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Safety in nursing


Definition: Recognize the patient or designee as the source of control and full partner in providing

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compassionate and coordinated care based on respect for patient’s preferences, values, and needs.

Knowledge Skills Attitudes

Integrate understanding of multiple

dimensions of patient centered


 patient/family/community

preferences, values

 coordination and integration of care

 information, communication, and


 physical comfort and emotional


 involvement of family and friends

 transition and continuity

Describe how diverse cultural,

ethnic and social backgrounds

function as sources of patient,

family, and community values

Elicit patient values,

preferences and expressed

needs as part

of clinicalinterview,

implementation of care

planand evaluation of care

Communicate patient values,

preferences and expressed

needs to other members

of health care team

Provide patient-centered care

with sensitivity and respect

for the diversity of human


Value seeing health care

situations “through patients’


Respect and encourage

individual expression of patient

values, preferences and

expressed needs

Value the patient’s expertise

with own health and symptoms

Seek learning opportunities

with patients who represent all

aspects of human diversity

Recognize personally held

attitudes about working with

patients from different ethnic,

cultural and social


Willingly support patient-

centered care for individuals

and groups whose values differ

from own

Demonstrate comprehensive

understanding of the concepts

of pain and suffering, including

physiologic models of pain and


Assess presence and extent

of pain and suffering

Assess levels of physical and

emotional comfort

Elicit expectations of patient

& family forrelief of pain,

discomfort, or suffering

Recognize personally

held values and beliefs about

the management of pain or


Appreciate the role of the nurse

in relief of all types and

sources of pain or suffering

Initiate effective treatments to

relieve pain and suffering in

light of patient values,

preferences and expressed


Recognize that patient

expectations influence

outcomes in management of

pain or suffering

Examine how the safety, quality

and cost effectiveness of health

care can be improved through the

active involvement of patients and


Examine common barriers to

active involvement of patients in

their own health care processes

Describe strategies to empower

patients or families in all aspects

of the health care process

Remove barriers to presence

of families and other

designated surrogates based

on patient preferences

Assess level of patient’s

decisional conflict and

provide access to resources

Engage patients or

designated surrogates in

active partnerships that

promote health, safety and

well-being, and self-care


Value active partnership with

patients or designated

surrogates in planning,

implementation, and evaluation

of care

Respect patient preferences for

degree of active engagement

in care process

Respect patient’s right to

access to personal health


Explore ethical and legal

implications of patient-centered


Describe the limits and

boundaries of therapeutic patient-

centered care

Recognize the boundaries of

therapeutic relationships

Facilitate informed patient

consent for care

Acknowledge the tension that

may exist between patient

rights and the organizational

responsibility for professional,

ethical care

Appreciate shared decision-

making with empowered

patients and families, even

when conflicts occur

Discuss principles of effective


Describe basic principles of

consensus building and conflict


Assess own level of

communication skill in

encounters with patients and


Participate in building

consensus or resolving

Value continuous improvement

of own communication and

conflict resolution skills

Examine nursing roles in assuring

coordination, integration, and

continuity of care

conflict in the context of

patient care

Communicate care provided

and needed at each

transition in care


Definition: Function effectively within nursing and inter-professional teams, fostering open

communication, mutual respect, and shared decision-making to achieve quality patient care.

