Published Back to Strategy Search Strategy Submission Linking EBP with a Nursing Procedure Author: Kelly Beischel PhD, RN, NCSN, CNE; Deborah Davis BSN, MSN, MEd Title: Assistant Professor; Faculty Coauthors: Institution: Xavier University Email: beischelk@xavier.edu Competency Categories: Evidence-Based Practice, Informatics, Teamwork and Collaboration Learner Level(s): Pre-Licensure BSN Learner Setting(s): Classroom Strategy Type: Paper Assignments Learning Objectives: Locate evidence reports related to clinical practice topics and guidelines. Explain the role of evidence in determining best clinical practices. Compare and contrast evidence-based practice (EBP) with actual practice. Value the concept of EBP as integral to determining best clinical practice. Develop scholarly writing skills. Seek necessary resources to complete the assignment. Strategy Overview: We developed a scholarly paper assignment using Chris Tesch's teaching strategy "Linking EBP with a Nursing Procedure" as the framework.” We assign junior students to choose a nursing intervention they have performed or have seen performed on their clinical unit. They are required to locate and make a copy of the policies, procedures or standards available in their clinical setting related to the intervention they observed. Using the information search strategies they have previously learned, as well as, available resources, they locate the best-published evidence related to the intervention they observed. Students then write a scholarly paper that thoroughly describes the policy and procedure, synthesizes the best evidence, compares and contrasts the written policy with the best evidence, and discusses their reflection concerning what they found, their ease or difficulty in locating evidence and anticipated challenges implementing the best evidence. We are sure to include detailed instructions required to complete the paper as well as helpful hints for scholarly writing and APA formatting. We require that students submit a self-evaluation of their paper using the instructor's rubric. Requiring the self-evaluation assures us they are familiar with the criteria with which they will be evaluated. Informatics is emphasized with this assignment. First, computer and information literacy skills are both necessary to complete the assignment. In addition, students are encouraged to use high quality information sources. Examples of these sources are provided in the description of Submitted Materials: Additional Materials: Evaluation Description: Papers are graded using the rubric created for this assignment. Students can earn up to 4 points in each of the 15 categories resulting in 60 possible total points. The percentage grade for the paper is then calculated by adding up the number ofpoints the student earned in each category and dividing this number by the 60 total possible points. Grading these papers can be a wearisome and time intensive challenge, but one we think is important in facilitating student learning. It is apparent that students have had limited exposure to writing scholarly papers using an APA format in their previous courses. We are hopeful this assignment aids in developing scholarly writing skills that students will in turn use when they are in practice, reviewing and developing policies and procedures. Students admit they learn much from completing this assignment. They find the APA format challenging, but learn the importance of using the APA book to follow directions. Students comment on their surprise with the difficulty they had in locating current best evidence and nursing research. Students state they thought nurses had more evidence for the interventions they performed. Some admit to experiencing difficulty using the nursing search engines and knowing which key terms to use to yield useful articles. They learn being creative and persistent are key when searching the literature. Students report they appreciate going through the process of locating policies, procedures and standards in the clinical setting and think this will be helpful later in practice. We discuss their findings during a conference provided in the assignment description. When students who used the suggested resources (the librarian, faculty, and the writing center tutors) voice how helpful the resources were in completing the project, fellow students who failed to take advantage of those resources hear about the benefits of teamwork and collaboration. Students also report that nurses do not always follow policies and this assignment gives them the opportunity to reflect on how that might influence patient outcomes.

Published Back to Strategy Search Strategy Submission Mass Casualty Triage Bear Learning Activity Author: Marylou Robinson PhD, RN, FNP Title: Assistant Professor Coauthors: Institution: University of Colorado Denver College of Nursing Email: Marylou.Robinson@ucdenver.edu Competency Categories: Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: Communicate observations or concerns related to hazards and errors to patients, families and the health care team. Function competently within own scope of practice as a member of the health care team. Value the perspectives and expertise of all health team members. Communicate with team members adapting own style of communicating to needs of the team and situation. Value teamwork and the relationship upon which it is based. Strategy Overview: This is a low fidelity simulation exercise that can be used to enhance content on mass casualties. This activity was originally noted as a simulation activity for the Kirkland Fire Department in Washington. Some nursing curricula cover this content in advanced Med/Surg, alongside emergency room content. Other programs place this content in a public health course. The necessary content to properly contextualize this activity focuses on the mass casualty ideas of: scene safety, incident command structure, triage choke points and allocation of resources (e.g. staff, supplies and transportation). The value of this learning activity is that it augments a theoretical, academic discussion with a hands-on, low fidelity simulation learning activity. The necessary materials for this activity are a variety of stuffed animals that represent participants of a mass casualty. Although the activity is called “Triage Bears,” any kind of stuffed animal can be effective, and can convey the diversity of victims that might be the result of a mass casualty. Faculty have found it effective to include such diverse stuffed animals as teddy bears, stuffed snakes, gorillas, cats, dogs and tarantulas. Faculty aim to acquire one stuffed animal for every two students. Each of these stuffed animals represents a specific patient in a mass casualty situation. Faculty have found that worn and used stuffed animals work especially well. You can modify the appearance of the stuffed animal to match the nature of the injury (e.g. lipstick works very well as moulage blood on teddy bears, you can have a rip on the right arm to suggest a right arm fracture, etc…). Victims can also be grouped together as is appropriate (e.g. you can identify a family unit of a mother bear with two bear children, or bear siblings). It is helpful in this exercise to have a wide representation of ages and injuries. Including medical emergencies such as cardiac concerns and disabled individuals (e.g. a victim who is blind, or paraplegic, or a child with Down’s syndrome) adds to the complexity. Each stuffed animal has a tag that includes the following information: age, vital signs, and a brief description of the injury. Students are divided into teams of two students. Each team assesses every stuffed animal. The students use the Lou Romig Start/Jump Start Algorithim (pdf file is attached) to determine whether the patient’s condition needs minor attention (green), delayed attention (yellow), immediate attention (red) or whether the patient is deceased or beyond reasonable resuscitation (black). Consistent with this well recognized algorithm, the students have 15 seconds to determine the color assignment of each stuffed animal. The goal of this activity is to have the students be working very quickly, but be systematic and focused in their determination of triage priorities. Each team must keep track of how many victims end up in each color category per standard triage protocols. The team then provides an inclusive report to the site commander about the number of patients at the scene, the number in each category and the location of the victims that need priority attention. The scenario can be extended to include transport of bears to collection points, re-prioritizing those in each category, providing recommendations about how to organize care in a limited supply setting, and preparation for transport. After the class has finished this work in teams of two, there can be a group debriefing. Some questions and pointers for discussion might include: How did you find making decisions alongside another nursing clinician? How did it feel to be making determinations about care in such a compressed timeframe? What was most difficult about the limited timeframe? What information did you wish had been provided to you that was not on the victim’s tag? What are your insights into each of the triage categories (green, yellow, red, black) that you gained from this experience? How would your assessment have been different if there were other team members working on the victims alongside you, such as respiratory therapists, physicians or EMTs? How would your care have differed if there were families hovering over your victims as you were trying to make these quick clinical decisions? What was most difficult about the inclusive report that you provided to the site commander? What did you learn about your communication style/effectiveness from working alongside another nurse, and reporting off to the site commander? Reflections on cultural bias can include impact of “saving” spiders and snakes, but not puppy dogs. Submitted Materials: Additional Materials: Evaluation Description: It can be helpful to have students provide feedback to the student with whom they were teamed up. This feedback can be given in written form, or verbally, and can be provided to the course instructor. Some questions that students might want to consider in providing feedback to their team member: Name your team member’s strengths in working effectively in a stressful, time limited situation. Name two improvements your team member could make to work more effectively in a stressful, time limited situation What are your overall observations about your team member’s communication practices?

