Published Back to Strategy Search Strategy Submission Strategies to Decrease Student Anxiety and Improve Patient Safety in a Critical Care Clinical Setting Author: Julie Hopkins DNP, RN, PHNA-BC Title: Instructor Coauthors: Institution: Frances Payne Bolton School of Nursing, Case Western Reserve University Email: jlh208@case.edu Competency Categories: Patient-Centered Care, Safety Learner Level(s): Pre-Licensure BSN Learner Setting(s): Clinical Setting Strategy Type: General Strategy Learning Objectives: Through participation in this clinical exercise the student will: 1. Discuss the impact of student anxiety on patient safety in a critical care clinical setting. 2. State the effect reflective journaling has on decreasing anxiety. 3. Review previously learned skills in a lab setting during critical care clinical orientation as a means of decreasing anxiety in practice. 4. Demonstrate the effect student anxiety has on communication with patients and the care team. 5. Analyze the relationship between student anxiety and the provision of patient-centered care. Strategy Overview: The start of a critical care clinical rotation can be an exciting time for many nursing students. For some, however, the prospect of caring for critically ill patients in an intensive care unit (ICU) can be overwhelming. While some apprehension is to be expected, excessive anxiety can impede students’ ability to think clearly, therefore increasing the risk of errors and ultimately jeopardizing patient safety. Too much anxiety may also negatively impact students’ interactions with their patients, compromising communication and affecting the provision of patient-centered care. In an effort to decrease students’ anxiety and increase their comfort level in caring for critically ill patients, an orientation day “skills fair” along with reflective journaling will be introduced in this junior level BSN critical care course. Prior to the start of the course, students will be asked to reflect on their preconceptions of critical care clinical and identify any fears or anxieties they may have regarding caring for critically ill patients. A brief questionnaire will be posted on the course Canvas site one week prior to the start of the clinical rotation. Questions will include “What are your perceptions of the critical care clinical rotation?” “Do you have any fears of caring for ICU patients? If so, discuss them.” The students will upload their responses to the Canvas site prior to the first day of clinical. The content of this reflection will not be graded. Students will simply earn credit for submitting the assignment on time. On the first clinical day, each instructor will have their group engage in a roundtable discussion where students will be able to share their thoughts, feelings, and concerns regarding caring for critically ill patients. Students will not be mandated to share what they wrote in their pre-clinical assignment, but faculty will promote an environment where students feel safe to discuss their feelings. Students’ fears and apprehensions will be acknowledged. Instructors will stress to the group that the focus of this clinical rotation is not only hands-on patient care and clinical skill development, but also confidence building, patient safety, communication, and the provision of patient-centered care. Following this discussion and a tour of the ICU, students will reconvene in the school’s nursing lab for a “skills fair.” The following clinical skills were chosen to review: 1) Administering medications via a gastric tube 2) Inserting an indwelling Foley catheter 3) Inserting an intravenous (IV) line, administering medications by IV bolus, and administering medications by IV piggyback 4) Suctioning a tracheostomy and providing care of a tracheostomy 5) Medication math calculations These skills were chosen because of the high likelihood of having the opportunity to perform them in an ICU setting. Students enrolled in this course have tested out on these skills in their prior medical-surgical rotation. However, they likely had little opportunity to perform the skills in the clinical setting. The goal for the skills fair is to refresh students’ memory on correct technique and procedure, increase their confidence, and decrease their anxiety prior to the start of the ICU clinical rotation. Refining their skills, decreasing their anxiety, and improving their confidence will ultimately improve patient safety in the clinical setting. During the skills session, students will break into small groups and move through the five stations at 20-minute intervals. A clinical instructor will be at each station and will demonstrate the skill for students, then allow each student time to practice. If additional time is needed on a skill, students may return to repeat it after cycling through each station. Instructors will provide feedback and assistance, but students will not be tested or graded on each skill. The goal is to provide a low-stress environment for students to gain confidence prior to working with critically ill patients. Reflective Journaling Students will also complete one structured reflective journal during the seven-week clinical rotation. Reflection will allow the students to explore their thoughts and feelings related to the clinical experience. It will also help students understand their stress and anxiety, and the impact these factors have on patient safety and the provision of patient-centered care. Open-ended questions include “Identify and describe aspects of your clinical day which may have caused you to feel anxious.” “Describe how you communicated your feelings of anxiety to your clinical instructor and/or assigned nurse. How did communication with members of the health care team impact your anxiety level?” “What aspects of patient safety were your focus today?” “Evaluate your performance of patient care today. Include what you learned and where you feel you could improve, particularly in regard to patient safety.” A deadline for submitting this reflective assignment to the course Canvas site will be given to students at the beginning of the course. Finally, students will also complete a post-course reflection of this experience. The same questions posed at the beginning of the course will be revisited at this time. The questions will be posted on the course Canvas site and will include “Reflect on your fears and concerns prior to the start of the course. Based on your experiences during this rotation, what are your current perceptions of caring for critically ill patients?” “Reflect on your experiences from this clinical rotation. Did your anxiety level change throughout the rotation?” This post-course reflection is not graded, but credit is awarded for submitting it on time. Submitted Materials: 234-Revised-Critical-reflection-rubric.docx - https://drive.google.com/open?id=1qBXae3Lphj-F1jxqhQdyuJXloQESkv3b&usp=drive_copy Reflective-Journal-template-updated-1.docx - https://drive.google.com/open?id=16vB8834H6Il-e7ntgShUPD3yfybRi7L7&usp=drive_copy Additional Materials: See the attached files: 1. Reflective journal template 2. Critical reflection rubric Evaluation Description: One of the most helpful aspects of journaling is having the opportunity to reflect on an experience and think about how to improve upon a similar situation in the future. Through journaling, students have a written memoir of an experience. They can reflect on this, and think about how they overcame this particular difficulty. In this way, it encourages refinement of action (Miller, 2017). The students’ structured reflective journal will be scored based on content, quality of writing, and timeliness of submission. The true measure of success with the assignment, however, is a noted decrease in anxiety level for the student in caring for critically ill patients. For this reason, the focus of their journaling should not be on “hands on skills” performed, but on their own personal reflection of their feelings toward their patient assignment, and how those feelings impacted patient safety, communication with the patient and interprofessional team, and their provision of patient-centered care. Their ability to be able to make connections between their attitudes and fears and their overall performance will lead them to professional growth. The goal is for students to continue their practice of reflective journaling in future courses. Ideally, they may not only identify connections between student anxiety and patient safety, but also recognize their strengths and weaknesses which impact communication, safety, and the provision of patient-centered care. References Ganzer, C. A., & Zauderer, C. (2013). Structured learning and self-reflection: Strategies to decrease anxiety in the psychiatric mental health clinical nursing experience. Nursing Education Perspectives, 34(4), 244-247. Miller, L. B. (2017). Review of journaling as a teaching and learning strategy. Teaching and Learning in Nursing, 12, 39-42. Zhao, F.-F., Lei, X.-L., He, W., Gu, Y.-H., & Li, D.-W. (2015). The study of perceived stress, coping strategy and self-efficacy of Chinese undergraduate nursing students in clinical practice. International Journal of Nursing Practice, 21(4), 401–409.

