Quality and Safety Education For Nurses (QSEN) Ad
Quality and Safety Education For Nurses (QSEN) Ad
Quality and Safety Education for Nurses (QSEN) ad- on whether the KSAs for pre-licensure education are
dresses the challenge of preparing nurses with the appropriate goals for students preparing for basic
competencies necessary to continuously improve practice as a registered nurse.
the quality and safety of the health care systems in
which they work. The QSEN faculty members
adapted the Institute of Medicine1 competencies for
A
series of national commissions have documented
nursing (patient-centered care, teamwork and col-
significant problems related to safety and quality in
laboration, evidence-based practice, quality im-
the US health care system.1–5 In light of these
provement, safety, and informatics), proposing defi-
nitions that could describe essential features of what it problems, reports from multiple national committees con-
means to be a competent and respected nurse. Using cluded that if health care is to improve, providers need to
the competency definitions, the authors propose be prepared with a different set of competencies than are
statements of the knowledge, skills, and attitudes developed in educational programs today.1,6 Health pro-
(KSAs) for each competency that should be devel- fessionals, using scientific evidence, need to be able to
oped during pre-licensure nursing education. Quality describe what constitutes good care, identify gaps between
and Safety Education for Nurses (QSEN) faculty and good care and the local care provided in their practices,
advisory board members invite the profession to com- and know what activities they could initiate, if necessary,
ment on the competencies and their definitions and
to close any gaps.7 Faculties of medicine, nursing, and
Linda Cronenwett is a Professor and Dean at the School of Nursing, other health professions are challenged by the 2003
University of North Carolina at Chapel Hill. Institute of Medicine (IOM) Health Professions Education
Gwen Sherwood is a Professor and Associate Dean for Academic report1 to mindfully alter learning experiences that form
Affairs at the School of Nursing, University of North Carolina at Chapel
Hill.
the basis for professional identity formation so that grad-
Jane Barnsteiner is a Professor and Director of Translational Research uates are educated to deliver patient-centered care as
at the School of Nursing and Hospital of the University of Pennysylvania, members of an interdisciplinary team, emphasizing
Philadelphia, PA. evidence-based practice, quality improvement approaches,
Joanne Disch is Kathyrn R. and C. Walton Lillehei Professor and
Director of the Densford International Center for Nursing Leadership at and informatics.1
the School of Nursing, University of Minnesota, Minneapolis, MN. Will, ideas, and execution are required to incorporate
Jean Johnson is a Professor and Senior Associate Dean for Health the development of the above competencies in nursing
Sciences at The George Washington University, Washington, DC.
Pamela Mitchell is Elizabeth S. Soule Professor and Associate Dean for
education. Unlike medicine, where commitment to an
Research at the School of Nursing, University of Washington, Seattle, adapted version of the IOM competencies is now in
WA. place for the continuum from medical school to resi-
Dori Taylor Sullivan is an Associate Professor and Chair, Department dency program to certification,8,9 nursing has no con-
of Nursing at Sacred Heart University, Fairfield, CT.
Judith Warren is an Associate Professor at the University of Kansas
sensus on the competencies that could apply to all
School of Nursing and Director of Nursing Informatics at Kansas nurses—that would define what it means to be a
University Center for Healthcare Informatics, Kansas City, KS. respected and qualified nurse. At the core of nursing,
Reprint requests: Linda Cronenwett, PhD, RN, FAAN, Dean and however, lies incredible historical will to ensure quality
Professor, School of Nursing, University of North Carolina at Chapel
Hill, Carrington Hall, CB #7460, Chapel Hill, NC 27599-7460. and safety for patients. Evidence of valuing quality and
E-mail: [email protected] safety competencies in nursing is evident in nursing
publications,10 –12 standards of practice,13 and accredi-
Nurs Outlook 2007;55:122-131.
