Published Back to Strategy Search Strategy Submission A Universal Template for Designing QSEN Learning Activities: Setting Expectations Using KSAs Author: Ruth Zimmerman RN, MSN Title: Project Manager, Education Coauthors: Yolanda Ramirez, RN, MPH Institution: Kaiser Permanente Southern California Email: Ruth.K.Zimmerman@kp.org Competency Categories: Evidence-Based Practice, Informatics, Patient-Centered Care, Quality Improvement, Safety, Teamwork and Collaboration Learner Level(s): Continuing Education, Graduate Students, New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN, Staff Development Learner Setting(s): Clinical Setting, Skills or Simulation Laboratories Strategy Type: Online or Web-based Modules Learning Objectives: This “universal template” is strategically designed to be modifiable for all QSEN categories, pre-determined KSAs, and educational levels. Utilize a “universal template” to structure learning activities within any QSEN category, focusing on pre-determined KSAs. Simplify the process of creating QSEN-related learning activities that integrate classroom content into the clinical setting. Appreciate the value of a modifiable template as a means of assigning QSEN learning activities across the curriculum. Strategy Overview: It is a goal of nursing faculty for students to integrate didactic content into the clinical setting. Taken one step farther, in her recent publication Educating Nurses: a Radical Transformation, Dr. Patricia Benner recommends moving toward “situated learning”, or learning that takes place in the same context in which it is applied. For example, a Clinical Activity Template that was developed around the QSEN competency of EBP required second semester pre-licensure students to research the CDC recommendations regarding prevention of catheter-associated UTIs, assess whether the facility was following the bundle protocol on their assigned patients, implement the bundled interventions, and debrief afterward. The faculty reported that this experience for the students has been far more enriching than simply explaining the importance of each intervention (or task) individually, as was the case prior to implementing the EBP activity. During the QSEN curriculum integration process, there is even more demand to reach the goal of creating an environment or activities in which situated learning can take place. During this time, faculty is creating new learning activities, finding pre-existing activities online, and sharing ideas with each other. The Universal Template tool was created to aid in providing consistency among faculty throughout the QSEN learning activity development process and subsequent student activity assignment process. It has gone through multiple iterations since its initial design and implementation in Spring 2010. It has also been adapted and modified for use in alternative settings, such as a Professional Partnership (preceptor) Program and New Graduate RN Program. The Universal Template tool itself provides placeholders for vital information differentiating each course, category, and activity. Clinical or course objectives may be indicated when applicable. More importantly, it provides a uniform structure, stating the faculty’s expectations in a “universal language” – the QSEN KSAs. This template also helps faculty to write more focused activities. For example, a clinical activity may help in the selection of the most appropriate KSAs, while selection of the KSAs may spark creative clinical activity ideas. Alternatively, faculty may choose to leave the “activity” box blank and require the student to show competency in that area by offering the ways in which they met the KSA criteria. Structurally, the tool is formatted into a table, where “Knowledge” is separated from “Skills” and “Attitude”. This was an intentional and symbolic decision. Situated learning requires that students be prepared with the knowledge necessary to care for the given patient population before entering the clinical setting or during pre-conference; hence the label “pre-planning”. The “Skills” section then indicates the expectations/assignment during the students’ clinical experience. The “Attitude” section is assessed after the clinical experience is complete (either verbally during post-conference and/or written in self reflection via journals). I recommend a structured self-reflective model to organize the students’ thinking process. In our program we utilized Dr. Christine Tanner’s Model for Clinical Judgment (2006) to assess clinical judgment and competency in the affective domain. This Universal Template design and KSA format allows faculty to assess student competency in the stated KSAs, as well as providing students with the opportunity to assess themselves. The students can use this worksheet in any clinical setting to guide their experience. Instructors can likewise define this worksheet as a performance measurement or evaluation criteria. **Note: Please also refer to the sample Clinical Activity Template (CAT) for an Evidence-based Practice learning activity on the Catheter-Associated UTI bundle, which utilizes the Universal Template as the foundation. This activity was created for second semester, pre-licensure, ADN students. It has also been submitted as a “Teaching Strategy” for publication on QSEN.org. References: Benner, P., Sutphen, M., Leonard, V., & Day, L. (2009). Educating nurses: A call for radical transformation. San Francisco: Jossey-Bass. Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Retrieved from the National Academies Press website: http://www.nap.edu/catalog.php?record_id=12956 Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45, 204-211. Submitted Materials: 120.Universal-Category-Fill-in-Blank-Rv-8.16.11.doc - https://drive.google.com/open?id=1n2JkfiPECmbp6oAtiFaSwpbE23mfGPmG&usp=drive_copy Additional Materials: Numerous "Clinical Activity Templates" (CATs) have been designed within all six QSEN categories utilizing this Universal Template structure. A sample CAT for evidence-based practice has also been submitted to the QSEN website for publication in the teaching strategy database. For questions, comments, feedback, assistance in completing the template, or to request additional resources, please contact Ruth Zimmerman (Project Manager) at: Ruth.K.Zimmerman@kp.org. Evaluation Description This Universal Template has not yet been formally evaluated. We welcome further implementation and evaluation of this tool and would love to receive feedback on outcomes and satisfaction. Evaluation Description: See attached.

