Published Back to Strategy Search Strategy Submission Using End-of-Life Simulations Experience to Explore QSEN Competencies in the Didactic Nursing Classroom Author: David Foley PhD, MSN, RN-BC, CNE, MPA Title: Assistant Professor and Director of Faculty Development Coauthors: Institution: Case Western Reserve University Frances Payne Bolton School of Nursing Email: dmf106@case.edu Competency Categories: Evidence-Based Practice, Patient-Centered Care, Quality Improvement, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Classroom Strategy Type: General Strategy Learning Objectives: Learning Objectives: Through participation in this End-of-Life Simulation Exercise, the student will individually and collectively: •Identify QSEN competencies observed during discussions of end-of-life care between team member (i.e. nurse, advanced practice nurse, physician, and chaplain), patients, and family members. •Identify opportunities to promote a meaningful end-of-life experience for patients as framed within the QSEN Competencies of patient-centered care, evidence-based practice, safety, and quality improvement. •In particular, highlight the importance of teamwork and collaboration as an effective means to affect positively patients and their families as they face end-of-life care planning. Strategy Overview: Strategy Overview: End-of-life decision making can present patient-care scenarios highlighted by anxiety, spiritual distress, and complex family dynamics. Patients may discuss end-of-life planning with their bedside nurse, advanced practice nurse, physician, social worker, or chaplain as part of planned discussions or spontaneous interaction. As the nurse can often be the guiding force for these conversations and thus initiate referrals to other team members, opportunities are evident to frame these potentially difficult decisions within the QSEN competencies of patient-centered care, teamwork/collaboration, evidence-based practice, and safety. Given their highly sensitive nature, such conversations between patients, families, and other members of the team may understandably exclude students, thus excluding them from valuable opportunities for observational or interactive learning. In response, a didactic nursing instructor developed a classroom-based simulation utilizing acting students as well as an actual hospital chaplain to re-create such a conversation on end-of-life planning between a nurse-actor, patient-actor, family members-actors, and licensed chaplain. After introductory comments by the instructor, a nurse-actor greeted the patient-actor, who conveyed much conflict between his spiritual beliefs and his desire for end-of-life planning and in turn expressed concern about how his decisions may be perceived by his family. During the discussion, the nurse-actor explored options for patient-centered care from the perspectives of choice, autonomy, and locus of control. With no resolution for the patient-actor’s perceived conflict, the nurse-actor further recognized the opportunity engage in teamwork/collaboration by involving a practicing chaplain (also referred to as spiritual care in many institutions) as he discussed his wishes with family members. The chaplain, recruited from a nearby hospital, afforded students the chance to observe spiritually-based techniques designed to allay concern, provide comfort, and support patient choice. At the end of the scenario, the didactic instructor asked students to present questions to the actors as they remained in character, allowing them to engage in their art of improvisation. Students further explored the patient-actor’s perspective on end-of-life planning, recognized opportunities to education, explored complex family dynamics, and perhaps identified further opportunities for additional interdisciplinary referrals (Social Work or the Physician). At the end of the improvisational session, faculty provided concluding comments and reviewed basic course concepts that were highlighted during the simulation—and perhaps identified concepts that needed further exploration. As with the clinical post-conference, a simulation debrief in the didactic classroom allowed students to convey thoughts and emotions in a safe, affirming environment as they benefitted from the faculty’s clinical expertise. Follow-Up Reflective Journal: As a follow-up assignment, the didactic instructor asked the students to author a brief, one page reflective journal on how effectively the QSEN Competencies were explored during the exercise on end-of-life care. Such reflection is encouraged so students will engage the QSEN Competencies through the affective as well as the cognitive domains. The reflective journal presented three basic questions: 1.Which QSEN Competencies were engaged during today’s end-of-life simulation experience? Provide specific examples of each. 2.Comment on the application of QSEN Competencies to complex and often ethically laden scenarios such as end-of-life planning. 3.Describe how you may apply the QSEN Competencies like end-of-life care or other sensitive patient-care situations in your future nursing practice. Alignment of QSEN Competencies with Didactic Course Objectives: •As with any planned course activity, the QSEN End-of-Life Simulation is planned in accordance with course objectives and thus affirms curricular alignment: oStudents are requested to participate fully during the classroom-based simulation as they would during any patient care interaction in the clinical setting. oAs the clinical expert in the classroom, the didactic instructor’s pre-and post-simulation comments highlight course content as well as carefully frame the scenarios within the QSEN Competencies oFaculty read the students’ reflective journals and provide formative constructive feedback on the application of course content and effective therapeutic communication as they engage the