Published Back to Strategy Search Strategy Submission Students LEARN to Present Data Author: Lisa Singleterry PhD, RN, CNE Title: Assistant Professor Coauthors: Institution: Ferris State University Email: singlel@ferris.edu Competency Categories: Informatics Learner Level(s): Pre-Licensure BSN, RN to BSN Learner Setting(s): Clinical Setting Strategy Type: Online or Web-based Modules Learning Objectives: Presentation (adapted from Cronenwett et al., 2007, p. 129) • Explain why data presentation skills are essential for patient safety (Knowledge-informatics) • Use information to communicate data (Skill-informatics) • Apply technology and information management tools (Skill-informatics) Reflection (adapted from Cronenwett et al., 2007, p. 129) • Contrast benefit and limitations of different communication technologies and reflect on potential impact on safety and quality (Knowledge-Informatics) • Appreciate the necessity of information technology (Attitudes-informatics) • Value technologies that support clinical decision-making, error prevention, and care coordination (Attitude-informatics) Purpose: Undergraduate students experience information technology and the expression of data followed by guided reflection using the LEARN steps (Rideout, 2001, p. 133). Each student is exposed to information technology programs (i.e. excel, power point, adobe, blackboard 9.1) to manage and communicate data and information to peers. Reflection facilitates learner attitude development, technology and socialization in informatics. Strategy Overview: Pr e s e nt a t i o n : Every student is assigned to post a 5-minute presentation to the on-line discussion board [Alternatively, the instructor may use the Blackboard peer and self-assessment assignment tool, Padlet or other presentation platform for this presentation]. The presentation must contain written, audio and visual communication. ALL students (and your instructor!) MUST be able to open and view the presentation. The suggested presentation platform is audio added to power point. Alternatives include, but are not limited to Jing, Snagit, YouTube, Prezi, Google docs, and Slide Rocket. The data used for this assignment is gathered in an instructor-developed survey (see strategy material) that produces data at all four levels of measurement (nominal, ordinal, interval, and ratio) [alternatively, the instructor may direct students to use nurse sensitive data housed with AHRQ or other National data results. Note: computer program exposure will vary with this alternative choice] Students receive de-identified data on one survey question. The student is responsible for choice of data presentation (i.e. bar graph, table percentages) based on their identification of the data’s level of measure and interpretation of guidelines from Making Data Talk: A workbook (available FREE from http://www.cancer.gov/cancertopics/cancerlibrary/mdt-workbook.pdf ). R eflection: In the on-line discussion board, students will use the five reflective practice steps (LEARN), to critique five (5) peer presentations of their choice [Alternatively, the instructor may use the Blackboard peer and self-assessment assignment tool. This tool randomly assigns students to review peer submissions]. The reflection experience is an opportunity for students to view how information and data are interpreted, organized or structured, depending on the level of measurement. Secondly, students experience how data representation can change perception, attitudes and interpretation of that data. Each student describes a) their preference of data presentation style (i.e. table or pictorial data presentation), giving a rationale for that choice, b) the experience of using information technology, and c) how information technology can impact quality and safety in nursing practice. L ook at 5 peer data presentations. Try to look at the data in general terms; often data is used to communicate health information or qualityimprovement opportunities. Look at the way the data is presented; what makes an impact; what makes the data confusing?You will EARN points in this reflection section by posting a reply to each of the 5 peer presentations you review. Each reply will be formatted using the Elaborate-Analyze-Revise-New process outlined below. E laborate and describe, in writing, how you felt viewing the peer presentation. What happened during the presentation? How did you feel andhow do you think others felt? What were the outcomes? Were you surprised by what happened during the presentation or did it turn out as expected? A nalyze the outcomes-Consider the level of measure (nominal, ordinal, interval, and ratio), was this the best way to present that level ofmeasure? Consider how communication of quality improvement data can impact quality and safety outcomes. If the data presented is confusing, how will that impact practice? Does poor data presentation impact clinical reasoning or change practice? Review why the data turned out the way it did. Why did you feel or react the way you did? If the outcomes were not what you expected, consider how you could improve the data presentation. This is an opportunity to really question your beliefs and assumptions, and ask yourself what the experience reveals about how to value data and the use of technology to communicate. R evise your approach based on your review of the data and decide how, or if, you will change your approach. With your new learning, youmay decide to try a new approach, learn more about the subject, or decide that you handled the situation very well. Do you appreciate the use of technology to present data? Is there a better way? N ew trial. Put your new approach into action. This may require anticipating or creating a situation in which you can then try out your newapproach. Suggest a way you might use this data in your practice. Submitted Materials: Data-Presentation-Grading-rubric.pdf - https://drive.google.com/open?id=1SQLEavbzaVHG9-N5-Net8FFmYnhhPBIG&usp=drive_copy Instructor-developed-survey-1.pdf - https://drive.google.com/open?id=1TiWSgo75xIykFTz0UNuH-VEL9R3IeJSQ&usp=drive_copy Sample-Letter-1.pdf - https://drive.google.com/open?id=1X4B6BK4llT4xsIMWK9SozI0X-eqrQ4YN&usp=drive_copy Additional Materials: Evaluation Description: D a t a Presentation Grading rubric Needs improvement0-84% Competent 85-94% Proficient>95% Expert100% Points Slide 1 Title Introduces self Slide 2 Introduction Describes purpose of the assignment. Describes data, including adefinition of the level of measure. Explained why data presentation skills are important for patient safety. /10 Slide 3 D a t a (pictorial) Successful use of data management tools are evident. Communicationof data is clear: slide description includes an explanation of the data; choice of data representation (based on level of measure); and guidelines (from Making Data Talk: A workbook) for that data representation. /20 Slide 4 D a t a (table) /20 Slide 5 Reference(s) Reflection Needs improvement0-84% Competent 85-94% Proficient>95% Expert100% Points E l a bo ra t e E laborated and described feelings while viewing the peer presentation(this may include: descriptions of what happened during the presentation or feeling while watching the presentation). Described the outcome. /10 An a l yz e A nalyzed the peer data presentation (described why/why not it wasthe best way to present that data). Description of how presentation style of data could impact nursing practice quality. /10 R e v i se R evision included details for improvement or support for agreement.Includes appreciation of technology or suggested use of alternate technology to present data. /10 N e w N ew trial includes description of how the data or representation ofdata (i.e. pie chart) can be used in nursing practice to improve quality and safety. /10 DeductionsOver/under the 5 minute time limit (10 points per full minute) APA/ reference issues (1-26 points)Poor presentation quality (1-26 points) (i.e. Audio issues; Font size < 24; Visual issues) /-26 Final grade /100