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 I-SBAR reporting for the nursing student Author: Melani Stephens Stallkamp MSN, RN Title: Assistant Professor Coauthors: Institution: Good Samaritan College of Nursing Email: melani.stallkamp@email.gscollege.edu Competency Categories: Patient-Centered Care, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Classroom, Clinical Setting Strategy Type: Online or Web-based Modules Learning Objectives: Apply communication practices that minimize risks associated with handoffs among providers and across transitions in care. Communicate observations or concerns related to hazards and errors to patients, families and the health care team. Discuss potential and actual impact of national patient safety resources, initiatives and regulations. Identify patient values, preferences and expressed needs to other members of the health care team through I-SBAR reporting. Describe patient centered care as it relates to teamwork, collaboration and communication. Strategy Overview: Students are introduced to the concept of communication and I-SBAR reporting/safe patient handoff through lecture. To reinforce taught material through application, students are provided with the I-SBAR reporting activity. Students can complete this I-SBAR activity in lecture as a learning strategy, in a post conference to emphasize the content to the clinical environment, or as an independent study. This activity can be completed individually, as a group, or both. Students are given a blank I-SBAR form (attachment 1). Students are required to review nurse statements from a “Shift report handoff” (attachment 2) and apply these statements to the appropriate section on the I-SBAR form. Students are asked to address critical thinking questions that support patient-centered care, safety, teamwork and collaboration (attachment 3). Faculty is provided with a grading rubric and an answer key (attachment 4). The time allotted for this activity is 30 minutes. A debriefing can occur to discuss the activity and critical thinking questions as a group. This learning strategy relates to quality and safety in education as I-SBAR reporting supports the National Patient Safety Goal #2, “to improve effectiveness of communication among caregivers.” In addition, with the use of this I-SBAR activity, it allows students and educators the opportunity to assess the value of I-SBAR reporting which will enhance the quality of patient-centered care. Submitted Materials: Additional Materials: Additional Materials Evaluation Description: Evaluation of this learning activity can be completed through the grading rubric. Collectively, the educator is able to identify the learning needs of students as it relates to communication/I-SBAR reporting and students can recognize their own learning needs regarding safe patient hand-offs.

Published Back to Strategy Search Strategy Submission Create A Client Author: Tamara Greabell MSN-Ed., MA, RN Title: Nurse Educator Coauthors: Institution: Arizona College Email: tgreabell@arizonacollege.edu Competency Categories: Patient-Centered Care, Safety Learner Level(s): Pre-Licensure BSN Learner Setting(s): Classroom, Clinical Setting, Skills or Simulation Laboratories Strategy Type: Case Studies Learning Objectives: Patient-Centered Care: Learners will elicit patient values, preferences, and expressed needs as part of the clinical interview, implementation of the care plan, and evaluation of care a. Learners will practice communication and assessment skills with a client exhibiting a specific disorder. b. Learners will demonstrate knowledge of priority assessment data. c. Learners will create accurate clinical scenarios of specific system disorders. Safety: Reduce client risk through open communication and utilizing standardized practices. a. Learners will compose pertinent assessment questions necessary to developing a plan of care. b. Learners will demonstrate proficiency of nursing skills necessary to provide care to a client experiencing a system disorder. c. Learners will employ effective communication necessary to attain critical assessment data. Strategy Overview: This strategy fosters learners’ development of assessment and communication skills by creating case studies about clients with specific disorders. This strategy encourages learners to portray nurses’ and clients’ roles and engage in simultaneous role-playing and clinical reasoning. The case studies include learners creating a client’s medical chart or completing a fill-in-the-blank activity about a client with a particular condition. Learners create medical charts or create nurse-patient dialogue by filling in the blanks. Learners will create scenarios that are consistent with a system disorder, including nurse assessment questions and client responses. Learners are encouraged only to choose priority items that are relevant to the condition. Both strategies can be used in the classroom, whether in a face-to-face learning environment or a virtual breakout room. Learners are grouped in pairs and work together, portraying the roles of nurse and patient. Group work is especially critical during this virtual learning time as practical experience is limited. Learners know ahead of time that they are working on a specific disorder. The strategy works best after a lecture by applying gained knowledge to a real-life scenario. The teaching strategy is also useful as a comprehensive review for examinations. Both a chart and fill-in-the-blank templates are attached. The templates are easy to modify to specific disorders, depending on content topics. The attachments use asthma as an example. One template is designed for students to create a client chart. Following the lecture on asthma, learners can work in pairs and create a chart for a client diagnosed with asthma. Learners will apply their knowledge of asthma to create expected objective and subjective assessment findings. The fill-in-the-blank template asks learners to consider priority assessment techniques and medications that nurses will encounter in real-life practice. Learners can then take the completed templates and use the scripts in skills labs to role-play their created dialogues or implement the skills necessary to care for an asthmatic client. Submitted Materials: 277.1Create-a-Client-TemplatesFinal.docx - https://drive.google.com/open?id=1rpptISvDHTRs43au_BRGrfpNDsBq7itn&usp=drive_copy Additional Materials: Evaluation Description: Faculty can implement this strategy during a lecture in a formative fashion by having learners share the results of their creations during class time, whether in person or virtually. Instructors evaluate whether the scripts relate to specific disorders and whether learners have developed pertinent assessment questions and answers. Learners can also participate in peer evaluation by using this strategy as a study method. Learners complete the scripts and then assess whether the information aligns with the specific disorders. Learners can evaluate each other during skills labs when they implement their scripts by evaluating skills proficiency and whether the chosen skills relate to the diagnosis. The templates are fluid in that learners have the freedom to create the client’s illness severity. The settings can change from outpatient to inpatient, depending on learning needs or course content.

