Published Back to Strategy Search Strategy Submission Medication Variance Report: Authentic Assessment Exercise Author: Jean Yockey RN, MSN, FNP, CNE Title: Associate Professor Coauthors: Institution: The University of South Dakota Email: jean.yockey@usd.edu Competency Categories: Quality Improvement, Safety Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN Learner Setting(s): Classroom Strategy Type: General Strategy Learning Objectives: Appreciate that continuous quality improvement is an essential part of the daily work of all health professionals. Demonstrate effective use of strategies to reduce risk of harm to self and others. Communicate observations or concerns related to hazards and errors to patients, families and the health care team. Examine human factors as well as commonly used unsafe practices. Participate appropriately in analyzing errors and designing system improvements. Foster collaborative partnerships between academic and service settings. Strategy Overview: The goal of the strategy is to allow an authentic assessment of the consequences of a medication error. This exercise is completed individually if a student enters an incorrect response to a dosage calculation question on unit exams. Decreasing medication errors are a major goal of health care institutions. In this activity, a learner meets individually with a faculty member each time a dosage question on a unit exam is answered incorrectly. A variance form from an area institution is adapted for use in the learning setting. Faculty guide learners to consider: • The identification of gaps in dosage calculation knowledge • The importance of reflecting on dosage calculation for reasonableness, i.e. “Does this answer make sense?” • The potential outcomes of a dosage error • The professional communication protocols to follow should a dosage error be made • Accountability for each medication dosage administered Submitted Materials: 80.MedicationVarianceReport.doc - https://drive.google.com/open?id=1YFTvxXzLZd9eH0F9LB_lEiFdFbDR1zmY&usp=drive_copy Additional Materials: Evaluation Description: This experience does not affect the learner’s exam or course grade, but it does emphasize the consequences of dosage calculations that are wrong. The initial consequence of completing a variance report signifies the importance of any dosage error, in any setting. While the original activity is based on short answer exam questions, the activity can also be used with multiple choice questions. During the 1:1 learner and faculty interaction, both qualitative and quantitative data can be used to assess the activity. Qualitative questions that students have responded to include: What would be the impact to a client if this error were made in the practice setting? What preparation will you do to prevent a similar error in the future? What is your responsibility in administering medications as a student nurse? What have you learned from this experience? Quantitative data includes tracking of the number of repeat errors, the specific type of calculation error (conversion, decimal point, etc), and the communication process that would need to be followed in the practice setting (contact charge nurse, notify physician, inform client and client family, etc.). Outcomes of this experience include: 1. Increased awareness of the actual outcome of dosage errors. 2. The importance of quality improvement tracking devices to prevent future dosage errors. 3. Learner accountability for the dosage calculations that they perform. 4. Collaboration with faculty to identify knowledge gaps in dosage calculation. 5. Learner awareness of communication pathways. 6. Verbalized statements of the need for greater caution when calculating even routine medication doses. 7. Increased accuracy on unit exams for dosage calculation questions.

Published Back to Strategy Search Strategy Submission Introducing Evidence-Based Practice Using a Common Referent: Internet Shopping Author: Katie Morales PhD, RN, CNE Title: Associate Professor Coauthors: Institution: University of West Georgia Tanner Health School of Nursing Email: kmorales@westga.edu Competency Categories: Evidence-Based Practice Learner Level(s): Graduate Students, Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Classroom Strategy Type: General Strategy Learning Objectives: Objectives: Knowledge 1. Demonstrate a basic understanding of the purpose of the literature search. 2. Identify qualitative and quantitative evidence to be synthesized. 3. Synthesize the evidence to inform the practice. Objectives: Skills 1. View the instructor-created video posted in the learning management system. Objectives: Attitude 2. State the integral value of evidence-based practice in decision-making. Strategy Overview: This teaching strategy uses simple language and a common referent to convey complex concepts practically to facilitate students’ application. Following Knowles Adult Learning Theory, the course faculty developed this teaching strategy to make the content relevant and practical using a common referent to help students build on previous knowledge and experience. The course faculty found evidence-based practice (EBP) can be overwhelming to both undergraduate and graduate students. To help ease students fears, the course faculty related EBP to a teaching strategy intuitive to the students (online shopping). Students were asked to view a 5-minute instructor-created video posted in the learning management system. The course faculty demonstrated the following actions related to a practical problem (buying a running shoe). 1. The course faculty performed an internet search. The search terms included “best running shoe.” To help address the course faculty’s limitations on time, money, and effort in life as well as in practice, she introduced the use of filters for the search. 2. The course faculty identified biased and unbiased results. She discussed the importance of the literature search and how scholarly searches identify scholarly sources. Because sites from shoe manufacturers were likely to be biased, she identified and selected an unbiased site (such as those posted by The Buyer’s Guide). 3. The course faculty briefly reviewed the literature from the non-biased sources. 4. The course faculty interpreted the qualitative and quantitative data. When the course faculty clicked on the “buy at Amazon button, “she saw the number of ratings (sample size). She discussed how much more reliable findings are if there are data from 4,029 reviewers versus 4 reviewers. Quantitative data were reported in the star ratings and qualitative data were reported in the comments. The quantitative data were reported in numbers, and the qualitative data were reported in words. The course faculty stressed that students may prefer one over the other and that is acceptable. Both forms of data are valuable and useful. 5. The course faculty briefly interpreted data to inform the shopping decision. After the brief review, the course faculty selected a shoe to purchase. This demonstrated the role of evidence to determine the best clinical practice. Submitted Materials: Additional Materials: No funding was received for this teaching strategy. The equipment used for this teaching strategy included a computer which was required for the course and required no special adaptation of equipment. This teaching strategy has been presented to undergraduate (BSN) and graduate (MSN, EdD) students, receiving overwhelmingly positive feedback from each. Strengthening QSEN Competencies in Nursing Education The strategy strengthened the QSEN (2020) competency of EBP as it developed students’ knowledge of the basic characteristics of literature search and qualitative and quantitative research. Classroom activities and discussion included comparing and contrasting the basic characteristics of qualitative and quantitative research. In conclusion, the course faculty found this teaching strategy is an effective learning strategy to introduce students to EBP. The course faculty applied a common referent to help students grasp the basic characteristics of literature search, qualitative research, and quantitative research. Discussion Questions Discussion questions focused on the QSEN (2020) competencies of EBP such as: What are the basic characteristics of a literature search? How could funding affect confidence in results? How does sample size affect confidence in the reported findings? What are the basic characteristics of qualitative research? What are the basic characteristics of quantitative research? References Knowles, M. (1990). The adult learner. A neglected species, 4th Edition. Houston: Gulf Publishing. Quality and Safety Education for Nurses. (2020). QSEN Competencies. https://www.qsen.org/competencies/ Evaluation Description: Evaluation of the teaching strategy was accomplished via discussion for content comprehension. Because this strategy was not designed as a research project, Internal Review Board approval was not obtained, and no additional data were collected. Overall, students demonstrated higher content comprehension after this teaching strategy, with students consistently referring to qualitative and quantitative characteristics correctly throughout the semester after the teaching strategy. Discuss with students: How does the body of evidence inform their shopping decision (equivalent to practice in EBP)? Students’ Self-Report of Content Comprehension Student feedback was overwhelmingly positive. From a graduate student: I also genuinely appreciate the video feedback, and the course faculty did not consider any of it too elementary. Unfortunately, I do not always comprehend written information thoroughly, and it greatly helped my understanding of the content to hear you break it down in the feedback video.

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.

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.