0029-6554/07/$–see front matter
tation guidelines.14,15 The American Association of
Copyright © 2007 Mosby, Inc. All rights reserved. Colleges of Nursing Task Force on the Essential
doi:10.1016/j.outlook.2007.02.006 Patient Safety Competencies for Professional Nurs-
122 V O L U M E 5 5 ● N U M B E R 3 N U R S I N G O U T L O O K
Quality and safety education for nurses Cronenwett et al
Integrate understanding of multiple Elicit patient values, preferences Value seeing health care
dimensions of patient-centered and expressed needs as part situations “through patients’
care: of clinical interview, eyes”
● patient/family/community implementation of care plan
preferences, values and evaluation of care Respect and encourage
● coordination and integration of
individual expression of patient
care Communicate patient values, values, preferences and
● information, communication, and
preferences and expressed expressed needs
education needs to other members of
health care team Value the patient’s expertise
● physical comfort and emotional with own health and
support Provide patient-centered care symptoms
● involvement of family and friends with sensitivity and respect for
● transition and continuity the diversity of human Seek learning opportunities with
experience patients who represent all
aspects of human diversity
Describe how diverse cultural, Recognize personally held
ethnic, and social backgrounds attitudes about working with
function as sources of patient, patients from different ethnic,
family, and community values cultural and social
backgrounds
Willingly support patient-
centered care for individuals
and groups whose values differ
from own
Demonstrate comprehensive Assess presence and extent of Recognize personally held values
understanding of the concepts of pain and suffering and beliefs about the
pain and suffering, including management of pain or
Assess levels of physical and
physiologic models of pain and suffering
emotional comfort
comfort
Appreciate the role of the nurse
Elicit expectations of patient &
in relief of all types and sources
family for relief of pain,
of pain or suffering
discomfort, or suffering
Recognize that patient
Initiate effective treatments to
expectations influence
relieve pain and suffering in
outcomes in management of
light of patient values,
pain or suffering
preferences, and expressed
needs
Examine how the safety, quality, and Remove barriers to presence of Value active partnership with
cost-effectiveness of health care families and other designated patients or designated
can be improved through the surrogates based on patient surrogates in planning,
active involvement of patients and preferences implementation, and
families evaluation of care
Assess level of patient’s
Examine common barriers to active decisional conflict and Respect patient preferences for
involvement of patients in their provide access to resources degree of active engagement
own health care processes in care process
Engage patients or designated
Describe strategies to empower surrogates in active Respect patient’s right to access
patients or families in all aspects of partnerships that promote to personal health records
the health care process health, safety and well-being,
and self-care management
M A Y / J U N E N U R S I N G O U T L O O K 123
Quality and safety education for nurses Cronenwett et al
Table 1. Continued
Definition: Recognize the patient or designee as the source of control and full partner in providing
compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
Explore ethical and legal implications Recognize the boundaries of Acknowledge the tension that
of patient-centered care therapeutic relationships may exist between patient
rights and the organizational
Describe the limits and boundaries of Facilitate informed patient
responsibility for professional,
therapeutic patient-centered care consent for care
ethical care
Appreciate shared decision-
making with empowered
patients and families, even
when conflicts occur
Discuss principles of effective Assess own level of Value continuous improvement
communication communication skill in of own communication and
encounters with patients and conflict resolution skills
Describe basic principles of
families
consensus building and conflict
resolution Participate in building consensus
or resolving conflict in the
Examine nursing roles in assuring
context of patient care
coordination, integration, and
continuity of care Communicate care provided
and needed at each
transition in care
ing Care recently completed an enhancement to the continuing education programs. In addition, the defini-
Essentials of Baccalaureate Education for Profes- tions can provide a framework for regulatory bodies
sional Nursing Practice to include exemplars of qual- that set standards for licensure, certification, and ac-
ity and safety competencies.16 But the ideas for what to creditation of nursing education programs.
