QSEN
1. Ensuring
 Improving nursing outcomes in the healthcare setting. And professionalism of
nursing
 Safe quality care
2. Role of the nurse
 The role of the nurse: altering professional identity.
 Not only a caring but also knowledgeable
 Involved in continually assessing pt.
 QSEN came out of IOM Report due to errors in hospitals due to people not
following protocol, medical errors, mistakes, incorrect surgeries.
 Changing the perception of the nursing care
 Supporting quality and safety in the hospital
 More than just following what the doctor orders
 Nurses being included in the care; Providing quality care as a team
 High reliability- best care possible in the overall environment of work
 Interprofessional collaboration: equal partner in care. Everyone has a job that we
need to do. Respecting others job and being proficient in your job. Also getting
help to provide the best and most safe care.
 Communication: with the pt, other members of the health care team, charting.
3. Raising the Bar:
 Came in play because the Intitute of medicine was concerned with “raising the
bar” in the type of healthcare we provide. Pt. oriented
 Intentional emphasis on nursing as more than just caring. Instead directly looked
at as members of a team
 What do we do in our practices and how can we continually work on improving
them.
 Genesis of the idea of quality and safety nursing education
4. Quality Care:
 Everything we do in improving nursing will lead back to all these qualities:
centered around the patient
5. IOM/QSEN
 Medical errors started the 6 competencies generated from the IOM report.
 Attitude: approach to care “a job, save hospital money, different from pt to pt”
 STEEEP
6. Patient Centered Care:
 very powerful shift in how we provide care. Not specific to what the dr says
anymore.
 Emphasis that pt needs to be involved in care, making the decisions.
 Educate pt
 Listen to the pt preferences
7. Patient Centered Care:
 Integrating cares
 Emotional support
 Their values, what’s important in the decisions for care
 More towards the pt needs rather than what is the problem and how we can fix it
 Nursing process doesn’t we don’t diagnose disease
 Emphasize to be friendly and know the pt. important that we have a specific role.
We shouldn’t be anything other than professional.
 Get close to give them their needs, and support, but don’t go beyond that
 “do not become friends; be professional”
8. First Touch:
 Certain hospital use 1st touch for a pt centered approach/ through the pt eyes
 Made because nurses were overwhelmed by the clinical tasks. (Focused on
finishing tasks rather than pt.)
 First touch is used to connect with the pt. shouldn’t be a task : the first time
entering room and every encounter after that. Address by name
 Connect on genuine level with pt, fam, and friends.
 Have a conversation prior to any tasks
 Emphasis on the human rather than machines or tasks
9. Patient Centered Techniques
 Open- include ptand fam whenever they want to come.
 Family- comfortable places for the pt to interact with family
 View- putting plants in pt view or paintings. Less of sterile more of natural
 We are guests: we are here for the pt.
 reminds us that, that is our focus and why we’re there. Focus on human rather
than machines
10. Teamwork and Collaboration
 We’re not just working side by side we’re working with
 Communicate clearly
 Being our Best out of all staff, but not expecting one individual to complete all
tasks necessary
11. Teamwork and Collaboration
 Work closely with other members, and include them when its their area of
expertise.
 Being able to work with others
 Communication Can fall short during handoff or report; Using sbar to improve
that

Rapid Response- a second opinion, something going on with pt that you don’t
quite understand
12. SBAR
 Protocol when giving and getting report. Also calling any healthcare provider
EXAMPLE: “mr smith, 64 yo with pneumonia, why you’re calling, working on pt
breathing or pain med is not relieving pt pain additional pain control. Make sure
you keep an eye on breathing, and making sure respiratory treatments every 4
hours, additional albuterol as needed. Maybe IV push or morphine for pain
relief.”
13. Rapid Response Teams:
 Star team or red team
 Team of providers there to assess the pt.
 Transfer as necessary
 Talk to staff to monitor specific signs or symptoms from the pt.
14. Team STEPPS
 Formalize teamwork
 From the department of defense about pt safety
 Another example that healthcare formalize practice of teamwork “STEEEP”
 Teamwork safety focused on pt
 Implement things that make the nurse the best nurse they can be
15. Evidence-Based Practice:
 Taking the research, the situation, and expertise/ experience of nurses and
combining them to give the best care in that situation
16. Evidence-Based Practice
 Prevented extended stays: all because of evidence based practice
17. Joint Commission:
 Joint: certifies hospitals for safety and recommendation and requirements from
the hospital.
 Studies done to come up with bundles: Put together as way to improve care, not
just by individual but combined practices.
 IHI-institue for hospital improvement.
18. Why Evidence Based Practice
 Evidence changes: ongoing learning
19. Why Evidence Based Practice
 Safety of pt overall
 Understanding has evolved so does nursing practice
20. 5 Steps of EBP
 Will be tested on: read research, understand it, and ask questions that need to be
asked to provide better care.
 1 “why do we do it this way? Is there a better way?”
 5 “did this work, better outcome, or more we can do?”
21. The Question:
 P:
 I:
 C:what are you comparing it to?
