Kumpulan askep, laporan pendahuluan dan tugas stikes
NAMA : RIZKI DWI FAHREZA
NO. : 44
THE ONLINE JOURNAL OF ISSUES IN NURSING
Quality and Safety Education for Nurses (QSEN): The Key is Systems Thinking
Abstract
Over a decade has passed since the
Institute of Medicine’s reports on the need to improve the American healthcare
system, and yet only slight improvement in quality and safety has been
reported. The Quality and Safety Education for Nurses (QSEN) initiative was
developed to integrate quality and safety competencies into nursing education.
The current challenge is for nurses to move beyond the application of QSEN
competencies to individual patients and families and incorporate systems
thinking in quality and safety education and healthcare delivery. This article
provides a history of QSEN and proposes a framework in whichsystems thinking is a critical aspect in the
application of the QSEN competencies. We provide examples of how using this
framework expands nursing focus from individual care to care of the system and
propose ways to teach and measure systems thinking. The conclusion calls for movement from personal
effort and individual care to a focus on care of the system that will
accelerate improvement of healthcare quality and safety.
Citation: Dolansky, M.A., Moore, S.M., (September 30,
2013) "Quality and Safety Education for Nurses (QSEN): The Key is Systems
Thinking" OJIN: The Online Journal of Issues in Nursing Vol.
18, No. 3, Manuscript 1.
DOI: 10.3912/OJIN.Vol18No03Man01
Key words: QSEN, quality, safety, systems, QSEN competencies,
education, measurement
...national healthcare quality
organizations, such as the Leapfrog Group, report that the majority of
hospitals have demonstrated little progress in improving quality and safety. Over a decade has passed since the Institute of
Medicine (IOM) report, To Err Is Human: Building a Safer
Health System, and the follow-up report, Crossing the Quality
Chasm, which turned healthcare professionals’ attention to the
importance of improving healthcare outcomes (IOM, 2000; Committee on the Quality, 2001).
These reports highlighted the need to redesign systems of care to better serve
patients in the complex healthcare environment. During the last decade,
national initiatives to improve quality and safety have been implemented, such
as the Institute for Healthcare Improvement’s (IHI) Transforming Care
at the Bedside,5 Million Lives Campaign, and the Triple Aim (IHI, 2013a;IHI, 2013b; IHI, 2013c). To accelerate change, regulatory
agencies have implemented National Patient Safety Goals, Core Measures, (Joint Commission, 2013a;2013b; 2013c), and Hospital Acquired Conditions
(HAC) Never Events (Kuhn, 2008). Yet national healthcare quality
organizations, such as the Leapfrog Group, report that the majority of
hospitals have demonstrated little progress in improving quality and safety.
For example, although we know that zero central line infections should be a
reality in hospitals, thousands of infections are still reported each year (Clark, 2013).
QSEN is a national movement that guides
nurses to redesign the ‘what and how’ they deliver nursing care so that they
can ensure high-quality, safe care. In
2005, nursing leaders responded to the IOM call to improve the quality of
healthcare by forming the Quality and Safety Education for Nurses (QSEN)
initiative funded by the Robert Wood Johnson Foundation. The QSEN initiative
consisted of the development of quality and safety competencies that serve as a
resource for nursing faculty to integrate contemporary quality and safety
content into nursing education (QSEN Institute, 2013). The focus of QSEN,
now the QSEN Institute, has expanded from undergraduate nursing students’
education to include quality and safety education for allnurses.
The mission of QSEN is to address the challenge of assuring that nurses have
the knowledge, skills, and attitudes (KSA) necessary to continuously improve
the quality and safety of the healthcare systems in which they work. QSEN is a
national movement that guides nurses to redesign the ‘what and how’ they
deliver nursing care so that they can ensure high-quality, safe care. Linda
Cronenwett, PhD, RN, FAAN, the founder of QSEN, often states that QSEN helps
nurses to identify and bridge the gaps between what is and what should be and
helps nurses focus their work from the lens of quality and safety
(Personal Communication, 2013).
