AACN Essentials Domain 1: Knowledge for Nursing Practice
“Focuses on the discipline of nursing knowledge and other disciplinary knowledge.” (AACN, 2021, p. 27).
AACN Essentials Domain 5: Quality and Safety
“Focuses on safety and quality improvement, within systems and individually” (AACN, 2021, p. 39).
Domain 5: Essential Knowledge
To meet the objectives for Domain 5, knowledge is required in:
- Principles of safety science
- Quality and safety models
- Measurement: Quality improvement tools
- Practice guidelines and evidence-based guidelines
- Work environment hazards (violence, burnout, ergonomics, and chemical and biological agents)
- Interdependence of quality and safety
- System Environment: Secure and just environment for individual and health care providers
- Collaborative engagement with recipient of care
- Quality or Safety challenges are viewed as system failures
- Empowerment of Caregivers: Promotion of safety and prevention of adverse events
Domain 5: Leveling of the AACN Essential Objectives
“5.1 Apply quality improvement principles in care delivery.” |
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| Beginning of Program | Middle of Program | End of Program | |
| “5.1i Establish and incorporate data driven benchmarks to monitor system performance.” | Explore available benchmarks, models of care, person-centered care and data sources related to quality improvement and how they can be used to monitor system performance. | Identify benchmarks that impact the clinical challenges they witness during clinical rotations and will begin to create a plan to address opportunities for improvement. | Implement knowledge of quality improvement principles relating to models of care, person-centered care, and meaning of data sources/analysis related to quality improvement. |
| “5.1j Use national safety resources to lead team- based change initiatives.” | Explore available resources related to national safety. | Review evidence-based literature exploring concepts and current practices and begin to formulate ideas to enhance or improve practices. | Develop a strategic plan that incorporates national safety resources to enhance or improve practices. |
| “5.1k Integrate outcome metrics to inform change and policy recommendations.” | Analyze data and metrics to identify opportunities for improvement and participate in organizations that affect policy change. | Identify interventions to address identified opportunities for improvement. Students will collaborate with systems to examine outcomes. |
Create policies that measure outcome metrics to improve safety and affect needed policy change and evaluate. |
| “5.1l Collaborate in analyzing organizational process improvement initiatives.” | Identify opportunities for improvement of organizational processes based on evidence-based practices. | Collaborate in collecting and analyzing data on ongoing projects/processes and quality improvement initiatives. | Educate members of the healthcare team on the rationale and evidence for initiatives. |
| “5.1m Lead the development of a business plan for quality improvement initiatives.” | Collaborate with appropriate stakeholders to evaluate and compare the costs of different quality improvement initiatives. | Provide a summary of each of the quality improvement initiatives and do a cost benefit analysis. | Create a business plan that will be utilized to drive quality improvement initiatives. |
| “5.1n Advocate for change related to financial policies that impact the relationship between economics and quality care delivery.” | Identify current financial policies being utilized by the organization. | Analyze internal and external factors that impact financial policies that impact economics and quality health care delivery to determine gaps and determine potential solutions to fill those gaps. | Develop a detailed report of how financial policies impact the relationship between economics and quality health care delivery in the organization they are in and advocate for needed change. |
| “5.1o Advance quality improvement practices through dissemination of outcomes.” | Explore opportunities for dissemination of quality improvement practice outcomes. | Develop a strategic plan to disseminate outcomes of selected quality improvement practices. | Critique value and benefits of dissemination of health outcomes to improve practice. |
“5.2 Contribute to a culture of individual safety.” |
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| Beginning of Program | Middle of Program | End of Program | |
| “5.2g Evaluate the alignment of system data and comparative individual safety benchmarks.” | Identify individual safety benchmarks. | Compare system data measures to current individual safety benchmarks. | Formulate system strategies to align practice with individual safety benchmarks. |
| “5.2h Lead analysis of actual errors, near misses, and potential situations that would impact safety.” | Identify internal and external factors that impact errors, near misses and other potential situations to individual safety. | Appraise findings of actual errors, near misses and other situations that may impact safety in an organization. | Develop mitigation strategies for actual errors, near misses, and situations that impact safety. |
| “5.2i Design evidence-based interventions to mitigate risk.” | Identify evidence-based interventions to mitigate risk. | Demonstrate use of evidence-based protocols supporting risk mitigation. | Recommend a plan for system-wide risk mitigation reduction. |
| “5.2j Evaluate emergency preparedness system-level plans to protect safety.” | Identify opportunities for improvement related to system-level emergency preparedness plans based on evidence-based practice. | Examine emergency preparedness system-level plans for inequities or gaps in the system related to safety risks. | Formulate a plan to reduce safety risks in emergency preparedness system level plans. |
“5.3 Contribute to a culture of provider and work environment safety.” |
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| Beginning of Program | Middle of Program | End of Program | |
| “5.3e Advocate for structures, policies, and processes that promote a culture of safety and prevent workplace risks and injury.” | Identify the biopsychosocial components of the individual assessment in PMH advanced nursing practice. | Demonstrate ability to conduct a psychiatric assessment and determine a diagnosis for individuals across the lifespan. | Evaluate ability to skillfully conduct a full comprehensive psychiatric assessment, diagnosis and formulation for individuals across the lifespan. |
| “5.3f Foster a just culture reflecting civility and respect.” | Identify internal and external processes that impact fostering a culture of civility and respect. | Collaborate with external systems to address any gaps in fostering a culture of civility and respect. | Formulate a plan to address a culture of civility and respect system wide. |
| “5.3g Create a safe and transparent culture for reporting incidents.” | Explore current institutional practices related to reporting incidents and how the organizational culture might affect reporting. | Review evidence-based literature exploring the concepts related to current practices supporting a safe and transparent culture for reporting incidents. | Develop a strategic plan for creating a safe and transparent culture for reporting incidents. |
| “5.3h Role model and lead well-being and resiliency for self and team.” | Discuss well-being and resilience for self and team in practice. | Illustrate well-being and resilience strategies for self and team. | Critique well-being and resilience practices for self and team. |
Domain 5: Teaching/Learning Strategies
Examples of Clinical/Practicum Strategies
Example 1
Description: Assessment and Management of Psychiatric Emergencies
This assignment could be used as a case scenario(s), an individual assignment, team assignment, discussion board, or developed as a simulation. No specific rubric was used for this assignment but could easily be used as needed. For this example, the assignment was developed for students to work on individually and then present in a discussion board; they were required to respond to two peer posts at minimum, with an evidence-based response. Students could also be assigned in pairs to develop a presentation, which could be recorded using (insert your program platform for example in Teams, Zoom , etc.).
