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

Published Back to Strategy Search Strategy Submission Heath Informatics and Technology: Professional Responsibilities Author: Annette Peacock-Johnson RN, MSN Title: Associate Professor of Nursing Coauthors: Institution: Saint Mary's College Email: ajohnson@saintmarys.edu Competency Categories: Informatics Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Skills or Simulation Laboratories Strategy Type: Online or Web-based Modules Learning Objectives: 1. Describe the role and benefits of health informatics in the delivery of quality patient-centered care. 2. Discuss professional health care provider responsibilities for safeguarding confidential client information, including HIPAA regulations. 3. Explain possible consequences for breaches in privacy and confidentiality. 4. Discuss professional responsibilities in the use of social health care technology or media as it relates to relationships with patients, colleagues and employers. Strategy Overview: This learning program is a an online self-paced module created for pre-licensure ADN/Diploma/BSN nursing students. The program provides a general introduction to health informatics including the benefits of health informatics as well as the professional responsibilities related to privacy and confidentiality. In addition, the program explores the use of social health care technology/media and its potential impact on professional relationships with patients, colleagues, and employers. The program is interactive and includes links to a short video clip and professional resources. Submitted Materials: Health-Informatics-and-Technology-Professional-Responsibilites-QSEN-ppt.pptx - https://drive.google.com/open?id=1j4levWCxmaEsPFj-TZfUlzRfAGfCMs9b&usp=drive_copy Health-Informatics-and-Technology-Post-Test.docx - https://drive.google.com/open?id=1j4levWCxmaEsPFj-TZfUlzRfAGfCMs9b&usp=drive_copy Additional Materials: Evaluation Description: An 11 item objective post-test is included along with answers and rationale. A modified version of this test was used previously with first year nursing baccalaureate nursing students and found to be valid and reliable.

Published Back to Strategy Search Strategy Submission Integration of QSEN competencies when designing simulation scenarios Author: Paula Jarzemsky MS, RN Title: Clinical Professor Coauthors: Jane McCarthy, MSN, RN, Nadege Ellis, BSN, RN Institution: University of Wisconsin-Madison School of Nursing Email: pajarzem@wisc.edu Competency Categories: Evidence-Based Practice, Informatics, Patient-Centered Care, Safety, Teamwork and Collaboration Learner Level(s): Faculty Development Strategies, New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN Learner Setting(s): Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: Using this strategy, nursing faculty will be able to: 1. Develop learning outcomes for simulation scenarios that exemplify the knowledge, skills and attitudes underlying QSEN competencies 2. Create an inventory of sample events or triggers that target specific QSEN competencies before, during and after a simulation scenario. 3. Collaborate with other nursing faculty to design effective simulation scenarios. Strategy Overview: Task analysis is a detailed examination of the knowledge, skills and attitudes (KSAs) that are essential to job performance and an important first step in the process of developing learning outcomes for simulation-based training. QSEN offered a detailed list of KSAs that are critical to the nursing profession. We used this information to design learning activities and simulation events that would elicit such KSAs from students. This strategy describes a planning process which has helped our nursing faculty share ideas and craft scenarios best suited to the needs of their students. First, QSEN competencies were associated with examples of learning activities and events that might occur before, during and after simulation scenarios (see Summary). For instructors new to simulation, the summary offered a preview of possible learning outcomes and in some cases, inspiration to engage in the process. It also led to discoveries which are likely to influence our future plans for simulation scenarios. For example, we noted that KSAs related to Quality Improvement had been overlooked. In addition, we identified a need for more advanced communication challenges such as the need to consider boundaries of therapeutic relationships, barriers to active patient involvement and conflict resolution. Next, we examined key elements of our existing simulation scenarios, in relation to QSEN competencies. Five simulation scenarios serving first-year students in medical-surgical settings have been analyzed using this framework (see Table). From this analysis, we identified core features that were emphasized in every simulation, along with special features that made each scenario unique. We expect to adopt a similar approach to planning scenarios as our simulation program expands to meet the needs of more advanced students and nursing specialty courses. Submitted Materials: 109.Summary-of-Simulation-Activities-and-QSEN-Competencies.doc - https://drive.google.com/open?id=1n2JkfiPECmbp6oAtiFaSwpbE23mfGPmG&usp=drive_copy 109.Table-Mapping-QSEN-competencies.doc - https://drive.google.com/open?id=1n2JkfiPECmbp6oAtiFaSwpbE23mfGPmG&usp=drive_copy Additional Materials: Evaluation Description: No formal evaluation of the strategy has been planned.