Viewing nurses’ work through the lens of
quality and safety requires a contemporary approach that incorporates systems
thinking. A crucial skill, systems thinking helps nurses to meet the challenge
of improving healthcare as they move beyond the application of the QSEN
competencies from individual patients and families to accelerate the overall
improvement of healthcare quality and safety. In this article, we review the
history of QSEN and propose a framework that expands nursing focus from
individual care based on personal effort and care of the individual to systems
thinking and care of the system. Examples are provided to demonstrate how to
integrate systems thinking in the application of QSEN competencies and how
systems thinking can be taught and measured.
Although QSEN competencies have spurred
quality and safety in nursing education, it is now time to accelerate their use
and impact. In response to calls for improved
quality and safety, leaders from schools of nursing across the country joined
forces to create the Quality and Safety Education for Nurses (QSEN) initiative.
The Robert Wood Johnson Foundation in 2005 funded QSEN Phase 1 and three
subsequent phases followed (Table 1). The major QSEN contribution to
healthcare education was the creation of six QSEN competencies (modeled after
the IOM reports) and the pre-licensure and graduate-level knowledge, skills,
and attitude (KSA) statements for each competency (Cronenwett et al., 2007). The competency
statements provide a tool for faculty and staff development educators to
identify gaps in curriculum so that changes to incorporate quality and safety
education can be made (Barnsteiner et al., 2013).
The QSEN website serves as a national educational resource and a repository for
nurses to publish contemporary teaching strategies focused on the six
competencies: patient-centered care, teamwork and collaboration,
evidenced-based practice, quality improvement, and informatics. Currently,
there are over 100 teaching strategies posted.
Phase
|
Details
|
Websites
and References
|
Phase 1a
October
2005-March 2007
|
QSEN
competencies and their requisite KSAs
QSEN.org
website
|
|
Phase 2a
April
2007–October 2008
|
Funded 15
pilot schools to use the IHI Learning Collaborative method to develop, test,
and disseminate teaching strategies
Peer
reviewed teaching strategies on the website
|
|
Phase 3a
November
2008-February 2012
|
National
forums to educate nursing faculty
Incorporation
of nurses into the Veterans Affairs (VA)
Quality
Scholars program (VAQS- 2 year pre or post-doctoral fellowships in quality
and safety)
Faculty
modules to the QSEN website
8 regional
Faculty Development workshops (train the trainer) were coordinated by the
AACN
|
|
Phase 4a
March
2012-March 2014
|
American
Association of Colleges of Nursing (AACN) funded to further develop graduate
competencies and coordinate 5 graduate level faculty development conferences
|
|
San
Francisco Bay Area (SFBA) QSEN Faculty
Development
Instituteb
2009-2013
|
AACN
implementation and evaluation of impact of incorporating the QSEN content
into 22 schools of nursing in the San Francisco Bay area. Funding for a
series of workshops for faculty and clinical leaders
|
|
Academic/Clinical
Partnership and collaboration in QSEN
Lourdes
University and ProMedicac
|
Innovative
educational model for undergraduate education that includes a clinical
integration partner to assist with the QSEN-based clinical education model
|
|
QSEN
Institute
July 2012
to present
|
The
Frances Payne Bolton School of Nursing at Case Western Reserve University
continues to host the website and the National QSEN forum
|
|
aRobert Wood Johnson Foundation funding
bGordon and Betty Moore Foundation funding cBureau of Health Professions, Health Resource and Services Administration, Department of Health and Human Services Nurse Education Practice, Quality and Retention |
||
QSEN competencies have been used by
national nursing organizations and are the central focus of the National
Council of State Boards of Nursing (n.d.) Nurse Residency program, the
foundational concepts in the Massachusetts Future of Nursing Framework (Massachusetts Department of Higher Education, 2010), and the Ohio Hospital Association (Ohio Organization of Nurse Executives, 2013). The QSEN competencies also have been incorporated
into nursing textbooks such as the medical-surgical text by Ignatavicious and
Workman (2013), and other books, such as Quality
and Safety in Nursing: A Competency Approach to Improving Outcomes (Sherwood & Barnsteiner, 2012), Second
Generation QSEN, a special issue of the Nursing Clinics of North America (Barnsteiner & Disch, 2012)
and Quality and Safety for Transformational Leadership(Amer, 2012).