Published Back to Strategy Search Strategy Submission Clinical Evaluation Tools embodying AACN BSN essentials and 6 QSEN KSAs Author: Linda Flores MSN-Educator; CEN, RN Title: Assistant Professor Coauthors: Patricia Shakhshir, PhD, CNS, RN-BC, Mary Lopez, PhD, RN Institution: Western University of Health Sciences College of Graduate Nursing Email: lflores@westernu.edu Competency Categories: Evidence-Based Practice, Safety Learner Level(s): Pre-Licensure BSN Learner Setting(s): Clinical Setting Strategy Type: General Strategy Learning Objectives: 1) Utilize Clinical Evaluation Tools containing observable scaffolded competencies embodying the American Association of Colleges of Nursing BSN essentials and 6 QSEN knowledge, skills, and attitudes (KSA): Safety, evidenced based practice, patient centered care, team work/ collaboration, informatics, and quality improvement. The added core of professionalism embodies the spirit of the school’s clinical handbook and hospital’s mission statements. Tools range from semester I-IV, Fundamentals, Medical Surgical Nursing; Advance Medical Surgical Nursing; Pediatrics, and Community Health. (Obstetrical Nursing and Psychiatric Nursing pending). 2) Provide a numeric grade--The tool utilizes a numeric system 0-4 for each of the 6 QSEN competencies KSAs totaling 100 points for a "grade" in clinical (instead of pass/fail). 3) Document reflection of values and attitudes in the clinical setting with the use of exemplars (narrative pedagogy). Strategy Overview: 1) Students utilize the clinical evaluation tool to self-grade at midterm and final week. Clinical faculty agreement or recommend changes both at midterm and final week. 2) At Mid-term, a numeric value of 2 is acceptable since continued growth is expected until completion of clinical hours. a. When a QSEN competency KSA falls “below expectations,” a score of 2 out of 4; a remediation plan for competency I-VI and KSA a-f will be documented on the Performance Improvement Form. Agreement from student, clinical faculty, lead faculty, and director(s) signatures required. b. When remediation requirements meet time frames & criteria, the grade for the specific competency and KSA increases to “met” at 3 out of 4. 3) Early identification of areas falling below expectations and a clear action plan with time frames for student success facilitate clear communication and documentation of efforts. 4) Narrative Pedagogy (exemplar) required for a score of 4 documents personal knowledge application of skills and attitude changes while providing quality safe care for the sick client. One clinical exemplar may embody several competencies I-VI and KSAs a-f. Submitted Materials: Clinical-evaluation-tool-guidelines-WUHS-2014-1.doc - https://drive.google.com/open?id=15rm2JY7NInYRf-N95pkFkn-FnaclTkrl&usp=drive_copy Level-I-CGN6411-Clinical-Eval-Tool-1.pdf - https://drive.google.com/open?id=1U4CPUXy4TUvNjBsrN2QScqimKeVpQVhJ&usp=drive_copy Level-II-CGN6502-Clinical-Eval-Tool-A-1.pdf - https://drive.google.com/open?id=17UT2P0DLDf7_zQ7RcxcITupAnUku5Kjs&usp=drive_copy Level-III-CGN-6711-OB-Clinical-Performance-Evaluation-Tool-1.pdf - https://drive.google.com/open?id=1UiErlcZBrWq93B9soclc9QGSBjK25SRF&usp=drive_copy Level-IV-CGN-6902-Community-Health-Tool-A-1.pdf - https://drive.google.com/open?id=1UwA7OoK4dKLyxYSPSovEjWkcEbOxYPP1&usp=drive_copy Additional Materials: Level IV Community Health Clinical Evaluation tool available per request to Linda Flores lflores@westernu.edu Audio Power Point Presentation (18 minutes) explaining the quality improvement group activities (Level III) in post conference or debriefing available, please contact Linda Flores. Level IV Psychiatric Nursing tool in progress. OB and Community clinical evaluation tools will be available upon request. Teaching strategy enhancement from the version presented at QSEN 2012 by Nicholls State presenters: Eymard, A., Davis, A., & Lyons, R. (2012). Progressive clinical performance evaluation tools incorporating the QSEN competencies. Podium presentation at the Innovation to Transformation: 2012 QSEN National Forum, Tucson, Arizona. Evaluation Description: Since utilizing these tools, clinical grades range from 77% (passing) to 100% (above expectations). Those students achieving higher than 77% wrote clinical exemplars capturing their previous misconceptions and changes in attitudes or values; desiring methods for changing the system (blameless communication); creating opportunities for patient centered pain management or goals; and lastly reporting off during interdisciplinary rounds at bedside to advocate for the patient or family. Post conference discussion contain aspects of the tool such as quality improvement and safety. Embedded within the tool are post conference exercises such as root cause analysis of a “work around” of an active or latent safety failure. The critical care semester clinical evaluation tool (Level III) also highlights the hospital report card so that early introduction of measurable nurse sensitive indicators become part of their language, values, and evidenced based practice. Another activity embedded within the tool is the identification of the “sacred cow” or traditional “way of doing” thing. An audio PPP or 1:1 meeting with adjunct clinical faculty enhances their ability to decipher use of the clinical evaluation tool. Weekly e-mails from the lead course faculty member connects weekly course content to clinical assignments and aspects of the tool. Early identification of several students who did not meet performance improvement criteria at Midterm help all parties develop a plan for clinical progression. Several solutions included switching medical surgical units, additional clinical/ lab hours, and case study worksheets. The student, clinical faculty, lead course faculty, and director of the program agree upon solutions that consider the student’s ability, clinical site, patient, and course objectives. Outcome based competencies: Our clinical unit nurse educators also provided input such as customer service criteria. While the acronyms vary, the concept consistently contained themes such as immediate trouble shooting, acknowledgment, prevention, and service. The relationship with clinical site nurse educators will be integral for the future. When active or latent safety infractions occur on the unit, a post conference debriefing included a root cause analysis (level III clinical evaluation tool, Quality Improvement competency). Under the guidance of the clinical faculty, an option includes a plan, do, study, act proposal to bring to the unit nurse educator (to achieve a score of “4” above expectations). Without a “just culture” environment, the students might not feel safe to bring forth their quality improvement suggestions. The group exercise facilitates team work and collaboration. A score of 4 requires a clinical exemplar as recommended by Drs. Benner, Sutphen, Leonard, and Day's (2010) Educating Nurses: Call for Radical Transformation suggestion of critical reflection for finding new meaning within context of practice. Use of exemplars create connections between their knowledge integrated from the classroom into the clinical practice and the humanistic science of caring. One exemplar may capture several QSEN KSA areas as “exceeds” semester expectations. Usually 2-4 exemplars total document their development of attitude and values while providing safe, evidence based, patient centered care. Post conference debriefings facilitate student recognition of their success.

