Reflective Clinical Journaling: Using QSEN
Competencies to Promote Student self-Awareness
of Quality and Safety in Nursing Practice
Kathleen S. Fries, PhD
Assistant Professor & UG Director
Sacred Heart University
Objectives
• Describe Journal Assignment as T-L strategy to
implement IOM/QSEN + Essentials
Competencies
• Discuss Preliminary Research Findings to
measure effectiveness of assignment
(comparing pre-post means and qualitative
data)
The Assignment Directions
• Throughout the clinical rotation, you will be evaluated on your
ability to demonstrate the knowledge, skills, and attitudes
necessary to provide safe family centered care. The competencies
outlined below will provide the framework to guide your clinical
practice, post-conference dialogue, and journal entries that you will
share with clinical supervisor on a weekly basis.
• At the end of the semester, you will write about clinical
experiences that clearly exemplify how you met each
competency.
• The paper will be typed and will include at least three outside
references, along with textbook or journal articles used in class.
• This is a reflective paper, and the use of “I” statements is expected
as you describe how your actions met the competencies outlined
below. As you write, think about how you might suggest changes
in how you would function as a newly graduated RN….
The Assignment (con’t)
• These clinical objectives are specifically
identified to support the course objectives by
using evidence based practice as per the
recommendations by the “Quality and Safety
Education for Nurses” (QSEN) Core
Competencies. For more information,
students are encouraged to visit
http://www.qsen.org/competencies.php
The Competencies (n=10)
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Identify gaps between local and best practice. ~ QSEN Quality Improvement Competency
Seek information about quality improvement projects in the care setting. ~ QSEN Quality
Improvement Competency
Initiate effective treatments to relieve pain and suffering in light of patient values, preferences,
and expressed needs. ~ QSEN Patient Centered Care (PCC) Competency
Engage patients or designated surrogates in active partnerships that promote health, safety and
well-being, and self-care management. ~ QSEN Patient Centered Care (PCC) Competency
Communicate care provided and needed at each transition in care. ~ QSEN PCC & Teamwork &
Collaboration Competencies
Follow communication practices that minimize risks associated with handoffs among providers
and across transitions in care. ~ QSEN Teamwork & Collaboration Competency
Locate evidence reports related to clinical practice topics and guidelines. ~ QSEN Evidence Based
Practice (EBP)
Demonstrate effective use of technology and standardized practices that support safety and
quality. ~ QSEN Safety Competency
Demonstrate effective use of strategies to reduce risk of harm to self or others. ~ QSEN Safety
Competency
Navigate the electronic health record. ~ QSEN Informatics Competency
Data Collection (IRB Approved)
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Dear NU 330 Nursing Student: The American Association of Colleges of Nursing
(AACN), in conjunction with the Quality and Safety in Nursing Education (QSEN)
initiative helped to develop recommendations that baccalaureate nursing students
should achieve in order to provide safe, hi-quality patient centered care.
For each of the recommendations (also termed competencies or objectives),
please assess your level of confidence or mastery in meeting each competency as
it relates to your delivery of care to patients. Your response can range between “I
feel very unconfident” to I feel very confident”. Your responses will be kept
confidential and will be used to revise course and clinical content.
By choosing to participate, you acknowledge receipt and acceptance of SHU’s
Informed Consent Document posted online with this survey.
You may chose: (responses will be chosen using check mark survey posted to
Survey Monkey)
I feel very unconfident (mark 1)
I feel somewhat unconfident
I feel neither unconfident nor confident
I feel somewhat confident
I feel highly confident (mark 5)
Data
Pre (blue) Post (red)
5
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
Pre
Post
Qualitative Data: Initiating Tx to Alleviate Pain
“During my clinical session one patient expressed severe pain she was dealing
with due to a caesarian section. One medication the doctor prescribed her
made her feel physically and mentally uncomfortable even with the pain relief.
Speaking with her and my clinical instructor we found another medication
that she did previously take without side effects and this was brought up to
her physician who agreed to substitute the previous medication for a new one
to help control her pain.
By taking time to listen to her complaint helped her develop a trust in me.”
Qualitative Data: Identifying Gaps in Practice
“There were several local practices that differed from the practices we have learned in
class or what is recommended. Many of the nurses draw up medications with one
needle and administer it with a different needle. This local practice is different from
how we were taught. We were taught to use a different needle only if you’re drawing
up with a filter needle. If the medication can be drawn up with the same needle you
administer it, then we would only use one.
Also, one of my patients had a breech birth and when the baby was not wrapped in her
blanket, her hips tended to push out to the sides. The parents were told to use two
diapers to try and act as a brace to correct her hips, but many other nurses said that
the double diapers does not scientifically correct this and a brace would be used later
on. In the article ‘Hip, Leg, and Foot Abnormalities,” Dr. Liptak discusses how many hip
displacements occur from breech births and that padded diapers or double diapering is
not effective and should not be done to correct this hip displacement. He suggests the
Pavlik harness which holds the affected hips together and rotated externally (Liptak,
2010).”
Summary & Recommendations
• Continue to observe for changes in mean scores between
pre-post assignment
• Clinical Adjuncts report “awareness” re:
IOM/QSEN/Essentials 
• Clinical “challenges” fostered healthy post-clinical
discussion
• Future assignments with increased focus re: student voice
vs. reporting “I observed my nurse meeting QSEN
competency when she…..” encourage increased citation to
support position statements/clinical observations!
• Other suggestions from AACN participants?
• Questions/comments?