Although QSEN competencies have spurred
quality and safety in nursing education, it is now time to accelerate their use
and impact. The full effect of the QSEN
competencies to improve the quality and safety of care can only be realized
when nurses apply them at both the individual and system levels of care. Many nurse educators report that the QSEN competencies
are already integrated into their curriculum, but in our practice, we have
noted that often this integration is at the individual level of care, rather
than at the level of the system of care. The full effect of the QSEN
competencies to improve the quality and safety of care can only be realized
when nurses apply them at both the individual and system levels of care. Figure 1 provides a display of how the six
QSEN domains are linked to optimal patient care through both vigilant individual
care and vigilantsystems of care. Traditionally, nurses have
focused primarily on vigilant individual care; less attention has
been given to assisting nurses to provide vigilantsystems of care. We
propose that in addition to the emphasis on teaching critical thinking skills (Simpson & Courtney, 2002),
nurses also need to be taught the knowledge and skills associated with systems
thinking. In their day-to-day work, nurses’ abilities to engage in better
problem-solving, priority setting, delegation, interactions and collaborations,
decision making, and action-taking are greatly influenced by their ability to
view how any one component of their work system is related to other components
and to the whole.
Figure 1 Source: Authors
|
Systems thinking is the ability to recognize, understand, and
synthesize the interactions and interdependencies in a set of components designed
for a specific purpose. This strategy includes the ability to recognize
patterns and repetitions in interactions and an understanding of how actions
and components can reinforce or counteract each other. These relationships and
patterns occur at different dimensions: temporal, spatial, social, technical or
cultural (Oshry, 2007). Systems thinking links a person’s
environment to his/her behavior. In the delivery of nursing care, this involves
the nurse’s understanding and valuing how components of a complex healthcare
system influence care of an individual patient. Systems thinking can be viewed
as a continuum, ranging from the individual to the larger internal and external
environmental components. Figure 2 shows examples of care approaches
that represent increasing levels of systems thinking.
Figure 2 Source: Authors
|
Systems thinking links a person’s
environment to his/her behavior. How
nurses view both themselves as nurses, and their work, is shaped by the
structures and processes of the systems in which they work. Most nurses provide
care in healthcare organizations that are characterized as complex, multilevel,
and multifunctional. Greater knowledge and application of systems thinking
skills by nurses have the potential to mitigate errors in practice, improve
nurse priority setting and delegation, enhance problem solving and
decision-making, improve timing and quality of interactions with other
professionals and patients, and enhance workplace quality improvement
initiatives. The ability to engage in systems thinking has been viewed as a key
component in the successful delivery of safe and high quality care (Bataldan & Mohr, 1997; Bataldan & Leach, 2009; Batalden & Stoltz, 1993; Senge, 2006). Systems thinking is required to
redesign healthcare to improve the quality and safety of care.
The importance of systems thinking in
quality improvement (QI) initiatives was identified in early literature on
application of QI techniques to healthcare (Batalden & Stoltz, 1993;Deeming & Appleby, 2000)
and, more recently, was highlighted in reports from the Institute of Medicine (IOM, 2003), the Accreditation Council for
Graduate Medical Education (Varkey, Karlapudi, Rose, Nelson, & Warner, 2009), and the article, “Quality and Safety Education for
Nurses” (Cronenwett, Sherwood & Barnsteiner, 2007). Given the hypothesized importance of systems
thinking in the success of quality and safety in healthcare, it is probable
that if nurses engage in better systems thinking, greater improvements in
outcomes will be achieved. Knowledge and skills associated with systems
thinking, however, are seldom addressed in basic or continuing nursing education.