Published Back to Strategy Search Strategy Submission Utilizing movie watching to enhance student's psychiatric nursing clinical knowledge, skills, and attitudes. Author: Randi Flexner Clinical Assistant Professor Title: DNP, APN-C Coauthors: Institution: Rutgers University Email: Flexner13@gamail.com Competency Categories: Evidence-Based Practice, Patient-Centered Care, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure BSN Learner Setting(s): Classroom, Clinical Setting Strategy Type: Independent Study Learning Objectives: · Identify psychiatric/addiction conditions and effects on family/caregiver dynamics. · Explore treatment options' success and failures in psych/addiction diseases. (Patient centered care, Teamwork & Collaboration) · Review the importance of interdisciplinary care teams in psychiatric care. (Teamwork & Collaboration) · Analyze various levels of health care interventions and safety with acute and chronic psychiatric disease. (Quality Improvement, Safety) · Synthesize movie experience with post viewing document for reflection and correlation to QSEN competencies. Strategy Overview: Students are often afraid or uncomfortable in their psychiatric nursing clinical rotation. Often, their clinical exposure is limited to one semester and a particular population group, either inpatient or outpatient. Utilizing motion picture (movie watching) as a supplemental learning venue can expand one's knowledge of the disease/addiction condition, presentation, treatment options, and effects on the family/caregiver. Individual reflective journals and shared group discussion can bring supplemental topic learning opportunities, enhance the direct patient clinical experience, and build upon the psych learning objectives in an alternative venue. Submitted Materials: Movie-Options.docx - https://drive.google.com/open?id=1-FF6Zkdqt2re2zf_em58IkSAij-VP3yn&usp=drive_copy EXAMPLE-MOVIE-LIST.docx - https://drive.google.com/open?id=1Hu39Usxitd-rSpavok8l_V4uMdh5Ji-r&usp=drive_copy Psych-Movie-Supplemented-Learning-Reflective-Journal-1.docx - https://drive.google.com/open?id=11sp6bjmxXfxYizH0aRvu-YWxyHYj7Qnh&usp=drive_copy Clinical-faculty-instructionfinal.docx - https://drive.google.com/open?id=1v7Ta9_hvZJ4Prq7s1Ith0gpyocO43q4M&usp=drive_copy Additional Materials: Evaluation Description: Students perceived the movie watching experience as a positive addition to their onsite clinical learning. The movie dramatization introduced students to greater magnitude over time via a "virtual continuum of care". In turn, it provided an opportunity to expand on their knowledge, skills, and attitudes of psychiatric conditions, addictions, and family dynamics beyond the limitations of their clinical setting.

Published Back to Strategy Search Strategy Submission Humanizing task trainers to inform patient-centered care Author: Mary Franklin DNP, RN, CNM, FACNM Title: Assistant Professor Coauthors: Institution: Case Western Reserve University Email: mrf19@case.edu Competency Categories: Patient-Centered Care Learner Level(s): Graduate Students Learner Setting(s): Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: At the end of the experience, the learner will demonstrate the ability to perform physical assessment skills with sensitivity, empathy, and respect for the simulated patient Strategy Overview: Low fidelity task trainers are a cost-effective tool to teach skills. However, practicing skills on task trainers focuses learner attention on the task to the exclusion of the other aspects of patient-centered care. It is difficult for faculty to integrate experiences such as talking to the patient, or maintaining patient dignity while doing tasks, when the task trainer is a disconnected body part. Enhancing task trainers to resemble simulated patients reminds learners about the holistic nature of care while practicing physical assessment skills. Faculty facilitating the simulation skills lab for pelvic, breast, and pregnancy exams for advanced practice nursing students have used creative and inexpensive materials to enhance task trainers and integrate the skills of patient-centered care into physical assessment practice. Task trainers were humanized with inexpensive materials to emphasize holistic care. Wig heads in various skin tones were purchased and outfitted with accessories such as hair, scarves, hats, glasses, and earrings. Pillows, gowns, and drape sheets were used to set the task trainers up as simulated patients. Name labels were used for the task trainers. During physical assessment skill practice, learners were expected to address the simulated patients by name and to explain the maneuvers they were performing, as if they were speaking to a patient. Using gowns and drape sheets helped learners practice maintaining the dignity of patients during exams. Faculty were able to discuss the principles of trauma-informed care during assessment practice with concrete examples of how a practitioner would perform an assessment on a patient who was wearing their own clothing rather than a hospital gown. Pictures of materials used and an example of an enhanced task trainer are attached. Submitted Materials: Standardized-skills-checklist.docx - https://drive.google.com/open?id=18_6BTYfNI3qrY1LHrujkVTdnW_8pxPFA&usp=drive_copy Pictures-for-enhanced-task-trainer.pdf - https://drive.google.com/open?id=1k5s2bpdSUSsedWU5tv-MspVpRQAVInci&usp=drive_copy Additional Materials: Attached are an example of a standardized skills checklist. The highlighted areas indicate where patient-centered care is evaluated Attached in a pdf are pictures of an un-enhanced task trainer, the materials used to enhance the task trainer, and an example of an enhanced task trainer Evaluation Description: Using a standardized check list, faculty using enhanced task trainers observed the learner’s ability to include aspects of patient-centered care and trauma informed care into physical assessment practice. An example of a learner check list is attached. Faculty have observed faster integration of patient-centered care into exams using live standardized patients and in the clinical area since the practice of using enhanced task trainers was introduced. Faculty have also reported an increased ability to demonstrate trauma informed care with the enhanced task trainers. Students have reported a more life-like experience with the enhanced task trainers. They report a positive aspect of using the enhanced task trainers is the opportunity to practice the skills of explaining procedures to patients and maintaining patient dignity during exams.

