessions significantly increased their scores on their second attempt at the HESI exit examination after attending as active participants in the review sessions. Active participants are defined as those students who attended three or more online review sessions. Non-active participants are defined as students who attended three or less review sessions. Data includes information regarding students who were active participants versus non-active participants (those students who attended three or less review sessions) in relation to their scores on the HESI exit examination. This data was obtained via reports in the Adobe Connect system showing student participation and time in the session. Scores from the HESI exit examination were reviewed and included in the data presentation. These students significantly increased their scores on the HESI exit examination. Additionally, the student population has provided extensive verbal and written feedback regarding the effectiveness of the presentations. Review of current HESI and NCLEX pass rates has further substantiated the effectiveness of the project. Included in the attachments are the respective power point presentations regarding test-taking strategies for the faculty and student. The faculty power point presentation educates the instructor on how to facilitate successful student learning in the subject of test taking strategies and study tips. The student version of this presentation instructs the learner in basic test taking strategies and study tips. Also attached is a sample of a review session power point presentation.

Published Back to Strategy Search Strategy Submission Clinical Focus: Interprofessional and Patient-Centered Care Author: Cynthia Rothenberger DNP, RN, ACNS, BC Title: Assistant Professor, Nursing Coauthors: Institution: Alvernia University Email: cynthia.rothenberger@alvernia.edu Competency Categories: Patient-Centered Care, Teamwork and Collaboration Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Clinical Setting Strategy Type: General Strategy Learning Objectives: Learning Outcomes: -Describe the scope of practice and roles of interprofessional team members -Value the perspectives and expertise of all interprofessional team members in assisting clients and families meet health care goals -Value active partnership with the client/family in planning, implementing and evaluating care -Propose a strategy for improving interprofessional or patient-centered care for an assigned client in an acute care setting by the end of the clinical day Strategy Overview: Strategy Overview: Recognizing the value of members of the health care team, ensuring the patient and/or family are active partners, and participating in a team-based approach to care are basic competencies which are necessary for safe patient care (American Association of Colleges of Nursing, 2008; National League for Nursing, 2016). Collaboration with members of the interprofessional team is also included on the NCLEX-RN test plan (National Council of State Boards of Nursing, 2019). This teaching strategy is intended to introduce novice prelicensure nursing students to interprofessional and patient-centered care. Strategy Implementation: This learning activity was used in a junior-level prelicensure clinical course. Students had experiences in medical-surgical, pediatric and maternal-child nursing during the semester, and could complete the activity during any inpatient clinical day. The attached worksheet (Clinical Focus: Interprofessional and Patient-Centered Care) was completed about the assigned patient, in addition to the routine client assessment worksheet, and submitted to the Clinical Instructor at the end of the day. Clinical Instructors were encouraged to discuss student observations and recommendations during post-conference. This learning activity could be adapted to any clinical setting. It could also be used as an alternative clinical activity for low census days or days when an assigned client is discharged. References: American Association of Colleges of Nursing. (2008). The essentials of baccalaureate education in nursing. Retrieved from http://www.aacnnursing.org/portals/42/publications /baccessentials08.pdf National Council of State Boards of Nursing. (2015). 2019 NCLEX-RN test plan. Retrieved from https://www.ncsbn.org/testplans.htm National League for Nursing. (2016). Guide to effective interprofessional education experiences in nursing education. Retrieved from http://www.nln.org/docs/default-source/default-document-library/interprofessional-education-and-collaborative-practice-toolkit1.pdf Submitted Materials: QSEN-Clinical-Focus-Interprofessional-Care-2019-1.docx - https://drive.google.com/open?id=13t4OXD8MqBtbB3GtWPMAotDfdop0J_oc&usp=drive_copy Additional Materials: Evaluation Description: This learning activity was pass/fail, based on submission of a completed worksheet. Formative verbal feedback on the learning outcomes was provided during post-conference discussion. Students received written formative feedback about all learning outcomes from the Clinical Instructor on the submitted worksheet. Formative feedback focused on the quality and completeness of student responses to each question on the worksheet. Although not formally graded, the Instructor considered this learning activity when evaluating student performance for the following outcome on the Clinical Evaluation for the week: “Demonstrates understanding of evidence-based health care specific to patient care in weekly clinical assignments”. This clinical learning outcome was evaluated using a scale on the evaluation form (0 = Does not meet standard, 1 = Meets expected standard with direction/instruction from faculty, 2 = Meets expected standard). The form, with Instructor feedback, was returned to the student during the following clinical week. Each student submitted the completed form, with Clinical Instructor feedback, at the end of the semester as part of the Clinical Portfolio. Submission of all components of the Clinical Portfolio was a small portion of the final course grade. Anecdotal feedback from students and Clinical Instructors indicated this was a valuable learning experience. Students commented that they developed a more detailed understanding of the role of interprofessional team members in patient care across various settings, and increased awareness of strategies which could be used to ensure that the patient’s perspective was considered when planning and implementing care. In addition, faculty feedback indicated that students were better prepared for an interprofessional experience in a later clinical course.