Published Back to Strategy Search Strategy Submission Use of Institute for Healthcare Improvement (IHI) Open School Courses in a Prelicensure Nursing Program Author: Colleen A. Hayes MHS, RN Title: Assistant Professor of Nursing Coauthors: Institution: Western Carolina University Email: cahayes@wcu.edu Competency Categories: Patient-Centered Care, Quality Improvement, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure BSN Learner Setting(s): Classroom Strategy Type: Online or Web-based Modules Learning Objectives: 1. Value seeing health care situations “through patients’ eyes.” Respect and encourage individual expression of patient values, preferences and expressed needs. [patient centered care] 2. Acknowledge own potential to contribute to effective team functioning. Appreciate importance of intra- and inter-professional collaboration. [teamwork and collaboration] 3. Discuss effective strategies for communicating and resolving conflict. [teamwork and collaboration] 4. Choose communication styles that diminish the risks associated with authority gradients among team members. [teamwork and communication] 5. Value the influence of system solutions in achieving effective team functioning. [teamwork and communication] 6. Recognize that nursing and other health professions students are parts of systems of care and care processes that affect outcomes for patients and families. [quality improvement] 7. Use tools (such as flow charts, cause-effect diagrams) to make processes of care explicit. [quality improvement] 8. Examine human factors and other basic safety design principles as well as commonly used unsafe practices (such as, work-arounds (shortcuts or breaks in standard processes) and dangerous abbreviations) [safety] 9. Delineate general categories of errors and hazards in care. Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) [safety] Strategy Overview: Several Institute for Healthcare Improvement (IHI) Open School courses are completed by students in a leadership and management course during the last semester of a traditional and accelerated BSN program. Students independently complete IHI courses in patient safety and leadership, including: Introduction to Patient Safety, Fundamentals of Patient Safety, Human Factors and Safety and Communicating with Patients after Adverse Events, and Leadership (L101) So You Want to be a Leader in Healthcare throughout the semester. Content from the courses are incorporated into class activities and discussions, written assignments and course test questions. Learning Strategies related to IHI Open School Courses on Patient Safety: 1) One activity competed in class after students complete the patient safety courses is to have students write on post it notes to place on posters in the classroom. One poster is dedicated to what students learned by completing the IHI Patient Safety Courses, and the other poster is for students to add "how they felt" after completing these courses. To initiate discussion in the class, each student is asked to complete at least two post it notes (they may complete more) related to the IHI Patient Safety Open School courses. On one post it note students write at least one thing they learned by completed the Open School course, and one post it note on how completing the courses made them feel. The post it notes are placed on poster paper in the room. The instructor summarizes some of the most common responses on each poster, and facilitates discussion on common topics. Some common learning points identified by students are: “just culture”, causes of errors – human and system factors, how common errors are in healthcare, etc. Frequently students identify “how they feel” after the modules as: “afraid I will make an error that hurts someone”, “heartbroken for families that have been effected by errors.” Adequate class time for discussion is needed to process learning points and student fears and anxiety related to patient safety. 2) A cause and effect (fishbone) diagram is used in class after the patient safety modules are completed, to outline the causes of one scenario/situation presented in the IHI course. An airline crash scenario video in one of the modules is used to identify contributing factors of the crash, including communication, hierarchy/organizational culture, environmental factors, fatigue, stress. Students are then asked to describe an error or near miss they may have witnesses in the clinical environment, and discuss similar/contrasting factors leading to the error or near miss. 3) The students complete a patient interview assignment (attached) to gain understanding of a patient's perspective of a healthcare experience based on the IOM 6 Domains. During the course content and lecture period on patient centered care, the students discuss findings from their patient interviews. Data from patient interviews is compiled during class, including the types of care units, clinics where the patient experienced care, and themes of what constituted "good" or "bad" nursing care as perceived by patients and families. A review and discussion of learning from the IHI course related to completing a patient apology (IHI Course PS 105) is also completed during this class period. Students are divided into small groups with at least one student with a patient story with an untoward outcome or dissatisfaction with care. In small groups the students construct a patient (or family) apology based on the individual circumstances of the patient story and using principles of delivering an effective apology. Each small group then presents a brief summary of the patient experience, and delivers an apology to the patient or family member. The remainder of the class listens and critiques the apology. 4) Students also complete a paper (assignment attached) after completing the IHI leadership course. The IHI leadership course addresses being a leader in a system, and taking a leadership stance in difficult situations, no matter the official role or title. The course also addresses inter-professional communication and relationships. The purpose of the assignment based on the IHI course, is to have the student describe a past experience or situation in a job or school situation, and analyze how they could have handled the situation differently based on concepts learned in the IHI leadership course. Submitted Materials: Additional Materials: Evaluation Description: Evaluation Methods: 1. Course exams include specific questions related to IHI courses. 2. Patient Interview Assignment (attached) 3. Leadership Assignment (attached) 4. Class discussions and participation in activities Assessments: End of course evaluations indicate that students find the IHI courses relevant, interesting and add value to the nursing leadership course. The IHI "So You Want to be a Leader" Course (LD 100) has been mentioned most often by students as the most helpful, well presented and important IHI course they completed. The unfolding case study very clearly demonstrated how to approach an issue and address it as a "leader" in a health care situation. Students scored well on exam questions related to content covered in the IHI courses - scoring higher on those content areas than those presented through other methods (readings in the text, presentations in class) in the course. Each assignment included a section on learning points from the assignment. Comments added by students showed changes in attitudes and values related to patient safety and leadership.