Published Back to Strategy Search Strategy Submission QSEN TEACHING STRATEGY: USING AN AQUARIUM AND PUMP TO DEMONSTRATE CARDIAC FUNCTION Author: Katie Morales RN, MSN, CNE Title: Assistant Professor of Nursing Coauthors: Institution: Berry College Email: kmorales@berry.edu Competency Categories: Evidence-Based Practice Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Classroom Strategy Type: General Strategy Learning Objectives: Objectives: Knowledge 1. Demonstrate knowledge of basic scientific methods and processes. 2. Compare the various methods of hemodynamic monitoring (e.g., central venous pressure, pulmonary artery pressure, and arterial pressure monitoring). 3.Compare and contrast the continuum of normotension, prehypertension, hypertension, and hypertensive crisis. 4.Describe the action, side effects, and adverse reactions of antihyperlipidemics and peripheral vasodilators. 5.Describe the nursing care of a client who has undergone cardiac surgery. 6.Summarize the pathophysiology, clinical manifestations, and treatment of myocardial infarction. 7.Compare and contrast diastolic and systolic heart failure (HF), including pathophysiology and clinical manifestations. Objectives: Skills Theory application included simulated lab experience and clinical practice along with the following objectives: 8.Describe/Demonstrate the assessment and management of clients with HF. 9.Develop a teaching plan for clients with HF. Base individualized care plan on client values, clinical expertise, and evidence 10.Describe/Demonstrate the assessment and management of clients with pulmonary edema. 11.Describe/Demonstrate the management of clients with cardiogenic shock. 12. Locate evidence reports related to clinical practice topics and guidelines. 13. Question rationale for routine approaches to care that result in less-than-desired outcomes Objectives: Attitude 14. Value the concept of evidence-based practice as integral to determining best clinical practice. 15. Value the need for continuous improvement in clinical practice based on new knowledge. Strategy Overview: Students were asked to troubleshoot cardiac function problems demonstrated with an aquarium and pump. The following principles were demonstrated: First, the aquarium pump is electrical. Therefore, the pump must be plugged in to receive an electrical charge. Positive cations (such as magnesium, potassium, calcium, and sodium) provide the electrical charge to the heart, which is represented by the plugging the pump into the electrical outlet. To help students retain normal laboratory values, students were taught the 2X4 Rule: representing ideal serum magnesium and potassium levels for cardiac electrical function being a serum magnesium 2 mg/dL and serum potassium 4 mEq/L. The extension cord was labeled with “K” and “MG” for demonstration. Second, the pump requires sufficient volume (preload) to produce cardiac output. This is demonstrated by adding water from a container marked preload. The pump cannot function effectively or efficiently with a volume deficit or fluid overload. This is demonstrated by either submerging the pump or lifting the pump out of the water. Third, the pump must be able to accommodate resistance (afterload) that is demonstrated by using an obstacle to obstruct outflow. Follow-up discussion addressed the effects of vasodilator and vasoconstrictor medications. Finally, the (plastic) fish do not die from lack of water, but lack of oxygen (due to low perfusion). Follow-up discussion addressed cardiac perfusion, including differences in ventilation and perfusion, which were identified as difficult concepts for the students. Submitted Materials: QSEN-Aquarium-Abstract.doc - https://drive.google.com/open?id=19OmAZD5SF4fRb1kUBXF9RRY929xFGkFN&usp=drive_copy Additional Materials: No funding was received for this activity and no animals were used with this demonstration. The demonstration required no special adaptation of the aquarium or pump, other than a means to obstruct the pump. The equipment used included an electrical cord and pump to represent the electrical aspect of the heart, a basic aquarium, a bottle of water labeled preload, and a plastic turtle labeled afterload to obstruct the pump. For demonstration, the extension cord was also labeled with “K” and “MG”. This demonstration has since been presented at two NCLEX review programs, a professional educator conference, and in a peer-reviewed journal, receiving overwhelmingly positive feedback as well. Strengthening QSEN Competencies in Nursing Education This activity specifically strengthened the QSEN (2014) competency of safety and EBP by developing the students’ knowledge of the pathophysiology, clinical manifestations, and treatment related to altered hemodynamic function, the effect of hyperlipidemia and peripheral resistance, vasodilators. Classroom activities included comparing and contrasting assessment and management of clients with various types of shock. The strategy strengthened the QSEN (2014) competency of EBP as faculty shared clinical practice topics and guidelines. The simulated lab experience and clinical practice strengthened the QSEN (2014) competency of interdisciplinary teamwork & collaboration as students applied core measures to assess and manage clients with HF. The strategy strengthened the QSEN (2014) competency of quality improvement as simulation provided a safe environment to question care that resulted in less-than-desired outcomes. Furthermore, the strategy strengthened the QSEN (2014) competency of patient-centered care and informatics as students used technology to complete an individualized concept map based on client values. In conclusion, this activity allowed students to grasp the difficult concepts of cardiac function and apply them in a classroom activity. Students’ performances on course examinations throughout the semester demonstrated their retention of the material. The results demonstrate this is an effective active learning strategy to introduce students to advance cardiac concepts. Additional studies may help provide evidence base strategies for active learning and methods to evaluate active learning. Discussion Questions Discussion questions focused on the QSEN (2014) competencies of safety and EBP related to preload, such as: What conditions could affect blood volume? How would the client with those conditions look? What assessment findings would the nurse expect? What treatment would the nurse anticipate? How would the nurse evaluate the treatment? Discussion questions related to afterload, such as: What conditions could affect vascular resistance? How would the client with those conditions look? What assessment findings would the nurse expect? What treatment would the nurse anticipate? How would the nurse evaluate the treatment? References National League for Nursing. (2009). Building a science of nursing education: Foundation for evidence-based