Published Back to Strategy Search Strategy Submission Utilizing StoryCare: A Story Based Simulation Program to Improve Team Effectiveness and Patient Outcomes Author: Tanya Parker MA, MSN, RN, NPD-BC Title: Nursing Professional Development Program Director Coauthors: Institution: New York Presbyterian Hospital Email: tap9069@nyp.org Competency Categories: Evidence-Based Practice, Patient-Centered Care, Teamwork and Collaboration Learner Level(s): Continuing Education, Faculty Development Strategies, 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: Modules Learning Objectives: Define how the context and meaning of the Story Simulation demonstrates improvement in a variety of safety and patient satisfaction behaviors (Patient-Center Care, Teamwork, and Collaboration ) Design a plan to utilize a Story Discussion Guide to share best practices with the team based on a clinical practice issue (Patient-Center Care, Evidenced-Based Practice, Teamwork, and Collaboration) Outline how to utilize a Story Discussion Guide to generate ideas or integrate into the group discussion based on a clinical practice issue (Patient- Center Care, Evidenced-Based Practice, Teamwork, and Collaboration) Strategy Overview: Using storytelling to recreate an experience to teach, engage and develop others, complemented with reflected learning can result in behavioral changes which lead to improved outcomes. Utilizing storytelling as an alternative teaching methodology can enhance critical thinking regarding a clinical experience to develop a deeper insight to guide future practice. It provides an opportunity to expand on existing clinical knowledge, verify practice and explore transferable best practice strategies. Submitted Materials: QSEN-TS-Story-Instructors-Guide.docx - https://drive.google.com/open?id=166LLwS3WRCtmPMptGYJyY1nMwUHMLeYt&usp=drive_copy QSEN-TS-Discussion-Guide.docx - https://drive.google.com/open?id=161uUuSUv_9jpWuie_0lo2eLF3QSB2Ace&usp=drive_copy QSEN-TS-Discussion-Guide.pdf - https://drive.google.com/open?id=1lnPbvVpyzszAsAY9S1MWIgDLg74aOEA9&usp=drive_copy QSEN-TS-Story-Handout.pdf - https://drive.google.com/open?id=1lklVe3GtIOsvdp2ll7zsmiy3nAe-sDEf&usp=drive_copy Additional Materials: Student handouts (2) – story #215 •Discussion guide (2x)- story #215 •Instructor guide-Story #215 • Student guide- Story #215 •YouTube recording of story of #215 (https://youtu.be/Gsq8PlkkS4U) Evaluation Description: The unit leader was able to observe staff behavior and monitor positive change during the defined improvement cycle. Staff was able to identify the strategies utilized by the team to include at least one behavior or strategy that can be adopted as a best practice. Staff was able to self-discover insights regarding alternatives methods in addressing patient situations/issues. Staff was able to advocate for improving team effectiveness while providing safer patient care. Comparison of key organizational quality indicators (i.e. HCAHPS & NDNQI) before and after using Story simulation to demonstrate the effectiveness of the education.

Published Back to Strategy Search Strategy Submission Ten Minute Expert: Evidence-Based Bedside Teaching Bundle Author: Shannon S. Polson MSN, MSW, RN, CNL, NEA-BC, CWCN, LICSW, PIP Title: Instructor Coauthors: Cori Johnson, DNP, CRNP, AGNP-C, Nanci Claus, DNP, CRNP NP-C; Sylvia E. Britt, PHD, RN Institution: University of Alabama at Birmingham School of Nursing Email: sspolson@uab.edu Competency Categories: Evidence-Based Practice, Safety Learner Level(s): Continuing Education, New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN, Staff Development Learner Setting(s): Clinical Setting, Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: Knowledge: After exposure to an evidence-based teaching strategy bundle, students will return demonstrate skills operationalizing best clinical practice (Safety) (EBP) Skills: Learner will analyze the performance of routine, yet potentially harmful, clinical skills and will demonstrate competency in the skill using evidence-based practice to improve the process of care. (EBP) Use bedside teaching bundle to reduce reliance on memory. (Safety) Attitudes: Value the need of continuous improvement in clinical practice (EBP) Appreciate the need for diversity of learning styles and strategies in order to overcome the cognitive limits of human performance. (EBP) (Safety) Azer, S. A., Guerrero, A. S. & Walsh, A. (2013). Enhancing learning approaches: Practical tips for students and teachers. Medical Teacher, 35(6), 433-443. Institute for Healthcare Improvement. (2018). What is a bundle? Retrieved from: http://www.ihi.org/resources/Pages/ImprovementStories/WhatIsaBundle.aspx Lubbers, J., & Rossman, C. (2016). The effects of pediatric community simulation experience on the self-confidence and satisfaction of baccalaureate nursing students: A quasi-experimental study. Nurse Education Today, 39, 93–98. Rassin, M., Kurzweil, Y., & Maoz, Y. (2015). Identification of the learning styles and “On-the-Job” learning methods implemented by nurses for promoting their professional knowledge and skills. International Journal of Nursing Education Scholarship, 12(1), 1–7. Shinnick, M., & Woo, M. (2015). Learning style impact on knowledge gains in human patient simulation. Nurse Education Today, 35, 63–67. Theisen, J. L., & Sandau, K. E. (2013). Competency of new graduate nurses: A review of their weaknesses and strategies for success. Journal of Continuing Education in Nursing, 44(9), 406–414. Strategy Overview: The Ten Minute Tip teaching strategy innovates the use of bundling to combine effective teaching strategies that may be applied to diverse content successfully at the bedside. Essential bundle components include: that the teaching is time-limited (under four minutes), concept specific, incorporates use of metaphor, provides learners with evidence-based resources, and a return demonstration. The final bundle essential is that the teaching incorporates all learning styles. Kinesthetic learning styles are engaged through aforementioned return demonstration. Auditory learners are accommodated through the use of rhyme, assonance, alliteration or consonance and visual learners are accommodated by the production of a pocket card that can be viewed during the demonstration and kept for later reference. Four minutes is allowed for teaching, another four for return demonstration and the final time is utilized for questions and clarification allowing the evidence-based practice to translate into useful strategies, tips, and tricks to satisfy the interests and needs of the bedside nurse. (Please see four exemplars of content adapted to cover Medical Adhesive Related Skin Injury, IV Starts, Sacral barrier placement, and application and removal of barrier creams.) Submitted Materials: Ten-Minute-Expert-Video-Examples-Blinded-Link.docx - https://drive.google.com/open?id=1BTIsCd8_YkyBnHuNoegXoJhQiDokVNkB&usp=drive_copy Additional Materials: Below is a link to four recorded demonstrations of the teaching bundle applied to four areas of content: http://www.kaltura.com/tiny/tl8xn These are the original videos with credits. MARCI - http://www.kaltura.com/tiny/6zhks Border Sacrum Mepilex Application - http://www.kaltura.com/tiny/fwcl1 IV starts - http://www.kaltura.com/tiny/88jvo Barrier Cream - http://www.kaltura.com/tiny/he3t5 Evaluation Description: Embedded in the innovative teaching bundle is a teach teach-back (return demonstration) evaluation method.