Published Back to Strategy Search Strategy Submission Identifying Continued Use of Error Prone Abbreviations Author: Gail Armstrong ND, RN Title: Assistant Professor Coauthors: Institution: University of Colorado Denver College of Nursing Email: gail.armstrong@ucdenver.edu Competency Categories: Safety Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Clinical Setting Strategy Type: Case Studies Learning Objectives: Examine human factors and other basic safety design principles as well as commonly used unsafe practices (such as work-arounds, and dangerous abbreviations). Demonstrate effective use of technology and standardized practices that support safety and quality. Value the contributions of standardization/reliability to safety. Participate appropriately in analyzing errors and designing system improvements. Value vigilance and monitoring (even of own performance of care activities) by patients, families and other members of the health care team. Value relationship between national safety campaigns and implementation in local practices and practice settings. Strategy Overview: This clinical learning activity is appropriate for early clinical courses in a pre-licensure curriculum. In Colorado, where this strategy was developed, there is a long term care rotation in Fundamentals of Nursing. This learning activity is used in that rotation. The activity would also fit well for a junior Med/Surg clinical rotation. Before class, I assign the students the following homework: Go to the website for The Institute for Safe Medication Practices (www.ismp.org ). Under the “Medication Safety Tools and Resources,” print out the “Error Prone Abbreviation List.” Review the list and be sure that you are familiar with the abbreviations to avoid, the misinterpretations that have been reported, and the potential danger in their continued use. During class I lead a discussion on ISMP’s Error Prone Abbreviation List. We talk about the evolution of this list, the overlap of ISMP’s work with The Joint Commission’s National Patient Safety Goal that focused on abbreviations to avoid. I ensure during this class that all students have printed off the list and have a strong working knowledge of the list’s implementation in the practice setting. During this class I also review The Health Insurance Portability and Privacy Act (HIPPA), and have the students review the nature of deidentified patient data. The students then receive this assignment for a day at their clinical rotation: During your clinical rotation, as you review patient charts to prepare for patient care, keep a running list of all of the “error prone abbreviations” that you come across. Do not include any patient identifying information in your notes – all of your notes must be deidentified patient data. Keep record of the following information: • Copy down the error prone abbreviation in the context of the order or documentation, as it is written • If the error prone abbreviation is repeated in a set of orders or documentation, keep track of its recurrence. • Keep track of recurrence of error prone abbreviations by provider (e.g. LIP #1, LIP #2, RN #1, RN#2 etc…) Type up the inclusive list of error prone abbreviations that you found in charts. Create a two column table where for every use of an error prone abbreviation, you write how the order or documentation should have been correctly written, without the error prone abbreviation. See the example below: Error Prone Abbreviation as found in chart Correction for Order “give 10u regular insulin now” Give 10 units of regular insulin now “5,000u of heparin SC qd” 5,000 units of heparin subcutaneously daily After you have typed up your table, choose 3 examples of incorrectly written orders or incorrect documentatoin, and explicate what might have been a patient outcome if each of these 3 error prone abbreviations had been misinterpreted. What might be the dosage calculation error? Would the error result in underdosing a patient, or potentially overdosing a patient? Look up the normal limits for that medication and infer possible patient outcomes. What are other ways that patient care might be compromised by the misinterpretation of these 3 orders or pieces of documentation? Please conclude this write-up with a summary of what you learned from this data mining exercise. Were there any patterns to what you found (e.g. recurring offenders, recurring circumstances around the incorrect documentation, etc…). How will this exercise impact your nursing practice (please stretch for an insight beyond, “I will not use error prone abbreviations.”) Submitted Materials: Additional Materials: Evaluation Description: Possible total points: 100 List of error prone abbreviations from charts, without any patient identifiers: 10% Table listing incorrect documentation, with correct documentation 10% Clinical implications of incorrect documentation – example #1 20% Clinical implications of incorrect documentation – example #2 20% Clinical implications of incorrect documentation – example #3 20% What was learned from this exercise/impact on practice 20%

