DRAFT Professional and Advanced Nursing Education Essentials Tool Kit

Domain 5 - Quality and Safety

(updated March 21, 2021)
Integrative Learning Strategies

1. Perioperative Nursing Unfolding Case Study: This is an evidence-based learning activity that
follows a patient through the perioperative experience from admission, to holding area, to OR suite,
to PACU, to med-surg unit, to discharge, emphasizing quality and safety strategies and applying
AORN guidelines. This 57-slide presentation is designed as an unfolding case study for classroom
experience and can be adapted to a simulated clinical experience. The teaching strategy is available
at: https://qsicenter.tcnj.edu/perioperative-unfolding-case-study/

Publications for this activity include:

1. Altmiller, G. (2020). Perioperative unfolding Case: A lesson in quality and safety. AORN Journal,
112(2): 104-111. doi.org/10.1002/aorn.13101
2. Altmiller, G. (September 2020). Perioperative nursing unfolding case study: Bringing the OR
experience to the classroom. Nurse Educator, 45(5), 231-232. doi:
10.1097/NNE.0000000000000844. Available free at:
https://journals.lww.com/nurseeducatoronline/Fulltext/2020/09000/Perioperative_Nursing_Unfoldin
g_Case_Study_.3.aspx

Sub-competencies addressed by this activity: 5.1b, 5.1C, 5.1f, 5.2b, 5.2c, 5.2d, 5.2f
2. Medication Reconciliation: This 9-slide presentation is designed as an unfolding case study and
presents a patient admitted for heart failure and in need of a medication reconciliation. Students
practice important skills of extracting information from reluctant patients. It is followed by a clinical
learning component of conducting a medication reconciliation weekly for all clinical-based patient
assignments during the semester using a worksheet published in Nurse Educator. The slide
presentation for class is available at: https://qsen.org/medication-reconciliation-2/

Publications for this activity include:

1. Altmiller, G. (2018). QSEN and nursing education: Medication reconciliation. Nurse Educator.
43(3):111. doi: 10.1097/NNE.0000000000000512. Available free at:
https://journals.lww.com/nurseeducatoronline/Fulltext/2018/05000/Medication_Reconciliation.2.asp
x

Sub-competencies addressed by this activity: 5.1b, 5.1c, 5.1f,

3. Care Bundles Data Mining: This in-class activity has students working in groups for 30 minutes
using the Institute for Healthcare Improvement (IHI) website to retrieve information and create a
poster that identifies the evidence-based elements of specific care bundles used in practice,
including: VAP, CAUTI, CLABSI, HAPI, FALLS, and HAI. Afterward, each group reports out to
teach classmates about their assigned bundle using the poster; posters are pinned to classroom walls
for future reference.

Publications for this activity include:

1. Altmiller, G. (2019). Care bundles, QSEN, and student learning. Nurse Educator 44(1), 7-8. DOI:
10.1097/NNE.0000000000000617. Available free at:
https://journals.lww.com/nurseeducatoronline/Fulltext/2019/01000/Care_Bundles,_QSEN,_and_Stu
dent_Learning.5.aspx#pdf-link

Sub-competencies addressed by this activity: 5.1b, 5.1f, 5.2b, 5.2c

 DRAFT Professional and Advanced Nursing Education Essentials Tool Kit

4. Ask Me 3 Program: This is a national education program aimed at safety that teaches patients and
families what to ask regarding their care. This resource is used in practice by nurses and students as
a way to advance high quality patient education. Exercises focus on 3 questions: (1) What is my
main problem? (2) What do I need to do? (3) Why do I need to do it? Resources available at:
http://www.ihi.org/resources/Pages/Tools/Ask-Me-3-Good-Questions-for-Your-Good-Health.aspx