Published Back to Strategy Search Strategy Submission Maintaining Quality and Safety During a Disaster Author: Kathleen Szymanski MSN, RN Title: Coauthors: Institution: Lake Michigan College Email: kszymanski@lakemichigancollege.edu Competency Categories: Patient-Centered Care, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Skills or Simulation Laboratories Strategy Type: Case Studies Learning Objectives: Patient-Centered Care 1. Students will discuss the ethical challenges and limitations related to delivering patient-centered care using the START triage algorithm. 2. Students will demonstrate methods of effective communication when interacting with simulated patients and team members. Teamwork and Collaboration 1. Students will demonstrate awareness of their own strengths and limitations as a team member. 2. Students will communicate with team members, adapting their own style of communicating to the needs of the team and situation. 3. Students will act with integrity, consistency, and respect for differing views. 4. Students will contribute to the resolution of conflict and disagreement through working as a team to decide upon triage categories for patients. Safety 1. Students will demonstrate the effective use of the START triage algorithm in prioritizing safe care during an emergency. 2. Students will verbalize the value of using standardized algorithms in providing safe care. Strategy Overview: This strategy is based upon Sund’s (2013) “Start Triage Practice-Who Wants to be an EMT?” case study exercise. This can be implemented in a simulation lab in whatever method preferred (low fidelity manikins that have been “moulaged”, standardized patients as “victims”, etc..). When COVID made in-person simulation impossible, the strategy was turned into a case study using pictures that had been taken of the manikins during a prior simulation. If the simulation is not being done in person, it can be done using discussion board groups or online synchronous discussions. Students are broken into groups of 2-4 participants. Depending on the size of the group, a team leader may be chosen. Students are given colored “tags” and asked to triage the victims using the START triage algorithm that has been presented in class (United States Department of Health and Human Services, 2021). As they triage, they are asked to critically think, discuss their concerns and rationale as a team, and then come to a consensus on one triage color per patient. Once the group has completed the exercise, each participant is asked to fill out the reflection questions. For the final debriefing, the small groups come together for a large group discussion related to their findings and their reflections. References Sund, S. (2013, January 18). START Triage Practice-Who Wants to be an EMT? Disaterdoc. https://disasterdoc.net/2013/01/18/start-triage-practice-who-wants-to-be-an-emt/ United States Department of Health and Human Services. (2021). START Adult Triage Algorithm. Radiation Emergency Medical Management. https://chemm.nlm.nih.gov/StartAdultTriageAlgorithm.pdf Submitted Materials: QSEN-289-TS-Quality-and-Safety-Disaster-Sim-Student-Worksheet.docx - https://drive.google.com/open?id=134jgHZf3fY2QUcKQpjjNE45CcY7ao1-1&usp=drive_copy QSEN-TS-289-Quality-and-Safety-Disaster-Sim-Instructor-KEY.docx - https://drive.google.com/open?id=165rTPHwfI3kj3IB4nfviTQJIM_hB0Wj7&usp=drive_copy QSEN-TS-289-Disaster-Teaching-Strategy-Evaluation-Rubric.docx - https://drive.google.com/open?id=15KMABWMSw1D44dahmmdNc8ohm4swwZ64&usp=drive_copy Additional Materials: See attached: Student Worksheet Instructor Key Evaluation Rubric START triage algorithm Evaluation Description: See Attached Rubric Students were able to meet their learning objectives when this teaching strategy was performed in the sim lab and when the simulation was converted to a case study. In both settings, students demonstrated critical thinking and stated a better understanding of the learning objectives after completing the exercise.

