Quality and Safety Education for Nurses



The Role of a Registered Nurse in an MCI (Mass Casualty Incident)Introduction:The topic of this Quality and Safety Education for Nurses (QSEN) teaching strategy is principles of emergency and disaster preparedness. MCI is a growing concern in today’s society and nurses need to be prepared and equipped with knowledge and skills to effectively handle the situation. This growing concern is related to the realities of our political and social experiences with mass shootings, chemical attacks, and natural disasters like tornado, floods, and hurricane. Triage nursing plays an important role in ensuring effective management of the situation. This is an interdisciplinary effort and students need to realize that role identification is important. Supporting the patient, family, and the team is a crucial role as students identify their strengths and weaknesses. A solid policy and procedure on a mass casualty incident in every facility will assist all personnel to effectively manage circumstances. The use of a triage algorithm, in-service, regular drills and continuing education requirements are also recommended in applying evidence-based practice. The teaching strategy is applicable to new graduate nurses, pre-licensure ADN or BSN. Students will be able to apply the principles of triage in a mass casualty incident, identify their role as part of the interdisciplinary team, and identify supportive role to the team, patient, and family. This teaching strategy will benefit students as they consider desired employment settings. QSEN CompetenciesThe QSEN website has the following competencies defined and will be used in this teaching strategy.Evidence-based practice (EBP) – “Integrate best current evidence with clinical expertise and patient/family preferences and values of delivery of optimal health care.”Quality improvement (QI) – “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.” Safety – “Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.”Teamwork and collaboration – “Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care.” Informatics – “Use information and technology to communicate, manage knowledge, mitigate error, and support decision making.”Patient centered care- “Recognize the patient as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.”Student participation provided a new dimension of thinking as they identified concerns in the post discussion. Concerns for personal safety, readiness, and reevaluation of desired employment setting such as the emergency room were topics of discussion. There was a limited opportunity to apply the knowledge in the clinical setting as student rotation in the emergency department was limited to 2-3 12-hour shifts per quarter. Given this limitation, students were more confident in answering test questions involving MCI with the application of concepts learned and the use of an existing algorithm. More than 88% of students answered prioritization and triage questions in succeeding quizzes and exams. A pre-test is recommended for future use. Summary of ActivityFor this activity, students will learn the principles of emergency and disaster preparedness. Advance readings were assigned to students with emphasis on the student learning outcomes (SLOS). The activity commenced with an introductory video from You Tube about a hospital scenario in a mass casualty incident (MCI). Students were divided into 5 groups with 4-5 members, based on total number of the class. The class was presented with a case study. Students from each group were asked to classify victims according to a triage algorithm. The final activity included questions to guide discussion on how to effectively handle emergency nursing. The discussion included student’s strengths and weaknesses and possible ethical dilemmas they may anticipate. After about 15-20 minutes of group discussion, each group shared their ideas with open feedback from other groups, facilitated by the instructor. After class discussion, the instructor provided a conclusion with debriefing and addressed any other questions from students. Learning Objectives:Apply the principles of triage in a mass casualty incident (MCI) in prioritizing patient care (Knowledge, Skills) Effectively categorize patients of victims in a MCI (Knowledge, Skills)2. Identify the roles of the nurse as part of an interdisciplinary team in a MCI. (Knowledge)3. Describe the role of the nurse in supporting healthcare team, patients, and family in a MCI event. (Attitudes)4. Utilize technology and informatics in a teaching strategy. (Knowledge, Skills)a. YouTube videoStrategy ContentQSEN Competencies met in this strategy: EBP – use of existing algorithm to classify and prioritize patient care, meets the QSEN competencies of demonstrating knowledge of basic scientific methods and processes (K) and using tools to make processes of care explicit (S).QI – use of evaluation methods on how effective the teaching strategy (pre and post-test, debriefing, and reflection) meets the QSEN competency of using measures to evaluate the effect of change (S).Safety – identify the supportive role of the nurse to the team, patient, and families, meets the QSEN competency of communicating observations or concerns related to hazards and errors to patients, families and the health care team (S). Teamwork & Collaboration – identify roles in an interdisciplinary health care team, meets the QSEN competency of demonstrating awareness of own strengths and limitations as a team member (S). Technology/Informatics – use of YouTube video for simulation meets QSEN competency of the use of technology to provide reliable and effective tools for teaching. Patient centered care- integrate physical comfort and emotional support meets the QSEN competency of recognizing that patient expectations influence outcomes in management of pain or suffering (A). The levels of Bloom’s Taxonomy met in this activity are:Analyze Students will able to prioritize MCI victims and therefore prioritize their care. The use of case study and group discussion is an effective method for students to evaluate and apply what they learned from their readings. The use of the algorithm is also an effective method in giving the students a simplified guideline in their process of prioritization.Evaluate 1. Students will brainstorm in their assigned group and share their thoughts in class. Ideas that came out from the discussions were varied: a. “I am able to react appropriately in an emergency and will positively respond.” b. “I will be flustered and will need direction and supervision.” c. “My strength will be in providing the emotional support the patient and family will need.” d. “After dealing with a challenging situation, I will feel a sense of fulfillment with the team.”2. Reflection on individual strengths and weaknesses – evaluate individual characteristics (ability to work in clinical settings that require fast-paced decision-making, multitasking, and ability to coordinate and effectively work with other staff).3.As students identify their strengths and weaknesses, students will reflect on leadership skills, providing an opportunity for improvement. Future Implications:There are limitations of the teaching strategy as to evaluating the attitudes of students in a pre and post-test. It is recommended that instructors assess the students’ attitudes pre and post activity in terms of empathy, flexibility, interpersonal skills, quick response, and respect when dealing with a mass casualty incident. Although more than 88% of students answered prioritization and triage questions in succeeding quizzes and exams, a pre-test is recommended for future use to qualitatively evaluate how effective the teaching strategy in student learning. It is recommended that the instructor would require a 100-150 words reflection paper from students to identify their strengths and weaknesses in dealing with a mass casualty incident. ................
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