Linda R. Cronenwett

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.

Network structure, social support, and psychological outcomes of pregnancy

Fifty primigravid fathers and mothers responded to an investigator-developed tool that measured social network characteristics and perceived social support during the third trimester of pregnancy. At six weeks postpartum, these same parents completed the Postpartum Self-evaluation Questionnaire (PSQ) (Lederman, Weingarten, & Lederman, 1981). Relationships among network factors, perceived support, and postpartum outcomes were documented for four of the seven PSQ scales. A greater percentage of relatives in the network and more overlap with the spouses network were important factors associated with positive postpartum outcomes for men, but not for women. Emotional and instrumental support were important variables in explaining six-week postpartum outcomes, whereas information and appraisal support were not significant variables at this time. Men scored lower than women on the PSQ scale measuring confidence in ability to cope with the tasks of parenting.

Improving quality and safety education: The QSEN Learning Collaborative

As part of a national initiative to improve quality and safety education in prelicensure nursing programs, 15 schools participated in a 15-month learning collaborative sponsored by Quality and Safety Education for Nurses, funded by the Robert Wood Johnson Foundation. This article presents the rationale, design, activities, and outcomes of the collaborative. Collaborative members revised curricula, developed new teaching strategies, and established the foundation for future faculty development efforts to advance teaching of quality and safety concepts in nursing education.

The Doctor of Nursing Practice: A national workforce perspective

In 2004, the American Association of Colleges of Nursing (AACN) adopted a position statement concerning the future of advanced practice nursing education. A target date of 2015 was articulated as the point by which masters preparation for advanced practice nurses would be replaced by doctoral level education. Seismic shifts in the realities surrounding nursing education and practice have occurred since the proposal to require a Doctor of Nursing Practice (DNP) degree for entry into advanced practice nursing was proposed. Unprecedented economic challenges have resulted in significant budget downturns for all sectors, including higher education. The consequent cutbacks, furloughs, and restructuring in educational operations of all types have placed enormous demands on faculty, staff, and students across the country. In addition, the growing incidence and earlier onset of chronic disease, a rapidly aging population, health care reform agendas, a shortage of primary care practitioners, and projected severe shortages of nursing faculty have raised fundamental questions about the capacity of nursing education to produce the numbers of advanced practice nurses needed. This article addresses the changing realities and growing concerns associated with the future of advanced practice nursing. Recommendations to ensure continuing development of advanced nursing practice that serves the interests and needs of the public now and in the future are presented within the context of a national workforce perspective.

Assessing quality and safety competencies of graduating prelicensure nursing students.

The Quality and Safety Education for Nurses (QSEN) project is focused on enhancing nursing curricula and fostering faculty development to support student achievement of quality and safety competencies. The purpose of this descriptive study was to assess student perspectives of quality and safety content in their nursing programs along with self-reported levels of preparedness and perceived importance of the 6 QSEN competencies. Graduating students (n = 565) from 17 US schools of nursing completed an electronic student evaluation survey. Students reported exposure to QSEN knowledge areas, more often in classroom and clinical learning settings than in skills lab/simulation settings. Clinical experience outside of formal education was associated with perceptions of a higher level of preparedness for QSEN skills in several competencies. In general, students reported relatively high levels of preparedness in all types of prelicensure nursing programs and endorsed the importance of quality and safety competencies to professional practice.

Stress, social support, and the transition to fatherhood.

Over the past ten years, nurses have shown increasing interest in understanding and assisting men in their transition to fatherhood. Inadequate data and lack of a framework for interpreting diverse studies have hindered the development of appropriate intervention strategies. In this article, a paradigm from the field of stress research is adapted to the transition to fatherhood. The new paradigm organizes and integrates the factors that impact on a mans experience of becoming a father. The utility of this paradigm in generating theory and hypotheses for future research is illustrated by fully exploring one of the potential variables impacting on fatherhood, i.e., social support. Through this process a better theoretical understanding of social support as well as a guide to future inquiry concerning fatherhood is acquired.

Models of helping and coping in childbirth.

How professionals help clients is hypothesized to depend on whether clients assume responsibility for either problems or solutions. This paper outlines four possible models of helping and coping (based on the four possible combinations of client responsibility for problems and solutions) and applies them to understanding current practices in childbirth. Each of the models is shown to govern one or more forms of help presently offered to childbearing clients. Future research is proposed to assess why different practitioners prefer different models, and whether certain models are more effective than others in maintaining parent and infant health.

Newborn behavioral performance in colic and noncolic infants

The specific purpose of this investigation was to examine the newborn performance of colic and noncolic infants on the Brazelton Neonatal Behavior Assessment Scale (BNBAS). The sample was composed of 119 firstborn infants from healthy, married, white couples. Data were collected prenatally, during the perinatal period, and postnatally from birth through four month of infant age. A total of 38 infants (32%) were believed to have colic. Colicky infants differed significantly from noncolicky infants on one of the seven item clusters, labeled the BNBAS Orientation cluster (p < .05).

Multiple shift patient classification: Is it necessary?

Efficient, cost-effective patient classification systems are an essential component of information needed for staffing projections, budgeting, productivity monitoring, and determining the cost of nursing services. Data collection on every shift is typical of GRASP-based patient classification systems. In this study, comparisons among multiple shift measurements showed that no relevant information was being gained by multiple daily assessments of patient care requirements.

QSEN transforming education.

W ITH THE 2003 Institute of Medicine (IOM) Report, Health Professions Education: A Bridge to Quality, educators were challenged to alter the process of professional development so that health professionals, including nurses, would graduate understanding and accepting that their jobs consisted of both caring for individual patients and continuously improving the quality, safety, and reliability of the health care systems within which they worked. In 2005, the Robert Wood Johnson Foundation (RWJF) began a phenomenal effort to address the need for change within nursing education. The earliest phases of this RWJF initiative, titled Quality and Safety Education for Nurses (QSEN), were led by Drs. Linda Cronenwett and Gwen Sherwood, 10 nursing education leaders with expertise in quality and safety competencies and the pedagogies used in nursing education, and an advisory board of nursing and physician leaders representing clinical practice and the professional regulatory domains of accreditation, licensure, and certification. Over a period of 8 years, QSEN evolved from a focus on preparing prelicensure nurses for basic practice to its latest phase focused on assuring that graduate level nursing programs also include extensive content and experiences focused on meeting the IOM mandates. Quality and safety competencies were defined, and the knowledge, skills, and attitudes for new generations of nursing professionals were articulated for both prelicensure and graduate nursing programs. Fifteen pilot schools of nursing joined the core QSEN team to experiment with strategies for developing quality and safety competencies in prelicensure programs. A robust Web site (www.qsen. org) became a highly used repository of teaching tools, simulation exercises, video resources, publications, annotated references, and faculty self-development modules for faculties worldwide. As work commenced through the early phases of QSEN, there was clear evidence that a fundamentally critical element of transforming the curriculum for both prelicensure and advanced practice nursing education was the need for developing the capacity of faculty to envision and lead the curricular changes that were necessary to develop quality and safety competencies with students. Classroom instructors, simulation laboratory teachers, and clinical preceptor faculties all needed