teach, how to teach, and how to assess learning of the
competencies are sorely lacking, and there are few, if PRE-LICENSURE NURSING
any, examples of schools claiming to execute a com- EDUCATION
prehensive quality and safety curriculum. The competency definitions provided a broad frame-
work for QSEN’s work to define pedagogical strategies
DEFINING THE COMPETENCIES for quality and safety education; however, as is evident
Quality and Safety Education for Nurses (QSEN), in the accompanying article in this issue, when the
funded by the Robert Wood Johnson Foundation, was competency names and definitions were used alone, the
designed to address these gaps—to build on the will, to vast majority of pre-licensure program leaders stated
develop the ideas, and to facilitate execution of changes that they already included content related to the com-
in nursing education. Before teaching strategies could petencies in their curricula.17 Relying on the respondent
be developed, however, the QSEN faculty needed to to interpret the general definitions of the QSEN com-
identify specifically what was to be achieved. Working petencies, levels of satisfaction with the extent to which
with an Advisory Board of thought leaders in nursing students developed these competencies were high, and
and medicine (see acknowledgments), the authors re- program leaders believed that faculty possessed the
viewed the relevant literatures and adapted the IOM1 necessary expertise to teach these competencies.
competencies for nursing. The goal was to describe The QSEN faculty and advisory board members did
competencies that would apply to all registered nurses. not share the view that pre-licensure nursing students
In Tables 1– 6, the definitions are shared with the were graduating with these competencies. We knew
profession with the hope that nursing, through its that many students graduated without ever communi-
professional organizations, can benefit from the work. cating a recommendation for a change in patient care to
If nursing constituencies find these competency defini- a physician. Many of us knew that students learned the
tions clear and compelling, over time the competencies “five rights” of medication administration but lacked
can serve as guides to curricular development for the language of common concepts related to safety
formal academic programs, transition to practice, and sciences or quality improvement methods. With the
124 V O L U M E 5 5 ● N U M B E R 3 N U R S I N G O U T L O O K
Quality and safety education for nurses Cronenwett et al
Describe own strengths, Demonstrate awareness of own strengths Acknowledge own potential to
limitations, and values in and limitations as a team member contribute to effective team
functioning as a member of a functioning
Initiate plan for self-development as a
team
team member Appreciate importance of
intra- and inter-professional
Act with integrity, consistency and
collaboration
respect for differing views
Describe scopes of practice and Function competently within own scope Value the perspectives and
roles of health care team of practice as a member of the health expertise of all health team
members care team members
Describe strategies for identifying Assume role of team member or leader Respect the centrality of the
and managing overlaps in based on the situation patient/family as core
team member roles and members of any health care
accountabilities Initiate requests for help when
team
appropriate to situation
Recognize contributions of other Respect the unique attributes
individuals and groups in Clarify roles and accountabilities under
that members bring to a
helping patient/family achieve conditions of potential overlap in
team, including variations in
health goals team-member functioning
professional orientations and
Integrate the contributions of others who accountabilities
play a role in helping patient/family
achieve health goals
Analyze differences in Communicate with team members, Value teamwork and the
communication style adapting own style of communicating relationships upon which it is
preferences among patients to needs of the team and situation based
and families, nurses, and other
members of the health team Demonstrate commitment to team goals Value different styles of
communication used by
Describe impact of own Solicit input from other team members to
patients, families, and health
communication style on others improve individual, as well as team,
care providers
performance
Discuss effective strategies for Contribute to resolution of
communicating and resolving Initiate actions to resolve conflict conflict and disagreement
conflict
Describe examples of the Follow communication practices that Appreciate the risks associated
impact of team functioning on minimize risks associated with handoffs with handoffs among
safety and quality of care among providers and across transitions providers and across
in care transitions in care
Explain how authority gradients
influence teamwork and Assert own position/perspective in
patient safety discussions about patient care
Choose communication styles that
diminish the risks associated with
authority gradients among team
members
Identify system barriers and Participate in designing systems that Value the influence of system
facilitators of effective team support effective teamwork solutions in achieving
functioning effective team functioning
Examine strategies for improving
systems to support team
functioning
M A Y / J U N E N U R S I N G O U T L O O K 125
Quality and safety education for nurses Cronenwett et al