Published Back to Strategy Search Strategy Submission Using Beers Criteriato Prevent Medication Related Problems in Older Adults Author: Viki Saidleman RN MS Title: Nursing Instructor Coauthors: none Institution: East Central University Email: viklvog@ecok.edu Competency Categories: Evidence-Based Practice, Patient-Centered Care, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure BSN, RN to BSN Learner Setting(s): Classroom, Clinical Setting Strategy Type: Online or Web-based Modules Learning Objectives: 1. Value the concept of EBP as integral to determining best clinical practice for older adults. (EBP-attitude) 2. Describe how the strength and relevance of evidence in Beers Criteria influences the choice of interventions in provision of patient-centered care. (EBP-knowledge) (Patient-centered care-skill) 3. Demonstrate effective use of strategies to reduce risk of medication related harm to older adults. (Safety-Skill) 5. Assert own position/perspective in discussions about patient care. (Teamwork & Collaboration-skill) 6. Appreciate importance of intra- and inter-professional collaboration. (Teamwork & Collaboration-skill) Strategy Overview: This strategy can be used for either pre-licensure or RN to BSN students utilizing the clinical setting and either group or individual work in class, in post-clinical conference, or via online discussions or blogs. Prior to clinical, students are assigned the American Geriatric Society 2015 updated Beers Criteria for potentially inappropriate medication use for older adults link for review, the Hartford Geriatric Nursing Beers you-tube for viewing, and the ConsultGeri.org Try This Series site for regarding the Beers Criteria for reading. On the clinical day, a brief discussion can be held in pre-conference about Beers Criteria with a review of definitions for quality and strength of evidence and a brief account of methods used to analyze the evidence and to make recommendations. Students will be instructed to select an older adult patient over age 65 with 8 or more medications. In clinical, students are to record basic patient information like the client's medical diagnoses, prescribed, routine, prn and over the counter medications as well as vitamin and mineral supplements. They will record these on the first section of the QSEN Beers Learning Strategy Form. After the clinical experience, students are instructed to complete the second section of the form requiring students to utilize the Beers Criteria to analyze the patient's medications using the 5 tables in the Beers document to review the strength and quality of evidence, rationale, recommendations, safety concerns, risks, etc. The third part of the form includes questions about teamwork and collaboration interventions and appropriate patient centered interventions relevant for the completed evaluation of medications. This third part can be done in writing (individually or as a small group), on-line as part of a blog or discussion board or as part of a clinical post-conference session. The strategy focuses on the application of evidence to practice in the geriatric setting regarding medication safety. Attention is given to quality and safety by focusing on risk reduction and prevention of medication related problems for the older adult vulnerable population. Patient centered care is addressed with individualized interventions based upon the medication evaluation using Beers Criteria. Students are asked to formulate teamwork and collaboration strategies to address medication concerns. Submitted Materials: 2016-QSEN-Beers-Learning-Strategy-Form-1.rtf - https://drive.google.com/open?id=1EnuS4KywbSsSoi0-igh5UJZf0HEQ1P2Z&usp=drive_copy Discussion-Questions-for-Using-Beers-Criteria-to-Prevent-Medication-Related-Problems-in-Older-Adults.docx - https://drive.google.com/open?id=1Gvj3CfHAJ2oD8zwNh8bGnUhJwS3cxPzh&usp=drive_copy Best-Grading-Rubric-Using-Beers-Criteria-to-Prevent-Medication-Related-Problems.docx - https://drive.google.com/open?id=1G5BSckVs4-gVtZAuAT5ebpNivSo4nwat&usp=drive_copy Evaluation-Tool-for-Using-the-Beers-Criteria-to-Prevent-Medication-Related-Problems-in-Older-Adults-Evaluation-Tool.docx - https://drive.google.com/open?id=1HZz8OuIPz6WjAkK5Vtlw-uEk6vQ6jUcF&usp=drive_copy Additional Materials: https://www.guideline.gov/summaries/summary/49933? https://www.youtube.com/watch?v=USCwt-ISCTY https://consultgeri.org/try-this/general-assessment/issue-16 Evaluation Description: Evaluation will be based upon the following: 1) successful individual or group completion of the QSEN Beer's Learning Strategy paper after clinical 2) successful after clinical written discussion, post-conference discussion or on-line blog or discussion 3) use of the Best Grading Rubric applied to the paperwork and discussion 4) student evaluation tool using a Likert scale

