Assessing quality and safety competencies of graduating prelicensure nursing students

doi:10.1016/j.outlook.2009.08.004

Nursing Outlook

Volume 57, Issue 6, November–December 2009, Pages 323-331

https://doi.org/10.1016/j.outlook.2009.08.004 Get rights and content

The Quality and Safety Education for Nurses (QSEN) project is focused on enhancing nursing curricula and fostering faculty development to support student achievement of quality and safety competencies. The purpose of this descriptive study was to assess student perspectives of quality and safety content in their nursing programs along with self-reported levels of preparedness and perceived importance of the 6 QSEN competencies. Graduating students (n = 565) from 17 US schools of nursing completed an electronic student evaluation survey. Students reported exposure to QSEN knowledge areas, more often in classroom and clinical learning settings than in skills lab/simulation settings. Clinical experience outside of formal education was associated with perceptions of a higher level of preparedness for QSEN skills in several competencies. In general, students reported relatively high levels of preparedness in all types of prelicensure nursing programs and endorsed the importance of quality and safety competencies to professional practice.

Section snippets

Review of Literature

Early efforts to assess KSAs related to quality and safety competencies focused primarily on patient safety, as exemplified by a national education needs assessment survey of nurses and physicians⁴ and measurement of cultures of safety among both students and practicing professionals across nursing, medicine, and other health disciplines.5, 6, 7 A variety of approaches to educational program content and methods was found to develop increased knowledge of safety and quality, and improved skill

Development of the QSEN Student Evaluation Survey (SES)

The QSEN KSAs for each of the 6 competencies represented the domain of interest for the QSEN student evaluation survey (SES). Inclusion of all KSA elements was not feasible, however, because the length of the survey would have created too great a participant burden to achieve acceptable response rates. Therefore, expert reviewers (the QSEN Principal Investigators, Advisory Board, and Faculty) proposed sets of items that would represent each competency. The items comprising the SES were approved

Discussion

Prelicensure students from BSN, ADN, and diploma programs, in high percentages, reported that quality and safety knowledge and skills were addressed in their curricula. The knowledge topics perceived as present by the highest percentages of students reflected content from 3 of 6 competencies: patient-centered care, safety, and evidence-based practice. In contrast, the topics perceived as being addressed least frequently belonged to the quality improvement and teamwork and collaboration

Summary

Prelicensure nursing students from 17 schools of nursing perceived QSEN quality and safety competencies as very important to their future professional nursing practice. Many aspects of quality and safety content were perceived to be present in curricula, although the level of inclusion varied across the 6 QSEN competencies and the learning venues used. Quality improvement was consistently cited as the competency with the lowest perceived skill level and among the topics of lowest importance, a

Dori Taylor Sullivan, PhD, RN, NE-BC, CNL, CPHQ, is Associate Dean for Academic Affairs and Clinical Professor, Duke University School of Nursing, Durham, NC.

References (13)

Health professions education: A bridge to quality
(2003)
L. Cronenwett et al.
Quality and safety education for nurses
Nurs Outlook
(2007)
L. Cronenwett et al.
Improving quality and safety education: The QSEN Learning Collaborative
Nurs Outlook
(2009)
J.B. VanGeest et al.
Educational needs assessment for improving patient safety: Results of a national study of physicians and nurses
(2003)
J.B. Colla et al.
Measuring patient safety climate: A review of surveys
Qual Saf Health Care
(2005)
W.S. Madigosky et al.
Changing and sustaining medical students' knowledge, skills, and attitudes about patient safety and medical fallibility
Acad Med
(2006)

There are more references available in the full text version of this article.

Cited by (79)

