Читать книгу Quality and Safety in Nursing - Группа авторов - Страница 111

The six QSEN competencies have stood the test of time and are being incorporated into schools of nursing and clinical institutions. Where originally the focus was on educating faculty so that they could teach nursing students the competencies, the focus has spread over the years to also educating practicing nurses on contemporary nursing practice using the six QSEN competencies as the framework for practice, professional development, promotion, and evaluation. In the early years, the focus was on nursing practice in hospital settings. Over the intervening years, the QSEN competencies have made strategic differences in all settings, whether clinics, schools, prisons, nursing homes, community centers, homeless shelters, or on the streets. This QSEN text has been translated into four languages and, internationally, nursing leaders are using the QSEN framework for their own applications.

In short, QSEN has extended far beyond the original vision and related concepts have been identified that impact the environment within which nursing is practiced, including leadership and ethics. Furthermore, it has become apparent that there are new literacies and capacities that nurses must develop. To provide an organizing model for representing these concepts, Disch and Barnsteiner (2021) have developed a Nursing Model for Safety and Quality (Figure 3.3) that shows how the six QSEN competencies serve as the foundation for safe, high‐quality care, with literacies, capacities, and complementary competencies as the pillars.

A body of research is developing that shows improvement, yet work still needs to be done:

 The 2017 National Survey of Faculty (Altmiller and Armstrong, 2017) found that 83% of faculty reported using the QSEN competencies in their teaching. Patient‐centered care, evidence‐based practice, and safety were the most frequently identified, each selected by 93% of the respondents; with teamwork and collaboration at 88%, quality improvement 79%, and informatics 67%.

 In another national survey of schools of nursing, only 55% of nursing programs responding indicated having an error‐reporting system for student errors during clinical practicum, laboratory, and simulation (Barnsteiner and Disch, 2017).Figure 3.3 Nursing Model for Quality and Safety.

 In a more recent survey, Walker and colleagues (2020) surveyed prelicensure students regarding policies related to just culture in school of nursing. They reported that 70% of their programs had an error‐reporting system in place, yet only 12% of respondents described ever submitting a report.

 And moving beyond nursing, the advocacy group the Patient Safety Movement Foundation (PSMF) conducted a study of consumer perspectives about safety in health care in April and May 2020 (Lounsbury et al., 2020). The findings indicate that there needs to be a focus on educating the general public about quality and safety in health care. Members of the advocacy group and non‐members were asked to select their top three issues of concern specific to the health care system. While the general public respondents selected “out‐of‐pocket costs” with the most frequency (49%), PSMF community members opted for “safety of patients when receiving care” (59%) and “out‐of‐pocket costs” was ranked 7th. Interestingly, “safety of patients when receiving care” was ranked in 5th place by members of the general public (30%), illustrating that the general public may not recognize the significant potential for error when receiving health care. Most general public respondents reported only occasional worry about medical error in their care. A comparison with the PSMF community respondents, a majority of whom reported worry about medical error every time they use the health care system, demonstrated again that there is a significant discrepancy between the groups.