Published Back to Strategy Search Strategy Submission "What Would You Do Walk-Through" Author: Sarita James PhD, RN-BC, CNE Title: Associate Professor Coauthors: Institution: Louisiana State University at Alexandria Email: sjames@lsua.edu Competency Categories: Patient-Centered Care, Safety, Teamwork and Collaboration 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: 1. Apply critical thinking and clinical judgment to identify priority patient-centered nursing intervention in the care of maternal-newborn patients. 2. Apply evidence-based practice in the demonstration of a basic assessment. 3. Demonstrate professional behaviors when prioritizing and managing safe care for a maternal-newborn patient. 4. Demonstrate effective use of technology and standardized practices that support safety and quality patient care. 5. Uses effective verbal communication with team members to help the patient achieve health care goals. Strategy Overview: Prioritization/Delegation Scenarios Maternal-Newborn Care “What would you do Walk -Through” Process: Students will approach five client beds each client within the simulation lab. Each client’s name is clearly designated at the head of the bed. Each client has orders, armbands, Kardex, report off sheet or an actual “report off” nurse, and explanation of the scenario. Students are to review each scenario as a clinical group, collaborate with clinical group, and after review of each patient, determine priorities and/or delegations of care. Students will be informed of the correct priorities at debriefing. Submitted Materials: Sim-Evaluation-and-Debriefing_Maternal-Newborn1-1.docx - https://drive.google.com/open?id=18-txd2rrBzGhdKQJjVLJeGavzEoo3nAD&usp=drive_copy Situational-Scenarios-for-Decision-and-Delegation-1-1.docx - https://drive.google.com/open?id=18at_pdQ3caNJojeil3kizo662XtcSPM9&usp=drive_copy Additional Materials: Description of the scenarios is attached here as well as the evaluation form. The actual chart, or scenario materials for each client are available by emailing sjames@lsua.edu . All documents are modifiable as the focus is to create an environment to assist students to prioritize patient care and use delegation skills where appropriate to help them prepare for entry into practice. Evaluation Description: Students participate with the simulation facilitator (faculty member) for a one-hour debriefing of the experience to identify their strengths/weaknesses, what went well, what could have been improved. Students are given an evaluation form to anonymously evaluate the experience and provide feedback.

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

Published Back to Strategy Search Strategy Submission Individualized Capstone Experience Proposal Based on Quality and Safety Education for Nurses (QSEN) Competencies Author: Denise Albsmeyer MSN, RN, CNE Title: Assistant Professor Coauthors: Institution: Blessing-Rieman College of Nursing Email: dalbsmeyer@brcn.edu Competency Categories: Evidence-Based Practice, Informatics, Patient-Centered Care, Quality Improvement, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure BSN Learner Setting(s): Classroom, Clinical Setting Strategy Type: Course Syllabus Learning Objectives: Students will: Integrate professional nursing concepts and each of the QSEN competencies into an individualized nursing capstone experience. Strategy Overview: The Professionalism Capstone Experience is a one credit hour clinical component designed to allow the nursing student the opportunity to synthesize knowledge and skills from the curriculum and to integrate them into an individualized capstone experience. Students develop a written Capstone Experience Proposal with objectives based on Quality and Safety Education for Nurses knowledge, skills, and attitudes. Proposals are written by the student and approved by the course instructor prior to beginning the capstone experience. Additional content from the corresponding theory course objectives are incorporated into the proposal. Submitted Materials: Additional Materials: Evaluation Description: Students complete a typed capstone experience report evaluation. The capstone experience report by students includes two parts: Part 1) Narrative pedagogy: “Tell about a time that stands out in your mind as you reflect back on your capstone experience.” This is shared with the class. Part 2) For each objective, students provide a written example of how they did or did not meet the objective and provide a specific example. The Student and Preceptor Evaluation of Capstone Experience: Midpoint form, using the student’s objectives, is completed by the student and preceptor halfway through the hours and submitted to the course instructor. The Preceptor Evaluation of Capstone Experience: Final form, using the student’s objectives, is completed by the preceptor at the conclusion of the experience. Written documents from the Capstone Experience are saved as clinical evaluation tools. An alternate format would be inclusion of Capstone Experience evaluation in a student portfolio.

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

Published Back to Strategy Search Strategy Submission 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.