teaching- learning. New York: National League for Nursing National League for Nursing. (2007). Nurse Educator competencies: Creating an evidence- based practice for nurse educator s. New York: National League for Nursing Quality and Safety Education for Nurses. (2014). QSEN Competencies. Retrieved from http://www.qsen.org/competencies/ Evaluation Description: Evaluation of the teaching strategy was accomplished via pre- and post-test of the class using audience response system and the students’ self-report of content comprehension. A. The pre-and post-test items were taken from pre-lecture item bank provided by the publisher of the required course text book. As such, pre-and post-test items were proprietary property of the publisher. Additionally, the audience response system questions have since been replaced with adaptive learning technology to assess class preparation, exam preparation, and remediation after exams. Suggested pre/post questions for future use include: 1._______, such as potassium, magnesium, calcium, and sodium provide the electrical charge to the heart. (cations) 2.For optimal electrical cardiac function, the desired serum magnesium is __mg/dL and the desired serum potassium is __mEq/L (2,4) 3.Preload refers to ______. (volume) 4.Afterload refers to __________. (resistance) 5.Cardiac function is required for tissue _________. (perfusion) Because this demonstration was not designed as a research project, Internal Review Board approval was not obtained and no additional data collected. Overall, students had higher post-test scores after this demonstration, with students consistently answering preload and after load questions correctly throughout the semester after the demonstration. Students’ Self-Report of Content Comprehension Students in subsequent cohorts were divided into “think, pair, share” groups, creating posters on the discussion questions to present to the class. Student feedback was overwhelming positive. One student said, “The use of the aquarium brought the ‘mystery of cardiac function’ to actually understanding the how's and why's of heart issues. I pictured the ‘stuck turtle’ during the test and it helped me choose the right answer”. After using an aquarium and pump to demonstrate advance cardiac function, students reported an understanding of concepts and terminology. Overall, higher post-test scores were obtained after this demonstration. A former student reported drawing on the concepts while providing client education related to preload/afterload. To promote self-assessment and incorporate test-taking strategies, the educator ends each unit by asking the students to identify the most important concept they learned in class. Together the students and educator write a National Council Licensure Examination (NCLEX) style question with plausible distractors. Students in the original cohort wrote the following exam question: To increase cardiac output, the nurse knows the goal of therapy is to: (Select ALL that apply) A.Increase preload B.Decrease preload C.Increase afterload D.Decrease afterload The question has been subsequently modified as follows: Which of the following would increase cardiac output? (Select ALL that apply) A.Administration of IV fluids as ordered B.Administration of a diuretic as ordered C.Administration of a vasoconstrictor as ordered D.Administration of a vasodilator as ordered E.Administration of oxygen to keep oxygen saturation greater than 94% as ordered Both questions demonstrated reliable item analysis on course examinations. These activities satisfy the National League for Nursing’s (NLN, 2007) Nurse Educator Competency of Facilitate Learning and the following NLN (2009) Ten Principles of Learning: Students made and maintained connections mentally and experientially; learning was an active search for meaning by the student, constructing knowledge rather than passively receiving it; learning can be informal and incidental.

Published Back to Strategy Search Strategy Submission Practicing Effective Provider Phone Contacts Author: Jayme Nelson Title: Associate Professor Coauthors: Institution: Luther College Email: nelsjaym@luther.edu Competency Categories: Teamwork and Collaboration Learner Level(s): Pre-Licensure BSN Learner Setting(s): Skills or Simulation Laboratories Strategy Type: Case Studies Learning Objectives: Knowledge Discuss principles of effective communication Examine nursing roles in assuring coordination, integration, and continuity of care Describe impact of own communication style on others Skills Communicate patient values, preferences and expressed needs to other members of health care team Communicate with team members, adapting own style of communicating to needs of the team and situation Follow communication practices that minimize risks associated with handoffs among providers and across transitions in care Assert own position/perspective in discussions about patient care Choose communication styles that diminish the risks associated with authority gradients among team members Use appropriate strategies to reduce reliance on memory (such as forcing functions, checklists) Attitudes Value continuous improvement of own communication and conflict resolution skills Value teamwork and the relationships upon which it is based Value different styles of communication used by patients, families and health care providers Strategy Overview: Develop a realistic patient scenario that would mandate a health care provider contact (consider some of your past clinical experiences). Consider a typical situation that would warrant this phone call – a change in patient status, patient desires pain medication, has a fever, is constipated, desires “heartburn medication,” change in VS status, etc. Develop a realistic written narrative about your “patient.” Make sure that you think through information that you will need to provide for I-SBARR. For example, what is your “patient’s” admitting diagnosis? When were they admitted? What medications are they currently taking? Are there relevant lab results or x-ray results that you need to “create?" What assessment findings are you concerned about? Write all of this information down. You will submit it to your course professor after your “make a case” assignment. Schedule your “Make a Case” presentation with your course professor within the assigned 2-week time period. The “Make a Case” assignment will take about 30 minutes to complete the entire experience (including evaluation). Arrive at scheduled time to simulation exam room. Don’t forget your “Patient Information!" You will position yourself in the Simulation exam room facing the camera at a simulated nursing desk. You will receive the following supplies: scrap paper, a cell phone (if you do not have one), blank physician order forms, and a pen. You may wear professional clothes and a simulation lab coat for this experience. Call the health care provider (phone number and