Association of self-efficacy and faculty support on students’ readiness for practice
2024, Journal of Professional Nursing
The nursing shortage is apparent again after nearly five decades of having a stable workforce. One novel development is that new Registered Nurses (RNs) are exiting their careers too early. Many of them leave the profession for multiple reasons such as burnout and family obligations, yet one reason has emerged – lack of readiness for practice, that also drives the RNs to leave the profession.
The purpose of this study was twofold — (1) to investigate the relationship between students' characteristics, their Generalized Self-Efficacy (GSE), Perceived Faculty Support (PFS), the Assessment Technologies, Inc. (ATI) Comprehensive Predictor RN Exam scores and their self-report of readiness for practice and (2) to examine which variables best explains the students' readiness for practice.
A cross-sectional descriptive correlational research design with convenience sampling was utilized. Descriptive statistics were obtained to investigate the students' socio-demographic data. The Pearson r and multiple regression were used to analyze the relationships and influence between dependent variables Casey-Fink Readiness for Practice scale (CFRPS) and independent variables, students' characteristics, GSE, PFS, and ATI scores.
One hundred forty-three (143) out of 416 students in five baccalaureate schools from the western region of the United States participated in the survey. Findings showed GSE and PFS had significant positive correlations with students' readiness for practice. Further, factors of CFRPS in learning strategies, problem-solving, resourcefulness, and team player are best explained by GSE and PFS, accounting for 91 % of the variance.
Students' GSE and PFS can contribute to their readiness for practice. Nurse educators must employ strategies that will bolster students' preparedness by improving their sense of self-efficacy and showing them the utmost faculty support.
The Turkish version of the Patient Safety Competency Self-Evaluation Tool: A validity and reliability study
2021, Nurse Education in Practice
Citation Excerpt :
At the time of the study, there was no valid and reliable questionnaire in Turkish for use in nursing students. A range of surveys had been used to examine healthcare students' understanding of patient safety, for example, the Health Professional Education in Patient Safety Survey (Ginsburg et al., 2012), the Healthcare Professional Patient Safety Assessment Curriculum Survey (Mansour, 2015), the Patient Safety Attitudes, Skills and Knowledge Scale (Schnall et al., 2008), the Patient Safety Competency Self-Evaluation (Lee et al., 2014), the Student Perceptions of Quality and Safety Competencies (Sullivan et al., 2009) and the Safety Attitudes Questionnaire (Sexton et al., 2006). However, only two of them were measuring nursing students' patient safety knowledge, skills and attitudes; The Patient Safety Attitudes, Skills and Knowledge Scale (PS-ASK) developed by Schnall et al. (2008) and the Patient Safety Competency Self-Evaluation Tool (PSCSE) developed by Lee et al. (2014).
To test the validity and reliability of the Patient Safety Competency Self-Evaluation Tool in Turkish, which was developed to evaluate the patient safety competencies of nursing students.
In nursing education, it is crucial to provide students with the necessary professional knowledge and skills as well as appropriate attitudes in certain subjects. It is essential to address frequently encountered problems, to train nurses who can be aware of patient safety and improve the quality of nursing education. A valid and reliable measurement tool is needed to evaluate nursing students' current patient safety knowledge, skills and attitudes and review the curriculum and learning objectives in this context.
This is a validation study with a cross-sectional design.
The study sample consisted of 417 third and fourth-grade nursing students studying at two universities in Istanbul and volunteered to participate in the research. The study used the Turkish version of the Patient Safety Competency Self-Evaluation Tool was used for data collection. Content validity, construct validity, stability and reliability tests were performed. Data were analyzed using SPSS and AMOS programs. Ethics committee approval and permission from the institutions were obtained.
Nursing students’ mean age was 21.98 (SD = 1.17). The Scope Validity Index of the scale was calculated as 0.97. As a result of the confirmatory factor analysis performed in the original structure consisting of three dimensions, 12 factors and 41 items, it was found that all items were in the sub-dimensions of the original scale and factor loads were between 0.168 and 0.918. Four models were tested in confirmatory factor analysis and Model 4 had the best-fit indices. They were calculated as: χ2/df = 2.38, RMSEA = 0.06 and CFI = 0.91 for Model 4. Cronbach's alpha value of the total scale was 0.941 and ranged between 0.642 and 0.932 in its sub-dimensions.
The Turkish version of the Patient Safety Competency Self-Evaluation Tool is valid and reliable to measure nursing students’ patient safety competencies.
Construction of evaluation indexes of nursing students' quality and safety competencies: A Delphi study in China
2021, Journal of Professional Nursing
Providing quality and safe nursing care is considered the cornerstone of the healthcare system globally. However, there are no comprehensive evaluation indicators of nursing students' quality and safety competencies in China.
To develop the evaluation indicators and achieve experts' consensus on bachelor nursing students' quality and safety competencies at their graduation.
Based on the framework of the American Association of Colleges of Nursing's Quality and Safety Education for Nurses, literature review, semi-structured interview, and e-Delphi technique, the evaluation indicators were developed and obtained consensus through the participation of 22 nursing educational experts from August 2016 to May 2017.
The evaluation indicators consisted of six domains, including safety care, patient-center care, collaboration and teamwork, continuous quality improvement, informatics, and evidence-based practice competencies, and 88 indicators. These indicators obtained ≥76% consensus on the experts' judgments.
The evaluation indicators achieved the consensus on a panel of nursing experts, which were scientific and practicable. It could provide guidance for establishing a nursing curriculum to prepare bachelor nursing students' quality and safety competencies.
A cross-sectional survey of nursing students' patient safety knowledge
2020, Nurse Education Today
Knowledge provides a foundation for safe and effective nursing practice. However, most previous studies have focused on exploring nursing students' self-reported perceptions of, or confidence in, their level of patient safety knowledge, rather than examining their actual levels of knowledge.