The next sections describe strategies for teaching and learning systems
thinking, especially as related to QSEN competencies, and a newly developed
tool for measurement of systems thinking.
Systems thinking is an essential skill
for nurses. Yet, there has been little knowledge disseminated about how to
assist nurses to better engage in this type of thought process, despite their
key roles in planning, delivering, and improving patient care in complex
organizations. To teach systems thinking it is important to enhance the
learner’s awareness of the interdependencies in people, processes, and services
and to view problems as occurring as part of a chain of events of a larger
system, rather than as independent events.
The clinical environment is an ideal
place to teach systems thinking in undergraduate, graduate, and staff
development education. During the clinical experience, the faculty preceptor
can broaden the learner’s problem identification from a focus on personal
effort in a single situation to a focus on sequences of events with possible
multiple causes for both individuals and populations. Table 2 provides examples of this
continuum of systems thinking using the QSEN competencies. An example of a
teaching technique for systems thinking is to have learners create grids such
as those presented in Table 2 to expand their scope of thinking
from the individual to the system level of care. Students might obtain outcome
data from their unit and identify reasons for variation across time. Enhancing
systems thinking skills also can be done by having learners complete an
assessment of their unit or microsystem.
Assessment tools are available from the
Clinical Microsystem (2013) Green Books for inpatient, emergency
room, long-term care, and outpatient groups. These free workbooks from the
Dartmouth Institute have been developed to help individuals assess the
complexity of the system in which they work. Another approach to expand
learners’ scope of thinking to a systems level is to have them connect nursing
skills and clinical issues to national quality and safety initiatives (Armstrong & Barton, 2013).
For example, urinary care is connected to the National Quality Forum (2012) Catheter Associated Urinary Tract
Infection (CAUTI) prevention and the Joint Commission’s (2013c) National Patient Safety Goal Number 7.
 |
Nurses can also learn systems thinking
by creating flowcharts or process diagrams that elicit the steps of a care
process and the multitude of healthcare workers involved in that process. This
mapping technique is one of the first steps of a quality improvement project.
For example, to improve the care coordination of preparing hospitalized
patients for discharge, teams of healthcare professionals could map steps in
the course of a patient’s stay leading to discharge. This exercise has been
shown to increase knowledge about system factors and enhance awareness of the
importance of interprofessional collaboration (Brennen, Olds, Dolansky, Estrada, & Patrician, in press).
Another approach to teach systems
thinking is to have learners conduct a root cause analysis (Lambton & Mahlmeister, 2010; Tschannen & Aebersold, 2010).
Root cause analysis (RCA) is a widely used technique to assist people to move
beyond blame of an individual for errors made in the workplace to understanding
the system factors that may have contributed to errors. Healthcare
organizations routinely perform RCA after an event so that appropriate changes
can be made in the system to prevent future errors. This technique could be
used to understand system factors even when events “almost happen.” Having
nursing students participate in RCAs during their undergraduate education has
been shown to be beneficial (Dolansky, Druschel, Helba, & Courtney, 2013). For example, having students conduct an RCA for
addressing a medication error may lend a new perspective to how system level
factors interact with individual level factors in the creation of that error.
In the classroom setting, systems
thinking also can be enhanced by using case studies. The book Set
Phasers to Stun (Casey, 1998) includes stories of design,
technology, and human error that can be discussed in class. These stories
identify the close connection between technology and humans. Another book, Systems
Concepts in Action (Williams & Hummelbrunner, 2011),
is a practitioner’s toolkit to teach the principles of systems thinking, such
as system dynamics, outcome mapping, and social network analysis. Highly
effective and very interactive, the game Friday Night in the ER (2009) guarantees learning and fun. The game
is played by four people and simulates the challenge of managing a hospital
during a 24-hour period. Each player is in charge of a unit. The demands of the
game demonstrate that systems thinking is the key to success.
