Post on 14-Dec-2015
transcript
Quality Education for SENiors
Marsha Lewis, PhD, RN Bethany Robertson, DNP, RN Gerri Lamb, PhD, RN, FAAN Corrine Abraham, MN, RN
It’s been a busy year
100 seniors QSENed- Recognize QI process and tools when they see them
- Aware of and can search national quality initiatives: IHI, JCAHO, NQF
- Can conduct simple PDSA process using appropriate tools, run charts, fishbone, …
30+ faculty/4 courses - Speak “TeamSTEPPs” language - Experience facilitating QI process - Ask quality-centric questions in clinical
“Begin with the end in mind” Covey,1989
Focus our pilot work on the senior spring semesterWhat competencies do our students need to transition from Emory student to practicing RN?
Back this up a bit and try some small experiments in the junior year
What groundwork do we need to establish to build toward terminal competencies?
The timing was perfect
“Getting into the habit of quality” Emory Health Sciences Update March 2008
Fred Sanfilippo, MD, PhDExecutive VP and CEOEmory Woodruff Health Sciences Center
A Comprehensive Model for Teaching QSEN
Success in AchievingQSEN
Competencies
Curriculum
FacultyDevelopment
ClinicalPartners
StudentEngagement
I. Curriculum
Quality and safety as central themes Strong connection between
classroom and clinical Experience analyzing teamwork, QI,
in addition to reflective exercises Role model QI thinking – flexibility,
feasibility, always “OFIs”, evidence
An Integrated Curriculum
Nursing PracticePatient-Centered Care
Across the Care Continuum
(ClinicalExperiences)
Classroom
ProfessionalDevelopment
Classroom &Clinical
Seminars
Simulations
Integrating Across PD Class, Seminar and Clinical Groups
PD ClassPD Seminar
Role Transition&
CommunityClinical Groups
PTQSConceptsPrinciplesTools
Students-MentorspracticeConcepts & tools
Discussion of ClinicalApplicationPTQS Questions
Safety – for exampleQSEN Competency: Discuss impact of national safety initiatives
PD ClassPD Seminar
Role Transition&
CommunityClinical Groups
PTQSMajor national safety initiatives e.g. JCAHO, NDNQI, NQF, IHI …
Students explore websites related to national initiatives with guided questions
QS Question: RT: What quality initiatives affect practice in this setting? What outcomes are being tracked? C: What population-based outcomes are relevant to what you’ve observed this week? How are outcomes from other settings relevant to community practice?
Role Transition&
CommunityClinical Groups
Teamwork – for exampleQSEN Competency: Discuss effective strategies for communicating among members of the interdisciplinary team
PD ClassPD Seminar
PTQSComm. & Patient safetyTools
Pick a process: communicating a change in patient status, (hand-offs).Practice communication tools: SBAR, IPASStheBATON, etc.
T Question: RT: What forms of team communication have you seen/been part of this week? Which were effective, not… C: Same plus: how is communication the same/different in community settings? How do community members participate?
II. Faculty Development
“Quality and safety: nursing at the turning point” Jan 2008 Keynote
Marla Salmon, Dean
The Case for QualityWhy We Must Improve
Susan M. Grant, MS, RN, CNAA
Chief Nursing Officer, EHC
William A. Bornstein, MD, PhD
Chief Quality Officer, EHC
III. Clinical PartnersIII. Clinical PartnersEmory Healthcare Emory Healthcare Quality Academy Quality Academy
Office of Quality
N
IV. Student Engagement
“In your efforts to structure connections between courses, don’t overlook important clinical moments and insights.”
“It’s important to capitalize on the diversity of the background and
expertise of our class.” “You reinforce effective teamwork and leadership modeling at each opportunity.”
