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Quality and Safety Education for Nurses

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Quality and Safety Education for Nurses

Systems thinking is directly related to the Quality and Safety Education for Nurses (QSEN). QSEN emphasizes six competencies — patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics (Stalter & Mota, 2018). The practical mastery of these competencies affects healthcare on multiple levels. For instance, a nurse acts on an individual level, and their performance impacts care in a local hospital. Subsequently, the performance of local healthcare organizations finds a reflection in the regional and national healthcare trends. Finally, the compilation of national trends constructs a global health situation with its features and issues. Stalter and Mota (2018) compared this systemic phenomenon to dropping a pebble into a pool of water. Dolansky and Moore (2013) viewed systems thinking in QSEN as continuums, in which the personal effort of a single nurse continuously ascends to the level of system care. Therefore, one can define systems thinking in QSEN as educating the nurses on interdependencies in healthcare and disseminating a systemic approach to care on an individual level.

The latter part of the systems thinking continuum in QSEN is crucial since healthcare consists of interdependent elements. Dolansky and Moore (2013) portrayed the continuum as a double-headed arrow, which means that expanding the scope of thinking beyond the individual care toward the system care impacts the nurse’s personal effort. For example, the individual level of care within the QSEN competence of safety would be washing hands at the appropriate times. System-level care would result in an internal investigation in the unit and the creation of a cause-and-effect diagram to summarize why nurses do not wash their hands (Dolansky & Moore, 2013). Consequently, the investigation findings would lead to positive changes in the individual level of care. The continuum of system thinking would persist, making improvements in the overall state of healthcare more feasible.

In this regard, the work of regulators and accreditors lies in promoting systems thinking in QSEN in order to achieve an overall improvement across the various domains of healthcare. Dolansky and Moore (2013) highlighted the interdependency and urged to integrate QSEN competencies into the nursing curriculum with a strong systems-perspective emphasis. Such a position finds a reflection in the evidence from healthcare professionals and educators. Plack et al. (2018) interviewed 26 medical faculty members at the George Washington University Medical School and found that the shift towards systems thinking was primarily externally driven. In particular, the adoption of the systems thinking paradigm was influenced by the Accreditation Council for Graduate Medical Education (ACGCME). In regard to nursing, the external push was made by healthcare regulators, which “incentivized all the players to look at the systems” (Plack et al., 2018, p. 6). From their perspective, systems thinking was a solution to the problems of medical errors and cost containment (Plack et al., 2018). Overall, one can claim that the regulators and accreditors heard the call made by Dolansky and Moore back in 2013.

In summary, the accreditors and regulators see the systems thinking approach as a means of achieving progress on the individual level of care. These organizations act as an external driving force that strives to raise the awareness of interdependencies in the healthcare system among medical professionals. The mastery of QSEN competencies on a local level, such as the hospital unit, would positively influence the whole healthcare system. Therefore, accreditors and regulators actively promote systems thinking, incentivizing health educators and professionals to shift away from the individual care paradigm.

Integration of nursing intervention in a multidisciplinary care plan is a challenging task. An insufficient competence in teamwork and collaboration may lead to situations in which other team members ignore beneficial nursing interventions. For instance, collaborative care planning in a mental health setting is a therapeutic intervention in itself; it is based on a strength-focused approach that empowers mental health patients (Reid et al., 2018). However, other nursing team members frequently disregard this intervention, making it pointless and tokenistic from the patients’ perspective.

The lack of intervention recognition in the multidisciplinary care plan severely undermines its effectiveness. For instance, Reid et al. (2018) interviewed twelve patients in an acute inpatient mental health unit in Sydney, Australia, and found that the participants enjoyed the collaborative care planning proposed by the nurses. However, nearly all patients observed that other nursing team members did not check back in regarding their goals and progress (Reid et al., 2018). Some participants noted with disappointment that their care plans were seemingly not valued by the nursing team (Reid et al., 2018). From this example, one can claim that nursing interventions in mental health settings are susceptible to poor integration into multidisciplinary care plans due to the emphasis on the individual level of care.

In this regard, systems thinking could become a viable way of supporting and integrating a beneficial intervention. According to Reid et al. (2018), mental health nurses are well-placed for championing patient goals within the multidisciplinary team. However, focusing on personal effort in teamwork and communication impedes the integration of corresponding interventions, such as collaborative care planning. On the contrary, systems thinking emphasizes collective activities (Dolansky & Moore, 2013). Therefore, it provides an opportunity for convincing multidisciplinary team members of the intervention’s effectiveness.


Dolansky, M. A., & Moore, S. M. (2013). Quality and safety education for nurses (QSEN): The key is systems thinking. OJIN: The Online Journal of Issues in Nursing, 18(3), 1-12. Web.

Plack, M. M., Goldman, E. F., Scott, A. R., Pintz, C., Herrmann, D., Kline, K., Thompson, T., & Brundage, S. B. (2018). Systems thinking and systems-based practice across the health professions: An inquiry into definitions, teaching practices, and assessment. Teaching and Learning in Medicine, 30(3), 242-254. Web.

Reid, R., Escott, P., & Isobel, S. (2018). Collaboration as a process and an outcome: Consumer experiences of collaborating with nurses in care planning in an acute inpatient mental health unit. International Journal of Mental Health Nursing, 27(4), 1204-1211. Web.

Stalter, A. M., & Mota, A. (2018). Using systems thinking to envision quality and safety in healthcare. Nursing Management, 49(2), 32-39. Web.

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