Lastly, teaching systems thinking
requires guided reflection. Faculty need to assist learners to look for and
recognize patterns in systems of care by standing back, reflecting on data, and
considering the system as a whole. Too often in healthcare we make quick
judgments that are based on limited information and preconceived ideas.
Teaching nurses to step back and consider the dependencies and interconnectedness
of system components will lead to a broader understanding of the healthcare
system and the quality of care that results from that system.
To improve systems thinking, we need to
be able to measure it. A valid and reliable measure of systems thinking is now
available. The Systems Thinking Scale (STS) is an instrument that measures
healthcare professionals’ systems thinking specifically related to system
interdependencies. The 20-item STS has good reliability as demonstrated by a
test-retest reliability assessment (N=36; correlation of .74) and internal
consistency testing (N=342) using Cronbach’s alpha (.89) (Case Western Reserve University, 2013b).
...systems thinking can be taught and
learned and an individual’s level of systems thinking can be changed. Data from recent studies indicated that systems
thinking can be taught and learned and an individual’s level of systems
thinking can be changed (Abourmatar et al., 2012; Moore, Dolansky, Palmieri, Singh, & Alemi, 2010). Moore and colleagues tested three groups of
healthcare professions students (n= 102) who received high, low, or no dose
levels of systems thinking education. There were no differences in STS mean scores
at pretest. At posttest, the high-dose systems thinking education group scored
significantly higher on the STS than both the low and no-dose groups (p=.05 and
.01, respectively). The STS is now publicly available for use and a website has
been established to provide information on its use (Case Western Reserve University, 2013a).
Almost 10 years have passed since the
QSEN competencies were developed, and the field of quality and safety is
rapidly advancing. The time has come to consider what new competencies should
be added. We propose that the current QSEN competencies and knowledge, skills,
and attitudes (KSAs) be reviewed and evaluated. Do the KSAs need to be updated,
reclassified, or expanded? Should a systems perspective be made more prominent
in the QSEN model? The QSEN competencies were developed to be a tool to promote
better education for nurses in healthcare quality and safety. We need to update
the QSEN competencies to be as useful as possible to prepare all nurses to
ensure the highest level of care possible.
... a safe and high quality system
of care requires that all healthcare professionals take responsibility to learn
and apply skills associated with improving the wider system of care. Throughout QSEN history, reports from nurses and nurse
faculty are that they already integrate the QSEN competencies into education
and practice. However, we have observed that, despite the fact that
contemporary approaches to quality and safety emphasize a systems view, much of
the nursing education approach to teaching quality and safety (including
application of the QSEN competencies) emphasizes personal effort at the
individual level of care. Although we believe that personal expertise of the
nurse with individual patients is necessary, a safe and high quality system of
care requires that all healthcare professionals take responsibility to learn
and apply skills associated with improving the wider system of care.
We argue, therefore, that the QSEN competencies should be integrated into
nursing curriculum and practice with a strong systems-perspective emphasis.
Nurse faculty and staff development educators must critically evaluate the
extent to which they apply QSEN competencies and at what levels.
Authors
Mary A. Dolansky is an Associate
Professor at the Frances Payne Bolton School of Nursing, Case Western Reserve
University in Cleveland, OH. Dr. Dolansky is Director of the QSEN Institute
(Quality and Safety Education for Nurses) and Senior Fellow in the VA Quality
Scholars program, mentoring pre- and post-doctoral students in quality and
safety science. She has co-published two books on quality improvement,
co-authored several book chapters and articles, and was guest editor on a
special quality improvement education issue in the Journal of Quality
Management in Health Care. She has taught the interdisciplinary course,
“Continual Improvement in Health Care,” at CWRU for the past 8 years and was
chair of the quality and safety task force at the School of Nursing that
integrated quality and safety into the undergraduate and graduate curriculum.