Published Back to Strategy Search Strategy Submission Interdisciplinary CQI Course Syllabus Author: Shirley M. Moore PhD, RN, FAAN Title: Associate Dean for Research and Professor of Nursing Coauthors: Institution: School of Nursing, Case Western Reserve University Email: Shirley.moore@case.edu Competency Categories: Quality Improvement, Safety, Teamwork and Collaboration Learner Level(s): Continuing Education, Graduate Students, 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: Uses data to monitor the outcomes of care processes, and uses improvement methods to design and test changes to continuously improve the quality and safety of health care systems. Functions effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care. Minimizes risk of harm to patients and providers through both system effectiveness and individual performance. The goal of this course is to equip health professions students (medicine, nursing, health administration and others) with the ability and confidence to contribute to continual improvement in health care. The focus is on collaborative work for the benefit of patients and communities. The specific course objectives are included in the syllabus document. Strategy Overview: This is a syllabus of a semester-long Interdisciplinary CQI course. This course has been taught levels of learners ranging from the undergraduates to practicing professionals for over ten years with great success. It is structured to be 16 weeks in length and includes class didactic go to experiences and a group field CQI project. The syllabus includes the grading schema for the course. A sample course schedule and the student course evaluation also are provided. We also have taught much of this course online. go to go to Submitted Materials: Additional Materials: I can provide more information on the use this syllabus to teach CQI, including more detail of what is taught in the major topic areas covered and the field experience. I am best reached at Shirley.moore@case.edu Evaluation Description: Successful completion of the course depends on: 1. Active participation in all class sessions, unless excused by the instructor (10% final grade). Successful completion of the interdisciplinary student field team project: a. Mid-course team self-analysis (10% final grade) b. Final field report (40% final grade) Completion of a personal improvement project (20% final grade). Completion of final case studies (20% final grade). Participation in course evaluation. The field project assessment is explained in greater detail in the document: QSEN field project assessment.doc The team self-analysis is explained in greater detail in the document: QSEN field improvement project.doc)

Published Back to Strategy Search Strategy Submission The Faculty Checklist Manifesto: Utilizing a QSEN based orientation checklist for the first day of a clinical rotation Author: Kimberly Silver Dunker DNP, RN Title: Associate Professor of Nursing Coauthors: Karen Manning RN, MSN, CRRN, CHPN; Susan Knowles, DNP, RN, WHNP-BC Institution: Worcester State University Email: kdunker@worcester.edu Competency Categories: Evidence-Based Practice, Informatics, Patient-Centered Care, Quality Improvement, Safety, Teamwork and Collaboration Learner Level(s): Faculty Development Strategies, Graduate Students, Pre-Licensure BSN Learner Setting(s): Clinical Setting, Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: Faculty will be able to: Increase quality and safety during guided clinical experiences using a standardized Quality and Safety Education for Nurses (QSEN) competency-based clinical orientation checklist during the first day of the clinical experience. The student will be able to: Demonstrate the knowledge, skills, and attitudes of safe patient care through the completion of the QSEN checklist assignments. Goal: The goal of this project was to provide clinical adjunct faculty members with a standardized checklist for the clinical orientation. The orientation checklist was developed with support from the QSEN Academic Clinical Practice Task Force committee using the six QSEN competencies. Strategy Overview: Relevance Standardized Checklists for clinical orientation are not found in the nursing journal literature. Therefore, many clinical faculty will develop their own checklist as well as, perform a scavenger hunt for the first clinical day. However, a list of items does not provide the critical thinking aspects necessary for the clinical orientation. A list will only inform the student about items to locate in the clinical agency. Alternatively, the QSEN clinical orientation checklist provides a structured guide for faculty to incorporate the QSEN competencies ,knowledge, skills, and attitudes (KSA)s for their assigned clinical students. The checklist utilizing the QSEN competencies adapted for nurse educators includes: (a) patient-centered care, (b) teamwork and collaboration, (c) evidence-based practice, (d) patient safety, (e) quality improvement, and (f) technology and informatics. Embedded within the checklist are strategies to help guide the clinical faculty in orienting their student group to the clinical environment. Strategy and Implementation Clinical faculty need to provide a quality orientation for students. This adapted orientation checklist was designed for pre-licensure nursing students in all guided clinical rotations including specialty rotations. faculty utilizing this checklist are provided clear objectives for the clinical orientation, which highlights the six QSEN competencies. The new checklist contains an itemized list, a scavenger hunt, and critical thinking strategies to orient students on their first clinical day. Goal: The ultimate goal in using this newly developed standardized orientation checklist is to ensure quality and safety is embedded into the clinical rotation from the first clinical day. Submitted Materials: Clinical-Orientation-CheckList-2.docx - https://drive.google.com/open?id=1vf-PK4-7uHgnrAXxwP-u2gy8vW8LJoC1&usp=drive_copy QSEN-Teaching-Strategy_Checklist-2-1.docx - https://drive.google.com/open?id=15vVscBA2B_jDGDhV60XDUoPnaNug91L9&usp=drive_copy Additional Materials: Clinical Orientation Checklist Found at: https://onlinetraining.umassmed.edu/checklist/ Evaluation Description: Evaluation Faculty were given the checklist before taking their students to the clinical site.. After using the checklist on the first day, faculty reported that utilizing the checklist allowed students to have a systematic orientation as well as, an introduction to the QSEN competencies. Faculty were queried about their experience using the QSEN adapted checklist during their orientation on the first clinical day. All faculty were asked these specific questions: Clinical Faculty Questions Did the checklist help organize your orientation day? Did you add additional items to the checklist? Were you able to integrate QSEN KAS into orientation? Which KAS activities did you utilize? Rationale for using the particular strategy? Student feedback: What was their take away learning from completing the activities? Lastly, the clinical instructor used the QSEN activities and post conference ideas throughout the remainder of the clinical rotation to enhance post conference discussions. Implication for Nursing Practice This newly developed orientation checklist resource is available on the Academic Clinical Practice Task Force website, which allows both academic and clinical partners an opportunity to implement this standardizing orientation strategy into any clinical rotation. In the future, implementation of this orientation checklist strategy into all clinical rotations can provide greater quality and safety for students while attending a clinical experience.

Published Back to Strategy Search Strategy Submission Incorporating Quality and Safety Case Studies, problem-based learning assignments and reflective practice exercises into Geriatric Practicum Setting Author: Jill Gaffney Valde PhD, RN Title: Associate Professor Coauthors: Institution: University of Iowa; College of Nursing Email: jill-valde@uiowa.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): Clinical Setting Strategy Type: Case Studies Learning Objectives: 1.Communicate patient values, preferences and expressed needs to other members of health care team. (PCC ) 2. Recognize contributions of other individuals and groups in helping patient/family achieve health goals. (T&C) 3. Locate evidence reports related to clinical practice topics and guidelines. (EBP) 4. Identify gaps between local and best practice. (QI) 5. Communicate observations or concerns related to hazards and errors to patients, families and the health care team. (Safety) 6. Use high quality electronic sources of healthcare information. (Informatics) Strategy Overview: The purpose of this teaching strategy is to incorporate the six QSEN competencies into a series of geriatric practicum seminars. Using a variety of interactive teaching techniques, including the unfolding case study and problem-based learning, students increase their awareness and assessment of quality and safety issues specific to older adults. Seminar A: Students listen to the unfolding case study of an elderly man named Sherman “Red” Yoder, who is an 80 year old widower with multiple health care needs. The case study is available free at the National League of Nursing (NLN) website http://www.nln.org/facultyprograms/facultyresources/ACES/unfolding_cases.htm . Students divide into pairs and identify and prioritize care needs of the client focusing on individual preferences and values revealed in the tape. They are also asked to discuss what other members of the health care team would be appropriate to collaborate with based on the team member’s role and education, and what referrals they would make. (PCC and T&C) Seminar B: Students interview a client the week before and bring a comprehensive medication list (both prescribed and over the counter) of their client to this week’s seminar. Students then draw from a list of pre-selected websites by the instructor and look up medication information and interactions. The students critique the credibility of the sites selected using the critique developed by the University of Minnesota. http://hsl.lib.umn.edu/biomed/help/evaluating-web-resources (Informatics) Seminar C: Students research and present articles on evidence based practice for one of the 3 D's- (Delirium, Dementia or Depression) comparing their literature findings to the current practice and policies in their assigned facility. Students are then expected to share their findings with their assigned preceptors. (EBP) Seminar D: Students are asked to select an assigned client and to go into the client’s room and time and conduct the “One Minute Safety Checklist” developed by K. Amer and found under Submitted Materials . Students need to quickly assess six categories of safety risks, (e.g. weight and age, assessment of airway) and based on the findings develop a prioritization of concerns and a plan of care (POC). The student is expected to involve the client, family and preceptor in the discussion of possible risks and interventions. (Safety and PCC) Seminar E: Students do a quality assessment of a long term care facility where they have a client and develop plans for improvement based on identified needs and opportunities using the “Observable Indicators of Nursing Home Care Quality Instrument" found under Submitted Materials . Students are instructed to spend 30 minutes walking around the long term care facility and making observations, focusing on what they see, hear and smell. Following the observation walk, students answer the 30 questions and compute a score. The results of their findings are shared with the preceptor and or administrator. In seminar students share findings, looking for common themes and identifying opportunities for quality improvement. (QI) Submitted Materials: Additional Materials: • Evaluating Web Resources (http://hsl.lib.umn.edu/biomed/help/evaluating-web-resources) University of Minnesota. Accessed August 16, 2012. • National League for Nurses. (www.nln.org). http://www.nln.org/facultyprograms/facultyresources/ACES/unfolding_cases.htm. Accessed August 16, 2012. • Rantz, M., Zwygart-Stauffacher, M., Mehr, D., Petroski, G., Owen, S., & Madsen, R. (2006). Field testing, refinement and psychometric evaluation of a new measure of nursing home care quality. Journal of Nursing Measurement, 14(2), 129-148(20).* PMCID: PMC3254215 Evaluation Description: The clinical practicum seminar activities have not yet been formally evaluated. The plan is to revise the existing clinical evaluation tool to include successful demonstration of the six identified learning objectives. I welcome further implementation and evaluation of these activities and would be interested in receiving feedback.