patient, family members, and chaplain in conversation that promotes patient-center care, safety and teamwork-collaboration, all supported by evidence-based practice. Summary With much careful planning, a complex clinical scenario involving end-of-life care and can highlight the need for effective teamwork and collaboration even as patients and their families face sensitive and potentially ethically laden decisions involving end-of-life care planning. The QSEN competencies can be an effective framework to maximize students’ opportunities to individually and collectively identify opportunities to enhance patient care as well as clarify their own thoughts and feelings. Classroom group discussions, faculty debriefing, and introspection through reflective journaling can all be effective mans to exploring the QSEN competencies’ efficacy, even during end-of-life planning. References Lindemulder, L, Gowens, S., & Stefo, K. (2018). Using QSEN competencies to nursing student end-of-life care during simulation. Nursing 48(4), 60-65. Fabro K, Schaffer M, Scharton J. The development, implementation, and evaluation of an end-of-life simulation experience for baccalaureate nursing students. Nurs Educ Perspect. 2014;35(1):19–25. Siles-Gonzales & Solano-Ruiz (2016). Self-assessment, reflection on practice, and critical thinking in nursing students. Nurse Education Today, 45, 132-137. Submitted Materials: QSEN-Competencies-and-End-of-Life-Decision-Making-Teaching-Strategy.docx - https://drive.google.com/open?id=14Q4_NX9wOp1bZQNZWJLGpp85pjs63i1C&usp=drive_copy QSEN-Competencies-and-End-of-Life-Decision-Making-Sketch.docx - https://drive.google.com/open?id=14RMC3BN9LnQWztm9HSQSx9tMvgL3349R&usp=drive_copy QSEN-Competencies-End-of-Life-Care-Journal.docx - https://drive.google.com/open?id=144B-zX50uY1ZeyDiF8bKr8YOvzzAPpnv&usp=drive_copy Additional Materials: 1. Suggested outline of end-of-life classroom simulation 2. Critical Reflection Journal Template Evaluation Description: Evaluation Description 1). Critical Reflection Journal faculty feedback 2). Informal feedback from students and actors 3). Comments made by students on course evaluations

Published Back to Strategy Search Strategy Submission Reformulating SBAR to "I-SBAR-R" Author: Wendeline Grbach MSN, RN, CCRN, CLNC Title: Curriculum Developer for Simulation Education Coauthors: Lizbeth Vincent, RN, MSN, CEN; Deborah Struth, MSN, RN Institution: UPMC Shadyside School of Nursing Email: grbachwj@upmc.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, RN to BSN, Staff Development Learner Setting(s): Classroom, Clinical Setting, Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: (Slight modifications of QSEN Competencies) 1) Adopt and practice communication techniques focused on patient safety. 2) Use appropriate strategies to reduce reliance on memory. 3) Demonstrate effective use of strategies to reduce risk of harm to patients or self 4) Utilize standardized communication formats to minimize risk at care transitions/handoffs 5) Develop collaborative team communication practices which focus on patient safety 6) Examine nursing roles in assuring coordination, integration, and continuity of care. Strategy Overview: SBAR is a standardized communication format widely used in education and healthcare arenas to enhance patient safety and quality care delivery. Recent adaptation of SBAR-R (Situation, Background, Assessment, Recommendation and Readback) has been utilized in the curriculum at UPMC Shadyside School of Nursing for the past year to reinforce Joint Commission on Accreditation of Hospitals (JCAHO) initiatives regarding safety practices; this includes the 2007 update to Patient Safety Goal #2, indicating "Implementation of a standardized approach to handoff communications, including the opportunity to ask and respond to questions". Students participated in varied levels of simulation exercises in which they practice the SBAR-R communication techniques. However, in some instances we found that the most basic of communications when initiating care of a patient were being neglected...identification of the nurse/healthcare provider as well as the patient. Students were videotaped during simulation exercises and upon debriefing review recognized this error. To promote safe practice, we have adapted SBAR to the I-SBAR-R format, indicating Identification of yourself and your patient (2 identifiers to be used), standard SBAR and finally Readback. The strategy is introduced in fundamental nursing courses and is implemented throughout the curriculum and clinical experiences via faculty and student education for reinforcement. Students are provided laminated pocket cards with the SBAR format for ease of reference. Clinical communications related to shift report, condition changes, or physician requests are formulated using the I-SBAR-R format. Simulated and observational experiences will continue to enhance the correct procedures so that upon transition to employment, the use of the mnemonic will be ingrained in the student/graduate nurse care delivery processes. Submitted Materials: Additional Materials: We have implemented pocket reference SBAR cards which will be adapted to the new I-SBAR-R format. Handouts regarding this initiative are given in fundamental nursing courses. Evaluation Description: Students are participating in continued scenario work and case study opportunities to refine the I-SBAR-R techniques in the fundamentals as well as Complex Health Nursing (Senior level Critical Care) courses. Through simulation and debfriefing sessions where the students reviewed their performances, they self-identified that the I-SBAR-R was deficient and they improved on this in successive scenarios. Students related more comfort with increased reinforcement of the mnemonic and being able to communicate with other health team providers by practice sessions in the simulator setting.

