QSEN
Quality and Safety and Education for Nurses
Practice Standards
Melanie Guikema
Rene Larson
Steve Rich
Amanda Roberts
QSEN- What is it?
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Quality and Safety Education for Nurses
QSEN is a project of the American Association of College of Nursing
(AACN) and the Robert Wood Johnson Foundation initiative to ensure that
nurses and nursing students are educated in quality and safe nursing
practice.
The Robert Wood Johnson Foundation awarded a grant to fund a national
study to educate nursing students on patient safety and health care
quality. The lead investigator is Linda Cronenwett, PhD, FAAN and Dean
at University of Carolina at Chapel Hill School of Nursing. The study is
broken into four phases.
Goal of QSEN
“The overall goal through all phases of QSEN has been to
address the challenge of preparing future nurses with
the knowledge, skills, and attitudes (KSAs) necessary to
continuously improve the quality and safety of the
health care systems in which they work” (QSEN, 2013).
Phases of QSEN
Phase One: Outline of the core knowledge, skills, and attitudes (KSA’s) that should be mastered
by prelicensure nursing students. QSEN adopted six competency standards.
Phase Two: QSEN works with programs that support advanced practice nurses to define a
program to enhance education in the KSA’s for graduate study nurses. They also worked with
15 pilot schools to change curriculum to include education on quality and safe nursing practices
(QSEN, 2013).
Phase Three: Focuses on training faculty on quality and safe healthcare practices and
incorporating the information in texts (QSEN, 2013).
Phase Four: Supporting the IOM’s campaign to encourage nurses to further their education and
become advanced practice nurses (QSEN, 2013).
QSEN Practice Competency Standards
1.
Patient-Centered Care
2.
Teamwork & Collaboration
3.
Evidence Based Practice
4.
Quality Improvement
5.
Safety
6.
Informatics
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In addition to the six competencies, sets of KSA’s were created for each
competency. (QSEN, 2013)
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” (American Association of
Colleges of Nursing, 2012).
Knowledge associated with patient centered care includes the ability
to:
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Analyze multiple dimensions of patient centered care
Describe the limits and boundaries of therapeutic patient-centered care
Analyze strategies that empower patients in all aspects of the healthcare process
Integrate principles of effective communication with knowledge of quality and safety
competencies (QSEN, 2013)
Patient-Centered Care
Skills associated with patient centered care include:
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Providing patient centered care with “sensitivity, empathy, and respect for the diversity of
human experience” (QSEN, 2013).
Respecting the boundaries of therapeutic relationships
Encourage patients to be active partners in their own health care
Continuously improve own communication and problem solving skills (QSEN, 2013)
Attitudes include:
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“Value seeing health care situations ‘through patients’ eyes’” (QSEN, 2013)
Value shared decision making with patients, even if there is conflict
Respect patient preference for engagement in their own health care (QSEN, 2013)
Teamwork Important?
Teamwork is the reason for success for healthcare
facilities and their patients. There needs to be
communication through the whole process of care
through staff. Team work does not only apply to staff
to staff but also staff to patient. This is imperative for
the success of the patient and the healthcare facility.
Informatics
Definition: “Use information and technology to
communicate, manage knowledge, mitigate error, and
support decision making” (QSEN, 2013).
Why is Informatics Important?
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Informatics is huge in providing high quality of care to our patients.
Informatics allows healthcare professionals to record and document on
patient outcomes. These documentations will provide good learning
material for the future.
A huge part of informatics is technology. Technology allows
communication through electronic medical records, bar-code scanning
systems, and through other electronic sources. Informatics are so
important because technology is taking over healthcare.
Evidence Based Practice
“Integrate best current evidence with clinical expertise and patient/family
preferences and values for delivery of optimal health care” (American
Association of Colleges of Nursing, 2012).
Knowledge associated with evidence based practice (EBP) includes the
ability to:
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Describe EVP to include the components of research evidence, clinical expertise, and
patient/family values
Ability to critically appraise current research and identify any gaps in current EBP
Evaluate current EBP in the health care environment (QSEN, 2013).
Evidence Based Practice
Skills include:
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Modeling clinical skills based on current EBP
Initiate changes in care when new evidence shows ways to improve outcomes and/or decrease
adverse events (QSEN, 2013)
Attitudes associated with Evidence Based Practice include:
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Value knowing and understanding EBP for one’s practice specialty
Value the need for continuous improvement in clinical practice based on new knowledge
(QSEN, 2013).
Quality Improvement
Definition: using 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” (QSEN,
2013).
Quality Improvement
Examples of knowledge:
Explanation of strategies that enhance patient outcomes.
Distinguishing which quality measures are nationally approved.
Evaluating the importance of quality indicators and the necessity of change.
Examples of skills:
Interpreting quality improvement goals.
Using multiple data sources, such as flow charts and cause-effect diagrams to
evaluate various aspects of care.
Safety
Definition: minimizing the “risk of harm to
patients and providers through both system
effectiveness and individual performance”
(QSEN, 2013).