Sub-competencies s addressed by this activity:5.1a, 5.1b, 5.1c, 5.1f

5. Quality Improvement Project for Prelicensure Nursing Students: A 15-slide presentation teaches
students in introductory nursing courses how to implement and evaluate a quality improvement
project using the Model for Improvement. The corresponding assignment spans a total of 4 weeks
with students choosing something to improve about themselves and applying the model. Students
implement 3 PLAN, DO, STUDY, ACT (PDSA) cycles, one cycle per week over 3 consecutive
weeks,recording data to measure the change. On the fourth week, students submit a 1-page essay
meeting the criteria of the grading rubric and attach a graph to demonstrate the data points. Through
this assignment, students learn how to 1) develop an aim statement, 2) implement change using the
model for improvement (PDSA cycles), 3) collect data to measure change/improvement, and 4)
report data using charts or graphs. The presentation includes all the information the student needs to
be successful, including the Institute for Healthcare Improvement tool kit for reporting data.
Available at: https://qsicenter.tcnj.edu/quality-improvement-project-learning-the-model-for-
improvement/

Publications for this activity include:

1. Altmiller, G. (2020). Teaching quality improvement in prelicensure education. Nurse Educator,
45(1), 9-10. doi: 10.1097/NNE.0000000000000772. Available free at:
https://journals.lww.com/nurseeducatoronline/Fulltext/2020/01000/Teaching_Quality_Improvement
_in_Prelicensure.6.aspx

Sub-competencies addressed by this activity: 5.1a, 5.1b

6. Giving and Receiving Constructive Feedback: This evidence-based teaching strategy is an 18-
minute narrated presentation that speaks directly to students about constructive feedback’s role in
quality improvement and patient safety, teaching them to view constructive feedback as an
opportunity for improvement rather than a review of deficiencies. This teaching strategy has been
validated in a multi-site study with over 500 students from 9 schools of nursing across the country.
Available at: https://qsicenter.tcnj.edu/giving-and-receiving-constructive-feedback-activity/

Publications for this activity include:

Constructive feedback teaching strategy: A multi-site study of its effectiveness. (2018). Altmiller,
G., Deal, B., Ebersole, N., Flexner, R., Jordan, J., Jowell, V., Norris, T., Risetter, M., Schuler, M.,
Szymanski, K., Vottero, B., Walker, D. Nursing Education Perspectives Special Summit 2018 Issue
on Educational Research Collaborations, 39(5), 291-6. doi: 10.1097/01.NEP.0000000000000385

Sub-competencies addressed by this activity: 5.1a, 5.1f, 5.2b, 5.3a, 5.3b, 5.3d
7. Template for Debriefing Following a Student Error Using Reflection and Quality and Safety
Competencies: This template is designed for clinical learning and is used by the Safe Student
Reporting Study by the National Council of State Boards of Nursing. It provides step-by-step
instruction for debriefing after a student error in the clinical environment. Actions are focused on
safety strategies and improvements to prevent future errors. Available for free download at:
https://www.ncsbn.org/safe-student-reports.htm

Sub-competencies addressed by this activity: 5.1a, 5.2a, 5.2b, 5.2d, 5.2e

Resources
 DRAFT Professional and Advanced Nursing Education Essentials Tool Kit

1. IHI Open School Modules: The IHI offers training modules for quality and safety education. Thirty-
three modules are offered toteach updated concepts of quality and safety. For educators,1.5
continuing education credits are provided for each module that teach updated concepts related to
quality and safety. For students, completion of 13 specific modules provides a Basic Quality and
Safety Certificate, which signals achievement of basic quality and safety education. Students can add
the certificate to their portfolio. These modules are appropriate for all levels of nursing education and
can be spread across the curriculum as a quality and safety thread that runs throughout the program.
Available free to faculty and students at: www.ihi.org.

Publications for this activity:

Altmiller, G. (2018). QSEN and nursing education: Establishing frameworks for QSEN integration.
Nurse Educator 43(5), 230-1. doi: 10.1097/NNE.0000000000000567. Available at:
https://journals.lww.com/nurseeducatoronline/pages/articleviewer.aspx?year=2018&issue=09000&a
rticle=00005&type=Fulltext

Sub-competencies addressed by this activity: 5.1a, 5.1b,5.1e, 5.1f, 5.2a, 5.2b, 5.2c, 5.2e

2. TeamSTEPPS Instructor Videos: These free training tools are short video vignettes and excerpts
that can be used in classroom instruction to demonstrate and emphasize strategies to maintain
patient safety. Vignettes include emergency department care, inpatient medical care, inpatient
surgical care, labor and delivery care, and physician’s office care. Videos include examples of
excellent safety-structured communication as well as poor communication and the resulting
sequelae for patients that can be used as a stepping off point for discussion. Available at:
https://www.ahrq.gov/teamstepps/instructor/videos/index.html