Published Back to Strategy Search Strategy Submission Promoting Safety in an Unfolding Simulated Public Health Disaster Author: Agnes M. Morrison EdD, RN Title: Simulation Coordinator Coauthors: Ana Maria Catanzaro, PhD, RN Institution: La Salle University Email: morrisona@lasalle.edu Competency Categories: Evidence-Based Practice, Informatics, Patient-Centered Care, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure BSN Learner Setting(s): Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: Recognize signs and symptoms of an infectious disease outbreak. Identify essential assessment parameters for mass causalities during a gastrointestinal infectious disease outbreak. Identify essential assessment parameters for mass causalities during a respiratory infectious disease outbreak. Participate effectively in an interdisciplinary team during a simulated infectious disease outbreak. Apply appropriate infectious control standards and safe care during a simulated infectious disease outbreak. Demonstrate correct nursing actions to safely administer an intravenous antibiotic via a Peripherally Inserted Central Catheter using SAS protocol (Saline, Additive, Saline) procedure. Strategy Overview: Nursing laboratory sugar daddy website NYC simulation – Simulated infectious disease outbreak at an sugar daddy website NYC urban sugar daddy website NYC high school unfolds as the school nurse is performing a high-risk, low-frequency procedure. In the simulated health office, the school nurse is in the process of administering an intravenous antibiotic via a Peripherally Inserted Central Catheter (PICC) to a student with Lyme Disease when a large number of sick students and staff arrive at the health office. sugar daddy website NYC Submitted Materials: 75.PromotingSafety-PublicHealthDisaster.doc - https://drive.google.com/open?id=1YFTvxXzLZd9eH0F9LB_lEiFdFbDR1zmY&usp=drive_copy Additional Materials: Evaluation Description: The last section of the complete Public Health Disaster Simulation includes an evaluation instrument for students to complete. It is found in the File 1 complete packet document.

Published Back to Strategy Search Strategy Submission Using Evidence to Address Clinical Problems Author: Pamela M. Ironside PhD, RN, FAAN Title: Associate Professor Coauthors: Institution: Indiana University School of Nursing Email: pamirons@iupui.edu Competency Categories: Evidence-Based Practice Learner Level(s): New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN Learner Setting(s): Clinical Setting Strategy Type: Independent Study Learning Objectives: Differentiate clinical opinion from research and evidence summaries Explain the role of evidence in determining best clinical practice Identify gaps between local and best practice Discriminate between valid and invalid reasons for modifying evidence-based clinical practice based on clinical expertise or patient/family preferences Participate effectively in appropriate data collection and other research activities Consult with clinical experts before deciding to deviate from evidence-based protocols. Appreciate strengths and weaknesses of scientific bases for practice Acknowledge own limitations in knowledge and clinical expertise before determining when to deviate from evidence-based best practices Strategy Overview: In this exercise, students work collaboratively to explore current practice on a unit where they are having clinical experience. In most cases, not every student will complete every phase. Rather, students will take turns investigating the problem and reporting results to the group. While this exercise describes only a part of the quality improvement process, you can expand it to be more inclusive as the timeframe and situation allows. Similarly, this exercise can span a few weeks or an entire semester. It is most helpful if the problem students explore is specific to the unit on which they are currently having clinical experiences so that they can look at their own practice over time as well as that of the staff. You may specify the problem in advance [i.e.: hospital acquired infections] based on your experience, or you may make the process of coming up with the problem part of the exercise [i.e.: after several weeks on the unit, students can collectively decide on a problem (potential problem) they have identified in the clinical setting]. Once the problem is identified, an assigned student investigates staff perceptions of the problem. [For instance, do staff see this as a problem? Why or why not? What initiatives have been tired (if any) by the unit staff to address or prevent it? Is this problem addressed at unit meetings/in-services?] Another student investigates the nursing literature related to the problem. [i.e.: Looking at the last 5 years, how many studies of this problem have been reported? What are the major conclusions?] Another student may look at the health literature more broadly [Who IS studying this problem? What does the literature recommend? How and in what ways does this relate to nursing?] Another student investigates the Cochrane Library and/or national benchmarks to gather evidence and recommendations for practice. Discussion throughout this part of the exercise focuses on the evidence related to the problem – where it is, how the problem is (or is not) being studied, and what questions remain for students. Simultaneously, another student may review charts on the unit to identify the extent of the problem (alternatively, each student may report relevant data related to the problem for their assigned patients and construct a simple database to look at incidence of the problem for their patients over time related to national data). As the exercise nears completion, discussion may include: When you think about the patients for whom you have been providing care this semester, what could possibly be wrong with the best evidence available to date? In what specific situation would you NOT use this evidence when planning care for this patient? Why? With whom would you consult (if anyone) in making this determination? Are there data sources that we have not yet explored that could be helpful in considering [this problem] or planning ways to alleviate it? What questions do you have (about this problem or nursing practice related to care of patients experiencing the problem) that aren’t being addressed by current researchers? Submitted Materials: Additional Materials: Evaluation Description: This exercise can be used for discussion or as a group project that is marked pass/fail. An important aspect of discussion is to engage students in thinking about the practical use of evidence in its most inclusive sense (i.e.: students immersed in exploring various data sources may inadvertently discount other valuable sources such as patient/family values and/or clinical expertise). As well, exploring what’s missing is a great time to talk about the importance of ongoing research and what to do when decisions must be made for which there is little, no, or conflicting evidence. Differentiating between valid and invalid reasons and the importance of backup from clinical experts can also help students explore the limits and boundaries of their current knowledge and experience. Alternatively, you may ask each student to write and submit a one page summary of their findings which you can mark using a rubric consistent with those used at your school. (ie: A – work is clear, complete and concise, demonstrates excellent command and critical use of resources related to [the problem]. B – work is clear and concise, reflects consistent and appropriate use of resources related to [the problem]. C – work is incomplete and reflects non-critical or superficial use of resources). The questions at the end, however, should be for discussion only.

