INTRODUCTION:

Our health care system has significant safety and quality problems. There is a need to redesign what and how we teach the next generation of nurses and other health care professionals so that they understand what goes into, ensuring good and safe care and can identify and bridge the gap between what is and what should be. People become nurses in- order to relieve suffering and contribute to the overall health of communities and individuals. Quality carries a moral and ethical imperative¹. Quality care is an essential value. We have to recognize the strong link between nursing education and the ability to provide safe patient care. Towards this end, need to promote continued innovation in the development and evaluation of methods to promote and assess student learning of the knowledge, skills and attitude of the six competencies as well as develop the faculty expertise necessary to assist the learning and assessment of achievement of quality and safety competencies in all nursing programs and create a mechanism to sustain the will to change among all programs.

What is QSEN?

Quality and safety education for nurses (QSEN) is to prepare future nurses to have the knowledge, skills and attitudes (KSA’s) necessary to continuously improve the quality and safety of the health care system in which they work ².

Quality and safety is the both global and local issue. Therefore educators across the disciplines are coming together to work on curricular reforms.

Ø Knowledge

– Describe strategies for learning about the outcomes of care in the setting in which one is engaged in practice

Ø Skills

– Seek information about outcomes of care for populations served in care setting

– Seek information about quality improvement projects in the care setting

Ø Attitudes

– Appreciate that continuous improvement is an essential part of the daily work of all health professionals

Nurses are a core part of the changing quality and safety paradigm in health care. New roles and expectations of nurses lend urgency to call to transform nursing curricula and new graduate competencies to match practice setting and patient care needs.

Six Safety competencies Identified by QSEN:

There are 6 quality and safety competencies for nurses identified by QSEN; these following six competencies, which apply across the health professions are not separate linear concepts but each interacts with others to create the whole².

1. Patient centered care

2. Team work and collaboration

3. Evidence based practice

4. Quality improvement

5. Safety

6. Informatics

Patient-Centered Care:

Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs. Patient-centered care encourages active engagement of patients in their care, thus enhancing quality and safety by including the patient and family as watchful partners. As part of patient-centered care, more delivery settings have open visiting hours and transparency of information to insure individual and family needs are met. Students and faculty are exposed to variations in how clinicians implement partnerships with patients and families. Faculty exposure to model units, however, can better enable them to help students develop and apply these skills in all environments in which clinical instruction occurs. Increasing chronic illness translates to more patients presenting with co-morbidities with increasingly complex patient care needs that require coordinating care across interdisciplinary teams. The traditional student clinical experience involves caring for 1 or 2 patients on 1 or 2 days per week, making it difficult to grasp these complexities of care and the complete illness trajectory. Students may not always have opportunities to witness shared decision-making and may not see ways to incorporate patient preferences and values into individualized plans of care, yet these complex negotiations are critical to achieving good outcomes. Increasingly, schools offer a capstone course to allow students a more sustained exposure to the progression of care that patients encounter. Designing a capstone course together is an ideal academic-practice partnership activity and, with planning, this course can begin the transition to practice and foster seamless movement to the practice setting’s residency program ³.

Teamwork and Collaboration:

Function effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care. Team collaboration skills are essential to the delivery of reliable, coordinated care across interprofessional teams, settings, and periods. Education about communication has traditionally focused on developing empathy and the ability to assess and educate patients and families⁴. The primary focus of instruction about teamwork instruction was about working in nursing teams and delegation to assistive personnel. Even though teams of people deliver most care, education has been primarily focused on developing individual responsibilities within the silo of one’s own discipline. Practice-education partnerships are a valuable resource for designing teamwork and collaboration skill development. Faculty members need exposure to high functioning interprofessional teams so they can know how to help students develop those competencies, regardless of setting. Practice setting leaders and faculty could, together, identify good partners for student exposure to interprofessional communications and decision making, such as working with physician partners in setting up joint learning sessions for nursing and medical students to practice communication with each other.