patient’s provider name posted on white board in simulation exam room). Convey your patient concern to the health care provider using the I-SBARR technique. Receive patient orders and correctly transcribe orders on physician order sheet. After you’ve completed the phone call, meet your course professor in the nursing conference room to review your videotaped “make a case” presentation and offer feedback. Consider professionalism, confidence, tone, non-verbal communication, pronunciation, and preparedness. Submitted Materials: Additional Materials: I-SBARR SBAR is communication tool originally developed by Dr. Michael Leonard at Kaiser Permanente of Colorado. This tool provides a template for doctors and nurses to effectively communicate during telephone calls and patient handoffs. Two nurses (Ruth Zaflan, a clinical nurse specialist and Lynn Jansky, a nurse manager) in Hartford, Connecticut noted that many times staff did not introduce themselves. They have advocated the addition of an “I” to the SBARR format. I-SBARR communication has the following components: I= Introduction • Include your name, your title and the unit that you are working on S= Situation • Patient’s name and Room Number • The problem (situation) that you are calling about B= Background • Patient’s Admission Diagnosis and Date of Admission • Patient’s Allergies • Patient’s Code Status A= Assessment • Brief Relevant Assessment of your patient (Make sure you’ve assessed your patient prior to initiating a phone call!). Consider including the following assessment data if relevant: cardiac, respiratory (O2 therapy & respiratory effort), neurological, musculoskeletal, skin, I & O, IV’s, Psychosocial, Blood glucose results (and any needed interventions), Abnormal labs, relevant radiology reports • Always have current set of VS, including pain and pulse ox R= Recommendation • What do you think would be helpful or needs to be done? Do you think your patient needs medications? A treatment of some sort? X-rays? EKG? Transfer to ICU? To be seen immediately by physician? • Ask about any changes in orders. R= Read Back • Repeat and read back any orders that have been given. • Clarify criteria for calling back, frequency of VS, glucose checks, etc. • “Thank you” for responding Evaluation Description: This project has been an ongoing project for the last several years. Students have highly evaluated it as an experience that helps structure effective communication with a health care provider about a patient care need. Students typically struggle with organization of all relevant background information, and often forget to have current medication record handy or current assessment data readily available. Initially the project was completed in tandem with an ongoing simulation. Student feedback was positive. Students at the senior level appreciated the opportunity to create their own “patient case” for the health care provider contact. Many students had relevant clinical experiences that warranted provider contact that provided context for this assignment.

Published Back to Strategy Search Strategy Submission Observing the 4Ms in Nursing Care of Older Adults Author: Lisa Foster MSN, APRN, CNP Title: Assistant Professor of Instruction Coauthors: Institution: The University of Akron Email: ljf11@uakron.edu Competency Categories: Evidence-Based Practice, Patient-Centered Care Learner Level(s): Pre-Licensure BSN Learner Setting(s): Clinical Setting Strategy Type: General Strategy Learning Objectives: Patient-Centered Care knowledge, skills, and attitudes (KSAs): Knowledge- Integrate understanding of multiple dimensions of patient-centered care Skills- Identify patient preferences and implement them in the plan of care Attitudes- Value seeing what matters most “though patients’ eyes” Evidence-Based Practice knowledge, skills, and attitudes (KSAs): Knowledge- Discuss the role of evidence in determining best clinical practice Skills- Participate in structuring the work environment to facilitate integration of new evidence into standards of practice Attitudes- Value the need for continuous improvement in clinical practice based on knowledge Safety knowledge, skills and attitudes (KSAs): Knowledge- Recognize potential and actual impact of national patient safety initiatives Skills- Apply national patient safety initiatives to focus attention on safety in acute care settings Attitudes- Value relationship between national safety initiatives and implementation in the clinical setting Strategy Overview: The purpose of this teaching strategy is to introduce undergraduate nursing students to the John A. Hartford Foundations (JAHF), Institute for Healthcare Improvement (IHI), American Hospital Association (AHA) and the Catholic Health Association of the United States (CHA), 4Ms (what matters, medication, mentation, and mobility) Framework for Age-Friendly Healthcare Systems in which older adults received evidence-based care that is patient-centered, in alignment with their goals and preferences, and is safe, causing them no harm. This strategy best complements a Nursing Care of Older Adults at the junior level in an acute care setting. This teaching strategy will be implemented after nursing students have a simulation in the learning resource center including a geriatric cardiac client who is end-stage CHF and experiences delirium during hospitalization. To prepare for clinical the night before, the students will read the article, Nurses Leading the Way to Age-Friendly Care Using the 4Ms Model. In pre-conference, students will be given a pre-evaluation to assess baseline knowledge about age-friendly care using the 4Ms framework and will view the PowerPoint presentation, Observing the 4Ms in Nursing Care of Older Adults. Students will then be instructed on how to use the Find the 4Ms at your Clinical Site. In post-conference, students will discuss their findings including health screenings. Submitted Materials: QSEN-282-Observing-the-4Ms-Final-1.pptx - https://drive.google.com/open?id=1o3befXU3nHTH9XXDs4hPRPIOVAR7dAfN&usp=drive_copy QSEN-282-CardioVascular-AssessmentFinal-1.docx - https://drive.google.com/open?id=12WIFyfi4ZhAadAaQYVDZF7jEuq-1veOT&usp=drive_copy QSEN-282.-Observing-4Ms-Pre-Post-QuizFinal-1.docx - https://drive.google.com/open?id=12euiWdVX3BG0fRRpUXW7p5IhQzyp1crI&usp=drive_copy QSEN-282-Observing-4Ms-Clinical-Form-1.docx - https://drive.google.com/open?id=12UeE9_cllf2m9TVfnhBBz2Df3ESxSwlU&usp=drive_copy Additional Materials: Evaluation Description: Evaluation of the strategy will be through a pre and post-evaluation. At the beginning of clinical in pre-conference, students will be asked to complete a five-item survey about the 4Ms Framework of Age-Friendly Health Systems and the research article they read to determine the student’s baseline knowledge. At the end of clinical, in post-conference, students will be asked the same five questions to measure changes in their knowledge.