Published Back to Strategy Search Strategy Submission Sentinel Event Analysis Learning Activity Author: Gail Armstrong ND, RN Title: Assistant Professor Coauthors: Institution: University of Colorado Denver College of Nursing Email: gail.armstrong@ucdenver.edu Competency Categories: Safety Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Classroom Strategy Type: Case Studies Learning Objectives: Examine human factors and other basic safety design principles as well as commonly used unsafe practices. Demonstrate effective use of technology and standardized practices that support safety and quality. Value the contributions of standardization/reliability to safety. Appreciate the cognitive and physical limits of human performance. Value own role in preventing errors Describe processes used in understanding causes of error allocation of responsibility and accountability (such as root cause analysis and failure mode effects analysis). Discuss potential and actual impact of national patient safety resources, initiatives, and regulations. Use national patient safety resources for own professional development and to focus attention on safety in care settings. Value relationship between national safety campaigns and implementation in local practices and practice settings. Strategy Overview: This learning activity explores various facets of sentinel events and national patient safety goals. This activity can be used in a junior or senior level Med/Surg class, or in an OB class, because the sentinel event analysis focuses on an event with a healthy newborn. Prior to the class, I ask the students to complete the following homework: 1) Please go to the website for The Joint Commission (www.jointcommission.org ) and use the “Sentinel Event” link at the top of the homepage to read all the background information on sentinel events. Use the “Patient Safety” link and read the provided information on National Patient Safety Goals. Download the “2009 NPSG Powerpoint Presentation” and review it. Take notes on the NPSG that are new for 2009. 2) Please read the following two articles: Berntsen, KJ. (2004). How far has health care come since “to err is human”? Exploring the use of medical error data. Journal of Nursing Care Quality. 19(1): 5-7. Smetzer, JL. (1998). Lesson from Colorado: beyond blaming individuals. Nursing Management. 29(6): 49-51. 3) Be sure to review levels of research evidence as outlined in Chapter One of: Ackley, B.J., Ladwig, G.B., Swan, B.A., & Tucker, S.J. (2008). Evidence based nursing care guidelines. St. Louis: Mosby During class, we review what the students learned about sentinel events and NPSG from The Joint Commission’s website. I focus the discussion on the connection between sentinel event reporting and the evolution of new NPSG each year. We also spend time on the NPSG for the coming year. The Berntsen article is useful in recounting recent history of systems’ approaches to addressing patient safety issues. Although new approaches have emerged in patient safety since this 2004 article, Berntsen’s article is helpful in providing students a sense of how systems change, and some of the barriers in the years immediately after “To Err Is Human.” We also review the Smetzer article together in class. This article outlines a sentinel event from Colorado that resulted in the death of a newborn. This 1996 case resulted in three nurses being indicted on charges of negligent homicide. The author of this article used information prepared for the trial to identify over 50 different failures in the system that allowed this error to develop, remain undetected and ultimately, reach the infant. As one of the article’s most poignant points, the author states, “Had even one not occurred, the chain of mistakes would have been broken and the infant would not have been harmed.” (p48). After the class discussion, I ask the students to complete the following paper: In her article, Lessons from Colorado: Beyond Blaming Individuals, Judy Smetzer identifies 14 system failures that were present in the case newborn Miguel. These 14 system failures are: Incomplete clinical information The language barrier Inconsistent procedure for communicating prenatal care Staff inexperience and poor documentation Nonstandard method of writing the drug order Insufficient drug information Lack of a unit dose system Insufficient information on infant injections Inconsistent independent double check system No staff education before dispensing nonforumlary drugs Insufficient drug information and inadequate drug references Unclear definition of nonphysician prescriptive authority Unclear manufacturer labeling Conflicting information on IV use of milky white substances Choose two system failures from Smetzer’s list of 14 and complete the following assignment: For each system failure that you choose, write a paragraph explaining how the system failure contributed to the sentinel event of the article. What kind of precautions would be needed to avoid a repetition of this particular system failure? From which discipline might this precaution emerge (e.g. nursing, pharmacy, medicine, nursing administration, hospital administration)? For each of the system failures that you have chosen, find the most recent piece of evidence, with the strongest level of research evidence (I – VII) that demonstrates either research being done in this area, or new recommendations to address this particular system failure. If you cannot find any evidence based practice, or research in this area, see if you can find a national initiative (e.g. National Patient Safety Goal, initiative from 5 Million Lives Campaign, initiative from The Leapfrog Group, IOM recommendation) that addresses this system failure. Provide a summary of the article or initiative, and if appropriate, attach a copy of the article to your paper. Submitted Materials: Additional Materials: Evaluation Description: The Smetzer article is an extremely powerful exploration of a sentinel event for junior nursing students' reading. They are consistently captivated by the accessability of the 14 system failures outlined in Smetzer's very concise article. I have often not graded this assignment, but use it for small group discussion, because the article is often a turning point for the students in understanding how errors are not about blaming individuals but about addressing systems.

