Implementing Quality and Safety at the Unit Level in an Innovative Clinical Education

ModelKathleen Williams Kafel MS,RN

JoAnn Mulready-Shick EdD,RN,CNEJudith 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-UpMGH 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