Quality Improvement

Building on the Institute of Medicines six aims for improvements in health care systems,
faculty and advisory board members of the Quality and Safety Education for Nurses (QSEN)
initiative developed six quality and safety competencies to incorporate into nursing education
programs to better prepare all nurses with the knowledge, skills, and attitudes necessary to
identify areas in need of improvement and the ability to initiate change in order to deliver a
higher quality of care to patients (Cronenwett, Sherwood, Barnsteiner, Disch, Johnson, Mitchell,
Sullivan & Warren, 2007). Included in the six competencies is the concept of quality
improvement (QI) which, as defined by the QSEN faculty and advisory board members is to 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 (Cronenwett et
al., 2007).
Due to the vital role that nurses play in providing direct patient care, they are in an
optimal position to evaluate clinical practice and participate in QI efforts that are motivated by
the desire to improve patient care (Kovner, Brewer, Yingrengreung, & Fairchild, 2010). As
Kovner, Brewer, Yingrengreung, & Fairchild (2010) point out, nurses are able to recognize that
the quality and safety of patient care is often inadequate however, they lack the cognitive tools
and knowledge of the steps needed to initiate efforts toward effective patient care improvements.
For this, quality improvement should be a core clinical skill that can be taught and learned
throughout all nursing courses so that graduate nurses can enter the workforce ready to take part
in QI activities at a beginning level rather than be introduced by the health care organization to
what may be considered a foreign concept and be presented with the challenge of obtaining the
experience and understanding of QI related knowledge, skills, and attitudes at that time.

Included in the role of educators is to convey to learners that the importance of

understanding the full effect of QI requires nurses to extend their application of QI knowledge,
skills, and attitudes beyond the individual level and apply it to a systems-based level of care.
Systems-thinking is the ability to recognize, understand, and synthesize the interactions and
interdependencies in a set of components designed for a specific purpose which includes the
ability to recognize patterns in an environment and understand how various actions can reinforce
or counteract each other (Dolansky & Moore, 2013). By being able to utilize this process, nurses
will be better prepared to expand ideas on QI in one area of patient care to improvements of that
same identified area of care for all patients. An example of the continuum from individualized
care to systems-thinking or system-based care provided by Dolansky & Moore (2013) consists of
individual nurses ensuring that he/she cares for central lines using evidence-based practice to
participating in a QI project to improve compliance with utilizing the central line bundle on the
nursing unit.
By engaging in a systems-based way of thinking to expand QI efforts to a broader scope,
an improved quality of health care delivery for patients in all settings can be achieved thus
leading to an overall improvement in patient outcomes led by nurses and across all settings. To
accomplish this, a closer look at how the concept of QI is addressed and incorporated into
nursing programs must take precedence.

Core Concept Teaching Strategies

CONCEPT: Quality Improvement
Educational Program: Four Year BSN Program
Competency
Level 1 Competency
Blooms Level:
Understand

A practitioner who can

explain what quality
improvement means in
terms of nursing
practice.

Level 2 Competency
Blooms Level: Analyze

A practitioner who can

identify an area of
clinical practice in need
of improvement and
investigate reasons
contributing to the
problem.

Level 3 Competency
Blooms Level: Evaluate

A practitioner who can

accurately determine

Learner Objective(s)
1. The learner will be
able to give
examples of the
impact the QI has
on patient outcomes

Teaching Strategies
1. Mr. Potato Head:
A lean, mean QI
teaching machine!
(Murphy, Alper, &
Dickson, 2014)

2. The learner will be

able to discuss the
steps of the nurses
role of a QI project
(PDSA)

2. Jigsaw: Putting the

PDSA pieces
together (Herrman,
2008)

1. The learner will be

able to examine the
clinical environment
to detect areas in
need of QI

1. Staff work-around
assignment: Whats
the policy? (Day &
Smith, 2012)

2. The learner will be

able to deconstruct
near-miss events to
determine a
systems-related
probable cause

2. Fishbone diagram:
Uncovering the root
cause (Rodriguez,
2011)

1. The learner will be

able to provide
rationale for
selecting a specific
strategy upon

1. Egg Drop Soup:

Whats your
strategy? (Hanson,
Rosenbluth, &
McPeak, 2013)

the results of a QI
initiative.

consideration of
various options
2. The learner will be
able to assess for
the intended effect
of selected strategy

Level 4 Competency
Blooms Level: Create

1. The learner will be

able to design a
complete QI project

A practitioner who can

produce a product
depictive of the QI
process.

2. The learner will be

able to develop an
educational resource
that reflects a QI
project.