Sub-competencies addressed by this activity: 5.1a, 5.1b, 5.1c, 5.1f, 5.2b, 5.3d
Recommended Content

Recommended Assessment Strategies

1. Prelicensure Clinical Evaluations Instruments: These clinical evaluations are framed in quality
and safety competencies and are developed and validated for all prelicensure clinical courses. Each
evaluation has 38-43 evaluative items that align with the knowledge, skills, and attitudes of the
QSEN competencies. The quality and safety framed evaluations assist learners to identify the
expected mastery for each clinical course. They demonstrate progression through the program with a
clear focus on quality and safety competencies that align with practice expectations. A standardized
grading rubric is included with each but scoring can be modified to pass/fail, making these
evaluations adaptable to any program. Available at https://qsicenter.tcnj.edu/resources/

Publications for these instruments:

1. Altmiller, G. (2019). Content validation of Quality and Safety Education for Nurses (QSEN) pre-
licensure clinical evaluation instruments. Nurse Educator, 44(3), 118-121. doi:
10.1097/NNE.0000000000000656. Available free at:
https://journals.lww.com/nurseeducatoronline/Fulltext/2019/05000/Content_Validation_of_Quality_
and_Safety_Education.2.aspx
 DRAFT Professional and Advanced Nursing Education Essentials Tool Kit

2. Altmiller, G. (2017). Content validation of a QSEN based clinical evaluation instrument. Nurse
Educator, 42(1). 23-27. doi: 10.1097/NNE.0000000000000307. Available free at:
https://journals.lww.com/nurseeducatoronline/Fulltext/2017/01000/Content_Validation_of_a_Qualit
y_and_Safety.7.aspx

Sub-competencies addressed by this instrument: 5.1a,5.1b, 5.2b, 5.2f, 5.3d

2 Graduate Level Clinical Evaluation Instrument: This quality and safety framed clinical evaluation
was developed and validated for graduate level nurse practitioner clinical education. The 34 items of
the evaluation align with the knowledge, skills, and attitudes of the graduate QSEN Competencies
and with the NONPF core competencies for nurse practitioner education. The 34 items describe the
expected mastery for safe, high-quality nurse practitioner clinical practice and are applicable to any
specialty nurse practitioner clinical rotation Available at: https://qsicenter.tcnj.edu/resources/

Publications for this instrument:

1. Altmiller, G. & Dugan, M. (Published ahead of Print-May 2021). Content validation of the
quality and safety framed clinical evaluation for nurse practitioner students. Nurse Educator, 46(3).
doi: 10.1097/NNE.0000000000000936. Available free at:
https://journals.lww.com/nurseeducatoronline/Abstract/9000/Content_Validation_of_the_Quality_a
nd_Safety.99241.aspx

Sub-competencies addressed by this instrument: 5.1a,5.1b, 5.2b, 5.2f, 5.3d

3. Just Culture Assessment Tool-Nursing Education: This validated 27-item instrument assesses the
6 important dimensions of Fair and Just Culture in schools of nursing. Just culture in practice
encourages practitioners to report errors so that systems can be improved and future errors can be
prevented. The same is not true in nursing education where mistakes are frequently met with a
punitive response. The instrument was developed to assess Fair and Just Culture in nursing
academia and validated in a pilot study of 133 students. This tool was then implemented with over
800 students from 15 schools across the country in a multi-site study that was awarded the 2020
Sigma Theta Tau Generating Evidence for Nursing Education Practice Award. Refined through
factor analysis, this instrument can be used by all nursing education programs to establish a
baseline for Fair and Just Culture and then used to measure improvements over time. Available at:
https://qsicenter.tcnj.edu/just-culture-assessment-tool-nursing-education-jcat-ne/

Publications for this instrument:

1. Walker, D., Altmiller, G., Hromadik, l., Barkell, N., Barker, N., Boyd, T, Compton, M., Cook, P.,
Curia, M., Hays, D., Flexner, R., Jordan, J., Jowell, V., Kaulback, M, Magpantay-Monroe, E.,
Rudolph, B., Toothaker, R., Vottero, B., & Wallace, S. (2020). Nursing students’ perception of just
culture within nursing programs: A multisite study. Nurse Educator, 45(3), 133-138.
doi: 10.1097/NNE.0000000000000739. Available free at:
https://journals.lww.com/nurseeducatoronline/Fulltext/2020/05000/Nursing_Students Perceptions
_of_Just_Culture_in.12.aspx

2. Walker, D., Hromodik, L., Altmiller, G., Barkell, N., & Toothaker, R. (Published ahead of print
2020). Exploratory factor analysis of the just culture assessment tool for nursing education. Journal
of Research in Nursing. Doi: 10.1177/1744987120951589.

3. Walker, D., Altmiller, G., Barkell, N., Hromodik, L., Toothaker, R. (2019). Development and
validation of the just culture assessment tool for nursing education (JCAT-NE). Nurse Educator,
44(5), 261-264. doi: 10.1097/NNE.0000000000000705

Sub-competencies addressed by this instrument: 5.2a, 5.2d, 5.3d

 DRAFT Professional and Advanced Nursing Education Essentials Tool Kit

References

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Silver Spring, MD: Nursesbooks.org Retrieved from: https://www.nursingworld.org/practice-
policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only/
• Aspden, P., Corrigan, J.M., Wolcott, J. & Erickson, S.M. (Eds.). (2004). Patient safety: achieving
a new standard for care. Washington, DC: National Academies Press.
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QSEN Competencies Across Schools of Nursing: The AACN/RWJF Faculty Development
Institutes. Journal of Professional Nursing, Volume 29, No. 2, (March-April) 2013.
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Content in San Francisco Bay Area Schools of Nursing. Journal of Professional Nursing,
Volume 29, No. 2, (March-April) 2013.
• Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: Care of the patient requires
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• Institute of Medicine Committee to Design a Strategy for Quality Review and Assurance in
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• Institute of Medicine. (1990). Medicare: A strategy for quality assurance, Volume II: Sources
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• Institute of Medicine. (2000). To err is human: Building a safer healthcare system. Washington,
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• Institute of Medicine. (2003). Health professions education: A bridge to quality. Washington,
DC: The National Academies Press.
• Hughes, R. G. (2008). Tools and strategies for quality improvement and patient safety
(chapter 44).In NIH Patient Safety and Quality: An Evidence-Based Handbook for Nurses.
Available for free download at: https://www.ncbi.nlm.nih.gov/books/NBK2682/
• Kahn, W. (1990). Psychological conditions of personal engagement and disengagement at work.
Academy of Management Journal, 33(4): 692-724.
• Johnson, J., Drenkard, K, Emard, E, McGuinn, K. (2015). Leveraging Quality and Safety
Education for Nurses to Enhance Graduate-Level Nursing Education and Practice. Nurse
Educator, Volume 40, No. 6, May, 2015.
• Koffell, C, Burke, K., McGuinn, K., Miltner, R. (Fall 2017). “Quality and Safety Education for
Nurses (QSEN) and Academic Practice Partnerships” Nurse Educator, Volume 42, Number 5,
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• Marx, D. (2019). Patient Safety and the Just Culture. Obstetrics and Gynecology Clinics of North
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• Nurse Educator QSEN Supplement September/October 2017 Volume 42 Issue 5S. This
supplementis free access with 11 articles that share teaching strategies, studies, and
implementations that support quality and safety competency. Available at:
https://journals.lww.com/nurseeducatoronline/pages/toc.aspx?year=2017&issue=09001
• Perlo, J., Balik, B., Swensen, S., Kabcenell, A., Landsman, J., & Feeley, D. (2017). IHI
framework for improving joy in work. Cambridge, Massachusetts: Institute for Healthcare
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• Scoville, R., Little, K., Rakover, J., Luther, K., Mate, K. (2016). Sustaining improvement.
IHIWhite Paper. Cambridge, MA: Institute for Healthcare Improvement. Retrieved from:
http://www.ihi.org/resources/Pages/IHIWhitePapers/Sustaining-Improvement.aspx