Published Back to Strategy Search Strategy Submission Virtual Critical Care Transport Communication Simulation Author: Donna M. Thompson MSN, RN, AGCNS-BC, CCRN Title: Instructor Coauthors: Second Author: Amy D. Lower MSN, RN, CCRN, CHSE Title: Lecturer Institution: Frances Payne Bolton School of Nursing, Case Western Reserve University Email: adl90@case.edu . Additional credit to our actors Angela Arumpanayil DNP, RN, AGACNP-BC, CCRN (Instructor) and Shalyn Adams BSN, RN, BBA(Clinical Instructor) from Frances Payne Bolton School of Nursing, Case Western Reserve University. Simulation expertise, technical and video assistance was provided by Thomas Baum Paramedic (Simulation Manager) and Jared Lee AAS, Paramedic, CHSOS (Simulation Operations Specialist) from the Center for Nursing Education, Simulation, and Innovation, Frances Payne Bolton School of Nursing, Case Western Reserve University. This strategy was adapted from a simulation co-created by Eric Simpson MSN, RN, AGACNP-BC, NREMT. Institution: Frances Payne Bolton School of Nursing, Case Western Reserve University Email: dmt64@case.edu Competency Categories: Patient-Centered Care, Teamwork and Collaboration 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: The student will prioritize the integration of their plan of care. (Knowledge) The student will formulate 2 effective ISBAR (Identify, Situation, Background, Assessment, and Recommendation) handoffs at transitions in care. (Skill) The student will analyze the communication styles and team dynamics observed in the simulation. (Knowledge) The student will assess their own potential to contribute to effective team functioning. (Attitude) Strategy Overview: This simulation was originally written for student participants, but was converted to a virtual format to meet clinical or lab program requirements during the Covid-19 pandemic. The simulation actors are practicing intensive care unit registered nurses who are also faculty and clinical instructors, acting out specifically created transport roles. The Ohio Board of Nursing stated creative options for meeting course objectives could be utilized, such as remote or virtual simulation (OBN, 2020). This virtual simulation is FREE for use. Once you have made your own google forms copy, feel free to modify any portion to meet your course educational needs. The simulation template was adjusted to include 4 video simulation segments. Each video is structured to have a specific stopping point in which the students were prompted to answer strategic questions. The questions provided the students with an opportunity to critically think about the management of the patient. Students also created 2 ISBAR communications at each transition in care. A Google Form was utilized to house the videos and questions with the ability to section the materials so the students couldn’t skip ahead without answering the prompts. Additionally, students had the ability to re-watch the video segments as needed. This made the virtual simulation completely self-directed and easily accessible with an internet connection. Video simulation allows the students to complete the activity at their own pace and at a location of their choosing. This flexibility not only facilitates learning but also motivates the student (Da Silva et al., 2020 from Harris et al, 2008). Virtual simulations have the ability to bring real-world situations to students and engage their clinical reasoning skills, which allows the students to experience the role of the registered nurse and practice thinking like a nurse. Students report feeling comfortable and engaged, appreciating the ability to make decisions independently through virtual simulation (Padilha, Machado, Ribeiro, & Ramos, 2018). Healthcare professionals do not work in a silo, and patient management can be quite complicated. Patricia Benner (2010) theories state that simulation is a strategy used to integrate higher-level thinking and problem-solving activities appropriate for practice readiness when facilitated by a clinical faculty experienced in the art of debriefing. Debriefing is where opportunities to tease out “how to think like a nurse” arise. Students need to know that errors are expected, and feel comfortable discussing mistakes and rationale with peers, as the literature demonstrates that the majority of learning occurs during skilled debriefing (Deifuerst, 2012; INACSL, 2016; Jeffries, 2014; Rudolph, et al 2007). Although limited, literature related to the debriefing in the realm of virtual simulation does exist, and the concepts are the same: appropriate pre-briefing, small groups, experienced faculty, and sufficient time allotment (Gordon, 2017). With more nursing schools moving to online instruction during the Covid-19 pandemic, there were limited resources to meet program requirements. Facilitating learning is the first core competency mandated by the NLN (Halstead, 2019). Virtual reality is one strategy that will help master this competency, especially during times when clinical or lab experiences are limited or absent. This ICU Transport Virtual Simulation could fulfill 4 hours of clinical or lab hours. Submitted Materials: Additional Materials: General Instructions: - Establish the time of the lab and notify students. Allow approximately 2 hours for assigned pre-reading and completion of the virtual simulation. - Arrange for video conferencing times for debriefing, provide students with meeting ID ahead