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 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.

Published Back to Strategy Search Strategy Submission Using Role Play in Community Health Author: Alisa Gadon MSN/ED Title: Community Health Instructor Coauthors: Institution: Phillips School of Nursing at Mount Sinai Email: alisa.gadon@pson.edu Competency Categories: Patient-Centered Care, Teamwork and Collaboration Learner Level(s): RN to BSN Learner Setting(s): Classroom Strategy Type: Case Studies Learning Objectives: Demonstrate the ability to foster open communication, mutual respect, and shared decision-making to promote quality patient care Evaluate the student’s ability to perform in a community setting Demonstrate community health critical thinking skills Demonstrate teamwork and collaboration during patient/nurse interactions Strategy Overview: Strategy Overview Community Health nursing is an unfamiliar aspect of nursing for most students in the RN- BSN program. Role-playing in community health care presents patient-centered care “real life” scenarios. The interactive aspect of Role-play promotes teamwork and collaboration using critical thinking skills. During the role-play scenario, the instructor has an opportunity to intervene and invite class feedback to further develop the student’s critical thinking skills. The instructor reads the case scenario and presents the providers' order form to the class and asks for two student volunteers to act out each role. The instructor explains to the class that it is an interactive learning experience and there are no right or wrong answers. The “actors” are allowed to ask the class for assistance and vice versa during the role-play scenario. This encourages open communication with peers and enhances the learning process. The instructor places two chairs in the front of the class and hands out available props such as empty medication bottles or costumes to set the stage for the actors. The instructor is then able to further describe the patient and nurse’s roles in more detail by adding information to the basic scenario. The details may include challenges such as bad weather conditions or a recent family crisis. The instructor may need to refocus the “actors” and class discussion to stay on track and for time management. The scenarios should be limited to 15-20 minutes or class time permitting. The props can include empty medication bottles labeled with the medications listed on the provider’s order form and filled with tic tacs. Old robes for the patient and a scrub top for the nurse to wear can be added. Strategy Content The strategy content includes developing patient-centered communication and the students critical thinking skills Submitted Materials: 218QSEN-Scenario-1.docx - https://drive.google.com/open?id=1qKdbZDzgDNIAzUGKnibyqapE-CxLNna4&usp=drive_copy 218QSEN-Scenario.docx - https://drive.google.com/open?id=1qKdbZDzgDNIAzUGKnibyqapE-CxLNna4&usp=drive_copy Additional Materials: Props for the "actors" if available i.e. empty medication bottles, costumes. Evaluation Description: Evaluation of the Role-playing activity is obtained through the students’ five-minute verbal responses to the question: “What did you like or dislike about this activity”. Role-playing allows for observation of the students' ability to problem solve and demonstrate good customer service during the role play interactions. Videotaping the “actors” and playing back during the debriefing session will evaluate the student’s ability to perform in the community setting. A written evaluation tool could be developed and used to demonstrate specific measurable outcomes. Debriefing session conducted with the class after the role play scenario provided positive student feedback. Students reported that the role play scenario demonstrated “how difficult it can be to assess a patient in the community setting”. The student ‘actors” reported that they gained an understanding of the importance of having knowledge of the patient’s community resources. One student “actor” stated: “I really felt that this patient relied on my knowledge to keep them safe and out of the hospital”. Faculty members can reflect on Kolb’s Experiential Learning Model to debrief for meaningful learning. Kolb’s Experiential Learning model stages of (a) concrete experimentation, concrete experimentation phase explores the feelings and reactions of the participants (b) reflective observation phase, the participants describe and discuss the actual events that took place (c) abstract conceptualization, and (d) active experimentation.