Published Back to Strategy Search Strategy Submission Case Study: Focus on Teamwork/Collaboration, Quality Improvement, and Safety in Caring for a Newly-Diagnosed Schizophrenic Patient Author: David Foley PhD, MSN, RN-BC, CNE, MPA Title: Research Associate Coauthors: Institution: Case Western Reserve University Email: dmf106@case.edu Competency Categories: Quality Improvement, Safety, Teamwork and Collaboration Learner Level(s): Advanced Practice Providers, Continuing Education, Faculty Development Strategies, Graduate Students, Interprofessional, 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: Case Studies Learning Objectives: Global QSEN Competency Objective (GQCO): The purpose of analyzing this case study is to provide nurse educators (clinical/classroom faculty, practice-based nurse educators, and staff development personnel) with an immersive situation to promote critical/analytical thinking regarding the QSEN competencies of Teamwork/Collaboration, Quality Improvement, and Safety. The questions that follow the case study should thus be used to provide learners with opportunities to demonstrate a practical understanding of these QSEN competencies. Unit Learning Objectives: As an immersive exercise, this scenario thus promotes affective development by placing leaders within a low-incidence/high-risk clinical scenario involving a serious breach of safety during the initial assessment of a young male patient experiencing his noted episode of psychosis and subsequent transfer from the primary care to the Emergency Room settings. Three key QSEN Competencies (Teamwork and Collaboration, Quality Improvement, and Safety) provide the framework for the development of analytical skills through reflective thought and ensuing discussion: 1. Through analysis, reflective thought, and discussion the learner will affirm the importance of safety for patients and caregivers in the acute phase of mental illness. 2. Through analysis, reflective thought, and discussion the learner will identify opportunities to enhance effective teamwork/collaboration during a low-incidence/high-risk psychiatric patient care scenario. 3. Through analysis, reflective thought, and discussion the learner will identify rapid-cycle quality improvement as a top priority following low-incidence/high-risk situations involving acutely ill psychiatric patients. Strategy Overview: The QSEN competencies provide an ideal framework to promote opportunities for analysis, reflective thought, and discussion. In the case of this scenario, the lead characters in a primary are setting perceive their performance as competent as they provide appropriate care to a newly-arrived psychotic patient. Despite finding themselves in a low-incidence/high-risk scenario, they engaged in Teamwork/Collaboration to promote safety throughout the initial assessment and subsequent transfer to the Emergency Room. After the transfer, however, it appears that the narrative of safety may have been a fallacy, as a serious breach in safety is observed and the need for rapid-cycle quality improvement. In short, while many nurses are highly clinically competent, opportunities for analytical/critical thinking skills may be evident. This scenario thus focuses on promoting critical thinking and reflective thought to prevent such a highly dangerous scenario from reoccurring. As for tips for educators, the mechanics of this unit thus provide opportunities to review the scenario within the framework of three key QSEN competencies (Teamwork/collaboration, quality improvement, and safety in that: o Questions for group discussion are strategically inserted at the end of the case study and are intended to be discussed—with corresponding instructor/peer feedback—in a synchronous manner. o Whether in the classroom or clinical setting, learners should be granted no prior access to the scenario but given approximately one-half hour to read it independently, with peer interaction followed by instructor-facilitated discussion immediately following. o Following robust discussion, a written Reflective Journal assignment follows the exercise’s conclusion and should be prepared and submitted to the instructor prior to the next classroom/clinical, or staff development session. The Reflective Journal is completed asynchronously and thus gives students a more discrete format to present the thoughts they might not have felt comfortable sharing in a public forum. Submitted Materials: QSEN-301.-Student-Reflective-Journal-Format-SNITCH-SNITCH-WITCH.docx - https://drive.google.com/open?id=1o5VQ_u6URy1w-xWiSRfzwbDyQduUoRxR&usp=drive_copy QSEN-301.Case-Study.docx - https://drive.google.com/open?id=12uOVyG1Fgxu7dD72Zfm5eg1pTgxrncZJ&usp=drive_copy QSEN-301.Psychotic-Disorders-Overviewpp.pptx - https://drive.google.com/open?id=1o5VQ_u6URy1w-xWiSRfzwbDyQduUoRxR&usp=drive_copy QSEN-301.Faculty-Communication-Teaching-Strategies.docx - https://drive.google.com/open?id=136SFqp8IYJUZkQrV7nFxdCW_KZJ44Vda&usp=drive_copy Additional Materials: 1). “Snitch, Snitch, Witch” Case study 2). Critical Reflection Journal Template 3). Faculty Tips Sheet: Therapeutic Communication 4). Psychotic Disorders: A Brief Overview Evaluation Description: Post-Scenario Evaluative Questions All involved ER staff are interviewed the next week as part of a Root Cause Analysis (RCA) performed by Quality Management. Please project into this situation and imagine you are one of the ER nurses being interviewed. How would you respond to the following questions? • How often do you receive patients from an individual provider’s office? Is this a relatively novel occurrence? • Given the patient arrived undressed and wearing a gown, would you assume he had already been ‘wanded’ and his belongings searched/inventoried? (Obj. 1) • Given the opportunity to review the entire scenario, is there a breakdown of teamwork/collaboration that ultimately impacted patient safety? (Obj. 1 and 2) • What recommendations would you have for quality improvement to prevent this scenario from happening in the future? (Obj. 3) Summary Evaluation Description 1. Written instructor feedback as to evidence of analytical/critical thinking in Reflective Journal questions, each of which is tied to a learning objective/QSEN competency. 2. Student to peer and instructor to peer verbal feedback regarding evidence of affective development as tied to learning objectives/QSEN competencies in classroom sessions, clinical pre- or post-conference discussion, staff development, or any other group as facilitated by a nurse educator.

