Learner-Centered Activities for the Classroom based on QSEN

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Learner-Centered Activities for the Classroom
based on QSEN

• Donna D. Ignatavicius, MS, RN, ANEF
• President, DI Associates, Inc.
• 505-301-6486
• donna_at_diassociates.com

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Six QSEN Competency Areas (www.qsen.org)

• Patient-Centered Care
• Teamwork and Collaboration
• Evidence-Based Practice
• Safety
• Quality Improvement
• Informatics

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Integrating Safety Throughout the Curriculum is 1

• Individual, staff, and system safety (include
  patient as safety partner just culture culture
  of safety)
• Select areas within each course for emphasis,
  e.g.
• Communication and patient identification
• Infection prevention and control
• Medication administration and reconciliation

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Integrating Safety Throughout the Curriculum
(contd)

• Injury prevention (TCAB project)
• Failure to rescue/risk reduction
• Prioritization, delegation, and supervision

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Specific Example of Updating Content MCH

• Discuss latest health system safety initiatives,
  including efforts to reduce sentinel events
  e.g., Preventing Maternal Death (global issue)

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Specific Example of Updating Content MCH

• Most common preventable nursing errors include
• Failure to pay attention to VS after C-section
• Hemorrhage after C-section
• www.jointcommission.org

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Specific Example of Updating Content MCH (contd)

• Discuss triggers for responding to changes in
  vital signs and clinical condition (individual
  safety PCC)
• Share sample protocols to prevent these errors
  (EBP informatics)

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Specific Example of Updating Content MCH (contd)

• Discuss the value of drills in hospitals
  (teamwork collaboration)
• Review and provide examples of memory
  jogger/reminder tools like checklists (reduces
  reliance on memory) (health care system safety)

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Specific Example of Updating Content
Fundamentals of Nursing

• Medication administration (safety)
• NPSG 3
• Two patient identifiers
• High-alert drugs
• Look-alike/sound-alike drugs
• Do not use and Error Prone Abbreviation lists

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Specific Example of Updating Content
Fundamentals of Nursing (contd)

• Read-back techniques
• Nurse timeouts to give meds
• Labeling errors and systems/ways to improve
• Electronic/bar code systems to prevent medication
  errors (safety-enhancing technologies)

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Specific Example of Updating Content/Learning
Activities Adult Health

• Reporting critical results and values of lab
  tests (NPSG 2 under Communication within team)
  or change in patient condition
• Use case studies or unfolding case studies
• Role play using SBAR or I-SBAR-R
• Discuss examples of patient changes in condition
  if lab is critical

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Benjamin Dexter Case Study

• Benjamin Dexter is a 56-year-old African-American
  male who awoke this morning with right-sided
  weakness. He was confused, fell on his way to the
  bathroom, and had slurred speech. His wife
  suspected that he had a stroke and called 911.
  Emergency personnel arrived within minutes of her
  call and are transporting Mr. Dexter to your
  hospital.
• Courtesy of Tami Little, MS, RN, Nursing
  Instructor, Brookline College

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Benjamin Dexter

• In a group of 3-4 students Discuss your hospital
  system.
• What processes or procedures are in place to care
  for Mr. Dexter?
• Which members of the health care team will be
  involved in the immediate care of Mr. Dexter?
• Which team members might be involved in the long
  term care of Mr. Dexter?
• Who organizes the members of the health care
  team?
• What will your role be?

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Benjamin Dexter

• Upon arrival to the emergency room, Mr. Dexter is
  found to have right hemiparesis and difficulty
  articulating answers to the questions he is
  asked.
• As the registered nurse you are assigned to
  perform a complete assessment.
• What health history will you collect?
• What physical examination will you perform?

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Benjamin Dexter

• Health history
• Moderately obese (BMI 32)
• Hypertension
• High Cholesterol
• Smoked 2 packs of cigarettes a day for past 38
  years
• Vitals
• Pulse 88 /minute
• BP 160/100
• Respirations 24 /minute
• Pulse Ox 95 on RA
• Temp 98.8 F

• Assessment Findings
• Alert and oriented
• Speech slurred (dysarthria)
• Right facial droop present
• Right hemiparesis
• Swallowing - impaired
• Lab Results
• WBC 7,000
• H/H 14/40
• Plts 350,000
• BUN/Cr 46/1.6
• Na 142 K 3.5
• Total Cholesterol 280
• LDL/ HDL 210/ 30

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Benjamin Dexter

• Mr. Dexters assessment correlates with a
  potential stroke.
• With a partner answer these questions
• In what position will you place the patient?
• For what diagnostic testing will you prepare Mr.
  Dexter?
• What information will you share with Mr. Dexter
  and his wife at this time?

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Benjamin Dexter

• After having a CT scan, Mr. Dexter is transferred
  to a medical unit with the following orders
• Vitals and neuro checks every 4 hours
• NPO
• Swallow evaluation
• PT/OT evaluate and treat
• ASA 325mg PO daily
• Lipitor 10mg PO daily
• Enalapril 10mg PO BID
• Are there any other orders you think the MD
  should include in the plan of care? Why?

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Benjamin Dexter

• Mr. Dexter fails his bedside swallow evaluation.
  The therapist suggests a barium swallow test for
  the morning.
• After the swallow evaluation, Mr. Dexter
  complains of chest discomfort. He states I feel
  like my heart is fluttering.
• After an assessment, you plan to call the MD.
• What if you cant reach the MD?

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Benjamin Dexter

• With a partner
• Develop the SBAR communication you will use when
  calling the MD what information will be
  included?
• S Situation
• B Background
• A Assessment
• R - Recommendation

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Benjamin Dexter

• After Mr. Dexter improves over the next two days,
  he is ready to transfer to the inpatient
  rehabilitation unit for ongoing therapy before
  D/C.
• With your partner
• What teaching will you provide Mr. Dexter and his
  wife at this time?
• What factors will you include in his discharge
  preparation and teaching?
• What community resources can you provide?

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Specific Example of Updating Content/Learning
Activities Leadership/Management of Care

• Discuss why and how to do root cause analysis
  (RCA) as a tool for QI and/or PDCA model for
  change.
• Assign students in groups to perform an RCA of a
  sentinel or never event in their clinical
  agencies.
• Present to unit staff.

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PDCA Model of Change
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Other General Learning/Evaluative Activities for
QSEN Competencies

• Use of information systems, including wireless to
  access data
• Videos with discussion/reflection
• Posters (e.g., EBP issue, RCA, PDCA)
• Practice test questions
• Pair activities
• Role play

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Evaluative Tools

• Tests (deliberate measurement of QSEN
  competencies based on QSEN-related objectives)
• Clinical evaluation tools (same as above)
• Clinical paperwork (collaborative concept map
  rather than traditional care plan)

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Summary

• Be deliberate in content, learning strategies,
  and evaluative methods related to QSEN
  competencies.
• Be creative, think differently, but DO NOT add to
  what you are already doing in class!