Look at the policy and procedure book in your unit, department, or organization. Select a policy or procedure and determine the type of evidence used as evidence to create the policy/procedure. Use the pyramid of evidence discussed in Chapter 11 to examine the types of evidence that supports the policy/procedure.
Then, address these questions in your initial posting: What is the policy/procedure you selected? Why did you select this policy/procedure for review? Is the evidence supporting the policy/procedure appropriate? Can you tell how the evidence was evaluated? Why is it important for nurses to know the type of evidence used to create a policy/procedure?
Core Competencies for Nursing Leadership and Management
QUALITY AND SAFETY EDUCATION
PATRICIA KELLY BETH A. VOTTERO CAROLYN A. CHRISTIE-MCAULIFFE
ISBN 978 ‑0‑8261 ‑2341‑1
11 W. 42nd Street New York, NY 10036-8002 www.springerpub.com
INTRODUCTION TO QUALITY AND SAFETY EDUCATION FOR NURSES Core Competencies for Nursing Leadership and Management, SECOND EDIT ION
Editors PATRICIA KELLY, MSN, RN BETH A. VOTTERO, PhD, RN, CNE CAROLYN A. CHRISTIE-MCAULIFFE, PhD, FNP
The second edition of Introduction to Quality and Safety Education for Nurses has been thoroughly updated with an emphasis on leadership and management. The content continues to focus on knowledge and skills required of entry-level nurses in the six Quality and Safety Education for Nurses (QSEN) domains. After heart disease and cancer, patient safety errors rank as the third-leading cause of death in the United States. As patients’ needs have increased in complexity and inter-professional teamwork and collaboration have become essential, only strong leadership skills can ensure high-quality and safe care. Nurses, the largest group of healthcare professionals that spend the most time with patients, are uniquely suited to lead through effective management and communication in this dynamic environment.
With contributions from nurses, physicians, pharmacists, librarians, attorneys, and other healthcare professionals throughout the United States and beyond, Introduction to Quality and Safety Education for Nurses, Second Edition underscores the inter-professional focus grounding healthcare practice today. The updated edition includes four new chapters on implementing quality and safety initiatives from a leadership and management perspective, and state-of-the-art information on quality improvement. Each chapter contains learning objectives, opening scenarios, case studies, interviews, critical thinking exercises, key concepts, clinical discussion points, review activities, NCLEX-style questions, and web resources.
New to the Second Edition:
• Increased focus on leadership and management aspects of quality and safety • Updated information from national and state healthcare and nursing organizations • An evolving clinical case study for application of concepts throughout the text • Additional patient care cases and real-life examples • Interviews with a myriad of healthcare professionals such as educators, library scientists, lawyers,
psychologists, risk managers, and many others • Four new chapters addressing nurse leadership and management of high-quality care, legal and ethical
aspects of quality and safety, delegating patient care and setting priorities, and quality improvement project management
• Helps nursing schools to fulfill accreditation standards for quality and safety curricula • Maps the QSEN competencies for knowledge, skills, and attitudes (KSAs) for each chapter • Includes objectives, critical thinking exercises, case studies, interviews, NCLEX-style questions, photos,
tables, suggested readings, and more in each chapter • Provides instructor package with PowerPoint slides, Q&A, answers for case study and critical thinking
exercises, and more • Provides knowledge for nursing education QSEN-specific courses • KSAs throughout chapters
SECOND EDIT ION
LITY A N
FETY ED UC
R N URSES
Kelly_9780826123411_mech.indd 1 6/19/18 9:39 AM
INTRODUCTION TO QUALITY AND SAFETY EDUCATION FOR NURSES
Patricia Kelly, MSN, RN, earned her diploma in nursing from St. Margaret Hospital School of Nursing, Hammond, Indiana; baccalaureate in nursing from DePaul University in Chicago, Illinois; and master’s degree in nursing from Loyola University in Chicago, Illinois. She is Professor Emeritus, Purdue University Northwest, Hammond, Indiana. She has worked as a staff nurse, travel nurse, school nurse, and nurse educator. Patricia has traveled extensively in the United States, Canada, and Puerto Rico, teaching at conferences
for the Joint Commission, Resource Applications, Pediatric Concepts, and Kaplan, Inc. She currently teaches nationwide National Council Licensure Examination for Registered Nurses® (NCLEX-RN®) review courses for Evolve Testing & Remediation/ Health Education Systems, Inc. (HESI), Houston, Texas. She also currently volunteers in a level one trauma center, emergency room, Advocate Christ Medical Center, Oak Lawn, Illinois and has been a nursing volunteer at the Old Irving Park Community Clinic in Chicago, a free clinic for patients without healthcare insurance.