Published Back to Strategy Search Strategy Submission Cory Doolittle: Impaired Nurse Simulation Author: Maria del Carmen Molle MSN, RN-BC Title: Assistant Professor-Nursing Coauthors: Professor Heather Heithoff, MN, RN Institution: Raritan Valley Community College Email: maria.molle@raritanval.edu Competency Categories: Evidence-Based Practice, Patient-Centered Care, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN Learner Setting(s): Classroom, Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: The nursing student will: - demonstrate sensitive patient-centered care to an impaired nurse. - apply the clinical judgment model to implement appropriate nursing interventions to a substance-impaired nurse (patient safety, patient-centered care) - apply evidence-based practice in the assessment of the substance impaired nurse (evidenced-based practice). - demonstrate professional behaviors while prioritizing and managing nursing care to a substance-impaired nurse while collaborating with multiple nursing specialist(s) (Patient-centered care, teamwork, and collaboration, safety). - demonstrates standardized nursing practice and use of technology that supports patient safety and quality patient-centered care (Evidenced-based practice, teamwork & collaboration, safety). - demonstrate effective communication with team members to assist the patient achieve health care goals (Teamwork & collaboration). Strategy Overview: The Cory Doolittle: Impaired Nurse Simulation, provides nursing faculty and students the opportunity to participate in a clinical judgment activity in order to provide the appropriate care for an impaired patient while collaborating with interprofessional team members. The Impaired Nurse Simulation can be used for graduating ADN or BSN nursing students. The students are expected to apply all levels of clinical judgment model but more specifically all the steps in level 3 when providing care to a substance-impaired nurse. This activity has been designed to facilitate the clinical judgment process when assessing patients with substance abuse disease processes and providing the appropriate required patient-centered care. Submitted Materials: 279.2SimulationImpaired-Nurse-DebriefingTools.docx - https://drive.google.com/open?id=1s03f8rZG1lQAX9K7ikiAGaZUhrnEPd1C&usp=drive_copy 279.1Simulation-Scenario-CoryDoolittleImpaired-Nurse.docx - https://drive.google.com/open?id=1s9UY-TRu-6YBSfweSuoSHQE_UeDS9PDr&usp=drive_copy Additional Materials: Cory Doolittle: Impaired Nurse Simulation and Debriefing Tools. References: Adams, M., Holland, N. and Urban C. (2017). PHARMACOLOGY FOR NURSES-A PATHOPHYSIOLOGIC APPROACH. Pearson. Barlett, D. (2019). Drug Diversion Training. nurseCe4Less.com Chmil, J.V. (2016). Prebriefing in Simulation-Based Learning Experiences. Nurse Educator- Teaching Strategies. Vol.41, 64-65. http://dx.doi:10.1097/NNE.0000000000000217 Cutara, K.P (2015). Prebriefing in Nursing Simulation: A Concept Analysis. Clinical Simulation in Nursing. (2015). 11, 335-340. http://doi.org./10.1016.ecns.2015.05.001. Dusaj, T.K. (2014). Five Fast Fixes: Debriefing. INASCL. http://doi.org/10.1016/j.ecns.2014.06.002 Gardner, R. (2013). Introduction to Debriefing. SciVerse Science Direct. 37(2013) 166-174. http://dx.doi.org/10.1053/jsemperi2013.02.008 Halter, M.J. (2018). Varcarolis’ FOUNDATIONS of PSYCHIATRIC-MENTAL HEALTH NURSING: A Clinical Approach. Elsevier. Lestander, O., Lehto, N. and Engstrom, A. (2016). Nursing students’ perceptions of learning after high fidelity simulation: Effects of a Three-step Post-simulation Reflection Model. Nurse Education Today. 40(2016) 219-234. http://dx.doi.org/10.1016/jnednedt201603011. NCSBN (2014). NCSBN Guidelines for Alternative Programs and Discipline Monitoring Programs. Substance Use Disorder Guidelines. https://www.ncsbn.org/Mgr_SUDiN_Brochure_2014.pdf https://www.ncsbn.org/SUDN_11.pdf NCSBN (2020). NCSBN Clinical Judgement Model. https://www.ncsbn.org/search.htm?q=clinical+judgement+model. NCSBN (2020): NCSBN State Boards of Nursing. https://www.ncsbn.org/search.htm?q=state+board+of+nursing New Jersey Board of Nursing Laws (2020). https://www.ncsbn.org/SUDN_11.pdf Plus/Delta Template Example: https://miro.com/templates/plus-delta/ RAMP of N.J. (2019). RAMP, Recovery and Monitoring Program. RAMP@njsna.org , peerassistance@njsna.org , www.njsna.org . Evaluation Description: Pre-briefing Time: 1 hour All students will engage in an open discussion regarding medication diversion specifically by the nurse in varied healthcare settings and current national substance abuse situations with participation in a pre- and post-test. The students are randomly assigned nursing roles: Cory: impaired nurse, Avery: Cory’s partner, Surgical Nurse, ED nurse preceptor, ED nurse preceptee, Psychiatric Advanced Practice Nurse and 4 nursing student observers for a total of 10 potential student participants. Expected Simulation Run Time: 20 minutes Debriefing Time: 40 minutes

Published Back to Strategy Search Strategy Submission Information Literacy in Nursing Author: Paula Jarzemsky MS, RN Title: Clinical Professor Coauthors: Cassie Voge, MSN, RN Tim Piatt, Information Processing Consultant Institution: University of Wisconsin-Madison Email: pajarzem@wisc.edu Competency Categories: Evidence-Based Practice, Informatics Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN Learner Setting(s): Clinical Setting Strategy Type: Online or Web-based Modules Learning Objectives: Appreciate the importance of regularly reading relevant professional journals Value the concept of EBP as integral to determining best clinical practice Describe reliable sources for locating evidence reports and clinical practice guidelines Read original research and evidence reports related to area of practice Use high quality electronic sources of healthcare information Strategy Overview: When surveyed about how they sought information needed for clinical practice, our students indicated a preference for using internet sources (such as Google) over bibliographic databases such as CINAHL or PubMed. In contrast, our library instruction emphasized how to search the latter sources. Based on this data, we developed an online tutorial that incorporated a wider variety of information sources. In addition to traditional bibliographic databases, the new online tutorial explained how to search for clinically relevant information using reference textbooks and personal digital assistants (PDAs), along with health portals such as Medline Plus and decision support tools such as UptoDate. Tips for assessing the credibility of information from popular open sources such as Google and Wikipedia were also included. This activity was intended to help students locate and evaluate information, in preparation for clinical. Independent study of an online tutorial was assigned by first-semester clinical instructors, each working with a group of 8 students. After completing the tutorial, each student searched one of the sources mentioned above, using a term that was relevant to his/her particular clinical setting (provided by instructor), and then described their search results using parameters defined in the tutorial (see Word attachment). Submitted Materials: 91.Assignment_Ideas_for_Information_Literacy_Tutorial.2.doc - https://drive.google.com/open?id=1YFTvxXzLZd9eH0F9LB_lEiFdFbDR1zmY&usp=drive_copy Additional Materials: http://academic.son.wisc.edu/courses/n219/info_lit/info_lit.htm Note: you may use this link to view the online tutorial Evaluation Description: Informal student/faculty feedback on the tutorial and assignment has been positive. Students seem to be citing from a wider variety of sources. Plans are in place to survey students about their information-seeking patterns at the end of this semester. Note: you may use this link to view the online tutorial http://academic.son.wisc.edu/courses/n219/info_lit/info_lit.htm

Published Back to Strategy Search Strategy Submission “Building a Quality House” Using an Interdependent QSEN Competency Model Author: Ann Hook RN, MSN Title: Nursing Lecturer Coauthors: Pam Dunagan, RN, PhD Institution: Berry College Email: ahook@berry.edu Competency Categories: Evidence-Based Practice, Informatics, Patient-Centered Care, Quality Improvement, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure BSN Learner Setting(s): Classroom, Clinical Setting, Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: Following implementation of the teaching strategy, students will be able to: 1. Identify clinical issues/situations surrounding each individual QSEN competency within the clinical practice setting. 2. Demonstrate knowledge of the interdependency of competencies as revealed in the Interdependent QSEN Competency Model. 3. Value the interdependency of the QSEN competencies and how each competency influences the other competencies in the pursuit of safe, quality outcomes. 