Differentiate clinical opinion from Read original research and Appreciate the
research and evidence summaries evidence reports related to area importance of regularly
of practice reading relevant
Describe reliable sources for
professional journals
locating evidence reports and Locate evidence reports related to
clinical practice guidelines clinical practice topics and
guidelines
Explain the role of evidence in Participate in structuring the work Value the need for
determining best clinical practice environment to facilitate continuous improvement
integration of new evidence into in clinical practice
Describe how the strength and
standards of practice based on new
relevance of available evidence
knowledge
influences the choice of Question rationale for routine
interventions in provision of approaches to care that result in
patient-centered care less-than-desired outcomes or
adverse events
Discriminate between valid and Consult with clinical experts before Acknowledge own
invalid reasons for modifying deciding to deviate from limitations in knowledge
evidence-based clinical practice evidence-based protocols and clinical expertise
based on clinical expertise or before determining
patient/family preferences when to deviate from
evidence-based best
practices
goal of clarifying rather than prescribing current mean- school faculty from 16 universities in the Institute for
ings of the competency definitions, we outlined the Healthcare Improvement Health Professions Education
knowledge, skills, and attitudes (KSAs) appropriate for Collaborative reviewed the KSA draft, they uniformly
pre-licensure education. reported that nursing students were not developing these
During 2 workshops and multiple email communica- KSAs. Additional focus groups were held with faculty
tions, the authors led the process of KSA development. who taught pre-licensure students in QSEN faculty mem-
We focused on all of pre-licensure education (associate, bers’ schools, and the responses were the same. Although
diploma, baccalaureate, and master’s entry), because the the faculty agreed that they should be teaching these
ultimate goal is to assure that all patients will be cared for competencies and, in fact, had thought they were, focus
by nurses who have developed the KSAs for each com- group participants did not understand fundamental con-
petency. We tried to answer the question, “What should cepts related to the competencies and could not identify
nursing promise with regards to its pre-licensure gradu- pedagogical strategies in use for teaching the KSAs.
ates’ quality and safety education?” A chief nurse executive serving on the QSEN advi-
At each step, we sought feedback from nursing faculty. sory board led a focus group of new graduates. Not only
In contrast to the results of the survey, when nursing did these nurses report that they lacked learning expe-
126 V O L U M E 5 5 ● N U M B E R 3 N U R S I N G O U T L O O K
Quality and safety education for nurses Cronenwett et al
Describe strategies for learning Seek information about outcomes Appreciate that continuous quality
about the outcomes of care in of care for populations served improvement is an essential part
the setting in which one is in care setting of the daily work of all health
engaged in clinical practice professionals
Seek information about quality
improvement projects in the
care setting
Recognize that nursing and other Use tools (such as flow charts, Value own and others’
health professions students are cause-effect diagrams) to contributions to outcomes of
parts of systems of care and make processes of care explicit care in local care settings
care processes that affect
outcomes for patients and Participate in a root cause
families analysis of a sentinel event
Describe approaches for Design a small test of change in Value local change (in individual
changing processes of care daily work (using an experiential practice or team practice on a
learning method such as Plan- unit) and its role in creating joy
Do-Study-Act) in work
Practice aligning the aims, Appreciate the value of what
measures and changes individuals and teams can to do
involved in improving care to improve care
Use measures to evaluate the
effect of change
riences related to the KSAs, they did not believe their tors understand the competency definitions by seeing
faculties had the expertise to teach some of the content. the KSAs, they acknowledge that the KSAs represent a
In September 2006, three QSEN faculty leaders new view of what is required.
presented the competencies and KSAs in a special One additional source of feedback was obtained
session of the National League for Nursing (NLN) through written requests to leaders of advanced practice
Educational Summit. Over 100 ADN, diploma, and organizations that represent nurse practitioner and clin-
BSN faculty members listened to the results of the ical nurse specialist faculties and accrediting bodies for
survey and contrasted those results with the responses nurse anesthesia and nurse-midwifery programs. We
from faculty focus groups. Once again, this audience asked whether the competency definitions were appro-
confirmed the focus group feedback. Nurses and nurs- priate for all nurses, including advanced practice
ing faculty hold commitments to patient-centered care nurses, and were told they were. We received helpful
and safety central to their professional identities. They comments on the KSAs, and respondents supported the
consider their teaching approaches to be aimed at the assessment that they were appropriate for pre-licensure
development of these competencies. Yet when educa- graduates.