Published Back to Strategy Search Strategy Submission Student Innovator Award Author: Sharen Ziska MSN, RN Title: Nursing Instructor I Coauthors: Darla Mack, MSN, RN, Nursing Instructor I Elaine Patalski, CRNP, MSN, Nursing Instructor II Institution: University of Pittsburgh Medical Center (UPMC) Shadyside School of Nursing Email: ziskasa@upmc.edu Competency Categories: Quality Improvement Learner Level(s): Pre-Licensure ADN/Diploma Learner Setting(s): Classroom, Clinical Setting Strategy Type: Case Studies Learning Objectives: Learning objectives Students will: Demonstrate a comprehensive understanding of rapid-cycle improvement concepts Identify clinical implications for improving safety and quality of patient care Implement work redesign initiatives for improving patient safety in the practice environment Function as a change agent while working within an active quality collaborative Practice leadership behaviors that strengthen teamwork and promote patient safety QSEN Quality Improvement KSA’s: K = Describe approaches for changing process of care. S = Design a small test of change in daily work (using an experiential learning method such as Plan-Do-Check-Act) S = Use measures to evaluate the effect of change A = Appreciate the value of what individuals and team can do to improve care Strategy Overview: A student innovator award was developed to recognize the professional role transition student who demonstrated a commitment to improving the quality and safety of patient care by showing outstanding initiative and leadership qualities in the development and evaluation of a test of change project. The award was modeled after the nationally recognized Josie King Patient Safety Award and provides a foundation for professional development. TCAB rapid-cycle quality improvement concepts have been integrated into classroom and clinical educational methods during this senior-level course. Classroom instruction consists of a brainstorming session designed to help the students identify clinical implications for improving safety and quality of patient care. Students are then instructed on the PDSA rapid-cycle improvement concepts to create work redesign initiatives for improving patient safety in the practice environment. During clinical application, students function as change agents as they collaborate with nursing and inter-professional teams to implement and evaluate their identified test of change project. The students perform a poster presentation of their test of change projects to the class as a course requirement. At the completion of the class presentations, faculty nominate students for the student innovator award based on specific process improvement criteria. The student nominees are then required to present their test of change projects to a selection committee consisting of two nurse mangers from TCAB designated units, one improvement specialist, and two professional role transitions course coordinators. The winner is chosen based on specific process improvement criteria, collaboration and sustainability of test of change and is presented with an award during the graduation ceremony. Submitted Materials: QSEN_Upload__Student_Innovator_Award.pdf - https://drive.google.com/open?id=1VdE9NQpNjwEkvInRT3tXq6MtADYWimHk&usp=drive_copy Additional Materials: Evaluation Description: Since January 2007, there have been 221 graduate nurses exposed to the TCAB process improvement methodologies, completing 91 improvement projects on 35 nursing units in 7 different system hospitals. With the introduction of a student innovator award in June 2008 faculty have documented a significant improvement in the quality of improvement projects, level of student commitment and a greater impact on improving patient care. Students have demonstrated a more comprehensive understanding of process improvement principles with the ability to carry these concepts into their professional practice. The nurse managers and improvement specialist who participated on the selection committee were impressed by the students’ passion for creating a safer environment for patients and plan to implement the student project ideas on their own units.

Published Back to Strategy Search Strategy Submission Impaired Perfusion High Risk Obstetrical Simulation Author: Dawn Tassemeyer RN, MSN Title: Instructor Coauthors: M.J. Jobes, RN, MA, Assistant Professor, mj.jobes@unmc.edu Institution: University of Nebraska Medical Center College of Nursing-Lincoln Division Email: dtassemeyer@unmc.edu Competency Categories: Patient-Centered Care, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure BSN Learner Setting(s): Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: Impaired Perfusion High Risk Obstetrical Simulation Learning Objectives At the end of this clinical simulation experience, the learner will be able to: Knowledge: 1. List the actions of three common obstetrical medications (Pitocin, MG SO4, and Methergine). 2. Define and identify TeamStepps key principles (Team Structure, Leadership, Situation Monitoring, Mutual Support, and Communication) and give examples. 3. Verbalize the learning opportunities that Simulation provides. 4. Explain how the concept of perfusion relates to the high risk obstetrical (OB) patient. 5. Discuss the pathophysiology, assessment, nursing diagnoses, nursing and medical treatment, and outcomes of the following obstetrical complications: a. Placental problems. b. Post-partum bleeding. c. High risk pregnancy. d. High risk neonate. e. HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. f. Pre-eclampsia. g. Eclampsia. h. Disseminated intravascular coagulation (DIC). 6. Identify and explain the rationale for the risk factors of a high-risk pregnancy. 7. Using the American Academy of Pediatrics newborn resuscitation algorithm, identify intrauterine resuscitation criteria and methods for intervention. 8. Using the case study of a 30-week primigravida, identify signs and symptoms, labs., nursing diagnoses, nursing and medical interventions, and outcomes of the following complications: a. Pre-eclampsia. b. HELLP syndrome. c. Eclampsia. d. Grand mal seizures. e. Intrauterine resuscitation. 9. During the Simulation experience, identify the pathophysiology, assessments, nursing diagnoses, nursing and medical interventions, and outcomes of obstetrical bleeding disorders. Skills: 10. Perform psycho-motor skills safely (venipuncture, prime IV tubing, program IV pump, administer IVPB medication, and insert Foley catheter) in the Simulation laboratory. 11. Using clinical models, determine the dilation of the cervix (in cms.) and presence of shoulder dystocia. Attitudes: 12. Reflect and record in clinical journal individual student reactions to the Simulation experience. Comment specifically on individual student changes in abilities in confidence, knowledge, critical thinking, organization, prioritization, teamwork, and psycho-motor skills. Strategy Overview: Impaired Perfusion High Risk Obstetrical Simulation Because of low patient census and the inability to ensure high risk obstetrical patient experiences, securing student clinical opportunities is difficult. Using the principles of a “flipped classroom”, an eight hour high risk obstetrical simulation clinical was developed for fourth semester, senior level nursing students. The content focused on the concept of impaired perfusion. This learning strategy allowed for student learning in a safe environment (where student could do no harm) while focusing on quality patient-centered care. Pre-briefing Power point presentation (outlined the agenda, outcomes, and expectations). Outcomes included prioritization, critical thinking, becoming more comfortable in the clinical setting, being confident in one’s own nursing skills, and knowing when to ask for help from others in order to ensure patient safety . Discussion on the patient safety initiative TeamSTEPPS. The key principles of team structure, leadership, situation monitoring, mutual support, and communication were highlighted. The reasons for simulation clinical instead of clinical at the hospital were explained (see above). Power point continued with a review of obstetrical content presented in past semesters. The concept of perfusion as it relates to OB high risk situations were presented. Preeclampsia (how it effects the body systems and organs, assessment, management and treatment) and hypertension in pregnancy were explained. Risks for other disorders (HELLP syndrome and Eclampsia) and intrauterine resuscitation methods were discussed. Laboratory/Simulation Experience Group 1 independent paperwork Case studies of high risk OB situations--Drug use and domestic violence, preeclampsia, placental problems (abruption placentae and placenta previa, DIC and HELLP syndrome) Healthy people 2020 objectives (as they relate to the postpartum period) Fetal monitoring tracing Group 2 Skills Laboratory Simulation--students