Published Back to Strategy Search Strategy Submission “Elder” Centered Care: Flipping the concept map Author: Kimberly Silver Dunker DNP, RN Title: Assistant Professor of Nursing Coauthors: Institution: UMASS Graduate School of Nursing Worcester Email: kimberly.silver@umassmed.edu Competency Categories: Patient-Centered Care Learner Level(s): Graduate Students, Pre-Licensure ADN/Diploma Learner Setting(s): Clinical Setting Strategy Type: General Strategy Learning Objectives: Upon completion of this activity the students will be able to: Identify an elderly client in clinical (who is 65 years or older, has poly-pharmacy, dementia or delirium, a fall, or end of life care issues) and create a patient centered plan of care. Synthesize the needs of their client to identify specific interventions to their elderly and family while at clinical. Utilize their patient centered elder plan of care to provide specific nursing care, interventions, and teaching to their client while at clinical. Strategy Overview: This clinical activity is used to teach students to create an elder centered plan of care. In preparing to understand more about elders the student will review the following learning modules (Knowledge) produced by UMMS (University of Massachusetts Medical School) Senior Patient Navigator Program ©. href="http://www.umassmed.edu/uploadedFiles/AGE/Navigator/Navigator%202013-Mod%20I.pdf">Module I: Communicating with Older Adults href="http://www.umassmed.edu/uploadedFiles/AGE/Navigator/Navigator%202013-Mod%20II.pdf">Module II: Geriatric Prescribing href="http://www.umassmed.edu/uploadedFiles/AGE/Navigator/Navigator%202013-Mod%20III.pdf">Module III: Geriatric Specialty-Specific Considerations href="http://www.umassmed.edu/uploadedFiles/AGE/Navigator/Navigator%202013-Mod%20IV.pdf" Module IV: End-of-Life Care and Considerations Quality Improvement Students will identify an elderly client (see criteria below) while at clinical. They will identify the aged related changes and the body system changes that occur (Knowledge, Skills). Older than 65 years Has a recurrent hospitalization due to chronic illness Poly-pharmacy or medication reconciliation concerns End of life care Dementia/Delirium/Alzheimer’s disease Falls Client information that is gathered will help the student to prepare a case study presentation (Knowledge, Skills). The students identify the role of the nurse and hospital team in providing elder specific care, valuing what the team identifies as specific and specialized needs for elderly clients within the acute care environment. (Attitudes) Utilizing a standard concept map format the student will create a geriatric focused plan of care including patient centered interventions and present their case to the clinical group in post conference (Knowledge, Skills). Patient Centered Care Students will gain knowledge, understanding, and value their client by learning the preferences and expressed needs of their elder, family, and community. (Knowledge, Skills, Attitudes). Students will discuss in their presentation and paper how they provided elder specific nursing care, interventions, and goals, which promoted a more patient-centered environment (Knowledge, Skills). Submitted Materials: Additional Materials: Module 1 "Communicating with Older Adults" Hyperlink: http://www.umassmed.edu/uploadedFiles/AGE/Navigator/Navigator%202013-Mod%20I.pdf Module 2 "Geriatric Prescribing" Hyperlink: http://www.umassmed.edu/uploadedFiles/AGE/Navigator/Navigator%202013-Mod%20II.pdf Module 3 "Geriatric Specialty-Specific Experiences & Considerations Hyperlink: http://www.umassmed.edu/uploadedFiles/AGE/Navigator/Navigator%202013-Mod%20III.pdf Module 4 "End of life Care & Considerations" Hyperlink: http://www.umassmed.edu/uploadedFiles/AGE/Navigator/Navigator%202013-Mod%20IV.pdf Evaluation Description: Each student presented their elder case study to the clinical group at an assigned date and time during post conference. Presentations were 15-20 minutes, 5 minutes for NCLEX question review, and 5 minutes for questions. This presentation was a PowerPoint presentation with handouts and references. The students completed a concept map (see example) including: top 3-5 nursing diagnoses, subjective & objective assessment, medications, laboratory and diagnostics, nursing interventions (actions, teaching, collaborative), goals and outcomes for the patient and evaluation of their nursing care. Above all, the care plan must have an “Elder centered care focus.” The students must focus the aspects of patient centered care of the older. The students need to ask themselves: “Did their care plan and nursing interventions make a difference in their elder patient’s outcome?” (See attached template and examples). Lastly the students included 3-5 NCLEX questions related to their cases to discuss with the group. The NCLEX questions focused on the elder care plan and nursing interventions specific to elders. A grading rubric was utilized for evaluating the concept maps. Students had to receive a 95% or greater to successfully pass this assignment. Anecdotal information: This assignment was utilized in a graduate level program with pre-licensure nursing students. The assignment is designed for an adult medical-surgical, gerontology course, or chronic care course. Prior to integrating elderly specific nursing care into the standardized care plan; the students previously developed concept maps, which only addressed standardized acute concerns. However, as many patients in the acute hospital setting have multiple concerns and elder care issues, it is evident the students must create a patient centered care to include the needs of the geriatric population. Feedback from this assignment has been positive. Students were able to learn about the elder client transforming their care to be more patient centered. This assignment reinforced geriatric concepts taught in the classroom and integrated geriatric assessment into the clinical practice environment. As a result, students reported having an increased knowledge of elder specific concerns, more skill in providing quality patient centered care, and a greater value for the geriatric population.