M A Y / J U N E N U R S I N G O U T L O O K 127
Quality and safety education for nurses Cronenwett et al
Table 5. Safety
Definition: Minimize risk of harm to patients and providers through both system effectiveness and
individual performance.
Examine human factors and other Demonstrate effective use of technology Value the contributions of
basic safety design principles as and standardized practices that standardization/reliability
well as commonly used unsafe support safety and quality to safety
practices (such as work-arounds
and dangerous abbreviations) Demonstrate effective use of strategies Appreciate the cognitive
to reduce risk of harm to self or others and physical limits of
Describe the benefits and limitations human performance
of selected safety-enhancing Use appropriate strategies to reduce
technologies (such as barcodes, reliance on memory (such as, forcing
Computer Provider Order Entry, functions, checklists)
medication pumps, and
automatic alerts/alarms)
Discuss effective strategies to
reduce reliance on memory
Discuss potential and actual impact Use national patient safety resources for Value relationship
of national patient safety own professional development and to between national
resources, initiatives, and focus attention on safety in care safety campaigns and
regulations settings implementation in local
practices and practice
settings
More presentations to faculty at national meetings and curricula generally address principles of commu-
are scheduled, and we expect the profession’s vision for nication, physical comfort, emotional support, and
pre-licensure KSAs to evolve over time. The current education. The QSEN faculty and advisory board
versions of the KSAs are included in Tables 1– 6. members believed greater attention might be needed
Although it is beyond the scope of this article to to KSAs that are concerned with eliciting and incor-
describe and reference every idea presented, we include porating patient preferences and values in the plan of
in the section below a few comments and references for care, valuing the patient (or surrogates) as partners in
each competency. care, appreciating the legal and ethical dilemmas
posed by shared decision-making, and developing
DISCUSSION OF KSAs expertise in managing conflict. New graduates who
Patient-centered Care develop the KSAs would be advocates for removing
The essential features of this competency were barriers to the presence of patient surrogates and
derived from work by Bezold,18 the Picker Insti- would invite patients or surrogates to partner with
tute,19 and Lorig.20 Educators have worked hard on them, for example, in safe medication administration
the issues related to diversity during the last years, and safe transitions in care.
128 V O L U M E 5 5 ● N U M B E R 3 N U R S I N G O U T L O O K
Quality and safety education for nurses Cronenwett et al
Table 6. Informatics
Definition: Use information and technology to communicate, manage knowledge, mitigate error, and
support decision-making.
Explain why information and technology Seek education about how Appreciate the necessity for all
skills are essential for safe patient care information is managed in care health professionals to seek
settings before providing care lifelong, continuous learning
of information technology
Apply technology and information
skills
management tools to support
safe processes of care
Identify essential information that must Navigate the electronic health Value technologies that
be available in a common database record support clinical decision-
to support patient care making, error prevention,
Document and plan patient care
and care coordination
Contrast benefits and limitations of in an electronic health record
different communication technologies Protect confidentiality of
Employ communication
and their impact on safety and protected health information
technologies to coordinate care
quality in electronic health records
for patients
Describe examples of how technology Respond appropriately to clinical Value nurses’ involvement in
and information management are decision-making supports and design, selection,
related to the quality and safety of alerts implementation, and
patient care evaluation of information
Use information management
technologies to support
Recognize the time, effort, and skill tools to monitor outcomes of
patient care
required for computers, databases, care processes
and other technologies to become
reliable and effective tools for patient Use high quality electronic sources
care of healthcare information
Teamwork and Collaboration desired a set of KSAs that would be achievable in all
The essential features of this competency include pre-licensure programs, recognizing that some bacca-
sections related to self, team, team communication and laureate and graduate-entry programs might choose to
conflict resolution, effect of team on safety and quality, devote additional curricular time to develop additional
and the impact of systems on team functioning.21–25 KSAs for this competency. Currently, all programs
Although educators devote curricular time to fostering were perceived to be lacking in sufficient development
teamwork competence with members of the nursing of KSAs that go beyond “understanding of basic scien-
team, faculty focus group participants acknowledged tific methods and processes.”29 New graduates who
that little is done to foster shared mental models and develop the KSAs would differentiate between clinical
communication styles essential to inter-professional opinion and various levels of scientific evidence30 and
team functioning. A mandate to strengthen teamwork value the need for continuous improvement based on
and collaboration skills is derived from knowledge of new knowledge. They would also understand that EBP
the relationships between quality of team communica- is about more than evidence—that it involves patient
tions and clinical outcomes.23,24 New graduates who preferences and values and the clinical expertise nec-
develop the KSAs would use team communication essary to understand when it is appropriate for clini-
practices25 and seek system support for effective team cians to deviate from evidence-based guidelines in
functioning wherever they worked. order to deliver high quality, patient-centered care.