assigned to a “patient” being prepped for a cesarean section. Start an IV, prime tubing, program a pump, secondary (piggyback) and insert a Foley catheter (problem solve with minimal assistance from the instructor). “Trouble shooting” with IV pumps, piggybacks, and tubing and Foley catheter insertion. Unfolding Case Study: 30 week primigravida patient, determine if symptoms were normal or abnormal for gestation. Identify abnormal vital signs, key lab values, important nursing interventions, and plan ahead for emergencies. Role play calling doctor using SBAR. Patient progressed from preeclampsia, HELLP syndrome, to eclampsia with a grand mal seizure. Demonstrate nursing care and interventions (seizure precautions and intrauterine resuscitation). Demonstration of assessing deep tendon reflexes and clonus. Group 1 and 2 switched and the above was repeated. Simulation “Noelle” 4 hours post-partum, “just did not feel very well and was a little lightheaded.” During the fundal assessment, the students discovered a large amount of blood on the chux pad. Student expectations: perform nursing interventions to assist with postpartum hemorrhage, implementation of hemorrhage management (calling doctor, IV start, medication administration, physical assessment, fundal massage). Instructor challenged students by asking critical thinking questions. Laboratory Vaginal examinations using cervical models. Determination of dilatation at 1, 3, 5, 8, & 10 centimeters (baby in vertex, footling breech positions, and prolapsed cord presentations). Interventions discussed. Shoulder dystocia demonstrated using a mannequin, pelvic model and baby. Turtle sign, McRoberts maneuver, and suprapubic pressure were shown. Brachial plexus injury and the Zavanelli maneuver were discussed. Precipitous labor, precipitous delivery and nursing interventions were examined. Neonatal resuscitation was discussed. Principles such as initial assessment, oxygen administration, PPV, chest compressions and AGPAR scoring were demonstrated using a baby model. The Newborn resuscitation algorithm was shown and discussed in terms of routine vs. resuscitative care. Students demonstrated skills. NCLEX Review NCLEX review was done using clickers and consisted of 14 questions involving high risk OB situations. After the review faculty clarified the reasoning for the correct answer. Debriefing Debriefing was done as well as faculty shared personal experience and answered questions throughout each teaching session. A final debriefing was done with all students at the end of the day. Paperwork and fetal monitoring strips were reviewed. Submitted Materials: Additional Materials: Evaluation Description: Student Evaluation Students completed a clinical journal discussing their impression of the clinical day, what they learned, and what they would change (if anything). Students commented that this type of learning was beneficial to them, being able to call on their peers for help or advice instead of being put on the spot when they felt stressed. Students remarked that the clinical experience was helpful as many had not had the opportunity to practice the skills in the clinical setting. Overall the feedback from the clinical journals, emails, and verbal comments from the students was positive. A few students did express the desire to have this simulation clinical along with a clinical day spent at the hospital.

Published Back to Strategy Search Strategy Submission Sex Trafficking and the Nursing Role: An Online Educational Module for Nurses Author: Lindsay Larison BSN, RN Title: Registered Nurse Coauthors: Rhonda K. Lanning, RN MSN CNM IBCLC Institution: Randolph Hospital Emergency Department Email: larison@email.unc.edu Competency Categories: Patient-Centered Care Learner Level(s): Graduate Students, Pre-Licensure BSN, RN to BSN, Staff Development Learner Setting(s): Skills or Simulation Laboratories Strategy Type: Online or Web-based Modules Learning Objectives: Learners will be able to: Define sex trafficking. Recognize signs of sex trafficking. Understand the nursing role as it pertains to sex trafficking, in relationship to nursing assessment, interventions, communication and patient-centered care planning. Identify barriers that victims of trafficking may have from leaving the trafficking situation. Role play the implementation of patient-specific interventions for the care of the client who is a victim of trafficking by the use of simulations, case studies and/or in-class discussions. Identify resources available for victims of trafficking and healthcare providers. Strategy Overview: Sex trafficking is an issue that nurses in the United States need to be aware of in order to provide the best care to their clients. It was estimated in 2005 by the U.S. Department of Justice that there were between 100,000 and 150,000 people living and working as sex slaves in the United States, and these numbers are only rising. It is imperative that nurses know how to recognize signs of trafficking and know how to intervene in order to protect the health and safety of the clients that they work with. In order for nurses to confidently and successfully intervene when they find themselves in situations where trafficking is suspected, they must be educated. I propose that utilizing the Sex Trafficking and the Nursing Role: An Online Educational Module for Nurses could be very beneficial in this endeavor. Accessible at www.nursingstrafficking.web.unc.edu , the module was developed to be learner-focused to meet each individual’s stylistic learning needs, including: a lecture on the topic with resources provided to reflect evidence based practice guidelines, assessment of potential victims, and interventions related to sex trafficking in various formats; two case studies, both of which are adaptable for use as simulations, and pre- and post-tests reflecting module content. The intended use for the Sex Trafficking and the Nursing Role: An Online Educational Module for Nurses is for incorporation into the registered nurse curriculum, particularly as an addition to the public health nursing course. Faculty would follow-up in a variety of ways, which they can tailor to the needs of their students. Educators could use the module quizzes as an assessment of module understanding for a grade in their courses. The case-studies could be distributed as an essay discussion assignment or could be used to assess understanding as part of a simulation or class discussion; participation and understanding may be evaluated as strictly as the educator sees fit, no rubric is included in the module for case-study grading purposes. Furthermore, the module could be an efficacious teaching tool used as continuing education units for graduate students, nurses in practice, as well as other healthcare providers. The content included in the lecture portion of the module is intended to define sex trafficking and to make learners aware that sex trafficking is a problem in the United States. A description of different modes of sex trafficking, at-risk populations, the process of victimization, and barriers to escape are included in the module. The module also includes a discussion on victimization, nursing assessment and interventions, and the role of the law in sex trafficking. Submitted Materials: Case-Studies-1.docx - https://drive.google.com/open?id=1FezWyz0-vekWfSJs9dnwaT2NZv3ipj9B&usp=drive_copy Free-Response-Test-1.docx - https://drive.google.com/open?id=1IJ7sCpATW7ZOL9Tf2TOEpY3aFFCKgCrQ&usp=drive_copy Multiple-Choice-Quiz-1.docx - https://drive.google.com/open?id=1Kl3ey-GV5KGGYuULdK-yoIXXcqsenkTS&usp=drive_copy QSEN-1.docx - https://drive.google.com/open?id=1Mfp9QKY4RS-PW9NhweoWCdf4lbMBJca5&usp=drive_copy Test-Answer-Keys-1.docx - https://drive.google.com/open?id=1QnJgakwRpXqLvYYDr3-WRi4-FJeJ-uKi&usp=drive_copy Additional Materials: All of the module study materials are accessible at nursingstrafficking.web.unc.edu. Evaluation Description: Within the module, there are a variety of ways to assess the student’s learning. First, there are multiple choice and fill-in-the blank assessments that faculty can use to ascertain how much of the material the students are retaining from the lecture. Also, the module includes case studies, which could be used as live simulations as well, where faculty can see how students relate the material to “real-life” situations. Although currently the module has not been evaluated for efficacy, one way to test this would be to assess learners’ knowledge of the subject matter before and after they view the module lecture. This assessment could be completed with the tests included in the module. Also, asking students to complete a survey after they complete module activities would be helpful. Questions included in this survey inquire what new information students learned from the module, and would seek student opinions on the module format and material.