Published Back to Strategy Search Strategy Submission Evolving Stem Cell Transplant Simulation Scenario: Stem Cell Infusion and Mock Code Author: Naomi Cazeau MSN, ANP-BC, AOCNP Title: Adult Stem Cell Transplant Nurse Practitioner & Ed.D student Coauthors: Institution: Memorial Sloan Kettering Cancer Center/ Teachers College, Columbia University Email: cazeaun@mskcc.org Competency Categories: Patient-Centered Care, Safety, Teamwork and Collaboration Learner Level(s): Staff Development Learner Setting(s): Skills or Simulation Laboratories Strategy Type: Case Studies Learning Objectives: 1.Enhance learner knowledge and confidence with the stem cell infusion process (knowledge, attitudes) 2.Orient learner to key elements of the interdisciplinary management of the critically ill BMT patient (knowledge, attitudes) 3.Review basic components of stem cell infusion process (knowledge, skills, attitudes) 4.Demonstrate patient and room set up for a stem cell infusion (skills) 5.Identify primary components of emergency code cart (knowledge, skills, attitudes) 6.Apply evidence-based communication techniques (i.e., SBAR, closed loop) to a resuscitation event (skills, attitudes) 7.Simulate the interdisciplinary management of a BMT patient emergency (knowledge, skills, attitudes) Strategy Overview: According to Stephenson (2015), simulation can be used to ensure competency and evaluate nursing performance with high risk/low frequency procedures and processes. Stem cell transplantation and codes are both such events in healthcare. This strategy submission details the design of a stem cell infusion/mock code simulation learning activity for the professional development setting. The simulation is based on a stem cell infusion evolving case study, wherein the patient rapidly declines and requires a medical code. The program was designed and implemented within an inpatient stem cell transplant unit orientation for new graduate nurses. The topic was selected based on a needs assessment from the unit clinical nurse specialist and one of the senior staff nurses. The simulation program aims to enhance learner knowledge and confidence with the stem cell infusion process and orient the learner to the key elements of the interdisciplinary management of a critically ill stem cell transplant patient. The program also aims to foster clinical reasoning, clinical judgement, and improved communication skills within the new graduate nurse. Evidence Institutions vary in the prescribed clinical practice guidelines and role for the bedside nurse managing patients with stem cell infusions. Hematopoietic stem cell transplantation: A manual for nursing practice (Ezzone, 2013), published by the Oncology Nursing Society, guided the stem cell infusion aspect of this activity. For the mock code, Kaye’s (1981) landmark article on mega-code for advanced cardiac life support provided an evidence-base. More recent literature was also used to guide the design of the mock code (Adams, Dobbs, Greene, MacGillis, & Stockhausen, 2002; Spunt, Foster, & Adams, 2004). Theoretical Framework According to the International Nursing Association for Clinical Simulation and Learning (INACSL, 2016) a theoretical or conceptual framework is a required element of simulation design. Frameworks help structure learning activities and provide guidance in how learners connect clinical learning to theoretical knowledge. Simulation frameworks should align with overall program curricula objectives, simulation objectives, and the knowledge and skill level of anticipated learners (INACSL, 2016; Nehring & Lashley, 2010). The Outcome-Present State-Test (OPT) Model (Persut & Herman, 1998), The Nursing Process (Yura & Walsh, 1988), and PEARLS Debriefing Model were the conceptual frameworks used in this simulation scenario. The OPT model is an outcomes-focused approach to the nursing process (Persut & Herman, 1998). According to Persut & Herman (1998), “This process results in framing the context and content of clinical reasoning for the purpose of testing outcome achievement. Outcome achievement is determined by juxtaposing outcome-state criteria with present-state client data” (pg. 29). The OPT model has encouraged clinical reasoning within high-fidelity simulation in nursing education (Kuiper, Heinrich, Matthias, Graham, & Bell-Kotwall, 2008). Because clinical reasoning is a learning outcome of interest, this model was chosen as the framework for the pre-briefing portion of the activity. Promoting Excellence and Reflective Learning in Simulation (PEARLS; Eppich & Cheng, 2015) is a blended scripted debriefing framework, which consists of four phases (reaction, description, analysis, and summary). This scripted model facilitates debriefing for the novice simulation educator. A pediatric study using the EXPESS scripted debriefing model also showed the effectiveness of a similar model in improving knowledge acquisition among learners in a simulated cardiopulmonary arrest (Cheng et.al., 2013). For these reasons, PEARLS scripted debriefing model was chosen for the debrief of this simulation. The nursing process (Yura & Walsh, 1988) was the conceptual framework used to structure the simulation scenario. Based on the patient’s background and clinical data, learners will be expected to make specific nursing assessments and interventions. Setting This activity was designed for a group of 8 new graduate nurses, as part of orientation to an inpatient stem cell transplant unit. The simulation lab at the hospital where this activity took place consisted of a mock hospital room (including vital signs control monitor, bed, wall oxygen, suction and air, infusion pump, primary and secondary infusion bags and tubing, bedside table, dining tray, code cart, supply cart [including infusion bags, IV tubing, peripheral IV insertion kits, central line dressing kits, gauze, medical tape, urinals, indwelling catheter insertion kits, and toiletries], and a desktop computer). The Laerdal SimMan is located in this room, on the hospital bed. The manikin is a Caucasian adult male, dressed in a hospital gown. Wigs are available, if required for a female scenario. The lab does not have a control room or audiovisual recording capability. There is not a separate room available for pre-briefing and debriefing. There is a conference table (~120W x 48D) with 10 office chairs, a projector screen (with connectivity to the labs desktop computer), and projector available in the simulation lab. The Nursing Education department allotted 4 hours of simulation lab time for this activity. The plan was to allot 30 minutes in orientation; 30 minutes in pre-briefing; 1 hour in the scenario (30 minutes each for two 4-learner groups); and 2 hours in debriefing and evaluation. The