“We’re all on this journey together. There are no experts. We’re taking it one step at a time.” With that exhortation to collaboration, Linda Cronenwett, Ph.D., R.N., F.A.A.N., launched the second national forum of the Robert Wood Johnson Foundation’s Quality and Safety Education for Nurses (QSEN) project, in Milwaukee on May 31. Cronenwett is principal investigator for QSEN.
Cronenwett’s audience of more than 460 educators, practitioners, publishers and others was significantly larger that the audience at the project’s inaugural forum in 2010—evidence of QSEN’s growing reach. This year’s attendees heard from dozens of presenters over the course of three days, each exploring a specific element of the effort to embed six core competencies into pre-licensure and graduate education for nurses. The competencies are patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety and informatics.
Following Cronenwett to the podium, keynote speaker James Conway, M.S., focused in on one of those competencies: patient-centered care. After a 27-year career at Children’s Hospital, Boston, Conway became chief operating officer of the Dana-Farber Cancer Institute in the wake of a grievous medical error that claimed the life of a patient. Betsy Lehman, a Boston Globe health reporter and the wife of a cancer researcher at Dana-Farber, was mistakenly prescribed what Conway called a “massive overdose of a powerful anti-cancer drug.”
“One great tragedy,” Conway said, “was that she thought something was wrong. For three weeks, she was telling people, ‘I’m having an atypical response to the protocol.’ The day before she died, she called people outside the hospital to say, ‘please help me, they’re not listening.’”
Conway led the ensuing overhaul of the hospital’s safety program. The real problem, he said, was not with the people, but with the hospital’s methods. “What I learned,” he said, “is that our systems were too complex to expect 100-percent perfection. We hadn’t put in place systems that supported our practitioners.” In the years since, Dana-Farber has been at the forefront of safety efforts, instituting a variety of protocols to ensure safe administration of medicine, as well as safeguards against other potential mishaps.
High on the list of necessary reforms, Conway said, was instituting truly patient- and family-centered care. Among other things, that means involving patients and their family members in a broad range of hospital decision-making and care delivery, including participation on panels and working groups on policy and program development, hiring, evaluation and more. He also stressed the importance of sharing information with patients and their families, and soliciting and paying attention to their input.
Simulations and Technology as Teaching Tools
Conference-goers had a full day of concurrent sessions on June 1, with presentations from more than 65 separate participants. Speakers all focused on some aspect of incorporating the QSEN knowledge, skills and attitudes into nursing education. Presenters from around the nation discussed the design and role of simulations, graduate education, curricular innovations, academic-practice partnerships, teamwork and collaboration, national quality and safety initiatives, the nuts and bolts of integrating QSEN into the curriculum, research on quality and safety and assessing student learning. The day’s sessions were followed by poster presentations, and then by an additional series of presentations the next morning, the conference’s final day.
Many presentations focused on technology and simulations. Dana Tschannen, Ph.D., R.N., of the University of Michigan, described her program’s use of “Second Life,” an online virtual community. Tschannen and her colleagues unspool a series of scenarios in which virtual people experience a variety of health conditions. Nursing students interact with the individuals, by way of their own avatars, coming into contact with a range of health care professionals and scenarios. Tschannen played a brief clip from one scenario, in which a virtual nurse, worried that a virtual doctor’s handling of an emergent situation was insufficiently aggressive, engaged in “hinting and hoping,” rather than raising her concerns directly.
In a separate presentation, Tschannen’s University of Michigan colleagues Michelle Aebersold, Ph.D., R.N., and Cynthia Fenske, M.S., R.N., C.N.E., described their use of “The Neighborhood,” a virtual community that offers a continuous, weeks-long scenario in which students see 36 separate characters play out a series of health challenges. Students watch characters interact with medical professionals, but also observe them in various scenes from their daily lives, allowing for a deeper understanding of all that contributes to their mental and physical health.
Later in the day, Amy Barton, Ph.D., R.N., and Gail Armstrong, N.D., R.N., C.N.E., both of the University of Colorado, described their efforts to introduce QSEN competencies to nursing schools across the state through a series of on-site trainings. The University was one of 15 pilot sites during the second phase of the QSEN project, focused on testing teaching strategies for the QSEN competencies. Barton and Armstrong, together with their colleague Gayle Preheim, Ed.D., R.N., C.N.A.A., B.C., C.N.E., were leaders of the University’s project. In all, 64 percent of nursing schools in the state took part.
New Online Learning Modules
A new and valuable tool in the effort to encourage nursing schools to incorporate the QSEN approach into their curricula is a series of online learning modules developed and edited by Pamela Ironside, Ph.D., R.N., F.A.A.N., associate professor and director of the Center for Nursing Education Research at Indiana University.
The new modules address a variety of topics, from informatics to managing curricular change. Some focus on the “mindfulness” nurses need to provide quality care. A module on “cognitive stacking” provides strategies to teach students how to organize and prioritize existing and incoming information in health care settings. Another module explains how to use narrative and reflective pedagogies to help nurses improve their ability to always be “present” with patients, families and other members of the health care team.
“In developing these modules, we were thinking about how nurses improve quality of care, and that doesn’t necessarily mean teaching more content,” said Ironside. “It’s about teaching differently and pushing the envelope on how we think about quality and safety and meeting patients’ needs. The question is, ‘How can we persistently improve our teaching practice just as we do our clinical practice?’”
Each module takes less than an hour to complete, and several last 30 minutes or less. Ten are currently posted on the QSEN Web site. By autumn, the program intends to have 18 modules available online.
“QSEN is already making an impact on how nursing students are educated in schools around the country,” concludes Cronenwett. “Nursing faculty are helping their students obtain the knowledge, skills and attitudes that are becoming increasingly important in ensuring safety cultures and reliable systems of care, and textbook publishers from across the country have been including the QSEN competencies’ in their nursing school texts. These learning modules are one more way to help faculty effectively prepare the next generation of nurses.”