Published Back to Strategy Search Strategy Submission Empowering students to create a safer clinical environment utilizing Evidence Based Practice Author: Kimberly Silver-Dunker DNP, RN Title: Assistant Professor Coauthors: Institution: UMASS Graduate School of Nursing Worcester Email: Kimberly.silver@umassmed.edu Competency Categories: Evidence-Based Practice, Patient-Centered Care, Quality Improvement, Safety Learner Level(s): Graduate Students, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN Learner Setting(s): Classroom, Clinical Setting Strategy Type: Paper Assignments Learning Objectives: Upon completion of this activity the students will be able to: 1) Assess the needs of hospitalized patients and identify a clinical problem to evaluate the most current evidence-based practice. 2) Identify strategies to improve quality of care and patient safety by planning evidence-based practice plan. 3) Demonstrate quality patient care in clinical by integrating current evidence into their nursing practice. Strategy Overview: Evidence Base Practice Students will have experiential clinical learning that will require them to collaborate and work together as a team to identify an evidence-base practice issue in the clinical setting. They will then assess the literature to further identify the evidence to support best clinical nursing practice. (Knowledge, Skills, Attitudes) Quality Improvement Students will identify a clinical practice issue on their unit. They will formulate interventions to improve the quality of care based on evidence-based practice. The students will prepare a presentation and paper on this topic. (Knowledge, Skills, Attitudes). Safety Students will identify how current evidence improves the delivery of care to patients and results in increased patient safety. (Knowledge, Attitudes). Patient Centered Care Students will discuss in their presentation and paper how the integration of evidence-based practice promotes a more patient-centered environment. (Knowledge, Attitudes) Evidence Based Practice Paper Activity Students will divide into groups of 3 or 4 students within a clinical group. While at clinical, they will identify a clinical problem (see examples below). They are instructed to utilize the clinical health care environment to explore and discuss their topic in the clinical setting. Students will collaborate with their clinical faculty regarding the unit’s policy and procedures and current practice guidelines for their topic. It will be is critical for students to be organized at the beginning of their clinical experience so that they can focus on their Evidence-Based Practice project. Students will compare the unit’s policies and current evidence on their topic, and will prepare a group presentation following a grading rubric (see attached). They will then, synthesize the evidence and present current information about their topic and discuss the impact on the safety of their patients, the quality of care delivered, and how to make the care they give more patient centered care. Lastly, the students will individually prepare and write an APA formatted evidence based practice paper emphasizing best practices within their topic. This paper must include a minimum of 3 nursing articles written within the past 5 years as well as integration of a least one QSEN competency within the evidence based paper. Topic Examples: Pain Assessment, Management (ex. acute, post-operative pain vs. versus chronic Pain) and patient centered care Falls prevention in the hospital and patient centered care Medication errors and medication reconciliation increase safety Nursing Report and handoffs including nursing and physician SBAR (Situation, Background, Assessment, Recommendation) Communication Hand hygiene use of antimicrobial soap versus alcohol-based hand rubs- best evidence based practice Preventing Pressure Ulcers and Turning Practices to enhance quality improvement Quiet hours and noise level on patient units and patient centered care Electronic documentation at the bedside and bar code scanning. How does it improve nursing care and patient safety? Infection of central line and blood stream best evidence base practice. Social Media dangers and ( F acebook © , email, T witter ©) impact of HIPPA and safety of patient information. Submitted Materials: Additional Materials: Evaluation Description: The evaluation methods for grading include a rubric for the presentation and the paper that are attached. Both of the grading rubrics included in the course syllabus for the paper and presentation. Students will receive a grade for both the paper and group presentation. They will be allowed to submit a draft prior to the presentation to receive feedback from the instructor. All clinical faculty will be present for the presentation. The learning objectives will be met by the delivery of presentation according to the rubric, providing the audience with current evidence-based practice and best practice guidelines (see rubric). Students will formulate a meaningful paper grounded in evidence from the literature (see rubric). Anecdotal information: This assignment was utilized in a graduate level program with pre-licensure nursing students. This integrated cogitative and psychomotor competencies from three pre-licensure nursing courses; (1) medical-surgical nursing theory (2) medical-surgical nursing clinical, and (3) nursing concepts course. The integration of assignments between three courses enhanced students’ ability to translate theory into practice. The assignment could be utilized in a variety of settings including: adult medical surgical, maternal child, pediatrics, mental health, and leadership courses. Feedback from this assignment has been positive. Students were able to identify the correlation between current evidence and the impact of this information on the quality and safety of their nursing care while facilitating a more patient centered environment. Thus connecting the clinical environment and course or theory component. It has helped the students see the correlation between theory and clinical, and increased their awareness of evidence based practice and topics in nursing. This exercise has bridged the clinical practice environment with theory. As a result, adjunct part-time faculty have reported becoming more involved in guiding the students in their discovery of evidence base practice, safety, quality improvement, and creating a more patient-centered environment while at clinical.

