Informed Consent Regarding Qsen Competencies

¶ … Consent Regarding Qsen Competencies14

The following paper describes patient safety as being one of the concerns of patient care. It also discusses the QSEN competency related to patient safety. Moreover, the paper describes the significance of patient safety with reference to the QSEN competency. A review of literature and a case example related to the aforementioned topics are also included. Lastly, the paper gives implications related to better patient safety.

Patient Care Concern

Health is very important to everyone and therefore, people pay a great deal of attention to their health problems and concerns. The nursing staff taking care of patients is also concerned about the issues that the patient may face. As the patient starts getting medical help, there are multifarious issues and concerned that, he may encounter. The nurses must then keep these issues in mind in order to ensure a healthy recovery of the patient. (Scott, 2003)

Among these issues, provision of information is an issue, which is very critical. The nurses taking care of patients in a full day or part time setting should provide complete and reliable information to the patients. The provision of information is necessary for the patient in order to make correct decisions about their treatment and medication. If the patient is aware of the problem they are facing and they are briefed about the treatment options correctly, they will be fully aware of the problem and the proposed solutions before taking a decision. (Woolf & Chan et al., 2005)

Informed consent means informing the patient and his family about the disease and the proposed solution so that they make a correct decision. It is a legal duty of medical staff and institution to obtain informed consent from the patient or in some cases, the patients' representatives. Therefore, the nurses should be careful about providing the correct and relevant information to the patient. (Barry & Edgman-Levitan, 2012)

There is a change in the decision making process nowadays. Previously, the doctors were considered the supreme authority. Nowadays, the patient is given a greater say in the medical treatment processes and options. This is because of a major shift to patient-centered care. (Krumholz, 2010)

In addition, the internet has made the people familiar to a plethora of treatment options and therefore, people prefer their own choices rather than agreeing to the options given to them. Moreover, the doctors also feel that it is their moral duty to inform the patient about all the available options and the benefits and drawbacks associated with them. The final decision should remain with the patient and his family. (Woolf & Chan et al., 2005)

Lastly, the doctors and the medical staff believes that the patients who are informed about the available options and the disease itself do not contest the quality of care provided. Moreover, the decision is made by the patient and therefore the responsibility of adverse effects also remains with him. Therefore, informed consent is beneficial to both the medical staff and the patients and has a very strong relationship with patient safety. (Woolf & Chan et al., 2005)

Despite the fact that the informed consent is beneficial to both the sides, there are still information failures. One of the major reasons behind these failures is that the physicians and the medical staff are very busy in their routine and they cannot take out time to inform the patients about the problems and their detailed solutions. (Woolf & Chan et al., 2005)

QSEN Competency

QSEN institute has developed a set of competencies, which act as outlines to mark the knowledge, skills and attitudes to be developed in an individual before licensure or graduation. The main objective of these competencies is to inject the necessary skills and to improve the behavior of nurses. Following these competencies, the nurses are able to provide better care to the patients keeping in mind all the technicalities that may arise. (Batalden & Bednash et al., 2014)

The relevant competencies are informatics and patient safety. Many pieces of knowledge, skills and attitudes should be given to the nurse in order to ensure smooth information flow and better patient safety. First of all, the nurses should analyze the design and the theory of system that applies to the provision of the information to the patient. They should then follow the design and develop skills of using tools that improve the performance of the medical staff in the provision of information. The nurses must also develop the skill to employ project management methods in order to implement new technologies. The new technology will help in transferring the information smoothly. To develop these skills, the nurses must value the importance of a proper design of information system. In addition, the nurses must also understand the importance of the information to the patient and his family. (Batalden & Bednash et al., 2014)

Secondly, the nurses should identify the procedures that ensure the safety of patients and the community. For that, the nurses must have the skill to use multiple strategies that work together to reduce the risk of damage to the patient, the community and the nurse himself. The competency also requires the nurses to develop a habit of valuing the procedure of risk reduction. The nurses should keep in mind that reduced risk will lead to better patient safety conditions. (Batalden & Bednash et al., 2014)