Published Back to Strategy Search Strategy Submission Environmental Safety Learning Activity Author: Jennifer Zanotti MS, RN, CEN, CCRN Title: Clinical Education Center Instructor Coauthors: Fara Bowler, MS, RN, C-ANP Kerri Reid, MS, RN, CNS Institution: University of Colorado Denver College of Nursing Email: jennifer.zanotti@uchsc.edu Competency Categories: Safety Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Skills or Simulation Laboratories Strategy Type: Case Studies Learning Objectives: Examine human factors and other basic safety design principles as well as commonly used unsafe practices (such as work-arounds, and dangerous abbreviations). Demonstrate effective use of strategies to reduce risk of harm to self and others. Appreciate the cognitive and physical limits of human performance. Communicate observations or concerns related to hazards and errors to patients, families, and the health care team. Value own role in preventing errors. Value vigilance and monitoring (even of own performance of care activities) by patients, families, and other members of the health care team. Strategy Overview: This clinical learning activity is appropriate for early clinical courses in a pre-licensure curriculum. In Colorado, where this strategy was developed, this simulation is used in Fundamentals of Nursing. This is a low fidelity simulation exercise that emphasizes environmental safety to nursing students. The student can best perform this learning activity after content of asepsis, infection control and safety have been taught. The student is invited into a simulated hospital room, where a low fidelity mannequin lies in bed. The student is asked to identify any compromise in this patient’s environmental safety that he/she sees. As the hazard is identified, the nursing student is asked to address the best way to correct the hazard, and create a more safe patient room environment. The students are given the following scenario with limited details: One of your patients is Mr. Neat. In report you learn that Mr. Neat is a 64 y.o. gentleman admitted to you unit 3 days prior for a R leg wound that has become worse. An irrigation and drainage was performed on this R leg wound the previous night, and a C&S culture was sent to the lab from the OR. There are no results reported yet for this C&S. Mr. Neat is a Type 2 diabetic on insulin, and he has has COPD, for which he wears 2L of 02 per nc. Mr. Neat has a chronic productive cough, for which he likes to use the yankeur suction to facilitate removal of the mucus he is coughing up. The doctor has ordered that Mr. Neat be ambulated this morning. You are entering Mr. Neat’s room for the first time during your day shift and Mr. Neat is sleeping quietly. This activity centers on your assessment of Mr. Neat’s environment while he is sleeping. There are 15 compromises in Mr. Neat’s patient room environment. Name 12. Please address how you would remedy each hazard that you identify. You have ten minutes for your environmental assessment. The student is expected to be able to identify 12 of the following 15 environmental hazards: 1. A 4X4 piece of gauze with serosanguinous drainage sits at the foot of the bed 2. There is a visible uncapped insulin syringe in the bed, alongside the patient 3. The bed’s wheels are unlocked 4. The suction mechanism is missing the connector tubing and the apparatus is set up incorrectly 5. The bed is in the high position 6. There is various debris on the floor (e.g. needle caps, a bandaid, and a potato chip bag) 7. The patient’s IV tubing is obstructing the patient’s pathway to the bathroom. 8. The sharps container is totally full 9. There is an unsafe rug on the floor that could easily slip out from under someone. 10. The patient has no footwear (slippers or hospital booties). 11. There is an overflowing trashcan, with a red hazardous material bag open at the top. 12. There are loose unidentified pills on the over the bed table 13. The oxygen tubing is disconnected from the 02 christmas tree and the 02 is set at 2L. 14. There are dirty Kleenexes in the bed and on the floor alongside the bed 15. A part of the paper chart has been left on the bedside table with sensitive information about the patient’s history (e.g. details of the patient’s history of mental illness, or a sensitive aspect of the patient’s psychological/social history like a recent divorce) Submitted Materials: Additional Materials: Evaluation Description: This activity is most easily evaluated as a pass/fail activity. The instructor can use a checklist to keep track of the hazards that the student identifies or misses. Evaluative support to the student can be similar to other simulation debriefing where the student provides reflection on his/her strengths, what was missed and what he/she learned from the learning activity. It is also helpful during the debrief to have the student describe the clinical implications of the environmental hazards (e.g. hypoxia from the unhooked 02 can lead to respiratory arrest, transmission of bacteria by the contaminated gauze and open hazardous material bag can lead to nosocomial infections for other patients, a patient fall from the rug and lack of foot wear can result in serious injury to the patient etc…)

Published Back to Strategy Search Strategy Submission Time Out! QSENizing the Curriculum Requires Educating the Educator Author: Kristina Patterson MSN, RN Title: Faculty Coauthors: Marc Rupp, MBA, MSN, RN, CCRN Institution: St. Petersburg College Email: patterson.kristina@spcollege.edu Competency Categories: Informatics, Safety Learner Level(s): Pre-Licensure ADN/Diploma, Staff Development Learner Setting(s): Clinical Setting, Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: (1) Faculty will gain insight into the meaning and use of the QSEN KSA’s for the standard of informatics using a simulation-based methodology. (2) Faculty will explore various applications of informatics and understand how use of the QSEN KSAs for informatics can help nursing students learn the impact of technologies on safe patient care. (3) Faculty and students will be able to “explain why information and technology skills are essential for safe patient care.” (4) Students will be able to: “identify essential information, contrast benefits and limitations to communication technologies and their impact on safety and quality and develop appropriate attitudes of valuing technologies that support safety and quality of care as well as valuing nursing’s contribution to such technologies.” (5) Faculty and students will gain insight into gaps in clinical partnerships. Strategy Overview: This strategy can be used to educate faculty and/or students. (1) Hand each faculty member and/or student Attachment #1: Worksheet and QSEN KSAs for Informatics. (2) Run video (Attachment #2). During each “pause and discuss” session, stop the video and allow faculty and/or students to review the competencies and discuss how the competencies were met or not met during the video in relation to informatics and patient safety. Faculty and/or students should gain valuable insight into how informatics effects patient safety. (3) After the video simulation, faculty and/or students should be given time to openly discuss the worksheet and any barriers experienced in practice. This will help faculty and administrators gain valuable knowledge as to gaps in clinical partnerships faculty and students may face. Submitted Materials: Worksheet.docx - https://drive.google.com/open?id=1QvPmaqkoC2f_vQa4T0dqjN4pg_395vrS&usp=drive_copy Additional Materials: For security reasons, this website would not allow a link to the video to be placed as a resource. Please refer to https://youtu.be/4RqvhRfyaqQ for the video. Evaluation Description: Faculty and/or students should express increased confidence in knowledge, skills and attitudes related to informatics and patient safety. Faculty and students should also have time to express gaps in clinical practice and brainstorm ways to close those gaps. Administrators should gain valuable knowledge in practice gaps and use that to begin conversations with key stakeholders at clinical facilities to ensure students are gaining appropriate informatics competencies during their clinical time.

