Application QSEN Core Competencies

QSEN Core Competencies: Application
1:
The story of Josie King is sad and very compelling. It reminds us of the relevance of our role when it comes to the improvement of outcomes in a healthcare setting. Despite having healed well, and due to be released from the hospital in a few weeks’ time, Josie died of severe dehydration and central line infection.
One of the QSEN competencies, patient-centered care, calls for the analysis of all the dimensions of patient centered care; with “involvement of family and friends” being one of the competency’s rallying calls (QSEN Institute, 2017). As one of the nurses attending to Josie, I should have taken the mother’s concerns more seriously – especially given that they were raised multiple times. Those who spend most time with the patient (i.e. family members) are able to notice even minuscule details regarding change of behavior. They must not be ignored.
Next, teamwork and collaboration calls for nurses to “function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care” (QSEN Institute, 2017). Teamwork was clearly lacking in the case of Josie. As a nurse caring for Josie, I would have discussed some of her behaviors with my team or with superiors – i.e. her feverish sucking of a washcloth. I would have promptly called for assistance the moment her eyes rolled back. I would have been aware of my own limitations and those of others working towards Josie’s wellbeing and sought to initiate and sustain better team effort.
Evidence-based practice, amongst other things, calls for the summarization of “current evidence regarding major diagnostic and treatment actions within the practice specialty…” and determination of gaps that exist (QSEN Institute, 2017). In Josie’s case, there was no assessment of the child past the vitals and there was also failure to address the concerns of the mother. There is already solid-research demonstrating the relevance of wholesome patient examination and the need to involve caregivers in every stage of treatment. In one such study, it was found that “because children are dependent on their caregivers, their care must be approved by parents or surrogates during all encounters” (Hughes, 2008). I would have been more attentive to all the issues raised by the Josie’s mother, and crosschecked her claims and concerns more actively.
Informatics has got to do with the utilization of information as well as technology not only in communication, but also in the management of knowledge and mitigation of error… (QSEN Institute, 2017). In Josie’s case, I would have identified the relevance of maintaining all the relevant information in an easy to retrieve and confirm format. A quick perusal of information maintained about Josie in the system could have raised some concerns, i.e. her drastic weight loss in just under 24 hours. Further, I would have double-checked the mother’s claim that an order had been effected for no additional narcotics.
Lastly, we have quality improvement, a competency that concerns itself with the utilization 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 healthcare systems” (QSEN Institute, 2017). An ineffective communication system significantly contributed to Josie’s death. A regular audit of patient-nurse-doctor communication system would have helped identify weaknesses way before – effectively meaning that no life would have been lost as a consequence of the same. I would have identified the miscommunication weaknesses and referred the issue appropriately.


2:
The potential health concern at my place of work has got to do with infection control. It is important to note that the last thing a hospital would want to be accused of is causing the infection of its patient(s). Already, there have been instances of hospital-acquired infections in various facilities across the United States. This is something that could be easily prevented. At my place of work, I have in numerous instances identified clear deviations from evidence-based infection-control procedures. For instance, I have colleagues who fail to put on personal protective clothing even when the prevailing circumstances call for the same. Further, yet another easy-to-ignore but equally important infection control procedure (that is often times ignored at my place of work) is hand washing. There is need for all hospital staff to be reminded, and perhaps sensitized (through workshops, etc.) on the need to embrace infection-control policies so as to rein in avoidable infections. Signs could also be erected at various points reminding staff to, for instance, wash their hands. A sign such as – have you washed your hands today? – could be very effective. This is a concern that falls in the realm of Evidence-based practice. In her piece, Infection Control in Acute Care Facilities: Evidence-Based Patient Safety, Nicolle (2001) points out infection control programs have historically been shown to be effective in the minimization of infection rates, and hence reduction of mitigation costs as a result of non-adherence.





References
Hughes, R.G. (Ed.). (2008). Patient Safety and Quality: An Evidence-Based Handbook for Nurses. New York, NY: Agency for Healthcare Research and Quality
Nicolle, L.E. (2001). Infection Control in Acute Care Facilities: Evidence-based Patient Safety. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2094816/
QSEN Institute. (2017). Graduate QSEN Competencies. Retrieved from http://qsen.org/competencies/graduate-ksas/#patient-centered_care