simulation takes place in 2 phases; phase 1 includes the stem cell infusion and phase 2 includes the mock code. The first 4-learner group will perform phase 1 of the simulation and hand-off the patient to the following group, who will perform phase 2. Prebriefing Prebriefing is the phase of simulation in which the learners are generally oriented to the simulation activity. Facilitators can use this period to introduce the learning objectives, scenario, roles, program schedule, and confidentiality agreement (Page-Cutrara, 2014). Theoretical content can also be reviewed in this phase to ensure learners all have the knowledge basis needed to proceed with simulation activity. The prebriefing for the stem cell infusion/mock code simulation begins with a welcome, wherein the instructor and learners each introduce themselves. The instructor describes their role as facilitator and informs participants that the goal is for them to actively learn from one another. The instructor also establishes a non-judgmental safe environment where mistakes are anticipated and will be used as a means of learning. The objectives and schedule outline are reviewed, followed by a review and signing of the confidentiality agreement. Pesut & Herman (1998) explain that knowledge work (reading, memorizing, writing, practicing) is essential to clinical reasoning. In preparation for simulation, learners would be provided with required reading 1-week prior to the activity (readings detailed below, in simulation outline). In prebrief, the instructor would guide learners through the development of a concept map for their patient. Using the OPT model, learners would analyze the patient case, including their history, present illness, and clinical scenario (client-in-context). From there, learners would identify potential areas of concern (keystone issues) that would frame the context of care. Lastly, learners would compare the present clinical state of their patient to standard outcomes and make judgments about areas requiring nursing intervention to transition from a suboptimal present state to the standard outcome state (Pesut & Herman, 1998). The simulation scenario is based on a patient with cardiac amyloidosis receiving an autologous stem cell transplant. Common issues in these patients, which the facilitator would plan to identify with learners, include heart failure, constipation, musculoskeletal pain, neuropathy, and (for those receiving stem cell transplantation) anxiety. The instructor would also review the key components of inpatient code management and briefly review the components of the code cart. Lastly, the instructor would challenge the learners to identify ways in which a cardiopulmonary arrest would alter their concept map for the patient. Orientation to Simulation Lab Following the prebrief, learners would be oriented to the simulation lab. Beginning with the room, learners would be guided through the layout of the vital signs monitor; the location of the wall oxygen, suction and air, as well as how to control each; supplies available in the supply cart; and the computer (including how to log-in to SimChart, where their patient’s orders, labs, notes, and flowsheets will be). Orientation to the SimMan would include its basic functions (i.e., blinking, pupil response, spontaneous breathing, normal and abnormal breath sounds, detectable peripheral oxygen saturation, peripheral pulses, IV access (right arm only), and CPR capability (Laerdal, 2018). Manikin precautions would also be provided, such as avoiding exposure to ink and no actual administration of oral or iv medications. For this scenario, the SimMan will have additional attachments for the learner to be aware of, including a right chest wall central venous catheter and Foley catheter. The central line will be connected to a primary IV line that is regulated by an Alaris pump. However, the pump will be powered off so as to avoid actual infusion into the manikin. Learners would be notified of areas lacking fidelity (i.e., fluid output [urine, emesis, stool] & blood return), where the instructor will verbalize details if necessary. Learners would also be instructed to verbalize or simulate medication administration. Scenario Using the National League for Nursing (NLN, 2015) Simulation Design Template, an outline of the simulation scenario is attachment file below. Submitted Materials: CAZEAUSBARCommunicationEvalChecklist.docx - https://drive.google.com/open?id=1v7AYCRLShrTu1X5ih0ylSpVCJwvN4rOF&usp=drive_copy CazeauSimConfidentialityAgreementTemplate.docx - https://drive.google.com/open?id=1v0HT2CaezVgxthm5vH1dVBR4fK8TCNUR&usp=drive_copy CAZEAUSimulation-Design-Template-4.docx - https://drive.google.com/open?id=1uyfCo0n3xCj73otk0sG2Dev3TGZ7wQ0m&usp=drive_copy CazeauStemCellInfusionEvaluationChecklist.docx - https://drive.google.com/open?id=1uorO80ZntscsTaJoQsvQCXblkun2eowV&usp=drive_copy CazeauStemCellMockCodeProgramEval.docx - https://drive.google.com/open?id=1vQ7YfyfjTuTALB48kDjRH_8TBwrrLGes&usp=drive_copy Competency-Categories-2-1.docx - https://drive.google.com/open?id=1wA0l0OjLoywmwPSbkItopVcw7toTmAnQ&usp=drive_copy Additional Materials: References: Adams, D.A., Dobbs, J., Greene, M., MacGillis, P.A., Stockhausen, P.A. (2002). A model to enhance staff response in cardiopulmonary arrest. Journal of Nursing Care Quality, 17, 47-54. Blom, L., Petersson, P., Hagell, P., and Westergren, A. (2015). The Situation, background, assessment and recommendation (SBAR) model for communication between health care Professionals: A clinical intervention pilot study. International Journal of Caring Sciences, 8, 530-535. Callaway CW, Donnino MW, Fink EL, Geocadin RG, Golan E, Kern KB, Leary M, Meurer WJ, Peberdy MA, Thompson TM, Zimmerman JL. Part 8: post–cardiac arrest care: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(suppl 2): S465–S482. Cheng, A., Hunt, E.A., Donoghue. A., Nelson-McMillan, K., Nishisaki, A., LeFlore, J.,…Nadkarni, V.M. (2013). Examining