of time. It is best to use groups of 6 students or less. - Provide the link for Virtual Critical Care Transport Communication Simulation Activity. - If debriefing is being recorded, students must be informed of this prior to the start of the debriefing. Provide students rationale for recording and who may be listening to the recording. - Provide the participants with the debriefing agenda, including that discussion may focus on exploring student responses. - May utilize Virtual Critical Care Transport Communication Simulation Debriefing Points as needed. - Allow for at least 2 hours for debriefing. - Upon completion of debriefing, encourage participants to complete Virtual Critical Care Transport Communication Simulation Evaluation. - Faculty should have skill and experience with debriefing. We are planning to share the faculty development seminar on debriefing as a QSEN teaching strategy, feel free to utilize this succinct presentation if needed. - If this virtual simulation is utilized, please complete the Virtual Critical Care Transport Communication Simulation Survey listed in the links below. Links: - Virtual Critical Care Transport Communication Simulation Activity: https://forms.gle/8fzqyJ64UkaZh69X8 - Virtual Critical Care Transport Communication Simulation Debriefing Points: https://docs.google.com/document/d/1mCjAh4oBg7882EklrmoZ4xJgZZ4DABp9Ta0ypKkDqEM/edit?usp=sharing - Virtual Critical Care Transport Communication Simulation Evaluation: https://forms.gle/kM1vvHKeQg8bRA7V9 - Virtual Critical Care Transport Communication Simulation Survey: https://forms.gle/zfs4uifKoVdHfQSG7 References: Benner, P., Sutphen, M., Leonard, V., Day, L. (2010). Educating nurses: A call for radical transformation. San Francisco, Jossey-Bass. Da Silva, C., Peisacovich, E., Gal, R., Aniyinam, C., Coffey, S., Graham, L. (2020). A programmatic approach to the design of a video simulation care study. Clinical Simulation in Nursing, 41, 1-8. Dreifuerst, K. T. (2012). Using debriefing for meaningful learning to foster development of clinical reasoning in simulation. Journal of Nursing Education, (51)6, 326-333. Foronda, C., Godsall, L., & Trybulski, J. (2013). Virtual clinical simulation: The state of the science. Clinical Simulation in Nursing, 9, 3279-e286. Gordon, R. M. (2017). Debriefing virtual simulation using an online conferencing platform: Lessons learned. Clinical Simulation in Nursing, 13, 668-674. Harris, A., Hegg, M., Harris, A., Mikkelsen, J. (2008). Nursing students learning of managing cross-infection- scenario-based simulation training versus study groups. Nursing Education Today, 28(6), 664-671. INACSL Standards Committee (2016). INACSL Standards of best practice: Simulation debriefing. Clinical Simulation in Nursing, 12(S), S21-S25. http://dx.doi.org/10.1016/j.ecns.2016.09.008 Ohio Board of Nursing (2020/03/24). Additional Guidance to Prelicensure Nursing Education Programs. Obtained on 4/10/2020 from https://nursing.ohio.gov/wp-content/uploads/2020/03/Education-Program-Guidance.pdf Padilha, J. M., Machado, P. P., Ribeiro, A. L., & Ramos, J. L. (2018). Clinical virtual simulation in nursing education. Clinical Simulation in Nursing, 15, 13-18. Rudolph, J. W., Simon, R., Rivard, P., Dufresne, R. L., & Raemer, D. B. (2007). Debriefing with Good Judgment: Combining rigorous feedback with genuine inquiry. Anesthesiology Clin, 25, 361-376. Evaluation Description: Students participated in a 2-hour debriefing session on the same day as the virtual simulation activity by skilled facilitators. Each facilitator was assigned to read specific student responses to the virtual simulation activity. Debriefing facilitators asked about what went well, what could have been improved upon, considered student responses, and integrated some of the debriefing points which provided students with a formative evaluation of their responses. This virtual simulation’s primary focus was on interprofessional collaboration, so specific questions were asked about what was observed regarding communication and teamwork during the virtual simulation and in their clinical setting. After each debriefing session, students were provided a link to an anonymous google forms evaluation to express their feedback regarding the experience including the debriefing. Two main themes emerged including focusing more on critical thinking skills as opposed to hands-on skills and being able to observe how experienced nurses would effectively manage a deteriorating patient. One student stated “I think it was nice to see how things are "supposed" to go and then try and make decisions about what should happen next.” Faculty are rewarded with positive feedback from the students during the debriefing, in the virtual simulation and course evaluations. Students consistently enjoy simulation and ask for more throughout the program. Students complete an end of semester course evaluation, which includes some questions specific to labs provided to them with Likert scale questions and open-ended responses. This simulation could be considered for use by advanced practice provider students in a deeper evaluation of the treatment plan. We did not make our debriefing groups small enough for virtual simulation due to inexperience in this method of lab delivery, this was also mentioned in the students’ evaluation of this lab. Additionally, providing facilitators time to read their assigned student responses to formulate group-specific debriefing points.