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

Published Back to Strategy Search Strategy Submission Unfolding Case Study to Teach Assessment and Care of the High-Risk Newborn Author: Elizabeth Riley DNP, RNC-NIC, CNE Title: Clinical Assistant Professor Coauthors: Nicole Ward, PhD, APRN, WHNP-BC, RN; Leslie McCormack, MSN, CNM, RN; Natalie Capps, MNSc, RN Institution: University of Arkansas for Medical Sciences – College of Nursing Email: eriley@uams.edu Competency Categories: Evidence-Based Practice, Patient-Centered Care, Safety Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Classroom, Skills or Simulation Laboratories Strategy Type: Case Studies Learning Objectives: 1. The student will identify the major complications requiring care in infants born to diabetic mothers (IDM) to promote patient safety. (Knowledge) 2. The student will describe the pathophysiological basis of the major complications in IDM for early assessment and patient-centered care. (Knowledge) 3. The student will recommend the patient-centered care provided to high-risk newborns who are IDM based on risk factors and individualized patient information (labs & assessment) using evidence-based guidelines. (Skills) Strategy Overview: Research shows that unfolding case studies can be used as formative assessment technique to aid with experiential learning (Kaylor & Strickland, 2015). The purpose of this assignment was to create an unfolding case study scenario that students could complete as an alternative clinical assignment that would use a formative assessment method, similar to a clinical experience. Case studies have been discussed in the literature as a method for alternative clinical assignments to promote critical thinking and ensure students make connections between didactic knowledge and clinical experience (Bowman, 2017). This case study can be completed by students asynchronously or synchronously as a group and can be implemented in both the face-to-face classroom or online environments. The case study should be implemented in parts, utilizing the identified sections (1, 2, and 3). For synchronous environments (face-to-face or online), students should be instructed to identify, describe, and examine their answers to each question with the instructor providing support and guidance throughout the entire unfolding case. For asynchronous environments (online), students can complete their answers to the case study and receive individualized instructor feedback upon submission. Students can meet the learning objectives by using the resources (provided or instructor chosen, ex: textbook) to answer the questions within each scenario. Answers should be thorough and provide enough information that covers all pertinent areas of management and care of the IDM with emphasis on safety, patient-centered care, and evidence-based guidelines. Safety should be addressed through student identification of abnormal lab values, signs/symptoms requiring further assessment, and discussing the RN’s role to ensure safe patient care to the IDM in the specific scenario. By addressing these aspects of safety, students will examine their role in communication and implementing interventions to ensure reduced risk of patient harm. Patient-centered care is addressed through standards of care for the IDM and the use of communication and patient teaching for the parents of the IDM. Evidence-based practice will be addressed by the use of guidelines and resources (provided in references) to determine the best clinical practice and management of the newborn in the scenario. Submitted Materials: 266.1.docx - https://drive.google.com/open?id=1r3ltmy_RNDaiGPv-y-sauy9ReYVznRuK&usp=drive_copy Additional Materials: Evaluation Description: The strategy evaluation of this assignment is through formative assessment in either face-to-face or online environments as an asynchronous or synchronous activity. The use of formative assessment allows the instructor to assess students’ performance during the learning activity in a face-to-face format by walking through the students’ responses to the questions synchronously during class time. If utilized in the online environment, the case study can be implemented formatively following a recorded lecture asynchronously. Through the online format, instructors can require students to submit their written answers to the case study to be formally reviewed by the instructor with individualized feedback. The case study should evaluate the students’ learning related to the pathophysiological presentation, evidence-based care, and management of IDM. Students should reference evidence-based guidelines, such as The S.T.A.B.L.E. textbook (gold standard for hypoglycemia and airway management for newborns), referenced journal articles, and organizational websites (American Diabetes Association [ADA], 2020; Karlsen, 2012; Mimouni, Mimouni, & Bental, 2013; Rubarth, 2015), to answer the case study questions from each scenario section.

Published Back to Strategy Search Strategy Submission OB Case Studies for Application of QSEN Safety Competencies: Examination of the Concept of a ‘Just Culture’ through Root Cause Analysis 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: Safety Learner Level(s): Pre-Licensure BSN Learner Setting(s): Classroom Strategy Type: Case Studies Learning Objectives: Following implementation of this strategy, the student nurse will: Describe factors that create a culture of safety (such as open communication strategies and organizational error reporting systems). Describe processes used in understanding causes of error and allocation of responsibility and accountability (such as root cause analysis). Participate appropriately in analyzing errors and designing system improvements. Engage in root cause analysis rather than blaming when errors or near misses occur. Value vigilance and monitoring (even of own performance of care activities) by patients, families, and other members of the health care team. Value own role in preventing errors. Strategy Overview: Background of Strategy: Considering the high risk stakes and high costs of obstetrical care and that many deaths attributable to human error may be potentially preventable, the Maternity Nursing classroom or clinical sitting (clinical conference) provide a forum that is ripe for application of the QSEN Safety Competencies. This strategy focuses on promoting a culture of safety and the role of root cause analysis. Implementation of Strategy: To challenge senior nursing students in their Maternity Nursing Course to embrace the concept of just culture, an obstetric case study is presented in which patient safety is jeopardized. (Three sample case studies are provided in the attachments.)Students are divided into teams to review the timeline of events of the same case study. As the investigative team, students must decide on clear roles and methodologies in the analysis of findings and identification of root cause (of the patient safety problem). A root cause analysis flow-sheet is provided to the teams for a systematic approach. Determination of root cause is followed by devising a plan for corrective action. Students utilize a just culture algorithm to ensure that appropriate corrective actions are implemented. Facilitation of effective channels of communication is reflected in their plans. Use of course textbooks and electronic resources are encouraged in order to research system policies and standards of practice (such as AWHONN and ACOG). System weaknesses are evaluated in relation to individual healthcare provider performance. Students gain not only an understanding of maternity care risks but also of health care system policies and practices. The concept of a ‘just culture’ is brought to life through student participation resulting in increased awareness, understanding and appreciation of the complexities of the health care system. Groups share their findings with all participants at the culmination of the activity. Submitted Materials: Additional Materials: Evaluation Description: A survey was used to evaluate student response to this teaching strategy. By self-report, students in the first participating class (n=50) ‘agreed’ to ‘strongly agreed’ to an increased understanding of root cause analysis (92%) as well as increased awareness and appreciation of the complexities of the health care system when patient safety is jeopardized (95%). A sample of the survey is attached. In order to measure knowledge gained, a pre and post activity quiz was devised to assess student understanding of ‘just culture’ and root cause analysis. A sample of the quiz is attached.