4. Apply the Interdependent QSEN Competency Model to clinical problem solving when striving for safe, quality outcomes. Strategy Overview: Integrating the Quality and Safety for Education of Nursing (QSEN) competencies as individual concepts or “silos” of knowledge into existing nursing curricula limits the student’s ability to apply the concepts in clinical decision making. Nursing academia is obligated to instill knowledge, skills, and attitudes in clinical decision making that promote a culture of safety and quality outcomes (IOM, 2003; QSEN, 2012). The Institute of Medicine (2003) suggested an interdependent relationship between competencies for the clinical education of healthcare professionals. It is believed that the competencies are not relevant to the students unless they see a use for them in clinical decision-making. Illustrating the interdependency of the competencies through practical clinical application encourages the need for and use of all the competencies throughout the decision-making process. Using the theories of Problem-based Learning (Savery & Duffy, 1995) and Mezirow’s (1995) Transformative Learning Theory, an Interdependent QSEN Competency Model was developed (Hook & Dunagan, 2013). The “Quality House” model illustrates Safety and Quality Improvement as overarching or “roof” competencies supported by the “pillars”: Patient-centered Care, Teamwork and Collaboration, Evidence-based Practice, and Informatics. The nurse at the bedside acts as the “foundation” and “general contractor” of the house. Each component of the house is interdependent and structurally sound only when all parts are equally valued and maintained. A holistic and interdependent view of the competencies is promoted with continual and early application of the model to theory, clinical problem solving, and simulated laboratory experiences. One way to apply the interdependent QSEN competency model is using the following strategy in the clinical setting or simulation laboratory. An innovative teaching strategy which integrates interdependent QSEN competencies has been developed to prepare nursing students to actively participate as collaborative partners in a transforming health care system. After learning about the Interdependent QSEN Competency Model in the classroom, faculty will implement a teaching strategy in the clinical setting which applies real life healthcare problems to the model. In addition to their patient care assignments, each student will be assigned one of the six QSEN competencies. Students will be instructed to identify issues/situations illustrating use or lack of use of a specific competency in the clinical setting for the day. In post conference, faculty will ask students to share their findings with the group. Faculty will guide discussion with the students to aid them in identifying how an issue with one competency is affected by other competencies. For example, one student may be asked to identify issues/situations surrounding Team-Work and Collaboration. Faculty will assist the student in identifying how an issue with Team-Work and Collaboration may compromise Safety and Quality Improvement; as well as how Informatics and Patient-Centered Care could be a part of the solution. Changing healthcare systems demand that nurses participate in collaborative partnerships to promote safe, quality care. Within these collaborative partnerships, bedside nurses must be comfortable advocating for a culture of safety and quality (Rutherford, Lee, & Greiner, 2004; Rutherford, Phillips, Coughlan, Lee, Moen, Peck, & Taylor, 2008). To support competencies of safety and quality improvement, students should continually assess for factors that increase patient risk and be willing and able to assume a nursing identity that demonstrates efforts to promote quality outcomes (IOM, 2011). A culture of safety and quality is dependent on the nurse’s ability to apply knowledge, skills, and attitudes associated with each competency both separately and interdependently to clinical problem solving. Submitted Materials: Additional Materials: Evaluation Description: The student’s ability to identify a clinical issue/situation surrounding a competency indicates knowledge about the individual competency and its value to clinical practice. Evaluation of the student’s ability to meet each individual competency is also accomplished through the clinical evaluation tools (QSEN, 2013). Following this teaching strategy, learning related to the competency’s interdependency will be assessed in post conference by the faculty. Learning is realized when the nursing student is able to identify interdependent relationships among the competencies when problem solving in the clinical setting. No current researched evaluation method exists to assess students for knowledge about the interdependency of the competencies in the clinical setting. Prior to the development of the model, clinical instructors have determined a lack of student insight into clinical reasoning using QSEN competencies in an interdependent manner. Students had limited ability to see the relationship between the competencies when applied to real life clinical problem solving. It was observed that student insight was enhanced when current quality improvement projects in the clinical setting were used to demonstrate the interdependency of the competencies. In order for students to appreciate the interdependency of the model, they must first value the professional nurse’s foundational role and contributions to the quality improvement process. Research is needed to explore the benefits of teaching students to value the competencies, their interdependent relationship, and their contribution to safe, quality outcomes.

Published Back to Strategy Search Strategy Submission SAFETY Bundle Simulation Day Author: Randi Flexner DNP, APN, FNP-BC, RN Title: Clinical Assistant Professor Coauthors: Robert Strayer, PhD, APN Institution: Rutgers,the State University of New Jersey Email: Flexner13@gmail.com Competency Categories: Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure BSN Learner Setting(s): Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: 1. Identify actual and potential safety risks at patient bedside-environment. 2. Application of self-reflection and peer evaluation in group debriefing 3. Demonstrate knowledge and skills of peri-operative experience: (1) identify various nursing roles, (2) clean verses aseptic environment, and (3) patient safety during peri-operative experience. 4. Maintain sterility in operating room. (Knowledge and skills) 5. Collaborate with interdisciplinary team in operating room. (KSA) 6. Utilize SBAR communication appropriately and efficiently. (KSA) 7. Preparation of content completed in advance to facilitate skills application, deploy critical thinking, and accountability during simulation. (KSA) 8. Demonstrate teamwork and collaboration by establishing specific roles during emergency mock code to effectively perform skills and patient outcome. (KSA) 9. Identify various interdisciplinary roles in mock code, demonstrate respect, professionalism, and collaboration for efficiency and patient safety. (Attitude, confidence, professionalism) 10. Recognize family stress during emergency mock code and intervene effectively. (Attitude, respect, professionalism) Strategy Overview: At conclusion of junior year, students completed course theory in Nursing Foundations and Adult Health and Illness pertaining to but not limited to peri-operative nursing, SBAR communication, patient safety risks, cardiopulmonary resuscitation, and medication delivery. Students had one semester of medical surgical clinical and also completed their foundation skills competencies through-out the year in labs. Safety Bundle Day was constructed to apply a full day simulation experience in lieu of the last clinical day for the entire junior class. The purpose was to apply the culmination of content learned to clinical practice in a safe controlled environment, provide an opportunity to apply new skills in the mock code, collaborate with one another and with interdisciplinary persons. In a cost effective planning approach, faculty organized the simulation utilizing available materials in lab, and resources within the college at large, and personnel, i.e.: simulation operating room facility The activity ran multiple times through-out the day with student groups pre-assigned. 1. Operating room: Surgeon (interdisciplinary teamwork and collaboration) provided group of students’ discussion on various nursing roles in operating room, circulating nurse, scrub nurse, nurse anesthetist and/or anesthesiologist. Students scrubbed and gowned, maintaining sterility (safety and QI) Students opened sterile drapes and equipment, identified safety concerns in operating room, patient positioning, oxygenation, and fluid volume. Surgeon role play of time out procedure (QI and EBP) and discussed sutures, dressings, specimen collection, and blood loss. Students role played SBAR report to one another for recovery room transport (Communication, Safety). Recommend utilization of unique resource opportunities, facilities, and interdisciplinary care providers to enrich simulation experience and student interaction. This exercise can be basic or further developed according to available resources and learning objectives. Additional interdisciplinary roles could include medical techs, surgical techs, medical residents, physician assistants, nurse practitioners, certified nurse anesthetists, anesthesiologist, for further elaborate simulation scenario. 2. Patient Bedside Environment: Similar to "House of Horror, or "Little Room of Errors" students enter lab to find 4 patient rooms with various safety risks for patient, self, and others. One section relates to intravenous tubing, central line dressing, oxygen, and tracheostomy risks on a mannequin. Another section has basic patient safety risks related to side-rails, bed height, Foley bag placement, improper ted stockings, non-labeled intravenous bags, etc. Last section has environmental risks, dirty commode, overflowing trash, uncapped needles and specimens on nightstand, etc. Student navigate silently from bed to bed and write down all actual and potential safety risks identified. This is individual work, in a set time limit. Group debriefing is done immediately, faculty silent facilitator and allows students to peer review findings and rationale (communication). Students compare total number of findings, utilize self-reflection, and critical thinking skills by thinking beyond actual safety concerns to potential safety concerns. 