The QSEN Institute website is a central repository of information on the core QSEN competencies, KSAs, teaching strategies, and faculty development resources designed to prepare future nurses in continuously improving the quality and safety of the healthcare systems within which they work. QSEN Home QSEN News Taking a Pulse on Quality and Safety Education QSEN Memories Video Strategies Search by Title Search by Category QSEN Competencies Using the Institute of Medicine (2003) competencies for nursing, QSEN faculty have defined pre-licensure and graduate quality and safety competencies for nursing and proposed targets for the knowledge, skills, and attitudes to be developed in nursing pre-licensure programs for each competency. Read More

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 Assessment of Informatics Competencies Nursing Students Author: Paula Jarzemsky MS, RN Title: Clinical Professor Coauthors: Diana Girdley, MSN, RN Mary Ellen Murray, PhD, RN Stephen Douglas, MSN, RN Institution: University of Wisconsin-Madison Email: pajarzem@wisc.edu Competency Categories: Evidence-Based Practice, Informatics Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN Learner Setting(s): Classroom Strategy Type: General Strategy Learning Objectives: Describe examples of how technology and information management are related to the quality and safety of patient care. Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills Value technologies that support clinical decision-making, error prevention, and care coordination Use high quality electronic sources of healthcare information Strategy Overview: While information technology abounds in the nursing workplace, many students don’t perceive that they are receiving sufficient formal education about its application in health care (Maag, 2006). Prior to hearing a presentation on nursing informatics in a required nursing fundamentals lecture course, first-semester undergraduate nursing students were asked to complete a 35-item self-assessment of informatics competencies. The purpose of the survey was to assess students’ competence and attitudes related to informatics and information retrieval. Items were developed from a research-based, master list of informatics competencies for the beginning-level nurse, as defined in the work of Staggers et al (2002). The list essentially outlined how nurses relate to technology in their workplace, i.e. for purposes of administration, communication, data access, documentation, client education, monitoring, quality improvement and research. In addition, it identified a nurse’s obligation to learn how to protect privacy and security of protected health information. Specifically, students rated their knowledge, skill and use of computer applications for these purposes using a Likert scale of 1 to 5 (1 = very little and 5 = very much). Next, students were asked how often they accessed particular information sources, using a scale of 1 to 5 (1 = never and 5 = often/daily). These items replicated a national survey which examined the readiness of practicing nurses to access evidence-based information sources for best clinical practices (Pravikoff et al, 2005). Submitted Materials: 90.assessment-of-information-survey71.doc - https://drive.google.com/open?id=1YFTvxXzLZd9eH0F9LB_lEiFdFbDR1zmY&usp=drive_copy Additional Materials: Evaluation Description: Survey results were shared during the presentation and stimulated an interesting discussion about the group’s self-reported competence and attitudes related to informatics and information retrieval. Students seemed to engage with the topic on a more personal level by reflecting on their knowledge, skills and experience with informatics. In general, the survey helped to raise awareness about how often nurses encounter information technology. Students were encouraged to recognize opportunities to build upon informatics and information literacy skills as part of their remaining clinical education. Note: I asked clinical faculty and staff nurses from their units to review the survey and received feedback that survey items could be clarified by adding specific examples of various technologies mentioned – shown here, but not included on my original survey. It will be important to adapt items to individual clinical settings, using relevant examples.

Published Back to Strategy Search Strategy Submission Patient Safety and Quality Improvement Educational Strategy for Pre-Licensure Students Author: Kathleen Z. Wisser PhD, RN, CNE, CPHQ Title: Dean of Nursing Coauthors: Louise Fura, DNP Institution: Notre Dame of Maryland University Email: kwisser@ndm.edu Competency Categories: Quality Improvement, Safety Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Classroom Strategy Type: Case Studies Learning Objectives: •Apply quality improvement (QI) tools for process and system improvement. •Articulate awareness of strategies to mitigate harm through the systems approach. Strategy Overview: The educational strategy, a one four-hour learning activity, engages pre-licensure nursing students in the application of a QI tool and systems thinking approaches to patient safety. The non-graded patient safety and QI educational strategy encompasses a two-pronged approach. First Prong The first prong consists of an introduction to patient harm using a video (The Josie King Story, 2001). In small groups, students brainstorm patient safety risks to Josie’s safety by answering the following question. In what ways could or should the nurse have