Knowledge Skills Attitudes

Describe own strengths,

limitations, and values in

functioning as a member of a


Demonstrate awareness of own

strengths and limitations as a

team member

Initiate plan for self-development

as a team member

Act with integrity, consistency and

respect for differing views

Acknowledge own potential to

contribute to effective team


Appreciate importance of

intra- and inter-professional


Describe scopes of practice

and roles of health care team


Describe strategies for

identifying and managing

overlaps in team member roles

and accountabilities

Recognize contributions of

other individuals and groups in

helping patient/family achieve

health goals

Function competently within own

scope of practice as a member of

the health care team

Assume role of team member or

leader based on the situation

Initiate requests for help when

appropriate to situation

Clarify roles and accountabilities

under conditions of potential

overlap in team member


Integrate the contributions of

others who play a role in helping

patient/family achieve health


Value the perspectives and

expertise of all health team


Respect the centrality of the

patient/family as core

members of any health care


Respect the unique attributes

that members bring to a team,

including variations in

professional orientations and


Analyze differences in

communication style

preferences among patients

and families, nurses and other

members of the health team

Describe impact of own

communication style on others

Discuss effective strategies for

communicating and resolving


Communicate with team

members, adapting own style of

communicating to needs of the

team and situation

Demonstrate commitment to

team goals

Solicit input from other team

members to improve individual,

as well as team, performance

Initiate actions to resolve conflict

Value teamwork and the

relationships upon which it is


Value different styles of

communication used by

patients, families and health

care providers

Contribute to resolution of

conflict and disagreement

Describe examples of the

impact of team functioning on

safety and quality of care

Explain how authority

gradients influence teamwork

and patient safety

Follow communication practices

that minimize risks associated

with handoffs among providers

and across transitions in care

Assert own position/perspective

in discussions about patient care

Choose communication styles

that diminish the risks associated

with authority gradients among

team members

Appreciate the risks

associated with handoffs

among providers and across

transitions in care

Identify system barriers and

facilitators of effective team


Examine strategies for

improving systems to support

team functioning

Participate in designing systems

that support effective teamwork

Value the influence of system

solutions in achieving effective

team functioning


Definition: Integrate best current evidence with clinical expertise and patient/family preferences and

values for delivery of optimal health care.

Knowledge Skills Attitudes

Demonstrate knowledge of basic

scientific methods and processes

Describe EBP to include the

components of research

evidence, clinical expertise and

patient/family values.

Participate effectively in

appropriate data collection

and other research activities

Adhere to Institutional

Review Board (IRB)


Base individualized care

plan on patient values,

clinical expertise and


Appreciate strengths and

weaknesses of scientific bases

for practice

Value the need for ethical

conduct of research and quality


Value the concept of EBP as

integral to determining best

clinical practice

Differentiate clinical opinion from

research and evidence


Describe reliable sources for

locating evidence reports and

clinical practice guidelines

Read original research and

evidence reports related to

area of practice

Locate evidence reports

related to clinical practice

topics and guidelines

Appreciate the importance of

regularly reading relevant

professional journals

Explain the role of evidence in

determining best clinical practice

Describe how the strength and

relevance of available evidence

influences the choice of

interventions in provision of

patient-centered care

Participate in structuring the

work environment to

facilitate integration of new

evidence into standards of


Question rationale for

routine approaches to care

that result in less-than-

desired outcomes or

adverse events

Value the need for continuous

improvement in clinical practice

based on new knowledge

Discriminate between valid and

invalid reasons for modifying

evidence-based clinical practice

based on clinical expertise or

patient/family preferences

Consult with clinical experts

before deciding to deviate

from evidence-based


Acknowledge own limitations in

knowledge and clinical expertise

before determining when to

deviate from evidence-based

best practices


Definition: Use 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 health care systems.

Knowledge Skills Attitudes

Describe strategies for learning

about the outcomes of care in the

setting in which one is engaged in

clinical practice

Seek information about

outcomes of care for

populations served in care


Seek information about

quality improvement projects

in the care setting

Appreciate that continuous

quality improvement is an

essential part of the daily

work of all health


Recognize that nursing and other

health professions students are

parts of systems of care and care

processes that affect outcomes for

patients and families

Give examples of the tension

between professional autonomy and

system functioning

Use tools (such as flow

charts, cause-effect

diagrams) to make processes

of care explicit

Participate in a root cause

analysis of a sentinel event

Value own and others’

contributions to outcomes of

care in local care settings

Explain the importance of variation

and measurement in assessing

quality of care

Use quality measures to

understand performance

Use tools (such as control

charts and run charts) that

are helpful for understanding


Identify gaps between local

and best practice

Appreciate how unwanted

variation affects care

Value measurement and its

role in good patient care

Describe approaches for changing

processes of care

Design a small test of change

in daily work (using an

experiential learning method

such as Plan-Do-Study-Act)

