The impact of The Quality and Safety Education (QSEN) program on the knowledge, skills, and attit...
Nursing Competencies in Patient Care and Safety
Introduction
Patient safety (PS) is paramount in healthcare, with an estimated 43 million safety incidents occurring annually. PS encompasses actions that reduce healthcare risks, promote a culture of safety, and protect patients.
Junior nurses often lack the knowledge, skills, and attitudes (KSAs) for safe and effective patient care due to their limited experience. The Quality and Safety Education for Nurses (QSEN) initiative aims to equip nurses with these KSAs.
Research evidence supports the positive impact of QSEN competency programs on nurses' KSAs, highlighting the need for more studies to address this topic in specific contexts, such as Palestine, where challenges like a high nurse-to-patient ratio and political instability exist.
Theoretical Framework
This study adopts Patricia Benner's theory, which explains the progressive development of nurses' KSAs through experience and education. The Dreyfus Model of Skill Acquisition, based on Benner's theory, describes five proficiency levels that junior nurses in the Palestinian Ministry of Health can progress through. The QSEN-based curriculum aligns with Benner's theory, aiming to enhance nurses' KSAs gradually, enabling them to deliver safe and effective patient care while addressing the unique challenges of the Palestinian healthcare system.
Methods
Study Design
A quasi-experimental, within-subject between-subject design was used to evaluate the impact of a QSEN competency program on junior nurses' KSAs in Palestinian hospitals. The study adhered to the TREND Statement guidelines.
Study Settings and Population
The study involved junior nurses working in different departments at two governmental hospitals in Palestine. A total of 164 nurses were randomly selected and divided into two groups: an intervention group receiving the QSEN competency program and a control group receiving no intervention.
Data Collection
Data on nurses' KSAs was collected using two validated self-completion questionnaires: the Clinical Performance Evaluation Questionnaire (CPEQ) and the Patient-centered Care Scale (KSAI-PCCS).
The QSEN competency program, extracted from QSEN competency institutions and various literature, was implemented through structured interventions, educational resources, and training modules that focused on KSAs crucial for quality and safety in healthcare.
Statistical Methods
Statistical Package for Social Sciences (SPSS) version 28 was used to analyze the data. Descriptive statistics were employed to summarize the main features of the dataset. Inferential statistics, including the paired t-test and Wilcoxon Signed Rank test, were used to compare the pre- and post-intervention KSAs of nurses in the intervention group and the control group.
Results
Participants' Characteristics
Participants were mostly young (average age 28 years) with an average of four years of experience in their current job. The majority were female and married.
Pre- and Post-Test Scores
The intervention group displayed significantly higher average scores in all QSEN competency subscales (Patient-Centered Care, Teamwork & Collaboration, Evidence-Based Practice, Quality Improvement, Safety, and Informatics) compared to the control group at the post-test.
KSAs Following Intervention
In the intervention group, the educational intervention led to significantly higher levels of quality and safety knowledge, skills, and attitudes, demonstrating the effectiveness of the QSEN program.
In contrast, among nurses in the control group, there were no significant changes in KSAs from baseline to post-test, signifying that the intervention was crucial for improvements in these areas.
Discussion
The study findings support the positive impact of the QSEN competency program on junior nurses' KSAs in the Palestinian healthcare context. The intervention significantly enhanced their knowledge, skills, and attitudes toward patient safety protocols, with substantial gains observed across all QSEN core competencies. These findings align with previous research highlighting the effectiveness of QSEN programs in improving nurses' PS-related KSAs.
The disparity between gains in knowledge and skills suggests challenges in translating theoretical understanding into practical abilities, possibly due to structural issues and resource constraints within the Palestinian healthcare system. Despite lower skill gains, the intervention effectively elevated nurses' safety ratings and knowledge.
Nurses' confidence in exhibiting quality and safety competencies increased following the QSEN education, emphasizing the importance of comprehensive teaching and assessment techniques in nursing education. The study also highlights the crucial role of faculty in incorporating QSEN competencies into nursing curricula and acting as mentors for clinical practice.
Implications for Research and Practice
The study recommends the integration of QSEN competencies into nursing school curricula and the assessment of these competencies as part of nurses' professional development plans. Further research is needed to explore QSEN-based interventions targeting patient-centered care competencies.
Strengths and Limitations
The study contributes to the limited research on QSEN's effects in Palestine but has limitations. The small sample size may limit the generalizability of findings, and the reliability and validity of instruments in the Palestinian context need further investigation. Future research should address these limitations to enhance the robustness of the findings.