 O:
22. Asking PICO Questions
 Anyone one of these approaches helps us determine if we are doing this the best
way we can, the safest, highest quality outcomes
23. Gathering Evidence:
 Things used for standard research
 About getting info you can apply to job right then and there. Guidelines aren’t as
strict.
24. Using the Evidence:
 Reliable sources.
 does it deal with the current situation
 Evaluate: Apply it and see how: change how you do a particular procedure.
Helpful in providing the best care.
25. Quality Improvement
 Are Things being done in the best way possible?
 Going to be involved by identifying the culture of the environment: safe or get the
job done
26. Quality Imporvment:
 Never: never want to see happen. Pay special attention. More than an incident
report. Serious event and how it happened and how to prevent it from ever
happening again.
 The preventative measures used to make sure never events don’t happen.
 Looking at the entire nursing environment: not about who to put the blame on. It’s
about the environment of care and how to do things safely
 Nursing: “hospitals with higher BSN nurses have lower levels of never events”
certain percent of staff being BSN when becoming magnet
 Having Rapid response teams, specific nurses for procedures “picc, chemo”
 Preventing problems with central lines, falls, IV, etc.
 Test of change “PDSA intervention”: notice a problem, have a plan, make sure it
works.
 Being more than a nurse that does a job, it’s a nurse that looks at the environment
and sees it as a whole unit to provide the best care
27. Safety:
 Partly about helping us be the best we can be and think safety.
 It’s an individual performance but on a system level
 Things done to make it easier in the hospital environment: lift teams
 It’s about pt and providers
28. Safety:
 Human: mistakes we typically make “use color coordination to get passed our
humanness/ way of error”
 Reducing reliance on memory: it’s about using technology that may enhance
safety.
29. Safety in Medication
 Medication admin
 Help us to stay vigilant
 Medication: identify pt meds at home, continuing appropriate med in hospital, and
appropriate meds for discharge. Meds theyre supposed to .
 Involve: have the pt tell you the information necessary
 Decrease tolerance of risk: has to be on the arm, cannot be on the side table. More
likely to have error otherwise
30. Look alike medications:
 Different meds that look so similar that it may be difficult to be safe during
medication administration.
 Chance of using wrong med is higher.
 Nurses no longer able to put K+ in IV
 Insulin syringes are orange so we use the correct one
 Overall Environment for safety
31. Agency for Healthcare Research & Quality
 1 Instead of relying directly on memory
 2 dr put the info in themselves. Less errors of transcription
 3 more likely to cause error, so they lower this for error prevention
 4 what caused the problem. Prevention for the future. Something about the
enviroment that isnt helping you be safe
 5 SBAR
 6 isolation, protocols
 7 important for professionalism and safety
32. AHRQ
 Never events: specify why it happened and how to prevent it from the future.
 New regulations for residents to work or be on-call
 12 hr shift, ability to give safe and effective care diminishes during last 4 hours
 Involving the pt on safety
33. Joint Commission
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Things we are emphasizing to promote safety in the hospital
Lots of rules for blood
Critical test results: phone the unit and tell the nurse and identify who they spoke
to. Ensuring that info is passed correctly
34. Joint Commission
 HH: we’re getting better but not where we need to be at
 MDRO: multiple drug resistant organisms “hard to treat infections”
 Catheter: steps, and what needs to be done. Labs drawn etc.
 Prevent: time out- pause before surgery, everyone involved discusses the pt and
everyone is there to identify pt, correct procedure, correct site. To decrease
surgical mistakes.
35. CUS words
 Speaking up! Listening to people when they bring up concerns
36. Health Informatics
 Common database: need to pass information because it helps to pass on for safe
care.
 Electronic Health Records: technological elements that help to give better care.
 Alerts: flashing lights to complete charting correctly.
 Communication: electronically, much easier to share. Any other provider doesn’t
need the physical chart
 Decision: tools built in to guide for the best care. Less reliance on memory
 Up to the minute: go directly into the charts, info in there much more quickly
 EMR concerns: eye contact with pt, missing a lot of nonverbal communication.
Sends the wrong message “machines over pt” some say it decreases critical
thinking. If system goes down? Privacy is at concern
 but lots of benefits
37. Health Infromatics
 Most useful for the nurses
 Lifelong- keep up with the technological tools to do job more safely
 Have to be a step ahead in case the validity of resources or context of treatment
being used is being questioned
 Home monitoring- prior had to have pt record blood sugar. Now we have phones
hooked up to bp machine or blood sugar. Results go directly into the pt chart.
More comprehensive care and decreases human error.
 Technological integration for better care.
38. Final Thoughts:
 If it were just about task we wouldn’t need the level of knowledge and training.
 Nurses are here just to administer shots and meds,
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We could let that belief go in society but instead we can determine the
environment we work in. things important to provide best care. The research done
to improve quality of care.
How the members of team interact with one another.
Create the type of environment that will allow for safe quality care.
Quote: president for IHI. Lead this new perspective of nursing “no needless
deaths, no needless pain or suffering, no helplessness in those served or serving,
no unwanted waiting, no waste, and no one left out.”