Published Back to Strategy Search Strategy Submission Health Literacy: Incorporating QSEN (Quality and Safety Education in Nursing) Competencies into a Senior Capstone Project and Paper Author: Lori Rodriguez RN PhD Title: Associate Professor Coauthors: Institution: San Jose State University Email: lrodriguez@son.sjsu.edu Competency Categories: Evidence-Based Practice, Informatics, Patient-Centered Care, Quality Improvement, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure BSN, RN to BSN Learner Setting(s): Clinical Setting Strategy Type: Paper Assignments Learning Objectives: Integrate understanding of 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 Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values Elicit patient values preferences and expressed needs as part of the clinical interview, implentation of care plan and evaluation of care Communicate patient values, preferences and expressed needs to other members of the health care team Provide patient centered care with sensitivity and respect for the diversity of human experience Value seeing health care situations through the patients eyes This activity has the potential for evaluating many, many of the KSA's Strategy Overview: This is an integrative project that requires the student to connect and relate what they have learned throughout the nursing program. The product to be turned in is a paper that is scholarly, evidence based, and experiential. Two parts of the paper are turned in. The first part is scholarly and evidence based and can be turned in by the fourth week of the semester. The second part is experiential and should be turned in by the twelfth week of the semester. Directions Part 1 You will be doing a two part paper/project on Health Literacy integrating the QSEN competencies into your performance and then writing a paper reporting on that project. After reading a minimum of four original research articles, identify and discuss in your paper the best current evidence on health literacy. In the introduction to your paper, define health literacy, explain why health literacy is important in today’s healthcare environment, provide the rationale for ensuring that patients should become more health literate. Identify particular barriers to health literacy that you expect you will encounter in the particular population of patients that you are dealing with i.e. oncology patients, ICU patients, elder patients, children, etc. This is determined by your clinical assignment and the unit that you are on. When you write, use your own words as much as possible so that you demonstrate that you understand health literacy and how it relates to your patient population. You are encouraged to use cause-effect diagrams and flow charts to help make your discussion more clear. Directions Part 2 Among the patients who you are assigned to this semester, identify a patient with limited health literacy. Using the language of the QSEN (Knowledge, Skills & Attitudes) KSA’s, discuss your interventions to improve the patient’s (and perhaps family’s) health literacy . The goal is to show that you improved at least one aspect of this patient’s understanding of their disease management. Do not make it a litany of the entire patient teaching that you did for a patient. (Read Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., and Warren, J. (2007). Quality and safety education for nurses. Nursing Outlook, 55 (3), 122-131 in order to use the language of the QSEN KSA’s or review KSA's on www.qsen.org/ksas_prelicensure.php ) Using the terminology and language of health literacy and quality improvement explain how you ensured that the patient’s health literacy improved after your interventions. Minimally, you will have to do a “teach-back” and other creative methods are encouraged to show that you improved the outcomes for this patient by your interventions. Finally, you should conclude the paper with reflection on the project and if you feel that your interventions made a difference to your patient. Format: The paper must be typed in APA format, and grammatically correct with correct punctuation. Length of papers varies depending on the complexity and the clinical situation. Generally, the final papers average around 6-12 pages, with 3-6 pages for the first part and 3-6 for the second part. Use a minimum of 4 references. References are to be annotated, that is, include a short description of each reference (content and value) Submitted Materials: Additional Materials: Evaluation Description Scoring Rubric Content Evidence Patient Centered Quality improvement Safety Informatics Exemplary Demonstrates a superior understanding of health literacy applied to patient (and family) focusing on an appropriate & important learning goal Displays an analytic attitude in determining the patients barriers to health literacy and the best way to overcome them Determines a creative and accurate method of determining if learning has occurred Integrates best current evidence with clinical expertise and patient/family preferences and values Recognizes the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patients' preferences, values, and needs Demonstrates respect and sensitivity to the patient Uses objective factual information from the patient to determine if the patient's health literacy has improved Uses flowcharts, or cause and effect diagrams within the text of the paper to explain and clarify aspects Describes how the improvement of the patient's health literacy in the area chosen minimizes risk, harm, and prevents future hospital admissions Explains why information and technology skills are essential for safe patient care Acceptable Applies concepts of health literacy focusing on a learning goal Determines the patient's barriers to HL and ways to overcome them Uses a teach-back methodology Integrates current evidence with clinical expertise and patient/family preferences and values As above Uses objective factual information from the patient to determine if the patient's health literacy has improved As above As above Unacceptable (Examples) Performs traditional patient teaching without determining if the patient understands or learns Old or faulty evidence Talks down to patient No objective or factual information from patient Does not link health literacy to safety Does not link health literacy to information Evaluation Description: Scoring Rubric Content Evidence Patient Centered Quality improvement Safety Informatics Exemplary