If you are requiring group work, you are encouraged to use (identify program platform for example MS Teams/Zoom) to meet as a group to share and collaborate on group work. Presentations should be limited in time.
Instructions for this assignment are incorporated throughout the assignment.
Review the screening, assessment, and intervention protocols for at a clinical practice site.
- Suicide Risk Assessment
- Homicide Risk Assessment
- Serotonin Syndrome/li>
- Neuroleptic Malignant Syndrome
- Threatening/Aggressive Violence
Next, using evidence-based references, outline your actions based on the following individual statements and scenarios. Be specific and include in-text citations and a list of references at the end of the assignment.
1. “Recently, I have been thinking I might be better off if I just ended it all.”
How should you reply to the individual? Identify one type of therapy you might use in a scenario like this. Provide rationale for the therapy type selected. List at least three evidence-based statements/questions you might use in this situation to promote quality outcomes. Be specific. Outline the next steps in your assessment, as well as evidence-based assessments you should complete.
2. “If I would ever happen to run into the man who stole my wife, I would kill him.”
How should you reply to the individual? Outline the next steps in your assessment, as well as evidence-based assessments you should complete.
3. What would you anticipate observing in an individual with serotonin syndrome?
What question(s) should you ask to assess for adverse side effects specifically related to serotonin syndrome? Be specific. Outline the steps you should implement if you suspect serotonin syndrome.
4. What would you anticipate observing in an individual with neuroleptic malignant syndrome?
List priority differential diagnosis you should assess/evaluate for in the process of making your final diagnosis.
Domain 5: Resources
Articles/Textbooks
Armstrong, G. E. (2019). QSEN safety competency: The key ingredient is just culture.
The Journal of Continuing Education in Nursing, 50(10): 444-447. https://journals.healio.com/doi/full/10.3928/00220124-20190917-05
Gleason, K. T., VanGraafeiland, B., Commodore-Mensah, Y., Walrath, J., Immelt, S., Ray, E., & Himmelfarb, C. R. D. (2019). The impact of an innovative curriculum to introduce individual safety and quality improvement content. BMC Medical Education, 19, 1-8. https://doi.org/10.1186/s12909-019-1604-0
Hughes, R. G. (2008). Tools and strategies for quality improvement and individual safety (ch 44). NIH Individual Safety and Quality: An Evidence-Based Handbook for Nurses. https://www.ncbi.nlm.nih.gov/books/NBK2682/
Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare (4th edition). Wolters Kluwer.
Melynk, B. M., & Morrison-Beedy, D. M. (2019). Intervention research and evidence-based quality improvement (2nd ed.). Springer Publishing.
Polit, D. E., & Beck C. T. (2020) Nursing research: Generating and assessing evidence for nursing practice (11th ed.). Wolters Kluwer.
Sherwood, G. & Barnsteiner, J. (2021). Quality and safety in nursing: A competency approach to improving outcomes (3rd ed.). Wiley Blackwell.
Waltz, C. F., Strickland, O. L., Lenz, E. R. (2016). Measurement in nursing and health research (5th ed.). Springer Publishing.
Websites
Agency for Healthcare Research and Quality
AHRQ TeamSTEPPS
American Healthcare Association Quality & Safety
CDC Stacks Guidelines and Recommendations
IHI Individual Safety Essentials Toolkit
IHI Quality Improvement Essentials Toolkit
Quality and Safety Education for Nurses
Registered Nurses’ Association of Ontario (RNAO) Nursing Best Practice Guidelines
Standards for Quality Improvement Reporting Excellence (SQUIRE) publishing guidelines
Systematic Evidence Reviews and Clinical Practice Guidelines
TJC National Individual Safety Goals