Published Back to Strategy Search Strategy Submission Bedside Assessment and Documentation Basics: A Pocket Card for Beginning Nursing Students Author: Angela D. Jones DNP, RN Title: Assistant Professor, School of Nursing Coauthors: Institution: Stephen F. Austin State University Email: jonesas7@sfasu.edu Competency Categories: Informatics, Safety Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Clinical Setting, Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: Skills –Use appropriate strategies to reduce reliance on memory (such as, forcing functions, checklists). Attitudes –Appreciate the cognitive and physical limits of human performance. Value vigilance and monitoring (even of own performance of care activities) by patients, families, and members of the health care team. Knowledge – Identify essential information that must be available in a common database to support patient care. Skills - Document and plan patient care in an electronic health record. The student will use the Bedside Assessment and Documentation Basics pocket card in clinical practice (actual human patients and simulation) to facilitate the process of assessment explicit to the needs of the patient(s). The student will document the findings of the bedside assessment in clinical practice (actual human patients and simulation) in a clear and concise manner using the Bedside Assessment and Documentation Basics pocket card as a guide to promote communication of findings to other members of the interdisciplinary team. The student will use the Bedside Assessment and Documentation Basics pocket card in clinical practice (actual human patients and simulation) to reduce reliance on memory. Strategy Overview: The Beside Assessment and Documentation Basics: A Pocket Card for Beginning Nursing Students is a clinical tool to promote quality, safe care in beginning nursing students. First semester pre-licensure nursing students are challenged to acquire and develop the essential knowledge, skills, and attitudes necessary for basic patient care. This beginning educational experience is often stressful as students are required to integrate fundamental concepts and health assessment strategies in clinical practice during a relatively short period of time. In addition to the stress response of the students, faculty are met with the challenge of ensuring students perform quality, safe care while focusing on the patient and adequately communicating the patients’ needs to other members of the interdisciplinary team. In an effort to promote patient safety by minimizing student anxiety and omissions in assessment data collection, students are provided with the Bedside Assessment and Documentation Basics pocket card for use in the first clinical course. The Bedside Assessment and Documentation Basics pocket card is intended for student use with each clinical experience (actual human patients, laboratory, and simulation). The pocket card serves as a reminder of the essential components included in a basic bedside assessment and facilitates building a common database for documentation needs. The information contained on the card is common to nursing practice and has been adapted to meet the learning needs of the novice student. First semester pre-licensure nursing students are beginning to develop a working knowledge base along with the necessary skills associated with health assessment. By providing students with the pocket card, this decreases reliance on memory for patient assessment in students who are developing a clinical knowledge base. Clinical forms and clipboards often become a barrier to communication as students search for the appropriate form or space in which to document their findings rather than focusing on the patient. The pocket card decreases dependence on a vast array of clinical documentation forms at the bedside; however, students are encouraged to take notes regarding their assessment findings. The pocket card does not replace clinical documentation as defined by individual programs of study but facilitates translation of the students’ assessment data to meet the documentation requirements by fostering clear, concise communication among members of the health care team and assists with documentation in the electronic health record (EHR). Using the Bedside Assessment and Documentation Basics pocket card with beginning nursing students facilitates quality, safe patient care while fostering the use of informatics. Directions for use The Beside Assessment and Documentation Basics: A Pocket Card for Beginning Nursing Students is printed on card-stock paper and laminated for student use in all clinical settings (actual human patients, laboratory, and simulation). The pocket card will be given to students at the beginning of the first clinical course and used throughout the fundamental course. Student Instructions: Bring the card with you to all clinical experiences (lab, simulations, or actual patient clinical rotations). Use the pocket card to help guide your bedside assessment. This is to remind you of required components with each system. This promotes patient safety by reducing reliance on your memory. The pocket card also functions to remind you of essential information that must be included in the EHR to support patient care. This information is common to nursing practice and addresses basic documentation requirements. Make clear and concise notes regarding your assessment findings. By using the pocket card as a reminder of assessment needs, this keeps you from flipping through papers searching for necessary information so that you maintain focus on the patient. Use your notes to assist with your clinical documentation when you are away from the bedside entering the data in the EHR (as assigned by faculty). This aids in communication of assessment findings and ultimately promotes quality, safe patient care. Using the pocket card will also assist you in communicating with members of the health care team as you learn to gather data and share your insight regarding patient assessment (verbal and written). Submitted Materials: QSEN-Bedside-Assessment-Pocket-Card-Revised-2.doc - https://drive.google.com/open?id=19i9veTZaOQ41Y4ZMMaRHijfp4xklp7Gx&usp=drive_copy QSEN-Bedside-Card-Revision-01-26-16-1-1.doc - https://drive.google.com/open?id=1A0DXzwZH9hSifxK53ep0abVeIL6bBTQf&usp=drive_copy QSEN-Bedside-Assessment-Pocket-Card-Revised-3.doc - https://drive.google.com/open?id=19i9veTZaOQ41Y4ZMMaRHijfp4xklp7Gx&usp=drive_copy Additional Materials: http://qsen.org/admission-health-history-assessment-pocket-card/ Evaluation Description: When evaluating the effectiveness of the Bedside Assessment and Documentation Basics pocket card, it was noted that required clinical documentation had improved after implementation. Students had fewer assessment omissions and were able to articulate their assessment findings using appropriate terminology. Student reflection regarding their perception of using the pocket card in clinical is an effective strategy for evaluating the effectiveness of the pocket card with regard to promoting safety, valuing their contributions to patient care, enhancing communication, and facilitating documentation in the EHR. Data collected from students’ reflections of fundamental nursing experiences revealed an enhanced level of comfort in the clinical course associated with bedside assessment, documentation requirements, and communication. The pocket card was not required for lab or simulation at the beginning of the pilot semester, though it was incorporated as students asked to use the pocket card in simulated experiences to minimize personal anxiety. Improvement in performance was noted as students made fewer omissions in gathering assessment data when using the pocket card. Overall, using the Bedside Assessment and Documentation Basics pocket card in clinical has promoted quality, safe patient care while improving clinical documentation and communication. n.