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

Published Back to Strategy Search Strategy Submission Medication Error Reporting Form Author: Lacey Petersen MSN, RN Title: Instructor Coauthors: Institution: Blessing-Rieman College of Nursing Email: petersenl@brcn.edu Competency Categories: Patient-Centered Care, Quality Improvement, Safety Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Classroom Strategy Type: Paper Assignments Learning Objectives: Calculate accurate medication dosages using the Discuss the various types of adverse drug reactions. Recognize the role and responsibilities of a nurse in near-miss and medication error reporting. Examine the relationship between human factors and unsafe medication administration practices. Discuss medication errors and prevention strategies through the completion of an error reporting system for near-miss and error reporting. Discuss medication errors and prevention Strategy Overview: The Medication Error Reporting Form was created to help students link the process of medication math problems in the classroom with potential patient outcomes as a result of calculation errors. Entry-level student's that have minimal exposure to the clinical setting often have a difficult time understanding how medication math errors on a quiz or exam in the classroom are directly related to clinical patient safety. As a result, many students may make the same errors repeatedly because they fail to understand the dangers that exist for the patient related to their error. Strategy Implementation: Students are given medication math questions on selected quizzes and exams in their corresponding nursing course. If a student calculates a medication math question incorrectly, the question is treated as a medication error incident with a simulated patient, Susie Smith. The student must complete a medication error reporting form. The medication error reporting form requires the student to calculate the safe and correct dose which is verified by the course instructor. The student is then required to investigate what the medication is commonly given for and what are the potential adverse effects that Susie Smith may experience as a result of their medication error. Students are asked to identify safety measures that may help to prevent similar medication errors from occurring again and the student must reflect on how the medication error reporting form has changed their view of medication calculations and medication administration to patients. In conclusion, the student must sign the medication error reporting form to take accountability for the error just as a registered professional nurse would be required to sign a hospital incident report. Submitted Materials: Additional Materials: Evaluation Description: Selected quizzes and exams that include medication math calculation problems are given to students in their corresponding nursing course. If a student makes a medication calculation error, the student is required to complete a Medication Error Reporting Form as a method of remediation for making the error. The student can earn up to 10 assignment points for each Medication Error Reporting Form that they complete on selected math problems that were answered incorrectly. A maximum of five medication error reporting forms are completed each semester per student. Students that do not make medication calculation errors on the selected quizzes and exams are not required to complete the medication error reporting form. These students are awarded the 10 assignment points for not making a medication error. A maximum of 50 points can be earned by each student per semester for this teaching strategy. Faculty members that have implemented this strategy find it a useful tool to emphasize the importance of correctly calculating safe medication dosages. This assignment has been effective to introduce students to human factors and unsafe practices that can cause patient harm. It is a valuable teaching tool that has been successful to help entry-level nursing students to link education in the classroom to nursing practice in the clinical setting. The strategy provides an introduction to quality improvement measures including the analysis of medication errors and system improvement methods. In addition, the assignment is a lesson in responsibility and accountability for their own nursing practice and provides a unique opportunity to introduce concepts of Just Culture in healthcare. Students consistently report that this is one of the most valuable assignments in the course. Examples of student remarks after completing the assignment that were written on the form include: "I've learned how important precision in in administering medications. If too little is given, the medication won't help them. If too much is given, there could be serious adverse effects or even death." "I will be more aware and double check my math every time. It has also opened my eyes to see what my mistakes can do to a patient." "Completing the medication error form has changed my view on medication calculations and administration because I see that even the smallest mistakes can cause much larger problems. Just one mistake can put the patient's life at risk, cause a longer hospital stay for them, and possible a lawsuit for the hospital." "By doing this report it forces us to look at the real possibility of over/under-dosing a patient and the consequences. I am lucky that this drug, if under-dosed, would have a minimal effect on the patient. It still doesn't excuse the fact that the patient was under-dosed and as such, forces me to look more closely to the question and ask questions if I have any." "Completing this form helped me to realized why we try are the last line of defense for the patients so it is extremely important to ensure all calculations are correct."