Patricia was director of quality improvement at the University of Chicago Hospitals and Clinics. She has taught at Wesley-Passavant School of Nursing and Chicago State University. Patricia was program director of the Associate Degree Nursing Program and is Professor Emeritus, Purdue University Northwest, College of Nursing, Hammond, Indiana. Patricia has taught Fundamentals of Nursing, Adult Nursing, Nursing Leadership and Management, Nursing Issues, Nursing Trends, Quality Improvement, and Legal Aspects of Nursing. She has been a member of Sigma Theta Tau, the American Nurses Association, and the Emergency Nurses Association. She is listed in Who’s Who in American Nursing, Notable American Women, and the International Who’s Who of Professional and Business Women.
Patricia has served on the board of directors of Tri-City Mental Health Center, St. Anthony’s Home, and the Mosby Quality Connection. She is a coeditor/author of Introduction to Quality and Safety Education for Nurses, Core Competencies, first edi- tion, with coeditors/authors Beth A. Vottero and Carolyn Christie-McAuliffe. Patricia is also an editor/author of Nursing Leadership and Management, now in its third edi- tion in the United States and Canada; Essentials of Nursing Leadership and Management (with Janice Tazbir, coeditor/author), now in its third edition; and Nursing Delegation, Setting Priorities, and Making Patient Care Assignments (with Maureen Marthaler, coedi- tor/author), second edition. She contributed a chapter, “Preparing the Undergraduate Student and Faculty to Use Quality Improvement in Practice,” in Improving Quality, second edition, by Claire Gavin Meisenheimer. Patricia also contributed a chapter on Obstructive Lung Disease: Nursing Management in Contemporary Medical-Surgical Nursing by Rick Daniels. She has served as a national disaster volunteer for the American Red Cross and has also been a team member on healthcare relief trips to Nicaragua. Patricia has been a nurse for 50 years and currently lives in Chicago, Illinois, and in Fort Myers, Florida. She can be reached at [email protected]
Beth A. Vottero, PhD, RN, CNE, earned a baccalaureate degree in liberal studies with a focus in business management from the Uni- versity of Maine at Presque Isle; a baccalaureate degree in nursing from Valparaiso University; a master’s degree in nursing from Uni- versity of Phoenix; and a PhD in nursing education from Capella University. Previously, Beth taught in the undergraduate nursing at Purdue University North Central and the graduate nursing program at Bethel College. Beth currently is an associate professor of nursing
at Purdue University Northwest, teaching courses including Evidence-Based Practice and Knowledge Translation at the doctoral level and Informatics and courses in the
Nurse Educator program at the graduate level. At the undergraduate level, she teaches Quality and Safety for Professional Nursing Practice, Informatics, and Evidence-Based Quality Improvement projects in the Capstone course.
Beth’s background includes over 18 years as a staff and charge nurse. After com- pleting her doctorate, Beth coordinated and led a successful Magnet redesignation for Indiana University Health La Porte Hospital in La Porte, Indiana. She brought a desire to instill quality concepts to academia where she created an undergraduate quality course at Purdue Northwest focused on quality and safety in healthcare. Beth is a research associate with the Indiana Center for Evidence-Based Practice in Hammond, Indiana, a Joanna Briggs Institute (JBI) Collaborating Center. Through this associa- tion, she has completed systematic reviews on various topics. In collaboration with Dr. Lisa Hopp, she assisted in developing an Evidence Implementation Workshop to train nurses in translation science using an evidence-based quality improvement focus. Beth is a certified Comprehensive Systematic Review Program Trainer with JBI and conducts weeklong training for healthcare providers nationally.