Published Back to Strategy Search Strategy Submission The Role of a Registered Nurse in an MCI (Mass Casualty Incident) Author: Maritess Bernardo MSN-Ed, BSN-RN, PCCN Title: Instructor Coauthors: Institution: Rasmussen College Email: maritess.bernardo@rasmussen.edu Competency Categories: Evidence-Based Practice, Quality Improvement, Safety, Teamwork and Collaboration Learner Level(s): New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN Learner Setting(s): Classroom, Clinical Setting, Skills or Simulation Laboratories Strategy Type: Case Studies Learning Objectives: 1. Apply the principles of triage in a Mass Casualty Incident (MCI) in prioritizing patient care. (Knowledge, Skills). 2. Identify the roles of the nurse as part of an interdisciplinary team in an MCI. (Knowledge) 3. Describe the role of the nurse in supporting healthcare team, patients, and family in a MCI event. (Attitudes) Strategy Overview: For this activity, students will learn about the Principles of Emergency and Disaster Preparedness. Advance readings of the chapter from a reference was assigned to students with emphasis on the SLOs or Student Learning Outcomes. The activity will commence with an introductory video from You Tube about a hospital scenario in an MCI (Mass Casualty Incident) event. Students are divided into 5 groups with 4-5 members, depending on total number in class. The class is presented with a case study where students from each group are asked to classify victims according to a triage algorithm. The final activity is for given guide questions for discussion on how to effectively handle emergency nursing taking into consideration their strengths and weaknesses and possible ethical dilemma they may anticipate. After about 15-20 minutes of group discussion, each group will share their ideas with open feedback from other groups, facilitated by the Instructor. After class discussion, the Instructor will provide a conclusion with debriefing and address any other questions from students. Submitted Materials: MCI-Overview-1.docxaa.docx - https://drive.google.com/open?id=1zwV2IZ4yApMw37rW_R4bmDoiYsJO6T8W&usp=drive_copy MCI-PrePost-Test.docx - https://drive.google.com/open?id=1-53fHuG6RP7LtsacCVwU1HG0_RjvSnbo&usp=drive_copy MCI-Reflection-Questions-1.docx - https://drive.google.com/open?id=1-TpN1ykcX4bOiBXue6kYtCKb2-4eye77&usp=drive_copy MCI-Teaching-Strategy-2.docx - https://drive.google.com/open?id=1-Sd9Xl-5C9jRHgPe5cIzFyKQNhlor5gQ&usp=drive_copy Additional Materials: 1) Advance Reading: Chapter 10 – Principles of Emergency and Disaster Preparedness Reference: Ignatavicius, D.D., Workman, M.L., & Rebar, C.R. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care (9th ed.). St. Louis, MO: Elsevier. 2) YouTube video as introductory topic – October 3, 2017 Las Vegas shooting incident https://www.usatoday.com/videos/news/2017/10/03/go-inside-las-vegas-trauma-hospital/106288208/ 3) Utilize Triage algorithm Reference: U.S. Department of Health & Human Services. (2017). START adult triage. Retrieved from https://chemm.nlm.nih.gov/startadult.htm#more Evaluation Description: The levels of Bloom’s Taxonomy that are met in this activity are: Analyze 1.Students will able to categorize MCI victims and therefore prioritize their care. The use of case study and group discussion is an effective method for students to evaluate and apply what they learned from their readings. 2.The use of the algorithm is also an effective method in giving the students a simplified guideline in their process of prioritization. Evaluate 1.Students will brainstorm in their assigned group and share their thoughts in class. 2.Reflection on individual strengths and weaknesses – evaluate individual characteristics (ability to work in clinical settings that will require fast-paced decision-making, multitasking, and ability to coordinate and effectively work with other staff). 3.Students will reflect on leadership skills to provide an opportunity of improvement as students identify their strengths and weaknesses.