Safety
Examples of ways to incorporate safety into patient
care:
Establishing routines in all areas of care, as well as modifying any
behaviors that could lead to injuries and/or errors. Potential hazards
should be promptly reported to patients, families and/or staff members.
Acknowledging human performance limitations and accepting assistance
from others when needed, as well as identifying successful methods to
decrease reliance upon memory.
Rene Larson
In my current practice area of neuro/med-surg nursing, QSEN competencies affect my practice in
the following ways:
1. Patient-Centered Care: This is the heart of nursing at my facility, and something we try to excel at daily. I am
my patient’s best advocate, have learned to work with people from many different cultures, and strive to
communicate effectively every day.
2. Team Work: One person can not do it all. I work with many different disciplines in order to achieve the best
possible care for my patients.
3. Evidence Based Practice: I follow policies and procedures that are backed up by current EBP. This allows for
better patient outcomes. It is my responsibility to know current practice and how to access policies.
4. Quality Improvement: Providing the best possible care and maintaining quality indicators. These include
answering call lights in an appropriate time frame, managing pain, maintaining a quiet environment, preventing
infections, and being able to detect problems.
5. Safety: I maintain a culture of safety in my practice in many ways, including screening patients for being a high
fall risk and implementing a fall bundle (red socks, yellow bracelet, falling star on the door, bed/tab alarm)
6. Informatics: Technology is an important part of my practice. All of our charting/documentation is now done on
the computer. We carry individual phones so that we can be easily reached.
Steve Rich
The QSEN standards affect how I will work as a team. Teamwork is very important in
the healthcare world. Many different people are working to make a patient better
and there should be good communication and effort from everyone. These
standards will help me become a better nurse. I also take safety very seriously. I
think that making sure that the patients are in good hands is very important.
Making sure that my nursing aids are going their jobs and doing them properly. I
want to know that they know how to use the lifts correctly. I also maintain my
patients safety by completing assessments to tell me if they are a fall risk or at risk
for skin breakdown. Also following the policies and procedures is very important to
be. I want to be doing my best to be an advocate for my patients and educate them
so they can make the best decision as possible. Also the informatics is a great tool.
Having computers to help keep things on track is beneficial to everyone in the
healthcare field. QSEN set many great standards for us nurses.
Melanie Guikema
A few ways that I incorporate safety into my nursing duties while working is
to
➔ complete a fall assessment on a new admission and to make sure that
those at risk for falls are being closely monitored with alarms, red star on
their door, etc.
➔ Reminding aides to always use a gait belt when transporting patients,
reminding myself to always use proper body mechanics (ie: bending at
the knees when lifting, raising the bed to a working height when
completing dressing changes, etc.)
➔ Never recapping needles, wearing gloves during direct patient contact
and properly washing my hands between patients.
Amanda Roberts
I incorporate practice standards in my nursing care by utilizing the practice standards outlined by QSEN.
1.
Patient-Centered Care- When providing care for patients I strive to be attentive to their mental, physical, emotional, and
spiritual needs. Ensuring patients and their families fully understand and are in agreement with their plan of care.
2.
Team Work: Working as a team in a 24 hour care facility is extremely important. At times we have to finish what other
nurses have started and share the workload in order to provide quality care.
3.
Evidenced Based Practice: Utilizing educational opportunities available for CEU’s and education offered by my place of work
I am able to learn and keep up on current practices and utilize them in my care. Michigan requires 25 CEU’s to be completed every
two years with one credit in pain and symptom relief, I have kept up on these requirements every year.
4.
Quality Improvement: Where I work there are monthly quality improvement meetings and the nurses take turns attending the
meetings. This allows the facility to work together to resolve problems to improve patient care. For instance, we discussed recurrent
urinary tract infections and opted to have someone come in to educate the staff on proper assignment and fitting of incontinence
products and products to use for proper perineal care. We also elected to educate staff on proper bladder training programs to
decrease incidence of catheterizations.
5.
Safety: I am constantly thinking about safety when I am working by ensuring that I am utilizing the five rights of medication
administration, providing safety measures for patients who need assistance with safe transferring, ensuring patients are free from
neglect and abuse, and proper monitoring of patients.
6.
Informatics: Where I currently work we do not utilize computers for medical charting and medication administration, but we
use computers for education and communication through email. They are also working on installing a program that we text on-call
physicians instead of the paging system.
References
American Association of Colleges of Nursing. (2012). Graduate-level QSEN competencies:
Knowledge, skills and attitudes. Retrieved from
http://www.aacn.nche.edu/faculty/qsen/competencies.pdf
Quality and Safety Education for Nurses. (2013). Evidence based practice. Retrieved from
http://qsen.org/competencies/graduate-ksas/#evidence-based_practice
Quality and Safety Education for Nurses. (2013). Graduate ksas. Retrieved from
http://qsen.org/competencies/graduate-ksas/
Quality and Safety Education for Nurses. (2013) Project overview. Retrieved from
http://qsen.org/about-qsen/project-overview/
Quality and Safety Education for Nurses. (2013). Patient centered care. Retrieved from
http://qsen.org/competencies/graduate-ksas/#patient-centered_care