recognized risks to Josie’s safety? The first prong culminates with a “Patient Safety and QI. Educational Strategy” slide presentation, which includes two theory bursts. This slide presentation was adapted from Phase III of the QSEN National Initiative, Patient Safety and Quality Improvement Learning Module (2009). Second Prong The second prong introduces students to systems thinking and root cause analysis by using a fishbone diagram. This QI tool visually displays underlying causes for a specific problem or effect. The second prong encompasses a series of seven steps. In the first step, small groups of six to eight students, review a case study to examine the impact of a medication error from a systems perspective. Next, the faculty facilitator describes the purpose of a fishbone diagram and how to complete the diagram. There are a variety of videos available on the internet demonstrating how to complete a fishbone diagram. The faculty facilitator assigns each group one branch of a fishbone diagram—staff, work environment, admission process, and computer system. In the third step, ask each group to identify underlying causes for the medication error that resulted in deterioration of the patient’s medical condition as described in the case study. To ensure students stay on track in completing their assigned individual branch, the faculty facilitator guides individual groups to continually ask the question “why?” with the goal of thoroughly and accurately identify all underlying causal factors. In the fourth step, each student group generates one - two system improvement recommendations and any immediate corrective actions that address causal factors within the assigned individual branch. The fifth step occurs upon completion of the fishbone diagram. One student group exchanges a fishbone diagram with another student group that completed a different branch. The ‘new’ group evaluates the completeness of another group’s assigned branch by answering five questions as described on the student learning assessment rubric, “Patient Safety and Quality Improvement Educational Strategy for Pre-Licensure Students Rubric to Evaluate Student Learning.” The two groups are given an opportunity to ask each other questions and offer feedback. Questions on the rubric guide this conversation. The sixth step involves a report-out where all student groups present their assigned branches. During the report-out phase, a student recorder inserts underlying causal factors on a blank fishbone template visible to all participants. The purpose of this step illustrates the root cause analysis in its entirety. During the report-out step, all students examine recommendations and corrective actions identified by each student group and articulate strategies to mitigate harm from a systems approach. The faculty facilitator guides students in identifying the most appropriate and achievable recommendations. Finally as the last step, student groups are given the opportunity to re-convene. Groups revise their assigned branch using feedback from faculty and students. The first and second fishbone diagrams are submitted to the faculty facilitator. Submitted Materials: HO1.WISSER-K_FURA-L_Patient-Safety-and-QI-Educ-Strategy_Theory-Bursts-ppt_QSEN-Submission_2-26-16.ppt - https://drive.google.com/open?id=1Xq37aJTXANrQnaCuOuiUDr-Dh3EcqGvP&usp=drive_copy HO2WISSER-K_FURA-L_Evaluation-Tool-for-Pt-Safety-and-QI-Educational-Strategy_Submitted-to-QSEN_2-26-16.pdf - https://drive.google.com/open?id=1T5gtoVf9Eul_DPGomJvnYZDmO6RoBOC1&usp=drive_copy HO3.WISSER-K_FURA-L_RUBRIC-TO-EVALUATE-STUDENT-LEARNING_Pt-Safety-and-QI-Educational-Strategy_Submitted-2-26-16.pdf - https://drive.google.com/open?id=1TLs5zZF2wiwo_Ind2cFXhOWKk487wMsy&usp=drive_copy HO4-Event-Description-Case-Study-for-Fishbone-Diagram_Submission-to-QSEN.docx - https://drive.google.com/open?id=1JVrOuPW7-F_STiDSK3N58ffM-TUpHrHx&usp=drive_copy HO5.FISHBONE_Case-Study_Submitted-to-QSEN-1-1.docx - https://drive.google.com/open?id=1JTA6W4CDWjqL_fr_bbeW_zGW_gClR58e&usp=drive_copy Additional Materials: Additional Materials Evaluation Description: The faculty facilitator assesses student learning and if students satisfactorily met the two learning objectives by comparing student groups’ first attempt and the revised second attempt. The faculty facilitator offers written feedback to each student group about the thoroughness of their assigned branch and quality of recommendations for systems improvement using the same set of five questions on the rubric, “Patient Safety and Quality Improvement Educational Strategy for Pre-Licensure Students Rubric to Evaluate Student Learning.” To further evaluate student learning, at the conclusion of the educational strategy, students answer and submit answers to three questions: 1.Identify one nursing action that may prevent a medication error. 2.Identify the primary purpose in completing a fishbone diagram. 3.Offer one way to improve this learning experience. Indirect measurement of student learning occurs throughout the educational strategy based on student anecdotal comments. This educational strategy emphasizes integration of QI tools, brainstorming and fishbone diagram, and systems thinking principles in pre-licensure curriculum. Activities in this strategy have the potential to improve future practitioners’ application of systems thinking in the clinical environment. Additionally, the strategy may broaden thinking about errors with a change in focus from an individual to a systems perspective.