Published Back to Strategy Search Strategy Submission Preventing Catheter-Associated UTIs: Implementing a “Clinical Activity Template” to Incorporate EBP Author: Ruth Zimmerman RN, MSN Title: Project Manager, Education Coauthors: Vini Angel, DNP, RN, CNE Santa Monica College, Yolanda Ramirez, RN, MPH Kaiser Permanente Southern California Institution: Kaiser Permanente Southern California Email: Ruth.K.Zimmerman@kp.org Competency Categories: Evidence-Based Practice, Informatics, Quality Improvement, Safety Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Clinical Setting Strategy Type: Case Studies Learning Objectives: This Clinical Activity Template (CAT) was designed to develop KSAs from the QSEN category of Evidence-Based Practice. This activity was created for second semester, pre-licensure, ADN students. Student Objectives: Describe reliable sources for locating evidence reports and clinical practice guidelines. Base individualized care plan on patient values, clinical expertise, and evidence. Appreciate strengths and weaknesses of scientific bases for practice. Faculty Objectives: Utilize a “Universal Template” (previously submitted to QSEN website) to structure learning activities within any QSEN category, focusing on pre-determined KSAs. Simplify the process of creating QSEN-related learning activities that integrate classroom content into the clinical setting. Appreciate the value of a modifiable template as a means of assigning QSEN learning activities across the curriculum. Raise faculty and student awareness regarding current service initiatives in the clinical setting (including financial, legal, and ethical implications). Strategy Overview: Research shows that by implementing a specific set of nursing interventions (a bundle) with patients who have indwelling catheters, catheter-associated urinary tract infections (CAUTIs) can be prevented. Nursing students must be prepared to integrate this knowledge into the clinical setting by seeking out necessary resources to find the evidence, comparing those findings to current practice on the nursing unit, and implementing the interventions according to eidence-based practice and patient-centered care. As Medicare/Medicaid reimbursement decreases, healthcare reform takes shape, and patient acuity worsens, healthcare organizations across the nation are focusing on prevention now more than ever. Preventable complications such as CAUTIs have now made the Center for Medicare & Medicaid Services’ (CMS) list of “Never Events”. This makes CAUTIs part of every RN and Hospital Administrator’s vocabulary, so it is expected that the students are aware of this, as well. This Clinical Activity Template (CAT) for evidence-based practice has been completed based on the Universal Template tool, which was previously submitted. This design and KSA format allows faculty to assess student competency in the stated KSAs, as well as providing students with the opportunity to assess themselves. The “Knowledge” must be completed prior to entering the clinical setting, since this is the foundational concept of situated learning. The “Skills” are the activities that occur throughout the clinical experience. The “Attitude” component is assessed during post-conference verbally through discussion. This is one of the most important aspects of implementation, as it allows the students to apply the knowledge acquired during the pre-planning and clinical experience. Additionally, it allows the faculty to pose questions for discussion which incorporate systems thinking, as opposed to focusing on the task that was performed on their assigned patient(s). It is during post-conference debrief and the written self reflection that follows where the instructor can observe/assess the students’ “attitude”. I recommend a structured self-reflective model to organize the students’ thinking process. In our program we utilized Dr. Christine Tanner’s Model for Clinical Judgment (2006) to assess clinical judgment and competency in the affective domain. The students can use this worksheet in any clinical setting to guide their experience. Instructors can likewise define this worksheet as a performance measurement or evaluation criteria. **Note: Please also refer to the "Universal Template" strategy on the QSEN website for additional instructions on designing and implementing the template. References: Benner, P., Sutphen, M., Leonard, V., & Day, L. (2009). *Educating nurses: A call for radical transformation.* San Francisco: Jossey-Bass. Institute of Medicine. (2011). *The future of nursing: Leading change, advancing health. *Retrieved from the National Academies Press website: http://www.nap.edu/catalog.php?record_id=12956 Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. *Journal of Nursing Education, 45,* 204-211. Submitted Materials: 119.EBP_.CAT_.N20-Rv-8.16.11.doc - https://drive.google.com/open?id=1n2JkfiPECmbp6oAtiFaSwpbE23mfGPmG&usp=drive_copy Additional Materials: As stated in the strategy description, this strategy was designed utilizing the "Universal Template" (also submitted to QSEN.org). Please see the description for the Universal Template for detailed instructions on designing additional Clinical Activity Templates (CATs). Numerous "Clinical Activity Templates" (CATs) have been designed within all six QSEN categories utilizing this template structure. For questions, comments, feedback, assistance in completing the Universal Template, or to request additional resources, please contact Ruth Zimmerman (Project Manager) at: Ruth.K.Zimmerman@kp.org . Evaluation Description: This Clinical Activity Template has not yet been formally evaluated. We welcome further implementation and evaluation of this activity and would love to receive feedback on learning outcomes and satisfaction.

Published Back to Strategy Search Strategy Submission Perinatal Unfolding Case Study Author: Mary Lou Gies MSN, RN Title: Assistant Professor Coauthors: Institution: La Salle University Email: gies@lasalle.edu Competency Categories: Patient-Centered Care, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure BSN Learner Setting(s): Classroom, Clinical Setting, Skills or Simulation Laboratories Strategy Type: Online or Web-based Modules Learning Objectives: 1. To descibe the knowledge related to patient-centered care is demonstrated through patient teaching sessions throughout the perinatal period. Suicide and depression screening incorporate important safety measures to prevent negative outcomes of the high-risk obstetrical patient. 2. To apply attitudes, beliefs and values of the professional nurse when caring for patients of different social backgrounds are addressed. Respect and support of the patient, and how they can impact the quality of patient care, is included. Used as described above, this exercise can improve the competency of the pre-licensure nursing student. Strategy Overview: This unfolding perinatal case study takes the learner from the initial prenatal visit of a patient with many risk factors and complications through the perinatal period. Through this exercise, the pre-licensure learner can describe and apply safe and quality care to the patient whcih can lead to a positive outcome. This exercise can be used in a variety of ways. It can be used as an alternative to the traditional lecture. The scenario can be broken down and used in segments based on the material to be covered. This teaching strategy can also be used as an out of class assignment and reviewed in class. Alternatively, it can be used as a review exercise in its entirety at the end of the semester to prepare for the final exam. Upon completion of the pre-licensure nursing program, the case study can be used to review maternity material in preparation for the NCLEX exam. NCLEX style questions are included. Submitted Materials: QSEN-Unfolding-Perinatal-Case-Study-new-Aug2012-1-1.ppt - https://drive.google.com/open?id=16M-OyWSSpIZcB4rUoWQZDzH9FcSrqp9e&usp=drive_copy Additional Materials: Evaluation Description: Evaluation of learning using the unfolding case study was presented in the following ways. Questions are posed throughout the presentation to stimulate discussion. Application of the QSEN KSAs are described. Practice multiple-choice questions are included at the end of the presentation, to evaluate learning. This teaching strategy could enhance student and teacher satisfaction by providing an alternative learning experience.