Moreover, the nurses should pinpoint the safety design of the human factors that affect the patient safety. The nurses should also spot out the practices, which can be hazardous for patient safety. In order to accomplish the aforementioned task, the nurses must concentrate on the system whenever small errors occur. In addition, the nurses should also show leadership qualities and create an environment where safety design rules are made and implemented efficiently. Lastly, the nurses should also encourage the use of systems that do not rely on memory so that the risk of accidents can be reduced. In order to develop these qualities, the nurses must first accept the limitations of human beings and give importance to the system. (Batalden & Bednash et al., 2014)

Furthermore, the nurses should also find out strategies that will make the organization reliable. To accomplish that, the nurses must demonstrate the skills of analyzing the human factors and making a good strategy to avoid mistakes that were committed previously. The nurses should also give information about the errors and narrow escapes to the healthcare team. Moreover, the nurses must also develop the skill to foretell the accidents and therefore, avoid it. Nurses must build a positive attitude towards working hard to accomplish the desired reliability. They must also be honest with the patients about the errors and must encourage them to report errors as well. In addition, the nurses should also understand the importance of reliability to patient safety. (Batalden & Bednash et al., 2014)

Apart from that, the nurses should also try to find the root cause of the errors and then set evidence-based procedures in response of these errors. The nurses should have the skills to use evidence-based tests to set procedures for the errors. In addition, the nurses must also be able to apply changes to the root of the error once it is identified. The nurses must develop a postitive attitude towards the identification of errors and towards the accountability of the responsible party. In addition, the nurses must also understand the importance of error reporting system in an organization. (Batalden & Bednash et al., 2014)

In addition to that, the nurses must have the knowledge to inhibit the use of offensive language and actions that may harm the patient and the staff. To accomplish that, the nurses must exhibit the skills to develop a culture of respect and affection for patients and staff. Moreover, the nurses must also report the hostile and offensive behavior legally. The nurses should have an appreciative demeanor for a respectful culture at the workplace. (Batalden & Bednash et al., 2014)

The efforts made by the government and the nation to enforce patient safety also affects the safety conditions in private medical institutes. The nurses must analyze the effect and use it to improve the safety conditions in the workplace. The nurses must also have a positive mindset towards the relation between the national safety attempts and patient safety. (Batalden & Bednash et al., 2014)

Significance of Patient Safety in Relation to QSEN Competencies

There is a prominent relationship between patient safety and the decision made by the patients. If the patient is aware of the options and makes the correct choice, the chances of success increase dramatically. When a patient makes uninformed decisions, the chances of medical errors and poor quality of care increases. Moreover, a wrong surgery is also a direct consequence of the decision made by the patient without being given complete information about the disease. (Rao, 2008)

Different mistakes can lead to adverse effect on the patient, which is not a desired outcome of the medical practices. The legal duty of the medical staff is to provide the patietns with complete details in order to ensure the safety of the patient they are dealing with. If the medical staff fails to inform patients about these details, the result will be a wrong decision made by the patient. (Rao, 2008)

The QSEN competencies have segment dedicated to patient safety as well. This shows the importance of this issue. It is mandatory for the nurses to have the necessary knowledge, skills and attitude about patient safety. If they fail to fulfil the requirements, they will not get the license or graduation. (Gorski, 2010)

Provision of information to the patient before making medical decision is an important part of patient safety. If the patient is not informed about the options and risks facing him, he will definitely be put in harm's way. So, it is a duty of the medical staff to supply reliable information to the patient. (Rao, 2008)

Patient safety directly affects the reputation of the medical practices worldwide. The topic must be studied and explored so that future errors can be avoided and the practices can be adjusted accordingly. In addition, medical practices are targeted to achieve the betterment of humanity and these errors and lapses in patient safety does not let the medical staff accomplish their main objective. Therefore, the issue of patient safety should be given the importance it deserves for the benefit of humanity and reputation of medical service providers. (Gorski, 2010)

Review of Literature

Patient safety, as the name suggests, is the safety of the patients that are admitted to medical institutions or getting nursing services at home. According to Cherill Scott, the attitude of patient safety is far more wide and positive and include practices and procedures covering more areas than just avoiding accidents. The patient safety is necessary for the patients who are under the care of nursing staff for 24 hours or more. (Scott, 2003)

The doctor-patient relationship is a complex one. The trend nowadays, is that the patients make the decisions about the type of medical assistance they are going to get. In addition to that, the patients also have a say in the strategy made to cure them. Therefore, the patients should be given complete information so that they make informed decisions. The permission given to the medical staff by the patient after knowing all the consequences is known as informed consent. According to Satyanarayana Rao, the information is a legal right of the patient and providing this information is the ethical responsibility of the medical staff. This information has a direct impact on the safety of the patient and therefore, on the repute of the medical staff as well. (Rao, 2008)

