Using Unfolding Case Studies to Teach the QSEN

Using Unfolding Case Studies to Teach the QSEN Competencies Gerry Altmiller, Ed. D, APRN, ACNS-BC

Presenter has no conflict of interest

Objectives 1. Discuss how unfolding case studies support QSEN competency development in student learning. 2. Identify strategies to create unfolding case studies as instructional tools in classroom and laboratory student learning.

Teaching with Unfolding Case Studies Value: �Captures dynamic nature of situational mental models �Enhances critical thinking and problem solving �Focuses on learning concepts rather than nursing tasks �Actively engages students as they problem solve and make adjustments in patient care based on changing situations

Begin with an idea �List what you want students to learn �What details to include �What problems will make students think about what you want them to think about? �What information will they need in advance? �Provide a journal article for preparation reading for students

Outline How it will Unfold �Consider the amount of time you have for the activity -Classroom or Simulation Lab? �Are there props you want to use?

Develop the Case �Create a scenario � Setting � Situation � Symptoms/manifestations �Include lab data �Provide physician’s orders � Medications � IV fluids � Diet � Treatments ©Altmill

Questions for Students �What questions do you have? �What are you worried about for the patient? �What action will you take? �Leave something out for them to find �Always bring it back to patient needs

Theory Bursts �Short snip-its throughout the case study to teach major concepts �Provides information that student needs to know

As Simulation �High fidelity �Use of monitors, live patients, recorded sessions �Low Fidelity �Room of horrors, tubing connections jig-saw, create a scenario of system vulnerability needing solutions �Consider interprofessional teaching �Faculty as facilitator

Begin with Patient Presentation �Patient admitted to ED �Patient at Pre-natal visit �Patient admitted to ICU �Patient at outpatient visit

Inclusions �Use quality and safety terminology �Delegate work �Use SBAR communication �Shared decision making �Practice going up chain of command �Incorporate interruptions �Pause in the face of uncertainty (time-out) �Cultural aspects

Evaluating Student Clinical Reasoning �Exams �Classroom-clinical connection �Small group work �Identify priorities �List nursing diagnoses

Peri-operative Unfolding Case Study Impact Research http: //qsen. org/peri-operative-nursing-an -unfolding-case-study/

Impact Research Quantitative: Exam scores remained stable Qualitative Valued seeing peri-op experience through patient’s eyes Aha moment-that’s the process! Enjoyed challenge of problem solving

Integrating QSEN �Patient Centered Care �Teamwork and Collaboration �Concern for patient �Require inter-disciplinary communication; Student makes call to physician; uses SBAR �Identifies work to delegate �Uses SBAR for hand-off �Delegates work �Require assertion (CUS) �Situational monitoring �Safety huddles �Concern for family �How do we know their wishes? �Patient preferences and values �Family preferences �HIPPA considerations �Cultural values �Identify barriers to care ©Altmiller

Integrating QSEN �Evidence-based Practice �Standardized practices �Use of Bundles �Confirming appropriate care �Discuss choice of interventions �Strength of evidence that guides care �Differential diagnosis �Continuous Quality Improvement �How do we know the systems works? Did the patient gets the correct medications? Treatments? � How could it have gone better for patient? � How could team have worked better together? � What could we have done differently? � What did we do well? � Discuss Nursing Sensitive Quality indicators

Integrating QSEN �Safety �What risks are present for the patient? �How do we protect the patient? �Mindfulness: What is the worst thing that can happen? �Medication Reconciliation �Safe hand-off �Two patient identifiers �Critical lab values requiring readback �Work-arounds �Abbreviations �Insert errors for students to find �High Alert medications �Independent double checks �Informatics �Reporting of labs �Diagnostic tests �Use infusion pumps �Use monitors �Medication calculations �Use of PDA to retrieve information �Electronic Health Records �Find resources for the patient

Unfolding Cases on QSEN. org �Create Unfolding Case Studies that emphasize safety �http: //qsen. org/unfolding-case-study-applying-the-qsen- competencies-to-the-care-of-patients-with-parkinsonsdisease/ �http: //qsen. org/schizophrenia-unfolding-case-study/ �http: //qsen. org/perinatal-unfolding-case-study/ �http: //qsen. org/eating-disorder-unfolding-case-study/ �http: //qsen. org/peri-operative-nursing-an-unfolding-casestudy/

Medication Reconciliation

Resources QSEN Teaching Strategies �http: //www. qsen. org/ Institute for Healthcare Improvement �http: //www. ihi. org

� Questions? Thank you! Altmillg@TCNJ. edu