3. Mock Code: Students are provided a code packet 2 weeks prior to review roles of nurse, crash cart supplies, CPR, basic EKG strip rhythms and associated medications utilized, two current EPB articles on running a code. Students randomly select their individual role during the code with 3x5 card upon entry to lab. The patient assigned nurse finds mannequin unresponsive and calls Code Blue (communication, safety, collaboration). Role playing begins and students assume their roles. Faculty members are present and facilitate the code. The roles are provided and can vary in number ie: one with a script as the provider calling the code, one nurse anesthetist, or any individual certified in advanced cardiac life support (ACLS) training to assist with airway and one observer utilizing a check off rubric to identify actions taken and those omitted, and facilitate debriefing. Students assume roles such as code delegating charge nurse, family member, nurse manager, recording nurse, crash cart-medicine delivery, additional staff nurses - tending to nurse anesthetist and intubation, tending to family, assisting charge nurse, tending to remaining patients on unit floor during code. Immediate debriefing is done post simulation. Students and faculty identify "urgency" feeling during code, value of communication and teamwork, value of skills operating equipment and crash cart, interdisciplinary care, critical thinking, and accountability. Faculty addresses rubric, areas of strengths and weakness. Mock Code is repeated a second time (quality improvement), students randomly choose roles again for additional learning. Submitted Materials: EXAMPLES-OF-EKG-RHYTHMS.docx - https://drive.google.com/open?id=1ICj7LqkjKejjMsBq6mnjobo0ktBgzlGP&usp=drive_copy Patient-Bedside-Safety-Risk-Documents.docx - https://drive.google.com/open?id=1LxY6O5YNa1gkzs4J0a21ryXzqvFP_eWt&usp=drive_copy OPERATIVE-REPORT-POST-OP-Rubric.docx - https://drive.google.com/open?id=1L5VV85clAzZ54clndrA_PpX5TyPIyK9B&usp=drive_copy Safety-Day-Simulation-Evaluation-Survey.docx - https://drive.google.com/open?id=1ObnoTYkVFcgdUyd1TmuMYwdpcG0jTBfX&usp=drive_copy 190.Simulation-Activity-MOCK-CODE-DOCS-revised.docx - https://drive.google.com/open?id=1ELcbaMDW2yqFI0vA3cBFN1S5GPS-yIPz&usp=drive_copy Additional Materials: *Special Acknowledgment of ongoing annual simulation development contributions by Rutgers, Clinical Lab Instructors and assigned course leaders. EKG rhythm strips (samples provided) CPR review Commonly used medications during a cardiac arrest/code status (sample provided) ANY current articles on nurses’ role during a code event & current EBP: *recommendations: Bryce, W (2014) The Novice Nurse’s Guide to Calling “Code Blue” The Journal of Continuing Education in Nursing · Vol 45, No 3, 2014doi:10.3928/00220124-20140219-01 O’Donoghue et al (2015). Nurses’ Perceptions of Role, Team Performance, and Education Regarding Resuscitation in the Adult Medical-Surgical Patient Med Surg Nursing September-October 2015 • Vol. 24/No. 5 Mock Code Rubric (provided) Mock Code Roles (provided) Evaluation Tool (provided) Additional recommended content knowledge prior to exercise: Fundamentals of Nursing Skills completion on asepsis and sterile technique SBAR communication Stages of the operative process, and nurse roles (pre-op, operative, post-op) Various types of anesthesia methods Additional supplemental documents available upon request Evaluation Description: The students received a post exercise evaluation survey which inquired to student’s perception of the overall activity, meeting the learning objectives, role of faculty, and suggestions for future use. Overwhelmingly, the surveys were positive and students expressed satisfaction, learning, increased confidence, and continued use, plus MORE simulation exercises throughout the curriculum. Major themes identified were increased confidence, exercise provided additional learning opportunity and skill application not previously found in their actual clinical rotation, safe environment, appreciated emphasis on QSEN competencies, value of debriefing and opportunity to improve with immediate repetition of Mock Code. Students valued the interdisciplinary practice exposure and operating room simulation experience. The Mock Code check off rubric allowed for comparing objective outcome measures of initial performance, and secondary performance following immediate debriefing. The second application also provided student with increased confidence in their role performance, delegation and communication skills, collaboration, and patient safety.

Published Back to Strategy Search Strategy Submission Mind Mapping: An Active Classroom Learning Strategy Author: Annemarie Rosciano DNP, MSN, MPA, APRN, ANP-C Title: Clinical Assistant Professor Coauthors: Frances Cherkis DHSc, RN, CNE Farmingdale State College Institution: Stony Brook University Email: Annemarie.Rosciano@stonybook.edu Competency Categories: Evidence-Based Practice, Teamwork and Collaboration Learner Level(s): Graduate Students, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN Learner Setting(s): Classroom, Clinical Setting Strategy Type: General Strategy Learning Objectives: The student will: 1. Apply the use of a variety of nursing practices as components of the mind map. 2. Synthesizes a mind map using the Student’s Self-Assessment Instructional Rubric. 3. Establish effective collaborative relationships in a teamwork environment. 4. Acknowledge their own potential to contribute to effective team functioning. Strategy Overview: The purpose of this in-class mind mapping activity is to introduce nursing students in a nursing course to explore a variety of concepts of nurses’ ways of knowing in professional practice in a collaborative learning and teamwork environment. Students come to class prepared to synthesize a mind map after completing assigned readings, viewing a mind map You-Tube video, and reviewing the student self-assessment instructional rubric for the activity. Discussion of what mind mapping is and its implementation is facilitated by the instructor at the beginning of the class to ensure students understand this creative activity. A three step collaborative structure is used to illustrate the concept of critical thinking (or substitute any assigned course concept): (1) formulating groups, (2) sharing ideas related to critical thinking, and (3) developing a mind map. (Note: Critical Thinking was chosen as an exemplar from one of many concepts used by nurses as a way of knowing in clinical practice). Students work in teams of 5-6 to create a mind map reflective of what thoughts and actions are essential components of critical thinking used by nurses during their daily clinical practice. Each team is instructed to reflect silently about the posed query. Next, the students exchange thoughts, shared responses within their groups, and lastly share the synthesis of their mind maps with the class. Each team synthesizes a mind map on a 36x48 Post-it paper. The central concept, critical thinking is placed in the center of the Post-it paper and the team works outward from this focus to create a mind map incorporating safe evidence-based practices. Forty-five minutes is provided for the activity and 10 minutes for each group’s presentation and summative assessment by the instructor. The use of mind mapping activity allows varying levels of nursing students to develop an understanding of critical thinking (or the assigned nursing concept) using a collaborative team approach. This activity allows students to reflect and share effective safe quality clinical practices. Bulleted steps for the Mind Map Activity • •Students are to complete the reading assignment and video prior to coming to class (link below). • A brief discussion occurs about the assigned topic for concept of choice (exemplar: uses critical thinking). • The day of creating the mind map, students review the following video as a class. This is to reinforce the process of mind mapping. • https://www.youtube.com/watch?v=wLWV0XN7K1g • The instructor initiates a short discussion about mind mapping, encouraging feedback from the students to determine their understanding of the activity. • Formative (while in groups) and summative (class discussion) classroom assessment techniques are implemented for this strategy. • Upon completion of the activity the instructor facilitates team(s) discussion. The teams share the chosen concept related to ways of knowing used in their mind map based. • Materials for activity: markers, crayons, Post-it paper. • After completion discuss the mind maps as a group and identify commonalities based upon the central nursing concept. • Materials for activity: markers, crayons, Post-it paper. How Mind Mapping Contributes to Patient Safety: Although the effect of mind mapping is indirect, it has the potential to have significant value on the patient’s wellbeing and safety executed by nursing students. The synthesis of a mind map using the concept of critical thinking promotes the nursing student to problem solve, to reason, to think in a systematic way when making clinical decisions. Thinking critically and in a logical manner, which can be illustrated in a mind map, enables the nursing student to reflect how to appropriately use the reasoning process and what should be considered in this process to ensure the delivery of safe nursing practice and quality care. Submitted Materials: 1-s2.0-S1557308715000050-main-Mind-Mapping-4.15.pdf - https://drive.google.com/open?id=1EnuS4KywbSsSoi0-igh5UJZf0HEQ1P2Z&usp=drive_copy Mind-Mapping-Student-Evaluation-Questionnaire-Revised-4.14-Rosciano.pdf - https://drive.google.com/open?id=17zEoqVlT5WZbQiyeTtag7zJQYy0MnxJB&usp=drive_copy Mind_Mapping_Rubric_Rosciano.pdf - https://drive.google.com/open?id=1VLnle40blqpvhxcwM6K9n1fP_mLqMhwR&usp=drive_copy Additional Materials: 1. Mind map article/readings related to concept- reading assignment 2. You-Tube video https://www.youtube.com/watch?v=wLWV0XN7K1g 3. Student Self-Assessment Instructional Rubric Adapted from: http://rubistar.4teachers.org/index.php This is a free website that allows teachers to create and edit rubrics. 4. Mind mapping Student Questionnaire Evaluation Description: (A) Instructional rubric. The instructional rubric has three purposes: (1) to guide the team in their synthesis of the mind map, (2) to provide the team with the opportunity to achieve a level of proficiency for this activity, (3) to evaluate how well the team implemented the activity. The rubric can be used by faculty to grade the activity. (B) Formative assessment conducted by faculty as the team engages in creating the mind map. (C) Mind Mapping Student Questionnaire is voluntary, anonymous and used to evaluate the teams learning experience and faculty can realize the value of the activity. (D) Summative assessment provides the opportunity for the teams to share their mind maps and the identified evidence-based clinical practices with their peers.

