Arlene SN Johnston and Dr. Katreena Collette Merrill, RN, PhD. College of Nursing
Introduction
Quality and patient safety has become a strong focus in the hospitals. However, academic institutions vary in their approach to preparing student nurses in the areas of quality and patient safety. Quality and Safety Education in Nursing (QSEN) was initiated in 2007 with the charge to prepare student nurses with the knowledge, skills and attitudes (KSAs) necessary to improve healthcare quality and patient safety. Six QSEN competencies were developed. These QSEN competencies are patient centered care, teamwork and collaboration, evidence-based practice, quality improvement, informatics, and safety. These QSEN competencies are beginning to be implemented across nursing curriculums. Emphasis has been placed on the development and implementation of learning activities targeting these six areas of competency. Therefore, there is a need for an instrument to determine if curriculum changes are resulting in an improvement of knowledge, skills and attitudes of quality and safety in nursing education.
Purpose
The purpose of our study was to first, review the nursing literature related to QSEN. Second, was to develop an instrument to measure QSEN competencies. Our final purpose was to pilot test a survey of QSEN knowledge, skills and attitudes with undergraduate baccalaureate nursing students.
Methods
We searched the CINAHL database and the world wide web. The Key Words “education/teaching and quality and safety and undergraduate or baccalaureate” were used. Eleven articles and the QSEN website were retrieved and reviewed. Survey questions relating to QSEN KSAs were developed based upon the review of the literature and expert opinion.
A 48-item survey plus demographics was pilot tested using an on-line link sent to a convenience sample of undergraduate nursing students from one university. A total of 27 students completed the survey. The Survey Instrument had sixteen questions to determine students’ knowledge of QSEN competencies. It included sixteen questions to assess nursing students’ skills within the QSEN competencies and fourteen questions to evaluate the attitudes of undergraduate nursing students regarding QSEN competencies.
Results
A total of 27 undergraduate nursing students took the survey and ranked their own knowledge, skills and attitudes on the six QSEN competencies. Demographics were as follows:
Respondents were mostly Caucasian and female. 31% of nursing students surveyed were in the beginning of the nursing program. 45% were in the middle of the program and 24% were towards the end of the nursing program.
The 16 questions on Knowledge were scored on a 3 point scale. 1 = No knowledge, 2 = Some knowledge and 3 = Very knowledgeable. Mean was 1.8. Standard Deviation was 0.37.
The 16 Skills questions were also scored on a 3 point scale. 1 = No skills, 2 = Some skills, 3=Very skilled. Mean was 1.56. Standard Deviation (SD) was 0.35
The 14 questions on Attitudes regarding QSEN competencies were scored on a 5 point scale with 1=Strongly disagree to 5=Strongly agree. Mean was 3.79. Standard deviation (SD) was 0.34.
Discussion
Through our survey we discovered that nursing students generally feel they are knowledgeable about different communication styles of patients, families and the healthcare team. They report being knowledgeable about obtaining reliable sources for evidence based practice and guidelines. However, nursing students report gaps in knowledge about work a-rounds, SMART pumps, root cause analysis, and the Institute of Medicine report ‘to err is human’. They reported equally knowing or not knowing about bar codes, computerized charting and checklists.
Generally students report not being skilled. However they reported having some skill with computerized charting, lifting equipment, ‘Time out’, patient values and preferences, and SMART pumps. Students report not being skilled in completing a near miss event, designing a quality improvement project, changing processes to prevent harm, participating in root cause analysis, and using quality improvement tools.
Nursing students mostly reported having positive attitudes about QSEN competencies. In particular they reported positive attitudes in believing that standard procedures and protocols lead to safe care that errors can happen when we rely on memory, valuing their own role in preventing errors and the belief that the patient/family is a core member of the healthcare team. They reported lack of positive attitudes about QSEN competencies related to reading evidence based literature for their area of specialty at least monthly or more often and the belief that if they follow policies and procedures, mistakes will not be made.
Conclusions/Implications
Few articles have been published on outcomes of student QSEN knowledge, skills and attitudes after implementation of QSEN knowledge, skills and attitudes to nursing curriculums.
The QSEN website contains the most comprehensive information about Quality and Safety in Education for Nurses.
Increased awareness of QSEN competencies is necessary to improve quality and patient safety. Tools to measure QSEN implementations and resulting desired increase of student and faculty QSEN knowledge, skills and attitudes is necessary to successfully improve quality and patient safety.
In addition, further tools with validity and reliability are needed for the measurement of QSEN competencies implemented over nursing education curriculums.