The Nurses Core Competencies for Quality And Safety Education (EQSEN) cover six key areas: patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. These competencies provide nurses with the skills and knowledge necessary to provide safe, high-quality care.
Quality And Safety Education For Nurses Core Competencies
Although all health-care professionals have an obligation to provide safe and quality care, nurses have been directly linked to ensuring patient safety and quality care outcomes (Page, 2004). The national QSEN initiative has been funded by the Robert Wood Johnson Foundation since 2005 and was organized with the purpose of adapting the IOM competencies for nursing specifically to serve as guides for curricular development in formal nursing education, transitions to practice, and continuing education programs (Cronenwett et al., 2007, p.124).
In addition, the competencies provide a framework for regulatory bodies that set standards for licensure, certification, and accreditation of nursing education programs (Cronen wett et al., 2007, p. 124). In collaboration with a national advisory board, QSEN faculty adapted the five competencies outlined in Health Professions Education: A Bridge to Quality (Greiner & Knebel, 2003)—provide patient-centered care, work in interdisciplinary teams, employ evidence-based practice, apply quality improvement, use informatics—and added a sixth competency, safety.
The overall goal for the QSEN project is to prepare future nurses with the knowledge, skills, and attitudes necessary to continuously improve the quality and safety of the health-care systems within which they work (Cronenwett et al., 2007). Definitions of the core nursing competencies and comparisons with the IOM competencies follow.
For Patient-Centered Care
Patient-centered care is more than a one-size-fits-all approach to care (Frampton & Guastello, 2010). Health-care professionals must shift from disease-focused paternalistic care to ensuring that the patient is the source of control and facilitating shared decision making (Greiner & Knebel, 2003).
The IOM defines patient-centered care as follows: “identify, respect, and care about patients rather than differences, values, preferences, and expressed needs; relieve pain and suffering; coordinate continuous care; listen to, clearly inform, communicate with, and educate patients; share decision making and management; and continuously advocate disease prevention, wellness, and promotion of healthy lifestyles, including a focus on population health” (Greiner & Knebel, 2003, p. 45). The skills related to this competency identified by the IOM include the following (Greiner & Knebel, 2003, pp. 52–53):
- Share power and responsibility with patients and caregivers.
- Communicate with patients in a shared and fully open manner.
- Take into account patients’ individuality, emotional needs, values, and life issues.
- Implement strategies for reaching those who do not present for care on their own, including care strategies that support the broader community.
- Enhance prevention and health promotion.
The nurse-patient relationship has changed over the years. Nurses no longer make all the decisions or provide total care for patients. Instead, patients and their families enter into a full partnership with nurses and other health-care professionals. Today, active involvement of patients and their families in the plan of care and decision making is considered a precursor to safe, effective, and quality care. Patient safety and quality care require recognizing the patient as the source of control. Care is customized based on patients’ values, needs, and preferences.
The nursing core competency of patient-centered care is defined as the recognition of “the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patients’ preferences, values, and needs” (Cronenwett et al., 2007, p. 123). Nurses develop healing relationships with patients and families in which they share information and communication flows freely. The fundamental elements of the patient-centered care core competency include advocacy, empowerment, self-management, cultural competence, health literacy, and an optimal healing environment.
Advocacy
Advocacy is one of the philosophical underpinnings of nursing and encompasses caring, respect for an individual person’s autonomy, and empowerment. Advocacy in nursing is defined as “a process of analyzing, counseling, and responding to patients’ care and self-determination preferences” (Vaartio-Rajalin & Leino-Kilpi, 2011, p. 526). Nurses have an ethical obligation to advocate for patients.
The American Nurses Association (ANA) Code of Ethics for Nurses with Interpretive Statements asserts, “the nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient” (2015a, p. 9). Nurses often find themselves representing and/or speaking for patients who cannot speak for themselves.
Empowerment
As part of patient-centered care, nurses are called to empower patients and their families to engage in self-care, decision making, and developing a plan of care. Empowerment is defined as “patients’ perceptions of access to information, support, resources, and opportunities to learn and grow that enable them to optimize their health and gain a sense of meaningfulness, self-determination, competency, and impact on their lives” (Spence Laschinger, Gilbert, Smith, & Leslie, 2010, p. 5).
A sense of empowerment is vital from the nurse’s perception as well as the patient’s perception. To empower patients, nurses must believe that they have the power to accomplish work in a meaningful way. Spence Laschinger and colleagues (2010) contend that empowered nurses empower their patients, with the result being better health-care outcomes.
Self-Management
Self-management is a priority area identified by the IOM as needed for quality health care and in achieving patient-centered care. The major aim of self-management is “to ensure that the sharing of knowledge between clinicians and patients and their families is maximized, that the patient is recognized as the source of control, and that the tools and system supports that make self-management tenable is available” (Adams & Corrigan, 2003, p. 52).
Further, there is strong evidence that support for self-management is critical to the success of chronic illness programs. Nurses assist patients with self-management by helping them increase skills and confidence in managing their health problems. Health literacy, discussed next, plays a key role in self-management.
Health Literacy
A major barrier to patient-centered care is “the ability to read, understand, and act on healthcare information” or health literacy (Adams & Corrigan, 2003, p. 52). An estimated 90 million Americans have difficulty understanding health information (Finkelman & Kenner, 2016). Poor health literacy affects Americans of all social classes and ethnic groups (Adams & Corrigan, 2003). The IOM defines health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions regarding their health (Nielsen-Bohlman, Panzer, & Kindig, 2004, p. 2).
Low literacy skills are most prevalent among the elderly and the low-income population. Unfortunately, those people most in need of health care are the least able to read and understand information for self-management (Adams & Corrigan, 2003). Advocating for patients and their families experiencing health literacy problems can make a major difference in their health-care encounters.
Cultural Competence
Patient-centered care requires nurses to provide acceptable cultural care and to respect the differences in patients’ values, preferences, and expressed needs (American Association of Colleges of Nursing [AACN], 2008a). Cultural competence is defined as “the attitude, knowledge, and skills necessary for providing quality care to diverse populations” (AACN, 2008a, p. 1). Nurses have a moral mandate to provide culturally competent care to all, regardless of gender, age, race, ethnicity, or economic status.
Moreover, nurses must provide effective care across diverse population groups congruent with the tenants of social justice and human rights (AACN, 2008b). Part of cultural competence consists of understanding and respecting diversity. Not everyone is alike, and nurses must acknowledge and be sensitive to differences in patients and coworkers. Diversity is the “range of human variation, including age, race, gender, disability, ethnicity, nationality, religious and spiritual beliefs, sexual orientation, political beliefs, economic status, native language, and geographical background” (AACN, 2008b, p. 37).
Diversity is more than having different religious views, cultural beliefs, and ethnic backgrounds; diversity can also include generational and gender differences. Disparity is another issue related to cultural competence and encompasses unequal delivery of care, access to care, and/or outcomes of care based on ethnicity, geography, or gender. Disparity is defined as “racial or ethnic differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention” (Smedley, Stith, & Nelson, 2002, pp. 3–4).
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