Published Back to Strategy Search Strategy Submission Rapid Cycle Learning in Simulation- Utilizing a postpartum hemorrhage scenario Author: Randi Flexner DNP, APN, FNP-BC, RN Title: Clinical Assistant Professor Coauthors: No co-authors, but acknowledgment contributions: Course Leader, Carol Carofiglio, PhD, RN providing PPH lecture material & simulation lab set up and Dawn Geller BSN, MEd, RN, for contributions to rubric and lab simulation activities. Similar PPH teaching strategy initially posted on QSEN.org by Mary Lou Gies, Ed.D, RN (2013). Institution: Rutgers, the State University of New Jersey Email: Flexner13@gmail.com Competency Categories: Patient-Centered Care, Quality Improvement, Safety, Teamwork and Collaboration Learner Level(s): Continuing Education, Graduate Students, New Graduates/Transition to Practice, Pre-Licensure BSN, Staff Development Learner Setting(s): Clinical Setting, Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: 1. Identify signs and symptoms of postpartum hemorrhage and patient safety concerns. (Knowledge) 2. Perform non-invasive initial steps to remedy symptoms and evaluate results. (Knowledge, Skills) 3. Understand the value of teamwork and demonstrate collaboration to improve patient safety in emergency setting. (Attitude) 4. Utilize communication and delegation to meet necessary actions in emergency setting. (Attitude) 5. Utilize critical reasoning skills with the evolving patient status changes and apply necessary actions. (Knowledge, Skills) 6. Synthesize unfolding patient demise and urgency of more invasive interventions, collaborating with peers and interdisciplinary team. (Knowledge, Skills, Attitude) 7. Analyze and reflect on self and peer contribution to care of patient and family. (Attitude) 8. Acknowledge patient and family’s lack of knowledge and escalated fear, while providing them education and support. (Knowledge, Attitude) 9. Conduct SBAR communication for verbal report and transfer of patient. (Knowledge, Skills, Attitude) 10. Identify areas of one’s strength and areas of needed improvement with each cycle debriefing phase and audio/video recording, demonstrating increased confidence and action in subsequent cycle. (Knowledge, Skills, Attitude) 11. Utilize the model for improvement PDSA questions: What are we trying to accomplish? How do we know that a change is an improvement? What changes can we make that will result in the improvements we seek with each cycle to enhance learning? (Knowledge, Skills, Attitude) Knowledge: Incorporates the knowledge of postpartum hemorrhage complication following delivery. The nurse’s role in identifying signs and symptoms and role of providing safe care to patient and family. Skills: The ability to perform assessment skills, provide appropriate interventions based on assessment findings, collaborate and communicate with others, perform calmly during an urgent situation. Attitude: Demonstrate confidence in oneself, promote patient safety, be patient advocate, provide emotional support to patient and family, recognize need for assistance, delegate to others, self-reflect and identify areas of improvement. Strategy Overview: Preparation: Students are to complete the assigned textbook reading and a case study article provided prior to the exercise on PPH; etiology, signs and symptoms, nursing assessments, and treatment options. They should also be introduced to Kolb’s Change Theory of Learning, the Plan-Do-Study-Act cycle for change, and rapid cycle learning. Pre-briefing: Students are instructed how the rapid cycle learning will be performed in the simulation lab. Students are told they will conduct an initial assessment of their patient collectively as “one’ nurse in a group format. They will be guided by the faculty facilitator in regards to vital signs with student request. Following a pre-determined time limit (approximately 10-15 minutes) the cycle will end and there will be an immediate debriefing. The students are either audio or video taped during the simulation which is reviewed together immediately following the cycle. The students are then instructed that they will proceed to the next repeat simulation cycle paired together in varied nursing roles, rather than working collectively as “one”. Lastly in the final cycle, students will individually assume an assigned nursing role as the case study continues to evolve. By utilizing rapid cycle learning, students are expected to navigate through a process of reflection and growth within a short time frame, increasing their knowledge, critical reasoning skills, collaboration, confidence, and safety in practice. A predetermined time is established for each action cycle. The cycles can be equal in time or elongated as the scenario evolves with additional complications and necessary interventions. A specified amount of time promotes the urgency of the situation and encourages the students to think and act in a more efficient manner. Lab environment set up: The simulation scenario includes a mannequin with a soft uterus and a large amount of blood on a perineal pad hidden by a coversheet. A family member, played by faculty or another student is present by the bedside. The patient has an intravenous access in upper limb. A medication cart and oxygen delivery source is available in the simulation area. Clinical groups of 4-8 students are recommended. Strategy: The Plan-Do-Study-Act model and Kolb Theory of change demonstrates how learning evolves through phases. Rapid cycle learning is a similar method that provides students the opportunity to perform simulation, debrief and reflect immediately, then repeat the prior simulation multiple times along with an evolving scenario. This allows the student to incorporate what was and was not previously effective (Plan-Do-Study-Act) and further provides an option to build upon the prior experience with enhanced learning in each new cycle. The scoring rubric is recorded following each rapid cycle phase and the aim is that ultimately by the last cycle, all sections are completed. The scoring at each phase may vary depending on the student’s baseline actions, but should demonstrate evidence of progress with each new cycle. Step 1: Action - Students are prompted on entry to simulation room that the group would initially operate as “one nurse” collectively to perform a postpartum assessment. By working synergistically as “one” students are less intimidated with new application of skills assessment. The mannequin has large amounts of blood on perineal pad, soft uterus, and intravenous fluid infusing at slow rate. Students are told to brainstorm and shout out all thoughts as to what their assessment should entail (basic ABCs) and why. Faculty can utilize a video and/or audio device to capture student’s real time performance. Faculty allows the students to conduct initial assessments without instruction. Step 2: Initial Debriefing - Students and faculty facilitator view recording together and utilize a rubric check off list to award points of areas addressed during the first action cycle. Further Debriefing - reflective process, discussion of rationale for actions taken and not taken, and areas of needed improvement. Step 3: Action Cycle #2 - Repeat cycle of entry into patient’s room and initial assessments. Student are assigned roles working as pairs, rather than collectively as “one” nurse. Faculty facilitator evolves case with patient change of vital signs, increased uterine bleeding, and level of consciousness. Faculty records second cycle on recording device/or video. Step 4: Debriefing - Together faculty facilitator and students review recording and revisit grading rubric, new point total calculated with improved patient care measures. Further Debriefing - reflective process, discussion of rationale for actions taken and not taken, and areas of needed improvement. Step 5: Action Cycle #3 – Faculty facilitator advances students in their roles at this stage and assigns specific student roles, no longer collectively being “one” nurse or “paired”, but assigned independent roles. This is to promote further accountability for student participation. Students along with the facilitator identify before role playing, anticipatory nursing roles in caring for the patient in this PPH scenario. Together, the facilitator and students pre-select their role for this cycle before it begins. Such examples are, but not limited to; (1) nurse to care for family member, (2) primary nurse for patient, (3) additional unit