Demonstrates a superior understanding of health literacy applied to patient (and family) focusing on an appropriate & important learning goal Displays an analytic attitude in determining the patients barriers to health literacy and the best way to overcome them Determines a creative and accurate method of determining if learning has occurred Integrates best current evidence with clinical expertise and patient/family preferences and values Recognizes the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patients' preferences, values, and needs Demonstrates respect and sensitivity to the patient Uses objective factual information from the patient to determine if the patient's health literacy has improved Uses flowcharts, or cause and effect diagrams within the text of the paper to explain and clarify aspects Describes how the improvement of the patient's health literacy in the area chosen minimizes risk, harm, and prevents future hospital admissions Explains why information and technology skills are essential for safe patient care Acceptable Applies concepts of health literacy focusing on a learning goal Determines the patient's barriers to HL and ways to overcome them Uses a teach-back methodology Integrates current evidence with clinical expertise and patient/family preferences and values As above Uses objective factual information from the patient to determine if the patient's health literacy has improved As above As above Unacceptable (Examples) Performs traditional patient teaching without determining if the patient understands or learns Old or faulty evidence Talks down to patient No objective or factual information from patient Does not link health literacy to safety Does not link health literacy to information

The Web Content Accessibility Guidelines (WCAG) defines requirements for designers and developers to improve accessibility for people with disabilities. It defines three levels of conformance: Level A, Level AA, and Level AAA. QSEN Website is partially conformant with WCAG 2.0 level AA. Partially conformant means that some parts of the content do not fully conform to the accessibility standard. ​​ Acce ssibility Statement This is an accessibility statement from QSEN. Confo rmance S tatus The Web Content Accessibility Guidelines (WCAG) defines requirements for designers and developers to improve accessibility for people with disabilities. It defines three levels of conformance: Level A, Level AA, and Level AAA. QSEN Website is partially conformant with WCAG 2.0 level AA. Partially conformant means that some parts of the content do not fully conform to the accessibility standard. Compatibility with Browsers and Assistive Technology QSEN Website is designed to be compatible with the following assistive technologies: Modern major browsers (Chrome, Firefox, Edge, etc.) on Windows 7+ operating systems Technical Specifications Accessibility of QSEN Website relies on the following technologies to work with the particular combination of web browser and any assistive technologies or plugins installed on your computer: HTML These technologies are relied upon for conformance with the accessibility standards used. Assessment Approach QSEN assessed the accessibility of QSEN Website by the following approaches: Self-evaluation WIX WCAG Accessibility Wizard Feedback We welcome your feedback on the accessi bility of QSEN Website. Please let us know if you encounter accessibility barriers on this website: E-mail: qsen.institute@gmail.com Visit the [Contact Us ] section on this website Date This statement was created on 18 April 2023 using the W3C Accessibility Statement Generator Tool .

Published Back to Strategy Search Strategy Submission Escape Game for Postpartum Hemorrhage for Nursing Education Author: Linda Beaverstock MSN, Ed., RNC-OB, C-EFM Title: Perinatal Clinical Educator Coauthors: Vanessa Enloe, MSN, ED., RNC-MNN, IBCLC - Texas Health Resources Institution: Texas Health Resources Email: lindabeaverstock@texashealth.org Competency Categories: Quality Improvement, Safety, Teamwork and Collaboration Learner Level(s): Continuing Education, New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN, Staff Development Learner Setting(s): Classroom, Skills or Simulation Laboratories Strategy Type: Case Studies Learning Objectives: K: Recognize that nursing and other health professions students are parts of systems of care and care processes that affect outcomes for patients and families (QI - K) S: Use appropriate strategies to reduce reliance on memory (such as forcing functions, checklists) (Safety - S) A: Value teamwork and the relationships upon which it is based (Teamwork and Collaboration - A) Objectives addressed for specific OB Escape game activities are as follows: Students will work in teams to: analyze patient data (history, vital signs, lab values, blood loss) Identify areas of a focused postpartum assessment (BUBBLE HE) evaluate blood loss using Quantitative Blood Loss (QBL) identify risk factors identify appropriate medications prioritize interventions practice use of professional terminology Strategy Overview: As part of a national effort to improve early acknowledgment and intervention to postpartum hemorrhage (PPH), complicated by the fact that nursing students and graduate nurses are held accountable for a tremendous amount of content and skills, meaningful and interactive teaching techniques are needed. A game-based learning tool was developed to enhance nursing students’ knowledge retention, use of teamwork, and critical thinking in response to postpartum hemorrhage. This game, called "Escape Postpartum Hemorrhage," which is currently being utilized with BSN students and nursing residents, has shown to improve their test scores and perceived understanding of content. This case study scenario includes activities (puzzles, a decoder, a hidden message crossword, and sorting games) to unlock information to move forward. The activity guides students through recognizing PPH risks, presentation, and best practices in providing the recommended interventions. This in turn fosters a timely response, therefore improving patient safety and outcomes. The learning activity was initially created as a hands-on tool and was subsequently adapted to a digital format during COVID restrictions. Currently, a hybrid version is being used with the graduate residents and both have proved to enhance learning. Submitted Materials: 312.