pediatric resuscitation education using simulation and scripted debriefing: A multicenter randomized trial. JAMA Pediatrics, 167, 528-536. Eppich, W., Cheng, A. (2015). Promoting excellence and reflective learning in simulation (PEARLS): Development and rationale for a blended approach to health care simulation debriefing. Simulation in Healthcare, 10, 106-115. Ezzone, S.A. (2013). Hematopoietic stem cell transplantation: A manual for nursing practice 2nd Ed Pittsburgh, PA: Oncology Nursing Society. INACSL Standards Committee (2016, December). INACSL Standards of Best Practice: SimulationSM Outcomes and objectives. Clinical Simulation in Nursing, 12, S13-S15. http://dx.doi.org/10.1016/j.ecns.2016.09.006. Jeffries, P. (2012). Simulation in Nursing Education: From Conceptualization to Evaluation 2nd New York, NY: National League for Nursing. Kaye, W. (1981). The mega-code for training the advanced cardiac life support team. Heart and Lung, 10, 860-865. Kuiper, R.A., Heinrich, C., Matthias, A., Graham, M.J., Bell-Kotwall, L. (2008). Debriefing with the OPT model of clinical reasoning during high fidelity patient simulation. International Journal of Nursing Education Scholarship, 5, 1-14. Laerdal. (2018). SimMan 3G. Retrieved from https://www.laerdal.com/us/products/simulation-training/emergency-care-trauma/simman-3g/. Link MS, Berkow LC, Kudenchuk PJ, Halperin HR, Hess EP, Moitra VK, Neumar RW, O’Neil BJ, Paxton JH, Silvers SM, White RD, Yannopoulos D, Donnino MW. Part 7: adult advanced cardiovascular life support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015; 132(suppl 2): S444–S464. Miceli, T., Lilleby, K., Noonan, K., Kurtin, S., Faiman, B., Magnan, P.A. (2013). Autologous hematopoietic stem cell transplantation for patients with multiple myeloma: An overview for nurses in community practice. Clinical Journal of Oncology Nursing, 17, 13-24. National League for Nursing. (2015). Simulation Design Template. Retrieved from http://sirc.nln.org/course/view.php?id=18 Nehring, W. M. & Lashley, F. R. (2010). High-Fidelity Patient Simulation in Nursing Education. Boston, MA: Jones & Bartlett. ISBN 978-0763756512 Page-Cutrara, K. (2014). Use of prebriefing in nursing simulation: A literature review. Journal of Nursing Education, 53, 136-141. Pesut, D.J., Herman, J. (1998). OPT: Transformation of nursing process for contemporary practice. Nursing Outlook, 46, 29-36. Spunt, D., Foster, D., Adams, K. (2004). A mock code: A clinical simulation module. Nurse Educator, 29, 192-194. Stephenson, E. (2015). Tips for the use of simulation to maintain competency in performing high- risk/low-frequency procedures. The Journal of Continuing Education in Nursing, 46, 157-159. Wechalekar, A.D., Gillmore, J.D., Hawkins, P.N. (2016). Systemic amyloidosis. Lancet, 387, 2641-54. Weil, M.H., Fries, M. (2005). In-hospital cardiac arrest. Critical Care Medicine, 33, 2825-2830. Yura, H., Walsh, M.B. (1988). The nursing process: assessment, planning, implementation, and evaluation. 5th ed. Norwalk, CT: Appleton and Lange. Evaluation Description: Evaluation The instructor would note overall strengths and challenges of each learner during the simulation and share formative feedback during the debrief. Learners would also be specifically evaluated on the stem cell infusion process and SBAR technique, using the Stem Cell Infusion and SBAR Communication checklists (Appendix B and C).

Published Back to Strategy Search Strategy Submission The Use of the EHR with the Interdisciplinary Team: Improving Quality and Safety Author: Keevia Porter DNP, NP-C Title: Assistant Professor Coauthors: Institution: University of Tenn HSC Email: kporter6@uthsc.edu Competency Categories: Evidence-Based Practice, Informatics, Patient-Centered Care, Quality Improvement, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure BSN, RN to BSN Learner Setting(s): Classroom Strategy Type: Case Studies Learning Objectives: Describe how patient information entered into an electronic health record is used in patient evaluation and clinical decision making. Define meaningful use metrics. Consider how work-flow can contribute to patient outcomes and affect patient safety. Discuss the role of the interprofessional team, communication and the use of the EHR affect on patient outcomes. Strategy Overview: Students are divided into groups where they are assigned case study A or B. The( A )case has a negative patient outcome related to improper use of the EHR (electronic health record) and ineffective communication amongst the interdisciplinary team. Contrastingly, the (B) case has a positive outcome as a result of proper use of the EHR and effective communication amongst the interdisciplinary team. Each group is to submit a 3-5 page APA-style (6th ed.) paper that includes an overview of the case including any relevant information, the role of the interdisciplinary team, and answering six-eight questions pertaining to the assigned case. In addition to discussing the concepts of safety and quality improvement, students will also present the concepts of the EHR, communication, role of the interprofessional team, and workflow. These concepts are all connected to informatics in healthcare, Submitted Materials: QSEN-TS-228-REvisions-EHR_Case-Study-Rubric-QSEN-1.docx - https://drive.google.com/open?id=15ly9FtdSj_hM6PrTgET4LWqjkSK5abKR&usp=drive_copy QSEN-TS-228-RevisionsInformatics_EHR_Case-A-and-B-2.docx - https://drive.google.com/open?id=15ZUYJ-91exUnOBgyHeLA6X7_W9HZWlXX&usp=drive_copy Additional Materials: Instructors may create their own cases or contact Dr. Keevia Porter at kporter6@uthsc.edu for sample cases. Evaluation Description: The assessment is evaluated using a rubric designed specifically for this assessment. The rubric is applicable to both case studies. The rubric is able to effectively evaluate the assessment's learning objective.