Published Back to Strategy Search Strategy Submission Collaborative Exams to Promote Learning Through Teamwork and Collaboration Author: Katie Morales PhD, RN, CNE Title: Assistant Professor Coauthors: Institution: Berry College Email: KMorales@Berry.Edu Competency Categories: Teamwork and Collaboration Learner Level(s): Pre-Licensure BSN Learner Setting(s): Classroom Strategy Type: General Strategy Learning Objectives: The objective for this learning activity was to assess and promote learning individually and through teamwork and collaboration. Teamwork and Collaboration: Knowledge: Describe impact of own communication style on others. Discuss effective strategies for communicating and resolving conflict. Describe own strengths, limitations, and values in functioning as a member of a team. Skill: Solicit input from other team members to improve individual, as well as team, performance. Learning Objectives: 1) Assess and promote learning through teamwork and collaboration. Teamwork and Collaboration: Knowledge: Describe impact of own communication style on others. Discuss effective strategies for communicating and resolving conflict. Describe own strengths, limitations, and values in functioning as a member of a team. Skill: Solicit input from other team members to improve individual, as well as team, performance. Initiate actions to resolve conflict. Strategy Overview: This teaching strategy involves collaborative exams to promote learning through teamwork and collaboration. Collaborative exams are an evidence-based practice to help nursing students develop and practice team work and collaboration skills (Improved Class Preparation and Learning Through Immediate Feedback in Group Testing for Undergraduate Nursing Students by Peck, Stehle Werner, and Raleigh [2013]). Collaborative exams incorporate several learning theories (cognitive-developmental behavioral learning, social interdependence, and constructivism). The collaborative exam provides active and collaborative learning, immediate feedback, and structure which appeal to millennial learners. Collaborative exams are an interactive learning strategy allowing students to work together and answer exam questions. The items on the individual exams are developed each semester based on course objectives by the faculty members. Items may be original or from a test bank of previously used items. Test bank items are edited based on past exam analysis. All course faculty should edit course exams for content, clarity, and adherence with course objectives. The exam items and answer options are randomized on both the individual and collaborative exams to reduce the possibility of unplanned collaboration. To prepare the collaborative exam, the faculty simply copy the individual exam as a collaborative exam. Following a test-retest strategy, students take the individual exam again as a member of a small group immediately following the individual exam. In the initial cohort, when offered the opportunity to participate in the collaborative exam, all students elected to participate. Because the collaborative exam promoted group interaction and interpersonal skills, the collaborative exam was adopted in the course and used with all following cohorts since implementation. If a student misses a course exam, he/she must notify the course faculty prior to the exam and have an excused absence for the exam period. If excused, he/she may be given an alternate exam in an alternative format. If a student misses a course exam, he/she forfeits the collaborative exam and, subsequently, the collaborative points. Furthermore, to ensure success in the course and on National Council Licensure Exam (NCLEX-RN® exam), students scoring below 80 on any individual exam are given a remediation plan regardless of their collaborative scores. All individual post-exam remediation assignments must be completed prior to the next exam or three points will be deducted retroactively from the student’s grade on the individual exam which required remediation. Procedure Upon completion of the individual exam, students remain quietly (without electronics) in the exam room for the collaborative exam to begin. Collaborative exams occur after each exam. The final exam is not included as it is comprehensive. Students are placed in groups of 4-5. Student placement has included random assignment, assignment based on individual scores, or in learning groups used across the curriculum for the semester. All assignment options have worked well. Students have not reported being assigned groups rather than being allowed to choose their groups as an issue. One person per collaborative group logs into a copy of the individual exam. No other additional group members log into the exam. The team leader submits one exam for the group. As a result, students must reach consensus on the best answer. The collaborative exam allows the faculty to assess and promote learning. To assess learning, collaborative exams are scored in the same manner as the individual exams on a scale of 0-100. To incentivize the students and avoid grade inflation, points are awarded to each student’s individual exam score based on the following: Collaborative score of A (90-100) = 2 points Collaborative score of B (80-89) = 1 point Collaborative score of less than 80 = 0 points Upon completion, the items the group missed on the collaborative exam are displayed. As group members view and discuss the rationales, no other exam reviews are conducted in these courses. Discussion fosters learning among the groups. Students debate, integrate and synthesize course material while it is still foremost in their minds. The collaborative exam allows students to actively engage with the content and one another and obtain instant feedback to correct misconceptions. Immediate feedback is more effective than traditional testing to enhance learning (Peck, Stehle Werner, & Raleigh, 2013). Test-retest methods provide immediate answers to lingering questions, correct misconceptions, and promote retention of knowledge (Hann, Roberts, & Hurley, 2016). Students commented knowing the correct answers immediately was more effective than trying to recall and look up the items after class. Furthermore, immediate feedback from collaborative testing may improve final exam scores. Group collaboration increases learning and enhances critical thinking. Students work together, use active problem solving, and defend their positions. Students improve their analytical skills and critically evaluate the answer options based on group ideas and opinions. Students teach one another as they collaborate and reach consensus on the best answer. Consistent peer to peer deliberate practice may improve retention of student learning (Johnson, 2016). Students develop knowledge and skills for team work and collaboration during the collaborative exam. The students describe the impact of their own communication style on others as they solicit input to improve individual and group performance. The collaborative exam promotes effective communication and conflict resolution. Students were able to speak freely and reported verbal and non-verbal behaviors were appropriate and respectful. Although the author was prepared to initiate actions to resolve conflict, this was never necessary. Debriefing included the lively group discussion and debate regarding each question. Faculty reported fewer negative and argumentative behaviors following the collaborative exams. This learning strategy integrates the QSEN competency of teamwork and collaboration as students identify their own strengths limitations, and values when functioning as a team member. Students assess their personal learning through the collaborative exam. A top performing student learned she had to be more assertive while some lower performing students learned they had misplaced confidence in their knowledge. Additionally, students are offered the Loma Linda (2006) Learning Assistance Program Objective Analysis Worksheet to identify areas of strengths and weaknesses following each exam. In conclusion, the collaborative exam can be easily adapted to any learning setting to promote learning and team work, decrease test anxiety, and motivate students (Hann, Roberts, & Hurley, 2016). The faculty benefit from hearing the group discussion and seeing enthusiasm replace the typical post-test anxiety. Submitted Materials: 227Collaborative-Exam-Evaluation-.docx - https://drive.google.com/open?id=1qHP8vAqFWdtE7146pm2trtc34o-GIJbF&usp=drive_copy Additional Materials: Collaborative Exam Evaluation Selected References Hann, K., Roberts, T., & Hurley, S. (2016). Collaborative testing as NCLEX enrichment. Nurse Educator,00(0), 1-4. Doi: 10.1097/NNE.0000000000000241 Johnson, C.E. (2016). The effect of deliberate practice combined with high-fidelity simulation scenarios on psychomotor skill competency and retention in prelicensure nursing education: A mixed methods study. Retrieved from ProQuest Dissertations and Theses database. (Mercer University No. 10302144). Peck, S., Stehle Werner, J.L., & Raleigh, D.M. (2013). Improved class preparation and learning through immediate feedback in group testing for undergraduate nursing students. Nursing Education Perspectives, 34(6), 400-404. Doi: 10.5480/11-507 Evaluation Description: Informal student and faculty feedback have been obtained over the three-year period of collaborative exam implementation. The areas explored informally have been included on the Collaborative Exam Evaluation template for student and faculty use.