Shirley M. Moore is the Edward J. and
Louise Mellon Professor of Nursing and Associate Dean for Research, Case
Western Reserve University in Cleveland, OH. She is a past President of the
Academy for Healthcare Improvement and is on the leadership team of the
national Quality and Safety Education for Nurses (QSEN) project. She is
currently leading the integration of nurse scholars in the VA Quality Scholars
Program. She also is conducting NIH-funded studies testing a process
improvement approach to health behavior change with patients.
References
Abourmatoar,
H.J., Thompson, D., Wu, A., Dawson, P., Colbert, J., Marsteller, J., &
Pronovost, P. (2012). Development and evaluation of a 3-day patient safety
curriculum to advance knowledge, self-efficacy and system thinking among
medical students. BMJ Quality and Safety. 21(5).
Doi.org/10.1136/bmj qs-2011-000463.
Amer, K. (2012). Quality
and safety for transformational nursing. Upper Saddle River, NJ: Prentice
Hall, Inc. Pearson Publishing.
Armstrong,
G. & Barton, A. (2013). Fundamentally updating fundamentals. Journal
of Professional Nursing, 29(2), 82-87. doi: 10.1016/j.profnurs.2012.12.006
Barnsteiner,
J., Disch, J., Johnson, J., McGuinn, K., Chappell, K., & Swartwout, E.
(2013). Diffusing QSEN competencies across schools of nursing: The AACN/RWJF
Faculty Development Institutes. Journal of Professional Nursing,
29(2) 68-74. doi: 10.1016/j.profnurs.2012.12.003
Batalden,
P.B., & Leach, D.C. (2009). Sharpening the focus on systems-based
practice. Journal of Graduate Medical Education, 1, 1-3. doi:
10.4300/01.01.0001
Batalden,
P.B., & Mohr, J.J. (1997). Building knowledge of health care as a system.Quality
Management in Health Care, 5, 1-12.
Batalden,
P.B. & Stoltz, P.K. (1993). A framework for the continual improvement of
health care: Building and applying professional and improvement knowledge to
test changes in daily work. Joint Commission Journal on Quality
Improvement,19, 424-447.
Brennan,
C., Olds, D., Patrician, P. A., Dolansky, M. A., & Estrada, C. (in press).
Learning by doing: Observing an interprofessional process as an
interprofessional team.Journal of Interprofessional Care.
Case
Western Reserve University, Frances Payne Bolton School of Nursing. (2013a).Systems
thinking scale manual. Retrieved fromhttp://fpb.case.edu/systemsthinking/manual.shtm
Case
Western Reserve University, Frances Payne Bolton School of Nursing. (2013b). The
systems thinking scale: A measure of systems thinking. Retrieved fromhttp://fpb.case.edu/systemsthinking/index.shtm
Casey, S. M. (1998). Set
phasers on stun: And other true tales of design, technology, and human
errors (2nd ed.). Santa Barbara, CA: Aegean.
Clark, C. (2013)
Leapfrog hospital safety scores ‘depressing.’ HealthLeaders Media.
Retrieved from www.healthleadersmedia.com/page-1/QUA-292000/Leapfrog-Hospital-Safety-Scores-Depressing
Clinical
Microsystems.(2013). Materials overview. Retrieved fromwww.clinicalmicrosystem.org/materials/materials_overview/
Committee
on the Quality of Health Care in America. (2001). Crossing the quality
chasm: A new health system for the 21st century. Washington, DC: The
National Academies Press.
Cronenwett,
L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., &
Warren, J. (2007). Quality and safety education for nurses. Nursing
Outlook, 55, 122-131.
Deeming,
C. & Appleby, J. (2000). Measuring performance. Green with envy?. Health
Service Journal, 110, 22-25.