staff nurse for assistance (4) a charge nurse for staff support upon request, (5) an operating room nurse to receive SBAR. Faculty facilitator role plays the practitioner and provides new patient care orders at this stage of the evolving case. ie: Medications to stop bleeding, oxygen, blood transfusion, increased intravenous fluids, & urinary catheter insertion. During this cycle, the faculty facilitator determines that the patient should be prepared for surgery. The student nurse caring for the patient should utilize critical reasoning skills to collaborate and delegate necessary nursing care assistance from her peers who are acting in their pre-assigned nursing roles mentioned above. The patient’s primary care nurse should inform the charge nurse of the patient’s negative status change, seek assistance from additional staff to console spouse and keep him well informed, and assist in patient care. Ie: If patient receives blood transfusion, two person RN verification required. The patient’s primary nurse or charge nurse should contact the Operating room nurse and communicate the need for an immediate available OR and provide the SBAR report, including pertinent information such as blood type, medications received, vital signs, and recent lab values. Each student is actively participating in the simulation exercise working as a team. Step 6: Debriefing – Students and faculty facilitator review recording together as the final debriefing. Facilitator encourages student reflective process on areas of knowledge, safety, interdisciplinary collaboration of care, SBAR communication, critical reasoning, anticipation of events unfolding, prioritizing areas of care, student’s confidence, the various nursing roles with responsibilities and actions associated to that role, and family/patient centered care. Rubric scoring is recorded. Submitted Materials: Rapid-Cycle-Scoring-Rubric.docx - https://drive.google.com/open?id=1OVOK9zjqnSUXUPiHz8dE9_1h5kAdHIns&usp=drive_copy Rapid-Cycle-PDSA.docx - https://drive.google.com/open?id=1O6hB6GxrBRVKD5OH-H4zqwmvv9J2l3vd&usp=drive_copy 195.-SBAR-form.docx - https://drive.google.com/open?id=1EnuS4KywbSsSoi0-igh5UJZf0HEQ1P2Z&usp=drive_copy Simulation-Exercise-PPH-RCL-3-2-2-3.docx - https://drive.google.com/open?id=1PUMm4ljf3O2QrhdWk9_nTjwxSFmXxBao&usp=drive_copy Pre-reading-postpartum-hemorrage-article-1.pdf - https://drive.google.com/open?id=1NTc5ffRWDfPerpzLdMxW1c1Fi5NqsBEA&usp=drive_copy Additional Materials: Utilize current classroom textbook, NCLEX material, and evidence based practice content information on topic (postpartum hemorrhage) Provide content reading ahead of simulation experience. Incorporate QSEN competencies, and KSA into the curricula and simulation. Evaluation Description: At the conclusion of the activity, the instructor should perform a final debriefing. The instructor should compare the prior cycle rubric scores to the final rubric score to determine improved performance. At the conclusion, allow students the opportunity to self-reflect on the model for improvement PDSA questions, and discuss collectively their perception of the rapid cycle learning process and the end results. Data collection: Combine all rubric data scores for cumulative tally and note areas of improvement. Analyze student’s shared verbal reflection comments for common themes.

Published Back to Strategy Search Strategy Submission Gertrude Smith: A Neuro Unfolding Role-Playing Case Study Author: Crista Reaves PhD, RN Title: Assistant Professor Coauthors: Michael Martel DNP, APRN, AGCNS-BC Institution: Michigan State University College of Nursing Email: mitch350@msu.edu Competency Categories: Patient-Centered Care, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Classroom Strategy Type: Case Studies Learning Objectives: The learner will: Identify the need to activate the emergency response system in critical situations (PCC – knowledge) Identify risk factors for an acute ischemic stroke (PCC – knowledge) Evaluate and apply critical thinking to determine expected assessment, laboratory, and diagnostic findings for a patient with an acute ischemic stroke (PCC – skills) Design a plan of care, including prioritizing nursing interventions, and modify as the scenario unfolds (PCC – skills) Demonstrate effective therapeutic communication with the patient and family member while respecting the patient’s values and autonomy (PCC – attitudes) Address and support the patient and caregiver’s emotional well-being (PCC – attitudes) Compare and contrast the roles and responsibilities of the interdisciplinary team in emergent situations (T&C – knowledge) Explain when to collaborate with the provider regarding patient’s care (T&C – skills) Articulate risk factors and safety considerations for commonly prescribed thrombolytic medications for patients with acute ischemic stroke (safety – knowledge) Identify safety concerns for the patient when they return home and design a plan of care to reduce safety risks to improve patient outcomes (safety – skills) Strategy Overview: Strategy Method: This specific unfolding role-playing case study allows ADN or BSN undergraduate nursing students and faculty the ability to focus on the QSEN competencies of patient-centered care, teamwork and collaboration, and safety. The nursing students will role-play the nurse, while the educator is the facilitator and/or patient. If additional faculty are available, supplementary roles may be assigned such as provider, EMT, and the patient’s family. The students are provided with a brief history of present illness and must use their communication, critical thinking and reasoning, and judgment skills to ask the patient additional questions to obtain a complete history. The students will also use their critical thinking and reasoning to verbalize the components of an assessment that would need to take place and the expected findings with rationale. Students will use the information provided to collaborate with one another to determine their next steps of care. The nursing students will prioritize care and create a plan (including assessments, interventions, medications, and education) for the patient as the scenario unfolds. In addition, they will identify key safety concerns and the education and/or interventions needed to promote safety as they learn new information from the patient, the patient’s provider, and/or from labs and diagnostics. This unfolding role-playing case study will challenge the students to apply their critical thinking, reasoning, and judgment skills to translate content learned to a simulated patient encounter. Strategy Overview: Newly graduated nursing students are finding themselves ill-prepared to manage their patient’s convoluted care, with many new nurses demonstrating limited ability to critically think to make appropriate clinical decisions (Benner et al., 2015; Goode et al., 2016; Wotton & Gonda, 2004). The lack of inability to critically think and reason may lead to adverse patient outcomes and safety concerns (Good et al., 2016; Saintsing et al., 2010). Nurse educators have failed to prepare nursing students for the changing healthcare environment by educating students through passive lecture-based learning (Hammand & Khalaf, 2020). Passive learning impedes the ability for students to translate knowledge learned to a practice setting. The QSEN competencies of patient-centered care (PCC), teamwork and collaboration (T&C), and patient safety must be presented through active learning activities to develop competent nursing students who are equipped with the tools needed to manage their patient's care. Nurse educators must bridge the transition gap from school to practice by including active learning strategies encompassing QSEN’s core competencies during the didactic portion of each nursing course to improve students’ critical thinking and problem-solving skills (Duta, 2013; Powers, et al., 2019). One way to do this is through the incorporation of unfolding role-playing case studies (Hammad & Khalaf, 2020). Unfolding role-playing case studies encourage student participation, critical thinking, and reasoning (Dutra, 2013), and can enhance peer communication and collaboration (Gropelli, 2010). Unfolding role-playing case studies allows the students the ability to interact with the simulated patient (the faculty teaching the course) to analyze the situation and apply key concepts learned to improve patient outcomes (Lee et al., 2003). Students can gather the pertinent