Published Back to Strategy Search Strategy Submission Health Literacy Learning Activity Author: Tammy Spencer MS, RN Title: Senior Instructor Coauthors: Kathy Foss, MS, RN Institution: University of Colorado Denver College of Nursing Email: tammy.spencer@uchsc.edu Competency Categories: Patient-Centered Care Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Classroom, Clinical Setting Strategy Type: Case Studies Learning Objectives: Provide patient-centered care with sensitivity and respect for the diversity of human experience. Value seeing health care situations “through patients’eyes.” Examine common barriers to active involvement of patients in their own health care processes. Describe strategies to empower patients or families in all aspects of the health care process. Recognize the boundaries of therapeutic relationships. Strategy Overview: This learning activity works well with any level pre-licensure student, and is an excellent activity for a post clinical conference. The students will need to complete the following reading before this learning activity: Center on an Aging Society (1999) Low health literacy skills increase annual health care expenditures by $73 billion. Washington D.C.: Georgetown University. Accessed on the web 10/6/08 at: http://ihcrp.georgetown.edu/agingsociety/pubhtml/healthlit.html Center for Medicare Education.(2000).Considering health literacy. Issue Brief Vol. 1 No.6. Institute for Healthcare Advancement. (2008). Easy to use California advance health care directive. (pdf attached) Downloaded from the web on 10/6/08 at: http://www.iha4health.org/index.cfm/MenuItemID/266/MenuSubID/195.htm Instructions for the Instructor: This activity is to be done as a single post clinical conference experience ideally by the mid-term point in the rotation. The students will divide into pairs and perform the role of nurse or patient in a learning activity designed to illustrate the experience of having limited language skills similar to those experienced in situations of low health literacy. The role descriptions for the nurse and patient are attached as separate files. Following the Learning Activity: In Another’s Shoes, discuss the questions listed below. As part of this activity, share your own examples of forms, literature, etc. used in your organization that are written in an easy to read and easy to understand format. An evaluation follows this exercise. Students need to complete the evaluation and return it to you. At the end of the rotation, please return the learning activities evaluations to the course coordinator. Instructions for the Learning Activity: Divide students into pairs. Each student chooses one role (For example: Student A is the Nurse, Student B is the Patient) The student does not look at his/her partner’s instructions. Instruct the student to read the entire role sheet prior to starting the activity. Non-verbal communication can be used in this exercise. Students should role play for 2 – 3 minutes. Submitted Materials: 98.health-literacy-learing-activity-Evaluation.doc - https://drive.google.com/open?id=1YFTvxXzLZd9eH0F9LB_lEiFdFbDR1zmY&usp=drive_copy 98.QSEN_Learning_Activity_7_role_playing_instructions.doc - https://drive.google.com/open?id=1YFTvxXzLZd9eH0F9LB_lEiFdFbDR1zmY&usp=drive_copy Additional Materials: Evaluation Description: Following completion of the Learning Activity , use the following questions* as a guide for clinical instructor/student discussion: Tell about your experience in your role as nurse or patient. How does this exercise correlate to the frustrations experienced by nurses trying to provide health care information to clients who have low health literacy skills or limited ESL skills? How does this exercise correlate to the frustrations experienced by patients trying to assimilate healthcare information without relying on printed materials? What other factors might play a role in a patient’s understanding of health information? (For example: Medications that cause memory loss, sleep deprivation) What is health literacy? How can nurses assess illiteracy and adapt approaches to patient teaching? How does low health literacy skills impact patient outcomes? What resources are available on your unit or in your organization to assist patients with low health literacy skills? Why is it important to assess patient literacy? How does health literacy play a role in patient safety? * Reference: Young, J. & Ironside, P. Patient Teaching and Safety: Exploring Health Literacy. www.qsen.org An evaluation tool was used to collect student attitudes and feedback (attached document).

Published Back to Strategy Search Strategy Submission Reframing Constructive Criticism Using Reflection Based on QSEN Competencies Author: Gerry Altmiller EdD, MSN, APRN Title: Assistant Professor Coauthors: Institution: La Salle University Email: Altmiller@lasalle.edu Competency Categories: Safety, Teamwork and Collaboration Learner Level(s): Faculty Development Strategies, Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Clinical Setting Strategy Type: General Strategy Learning Objectives: Appreciate the importance of intra- and inter-professional collaboration Contribute to resolution of conflict and disagreement Appreciate the cognitive and physical limits of human performance Strategy Overview: Constructive criticism has been identified as a triggering event for incivility in nursing education. As part of professional development, it is essential that faculty create strategies to deliver constructive criticism without injuring with the faculty student relationship. This tool, while not all inclusive, provides examples of how constructive criticism can be reframed. Using the QSEN competencies, particularly the attitudes, as a guide, instructors can reframe their discussions with students regarding poor performance. With the instructor’s assistance, students can reflect on their performance and extract a realistic appraisal of the level of safe practice they have demonstrated, viewing it from the patient perspective. Such processes of reflection may help the student arrive at the conclusions that frequently are now communicated directly by the faculty member and so frequently serve as the triggering event for incivility in the faculty student relationship. Submitted Materials: 108.QSEN-Constructive-Criticism-Tool.doc - https://drive.google.com/open?id=1n2JkfiPECmbp6oAtiFaSwpbE23mfGPmG&usp=drive_copy Additional Materials: Evaluation Description: This tool was created to serve as an example of how direct constructive criticism of poor student performance can be reframed using the QSEN competencies. It has not been formally evaluated but has been offered as a strategy to reduce incivility in nursing education by improving communication techniques between faculty and students. Faculty can determine if it increases comfort level in situations of duress where student performance necessitates constructive criticism.