2. Clinical Area
Questioning: Myth
Busters (Herrman,
2008)

1. Mock Studies:
Whats your QI
plan? (Herrman,
2008)
2. Poster Session
Spread the word
(Herrman, 2008)

Teaching Strategy Plans

NAME OF
Jigsaw: Putting the PDSA pieces together
LEARNING ACTIVITY
Learning Activity The learners will be split up into 4 groups, each representing
Summary
a color-coded piece of the PDSA model. Upon finding others
in the classroom who belong to their identified piece, each
group will be responsible for collectively describing their
assigned part of the model, the rational for where their part is
located in the sequence of the model, the impact that the
absence of that part of the model would have on the
development of a QI project, and give an example of that part
of the model according to a provided case study. Each group
will put their answers on a poster board with their assigned
color which will be shared with the rest of the class. Then, one
person from each group will report to the front of the class
and arrange themselves accordingly to display the correct
sequence of the model and share their poster boards with the
rest of the class.
Cognitive (identify level): Understand, Apply, Analyze,
Evaluate
Domain of Learning
(Blooms Taxonomy Affective: Receiving, Responding, Organization
Revised)
Psychomotor: Articulation
Student-Centered
At the completion of this learning activity, the learner will:
Learning Objective(s)
Understand the steps of the PDSA sequence
Value each step as an integral role in promoting
improved quality and efficiency in the workplace
Identify each step of the sequence in various patientcare scenarios
Preparation Required Poster boards and markers to supply for the group work.
by Teacher/Facilitator Enough pieces of paper divided equally for the amount of
and Materials Needed students in the class to represent each step (puzzle piece) of
the sequence in uniform color. Assembly of the list of
questions to be answered as a team. Development and
provision of a QI case study that students will utilize to apply
each step of the sequence.
Time Allotted
3 minutes for delivery of clear instructions, 25 minutes for
group work, 15-20 minutes for presentation of complete
puzzle and discussion
Learning Styles
Information Presentation: _X_sight __sound _X_text
Addressed by Activity

Modality:

_X_visual

_X_verbal

Approach:

_X_active

__reflective

Understanding:
_X_sequential __holistic
How is content connected Students will utilize their knowledge of how the nursing
to prior learning?
process works and apply it to content related to the plan-dostudy-act sequence to learn more about the QI process.
Reflective Debriefing Debriefing will occur with students after their final
with Learners (post- presentation of the completed puzzle via open discussion
learning activity) How format. At this time, students will be able to explain the
will it be accomplished? procedural implications of the sequence and reflect on the
role of the nurse in each step.
Evaluation of
Students will complete a writing exercise reflecting on what
Learning (How will it QI is by completing a personal QI worksheet (Hanson,
be accomplished?)
Rosenbluth, & McPeak, 2013). The worksheet will ask the
student to identify an area of their life that they think could
use improvement (exercise more, eat out less, better study
habits, etc.) and answer a series of questions that follow that
measure students ability to specify aims, identify strategies,
determine achievement, etc. Once they have set an goal,
established measures, and selected changes to make, they will
complete each detail of each step of the PDSA sequence as it
applies to their personal example to demonstrate
comprehension of the QI process.
Teacher Reflection This strategy will allow for detailed understanding of each
step of the QI process and allow the students to value and
(justify choice of learning realize the importance of each step equally. It also allows
activity and good fit for them to practice applying the process to a clinical case
the identified learning scenario in which they can better realize the role of the nurse
in carrying out each step of the PDSA model.
objectives)
NAME OF LEARNING Mr. Potato Head: A lean, mean QI teaching machine!
ACTIVITY
Learning Activity
In this activity, learners will have to reassemble a family of 16
Summary
Potato Head members who encountered a terrible bus crash!
Emergency responders can only find scattered body parts at
the scene of the crash however, they also discover an album
that includes a photo of each family member, including their
pets. A health care team (group of 6-8 students) is awaiting
their arrival at the hospital and two of the members are the
appointed implantation specialists (trauma surgeons) who
need to correctly assemble as many family members as
possible in 7 minutes with the help of their support staff
members. Only the implantation specialists are able to

