343CHAPTER 29
QSEN CAROUSEL for First-Year Nursing Students
A. IMPLEMENTATION OF SIMULATION-BASED PEDAGOGY IN YOUR INDIVIDUALIZED TEACHING AREA
In this chapter, readers consider an approach used with concepts, tasks, and skills in a freshman nursing course. A Quality and Safety Education for Nurses (QSEN) framework orients students to a systems approach when evaluating quality so that “blame” is not a focus and professional accountability is developed. Burnhas, Chastin, and George (2012) describe a just understanding of safety. Removal of fear is critical in learning and practice. The International Nursing Association for Clinical Simulation and Learning (INACSL, 2013/2016) has developed the INACSL Standards of Best Practice: SimulationSM, an evidence-based framework to guide simulation design. Standard VI speaks of planned debriefing, which promotes reflective thinking (Decker et al., 2013). Simulation with directed prompts for reflection provides the tools and pedagogy for development of prelicensure QSEN behaviors. A simulation laboratory is a unique setting in which to introduce and develop QSEN competencies. In Chapter 26, the growth of simulation-based pedagogy is discussed. The foundation for simulation as a learning approach throughout the curriculum is practiced by full-time and adjunct faculty.
B. EDUCATIONAL MATERIALS AVAILABLE IN YOUR TEACHING AREA AND RELATED TO YOUR SPECIALTY
In addition to the simulation resources described in Chapter 26, technology resources include online and in-person librarian access to evidence-based data search engines, such as Cumulative Index of Nursing and Allied Health Literature (CINAHL), and electronic charting tools that allow for real-world experience in electronic documentation.
C. SPECIFIC OBJECTIVES OF SIMULATION USAGE WITHIN A SPECIFIC COURSE AND THE OVERALL PROGRAM
QSEN is an initiative promoting commitment to quality and safety recommendations from the Institute of Medicine. The Health Professions Education: A Bridge to Quality (IOM, 2003) discussed an overhaul and transformation of the education system. Joint gap analyses by faculty and clinical partners guided curricular development, strengthening experiences (Fater, 2013; Ouellet et al., 2012). Competencies include ability to provide patient-centered care, effectively work in interprofessional teams, understand evidence-based practice, measure quality of care, and use health information technology, as defined in Table 29.1 (QSEN, 2014). These competencies were developed with and demonstrate a basic skill set that includes cognitive knowledge, psychomotor skills, and professional nursing values and attitudes (Kantor, 2010). Introducing these competencies and skill sets in an introductory nursing course promotes a systems-based foundation for critical thinking and professional accountability in nursing (Lambton & Mahlmeister, 2010).
Table 29.1 QSEN Competencies
Competency | Definition |
Patient-Centered Care | Recognizes the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs. |
Evidence-Based Practice | Integrates best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care. |
Safety | Minimizes risk of harm to patients and providers through both system effectiveness and individual performance. |
Teamwork and Collaboration | Functions effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care. |
Informatics | Uses information and technology to communicate, manage knowledge, mitigate error, and support decision making. |
Quality Improvement | Uses data to monitor the outcomes of care processes and uses improvement methods to design and test changes to continuously improve the quality and safety of health care systems. |
QSEN, Quality and Safety Education for Nurses.
D. INTRODUCTION OF SCENARIO
Previous studies suggested students travel through a series of stations using a circular approach to learn and achieve desired outcomes (Florea & Rafeldt, 2005; Florea, Rafeldt, & Youngblood, 2011). Standardized patients and high- and low-fidelity simulations with individual workstations for online CINAHL searches and electronic record charting are used throughout the rotations. The term CAROUSEL is an acronym used to identify and translate the QSEN focus of each station. C = commitment to safe practice; A = achieving an “A” in practice by considering knowledge, skills and professional nursing values, asking about and evaluating care within systems; R = role play, simulation, and activities; O = consideration of others and patient-centered care; U and S = taking care of yourself so that you can be an effective team member; E = finding evidence-based practice resources using technology; and L = legal and ethical implications for documentation using technology.
The QSEN CAROUSEL approach can be used with any concept or skill within the curriculum. These activities also introduce students to the effective use of simulation and reflection. Many students then learn to practice in the laboratory on their own and with peers. Tables 29.2 and 29.3 list a sampling of approaches with first-year nursing students.