Published Back to Strategy Search Strategy Submission Healthcare Technology Innovation Paper Assignment: Using Informatics to Promote Quality and Safety Author: Cibele Webb PhDc, MSN, RN, CNE Title: Assistant Professor Coauthors: Julie Mack, DNP, RN Institution: Saint Mary's College Email: cwebb@saintmarys.edu Competency Categories: Informatics, Quality Improvement, Safety Learner Level(s): Pre-Licensure BSN Learner Setting(s): Classroom Strategy Type: Paper Assignments Learning Objectives: 1. Discuss potential and actual impact of national patient safety resources and initiatives (Safety KSA). 2. Demonstrate effective use of technology and standardized practices that support safety and quality (Safety KSA). 3. Explain why information and technology skills are essential for safe patient care (Informatics KSA). 4. Describe examples of how technology is related to the quality and safety of patient care (Informatics KSA). Strategy Overview: Healthcare informatics is an integral part of clinical nursing practice because it supports the delivery of evidence-based, quality, safe care (Forman et al., 2020). Current studies indicate that nurse educators continue to struggle to infuse informatics content into the undergraduate nursing curriculum (Foster & Sethares, 2017). This teaching strategy addresses this need by integrating the QSEN competency of informatics into a medical-surgical course assignment. This teaching strategy consists of an APA paper assignment. Students identify a healthcare technology innovation and use current literature to explain how this technology enhances patient outcomes. Students discuss the background of the technology, its impact on quality and safety, how the technology supports national patient safety goals, and identify ethical and cost considerations related to the use of this technology. This paper helps students articulate the importance of using healthcare technology innovations in clinical nursing practice to support the delivery of quality and safe patient care. Submitted Materials: 286.QSEN-Teaching-Strategy-286-RubricFinal.docx - https://drive.google.com/open?id=1rto9baudbAIbtwWxaKQ6bJh7mdkWtR3v&usp=drive_copy Additional Materials: Assignment Description and Grading Rubric References: Forman, T. M., Armor, D. A., & Miller, A. S. (2020). A review of clinical informatics competencies in nursing to inform best practices in education and nurse faculty development. Nursing Education Perspectives, 41(1), E3-E7. https://doi.org/10.1097/01.NEP.0000000000000588 Foster, M., & Sethares, K. (Fall, 2017). Current strategies to implement informatics into the nursing curriculum: An integrative review. Online Journal of Nursing Informatics (OJNI), 21(3). Evaluation Description: This paper is evaluated using the grading rubric tool attached.

Published Back to Strategy Search Strategy Submission Safety Hazard Identification Simulation Author: Matthew Fox MSN, RN-BC Title: Assistant Professor of Nursing Coauthors: Institution: Ohio University Email: foxm4@ohio.edu Competency Categories: Safety Learner Level(s): New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: SAFETY Knowledge: Discuss general categories of errors and hazards in care when working in the acute care setting. Skills: Participate in error and hazard identification room check. Attitudes: Value self reporting of errors identified in healthcare environments. Strategy Overview: The teaching strategy focuses on identifying errors in the acute care environment. A simulated hospital room was equipped with a manikin, medical equipment, and the following safety hazards: -Bed not in the lowest position. -NC Oxygen device inserted upside down. -MAR record with a different patient name/DOB than on the manikin. -Continuous pulse-oximetry probe not placed correctly. -Linen laying on the floor with soiled gloves. -Uncapped syringe laying on the patients bed. -Uncapped syringe laying on the bedside table. -IV Inserted in the incorrect direction. -IV fluids infusing at a different rate than is ordered on the physician order sheet. Students in a senior level clinical judgement course were allotted 3 minutes after entering the simulated hospital room to identify and record the safety hazards on the identification sheet. The faculty member collected the identification sheet as the student exited the room. Each student entered the room independently. To ensure validity students were held in two separate rooms so that discussion of safety hazards identified did not occur with students not yet completing the activity. A debriefing session occurred at the conclusion of the activity. Submitted Materials: SafetySimulationOrders.docx - https://drive.google.com/open?id=17cUF0Qhr27iV1T6c0yMnyQIZtXE2qEdO&usp=drive_copy SafteySimulationStudentANswerSheet.docx - https://drive.google.com/open?id=17djAlSUfiE0-CvJNy-5RTHhuGT-FsUT5&usp=drive_copy SafetySimDebriefingSurvey.docx - https://drive.google.com/open?id=17A42WsVQpCwEI-chmjK6VnsXalfoVEE9&usp=drive_copy SafetySimulationDebriefing.pptx - https://drive.google.com/open?id=1pRH04w_QKvImxePtpsVYtKV11hAY4MaT&usp=drive_copy Additional Materials: 1. Physician Orders 2. Safety Identification Sheet 3. Safety Simulation Debriefing Form 4. Debriefing PowerPoint Evaluation Description: A debriefing session was held when all student completed the safety hazard identification activity. Students were provided with a one page debriefing form and were given 10 minutes to complete. After 10 minutes, the faculty member presented a PowerPoint to guide the debriefing session and to illustrate the safety hazards in the room.