Published Back to Strategy Search Strategy Submission Reflective Clinical Journaling: Using QSEN Competencies to Promote Student Self-Awareness of Quality and Safety in Nursing Practice Author: Kathleen S. Fries PhD Title: Assistant Professor & UG Program Director Coauthors: Eileen Yost, MSN Institution: Sacred Heart University Email: friesk@sacredheart.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: Case Studies Learning Objectives: The reflective written assignment is designed to develop student awareness of the QSEN competencies and how they relate to a clinical experience in maternal-child health nursing. The assignment also evalutes student confidence level in meeting selected competencies using survey methodology that is administered prior to and following the clinical reflective written assignment. Strategy Overview: Historically, nursing students have been evaluated on their ability to demonstrate the knowledge, skills, and attitudes necessary to provide safe patient-centered care. In order to educate students about the QSEN competencies and their relationship to support excellent clinical practice, students were provided a document that referenced the QSEN Website and listed ten (instructor identified) KSA's that were relevant to the clinical experience and course content. Through weekly clinical journaling between the student and the clinical instructor, students described exemplar clinical experiences that reflected an understanding and demonstration of each of the ten listed KSA's. Qualitative data from the written journal assignment as well as pre-and post descriptive quantative data reflected a gain in student awareness and confidence in meeting the QSEN competencies. The Power Point attachment reflects on-going research and evaluation of the described Teaching-Learning strategy using survey methodology to measure student confidence in meeting selected QSEN competencies. Submitted Materials: 129.Clinical-Journal-Assignment-for-QSEN.docx - https://drive.google.com/open?id=1DaUk-dJKSNnEaL4MWK_s5fqB5nDShHqF&usp=drive_copy 129.QSEN-TL-PP-And-Survey-Data.pptx - https://drive.google.com/open?id=10PuidpIB6P3YqGoBlRoACzJd8bFzJV03&usp=drive_copy Additional Materials: File one contains the journal assignment. File two contains Qualitative Data (to illustrate student learning), and Survey Methodology results. Faculty are encouraged to contact me directly if they have additional questions. Kathleen S Fries, Phd UG Director, Sacred Heart University friesk@sacredheart.edu Evaluation Description: Survey methodolgoy was used to measure change in student confidence levels (self-reported) and was collected at week one of clinical, and then when the clinical rotation ended (and the journal assignment was submitted). Students reported higher levels of confidence in their ability to demonstrate the KSA's to support the QSEN competencies identified in the written clinical journal assignment.

Published Back to Strategy Search Strategy Submission Enhancing Goal-of-Care Conversations Author: Jared Bradshaw RN Title: Float Nurse Coauthors: n/a Institution: Bakersfield Memorial Hospital Email: jaredcb15@gmail.com Competency Categories: Evidence-Based Practice, Patient-Centered Care, Quality Improvement, Teamwork and Collaboration Learner Level(s): Continuing Education, New Graduates/Transition to Practice, Staff Development Learner Setting(s): Classroom, Clinical Setting Strategy Type: General Strategy Learning Objectives: KNOWLEDGE: Integrate understanding of 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 and describe how diverse cultural, ethnic, and social backgrounds function as sources of patient, family, and community values. SKILLS: Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan and evaluation of care; Communicate patient values, preferences and expressed needs to other members of health care team and Provide patient-centered care with sensitivity and respect for the diversity of human experience. ATTITUDES: 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 and Seek learning opportunities with patients who represent all aspects of human diversity. KNOWLEDGE: Examine common barriers to active involvement of patients in their own health care processes and Describe strategies to empower patients or families in all aspects of the health care process. SKILLS: Remove barriers to presence of families and other designated surrogates based on patient preferences; Assess level of patient’s decisional conflict and provide access to resources and Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. ATTITUDES: Value active partnership with patients or designated surrogates in planning, implementation, and evaluation of care and Respect patient preferences for degree of active engagement in care process. KNOWLEDGE: Discuss principles of effective communication and Examine nursing roles in assuring coordination, integration, and continuity of care. SKILLS: Discuss principles of effective communication. ATTITUDES: Value continuous improvement of own communication and conflict resolution skills. Strategy Overview: This project was intended to rectify some of the confusion pertaining to topic of goals-of-care (GOC) conversations. It has been observed that many of these conversations take to long to be addressed by busy physicians. Many of the perceptions of this topic from nursing staff are fraught with misunderstanding. Though it has been proven that families typically develop more of a rapport with the bedside nurse, the prospect of engaging a family or patient in GOC conversations is a source of anxiety. Despite the lack of formal education, nurses have many resources they may draw on in the literature to support certain interventions regarding GOC. This algorithm and presentation are effectively a condensed set of tips and methods from similar current research on the topic. It is meant to be used as a guide to the bedside nurse who sees a patient that may meet criteria for GOC conversations. It is meant to expedite this element of patient care and improve standards of advocacy in nursing. In moving nursing practice forward in this way, these resources will hopefully bring to light the pitfalls of the current system for better education in nursing and better outcomes for patients. The presentation of these materials was done in several different settings over the course of 3 months. All of the attendees were in bedside, managerial and administrative positions throughout the hospital. Everyone in attendance was a registered nurse. Each cohort received the same lecture via PowerPoint presentation and verbal instruction from the presenter on the background and purpose of the algorithm for GOC conversations. The education touched on the importance of the topic, the current failures to address goals of care early in the end-of-life process, and the mechanics of the algorithm itself. Examples and case studies were provided in the verbal instruction of the algorithm and questions were answered from the participants. Submitted Materials: QSEN-PS-284-2-Goals-of-care-conversation-QSEN-REVISED.pptx - https://drive.google.com/open?id=1oGav50871VltBf4g-EpPavy03_8iBJBT&usp=drive_copy algorthim-send-.docx - https://drive.google.com/open?id=1RSBUddpWf4EG7bCsiDVP1gGHkiLDVNs-&usp=drive_copy Likert-scale.docx - https://drive.google.com/open?id=1zSzSaKGBITuTIJgJUYjWyT1Or4--45rs&usp=drive_copy Additional Materials: Likert scale data may be provided upon request. Evaluation Description: A 5 question Likert scale was given before and after the presentation to attain a baseline of understanding and see how individuals felt about key issues surround goals-of-care (GOC) conversations after. Raw data showed improvements in respondents who answered the questions about whether the individual felt that they [had] “the tools necessary to at least start a conversation about goals-of-care and end-of-life with a patient.” Teach back was also used on an individual basis throughout the presentation as those in attendance were invited to give examples and feedback.

