Safety and Quality Education In Nursing What Is Quality and Safety?
Quality and safety in nursing are critical aspects of patient care that ensure effective, efficient, and safe delivery of healthcare services. The Quality and Safety Education for Nurses (QSEN) initiative, funded by the Robert Wood Johnson Foundation (RWJF) from 2007 to 2012, represents a landmark effort to integrate quality and safety principles into nursing education. This initiative developed key competencies—patient-centered care, teamwork and collaboration, safety, quality improvement, informatics, and evidence-based practice—to enhance nursing practice and improve health outcomes (QSEN.org).
Objectives of QSEN
The primary goal of QSEN, now operated by the QSEN Institute at Case Western Reserve University, is to ensure that all nurses acquire the necessary knowledge, skills, and attitudes to continuously improve the quality and safety of the healthcare systems in which they work (Cronenwett et al., 2007, 2009). This involves not only understanding quality and safety principles but also applying them in practice to enhance patient care and reduce errors.
Requirement of Quality and Safety Education in Nursing
The integration of quality and safety into nursing education represents a significant shift from traditional educational content, which often focused more narrowly on individualized patient care. Quality and safety education expands this focus to include systems of care and systems thinking. This shift is guided by the QSEN competencies and involves tailoring educational content for both undergraduate and graduate nursing programs (Barton, Armstrong, Preheim, Gelman, & Andrus, 2009; Pohl et al., 2009).
Incorporation into Curricula
The incorporation of quality and safety principles into nursing education occurs across various levels and settings, including:
- Curricular Programming: Quality and safety content is embedded in the overall design of nursing curricula. This includes integrating these principles into individual courses, teaching strategies, simulation scenarios, and clinical experiences (Armstrong, Spencer, & Lenburg, 2009).
- Academic and Clinical Partnerships: QSEN competencies are applied in partnerships between academic institutions and clinical settings. These partnerships may operate at institutional, regional, or state levels, fostering collaboration and ensuring that quality and safety principles are practiced in real-world settings (Didion, Kozy, Koffel, & Oneail, 2013; Disch, Barnsteiner, & McGuinn, 2013).
- Educational Resources: Resources such as nursing textbooks and specialty organization educational programs incorporate QSEN competencies. For example, the National Council of State Boards of Nursing (NCSBN) includes quality and safety competencies in its nurse residency pilot programs (NCSBN, 2013). Additionally, professional organizations like the American Operating Room Nurses integrate these competencies into their educational offerings.
Faculty Development
To support the integration of quality and safety principles, the American Association of Colleges of Nursing (AACN) has organized Faculty Development Institutes at both baccalaureate and graduate levels. These workshops, funded by RWJF, are designed to help faculty incorporate quality and safety principles into their teaching and are accessible at no cost through the AACN and QSEN websites (Barnsteiner et al., 2013; Disch et al., 2013).
Competencies in Safety and Quality Education
Teaching quality and safety competencies involves a range of settings and methods to ensure comprehensive learning. The QSEN website offers a database of teaching strategies, which includes peer-reviewed submissions from faculty nationwide. These strategies cover various settings, including:
- Classroom Instruction: Classroom strategies involve direct teaching methods, lectures, and discussions to introduce and reinforce quality and safety concepts.
- Simulation: Both low and high-fidelity simulations are used to replicate real-world scenarios, allowing students to practice and apply quality and safety principles in controlled environments. Simulation strategies range from single scenarios to complex, multi-faceted simulations that cover various patient populations, from pediatrics to geriatrics (Sharpnack & Madigan, 2012).
- Clinical Settings: Clinical teaching strategies include direct patient care experiences where students apply quality and safety principles in real-world settings. These strategies help bridge the gap between theoretical knowledge and practical application.
Dedicated Education Units (DEUs)
One innovative approach to enhancing quality and safety education is the use of Dedicated Education Units (DEUs). These units focus on developing students’ competencies at both individual and organizational levels, emphasizing contemporary quality and safety principles (Didion et al., 2013). Pilot studies of DEUs have demonstrated promising outcomes in terms of improving students’ understanding and application of quality and safety concepts (McKown, McKeon, McKown, & Webb, 2011).
Measurement and Evaluation
Assessing nurses’ knowledge, skills, and attitudes related to quality and safety is a crucial aspect of educational initiatives. Several psychometrically sound instruments have been developed to measure these competencies. For example, instruments to assess safety (Chenot & Daniel, 2010) and systems thinking (Dolansky & Moore, 2013) are used to evaluate the effectiveness of educational programs and guide improvements.
Impact of Quality and Safety Education in Nursing
Despite progress in integrating quality and safety education into nursing programs, several areas require further development to enhance the impact of these initiatives. Key areas for improvement include:
- Expansion of Evaluation Tools: There is a need for more psychometrically valid evaluation tools to compare data and benchmark progress across different academic and clinical sites. Such tools would facilitate the assessment of knowledge, skills, and attitudes across all six QSEN competencies.
- Formative and Summative Evaluation: Identifying essential components of formative and summative evaluations is crucial. This includes using research methods to demonstrate the efficacy of educational efforts and ensuring that the evaluation processes are robust and comprehensive.
- Faculty Development: Continued faculty development is necessary to ensure that all faculty members have the capacity to teach quality and safety concepts effectively. Despite the initial efforts of the QSEN initiative, gaps remain in faculty preparedness, particularly in teaching quality improvement principles.
- Integration into Ambulatory and Long-Term Care: Emphasizing quality and safety education in ambulatory and long-term care settings is essential. Expanding education to these areas will contribute to improving the patient experience, enhancing population health, and reducing per capita healthcare costs.
Future Directions
To accelerate the impact of quality and safety education in nursing, future efforts should focus on:
- Developing and validating new evaluation tools to better measure and compare educational outcomes.
- Enhancing faculty development programs to address current gaps in teaching quality and safety.
- Integrating quality and safety education into diverse healthcare settings, including outpatient and long-term care environments.
By addressing these areas, nursing education can better prepare future nurses to deliver high-quality, safe patient care and contribute to the ongoing improvement of healthcare systems.