Comments of Student Advisory Group Members
Inadequate sleep was a concern of the entire group
Group members expressed feelings of fatigue, difficulty concentration and were aware of the detrimental effects of sleep deprivation on health
After initial assessment, an inconsistent sleep duration pattern was noticed, measured in the course of a week
Sleep deprivation can lead to or be an aggravating factor in depression, heart disease, hypertension, irritability, slurred speech, slower reaction times, tremors, and weight gain (http://www.sleep-deprivation.com/
articles/effects-of-sleep-deprivation/)
Most studies of partial sleep deprivation have suggested that sleeping only 5-6 hours a night can lead to impairment (Weinger & Ancoli-Israel, 2002)
The psychomotor effects of going without sleep for 24 hours are similar to that of acute alcohol intoxication (Weinger & Ancoli-Israel, 2002)
Decreased sleep duration per night
SchoolSchoolSchoolSchool
Misc.Misc.Misc.Misc.Living Living situationsituationLiving Living
situationsituationIllnessIllnessIllnessIllness
SocialSocialSocialSocial Work/JobWork/JobWork/JobWork/Job
AssignmentsAssignments
Role TransitionRole Transition
Early class timeEarly class time
Financial stressFinancial stress
Stress r/t school workStress r/t school work
““Hanging out” lateHanging out” late
TelevisionTelevision
TelephoneTelephone
ComputerComputer
Eating/CaffeineEating/Caffeine StressStress
HoursHours
AllergiesAllergies
MedicationMedication
TemperatureTemperature InsomniaInsomnia
NoiseNoise Trouble falling asleepTrouble falling asleep
LightLight
Increase in stress level correlates to a decrease in perceived sleep quality (Daon et al., 2004)
People who use problem-based coping strategies to deal with stress have an increase in sleep (Daon et al., 2004)
Both the amount and quality of sleep should be considered when it comes to getting enough sleep (Blachowicz & Letizia, 2006)
One recommendation is to adjust the environment in a way that is favorable to sleeping (Blachowicz & Letizia, 2006)
Exposure to bright light in the evening can shift the circadian rhythm to a later time, thus increasing sleep latency (Cajochen et al., 1998)
Exposure to bright light upon waking shifts the circadian rhythm to an earlier time, which in turn improves sleep latency in the evening (Cajochen et al., 1998)
Week 1 Intervention – Limiting TV, cell phone, computer use prior to bedtime
Week 2 Intervention – Dim lights in home at least 30 minutes prior to bedtime; attain exposure to bright light within 10 minutes after awakening
Group members gained further awareness on the consequences of inconsistent sleep duration patterns
Group members became more aware of ways to improve sleep duration
Sleep consistency amongst the group members did not improve significantly
Group members were motivated to discuss methods to improve the interventions
It is important to look at the data findings from all perspectives, to avoid any misleading conclusions
It may be necessary to delete, revise or combine interventions to reach maximum effectiveness
The interventions might have been more effective if there was more control regarding certain other influences, i.e. school factors
Change is difficult, even when one has the best of intentions
QSEN Competencies in QI Project (Examples)
Safety Analyze the usefulness of national quality and safety
resources and initiatives for guiding clinical practiceTeamwork Analyze how professional and clinical team
performance affects quality of patient care and safety Identify and practice a set of effective strategies for
communication and resolving conflictQuality Improvement Design a small test of change Describe processes for identifying opportunities for
improving quality and safety. Describe processes and tools for analyzing quality and
safety problems and implementing and evaluating improvements.
Faculty Experience
“ I initially thought Role Transition (clinical course) already incorporated QSEN competencies – but once the concepts were highlighted consistently and clearly by framing them in a common language and reinforcing them between Role Transition and Professional Development, it became obvious (in group discussion and journaling) that students were noticing quality and safety indicators in clinical practice in more specific and meaningful ways.”
“Clinical preceptors involved in QI in practice settings were enthusiastic that students
knew about QI and were able to engage students in meaningful dialogue about specific initiatives on their units.”
Corrine Abraham, MN, RN Coordinator, Role Transition
Lessons
Students: “QI exercise was great!” Important to build awareness – what you will
see, what it means e.g. Students did not recognize PDSA and
tools in clinical practice until we brought it to their attention
Pick points of intersection carefully and efficiently
- too much intersection can get confusing especially in the beginning
Need to move some QSEN KSAs earlier in curriculum – quality & safety, teamwork
Recognize need for incremental growth, eg. Communication, conflict management
Critical Success Factors
Comprehensive ModelCurriculum Design, Student Involvement, Faculty Development, Clinical Partners
Faculty enthusiasm- willing to experiment- willing to learn along with students
Clinical course coordinators Lead coordinator role
- keep all the pieces integrated
Outcomes
100 graduates with basic competencies in teamwork, QI and knowledge of national quality initiatives.
30+ faculty familiar with QSEN competencies; practice with many
Experience with integrated framework for teaching QSEN
Closer collaboration with Clinical Partners, shared curriculum materials, potential for IHI projects