Jane Barnsteiner

Quality and safety education for advanced nursing practice

The Quality and Safety Education for Nurses (QSEN) project is a national initiative to transform nursing education to integrate quality and safety competencies. This article describes a two-year process to generate educational objectives related to quality and safety competency development in graduate programs that prepare advanced practice nurses in clinical roles. Knowledge, skills, and attitudes for each of 6 competencies are proposed to stimulate development of teaching strategies in programs preparing the next generation of advanced practice nurses.

Medication Reconciliation: Transfer of medication information across settings—keeping it free from error.

AJN ▼ March 2005 ▼ Supplement 31 the incidence of medication errors that occur during care at points of transition. As part of that process, the accuracy of the list is validated and it is reviewed and amended, if necessary, at specified times. A reconciliation record usually includes the name of the medication, dosage, frequency, and route of administration, as well as known allergies to medication.

Transition to Practice Study in Hospital Settings

This multisite study of transition to practice included 105 hospitals in three states. Hospitals volunteered to participate and were randomly assigned to either the study group or the control group, and all new graduate registered nurses hired between July 1 and September 30, 2011, were invited to participate. The study hospitals adopted the National Council of State Boards of Nursings Transition to Practice model program; control hospitals continued using their existing onboarding programs, which ranged from simple orientation procedures to structured transition programs with preceptorships. The new graduate nurses who volunteered for the transition to practice study ( n = 1,088) filled out surveys at baseline, 6, 9, and 12 months after beginning their first nursing position. Competence was reported by both the new nurses and their preceptors. New nurse self-reported data included the number of errors, safety practices, work stress, and job satisfaction. The hospitals provided retention data on the all the new graduates hired during the study period. Though the results showed few statistically significant differences between the two groups, when the hospitals in the control group were categorized as having established or limited programs, differences were detected. Hospitals using established programs had higher retention rates, and the nurses in these programs reported fewer patient care errors, employed fewer negative safety practices, and had higher competency levels, lower stress levels, and better job satisfaction. Structured transition programs that included at least six of the following elements were found to provide better support for newly graduated RNs: patient-centered care, communication and teamwork, quality improvement, evidence-based practice, informatics, safety, clinical reasoning, feedback, reflection, and specialty knowledge in an area of practice.

Explanation and elaboration of the SQUIRE (Standards for Quality Improvement Reporting Excellence) Guidelines, V.2.0: examples of SQUIRE elements in the healthcare improvement literature

Since its publication in 2008, SQUIRE (Standards for Quality Improvement Reporting Excellence) has contributed to the completeness and transparency of reporting of quality improvement work, providing guidance to authors and reviewers of reports on healthcare improvement work. In the interim, enormous growth has occurred in understanding factors that influence the success, and failure, of healthcare improvement efforts. Progress has been particularly strong in three areas: the understanding of the theoretical basis for improvement work; the impact of contextual factors on outcomes; and the development of methodologies for studying improvement work. Consequently, there is now a need to revise the original publication guidelines. To reflect the breadth of knowledge and experience in the field, we solicited input from a wide variety of authors, editors and improvement professionals during the guideline revision process. This Explanation and Elaboration document (E&E) is a companion to the revised SQUIRE guidelines, SQUIRE 2.0. The product of collaboration by an international and interprofessional group of authors, this document provides examples from the published literature, and an explanation of how each reflects the intent of a specific item in SQUIRE. The purpose of the guidelines is to assist authors in writing clearly, precisely and completely about systematic efforts to improve the quality, safety and value of healthcare services. Authors can explore the SQUIRE statement, this E&E and related documents in detail at http://www.squire-statement.org.