Published Back to Strategy Search Strategy Submission 5 Minute Hand-off Report Rubric Author: Diane Rudolphi RN, MS Title: Senior Instructor Coauthors: Institution: University of Delaware Email: drudolph@udel.edu Competency Categories: Evidence-Based Practice, Patient-Centered Care, Safety, Teamwork and Collaboration Learner Level(s): New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN Learner Setting(s): Clinical Setting Strategy Type: General Strategy Learning Objectives: Apply critical thinking and clinical judgement into the practice of professional nursing Demonstrate professional behaviors into the role of the nurse Apply research and best evidence into the care of patients Use verbal communication to complete an effective, clear and concise hand-off report Strategy Overview: New nurses (Del Bueno, 2005 and Kavanagh & Szweda, 2017) exhibit unsafe behaviors and a lack of critical thinking/clinical judgement that these researchers note can result in a "failure to rescue" the patient. In order to stimulate critical thinking, educators need to move away from low level questioning and memorization of material. Students completing hand-off report demonstrate high level learning and application. Using this 5 minute hand-off report rubric provides students with a guide along with clear, concise expectations regarding the grading process. This tool is an excellent 5 minute student assessment has a patient safety focus and demonstrates professionalism, application of evidence based care and critical thinking. Submitted Materials: 5-Minute-Patient-Report-Rubric.docx - https://drive.google.com/open?id=1YFTvxXzLZd9eH0F9LB_lEiFdFbDR1zmY&usp=drive_copy 5-Minute-Patient-Report-Rubric.pdf - https://drive.google.com/open?id=1YFTvxXzLZd9eH0F9LB_lEiFdFbDR1zmY&usp=drive_copy Additional Materials: Rubric Attached. Evaluation Description: The rubric provides students with a guide/evaluation (using a point system) of their handoff report. Using this rubric faculty and students can assess strengths and weaknesses.

Published Back to Strategy Search Strategy Submission Integrating QSEN into Clinical Evaluation Tools Author: JoAnn Mulready-Shick EdD, RN, CNE Title: Undergraduate Nursing Program Director Coauthors: Institution: University of Massachusetts- Boston Email: joann.mulreadyshick@umb.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): Clinical Setting Strategy Type: General Strategy Learning Objectives: This tool may be utilized to evaluate students in the clinical setting. Examples for the first clinical experience and the final clinical experience are included. This tool incorporates beginner level KSAs for all QSEN competencies for the first Clinical Evaluation Tool (#1 Freshmen Level) and incorporates advanced level KSAs for all QSEN competencies for the second Clinical Evaluation Tool (#2 SEnior Level) Strategy Overview: These clinical evaluation tools were created from a number of sources. First, to enhance reliability and performance ratings, a variation of the rating scale as published by S.D. Holaday and K. M. Buckley, A Standardized Clinical Evaluation Toolkit: Improving Nursing Education and Practice, was employed. Second, the ANA Standards of Practice criteria for Professional Behaviors. Third, faculty determined the most relevant QSEN competencies to include in clinical evaluation. The tool was piloted in 2009 and minor modifications have been made subsequently based on faculty feedback. Submitted Materials: 123.Clinical-Evaluation-Tool-1-Freshmen-Level.doc - https://drive.google.com/open?id=1n2JkfiPECmbp6oAtiFaSwpbE23mfGPmG&usp=drive_copy 123.Clinical-Evaluation-Tool-2-Senior-Level.doc - https://drive.google.com/open?id=1n2JkfiPECmbp6oAtiFaSwpbE23mfGPmG&usp=drive_copy Additional Materials: Evaluation Description: Faculty inter-rater reliability has improved through faculty development sessions and use of role plays of different scenarios for rating clinical performance with each tool. Additional tools for intermediate level courses are also available.