Beth has published chapters in Hopp and Rittenmeyer’s Introduction to Evidence-Based Practice: A Practical Guide for Nurses; Bristol and Zerwekh’s Essentials of E-Learning for Nurse Educators; and has developed case studies for Zerwekh and Zerwekh’s Nursing Today: Transitions and Trends. She has published several articles on “Teaching Informatics” (Nurse Educator QSEN Supplement), “Conducting a Root Cause Analysis” (Nursing Education Perspectives), and “3D Simulation of Complex Health Care Environments” (Clinical Simulation in Nursing). Beth is an active member of the QSEN Academic Task Force with multisite studies on quality and safety education for nurses (QSEN) teaching strategies. As a funded researcher through Purdue University, Beth has studied factors affecting medication errors in the clinical setting. Beth can be reached at [email protected]
Carolyn A. Christie-McAuliffe, PhD, FNP, obtained her diploma in nursing from Crouse-Irving Memorial Hospital School of Nursing, Syracuse, New York; a baccalaureate and master’s degree in nurs- ing from the State University of New York, Health Science Center at Syracuse, Syracuse, New York; and a PhD in nursing from Bingham- ton University, Binghamton, New York. Her clinical experience has included staff nursing, home healthcare, oncology care, and private practice. She has functioned as an administrator primarily in clinical
research and taught at the undergraduate and graduate nursing levels at Crouse-Irving Memorial Hospital School of Nursing, Syracuse, New York; the College of Notre Dame of Maryland, Baltimore, Maryland; State University of New York (SUNY) Institute of Technology, Utica, New York; and Keuka College, Keuka Park, New York. She has implemented multiple evidence-based practice and quality assurance programs and served as a compliance officer and Institutional Review Board chair at SUNY Institute of Technology. Carolyn’s research interest and efforts have focused on primary preven- tion. The majority of her publications and speaking engagements have centered on topics of research, evidence-based practice, and leadership.
Currently Carolyn provides Integrative Medicine in her private practice in Syracuse, NY. In addition, she runs a clinic at the Syracuse Rescue Mission where she serves as a preceptor for undergraduate and graduate nursing students. Carolyn can be reached at [email protected]
INTRODUCTION TO QUALITY AND SAFETY EDUCATION FOR NURSES CORE COMPETENCIES FOR NURSING LEADERSHIP AND MANAGEMENT
Patricia Kelly, MSN, RN
Beth A. Vottero, PhD, RN, CNE
Carolyn A. Christie-McAuliffe, PhD, FNP
Copyright © 2018 Springer Publishing Company, LLC
All rights reserved.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Springer Publishing Company, LLC, or authorization through payment of the appropriate fees to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600, [email protected] or on the Web at www.copyright.com.
Springer Publishing Company, LLC 11 West 42nd Street New York, NY 10036 www.springerpub.com
Acquisitions Editor: Joseph Morita Managing Editor: Cindy Yoo Compositor: diacriTech, Chennai
ISBN: 978-0-8261-2341-1 ebook ISBN: 978-0-8261-2385-5 Instructor’s Manual: 978-0-8261-2565-1 Instructor’s PowerPoints: 978-0-8261-2574-3
Instructor’s Materials: Qualified instructors may request supplements by emailing [email protected]
18 19 20 21 22 / 5 4 3 2 1
The author and the publisher of this Work have made every effort to use sources believed to be reliable to provide information that is accurate and compatible with the standards generally accepted at the time of publication. Because medical science is continually advancing, our knowledge base continues to expand. Therefore, as new information becomes available, changes in procedures become necessary. We recommend that the reader always consult current research and specific institutional policies before performing any clinical procedure. The author and publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or reliance on, the information contained in this book. The publisher has no responsibility for the persistence or accuracy of URLs for external or third-party Internet websites referred to in this publication and does not guarantee that any content on such websites is, or will remain, accurate or appropriate.
