NURS 6341: Week 2: Clinical Judgment and Ethics

“I was to give Synthroid IV to a woman who was hypothyroid… I thought it was a very large dose… [and] had this icky feeling that it wasn’t right… It was an error. I had given the woman three times the amount of the drug that was intended… She came through it…, but I will never give the wrong dose of Synthroid again. I will always check the original order and call the doctor if I have questions. I will never go against my instincts, overriding my icky feeling that this is not right.”

—Diane Pestolesi, from Educating Nurses, 2010, p. 100

 

Take a moment to recall this incident from last week’s readings. Although nurse educator Diane Pestolesi now uses it as an example when teaching connections between clinical practice and the 3Ps, her story of a medication error is applicable to this week as well. As Pestolesi explains, she called the pharmacy to question the order, but it was not until after she administered the full dose that she consulted the patient’s chart and found directions reading one vial, not three.

Note: This week you view a documentary that is 53 minutes in length. You may wish to watch this documentary throughout the span of a few days or all at once. Be sure, however, to allow yourself enough time to view this media in its entirety. This week’s media will take the place of the standard required reading time.

Learning Objectives NURS 6341: Week 3: Quality and Safety Education for Nurses Essay

Students will:

• Evaluate organizational structures that support quality and safety
• Evaluate the practicum experience as means to further develop QSEN competencies
• Evaluate a practicum experience in the context of quality indicators
• Evaluate evidence-base of quality indicators
• Construct a detailed practicum log

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Note: In this week’s Learning Resources, you are required to watch a 53-minute video. This will take the place of a textbook reading.

Required Readings

Quaid, D., Thao, J., & Denham, C. R. (2010). Story power: The secret weapon. Journal of Patient Safety, 6(1), 5–14.

The article describes specific stories of medical errors as catalysts for understanding causes and solutions to breakdowns in patient care. As you read, consider both the cases presented and the lessons to be learned in promoting greater patient safety in nursing practice.

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

This document provides 17 pages of graduate-level QSEN competencies covering the following: Quality Improvement, Safety, Teamwork and Collaboration, Patient-Centered Care, Evidence-Based Practice, and Informatics. Each competency presents the specific knowledge, skills, and attitudes to be demonstrated, organized in chart form.

Institute for Healthcare Improvement. (2013). Knowledge center. Retrieved from http://www.ihi.org/resources/Pages/default.aspx

Browse the Knowledge Center for information of greatest value with regard to your specialty area of interest.

The Joint Commission. (2013). National patient safety goals. Retrieved from http://www.jointcommission.org/standards_information/npsgs.aspx

Access the patient safety goals for the setting that matches your practicum and browse for other resources of particular interest and value to you (e.g., look-alike/sound-alike drug list and official “do not use” abbreviation list).

QSEN Institute. (n.d.). Retrieved February 21, 2013, from http://www.qsen.org

This section of the QSEN (Quality and Safety Education for Nurses) website provides resources such as YouTube videos of instructive patient stories, including the Josie King story, which is featured in the required article, “Story Power: The Secret Weapon.” Also browse the Learning Modules on quality and safety education for nurses in the Faculty Resources.

Required Media

Listiak, M., & TMIT (Producer). (n.d.). Chasing zero: Winning the war on healthcare harm [Video file]. Retrieved March 22, 2013, from http://www.safetyleaders.org/pages/chasingZeroDocumentary.jsp

Note: The approximate length of this media piece is 53 minutes. It is also available as a podcast. Please use the following resource for the transcript:

Safety Leaders. (n.d.). Chasing zero: Winning the war on healthcare harm: TMIT patient safety documentation transcript. Retrieved from http://www.safetyleaders.org/downloads/ChasingZero_transcript.pdf

Discussion: Supporting Quality and Safety Efforts in Clinical Settings

Consider the following statements from this week’s Learning Resources. What implications might they have for advanced nurses and nurse educators?

“…[G]raduate 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 Americans 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 measurement.”

—(AACN, 2012, p. 2)

As an advanced nurse educator, you will be responsible for supporting the quality and safety standards of the organization. In preparation, consider how you can use your practicum experience to further develop your own competencies in ensuring quality and safety in health care.

In this Discussion, you share quality and safety measures from your practicum setting and goals for enhancing your own competencies.