Didion,
J., Kozy, M. A., Koffel, C., & Oneail, K. (2013). Academic/Clinical
partnership and collaboration in Quality and Safety Education for Nurses
education. Journal of Professional Nursing, 29(2) 88-94. doi: 10.1016/j.profjurs.2012.12.004
Disch, J.,
Barnsteiner, J., & McGuinn, K. (2013). Taking a “deep dive” on integrating
QSEN content in San Francisco Bay Area schools of nursing. Journal of
Professional Nursing, 29(2), 75-81. doi: 10.1016/j.profnurs.2012.12.007
Dolansky,
M.A., Helba, M., Druschel, K., & Courtney, K. (2012). Nursing student
medication errors: A root cause analysis to develop a fair and just culture. Journal
of Professional Nursing, 29(2), 102-108. doi:
10.1016/j.profnurs.2012.12.010
Estrada,
C.A., Dolansky, M.A., Singh, M.K., Oliver, B.J., Callaway-Lane, C., Splaine,
M., & Patrician, P.A. (2012). Mastering improvement science skills in the
new era of quality and safety: The Veterans Affairs National Quality Scholars
Program. Journal of Evaluation in Clinical Practice, 18, 508-514.
doi: 10.1111/j.1365-2753.2011.1816.x.Epub 2012 Feb 5
Ignatavicious,
D. D., & Workman, L. M. (2013). Medical- Surgical nursing
patient-centered collaborative care. (7th Edition).
Philadelphia: PA: Elsevier.
Institute
for Healthcare Improvement. (2013a). IHI triple aim initiative.
Retrieved fromwww.ihi.org/offerings/Initiatives/TripleAim/Pages/default.aspx
Institute
for Healthcare Improvement. (2013b). Protecting 5 million lives from
harm. Retrieved fromwww.ihi.org/offerings/Initiatives/PastStrategicInitiatives/5MillionLivesCampaign/Pages/default.aspx
Institute
for Healthcare Improvement. (2013c). Transforming care at the bedside.Retrieved
fromwww.ihi.org/offerings/Initiatives/PastStrategicInitiatives/TCAB/Pages/default.aspx
Institute of Medicine
(2000). To err is human: Building a safer health system.
Washington, DC: The National Academies Press.
Institute of Medicine.
(2003). Health professions education: A bridge to quality.
Washington, DC: National Academies Press.
Joint
Commission. (2013a). Core measure sets. Retrieved fromwww.jointcommission.org/core_measure_sets.aspx
Joint
Commission. (2013b). Hospital: 2013 national patient safety goals. Retrieved
fromwww.jointcommission.org/hap_2013_npsg/
Joint
Commission. (2013c). National patient safety goals. Retrieved
fromwww.jointcommission.org/standards_information/npsgs.aspx
Kuhn, H. B. (2008). State
medicaid director letter. Retrieved fromhttp://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/SMD073108.pdf
Lambton,
J., & Mahlmeister, L. (2010). Conducting root cause analysis with nursing
students: Best practice in nursing education. Journal of Nursing
Education, 49, 444-448. doi: 10.3928/01484834-20100430-03
Massachusetts
Department of Higher Education. (2010). Creativity and connections:
Building the framework for the future of nursing education and practice. Retrieved
fromwww.mass.edu/currentinit/documents/NursingCoreCompetencies.pdf
Moore,
S.M., Dolansky, M.A., Palmieri, P., Singh, M., & Alemi, F. (2010). Developing
a measure of system thinking: A key component in the advancement of the science
of QI. International Health Forum on Quality and Safety in Healthcare,
Nice, France: Acropolis.
National Council of
State Boards of Nursing. (n.d.). Transition to practice regulatory
model. Retrieved from https://www.ncsbn.org/TransitiontoPracticeFinalModel.pdf
National Quality
Forum. (2012). Endorsement summary: Patient safety measures.
Retrieved from: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CDMQrAIwAA&url=http%3A%2F%2Fwww.qualityforum.org%2FWorkArea%2Flinkit.aspx%3FLinkIdentifier%3Did%26ItemID%3D69827&ei=VG8sUuqDOZDiyAHBlYDAAg&usg=AFQjCNE_qJ9BZSyI63f9avYGUXrfAbdhxA&sig2=xFAgr-SmYYONPVLUS1A3iw&bvm=bv.51773540,d.aWc
Ohio Organization of Nurse
Executives. (2013). Position statement: Quality and safety education
for nursing. Retrieved from www.ohanet.org/wp-content/uploads/2013/03/QSEN-White-Paper-3.21.13.pdf
Oshry, B. (2007). Seeing
systems: Unlocking the mysteries of organizational life. San Fransico:
Barett-Koehler.