Published Back to Strategy Search Strategy Submission Clinical Experience Discussion through the Lens of Evidence Based Practice (EBP) and Clinical Practice Guidelines (CPG’s) Author: Diane Rudolphi RN, MS Title: Senior Medical Surgical Clinical Faculty Coauthors: Institution: University of Delaware Email: drudolph@udel.edu Competency Categories: Evidence-Based Practice Learner Level(s): Pre-Licensure BSN Learner Setting(s): Clinical Setting Strategy Type: Online or Web-based Modules Learning Objectives: The students will: 1) Describe a clinical experience that provides an example of an event during which evidence-based practice and/or clinical practice guidelines were used, misused, or not used. 2) Provide evidence from research or literature related to best practices to support your position, judgment, or assessment of the clinical experience. Strategy Overview: Students complete this assignment using the discussion board found on their course site. This online format provides an excellent platform for students to interact, share and discuss clinical experiences. This assignment requires students to complete their initial discussion (part #1) using critical thinking and research to support their submission. They must then engage and reflect on their peer’s experiences in order to complete their response (part #2) of the assignment. In all submissions, students are expected to utilize research, literature, clinical practice guidelines and institution policies to support their position. During the senior preceptorship practicum, it can be challenging to schedule clinical group meetings. Students often are placed in different clinical specialty areas. This assignment using an on-line format has been successfully used across all clinical specialty areas. Submitted Materials: Assignment-Discussion-Rubric-2.docx - https://drive.google.com/open?id=1ttOmqmjmKW8EPr-nDdhOqfveczMJ5vmK&usp=drive_copy Clinical-Experience-Discussion-EBP.docx - https://drive.google.com/open?id=1vGCrgq3WKw1E0UCPmKO8I0ZtTItBbR58&usp=drive_copy Additional Materials: Attached Discussion Board Assignment Attached Grading Rubric Evaluation Description: The discussion Rubric provides students with clear guidelines for the grading process. The additional comments section is provided for faculty to individualize feedback for each student. Faculty have antidotally reported that the on-line student assignment has been more meaningful/thoughtful while supporting a strong EBP approach as compared to traditional student group discussions. Using the instructions as noted in this program, 13 Students submitted videotaped discussions and then were surveyed following the assignment. The data clearly indicated a preference for a videotaped assignment. Student comments submitted as part of the survey included, “I spent more time watching the videos of other students than I did reading other students’ written journal entries because I liked being able to hear what my peers had to say and it made it more engaging for me to listen to what they had to say.” Another noted, “I find it difficult to read through discussion posts as they are a bit long winded. I really enjoyed the video discussion, especially when it felt more of a conversation versus reading off of a script.”

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 The 60 Second Situational Assessment Author: Deborah Struth MSN, RN Title: Associate Director Coauthors: Wendeline Grbach, MSN, RN, CCRN; Lizabeth Vincent, MSN, RN; Joyce Heil, MSN, RN and Cari Simpson, MSN, RN Institution: Univeristy of Pittsburgh Medical Center Shadyside School of Nursing Email: struthdl@upmc.edu Competency Categories: Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure ADN/Diploma Learner Setting(s): Clinical Setting, Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: Teamwork and Collaboration: K = Describe strategies for identifying and managing overlaps in team member roles and accountabilities. S = Solicit input from other team members to improve individual, as well as team performance. S = Function completely within own scope of practice as member of the health care team. A = Value teamwork and the relationships upon which it is based. Safety: K = Delineate general categories of errors and hazards in care. S = Demonstrate effective use of strategies to reduce risk of harm to self or others. A = Appreciate the cognitive and physical limits of human performance. Strategy Overview: First level students are introduced to crew resource management (CRM) principles in all four level one nursing courses. One of these principles is situation awareness, which is taught in Introduction to Nursing Practice Strategies (N102) via the 60 Second Situational Assessment. The purpose and directions to students are outlined on the attached tool. The assessment is taught in the laboratory practice section of the course and practices during clinical and during high fidelity human patient scenarios (HFHPS) which were developed around the concept of “noticing”. The clinical faculty assigns each student one patient and gives the student up to 60 seconds to complete the Situation Assessment, at the same time the faculty completes the assessment on the patient. Findings between student and faculty are compared. After each individual assessment is completed, the instructor brings together all students, and each presents their situational assessments in SBAR format. The faculty facilitates a briefing using their assessment data to determine priorities for the student nurse “patient care team”. Submitted Materials: 96.60_Second_situational_Assessment_Revision_4.doc - https://drive.google.com/open?id=1YFTvxXzLZd9eH0F9LB_lEiFdFbDR1zmY&usp=drive_copy Additional Materials: Evaluation Description: Two cohorts of students (198 total) were divided into a study and a control group. The Wednesday clinical groups were not taught the situation assessment, but were given the CRM content and the Friday clinical groups were taught and practiced the 60 Second Situational Assessment over 12 weeks. In the final week (16) of the course, all students were taken to the simulation lab to participate in problem oriented HFHPS which were designed around patient/environmental observation or noticing. Students in the study groups initiated key assessments or interventions seconds to minutes faster that the control group. When N102 HPHFS data was compared to third level student nurse performance around time to assessment and intervention in the simulation lab, the third level students – who had neither CRM nor situation awareness education – did not engage or “notice” as quickly as either the control or study group. Faculty and student satisfaction with this assessment tool is high and the tool has been adapted to the second level student and a prototype tool around Situational Assessment for Maternal Newborn Nursing is in development. Please note this evaluation was developed as a performance improvement rapid cycle test of change using PI approaches.