The overarching objective of this study was to examine final year nursing students' levels of knowledge about key patient safety concepts.
A cross-sectional design was used for this study. Data collection was undertaken during 2018 using a web-based patient safety quiz with 45 multiple choice questions informed by the Patient Safety Competency Framework for Nursing Students. A Modified Angoff approach was used to establish a pass mark or ‘cut score’ for the quiz.
Nursing students enrolled in the final year of a pre-registration nursing program in Australia or New Zealand were invited to participate in the study.
In total, 2011 final year nursing students from 23 educational institutions completed the quiz. Mean quiz scores were 29.35/45 or 65.23% (SD 5.63). Participants achieved highest scores in the domains of person-centred care and therapeutic communication, and lowest scores for infection prevention and control and medication safety.
Based on the pass mark of 67.3% determined by the Modified Angoff procedure, 44.7% of students (n = 899) demonstrated passing performance on the quiz. For eight of the institutions, less than half of their students achieved a passing mark.
Given the pivotal role that nurses play in maintaining patient safety, the results from this quiz raise important questions about the preparation of nursing students for safe and effective clinical practice. The institutional results also suggest the need for increased curricula attention to patient safety.
Effects of a patient safety course using a flipped classroom approach among undergraduate nursing students: A quasi-experimental study
2019, Nurse Education Today
The nursing education system has changed with the increased emphasis on patient safety in healthcare settings. Early education in patient safety is crucial to preparing nurses to be competent in patient care. Therefore, providing undergraduate patient safety education courses using an innovative approach is essential to enhancing patient safety and quality in nursing care.
This study aimed to examine the effects of a patient safety course using a flipped classroom approach on patient safety competency among undergraduate nursing students in South Korea.
A pre- and post-test quasi-experimental design with a non-equivalent control group was adopted.
This study was conducted in the college of nursing at a university in Seoul, South Korea.
A total of 75 undergraduate nursing students participated. All students enrolled in the patient safety course comprised the experimental group (n = 32); those with similar characteristics to the experimental group (age, gender, and year) but did not take the course comprised the control group (n = 43).
A total of 14 sessions (28 h) addressing the topics from the World Health Organization patient safety curriculum guide were delivered using a flipped classroom approach. The teaching methods included online learning and quizzes, case studies, small and large discussions, incident report tasks, and group projects including the development of strategies for patient safety. A survey including a demographic questionnaire and the Patient Safety Competency Self-Evaluation tool was administered at the beginning and end of the fall semester.
Pre- and post-test results demonstrated a significant increase in students' patient safety competency including attitude, skills, and knowledge. Mean scores of patient safety competency in the experimental group were significantly higher than in the control group.
The flipped-classroom patient safety course was shown to be effective in improving patient safety competency in terms of attitude, skills, and knowledge among undergraduate nursing students.
The visibility of QSEN competencies in clinical assessment tools in Swedish nurse education
2017, Nurse Education Today
Citation Excerpt :
Items on the Audit Template were derived from the original QSEN definitions and the knowledge, skills and attitudes statements of the six QSEN competencies used to guide students' learning in both theoretical and clinical learning (Cronenwett et al., 2007). The Audit Template was based on the Swedish Society of Nursing's translation, application and description of the six QSEN competencies in the Swedish context (2010) along with the American Association of Colleges of Nursing QSEN Education Consortium (2012), Altmiller (2013), Preheim et al. (2009), Rosenblum and Sprauge- MacRae (2014), Sherwood and Zomorodi (2014), Pauly - O'Neill et al. (2013) and Sullivan et al. (2009). The template was thus evidence based.
Prospective nurses need specific and sufficient knowledge to be able to provide quality care. The Swedish Society of Nursing has emphasized the importance of the six quality and safety competencies (QSEN), originated in the US, in Swedish nursing education.
To investigate the visibility of the QSEN competencies in the assessment tools used in clinical practice
A quantitative descriptive method was used to analyze assessment tools from 23 universities. Results and Conclusion: Teamwork and collaboration was the most visible competency. Patient-centered care was visible to a large degree but was not referred to by name. Informatics was the least visible, a notable concern since all nurses should be competent in informatics to provide quality and safety in care. These results provide guidance as academic and clinical programs around the world implement assessment of how well nurses have developed these essential quality and safety competencies.

View all citing articles on Scopus

Dori Taylor Sullivan, PhD, RN, NE-BC, CNL, CPHQ, is Associate Dean for Academic Affairs and Clinical Professor, Duke University School of Nursing, Durham, NC.

Denise Hirst, MSN, RN, is QSEN Project Director and Clinical Assistant Professor, University of North Carolina at Chapel Hill, NC.

Linda Cronenwett, PhD, RN, FAAN, is Professor, School of Nursing, University of North Carolina at Chapel Hill, NC.

View full text

ArticleAssessing quality and safety competencies of graduating prelicensure nursing students

Section snippets

Review of Literature

Development of the QSEN Student Evaluation Survey (SES)

Discussion

Summary

Health professions education: A bridge to quality

Quality and safety education for nurses

Nurs Outlook

Improving quality and safety education: The QSEN Learning Collaborative

Nurs Outlook

Educational needs assessment for improving patient safety: Results of a national study of physicians and nurses

Measuring patient safety climate: A review of surveys

Qual Saf Health Care

Changing and sustaining medical students' knowledge, skills, and attitudes about patient safety and medical fallibility

Acad Med

Article
Assessing quality and safety competencies of graduating prelicensure nursing students