-Directions-for-OB-Escape-Game-7.pdf - https://drive.google.com/open?id=1_AzkvcD_0bjPuIuinvxvnKzejaRxSOFz&usp=drive_copy 312.-Prebriefing-for-online-activity.docx - https://drive.google.com/open?id=1sPCsv4GLFTjwDvFRns6Dv953qqWhdG4M&usp=drive_copy 312.-Escape-PPH-Debrief.docx - https://drive.google.com/open?id=1sYGBC7fdTOn7DLfOnee1BYFBMtC-hjHQ&usp=drive_copy 312.-Escape-PPH-post-survey.docx - https://drive.google.com/open?id=1sTRsEnkf3-XldVy6VyF--AWh6LZQ44eq&usp=drive_copy References-for-PPH-Escape-Game.pdf - https://drive.google.com/open?id=1lugT1rMvHbWEf10MGzr-I7B4N87QcH3L&usp=drive_copy Additional Materials: Please see attached: Directions for OB escape game (for instructor use) Pre-brief - instructional information/background for students Debrief Post activity survey References Evaluation Description: A study involving 20 hospital nursing residents was conducted to evaluate flow and perception. A 4-point Likert scale survey with a comment section evaluated the participants' perception of learning effectiveness. The digital escape game was successfully implemented in April 2020 for 120 university J2 students via Zoom in breakout groups of 3 or 4. All 120 students completed the game and participated in a post-conference debrief. Results revealed 95-100% of participants “strongly agreed” or “agreed” the activity promoted teamwork, reinforced knowledge, prepared for clinical experience, prioritization, and clinical reasoning. Students broadly commented they enjoyed it. The university students improved their test score averages over the related content by 4-6% compared to prior semesters with lecture alone. Responses strongly reinforced the use of escape tools to enhance learning. The creation of the attached digital escape version, which utilizes Google forms, revealed to be more affordable, less labor-intensive, adaptable and had the advantage of creating multiple locks or levels to breakthrough. Creating both helped to compliment the overall game. Also, see attached survey for individual evaluation following the application of this game.

Published Back to Strategy Search Strategy Submission Hand-off Strategies for Maternity (L&D/MBC) Clinical Practice: SBAR/Assessment Tools and More Effective Hand-off Timing Author: Sue Mahley MN, RN, WHNP-BC, CNE Title: Assistant Professor of Nursing Coauthors: Institution: Research College of Nursing Email: sue.mahley@researchcollege.edu Competency Categories: Patient-Centered Care, Teamwork and Collaboration Learner Level(s): Pre-Licensure BSN Learner Setting(s): Clinical Setting, Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: Following implementation of these strategies, the student nurse will: 1.Describe examples of the impact of team functioning during patient care hand-offs on safety and quality of care. 2.Utilize the SBAR/Assessment tool as a safe, effective communication practice that minimizes risks associated with hand-offs among providers and across transitions in care. 3.Appreciate the risks associated with the timing of hand-offs among providers and across transitions of care. Strategy Overview: A hand-off is a transfer and acceptance of patient care responsibility achieved through effective communication. It is a real-time process of passing patient specific information from one caregiver to another or from one team of caregivers to another for the purpose of ensuring the continuity and safety of the patient’s care. Student nurses are involved in some manner of hand-off communication prior to initiating care and at the conclusion of their clinical day. Observations of our students during hand-offs in the clinical setting revealed a process replete with potential for error. For example, when students listened to hand-offs between staff nurses, they were often unable to get close enough to clearly hear the report or to understand the medical jargon nurses used. Hand-offs were frequently interrupted by occurrences happening at shift change and nurses were sometimes unable to review patient data with students due to the responsibilities of shift change. Implementation of the Strategy: The Joint Commission Hand-off Communication Failures includes several strategies that might be helpful to student nurses. These strategies involve the development and use of standardized forms, including SBAR tools, establishing a workspace or setting that is conducive for sharing information about patients, and examining the work flow of health care workers to ensure a successful hand-off, focusing on the system, not just the people. Similar adaptations were made for our students, including the timing of hand-offs to a less stressful time for staff nurses. Nursing staff were surveyed regarding when hand-off communication to students would work best in their schedule. Staff agreed that a clinical start time approximately one hour after usual shift change would be the least stressful time. A later clinical start time was implemented with our students. An SBAR/Assessment tool was also developed specifically for students to use during hand-off communication with staff nurses. This SBAR/Assessment tool (one page front and back) served multiple purposes, as it included space for continuing data collection, nursing diagnoses, interventions and evaluation of outcomes. Submitted Materials: Additional Materials: Evaluation Description: To evaluate the effectiveness of these strategies, students and staff nurses were surveyed about their experience at the end of the clinical rotation (survey forms attached). All students and nurses reported more privacy, fewer interruptions and adequate time for hand-off communication. Students indicated that use of the SBAR/Assessment tool increased organization of patient information in a more clear and complete manner at hand-off and for continuing assessments throughout the day. Students felt more confident in the provision of safe care to their patients. Nurses agreed that patient safety was enhanced. Both students and staff nurses noted that the change to a later timing of hand-offs did not negatively impact their patient care. In fact, nurses commented that they felt less hassled by students, were able to provide more thorough hand-off communication and had more time to answer questions. The age old practice of having student nurses present at change of shift time for hand-offs may not be the best and safest teaching strategy. Faculty reported that the SBAR/Assessment tool (one page front and back) format was a time saving strategy in reviewing clinical paperwork.