Published Back to Strategy Search Strategy Submission Effectively Using EHRs with Interdisciplinary Teams: Improving Health & Quality of Care Author: Susan McBride PhD, RN-BC, CPHIMS Title: Professor Coauthors: Hanley, M.A., Acton, C., Jordan, J., Nixon-Lewis, B., Bradley, C., Gray, D., Mitchell, M.B. , Delaney, J., Thornton, D., Collins, R. & Philips, B. Institution: Texas Tech University Health Sciences Center School of Nursing Email: susan.mcbride@ttuhsc.edu Competency Categories: Evidence-Based Practice, Informatics, Patient-Centered Care, Quality Improvement, Safety, Teamwork and Collaboration Learner Level(s): Continuing Education, Graduate Students Learner Setting(s): Classroom, Clinical Setting, Skills or Simulation Laboratories Strategy Type: Online or Web-based Modules Learning Objectives: In using the case studies in modules, online education, classroom or conference settings at the completion of the exercise the participant will be able to: 1. Identify gaps in meaningfully using technology to address safe, efficient patient care in a clinical scenario. 2. Discuss knowledge necessary for the multi-disciplinary team to effectively use the data that was integrated in the EHR. 3. Describe how an interprofessional team approach along with the EHR improvements might have contributed to Mr. Head Injury’s care and ultimately, how this approach and use of EHRs could be used to improve health outcomes in other areas of their institution or organization. 4. Identify any workflow issues or common practices that contributed to Mr. Head Injury’s care. Strategy Overview: EHR case scenarios simulating patient safety and/or clinical events in which electronic information might improve care and electronic information that might hinder clinical care were developed and tested. A rubric designed for this project guided students in their analysis and solution development, and collaborative work processes and was used by faculty members to evaluate both solutions and work processes. Multi-disciplinary of healthcare professionals and students applied knowledge gained through participation in the conference to the EHR case scenarios and demonstrated the capacity to “think smarter.” They analyzed the case scenarios and were able to identify solutions to new technologies, which contributed to potential patient safety events, thus supporting and reinforcing the quality of care. Participants questioned information presented via technology when it did not appear to make clinical sense and determined whether the electronic information was accurate, and proposed solutions to the scenario. Submitted Materials: 135.-EHR-Teamwork-Solution-Finding-Rubriic.pdf - https://drive.google.com/open?id=1EISiXhkHUme_A2eiGVVW5MY77VlQYQkN&usp=drive_copy Guidelines-for-Case-Study-Write-up.pdf - https://drive.google.com/open?id=1T8GUKofsEC7UmImzpmQ1NFhXeCu4Htnm&usp=drive_copy Additional Materials: This case study can be used on multiple levels and settings. Additionally, the case studies have been used in online classes (MSN Core Informatics course), in classroom settings (DNP Intensives), and in conference settings for workshops reinforcing patient safety, quality, interdisciplinary teams and effective use of EHRs. This case study has been used coupled with workflow redesign to address gaps identified in the workflow related to safe and effect use of EHRs. Evaluation Description: The case scenarios were developed, tested, and evaluated by interprofessional teams. The development team included eight nurses: two nursing informaticists; two nursing educators with expertise in simulation, interprofessional team development, patient safety, and curriculum development; a staff nurse actively working in a Texas Emergency Room in a large healthcare system with hands-on experience of working with an EHR in the Emergency Room and the Director of the West Texas HIT Regional Extension Center and one of the nursing field consultants. The team also included three Physicians active clinically and Chief Medical Information Officers at their respective organizations responsible for the implementation of EHRs at multiple specialty clinics, and finally an Executive and Epidemiologist responsible for the West Texas HIT Regional Extension Center. The Case Studies were developed based on clinical scenarios experienced by the clinicians in implementation of the EHRs in various practice settings. The goal of the clinical scenarios was to create a clinical event that could be either helped or hindered given the proper use of the EHR. The clinical information was verified by the clinical team as to accuracy of pathophysiologic information and pharmaceutical products discussed in the scenarios. The electronic information was verified by a nursing informaticist and the epidemiologist both with expertise in working with the WTxHITREC. The original evaluation plan was to include medical students, nursing students and pharmaceutical students in an educational event to test the case scenarios developed by and for interdisciplinary teams. The F. Maria Hall Rural and Community Health Institute, WTxHITREC and the West Texas Area Health Education Center (AHEC) agreed to utilize their annual summer conference held June 27 and 28, 2011 in Lubbock Texas as the venue for testing the case studies for this QEP grant-supported activity. The attendance at the conference included 82 attendees for the lecture series of the conference and 21 participants in the full interprofessional team exercise to test the case studies. Attendees included hospital staff support (30%), ambulatory clinics (20%), academic (26%) and other setting (20%). The 82 participants included 45 (55%) leadership and administrative professionals, 19 (23%) nurses, 5 (6%) physicians, and 13 16%) “other” (dietary, social workers, and unspecified).

Published Back to Strategy Search Strategy Submission Quality and Safety Education for Nurses: An Introduction to the Competencies and the Knowledge, Skills and Attitudes Author: Gerry Altmiller EdD, MSN, RN Title: Assistant Professor Coauthors: Institution: La Salle University Email: Altmiller@lasalle.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, RN to BSN, Staff Development Learner Setting(s): Classroom Strategy Type: General Strategy Learning Objectives: Learner with be able to identify the IOM/QSEN competencies and resources that support development of those competencies. Strategy Overview: This powerpoint presentation is a brief overview for individuals that are unfamiliar with the IOM/QSEN competencies and wish to introduce ideas that promote development of the knowledge, skills, and attitudes that support the competencies. It includes direct links to helpful resources such as the First Touch web site, to Infection Control Bundles at The Joint Commission website, and to the TeamSTEPPS video collection at the Agency for Healthcare Research and Quality web site. Submitted Materials: Additional Materials: Evaluation Description: Faculty have found this presentation helpful as they learn about the IOM/QSEN competencies and as they share information with their students. Each semester the presentation is updated to include more information and resources. This powerpoint presentation is introduced in the Fundamentals of Nursing course but is also available to each course in our curriculum as faculty have found that there are variations in each course of how the information and the web link resources can be utilized.