M A Y / J U N E N U R S I N G O U T L O O K 129
Quality and safety education for nurses Cronenwett et al
130 V O L U M E 5 5 ● N U M B E R 3 N U R S I N G O U T L O O K
Quality and safety education for nurses Cronenwett et al
2. Kohn LT, Corrigan JM, Donaldson MS, editors. To err is eyes: Understanding and promoting patient-centered care.
human: Building a safer health system. Washington, DC: San Francisco: Jossey-Bass, Inc.; 1993.
The National Academies Press; 2000. 20. Lorig K, Ritter P, Stewart A, Sobel D, Brown BW, Bandura
3. Committee on the Quality of Health Care in America. A, et al. Chronic disease self-management program: 2-year
Crossing the quality chasm: A new health system for the 21st health status and health care utilization outcomes. Med Care
century. Washington, DC: The National Academies Press; 2001;39:1217-23.
2001. 21. Arford PH. Nurse-physician communication: An organiza-
4. Aspden P, Corrigan JM, Wolcott J, Erickson SM, editors. tional accountability. Nurs Econ 2005;23:72-7.
Patient safety: Achieving a new standard for care. Washing- 22. Lindeke LL, Sieckert A. Nurse-physician workplace collaboration.
ton, DC: The National Academies Press; 2004. Onl J Issues Nurs; January 31, 2005;10(1): MS 4. Available at:
5. Aspden P, Wolcott J, Bootman L, Cronenwett L, editors. http://www.nursingworld.org/ojin/topic26/tpc26_4.htm.
Preventing medication errors. Washington, DC: The Na- 23. Leonard M, Graham S, Bonacum S. The human factor: The
tional Academies Press; 2006. critical importance of effective teamwork and communication
6. VanGeest JB, Cummins DS. An educational needs assess- in providing safe care. Qual Saf Health Care 2004;13:i85-i90.
ment for improving patient safety: Results of a national 24. Rafferty AM, Aiken LH. Are teamwork and professional
study of physicians and nurses. National Patient Safety autonomy compatible, and do they result in improved
Foundation White Paper Report; 2003. hospital care? Qual in Health Care 2001;10:ii32-ii37.
7. Batalden P. Developing health professionals capable of contin- 25. Haig KM, Sutton S, Whittington J. SBAR: A shared mental
ually improving health care quality, safety and value: The health model for improving communication between clinicians.
professional educator’s work. Available at: http://www.ihi.org/ J Qual Patient Saf 2006;32:167-75.
IHI/Topics/HealthProfessionsEducation/EducationGeneral/ 26. Melnyk B, Gineout-Overholt E. Evidence-based practice
ImprovementStories/DevelopingHealthProfessionalsCapable in nursing and healthcare. Philadelphia, PA: Lippincott
ofContinuallyImprovingHealthCareQuality.htm. Accessed Williams & Wilkins; 2005.
on October 22, 2006. 27. Stevens K. Essential competencies for evidence-based prac-
8. Regnier K, Kopelow M, Lane D, Alden E. Accreditation for tice in nursing. (1st ed). San Antonio, TX: Academic Center
for Evidence-based Practice, University of Texas Health
learning and change: Quality and improvement as the
Science Center at San Antonio; 2005.
outcome. J Contin Educ Health Prof 2005;25:174-82.
