The primary purpose of the Quality and Safety Education for Nurses (QSEN) project is to prepare nurses for the future and to provide them with the “knowledge, skills, and attitudes necessary to continuously improve the quality and safety of the healthcare systems within which they work” (qsen.org, 2013). For a nurses to be fully capable of treating their patients, they must be fully aware of the competencies that the QSEN project entails; patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics.
The QSEN Institute has defined patient-centered care as the ability to “recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for the patient’s preferences, values, and needs” (qsen.org, 2013). It is necessary for all nurses to be aware of certain knowledge in order to achieve this core competency in practice; includes the ability to understand all aspects of patient care including patient and family preferences, coordination of care, information, communication, and education, physical comfort and emotional support, involvement of friends and family, and transition and continuity. The required skills include the ability to obtain information that allows the nurse to assess the patient’s wants and needs, the ability to implement a care plan and evaluate this plan’s success, and to convey the needs and wants of the patient’s to other members of the care team to ensure that the patient received equal treatment from everyone on staff. Lastly, the attitudes that the nurses must have to achieve this competency include the ability to view the situation through their patient’s prospective, trust that the patient is able to convey his or her own symptoms the best, to treat each patient and case as a potential learning opportunity, and to recognize that patients from different ethnic and cultural backgrounds have different preferences that should be respected and to support these people even if their opinions and values differ from the nurse’s own.
To ensure that I address this competency with respect to treatment of the sample patient, I must first observe whether or not the patient has family members or friends with them at the visit. Although the information that the patient provides about his or her symptoms will be primarily used during the diagnostic process, input about those symptoms from family and friends will be considered with the patient’s permission. In this particular case, doing so is integral to effective patient care; the patient’s daughter (a.k.a. “The Caregiver” reported that the patient was having rapid breathing and a high temperature. Since the patient failed to report this information and this is necessary information about the patient’s symptoms, it should be considered when diagnosing the patient. In addition, I believe that the ability to evaluate patient wants and needs from the patient clinical interview is one of the most essential competencies nurses need to master before becoming fully licensed; if one is unable to properly interview their patient, they will likely miss key information that is needed for a proper diagnosis. In many cases, this can lead to the worsening of the patient’s symptoms, and is highly irresponsible on the part of the nurse. Since the purpose of the example patient’s visit was the administration of Roxanol and yellowish mucous secretions were observed, it is essential for the nurse to conduct a proper clinical interview to obtain the necessary information to identify what is happening with the patient’s health. Objective questions that should be asked to the patient include “What other medications are you taking?”, “Do you take your medications as prescribed?”, “How often do you cough?”, “When you cough, how frequently do you observe the mucous secretions?”, “Do you have a sore throat?”, “Do you have any allergies?”, and “Have you been diagnoses with any other sicknesses lately?”. It is also necessary to ask the patient for access to personal health records, but the nurse must observe the right of the patient to deny this information if he or she pleases.
Next, the QSEN Institute has defined patient-centered care as the ability to “function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care” (qsen.org, 2013). In order to achieve this core competency, nurses must be aware of certain knowledge; first, they must know their own strengths and limitations compared to other members of the team, to identify the role the each team member will play in patient care, create methods to ensure that there are no gaps in the roles of healthcare personnel, to recognize the contributions of all assisting individuals, to communicate effectively and resolve differences in communication gaps, to determine the impact of the team on safety and quality of care, and to establish and evaluate strategies to develop the most effective teams. The associated skills include the ability to demonstrate awareness of strengths and limitations, to act with integrity and respect in situations in which team members offer opposing views, to act as a good team player, to ask for help when necessary, to define team roles and allow contributions from all members, and to communicate effectively. The associated attitudes include the ability to acknowledge one’s own and their team members potential to contribute to the group, to appreciate the collaboration, to respect all of the individuals on the team, to be able to resolve conflicts, note and work to prevent the risks with handoffs among providers and across transitions in care, and the want to participate in an effective team.
When considering this competency in the situation of the example patient, it is important to collaborate with other team members in order to ensure that he or she is diagnosed correctly. Firstly, since I may not be the first nurse to have worked with this patient at this institution, it will be helpful for me to consult other nurses who have worked with him or her before. It is very possible that the patient has suffered this symptom before and a solution is already available. If this is not the case, I should then work with other members of the nursing and healthcare staff to take the patient’s vitals so we can be sure of what is going on with him or her. To ensure that this is done effectively, the nursing staff should meet to discuss what diagnostic tests should be given; the input of many people in a group will certainly be more effective than mine or anyone’s individual opinion, so this is the best method to ensure that time will not be wasted and the patient will not have to come back to the institution for further testing. Before the nurses can meet to discuss what tests should be performed on the patient, they should establish a framework that will allow them to know what to do if one or more nurses disagree with the proposed solution. An ideal framework would be a debate of the contrasting proposals with a final vote in the end in which the decision of the majority will be performed; if the votes come too close and there is not a clear method that has been decided, then a compromise will be made until a majority of the nurses can agree that this is the correct set of tests to perform. While there usually shouldn’t be split decisions between the nurses, it is important to come up with a contingency plan before this occurs so everyone knows what to do and the patient is given testing that is in accordance with the expertise of all of the nurses present.