 

• View this week’s media, Chasing Zero: Winning the War on Healthcare Harm. Consider the ineffective quality and safety measures highlighted throughout the documentary as well as the quality initiatives and reforms that resulted.
• With the media in mind, investigate the organizational structure in your clinical practicum setting. How are quality initiatives supported? In addition, how are the contributions of each nurse impacting these initiatives?
• Review Graduate-Level QSEN Competencies: Knowledge, Skills, and Attitudes from this week’s Learning Resources. As you consider the six areas of competency, reflect on any gaps in your own expertise.
• Select a minimum of two competencies you could continue to develop during your practicum experience, noting how the clinical setting might help to foster this growth.

By Day 3 – NURS 6341: Week 3: Quality and Safety Education for Nurses Essay

Post an explanation of the organizational structure that supports quality and safety in your practicum setting. Identify at least two QSEN competencies you plan to further develop during your practicum experience and explain how this setting will help to foster this growth.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

• Ask a probing question, substantiated with additional background information or research.
• Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
• Validate an idea with your own experience and additional resources.
• NURS 6341: Week 3: Quality and Safety Education for Nurses Essay

 

 

ADDITIONAL INFO 

Quality and Safety Education for Nurses

Introduction

The nursing profession is often associated with patient safety and quality of care. Nurses who have learned how to use their knowledge in this way will become better professionals, but they must first understand what makes quality and safety important in their work.

Quality and safety education for nurses, (QSEN), is a national movement to

QSEN is a national movement to improve the quality and safety of patient care. It’s about ensuring that nurses have the knowledge, skills, and personal attributes needed to provide safe care for patients under their care.

QSEN helps nurses focus on patient safety by helping them understand how they can keep patients safe while they’re in hospital, or at home after discharge from hospital.

QSEN also promotes teamwork between healthcare providers, who work together toward improving quality and safety in their workplace environments by sharing ideas about what needs improvement (or not) among themselves—and with other healthcare professionals outside their group if appropriate!

QSEN, which was established in 2005, is made up of six competencies, or areas of knowledge.

The six QSEN competencies are divided into three categories:

• Patient care. This category includes knowledge and skills relevant to nursing, such as the ability to assess a patient’s condition, provide care for a variety of diseases and injuries, manage pain effectively through pharmacology or other methods (e.g., physical therapy), provide emergency care under stressful situations such as accidents or natural disasters. It also includes understanding how drugs affect health conditions like diabetes mellitus type 2 (DM2) so that you can prescribe medications accordingly; learning about ways preventative measures can reduce risks associated with certain diseases/conditions; knowing how complications arise during pregnancy so you can offer support before they become critical problems requiring hospitalization; knowing how infections spread between people through close contact like shaking hands while wearing gloves without washing hands afterwards—all these things fall under this category!

QSEN competencies are divided into three categories, informatics and patient-centered care included.

The first category of QSEN competencies is informatics and patient-centered care. This includes the ability to use information systems effectively, such as electronic health records systems, decision support tools for risk management, and clinical decision support software. You’ll also need to understand how nurse practitioners can use these technologies in their practice.

The second category is quality improvement or safety initiatives. Here you’ll learn about patient safety instruments (e.g., National Patient Safety Goals), risk assessment frameworks (e.g., HCAHPS), quality improvement methodologies (e.g., root cause analysis). This can include how nurses can improve processes within their organizations through teamwork efforts with other staff members like physicians or pharmacists since they’re often working together on one project at a time while helping each other out too!

Patient care will be evaluated based on six knowledge and skill areas.

Patient care will be evaluated based on six knowledge and skill areas.

Patient-centered care includes:

• Knowledge of the patient’s medical history, including diagnosis, treatment options, medications, lifestyle factors and personal preferences.

• Ability to communicate effectively with patients about their condition(s) or health status (e.g., physical limitations).

• Skill in assessing risk for falls or injuries related to mobility problems such as weakness in the legs or arms from stroke or dementia/Alzheimer’s disease complications such as decreased balance/coordination due to muscle weakness caused by loss of neurons controlling movement (neuromuscular disease).

Educational institutions that focus on nurses can adopt the QSEN model to help improve their curriculum.

If you are looking for a way to improve your educational curriculum and make it more relevant to the modern day environment, then QSEN is a great place to start. The QSEN model was developed by the National Quality Forum (NQF), an organization dedicated to improving healthcare quality. The NQF has already been involved with creating new standards for nursing education, including those related to patient safety education.

The six competencies that make up the QSEN model are divided into three categories: Clinical Competencies; Professional Competencies; and Leadership Competencies. These categories encompass all aspects of nursing practice, including research skills, communication skills between professionals in different fields such as medicine/surgery or health promotion programs at work places outside hospitals where nurses work regularly such as schools etc..