28. DiCenso A, Guyatt G, Ciliska D. Evidence-based nursing: A
9. Leach D. Evaluation of competency: An ACGME perspec-
guide to clinical practice. Hamilton, Ontario, Canada: Elsevier
tive. Am J Phys Med Rehabil 2000;79:487-9.
Mosby; 2005.
10. Cronenwett L. Educating health professional heroes of the
29. Ciliska D. Educating for evidence-based practice. J Prof
future: The challenge for nursing. Front Health Serv Manage
Nurs 2005;21:345-50.
2001;18:15-21.
30. Burns HK, Foley SM. Building a foundation for an evidence-
11. Maddox PJ, Wakefield M, Bull J. Patient safety and the need
based approach to practice: Teaching basic concepts to under-
for professional and educational change. Nurs Outlook
graduate freshman students. J Prof Nurs 2005;21:351-7.
2001;49:8-13.
31. Headrick LA, Moore SM, Alemi F, Hekelman F, Kizys N,
12. Arnold L, Campbell A, Dubree M, Fuchs MA, Davis N,
Miller D, et al. Using PDSA (Plan-Do-Study-Act) to estab-
Hertzler B, et al. Priorities and challenges of health system lish academic-community partnerships: The Cleveland ex-
chief nurse executives: Insights for nursing educators. J Prof perience. Qual Manag Health Care 1998;6:12-20.
Nurs 2006;22:213-20. 32. Hoff T, Jameson OL, Hannan E. A review of the literature
13. American Nurses Association. Nursing: Scope and standards examining linkages between organizational factors, med-
of practice. Silver Spring, MD: ANA; 2004. ical errors, and patient safety. Med Care Res Rev 2004;
14. American Association of Colleges of Nursing. The essentials 61:3-37.
of baccalaureate education for professional nursing practice. 33. VanGeest JB, Cummins DS. Educational needs assessment for
Washington, DC: AACN; 1998. improving patient safety: Results of a national study of physi-
15. National Organization of Nurse Practitioner Faculties and cians and nurses. Chicago, Il: National Patient Safety
the American Association of Colleges of Nursing. Nurse Foundation; 2003. Available at: http://www.npsf.org/download/
practitioner primary care competencies in specialty areas. EdNeedsAssess.pdf.
Washington, DC: US DHHS, HRSA, Bureau of Health 34. Papastrat K, Wallace S. Teaching baccalaureate nursing
Professions, Division of Nursing; 2002. students to prevent medication errors using a problem-based
16. American Association of Colleges of Nursing. Hallmarks of learning approach. J Nurs Educ 2003;42:459-64.
quality and patient safety: Recommended baccalaureate 35. Wolf ZR, Hicks R, Serembus JF. Characteristics of medica-
competencies and curricular guidelines to ensure high- tion errors made by students during the administration phase:
quality and safe patient care. J Prof Nurs 2006;22:329-30. A descriptive study. J Prof Nurs 2006;22:39-51.
17. Smith EL, Cronenwett L, Sherwood G. Current assessments 36. McNeil BJ, Elfrink V, Beyea SC, Pierce ST, Bickford C.
of quality and safety education in nursing. Nurs Outlook Computer literacy study: Report of qualitative findings.
2007;55:132-37. J Prof Nurs 2005;22:52-9.
18. Bezold C. The future of patient-centered care: Scenarios, 37. Marin H. Improving patient safety with technology. Int
visions, and audacious goals. J Altern Complement Med J Med Inform 2004;73:543-6.
2005;11:S77-S84. 38. Bakken S, Cook S, Curtis L, Desjardins K, Hyun S, Jenkins
19. Edgman-Levitan S, Gerteis M, Picker, and Commonwealth M, et al. Promoting patient safety through informatics-based
Program for Patient Centered-Care. Through the patient’s nursing education. Int J Med Inform 2004;73:581-9.
M A Y / J U N E N U R S I N G O U T L O O K 131