The next core competency is evidence based practice, which the QSEN defines as the ability to “integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care” (qsen.org, 2013). The knowledge that nurses require to achieve this core competency include the ability to demonstrate knowledge of basic science and methods and the ability to apply this information to patient care and diagnostics, to differentiate clinical opinions from actual research, and to differentiate between accurate and inaccurate reasons to mediate clinical practice. This competency requires that nurses have skills including the ability to participate in data collection, the ability to read primary research journal articles, the ability to adhere to Institutional Review Board (IRB) guidelines, to base individual patient care on both clinical research and experience, and to consult with experts in the field before choosing to deviate from standardized patient care protocols. The associated attitudes for successful achievement of this competency include the ability to appreciate the strengths and weaknesses of information learned in clinical research, to understand the importance of regularly reading primary journal articles relevant to the nurse’s field, to continue to learn things even though school is finished, and to know one’s own limitations of the understanding of clinical research and the ability to ask others for advice.
In the case of the example patient, I would make use of both the knowledge of my colleagues and primary literature to determine whether there is an interaction between Roxanol and the other many medications that the patient is taking. While the patient does have many symptoms and issues that may either be related or not related, it is important to note that he or she is refusing both food and fluids. It is possible that the Roxanol is having interactions with another drug that decreases the patient’s appetite; to assess this, many sources should be checked. In addition, I would also examine other interactions to see if they account for any of the other symptoms that the patient is experiencing.
The next QSEN competency is quality improvement, which is defined as the “use of data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems” (qsen.org). The knowledge that is required by this competency includes the ability to come up with strategies that describe the outcomes of care, to recognize the outcomes of care for both the patients and their families, to understand the importance of variation and management when examining patient quality of care, and to be able to describe approaches for different care processes. The skills required for this competency are the ability to find information that helps describe patient quality of care, to use graphical tools to make these outcomes of care explicit for comparisons, to identify care gaps between local practices and best practices, and to design tests that will indicate patient QI.
In this situation, I believe that it is important to monitor the example patient to see what happens after the administration of the Roxanol. According to WebMD, Roxanol has many dangerous side effects, many of which the patient is actually experiencing; these include possibly fatal breathing issues, constipation, dizziness, and drowsiness (WebMD, n.d). It is recommended that to avoid some of these symptoms, the patients who consume it should change their diet to ones with high fiber, they should exercise, and take a stool softener. Since we don’t know how long the patient has been taking Roxanol, it is important to check his or her records if allowed or to ask the patient or her daughter. Roxanol is also highly addictive, and the longer the patient has been taking this medication, the worse these symptoms can become. Depending on the patient’s other medical information, it may be more beneficial to remove the patient from the drug or provide him or her with subsequently lower doses to balance the negative effects of the medication with the pain that is being experienced. To benefit both this patient and the patients who are seen for similar problems following this treatment, quality improvement can be used to track the patient’s progress and response to the altered treatment. Additionally, it may be possible that a different drug containing morphine will allow the patient to have a better quality of life; if this decision is made, it should be monitored as well.
The next QSEN competency is safety and is defined as one who “minimizes risk of harm to patients and providers through both system effectiveness and individual performance” (qsen.org, 2013). This competency requires nurses to have the knowledge to adequately use certain technologies such as barcoding and labelling processes to ensure that patients are receiving the correct treatments and medications, the medical equipment is up to code, hazardous materials remain separate and are disposed of properly, and sources of error are recorded so these mistakes will not be repeated. Nurses are expected to have a skill set that includes assessing these errors and ensuring they are not repeated, the ability to communicate these hazards and errors to the appropriate personnel or to be able to take care of them on their own, and to use national patient safety references to focus their attention on safety in care settings.
In the case of the example patient, I would ensure that the Roxanol is adequately labelled and meets the description provided on the container; if it does not, I would go to the pharmacy for both an explanation and replacement. Even if the drug given was a generic and appears different than the name brand, it should not be labelled as Roxanol and should not be given because this was not what was prescribed. In addition, safety practices would require the accurate labelling of all blood tests and urine samples conducted on the patient; the correct bar codes will be placed on each so the people who analyze these samples will know how to match it back to the patient.
The last QSEN competency is informatics, which is defined as “use information and technology to communicate, manage knowledge, mitigate error, and support decision making” (qsen.org, 2013). Nurses should have the ability to understand why information technology is important to patient care, know how to use patient databases, and describe how information technology is related to quality control and patient care.
In the case of the example patient, the institutional database should be searched during the initial clinical interview period to confirm the information that the patient and her daughter gave. In addition, patient’s frequently don’t remember all of the medications they are taking and their doses, so this is a good way to double check this information. If the patient doesn’t have any information available on the institutional database, it is essential to record the results of this visit, in addition to the clinical interview and vitals, so that if he or she returns to the institution for an additional dose of the drug or for another issue, the next member of the nursing staff will have pre-existing information about his or her case.
Berwick, D. (n.d.). Patient Centered Care. Retrieved from http://qsen-patientcenteredcare.wikispaces.com/patient+centered+care
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Institute of Medicine. (2003)Health professions education: A bridge to quality. Washington DC: National Academies Press.
Qsen.org. (2013). Pre-licensure KSAS. Retrieved from http://qsen.org/competencies/pre-licensure-ksas/
WedMD. (n.d.). Roxanol Concentrate Oral. Retrieved from http://www.webmd.com/drugs/drug-91663-roxanol+concentrate+oral.aspx?drugid=91663&drugname=roxanol+concentrate+oral