The goal of QSEN’s first competency is to help nurses develop an understanding of the scope of their practice.

The scope of practice is the body of knowledge and skills that a nurse has been trained to perform.

The goal of QSEN’s first competency is to help nurses develop an understanding of the scope of their practice. This includes understanding what it means when a nurse says “I can’t do that” or “I don’t know how.” The competency helps you to identify times when your skill set may be limited, and it provides opportunities for improvement with both quantitative assessment tools (such as surveys) and qualitative assessment methods (such as interviews).

Patient-centered care is organized into five specific knowledge and skill areas.

Patient-centered care is organized into five specific knowledge and skill areas. These include:

• Identify patients’ needs and priorities.

• Understanding patients’ perspectives, values, beliefs, preferences and expectations (including cultural differences).

• Being aware of the impact on patient care from social determinants of health like poverty or unemployment.

• Recognizing the importance of personal values in decision making about your patient’s treatment plan (e.g., comfort vs efficiency).

Technological know-how is divided into four knowledge and skill areas.

The technology available to nurses is a tool that can be used to improve quality and safety. Technology is not a silver bullet, but it can be used to help with communication, education and patient safety.

Nurses are required to use technological know-how in order to provide high-quality care for patients. Technological know-how includes the ability to communicate effectively with other healthcare professionals as well as understand new developments in medical science or treatment methods (such as how they work). Another important aspect of technological know-how involves using information technology systems properly so that the system functions correctly without causing harm or inconvenience for people involved in its operation (for example: it may be necessary for one person who works on computers at night shift hours).

Professionalism is broken down into four distinct knowledge and skill areas.

Professionalism is about being a good role model for patients and other healthcare providers. It’s about maintaining high ethical standards, taking responsibility for your actions and teaching others how to do the same. And most importantly, it’s about being open to new ideas and learning new skills.

Professionalism is also about honesty and trustworthiness: telling the truth at all times—even when it might be hard or embarrassing—and acting with integrity by upholding the highest levels of ethical practice in all situations (including dealing with conflict).

Quality improvement includes four knowledge and skill areas that relate to nurses’ role in improving quality of care.

Quality improvement is a process of identifying and solving problems. It’s not just about doing better, but also about doing so in the right way.

Quality improvement is a continuous process that involves the whole organization, from front-line staff to top management. It’s also a team effort—not just one person working alone on their own ideas or solutions to problems within their area of responsibility (like an individual nurse working in isolation).

Quality improvement requires systematic approaches to assessing and improving performance across all aspects of patient care—from nursing staff having access to high quality information about patients’ needs (such as how well they’re responding to treatment), through implementing new techniques used by nurses during caregiving tasks such as feeding someone who has been diagnosed with cancer; this may include developing new technology products like tablets instead of paper charts so caregivers can see everything related – including medical records – at once while still maintaining privacy between themselves so they don’t feel overwhelmed when someone else comes into their room unexpectedly while they’re trying not only save lives but improve them too!

Safety is broken down into four distinct knowledge and skill areas related to nurses’ role in improving patient safety.

Safety is a priority for nurses, and the American Nurses Association is working to make it even more so. In their new Quality and Safety Education for Nurses (QSE) curriculum, they break down safety into four distinct knowledge and skill areas related to nurses’ role in improving patient safety:

• Safety as a shared responsibility: when you see something unsafe happening, you can help prevent it from happening again by talking with others who may also see the problem or need assistance with reporting problems.

• Learning how to do things safely: learning about how things work helps us know what risks there are when we use them—and gives us the tools we need to avoid those risks before they become problems!

Nurses can become better professionals by learning how to focus on quality and safety issues in the workplace.

Nurses can become better professionals by learning how to focus on quality and safety issues in the workplace. It is important for nurses to adopt QSEN as a way of improving their practices, even if they don’t have time or resources to do so. With proper training, nurses will be able to identify problems before they occur and take appropriate action. By doing this, patient safety is greatly improved because there will be fewer medical errors made on patients’ behalf. Additionally, patients will benefit from having high-quality care provided by skilled providers who are dedicated towards providing excellent care every day at all times throughout each shift that they work together with one another (e.g., doctor/nurse teams).

Conclusion

QSEN is the way to go if you want to become a higher quality and safety-conscious nurse. By focusing on these six areas of knowledge, nurses will learn how their job affects patients in different ways and how they can help improve their workplace culture through education. QSEN will help nurses become better professionals by providing them with a system that allows them to communicate effectively with other professionals