Quality and Safety in Nursing. Группа авторов
patient‐centered care despite widespread no‐visitors policies.
Significant Accomplishments
We have been engaged in QSEN for more than 20 years. As Linda Cronenwett pointed out earlier in this chapter, the seeds for the project began in 2000 and the formal launch of the program, Phase I, commenced in 2005. Over the past four years, a number of significant accomplishments have been realized. These include the following:
The seminal article defining the competencies and the related KSAs (Cronenwett et al., 2007) continues to be the most‐referenced article and touchstone for the dissemination and implementation of the QSEN competencies, having been cited in 1,476 publications according to Google Scholar (July 1, 2021).
The QSEN Institute at Frances Payne Bolton School of Nursing at Case Western Reserve University, directed by Mary Dolansky, continues to be the center for the QSEN movement. The Institute houses the QSEN website, which has a rich array of resources for students, faculty, and clinicians. The annual QSEN meeting, which draws over 500 faculty and clinicians, is the primary venue for sharing teaching innovations and clinical advancements related to quality and safety.
As the COVID‐19 pandemic seized the world, causing quick pivots for educators and clinicians alike, the QSEN Institute immediately established a rapid response action for teaching strategies to assist faculty. Most academic programs in the United States and many worldwide ceased in‐person classes and used various forms of interactive remote teaching. Safety becomes even more important in times of crises such as pandemics, and the QSEN Institute was able to offer help to demonstrate strategies for alternative forms of instruction.
A number of task forces have emerged from the Institute, furthering the work of QSEN. These include:The QSEN Clinical Practice Task Force, which serves as a resource for nurses in the practice setting looking for guidance with the QSEN competencies. Its work includes developing resources to infuse the QSEN competencies into orientation/residency/preceptor programs; human resource assistance with job descriptions/performance review/clinical advancement programs; nurse professional development; and Magnet and research.The QSEN Academic Task Force, which oversees the review of the teaching strategies for the website and champions the integration of the competencies and validation of best practices in academic settings.The Simulation Task Force, which is focused on incorporating QSEN competencies into simulation programs and initiatives.The International Task Force, which presented a poster at the 2019 QSEN National Forum reporting on QSEN work in Saudi Arabia, Palestine, Germany, Sweden, and the United States.
Regional institutes have been established, strengthening the foundation of the QSEN movement and spreading its mission. The QSEN Institute Regional Center at Jacksonville University was established in 2017 by Teri Chenot, with an annual meeting and several graduate tracks related to quality and safety at the university. The UNC likewise launched a Regional Center in 2018 with a focus on globalization and simulation, and the University of Alabama at Birmingham Regional Center also launched in 2018 with a focus on leadership. The Quality and Safety Innovation Center at the College of New Jersey led by Gerry Altmiller was established in 2019. These regional initiatives are shaping the future of nursing through education focused on the KSAs necessary to continuously improve the quality and safety of patient care.
The recently revised AACN Essentials (2021) documents have incorporated the six QSEN competencies throughout the domains of education.
The Journal Nurse Educator now has a department focused on the integration of the QSEN competencies into nursing education. Each issue has a column related to the education of prelicensure or graduate students. The Journal of Continuing Education in Nursing also now has a regular column on Teaching Tips for QSEN.
And since the second edition of Quality and Safety in Nursing, hundreds more articles have been written in the United States and abroad about the QSEN competencies.
The Ongoing Evolution of the QSEN Initiative
The six QSEN competencies have stood the test of time and are being incorporated into schools of nursing and clinical institutions. Where originally the focus was on educating faculty so that they could teach nursing students the competencies, the focus has spread over the years to also educating practicing nurses on contemporary nursing practice using the six QSEN competencies as the framework for practice, professional development, promotion, and evaluation. In the early years, the focus was on nursing practice in hospital settings. Over the intervening years, the QSEN competencies have made strategic differences in all settings, whether clinics, schools, prisons, nursing homes, community centers, homeless shelters, or on the streets. This QSEN text has been translated into four languages and, internationally, nursing leaders are using the QSEN framework for their own applications.
In short, QSEN has extended far beyond the original vision and related concepts have been identified that impact the environment within which nursing is practiced, including leadership and ethics. Furthermore, it has become apparent that there are new literacies and capacities that nurses must develop. To provide an organizing model for representing these concepts, Disch and Barnsteiner (2021) have developed a Nursing Model for Safety and Quality (Figure 3.3) that shows how the six QSEN competencies serve as the foundation for safe, high‐quality care, with literacies, capacities, and complementary competencies as the pillars.
A body of research is developing that shows improvement, yet work still needs to be done:
The 2017 National Survey of Faculty (Altmiller and Armstrong, 2017) found that 83% of faculty reported using the QSEN competencies in their teaching. Patient‐centered care, evidence‐based practice, and safety were the most frequently identified, each selected by 93% of the respondents; with teamwork and collaboration at 88%, quality improvement 79%, and informatics 67%.
In another national survey of schools of nursing, only 55% of nursing programs responding indicated having an error‐reporting system for student errors during clinical practicum, laboratory, and simulation (Barnsteiner and Disch, 2017).Figure 3.3 Nursing Model for Quality and Safety.
In a more recent survey, Walker and colleagues (2020) surveyed prelicensure students regarding policies related to just culture in school of nursing. They reported that 70% of their programs had an error‐reporting system in place, yet only 12% of respondents described ever submitting a report.
And moving beyond nursing, the advocacy group the Patient Safety Movement Foundation (PSMF) conducted a study of consumer perspectives about safety in health care in April and May 2020 (Lounsbury et al., 2020). The findings indicate that there needs to be a focus on educating the general public about quality and safety in health care. Members of the advocacy group and non‐members were asked to select their top three issues of concern specific to the health care system. While the general public respondents selected “out‐of‐pocket costs” with the most frequency (49%), PSMF community members opted for “safety of patients when receiving care” (59%) and “out‐of‐pocket costs” was ranked 7th. Interestingly, “safety of patients when receiving care” was ranked in 5th place by members of the general public (30%), illustrating that the general public may not recognize the significant potential for error when receiving health care. Most general public respondents reported only occasional worry about medical error in their care. A comparison with the PSMF community respondents, a majority of whom reported worry about medical error every time they use the health care system, demonstrated again that there is a significant discrepancy between the groups.
The Next Five Years
The next five years will provide answers to—or insights into—a number of the questions posed at the beginning of this update. We will have widespread distribution of a vaccine, and a better sense of how COVID‐19 affects the body. We will likely be increasing the use of telehealth. Hopefully, we will have secured an adequate supply of essential equipment needed for this