Published Back to Strategy Search Strategy Submission Improving Communication with SBAR in the Clinical Setting Author: Jalelah Abdul-Raheem Ph.D., RN Title: Director of Nursing and Assistant Professor Coauthors: Institution: Langston University Email: jaraheem@langston.edu Competency Categories: Evidence-Based Practice, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure BSN Learner Setting(s): Clinical Setting, Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: 1.Acknowledge potential to contribute to effective team functioning. (Attitudes) 2.Communicate with team members regarding a patient situation. (Skill) 3.Identify and analyze research and evidence related to the area of concern in practice based on the patient situation. (Knowledge, Skill) 4.Discuss observations or identified problems in the clinical setting to the healthcare team. (Knowledge, Skill) 5.Participate effectively in appropriate data collection and other research activities. (Skills) 6.Follow communication practices that minimize risks associated with handoffs among providers and across transitions in care. (Skills) 7.Differentiate clinical opinion from research and evidence summaries. (Knowledge) 8.Locate evidence reports related to clinical practice topics and guidelines. (Skills) 9.Value own role in preventing errors. (Attitude) 10.Communicate observations or concerns related to hazards and errors to patients, families and the health care team. (Skill) Strategy Overview: New graduate nurses have problems with determining what information is necessary to give providers when they contact them. Nursing students should learn how to communicate with providers during their program to help avoid miscommunications that may take place as a new graduate nurse. Students have the opportunity to gather patient information during clinical experiences and become aware of how to inform providers about patient problems. The clinical presentation assignment was developed and implemented to guide students on how to communicate situations to providers and other pertinent disciplines in an efficient way as new graduate nurses. Students are required to use the SBAR format to report a patient case . SBAR is the format used to communicate information to providers which include the situation, background, assessment, and recommendation regarding a particular patient situation. The SBAR format is reviewed in classroom prior to clinical rotations to allow students to learn how to appropriately use the format to facilitate communication with providers and nurses (Objective 4). Although students will not communicate directly with providers, they will be able to collaborate with assigned nurses and assist in interdisciplinary communication regarding their assigned patient (Objective 2). For instance, students will collaborate with their clinical instructor to identify data that supports the problem to advocate for their client and maintain consistent care across transitions with other disciplines. Students will have their clinical instructors present to guide them in identifying problems and addressing them utilizing the SBAR format appropriately to minimize miscommunication during the learning process (Objective 6). After the clinical day, students have the opportunity to create their SBAR and present current evidence to support recommendation to their instructor and peers to receive additional feedback (Objective 8). Nursing students who develop the skill of using SBAR efficiently will be able to minimize miscommunication errors with providers when addressing concerns as new graduate nurses. It is important for nursing students to experience the process of communicating with other disciplines including providers to reduce verbal and written miscommunication as a new graduate nurse. This assignment allows them to obtain that practice with their instructor instead of a provider as a student to help prepare them when they complete the program and enter into the profession. Nursing students must also learn how to document in a clear, concise way. The utilization of SBAR when recording accurate information within the notes is necessary to paint a clear picture of the situation that has occurred during patient care. The clinical presentation of SBAR allows students to practice documentation of clinical findings to facilitate successful communication with handoffs to providers and across transitions in the care (Objective 6). Student identification of research that supports the recommendation related to area of concern must be collected using appropriate means (Objective 5). Utilization of the research helps students distinguish between their clinical opinion and evidence based practice (Objective 7). This knowledge will assist them in communicating with providers to help to determine a valid solution to the patient situation. This learning strategy allows students to receive feedback from their clinical instructors based on documentation of SBAR and the identification of relevant research and evidence regarding their assigned patient. Students will confidentially report findings to their clinical instructor and peers during post-conference sessions. Individual feedback will be given to the student via the clinical instructor after further review of documentation. The clinical presentation is delivered during post conference to address team functioning and how communication can impact hazards and errors to patients, families, and the health care team. For instance, this is a safe environment where discussion regarding how students feel that can contribute to the team environment and minimize hazards and errors with effective communication are appropriate (Objective 10). Students have the opportunity to address attitudes related to their SBAR communication and research activities with peers and their clinical instructors. The assignment guidelines provided to the students prior to the beginning of their clinical rotation. They are required to identify a research article based on their assigned patient in the clinical setting before caring for them the next clinical day (Objective 5). Students are then required to address a particular problem using the SBAR format and apply information found in their research article outlined in the recommendation section (Objective 3). The research article will be summarized by the student during their presentation after describing their SBAR findings. The student will present their results during post-conference after their clinical experience that day. The assigned clinical instructor will schedule student presentations before their clinical experience to ensure enough time is allowed during post-conference for each student in the group to discuss findings. Clinical instructors provide 10 to 15 minutes per presentation and are not allowed to schedule more than two students each post-conference. The instructor gives feedback after the presentation and also allows peer feedback to enhance the learning experience. Clinical instructors can facilitate learning of communication with providers within a small group to help improve the quality of communication. The assignment allows students to take ownership in their future role as a nurse by effectively learning to team functioning and help prevent errors in care related to miscommunication (Objective 9). Submitted Materials: Clinical-Presentation-Assignment-and-Rubric-Final.docx - https://drive.google.com/open?id=1vcjoau4E5HPnf4_iZjQkEdEdw0pZmsb4&usp=drive_copy Additional Materials: Evaluation Description: The assignment was implemented in the January of 2017 with 4th-semester students in an Advanced Adult Health course was used to improve student communication and clinical reasoning skills with the use of current evidence. Initially, students were confused how to apply the format to the patient when assigned in the clinical setting. Many students were under the impression that SBAR format was also used to give hand-off reports to nurses. Since students misinterpreted the use of the SBAR format, clinical instructors spent the first week of post-conference explaining how to use SBAR properly. Students were required to collaborate with nurses and clinical instructors to gain a better understanding of SBAR format prior to working on their assignment (Objective 1 and 4). This additional time used to clarify the usage of the format helped students realizes the importance of accurate communication and how it can impact handoffs and transitions in care (Objective 6). Students used the assignment rubric as a guide to collect pertinent information. The rubric ensured students received necessary pieces and allowed them the opportunity to earn the maximum number of points in areas addressed. They had a chance to fully engage in the learning experience with immediate feedback from the instructor and peer feedback post presentation (Objective 2). The SBAR presentations lead to post conference discussion questions such as the following from peers (Objective 10): 1.How did the nurse alert the provider based on the patient issue? 2.How receptive was the nurse to the student's recommendation of the issue? 3.How to discuss an issue with a nurse based on student findings? 4.What happened to the patient and/or family if the issue was not addressed in a timely manner? These questions gave the clinical instructor an opportunity to address ways to help facilitate communication among team members to help reduce errors on the patient's behalf (Objective 9). Students began to grasp the concept of the nurse's role in preventing errors via effective communication and the importance to interdisciplinary collaboration. Students struggled with what nursing research articles were appropriate for their patient issue. The clinical instructors were very instrumental in guiding students to appropriate research and explaining how it contributes to evidence based practice (Objective 5). The students had a basic understanding of research based on the theoretical course taken during the previous semester but needed more assistance with application of content. The nurses and clinical instructor used hospital databases to show how nurse's and other providers on the unit access research to support their interventions and recommendations (Objective 3 and 8). After successful understanding of research and data collection, students were then able to distinguish between clinical opinions and evidence based findings (Objective 7). Once students felt comfortable in their role and research selection, they verbalized the ability to advocate for their patients with communication and avoid errors. Clinical instructors were satisfied with the ease of grading a clinical presentation at the scheduled time rather than returning to grade the assignment at a later date. Students and clinical instructors stated that the assignment gave students the chance to learn effective communication and develop clinical reasoning skills using current evidence. The clinical presentation is slowing being introduced to other clinical courses to maintain consistency and reinforce the importance of effective communication. The clinical instructors and faculty expressed satisfaction with the assignments and student results which led to the decision to incorporate the assignment in other clinical courses. All students who completed the assignment earned an 80% or higher and expressed satisfaction. Students also stated they gained a better understanding of how to communicate findings and the application of current evidence.