The medical staff should also be vigilant about the errors and lapses. In addition to that, Kenneth W. Kizer talks of patient safety as the basis of quality care. According to Kizer, there cannot be quality provision of care without patient safety. Moreover, Kizer also thinks that it is the moral responsibility of the medical staff to improve the state of patient safety. It is the duty of everyone who works in the field of medical science to reduce the errors and promote the safety of patients. (Kizer, 2001) (Scott, 2003)

The Quality and Safety Education for Nurses (QSEN) is and initiative targeted to improve the quality of nursing care provided to the patients. The faculty of QSEN has made a compendium of competencies. These competencies, according to the faculty of QSEN, help the nurses to develop certain knowledge, skills and attitude towards a certain aspect of care. According to the QSEN competencies, the nurses should keep in mind the KSA's and exercise different strategies in order to achieve a better standard of patient care and safety. These competencies are introduced to the nurses before graduation and licensure so that they are aware of these practices before starting practical work. The competencies are related to the following aspects of healthcare: (Batalden & Bednash et al., 2014)

Patient oriented care

Teamwork and helpfulness

Practice based on proof

Improvement of quality

Safety

Provision of information

The aspect related to safety is consistent with our current issue. (Batalden & Bednash et al., 2014)

According to the QSEN faculty, the definition of safety of patients, according to the competencies is to reduce the risk of adverse effects on the patients via correction of the system and individuals. The definition incorporates both the individuals and the system as a whole to make improvement in patient safety. There are certain skills, attitudes and pieces of knowledge (KSA's), which should be kept in mind in order to improve the performance of the nurse and the system. These KSA's are mentioned beforehand in the paper. (Batalden & Bednash et al., 2014)

Case Example

Sentara Norfolk General Hospital (SNGH) set a goal to improve the patient safety status of the hospital. The goal was to develop a culture of safety. SNGH needed a proper strategy to transform its culture into a safety oriented one. To accomplish the purpose, SNGH developed and implemented four strategies: (Mccarthy & Blumenthal, 2006)

To develop three sets of attitude expectations for the staff to learn and follow.

To steer the attention of the staff to the rules about operating in critical situations which may lead to adverse effects on the patient.

To provide information to the patients so that they are aware of the problems before making a decision.

To simplify the rules so that the staff can better understand and follow them. (Mccarthy & Blumenthal, 2006)

Changing the culture of an organization is never easy as bringing about behavioral changes is the most difficult. As a part of the strategy, all hospital staff was educated related to the expectations and rules. The staff was also trained to give the necessary information to the patients and help them in making correct decisions about their health. The results and changes in the behavior of staff was carefully monitored. (Mccarthy & Blumenthal, 2006)

Apart from that, the performance was checked using several indicators. The three indicators that were used are leading measures, real-time measures and lagging measures. Leading measures use data from a cultural survey in order to calculate a cultural index. Real-time measures are used to get observational data related to a specific topic of interest. Lagging measures include the calculation of errors and accidents that happen because of malpractice. The data obtained from these measures is then used to steer the overall project to success. (Mccarthy & Blumenthal, 2006)

As a result, the staff started to share information about the errors and accidents with their colleagues and patients. The employment of risk evaluation strategy and other sets of tools helped SNGH to get to the root of most of the accidents. Consequently, the cases of ventilator-associated pneumonia (VAP) was reduced by 84%. (Mccarthy & Blumenthal, 2006)

The aforementioned case shows that there were cases of VAP in the hospital. VAP is a special type of pneumonia that is found in patients who are getting mechanical ventilation in a hospital. The inflow of bacteria into a person's lungs causes VAP. Therefore, VAP is a disease which shows a lapse in patient safety. (Mccarthy & Blumenthal, 2006)

The strategies employed by the hospital are consistent with the strategies recommended by the QSEN competencies. The hospital started by making a culture of safety in the workplace which was the first piece of knowledge required by the competency. Therefore, application of the competency and its rules brought about favorable results. In addition to that, the employment of risk evaluation strategy and root cause finding tools is also consistent with the recommendations of QSEN. (Batalden & Bednash et al., 2014)