history, verbalize an assessment and expected findings, prioritize problems, identify nursing interventions, and provide education to the patient all within a simulated environment. In addition, role-playing engages the students in therapeutic communication while having real-time feedback on how the communication is perceived (Powers et al., 2010). Students leave lectures having learned the rationale behind the care provided, and the critical thinking needed to care for a patient with a specific condition. This active learning translates into clinical practice when the student is presented with a similar patient situation. Ensuring students are engaged in active learning through role-playing case studies promotes retention and translation of knowledge learned in the classroom setting. This will assist in developing competent nurses who are readily able to apply critical thinking and reasoning to provide safe, evidence-based care to the diverse patient population they serve (Hammad & Khalaf, 2020). Submitted Materials: References-for-Gertrude-Smith_An-Unfolding-Role-Playing-Case-Study.docx - https://drive.google.com/open?id=16Xvzlo6qwTkr38npVUgm42h-wofqYZ-1&usp=drive_copy QSEN-302-Case-Study-Neuro-Unfolding-Role-Playing-Case-Study-and-Evaluation.docx - https://drive.google.com/open?id=13WStiQezHRFi2juZOCQCIsaBtIMDaVJc&usp=drive_copy Additional Materials: Attached is the reference page as well as the case study. Please let us know if it did not upload correctly. Thank you for your review and consideration. Evaluation Description: Summative Case Study Evaluation Questions: 1. How did this unfolding case study make you feel? 2. Reflect and evaluate the care provided throughout the scenario: - What went well? - What did not go as expected? 3. What opportunities for improvement can you identify? 4. What were some of your strengths and weaknesses throughout the scenario? 5. How did this unfolding case study contribute to your learning?

Published Back to Strategy Search Strategy Submission Connecting QSEN Competencies to Identify Barriers and Empower Active Participation of a Patient in Their Own Health Care Author: LAURIE PITTMAN MSN, RN Title: Assistant Professor of Nursing Coauthors: Institution: Louisiana State University at Alexandria Email: lpittman@lsua.edu Competency Categories: Evidence-Based Practice, Informatics, Patient-Centered Care, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Classroom, Clinical Setting Strategy Type: Paper Assignments Learning Objectives: 1. Identify barriers to active participation of a patient in their own health care processes with respect to patient preferences for degree of active engagement. 2. Navigate the electronic health record to obtain supporting data in identification of patient barriers to participation in their own health care processes. 3. Utilize appropriate resources to develop strategies to engage a patient in active participation of their own health care processes. 4. Discuss the role and value of the nurse in implementing strategies to empower active participation of a patient in their own health care processes. 5. Identify members of the healthcare team needed to support the nurse and patient in the patient overcoming barriers to active participation in their own health care processes. 6. Discuss the role and value of members of the healthcare team in implementing strategies to empower active participation of a patient in their own health care processes. Strategy Overview: The QSEN written project provides an opportunity for nursing students to apply QSEN competencies in recognizing and addressing physiological, psychosocial, developmental, cultural, and socioeconomic barriers patients face with their health and within the healthcare system. Incorporating QSEN competencies into an ADN and BSN clinical project fosters awareness of the knowledge, skills, and attitudes needed by the student nurse and licensed professional nurse to promote high quality and safe nursing practice leading to positive patient outcomes. Specifically, the student has the opportunity to identify nursing and interprofessional interventions to help patients overcome barriers to improve active participation in their health care. Students are assigned the project at the beginning of the clinical rotation with a due date that provides time to recognize and choose an appropriate patient who exhibits barriers to active participation in all or part of their own health care processes and develop the paper using the specific instructions. The suggested time frame is 3-4 weeks. Through understanding and recognition of QSEN competencies, students will choose a patient and develop a paper addressing the following: A. Patient demographics and supporting data B. Barrier(s) to active involvement of health care, including type of barrier(s) with rationale Barrier(s) may include but are not limited to: social support system, living arrangements, language barriers, health literacy, cognitive status, insurance type, transportation, occupation, religious affiliation, gender identification, and/or denial of health status. C. Identify and discuss a minimum of three (3) evidence-based strategies to overcome barriers D. Nurse role in implementing strategies E. Identify and discuss the role of at least two (2) other healthcare team members needed to support the strategies F. Expected or actual outcomes of strategies The paper will adhere to APA format and include at least three scholarly nursing resources ≤ 3 years old. Students will follow the attached rubric which can be modified in the total point value to conform to course needs. Students will increase their understanding of QSEN and the application of selected competencies in supporting patients to overcome actual or perceived barriers to active participation in their own healthcare processes using evidenced-based practice strategies and collaboration with other healthcare team members. Students will recognize the selected competencies will enhance patient-centered care and safety that leads to positive patient outcomes. Submitted Materials: QSEN-Teaching-Strategy-Detailed-2020-1.docx - https://drive.google.com/open?id=14w69-CTn-TakOVJdgYQbgN4882Os2n1_&usp=drive_copy Additional Materials: Evaluation Description: The evaluation of objectives will be through the attached rubric.

Published Back to Strategy Search Strategy Submission Little Room of Errors Author: Robin Arends MS, CNP Title: Instructor Coauthors: Institution: South Dakota State University Email: robin.arends@sdstate.edu Competency Categories: Patient-Centered Care, Quality Improvement, Safety Learner Level(s): New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN Learner Setting(s): Clinical Setting, Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: Communicate observations or concerns related to safety and hazards in the environment for the patient. Identify safety hazards in the patient environment that will cause harm or could potentially lead to harm. Determine safety hazards that are patient related, health- care provider related, or system related. Strategy Overview: The goal of this strategy is to allow students to identify as many errors or hazards in a patient environment. Prior to the clinical or laboratory experience, faculty “creates” a patient room that has errors or hazards. This room may have 1 side rail down, water on the floor, patient allergy band stating Morphine and Morphine ordered on an open medication administration record, long cords strung over the patient’s bed, uncapped needles with “blood,” medications not locked up, cigarettes and a lighter in a purse, pills in a purse, etc. The options are endless. The student enters the room and has a certain amount of time to find the errors. If there are a lot of errors, you may give the student 1 minute to determine errors or allow them to roam throughout the room to see the errors. The hospital that set this up for their employees and our students that I participated in had 115 errors in it, so students were allowed to have 15 minutes. After each student does this individually, we discuss what we saw as a group. Then I take the students through as a group and point out errors that were missed by everyone. There is a lot of discussion as to what makes something a hazard or not. Submitted Materials: Additional Materials: Evaluation Description: This is an ungraded assignment, but could turn into a fun competition by the students to discover who could identify the most errors in the room.