Practice aligning the aims,

measures and changes

involved in improving care

Value local change (in

individual practice or team

practice on a unit) and its

role in creating joy in work

Appreciate the value of what

individuals and teams can to

do to improve care

Use measures to evaluate

the effect of change


Definition: Minimizes risk of harm to patients and providers through both system effectiveness and

individual performance.

Knowledge Skills Attitudes

Examine human factors and

other basic safety design

principles as well as commonly

used unsafe practices (such as,

work-arounds and dangerous


Describe the benefits and

limitations of selected safety-

enhancing technologies (such

as, barcodes, Computer

Provider Order Entry, medication

pumps, and automatic


Discuss effective strategies to

reduce reliance on memory

Demonstrate effective

use of technology and

standardized practices

that support safety and


Demonstrate effective

use of strategies to

reduce risk of harm to

self or others

Use appropriate

strategies to reduce

reliance on memory

(such as, forcing

functions, checklists)

Value the contributions of

standardization/reliability to safety

Appreciate the cognitive and

physical limits of human


Delineate general categories of

errors and hazards in care

Describe factors that create a

culture of safety (such as, open

communication strategies and

organizational error reporting



observations or concerns

related to hazards and

errors to patients,

families and the health

care team

Use organizational error

reporting systems for

near miss and error


Value own role in preventing errors

Describe processes used in

understanding causes of error

and allocation of responsibility

and accountability (such as, root

cause analysis and failure mode

effects analysis)

Participate appropriately

in analyzing errors and

designing system


Engage in root cause

analysis rather than

blaming when errors or

near misses occur

Value vigilance and monitoring (even

of own performance of care

activities) by patients, families, and

other members of the health care


Discuss potential and actual

impact of national patient safety

resources, initiatives and


Use national patient

safety resources for own


development and to

focus attention on safety

in care settings

Value relationship between national

safety campaigns and

implementation in local practices and

practice settings


Definition: Use information and technology to communicate, manage knowledge, mitigate error, and

support decision making.

Knowledge Skills Attitudes

Explain why information and

technology skills are essential for

safe patient care

Seek education about

how information is

managed in care settings

before providing care

Apply technology and

information management

tools to support safe

processes of care

Appreciate the necessity for all

health professionals to seek

lifelong, continuous learning of

information technology skills

Identify essential information that

must be available in a common

database to support patient care

Contrast benefits and limitations of

different communication

Navigate the electronic

health record

Document and plan

patient care in an

electronic health record

Value technologies that support

clinical decision-making, error

prevention, and care


technologies and their impact on

safety and quality

Employ communication

technologies to coordinate

care for patients

Protect confidentiality of

protected health information in

electronic health records

Describe examples of how

technology and information

management are related to the

quality and safety of patient care

Recognize the time, effort, and skill

required for computers, databases

and other technologies to become

reliable and effective tools for

patient care

Respond appropriately to

clinical decision-making

supports and alerts

Use information

management tools to

monitor outcomes of care


Use high quality electronic

sources of healthcare


Value nurses’ involvement in

design, selection,

implementation, and evaluation

of information technologies to

support patient care

REFERENCES 1 Institute of Medicine. Health professions education: A bridge to quality. Washington DC: National

Academies Press; 2003.

2 Cronenwett, L., Sherwood, G., Barnsteiner J., Disch, J., Johnson, J., Mitchell, P., Sullivan, D.,

Warren, J. (2007). Quality and safety education for nurses. Nursing Outlook, 55(3)122-131.

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