Table 29.2 Developing Safe and Competent Practice in Mobility, Critical for Health
Immobility, Fall Risk, and the Need for Mobility | Station Learning Activity |
C—Commitment to safety | Review practice guidelines for evaluating patients using fall-risk tools, pre- and postambulation vital sign assessement, and implementing safety plans |
A—Achieving an “A” in practice Considering knowledge, skills, and professional nursing values Asking about and evaluating care within systems | Knowledge—Practice guidelines for transferring a patient from bed to wheelchair and reverse, ambulating a patient Psychomotor skills—Completing the transfers with and without Hoyer, Seralift, and Sam Haul Turner, turning aids; ambulating the patient with and without gait belts Affect and professional values—Feelings related to using mechanical lifts, what to use if gait belt cannot be found, what if patient falls, and how to translate into safe practice; participating in root-cause analysis to ask about and evaluate care using a systems approach |
R—Role play and actual simulation | Transfer of patient from floor to bed, varying use of Hoyer lift, inflatable lift, or two-person assist |
O—Other considerations and patient-centered care | Consider age and disease/surgical condition variations in risk parameters—Vulnerabilities related to orthostatic hypotension; effects of a low hemoglobin and hematocrit; pain, multiple patient care tubes, orthopedic, neurologic, cardiac conditions Consider the effects of immobility. |
U and S—Taking care of yourself so that you can be an effective team member | Are you using ergonomic principles in care and preventing occupational vulnerabilities from becoming reality? |
E—Finding evidence-based practice resources and using technology | Use CINAHL and/or search engine to find an evidence-based practice scholarly article related to prevention of falls and the value of mobility in aging populations; share and discuss |
L—Legal and ethical implications for documentation and using technology | Reinforce need for risk assessment each shift, use of preventive devices, and documentation of falls; review use of an incident report |
CINAHL, Cumulative Index of Nursing and Allied Health Literature.
E. RUNNING OF THE SCENARIO
These simulation experiences can be completed in multiple 7.5-hour clinical labs, half-day clinical labs, or individual sessions.
Faculty structure the development of critical thinking with transparency in learning to facilitate application of theory to practice. Station learning activities can be discussion based—debriefing sessions, actual live or human simulator experiences, or individual work centers. Crafted prompts reinforce retention. Consideration related to student/faculty ratio, contact time for the experience, and early preparation of the student are some of the variables that influence the design.
Table 29.3 Developing Clinical Decision-Making Behaviors in Basic Nutritional Safety
Collecting, Interpreting and Implementing Nutritional Support and Safety for Patients | Station Learning Activity |
C—Commitment to safety | Reviewing practice guidelines working collaboratively with provider, nursing staff, dietary, and speech and occupational therapists as needed Review swallow guidelines Review how to approach patients who are not eating prescribed diet Review how to assess and evaluate advancing the diet from NPO to clear liquids in a postsurgical patient |
A—Achieving an “A” in practice Considering knowledge, skills, and professional nursing values Asking about and evaluating care within systems | Knowledge—Differentiating what is recorded for I&O, entering the percentage of meal eaten by the patient, differentiating when to enter percentage and actual foods for calorie count by dietitian Psychomotor skills—Completing an actual I&O or nutrition form Affect and professional values—Feelings related to nurses’ role in assessing nutrition, valuing own contributions in clinical settings, novice advocacy for changes in patient’s diet |
R—Role play and actual simulation | Feeding a patient—Varies in each group (opening containers—setup, verbal cueing, feeding with no adaptive devices, feeding with adaptive devices, mixing liquids with Thicket to varying consistencies) Assess for signs and symptoms of nutritional health and malnutrition Interpret nutritional laboratory values of serum albumin and prealbumin and their uses in clinical practice |
O—Other considerations and patient-centered care | Consider age and cultural variations in nutritional parameters Identify what to do if families bring in food for patient and where it is stored |
U and S—Taking care of yourself so that you can be an effective team member | Are you planning for your own meal during clinical? Are you reporting off to the nurse, CNAs/PCTs, and instructor when going to lunch/dinner? |
E—Finding evidence-based practice resources and using technology | Use CINAHL and/or search engine to find and identify implications of dysphagia in patients and how an NPO order over time affects patient outcomes |
L—Legal and ethical implications for documentation and using technology | Reinforce need for dietary order and assessment of the order with action as needed and documentation |
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