Published Back to Strategy Search Strategy Submission Perioperative Unfolding Case Study Author: Gerry Altmiller EdD, APRN, ACNS-BC, ANEF, FAAN Title: Professor of Nursing Coauthors: Institution: The College of New Jersey Email: altmillg@tcnj.edu Competency Categories: Informatics, Patient-Centered Care, Quality Improvement, Safety, Teamwork and Collaboration Learner Level(s): Continuing Education, New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, Staff Development Learner Setting(s): Classroom, Skills or Simulation Laboratories Strategy Type: Case Studies Learning Objectives: Examine how the safety, quality, and cost-effectiveness of health care can be improved through the active involvement of patients and families. (K) Describe strategies to empower patients or families in all aspects of the health care process. (K) Examine human factors and other basic safety design principles as well as commonly used unsafe practices (such as work-arounds and dangerous abbreviations). (K) Discuss potential and actual impact of national patient safety resources, initiatives, and regulations. (S) Demonstrate effective use of strategies to reduce risk of harm to self or others. (S) Use appropriate strategies to reduce reliance on memory (such as forcing functions, checklists). (S) Use national patient safety resources for own professional development and to focus attention on safety in care settings. (A) Value active partnership with patients or designated surrogates in planning, implementation, and evaluation of care. (A) Value the contributions of standardization/reliability to safety. (A) Value own role in preventing errors. (A) Value relationship between national safety campaigns and implementation in local practices and practice settings. Strategy Overview: The Perioperative Unfolding Case Study can be used for classroom or lab experiences. It follows a patient through the preoperative, intraoperative, and postoperative setting, allowing learners to gather information and react to changing situations. Theory bursts throughout the unfolding case, provide perioperative content that learners need to support clinical reasoning. A worksheet is provided to learners so they may record significant information to enable safe and effective decision making. Quality and safety competencies are emphasized throughout the learning experience. To implement, learners should be given preparatory work to read about OR safety prior to class. Learners should also be assigned the chapter on perioperative nursing care in their course textbook to read as preparation. The unfolding case study powerpoint presentation should not be made available to students prior to class as the answers are always on the next slide. Students should be encouraged to record information on the accompanying student worksheet and brainstorm to answer the questions as the case study unfolds. Three volunteers should be recruited prior to beginning. These volunteers will deliver reports and call physicians with updates using SBAR communication as the case study progresses. Theory bursts are woven throughout the case study. Following the class session, the case study file will be posted for the class to retrieve so that theory content is available to them. Submitted Materials: Perioperative-unfolding-case-4.pptx - https://drive.google.com/open?id=11dYMfwXPejfb9jSTMPKaZ0NMyY3L_j-F&usp=drive_copy 267.2-Student-Worksheet-Perioperative-Unfolding-Case.docx - https://drive.google.com/open?id=1qzAel75FBGLysXeyezkK-wbN6ym5qqps&usp=drive_copy Additional Materials: Students can use the student worksheet to record data as the case study unfolds. Evaluation Description: Evaluation strategies related to student learning included separate measurement of a cohort of questions on the final exam that focus on the decision-making skills of the nurse caring for the perioperative patient. Questions included content related to implementation of national patient safety standards for the surgical patient, appropriate and effective strategies to use to reduce risk of harm, and recognition of the role of the patient as well as the role of the nurse in preventing errors. Student satisfaction with this teaching strategy was evaluated following the presentation of this unfolding case study using a questionnaire with the five following statements followed by a 5 point Likert scale: (1) This presentation provided the information needed to care for the peri-operative patient. (2) I found myself actively thinking about the patient’s care during this presentation. (3) I recognize the value of my role in preventing errors and promoting safety for the surgical patient. (4) I would like to have more course content presented as unfolding case studies. (5) I found my mind wandering during this presentation. In addition, an area for comments was be provided. Evaluations demonstrated students gained knowledge and valued the learning experience.

Published Back to Strategy Search Strategy Submission Focusing on QSEN competencies during high-fidelity simulation The role of the observers Author: Connie L. Miller Ph.D Title: Assistant Professor Coauthors: Dr. Louise LaFramboise Institution: University of Nebraska Medical Center Email: clmiller@unmc.edu Competency Categories: Patient-Centered Care, Quality Improvement, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure BSN Learner Setting(s): Clinical Setting Strategy Type: General Strategy Learning Objectives: Critique simulation for examples of QSEN KSAs Communicate results of critique during debriefing displaying professional collegiality Strategize interventions that would better meet QSEN KSAs Discuss impact of QSEN KSAs on patient outcome Strategy Overview: Students enrolled in a complex adult health and illness course participate in a minimum of two high-fidelity simulations during their clinical rotations. Each clinical group of 8-9 students rotates through the simulation with 4 actively participating in the simulation while the remaining 4-5 students function as observers. The scenarios are based on: (1) patient on a cardiac floor who experiences chest pain with signs & symptoms of a myocardial infarction and (2) patient who experiences a spontaneous pneumothorax requiring chest tube insertion. Half of the observers are assigned to critique the performance of QSEN competencies. Competencies to be identified are patient-centered care, teamwork & collaboration, safety, and informatics. A critique form was developed based on the format of the Mayo High Performance Teamwork (MHPT) Scale. The form is attached and could be modified to include any or all of the QSEN competencies depending on the scenario. Submitted Materials: Additional Materials: Evaluation Description: No formal evaluation. This is structured as a formative educational experience.