Diffusing QSEN Competencies Across Schools of Nursing: The AACN/RWJF Faculty Development Institutes

A series of regional Quality and Safety Education for Nurses (QSEN) Faculty Development Institutes were held in 2010 and 2011 to provide nursing faculty with strategies to integrate quality and safety content into their curricula. The interactive coursework focused on the 6 core QSEN competencies. Using a train-the-trainer approach, the QSEN Faculty Development Institute Directors enabled nursing faculty attendees to (a) lead their institutions faculty to incorporate quality and safety content into the curriculum for students; (b) teach and mentor students to deliver high quality and safe patient care; and (c) train other faculty to accomplish these goals. Over 1,100 nursing faculty from across the United States attended the institutes. All types of prelicensure programs were represented including diploma, associate, and baccalaureate degree. In a preinstitute survey, faculty identified multiple opportunities to improve the integration of quality and safety content into curricula including the need for specific content on quality improvement, teamwork and collaboration, and informatics and the need for interprofessional experiences and electronic health record access. Postinstitute evaluations indicated that participants found the content clear, specific, usable, and presented in a format that facilitated thought, reflection, and application. The regional institutes served as a very effective strategy for engaging large numbers of faculty across the country in the QSEN work and for disseminating vital tactics to improve the teaching of quality and safety content.

A Just Culture for Nurses and Nursing Students

This article provides an overview of current safety science related to just cultures, the tracking of errors and near misses, and individual and system responsibilities for promoting safe practice; and applies these principles to schools of nursing.

The Role of the Clinical Nurse Specialist in Creating a Healthy Work Environment

The clinical nurse specialist (CNS) contributes to a healthy work environment through partnerships with the nursing staff, nurse manager, physicians, and other colleagues across the health system. Examples of these partnerships are described in this article, highlighting how the work of the CNS influences the care that patients and families receive, shapes the practice environment, and fosters collegial and respectful relationships among caregivers. The CNS is a pivotal figure in creating an environment where nurses can provide the care that is needed and feel valued for their work. Partnership with a variety of clinicians enables the CNS to influence critical care nursing practice, the intensive care unit team, and the environment in which care is provided.

Therapeutic relationships. Evolution of the Children's Hospital of Philadelphia model.

The evolution of family-centered pediatric care coupled with the increasing complexity of healthcare environments has had a tremendous impact on the nature of relationships between nursing staff and the children and families they serve. In order to address this, in 1988 the Nursing Department at the Childrens Hospital of Philadelphia (CHOP) identified parameters for the development and maintenance of therapeutic relationships. A therapeutic relationship is an interactive relationship with a child and family that is caring, clear, boundaried, positive, and professional. It encompasses the philosophy of the institution, empowerment of the caregivers, and empowerment for families. Utilizing family-centered care as a framework for the delivery of care, this article describes the evolution of therapeutic relationships as a standard of practice including the articulation of principles, clinical examples, implications for practice, and strategies for assessment, management, and evaluation.

Instituting a disruptive conduct policy for medical staff.

A healthy work environment is one that promotes interaction and communication among all professionals, a positive and strong working relationship between the nurse manager and physician director, and activities such as joint patient care rounds, shared clinical protocols, and joint teaching of physicians and nurses. There are situations when a physicians unacceptable conduct leads to a disruptive environment for patients, staff, and fellow physicians. This article describes the steps taken in one institution to establish structures and systems to communicate behaviors that are unacceptable and a policy to be followed should disruptive behavior be encountered. Having systems and structures in place assists in promoting a healthy work environment.

Innovative Collaborations: A Case Study for Academic Owned Nursing Practice

PURPOSE Academic service partnerships are critical for schools of nursing to maintain credibility regarding their missions of education, research, service, and practice. METHODS In this paper, we describe a case study of a ten year program, the Living Independently For Elders (LIFE) Program at the University of Pennsylvania School of Nursing that has provided community-based long-term care to high-risk older adults. FINDINGS Quality of care and financial outcomes were met with nurse faculty engagement, administrative commitment, and integration of business practices. CONCLUSIONS As a result, high risk older adults receive care in their communities rather than nursing homes, and the school- owned and -operated program is a nationally recognized innovative nursing model of care. CLINICAL RELEVANCE Strategies are described that can be used globally as more schools of nursing embrace and strengthen service partnerships.