Library of Congress Cataloging-in-Publication Data
Names: Kelly, Patricia, 1941–editor. | Vottero, Beth A., editor. | Christie-McAuliffe, Carolyn A., editor.
Title: Introduction to quality and safety education for nurses : core competencies for nursing leadership and management / [edited by] Patricia Kelly, Beth A. Vottero, Carolyn A. Christie-McAuliffe.
Description: Second edition. | New York, NY : Springer Publishing Company, LLC,  | Includes bibliographical references and index.
Identifiers: LCCN 2018012105| ISBN 9780826123411 | ISBN 9780826123855 (e-book) Subjects: | MESH: Nursing—standards | Quality of Health Care | Patient
Safety | Safety Management | United States Classification: LCC RT73 | NLM WY 16 AA1 | DDC 610.73071/1—dc23 LC record available at
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Printed in the United States of America.
This book is dedicated by Patricia Kelly to her loving Dad and Mom, Ed and Jean Kelly (Dad was a Safety Engineer at Inland Steel Company);
to her charming, wonderful fiancé, Ron Vana; to her super sisters, Tessie Kelly Dybel and Kathy Kelly Milch; to her dear aunts and uncles,
Aunt Pat and Uncle Bill Kelly and Aunt Verna and Uncle Archie Payne; her nephew, John Milch; her nieces, Natalie Dybel Bevil, Melissa Milch Arredondo, and Stacey Milch Monks; her nephews-in-law, Tracy
Bevil, Peter Arredondo, and Derek Monks; her grandnephew, Brock Bevil, and her grandniece, Reese Bevil. I love you all!
Beth Vottero would like to thank her support, her rock, and her hero . . . her ever-patient husband Dino. Thanks also go to her
children Tom (Army Strong), Mitchell (ump extraordinaire), Micah (King of Games), Michelle (ever-patient educator), and Trisha (the beautiful mother); to her amazing parents Tom and Judy, Ray and Dolly; and to her dog Ben, who sat on a chair and stared at her for
hours while she worked. To her super-human coworkers—you know who you are and how much you motivate me.
Carolyn A. Christie-McAuliffe would like to acknowledge all the patients she has been graced to know and work with. Her
efforts on this book are dedicated to them: for the trust and honor they place in her; for the honesty and courage they exhibit; but
most of all, for the privilege to hear, and see, and witness healing of mind, body, and spirit. For that privilege, she will always feel a sense of responsibility to do what she can to facilitate
higher levels of safety and quality in healthcare.
Contributors xi Foreword xv Mary A. Dolansky, PhD, RN, FAAN Ronda G. Hughes, PhD, MHS, RN, CLNC, FAAN Preface xix Acknowledgments xxv
UNIT I. INTRODUCTION TO QUALITY AND SAFETY EDUCATION FOR NURSES: CORE COMPETENCIES FOR NURSING LEADERSHIP AND MANAGEMENT
1. Overview of Patient Safety and Quality of Care 3 Ronda G. Hughes
2. Quality and Safety Education for Nurses 39 Catherine C. Alexander, Gail Armstrong, and Amy J. Barton
3. Nurses as Leaders and Managers for Safe, High-Quality Patient Care 65 Carolyn A. Christie-McAuliffe
4. Quality and Safety in High-Reliability Organizations 89 Patti Ludwig-Beymer
5. Legal and Ethical Aspects of Nursing 131 Theodore M. McGinn
6. Delegation and Setting Priorities for Safe, High-Quality Nursing Care 155 Maureen T. Marthaler
UNIT II. THE USE OF QUALITY AND SAFETY EDUCATION CONCEPTS BY NURSING LEADERS AND MANAGERS
7. Patient-Centered Care 179 Carolyn A. Christie-McAuliffe
Share Introduction to Quality and Safety Education for Nurses: Core Competencies for Nursing Leadership and Management, Second Edition
x • CONTENTS
8. Interprofessional Teamwork and Collaboration 211 Gerry Altmiller
9. Informatics 243 Beth A. Vottero
10. Basic Literature Search Strategies 277 Kimberly J. Whalen
11. Evidence-Based Practice 305 Beth A. Vottero
12. Patient Safety 339 Christine Rovinski-Wagner and Peter D. Mills
