Quality and Safety In Nursing Education
What Is Quality and Safety
Quality and safety are essential outcomes of nursing care. The Quality and Safety Education for Nurses (QSEN), a Robert Wood Johnson Foundation (RWJF), funded grants (2007-2012) and developed competencies (patient-centered care, team work and collaboration, safety, quality improvement, informatics, and evidence based practice) and resources to accelerate the education of nurses in contemporary quality and safety concepts (QSEN.org).
The goal of QSEN, now the QSEN Institute at Case Western Reserve
University, is to ensure that all nurses have the knowledge, skills, and
attitudes to continuously improve the quality and safety of the health care
systems in which they work (Cronenwett et al. , 2007, 2009).
Requirement of Quality and Safety Education In Nursing
Quality and safety education requires an extension of current nursing education content that focuses on individualized plans of care to include systems of care and systems thinking (Dolansky & Moore, 2013). The QSEN competencies guide this shift, and the knowledge, skills, and attitudes are tailored for undergraduate education (Barton, Armstrong, Preheim, Gelman, & Andrus, 2009) and graduate education (Pohl et al., 2009). The American Association of Colleges of Nursing (AACN) baccalaureate and doctoral essentials both include quality and safety as key competencies.
The
application of quality and safety content occurs in academic and practice
settings during the development of overall curricular programming including
individual courses, teaching strategies, simulation scenarios, and clinical
experiences (Armstrong, Spencer, & Lenburg, 2009 ) . The application of
quality and safety education content also occurs in academic clinical
partnerships at the institutional (Didion, Kozy, Koffel, & Oneail, 2013),
regional, or state levels (Disch, Barnsteiner, & McGuinn, 2013 ) .
Evidence for the use of the QSEN framework is widespread. QSEN competencies are incorporated in nursing textbooks (Ignatavicius & Workman, 2013) and in books regarding quality and safety (Sherwood & Barnsteiner , 2012). Quality and safety competencies are incorporated into the National Council of State Boards of Nursing (NCSBN) nurse residency pilot programs (NCSBN. 2013) and educational programs delivered by professional specialty organizations such as the American Operating Room Nurses.
In addition, many nursing models contain the OSEN competencies as an educational competency platform for practicing nurses.To assist with the integration of quality and safety principles in nursing education, the AACN provided regional Faculty Development Institutes for both baccalaureate and graduate levels with the support of the RWJF. These workshops are available without cost and can be accessed from both the AACN and QSEN websites ( Barnsteiner et al., 2013; Disch et al., 2013).
Competencies In Safety and Quality Education
Quality and safety competencies can be taught in a variety of settings using many methods. Settings include the classroom, low and high-fidelity simulation, and clinical setting. The QSEN website contains a database of teaching strategies that can be used in all settings. Teaching strategies are submitted by faculty across the country and peer reviewed. Simulation teaching strategies are available that use single to multiple simulations ranging from pediatrics to the aging adults (Sharpnack & Madigan, 2012).
Classroom and clinical teaching strategies are described and evaluated for graduate-level nurses that include and nursing administration (Miltner, Patrician, Dawson, & Jukkala , 2012). In addition, QSEN teaching strategies have been published as root cause analysis (RCA), post-conference quality improvement initiatives, and a safety assessment tool.A strategy to assist nursing schools to improve academic partnerships and facilitate the competencies of quality and safety is the dedicated education units (DEUs) or educational resource units.
These units share the primary objective of developing students' competencies at the individual and organizational levels and emphasize contemporary quality and safety competencies (Didion et al., 2013). Pilot studies published on academic clinical partnerships have demonstrated promising student outcomes in the facilitation of quality and safety (McKown, McKeon, McKown, & Webb, 2011).
Measurement of nurses' knowledge, skills, and attitudes of quality
and safety in nursing education curricula is an important aspect of educational
initiatives. Several psycho metrically sound instruments have been developed to
measure safety (Chenot & Daniel, 2010) and systems thinking (Dolansky &
Moore, 2013).
Impact of Quality and Safety Education In Nursing
Although progress has been made in quality and safety education in nursing, there are areas needed to accelerate impact. One area is to increase the number of psychometrically valid evaluation tools. This will provide the opportunity to compare data and benchmark progress across academic and clinical sites to determine what works and what does not. Instruments are needed to measure the knowledge, skills, and attitudes in all of the six QSEN competencies. Another area is to identify the essential components of formative and summative evaluation.
This includes using research methods to demonstrate efficacy of educational efforts. There is a need to continue faculty development to ensure that all faculty have the capacity to teach quality and safety. Although the QSEN initiative started this work, there continues to be gaps in the capacity for faculty teaching quality improvement. Lastly, to accelerate quality and safety education it is necessary to include an emphasis on quality and safety education in ambulatory care, and long-term care. These additions will contribute to education on improving the patient experience of care, improving health of populations, and reducing per capita cost of health care.
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