Patrician,
P. A., Dolansky, M. A., Pair, V., Bates, M., Moore, S.M., Splaine, M., &
Gilman, S. C. (2012). The Veterans Affairs National Quality Scholars (VAQS)
Program: A model for interprofessional education in quality and safety.
Journal of Nursing Care Quality,28(1), 24-32. doi:
Patrician,
P. A., Dolansky, M. A., Estrada, C., Brennan, C., Miltner, R., Newsom, J., …
Moore, S. M. (2012). Interprofessional education in action: The VA Quality
Scholars Fellowship program. Nursing Clinics of North America, 47,
347-354.
Senge, P.M.
(2006). The fifth discipline: The art and practice of the learning
organizations. New York: Doubleday.
Sherwood,
G. & Barnsteiner, J. (2012). Quality and safety in nursing: A
competency approach to improving outcomes. Hoboken, NJ: John Wiley &
Sons.
Simpson,
E. & Courtney, M. (2002). Critical thinking in nursing education:
Literature review. International Journal of Nursing Practice, 8,
89-98.
Tschannen,
D., & Aebersold, M. (2010). Improving student critical thinking skills
through a root cause analysis pilot project. Journal of Nursing
Education, 49, 478-485. doi: 10.3928-01484834-20100524-02
Varkey,
P., Karlapudi, S., Rose, S., Nelson, R., & Warner, M. (2009). A systems
approach for implementing practice-based learning and improvement and
systems-based practice in graduate medical education. Academic Medicine,
84, 335-339. doi: 10.1097/ACM.0b013e31819731fb
Williams,
B. & Hummelbrunner, R. (2011). Systems concepts in action: A
practitioner’s toolkit. Stanford, CA: Stanford University Press.
©
2013 OJIN: The Online Journal of Issues in Nursing
Article published September 30, 2013
Article published September 30, 2013
Related Articles
·
Building Linkages between Nursing Care and Improved
Patient Outcomes: The Role of Health Information Technology
Patricia C. Dykes, PhD, RN, FAAN, FACMI; Sarah A. Collins, PhD, RN (September 30, 2013)
Patricia C. Dykes, PhD, RN, FAAN, FACMI; Sarah A. Collins, PhD, RN (September 30, 2013)
·
An Academic Practice Partnership: Helping New
Registered Nurses to Advance Quality and Patient Safety
Deborah Flores, EdD, RN; Gale Hickenlooper, RN, MPH; Rebecca Saxton, PhD, RN (September 30, 2013)
Deborah Flores, EdD, RN; Gale Hickenlooper, RN, MPH; Rebecca Saxton, PhD, RN (September 30, 2013)
·
The Influence of Quality Improvement Efforts on
Patient Outcomes And Nursing Work: A Perspective from Chief Nursing Officers at
Three Large Health Systems
Marla Weston, PhD, RN, FAAN; Darryl W. Roberts, PhD, MS, RN (September 30, 2013)
Marla Weston, PhD, RN, FAAN; Darryl W. Roberts, PhD, MS, RN (September 30, 2013)
·
An Overview of the National Quality Strategy: Where Do
Nurses Fit?
Rosemary Kennedy, PhD, RN, MBA, FAAN; Judy Murphy, RN, FACMI, FAAN; Darryl W. Roberts, PhD, MS, RN (September 30, 2013)
Rosemary Kennedy, PhD, RN, MBA, FAAN; Judy Murphy, RN, FACMI, FAAN; Darryl W. Roberts, PhD, MS, RN (September 30, 2013)
EmoticonEmoticon