Published Back to Strategy Search Strategy Submission Just Call Me Amy: An Immersive Role Play to Discuss Appropriate Patient-Centered Care for Transgender Patients Author: David Foley PhD, MSN, RN-BC,CNE,MPA Title: Research Associate and Faculty Coauthors: Morgan Wiggins Institution: Case Western Reserve University and Hondros College Email: dmf106@case.edu Competency Categories: Evidence-Based Practice, Patient-Centered Care, 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, Quality and Safety, RN to BSN, Staff Development Learner Setting(s): Classroom, Clinical Setting Strategy Type: Case Studies Learning Objectives: Learning Objectives Global QSEN Competency Objective (GQCO): The purpose of this role play on providing appropriate care to a transgendered patient is to give nurse educators (clinical/classroom faculty, practice-based nurse educators, and staff development personnel) with an immersive situation to promote critical/analytical thinking and opportunities for affective development as framed within the QSEN competencies of Patient-Centered Care, Evidence-Based Practice, Safety, Teamwork and Collaboration. The questions that are embedded with the role play should thus be used to provide learners with opportunities to demonstrate a practical understanding of these QSEN competencies in a non-threatening setting with feedback provided by peers, co-participants, or facilitator. Unit Learning Objectives: As an immersive exercise, this role play thus promotes both critical thinking and affective development by placing leaders within a low-incidence/high-risk clinical scenario involving serious breaches in therapeutic communication and care practices for Amy, a 43 year-old transgendered patient with a history of Major Depressive Disorder (MDD) and previous suicide attempts who is currently experiencing an exacerbation of COPD and is thus being admitted to an inpatient Medical Unit. Four key QSEN Competencies (Patient-Centered Care, Evidence-Based Practice, Safety, and Teamwork/Collaboration) provide the framework for reflective thought and discussion: 1. Through analysis, reflective thought, and discussion the learner will affirm the importance of utilizing effective evidence-based practice and clinical interventions for transgendered patients. 2. Through analysis, reflective thought, and discussion the learner will identify opportunities to enhance effective teamwork/collaboration during a low-incidence/high-risk in which a transgendered patient displays suicidal risk on an inpatient unit. 3. Through analysis, reflective thought, and discussion the learner will identify opportunities to enhance safety as a primary artifact of a healing, therapeutic milieu for transgendered patients under their care. Strategy Overview: Strategy Overview Whether in the educational (i.e. classroom or clinical pre-/post-conference discussion), or work-place (i.e. staff development exercise) settings, 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 (a 43 year-old transgendered patient) and two nurses working in an inpatient medical setting exchange robust dialogue as they engage in conflict framed by a lack of knowledge of basic, evidence-based care practices for transgendered patients. Serious breaches in therapeutic communication, patient rights, and basic dignity lead to an unfortunate, yet highly avoidable outcome. Finding themselves in an exchange that is spiraling out of control, the two nurse characters fail to engage in effective teamwork-collaboration to seize any number of opportunities to de-escalate a volatile situation that ultimately results in a suicidal act by the patient, whose psychiatric history was grossly minimized. Although many nurses may have professionalism—and basic common courtesy—in caring for transgendered patients Nurse Eric and Nurse Tina must now face the consequences of their actions. This scenario thus focuses on promoting critical thinking and reflective thought to prevent such a highly dangerous scenario from reoccurring. The mechanics of this role play provide opportunities to engage in a role-play bounded by several QSEN competencies (Patient-Centered Care, Evidence-Based Practice, Safety, and Teamwork/collaboration) 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 an approximately one-half hour to read it independently, with peer interaction followed by instructor-facilitated discussion immediately following. At the discretion of the instructor or facilitator, the character descriptions can be distributed to those participants who will portray the characters. o At the conclusion of the role-play, a written Reflective Journal assignment is distributed and should be completed on/or before a date determined by the facilitator. As it is completed asynchronously, the Reflective Journal gives students a more discrete format to present the thoughts they might not feel comfortable sharing in a public forum and will return to them with written instructor feedback. Submitted Materials: 319-Appendix-ABC.docx - https://drive.google.com/open?id=1YFTvxXzLZd9eH0F9LB_lEiFdFbDR1zmY&usp=drive_copy 319-Appendix-D.docx - https://drive.google.com/open?id=1YFTvxXzLZd9eH0F9LB_lEiFdFbDR1zmY&usp=drive_copy 319.-Appendix-E.docx - https://drive.google.com/open?id=1spRy67tjrAGCDvpHxjKRiJK1rSfX5TBA&usp=drive_copy 319.-Appendix-F.docx - https://drive.google.com/open?id=1t2c4nJomp4aYYQDydpfSvlyEfzUGArLg&usp=drive_copy 319.-Role-Play-Script.docx - https://drive.google.com/open?id=1YFTvxXzLZd9eH0F9LB_lEiFdFbDR1zmY&usp=drive_copy Additional Materials: • Bios/descriptions for role play characters Participant reflective journal template Roleplay script Tips sheet for providing care to transgendered patients Faculty/facilitator guide Evaluation Description: Evaluation Description Post-Scenario Evaluative Questions Nurse Tina and Nurse Eric are interviewed by the hospital’s Risk Management Department the very next week as part of a Root Cause Analysis (RCA). Please project into this situation and imagine you are Nurse Tina or Nurse Eric. How would you respond to the following questions? • How often have you worked with transgendered patients? Do you perceive to be at least minimally culturally competent in working with the patient population, especially in terms of therapeutic communication and sensitive patient care practices (Obj. 1)? • Identify opportunities to improve teamwork/collaboration between Nurse Tina and Nurse Eric? How would you assess their communication with each other? (Obj. 1 & 2) • Given the opportunity to review the entire scenario, what factors ultimately impacted patient safety? (Obj. 3) • What recommendations would you have for quality improvement to prevent this scenario from happening in the future? (Obj. 3 and GQCO) 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 Integration of QSEN Competencies and TTP Program Leadership into a System's Shared Governance Structure Author: Maria Cosler RN, MS Title: RN Residency Program Manager Coauthors: Kim Barton, MSN, BSB/A, RN Institution: Premier Health Email: MTCosler@PremierHealth.com Competency Categories: Quality Improvement, Teamwork and Collaboration Learner Level(s): Continuing Education, New Graduates/Transition to Practice, Staff Development Learner Setting(s): Clinical Setting Strategy Type: General Strategy Learning Objectives: 1. To streamline TTP program communications with the leadership teams and bedside staff to enhance engagement. 