UNIT III. NURSE LEADERSHIP AND MANAGEMENT FOR QUALITY IMPROVEMENT
13. Essentials of Quality Improvement 375 Anthony L. D’Eramo, Melinda Davis, and Joanne Belviso Puckett
14. Tools of Quality Improvement 417 Anthony L. D’Eramo and Joanne Belviso Puckett
15. Quality Improvement and Project Management 447 Jamie L. Vargo-Warran
16. The Future Role of the Registered Nurse in Patient Safety and Quality 467 Jerry A. Mansfield, Danielle Scheurer, and Kay Burke
17. Transition from Student Nurse to Leadership and Management of Your Future as a Registered Nurse 501 Jodi L. Boling and Patricia Kelly
Appendix A: Selected Reports of the National Academies of Sciences, Engineering, and Medicine, Formerly the Institute of Medicine (IOM) 525
Appendix B: Prelicensure Knowledge, Skills, and Attitudes 527 Appendix C: Critical Thinking Extras 537 Glossary 547 Index 559
Catherine C. Alexander, DNP, RN VA Quality Scholar, White River Junction, Vermont, Adjunct Faculty, MGH Institute of Health Professions, Boston, Massachusetts
Gerry Altmiller, EdD, APRN, ACNS-BC Associate Professor, Director, QSEN Institute Regional Center at The College of New Jersey, School of Nursing, Health, and Exercise Sciences, Ewing, New Jersey
Gail Armstrong, PhD, DNP, ACNS-BC, CNE Associate Professor, University of Colorado College of Nursing, Aurora, Colorado
Amy J. Barton, PhD, RN, FAAN, ANEF Associate Dean for Clinical and Community Affairs Professor, Daniel and Janet Mordecai Endowed Chair in Rural Health Nursing, University of Colorado College of Nursing, Aurora, Colorado
Jodi L. Boling, MSN, RN, CNS Core Faculty, American College of Education, Indianapolis, Indiana
Kay Burke, MBA, BSN, RN, NE-BC Chief Nursing Information Officer University of California, San Francisco Health, San Francisco, California
xii • CONTRIBUTORS
Carolyn A. Christie-McAuliffe, PhD, FNP Integrative Practitioners, Syracuse, New York
Melinda Davis, RN, MSN, CCRN, CNL Clinical Improvement Consultant, VHA QMS Consultative Division (10E2C3), Office of Quality, Safety and Value, Antioch, Tennessee
Anthony L. D’Eramo, MSN, RN, CPHQ ISO Consultant, Region 1, VHA ISO Consultation Division, Office of Quality, Safety, and Value, Coventry, Rhode Island, Providence VA Medical Center, Providence, Rhode Island
Ronda G. Hughes, PhD, MHS, RN, CLNC, FAAN Director, Center for Nursing Leadership, Director, Executive Doctorate of Nursing Practice, Associate Professor, University of South Carolina, School of Nursing, Columbia, South Carolina
Patricia Kelly, RN, MSN Professor Emerita, Purdue University Northwest, College of Nursing, Hammond, Indiana, Faculty, Health Education Systems, Inc. (HESI), Houston, Texas
Patti Ludwig-Beymer, PhD, RN, CTN-A, NEA-BC, CPPS, FAAN Associate Professor, Purdue University Northwest, College of Nursing, Hammond, Indiana
Jerry A. Mansfield, PhD, RN, NEA-BC Executive Chief Nursing Officer and Chief Patient Experience Officer, Medical University of South Carolina, Charleston, South Carolina
Maureen T. Marthaler, RN, MS Professor Emerita, College of Nursing, Purdue University Northwest, Hammond, Indiana
CONTRIBUTORS • xiii
Theodore M. McGinn, JD, BBA, CPA Managing Partner Lavelle Law, Ltd., Adjunct Professor, The John Marshall Law School, Chicago, Illinois
Peter D. Mills, PhD, MS Director, VA National Center for Patient Safety Field Office, Veterans Affairs Medical Center, White River Junction, Vermont and Adjunct Associate Professor of Psychiatry, The Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
Joanne Belviso Puckett, EdM, RN Director, Quality and Risk Management, USAF 48th Medical Group, Royal Air Force, Lakenheath, United Kingdom