Published Back to Strategy Search Strategy Submission Vaccination Think, Pair, Share Activity Author: Brittany Lawson MSN, RN, CMAC Title: Instructor Coauthors: Institution: Lakeview College of Nursing Email: blawson@lakeviewcol.edu Competency Categories: Informatics, Patient-Centered Care Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Classroom Strategy Type: Case Studies Learning Objectives: Patient-Centered Care The learner will identify appropriate vaccinations for administration based on individual client data. The learner will select appropriate client education related to the administration of vaccinations. The learner will discuss the benefits and limitations of using the Center for Disease Control and Prevention’s (CDC) website to access information for vaccination schedules and client education. The learner will value the use of evidence-based practice sources of information to assist in the delivery of care. Informatics Use information and technology to communicate, manage knowledge, mitigate error, and support decision making. The learner will identify appropriate vaccinations for administration based on individual client data. The learner will select appropriate client education related to the administration of vaccinations. The learner will discuss the benefits and limitations of using the Center for Disease Control and Prevention’s (CDC) website to access information for vaccination schedules and client education. The learner will value the use of evidence-based practice sources of information to assist in the delivery of care. Strategy Overview: The think, pair, share learning activity allows students to identify appropriate vaccinations by utilizing high-quality sources of information, such as the Centers for Disease Control and Prevention (CDC) website. Four case studies are included within the activity to distribute to students. The case studies provide scenarios of clients in need of a vaccination. By using the CDC website students will get experience in navigating this high-quality source of vaccination scheduling and client education information. Debriefing questions are provided that allow the student to reflect upon the experience. This learning activity can be adapted to the online learning environment. Submitted Materials: 318.-Vaccinations-Think-Pair-Share-Activity.docx - https://drive.google.com/open?id=1spRy67tjrAGCDvpHxjKRiJK1rSfX5TBA&usp=drive_copy Additional Materials: Evaluation Description: The facilitating educator will formatively evaluate the student’s learning throughout the activity and during the debriefing process. Active facilitation of each group’s progress on the case will provide the educator with evaluation data as well. The educator will encourage all students to participate in the debriefing to facilitate learning, reflection, and student evaluation. Students should be provided with feedback throughout the learning activity from the educator and their peers. Alternatively, the debriefing questions can be submitted as a discussion board or written assignment. Many of the students that participated in this activity reported that they preferred this active learning method for immunization schedules and education over a more passive approach (such as lectures or handouts). Students that participated in this activity expressed that this activity helped them develop a greater appreciation for the use of high-quality information sources and their impact on nursing care. Students that participated in this activity expressed an increased level of confidence in identifying appropriate immunizations for clients.

Published Back to Strategy Search Strategy Submission A Novel Format for Student Post Conference and Teaching SBAR Communication Author: Jacqueline G. Ioli MSN, RN, CRNP, PNP-BC Title: Doctoral Student, Widener University Coauthors: Institution: Widener University Email: jgioli@mail.widener.edu Competency Categories: Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Clinical Setting Strategy Type: Case Studies Learning Objectives: After participation in this interactive learning activity, sharing their own work with peers, learns ware able to analyze their roles in QSEN competency 1, Patient Centered Care: a) knowledge of nursing roles in assuring coordination, integration & continuity of care; c) attitudes, values continuous improvement of own communication skills. QSEN competency 5, Safety: c) value own role in preventing errors. Strategy Overview: Based on Vygotsky’s theory of creating frameworks for learning, this PowerPoint teaches the principles of SBAR, guiding student how to sum up their patient’s situation, background, assessment, recommendation for care. In addition, students referenced an image from a website related to their patient. Additional slides asked students to describe the medical diagnosis, safety implications and lesson learned. Students took care to avoid identifying details and excluded patient initials & facility. Patients were described only by age, gender & presenting problem. A recent weather emergency provided an opportunity to trial this tool by using it as a virtual post conference medium. Students completed the PowerPoint and emailed the document to the group. During the weather emergency, students read and commented on peers’ patients from home. The instructor contacted students by phone to review their PowerPoint and engaged the student in discussion. Submitted Materials: 117.QSEN-Exercise.ppt - https://drive.google.com/open?id=1n2JkfiPECmbp6oAtiFaSwpbE23mfGPmG&usp=drive_copy Additional Materials: Evaluation Description: Student comments were positive, “I have learnt a lot of new and helpful information.” Many comments indicated specific clinical thinking about professional issues raised by peers, “I do think the school nurse should implement teaching since childhood is a high risk time for appendicitis.” In addition, students provided positive feedback to each other, “Great job with appendicitis! I liked how you politely put, ‘Patient refused to ambulate.’” Students were challenged by some of the unknowns in their caseload and looked up additional information, “After viewing the PowerPoint I did some research and found that with Non-Hodgkins Lymphoma it often may occur without fever at first. That intrigued me. Also, a biopsy is the definitive diagnosis. I wish we would have been back on the floor to find out what the biopsy revealed.” This faculty member guided the virtual conversation to stress common safety themes applicable to the group of clients under care. In summary, the SBAR template was an efficient and effective method of coping with a weather emergency and teaching safety information. Future groups will develop NCLEX style questions at the knowledge/comprehension level and application/analysis level. The NCLEX style questions together with a survey tool can form the basis of more formalized evaluation of this method.