2. Build a mechanism in which to share TTP metrics/outcomes with nursing on a monthly and quarterly basis illustrating program success. 3. Have a platform by which to have new graduates present their projects to organization leadership and staff nurses, to raise awareness of their valuable work. 4. Eliminate waste by combining structure and thereby multiple meetings. Strategy Overview: The practice strategy shared is the integration of our Transition to Practice (TTP) Programs Leadership/Oversight into our existing Shared Governance Structure including the use of QSEN competencies as its structural framework. Changes to the recommended TTP Leadership Committee structure triggered us to look at our structure and consider integrating program oversight into our current System Shared Governance Model which allowed us to create a platform, which supported our objectives outlined below. (Refer to the Shared Governance Practice model where each subcommittee was built into the shared governance subcommittee.) - To streamline TTP program communications with the leadership teams and bedside staff to enhance engagement. Streamline communication with leadership teams and beside staff through each facility's council structure. We were able to document the shared TTP information in the council meeting minutes and ensured that the chair of the council on the units was sharing this information at staff meetings, we were not able to track the dissemination of information prior to transitioning these meetings together. - Build a mechanism to share TTP metrics/outcomes with nursing on a monthly and quarterly basis illustrating program success. This was shared by Nurse Residency Manager in Transformational leadership and disseminated throughout the coordinating councils. When the data is shared during shared governance meetings it is then streamlined into our facility coordinating council each month. Prior to this, that data was shared with leadership only not the direct representative at each coordinating council. - Created a meaningful platform by which to have new graduates present their projects to organization leadership and staff nurses to raise awareness of their valuable work. Each cohort would present at the shared governance system meeting following their one-year mark. The PI projects for that cohort were divided into each shared governance subcommittee that the topic was relevant. Each project must illustrate the QSEN domain and any sub-competencies addressed in the project. Prior to this integration, each PI group would present at their own hospital only and only a few nurse leaders and that facility's CNO. - Eliminate waste by combining structure and thereby multiple meetings. Successful integration of a Transition to Practice (TTP) Programs Leadership/Oversight into our existing System Shared Governance Structure Submitted Materials: 281-Practice-2.pdf - https://drive.google.com/open?id=1YkB8RE80DiF4sIwq_hGn_4SDRqNjGcfh&usp=drive_copy 281-Practice.pdf - https://drive.google.com/open?id=1s03f8rZG1lQAX9K7ikiAGaZUhrnEPd1C&usp=drive_copy 1-1.png - https://drive.google.com/open?id=1n2JkfiPECmbp6oAtiFaSwpbE23mfGPmG&usp=drive_copy 2-1.png - https://drive.google.com/open?id=1EnuS4KywbSsSoi0-igh5UJZf0HEQ1P2Z&usp=drive_copy Additional Materials: Practice Model Infographic_PHP Shared Governance Council Model_PHP Evaluation Description: Qualitative and quantitative outcomes have been positive including: - Reduced meeting time required on council member/TTP Leadership schedules by 2 hours a month per individuals who were attending multiple committees and councils with similar content and topics. The committee had 33 members prior to integration into the system Shared Government. - Representation from all facilities/councils to communicate back to unit councils’ committees, facilities as relevant. By combining the monthly meetings 792 total hours per year were reduced for the TTP leadership members. In addition, reduction in work for Nurse residency managers by approx. 4 hours a month, preparing for those meetings such as agenda items and meeting minutes. - Streamlined communication through system shared governance committees (4) and facilities coordinating councils (3). By having the system shared governance model incorporate TTP leadership the communication can now filter down to site coordinating councils. This has also afforded the opportunity for nurses to be together to have a voice and making decisions in a more efficient and timely manner. Before when decisions or votes had to be made, it had to go to each individual shared governance council site first and TTP leadership, then collect the input for a decision to be made. This often delayed moving nursing practice and decisions about program forward and having the current model unifies our institutions nursing. - Able to successfully recruit additional Supportive Components Coaches for TTP support. By utilizing this platform, we increased our participation of new coaches to 86 active coaches over the past three years. We also could discuss each month when cohorts were starting how many coaches will be needed for that cohort. This method increased the number of new coaches reaching out to us via email on a more regular basis. We also streamlined coaching classes for the coaches and created a flyer to attach to monthly minutes that contained when those classes would be offered. - Platform for new grad RN resident PI project presentations and champions of the possible unit, facility, and system-wide implementation The audience for the PI project has three committees we filter it thru and this goes to all three coordinating councils which then can be shared in units shared governance council meetings. The new approach reaches every bedside nurse. - Improved involvement of Executive Leadership and bedside RNs in TTP decision-making. We now facilitate communication and decision making thru Transformational leadership (23 members), which is also communicated to our three sub-committees (70 members), and the three coordinating site councils (260 members). We also have a more open dialogue with our Nurse Executive Council (7 total members, Chief Nurse Officers, and Assistant Chief Nurse Officers at each site) as needed for decision-making on program changes since we have representation each month of an NEC member.