Transcript Implementing Quality and Safety at the Unit Level in an

Implementing Quality and
Safety at the Unit Level in an
Innovative Clinical Education
Model
Kathleen Williams Kafel MS,RN
JoAnn Mulready-Shick EdD,RN,CNE
Judith Healey Walsh MSN,RN
• A Partnership: University of
Massachusetts Boston, Massachusetts
General Hospital and Brigham and
Women’s Hospital
• A model where nursing practice informs
nursing education and nursing education
influences nursing practice
Dedicated Education Unit is….
• A client unit developed into an optimal
teaching/learning environment through the
collaborative efforts of nurses,
management, students and faculty.
Features of the DEU
• Exclusive use of the DEU by University of
Massachusetts Boston students
• Staff nurses would serve as clinical Instructors
• Orientation, faculty enrichment days provided to
the CIs by the College of Nursing
• University faculty expertise to support the CIs.
• Continuity of students with the staff nurse/CI
over length of semester
• Commitment by all parties to build an optimal
learning environment
Role Definement in the DEU Model
• CI= Clinical Instructor. A BS prepared staff nurse who
provides direct clinical instruction, supervision and
evaluation of two nursing students.
Challenge- the dual role of teacher and care giver. To
provide instruction while providing care.
CFC=Clinical Faculty Coordinator. A course professor at
UMass Boston who collaborates with nursing
management to support the CIs in their education and
evaluation of the students.
Challenge-The instruction of nurses rather than students.
Continuous active collaboration to ensure a positive
experience for all.
Operationalization of the DEU
• MGH- a traumatic surgery unit where 6 staff nurses/CIs
were assigned 12 junior level nursing students in their
Adult Health rotation.
• BWH- an intermediate medical unit where 3 staff nurses
were assigned 6 junior level nursing student in their
Adult Health rotation.
• Two students worked with same CI over entire semester.
• Students worked one12 hour shift per week
• Student expectations in terms of clinical papers were the
same as students in traditional clinical groups.
Opening Day at MGH!
January 31,2008
Opening Day At BWH!
January 31,2008
Practice informing education……
Student Presentations
• Utilizing the QSEN competencies the
students in collaboration with Nursing
Education chose to research and present
findings specific in the following areas :
– Alternatives to Restraints (at BWH)
– Pressure Ulcer Prevention (at MGH)
Education influencing Practice…..
Utilizing the QSEN Competencies
in this DEU model to effect change
• Teamwork and Collaboration
• Knowledge-the strengths, limitations scope of
practice of each on the unit team were
described.
• Skills- Team leader role was utilized, team goal
was formulated and roles were clarified.
• Attitudes-contributions of all members were
sought and respect and value were
communicated. The influence of systems in
formulating change was appreciated and
realized.
Patient Centered Care
• Knowledge-the information communicated
greatly affects the care and comfort
attained.
• Skills-respect, sensitivity to both physical
and emotional comfort were
communicated and assessed.
• Attitudes-the role of the nurse in relieving
and preventing all sources of pain was
recognized.
Evidence-Based Practice
• Knowledge-the scientific process and
components of research evidence were found
and utilized to educate and inform.
• Skills-routine approaches were questioned,
evidence was sought and experts consulted.
• Attitudes-the importance of professional
research was appreciated and need for
continuous improvement of practice
emphasized.
Quality Improvement
• Knowledge-the systems of care that affect
outcome were recognized and the approach for
changing the process of care were explored.
• Skills-information regarding quality improvement
projects were sought and a tool for assessment
was designed.
• Attitudes-appreciation of individual and team
contributions in improving care.
Informatics
• Knowledge-the importance of information
technology was realized.
• Skills-quality electronic sources of health care
information were utilized, electronic records
were navigated and PDAs were introduced.
• Attitudes-the necessity of health professionals to
seek out continuous learning of information
technology was appreciated.
Safety
• Knowledge-commonly utilized unsafe
practices were examined.
• Skills-effective use of strategies to reduce
harm were demonstrated
• Attitudes-the policies implemented around
safety and personal and system vigilance
were valued.
DEU Wrap-Up
MGH Clinical Instructors
BWH Clinical Instructors
Tell me and I’ll forget; show me and
I may remember; involve me and
I’ll understand.
Chinese proverb