Evidence-Based Practice:

EBP integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care. Safe, high quality health care requires knowledgeable workers who practice from a framework of scientific evidence. Nurses are confronted with rapidly expanding evidence in all areas to inform decision-making, but what learning opportunities are provided for students to search and evaluate this evidence and apply it in practice³. Competencies related to evidence-based practice intersect with those for informatics as nurses use search engines and databases to locate studies and integrative reviews to understand the evidence for specific care protocols. Care standards and protocols should derive from scientific evidence and there are specific skills nurses utilize in determining applicability of databased decision-making⁴.

Quality Improvement:

(QI) Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems. Quality of care is determined by the degree to which health services increase the likelihood of achieving desired health outcomes that are consistent with current knowledge. Organizations assess the degree to which the actual care patients receive matches the quality standard of care and known best practice, and initiate quality improvement processes to close any gaps. Quality initiatives have so permeated health care settings, that chief nurse executives indicate it requires the majority of their time. Student and faculty experiences with quality improvement methods and outcomes may be limited to assessing and following guidelines for care in particular settings; however, they may not be in the same facility long enough to observe or participate in an improvement project from beginning to end. Innovative practice academic partnerships have the potential to improve outcomes and quality improvement competencies for both settings³.

Safety:

It Minimizes risk of harm to patients and providers through both system effectiveness and individual performance. Building a safer health care system means designing processes of care that prevent or minimize harm. Patients have the right to know that treatment plans will be implemented reliably and safely to achieve optimal outcomes. Nurses have historically focused on creating safe environments for patients, performing such interventions as the “5 rights” of medication administration, assessing risks for falls, and other environmental monitoring activities. Individuals who made errors were punished. Safety science includes knowledge about working in teams, using information and information technology, quality measurement, and communicating with patients about error. Communication failures and poor working relationships are key factors in most untoward events in health care³. Faculty, together with clinicians, can teach and role-model behaviors that welcome “clarifying” questions when any team member (including student, patient or family member) sees the possibility of an error. Clinicians can help students understand how safety data are collected, analyzed, and benchmarked against national standards, and how and why root-cause analyses of safety events and near misses are conducted and looped back to improve the system⁴.

Informatics:

Use information and technology to communicate, manage knowledge, mitigate error, and support decision-making. Nurses must master an array of communication, information, and care-delivery technologies, yet often lack a basic foundation of informatics literacy that would facilitate their role in the design, selection, application, and evaluation of new products. Both practice and education continue to overcome a generation gap in informatics competencies. Competency in informatics allows nurses to search for and evaluate information sources, provides the skills to navigate computer order entry systems that provide decision support and help flag errors, and use electronic record systems. Patients are increasingly using electronic information sources requiring nurses to know how to evaluate and guide them in appropriate assessment and application of information².

CONCLUSION:

The growing focus on ensuring and measuring quality and efficiency of healthcare outcomes necessitates markedly transformed graduate-level nursing education. In keeping with the Institute of Medicine’s report on the Future of Nursing (2011), graduate nurses will be the future leaders in practice, administration, education, and research. Due to healthcare reform, multiple changes in the delivery of care, and the number of clients globally with access to this care, the need for highly educated nurses will expand dramatically. It is essential that these nurses understand, provide leadership by example, and promote the importance of providing quality health care and outcome measurement⁴.

REFERENCES:

1. American Association of Colleges of Nursing (2011). The Essentials of Master’s Education in Nursing. Washington, DC: Author

2. Cronenwett, L., Sherwood G., Pohl, J., Barnsteiner, J., Moore, S., Sullivan, D., Ward, D., & Warren, J., (2009). Quality and safety education for advanced nursing practice. Nursing Outlook, 57, 338-348.

3. Institute of Medicine. (2011). The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press.

4. Smith, E. L., Cronenwett, L., & Sherwood, G. (2007). Current assessments of quality and safety education in nursing. Nursing Outlook, 55 (3), 132-137.

Received on 21.06.2013 Modified on 02.10.2013

Asian J. Nur. Edu. & Research 4(2): April- June 2014; Page 172-174