Christine Rovinski-Wagner, MSN, ARNP National Transformational Coach Captain, VHA Office of Veterans Access to Care, Faculty Scholar, VA Quality Scholars Fellowship Program, White River Junction, Vermont and Clinical Instructor in Community and Family Medicine, The Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
Danielle Scheurer, MD, MSCR, SFHM Hospitalist and Chief Quality Officer, Associate Professor of Medicine, Medical University of South Carolina, Charleston, South Carolina
Jamie L. Vargo-Warran, DM/IST, MSN, BSN, LSSGB Dean, Academic Affairs, Chamberlain University College of Nursing, Rancho Cordova, California
Beth A. Vottero, PhD, RN, CNE Associate Professor of Nursing, Purdue University Northwest, College of Nursing, Research Associate, Indiana Center for Evidence-Based Nursing Practice, Joanna Briggs Collaborating Center, Hammond, Indiana
Kimberly J. Whalen, MLIS Associate Professor of Library Services, Health Sciences Librarian, Valparaiso University, Valparaiso, Indiana
Nurses are at the core of healthcare delivery and their role requires both competence and leadership to ensure that high quality and safe care is provided. It is exciting to see the publication of the second edition of Quality and Safety Education for Nurses: Core Competencies for Nursing Leadership and Management. Based on the Quality and Safety Education for Nurses (QSEN) competencies (Cronenwett et al., 2007) and emphasizing leadership and management principles, this book is a valuable educational resource that facilitates teaching contemporary nursing practice. Nursing students and fac- ulty across the nation will benefit from the content of the book. It includes personal interviews, essential content, and study questions that promote reflection and criti- cal thinking. The book is an essential resource to learning and applying the QSEN competencies.
Now is the time for nurses to have the knowledge, skills, attitudes, and leadership to provide consistent high quality and safe care. Although there is evidence that we have made some progress in the delivery of care (National Patient Safety Foundation, 2015) since the Institute of Medicine (IOM) report over 17 years ago (IOM, 2000, 2003), medical error remains the third leading cause of death (Makary & Daniels, 2016). This is due in part to the increasing complexity and dynamic nature of healthcare, the delivery of care by interprofessional teams that demands new types of communica- tion strategies, and the challenge of integrating informatics and the electronic health record. The delivery of healthcare is not what it used to be and new educational strate- gies are needed to address these changes.
The QSEN competencies were developed over 12 years ago and schools of nursing continue to report that the QSEN competencies are not integrated into their curricu- lum (Altmiller & Armstrong, 2017). This is concerning as 24% of NCLEX® questions are directly related to quality and safety content. Since 2012, the QSEN Institute at the Case Western Reserve University Frances Payne Bolton School of Nursing has contin- ued the QSEN movement by continuing to provide resources to integrate the QSEN competencies into the curriculum in the classroom, simulation lab, and clinical experi- ences. The qsen.org website provides ready-to-use teaching strategies, resources, and connections to QSEN experts. A monthly newsletter and annual conference connect nurse educators and nurse practice leaders to ensure that nursing students are quality and safety practice ready and that nurse preceptors and practicing nurses are ready to role-model quality and safety standards.
xvi • FOREWORD
The QSEN movement includes a fundamental paradigm shift: a shift from nurses not just doing their work but improving their work. This requires nurses and other healthcare professionals
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