implant the parts back into the potato bodies and at the end
of 7 minutes, the number of correctly assembled potato heads
and the number of errors will be totaled. On round 2, the bags
will be changed among the groups so there are new patients
to assemble and on round 3, bags will be changed again and
variations of team members will occur. After each round,
students will consider their strategies used through the PDSA
model and make changes accordingly to better improve their
potato assemblies/patient outcomes.
Cognitive (identify level): Remember, Apply, Analyze,
Evaluate, Create
Domain of Learning
(Blooms Taxonomy Affective: Receiving, Responding, Value, Organization
Revised)
Psychomotor: Imitation, Manipulation, Precision,
Articulation
Student-Centered
At the completion of this learning activity, the learner will:
Learning Objective(s)
Appreciate that continuous QI is an essential part of
the daily work of all health professionals
Understand concepts of Lean Process Management (an
approach to running an organization that supports
incremental changes in processes in order to improve
quality and efficiency)
Understand that nursing is part of a system of care that
affects patient care outcomes and therefore plays a
large role in QI
Design a small test of change using an experiential
learning method such as the Plan-Do-Study-Act model
Preparation Required Acquisition of more than enough parts for 16 assembled Mr.
by Teacher/Facilitator Potato Heads and enough tote bags (buses) for the number of
and Materials Needed teams being used. Assemble 16 different Potato Head family
members wearing various accessories and take photos of each
member. Laminate photos of assembled Potato Heads.
Establish a quality inspection table or area and obtain a
stopwatch.
Time Allotted
3 minutes for instruction, 2 minutes for groups to organize
themselves and assign roles, 7 minutes per simulation, 3
minutes for discussion after each round, and repeat each
round for a total of 3 rounds.
Learning Styles
Information Presentation: _X_sight __sound __text
Addressed by Activity
Modality:
_X_visual
_X_verbal

Approach:

_X_active

__reflective

Understanding:
__sequential _X_holistic
How is content connected Students would be incorporating concepts from previous
to prior learning?
classes relating to QI and applying them to this activity to
master a strategy that incorporates a team-based approach
and leads to better patient outcomes. They will use what they
have learned about effective communication to work through
the QI process and reach that level of success. Included in
effective communication is the respect and incorporation of
each persons unique ideas and contributions that lead to a
better quality of care and improvement in system efficiency.
Reflective Debriefing Students will evaluate the PDSA sheets that they completed as
with Learners (post- a team and consider the following points via class discussion:
learning activity) How The role of the system vs. the individual in QI, role of
will it be accomplished? communication in teamwork, importance of collecting data
throughout the QI process, how waste hinders efficiency,
and the benefit that eliminating steps of a process that do not
add value can have on QI.
Evaluation of
In addition to the group discussion, students will complete a
Learning (How will it worksheet with fill-in-the blanks related to the PDSA process
be accomplished?)
and features of a QI initiative to prove their knowledge of the
various concepts.
Teacher Reflection After explaining the importance and value of QI and the place
it has in the nursing process, this activity would be a fun
(justify choice of learning introductory lesson to how QI projects take place in the
activity and good fit for clinical setting. It would help students achieve the learning
the identified learning objectives by giving them the opportunity to see what
happens when a plan is initiated, enacted, evaluated and reobjectives)
evaluated, and modified or changed. It will also assist in
teaching both the benefits and challenges of working together
as a team.

NAME OF
Staff Work-Around Assignment: Whats the Policy?
LEARNING ACTIVITY
Learning Activity Students will select a practice that is commonly used in their
Summary
clinical setting and determine if it is being carried out
according to policy or if nurses have developed ways to work
around the policy when performing that procedure. After a
practice is selected, students will find the most current,
written nursing policy or procedure for that institution or unit
and answer a series of questions such as: how easy/difficult
was it to locate the policy/procedure, did the nurses know

where to find the written policy/procedure, and is the

policy/procedure evidence-based why or why not? Students
will then observe nurses performing the chosen procedure
and answer another set of questions regarding how the nurse
implemented the procedure and if applicable, how/why did
he/she deviate from the policy.
Cognitive (identify level): Understand, Analyze, Evaluate
Domain of Learning Affective: Receiving, Responding, Valuing
(Blooms Taxonomy
Revised)
Psychomotor: Manipulation, Precision
Student-Centered
At the completion of this learning activity, the learner will:
Learning Objective(s)
Identify inconsistencies in clinical practice and what is
recommended as best practice and supported by policy
Know how to locate professional nursing practice
policies and procedures
Understand and appreciate how to incorporate patient
preferences within safe and supported nursing
practices
Preparation Required Development and production of handouts with the selected
by Teacher/Facilitator activity related questions are essentially the only preparation
and Materials Needed that is required by the educator. Establishment of class
discussion questions and evaluation questions are also
required.
Time Allotted
10 minutes to explain the details and purpose of the
assignment, 20 minutes to select a procedure and look up the
corresponding policy, 1 clinical day to observe nurses and
answer assigned questions, 30 minutes to discuss findings
Learning Styles
Information Presentation: _X_sight __sound _X_text
Addressed by Activity
Modality:
_X_visual
_X_verbal
Approach:

_X_active

__reflective

Understanding:
__sequential _X_holistic
How is content connected Students will utilize their knowledge of various nursing tasks
to prior learning?
that are supported by institutional or unit policies when
determining what to investigate in the clinical setting. They
will also use their knowledge of research and evidence-based
practice when applying skills to locate the most up to date
resources containing nursing related policies and procedures
while also relating their knowledge of ethics and safety to

determine the rationale for nursing deviance from standard

policies and procedures.
Reflective Debriefing Students will briefly share their findings with each
with Learners (post- other including what surprised them most in completing this
learning activity) How assignment. Discussion will be further guided by determining
will it be accomplished? why nurses may or may not follow established policies and
procedures when performing patient care. Students will
provide examples and debate the pros and cons in various
instances of why it would or would not be appropriate to
follow written policies. The topic of nursing judgment will
also be discussed and defined.
Evaluation of
Students will complete a written, reflective assignment in
Learning (How will it which they express what they believe are the opportunities
be accomplished?)
and challenges of implementing evidence based practice into
nursing care and the various factors that may influence a
nurses decision to practice according to such standards.
Additionally, students will provide what they believe to be the
most appropriate response when as a licensed, professional
nurse, he or she notices practice that deviates from standards,
policies or procedures. What factors related to the practice
will guide his or her decision to handle the situation? What is
the role of safety and how is it determined?
Teacher Reflection This activity encourages students to be on the look-out for
systems-related nursing processes that are in need of QI. By
(justify choice of learning understanding the purpose of established evidence based
activity and good fit for practice policies, procedures, and guidelines and observing
the identified learning nurses continue to deviate from these written documents,
students (future nurses) should know how this may
objectives)
potentially impact patient outcomes that occur as a result.
Most importantly, by identifying nurses work around a
policy, figuring out why it occurs, and striving to improve that
systems-related process so that all of the established policies
reflect the latest evidence based practice and are implemented
by nurses, greater patient outcomes could occur.
NAME OF LEARNING
Fishbone Diagram: Uncovering the Root Cause
ACTIVITY
Learning Activity Students will be assembled into small groups and given a
Summary
specific case study related to a recent increase in incidence of
patient falls. They will collectively use a fishbone diagram to
fill in the problem statement and the major categories of
causes of the problem. From there they will brainstorm all
possible causes of the problem to identify as many causative
factors as possible and place them in the appropriate
categories on the diagram. Students will then be asked to

choose one intervention that may impact the problem

immediately and one intervention that may provide a more
long term solution. Ideas will be gathered from each group to
develop a collaborative diagram at the front of the class to
facilitate discussion of both the issue and the process of
conducting a root cause analysis.
Cognitive (identify level): Understand, Apply, Analyze,
create
Domain of Learning
(Blooms Taxonomy Affective: Valuing, Organizing
Revised)
Psychomotor: Manipulation, Precision
Student-Centered
At the completion of this learning activity, the learner will:
Learning Objective(s)
Develop a clear diagram to depict cause and effect
relationships of clinical systems that affect patient
outcomes
Appropriately analyze flaws of patient care and design
a plan for system improvement
Preparation Required
by Teacher/Facilitator
and Materials Needed
Time Allotted
Learning Styles
Addressed by Activity

Development and provision of blank fishbone diagrams and

the patient falls case study. Compilation of discussion
question topics for review after the activity.
20 minutes for completion of learning activity, 20 minutes
for class discussion
Information Presentation: _X_sight __sound _X_text
Modality:

_X_visual

__verbal

Approach:

_X_active

__reflective

Understanding:
__sequential _X_holistic
How is content connected Evaluation of cause and effect relationships pertaining to
to prior learning?
patient care relates to students prior knowledge of various
patient safety issues, nursing policies and procedures, and
how to troubleshoot a problem. In particular, students use
their knowledge of the implications of lack of resources and
safety protocols to complete this learning.
Reflective Debriefing Debriefing will be accomplished by class discussion,
with Learners (post- participation, and assembly of the final diagram. Questions
learning activity) How will include what the contributory causes were, where they
will it be accomplished? were placed on the diagram, if all causes could be placed
somewhere, if other bones could be added to the diagram, if it
matters if a cause is shown in more than one category, what
information would be provided to staff if an in-service on this

topic were to be delivered, the effect of falls on patient

outcomes, and the role of evidence based practice on
preventing patient falls. Students will also be asked to
consider how difficult it would have been to complete a root
cause analysis individually to teach the importance of
collaboration in the workplace.
Evaluation of
Having students complete another fishbone diagram with a
Learning (How will it different case study and similar questions to submit for
be accomplished?)
grading will determine if students met the learner objectives.
Teacher Reflection To take part in QI projects, nurses must be able to
deconstruct processes that may lead to adverse events or near
(justify choice of learning misses which is why this choice of learning activity is
activity and good fit for appropriate for this topic. The fishbone activity teaches
the identified learning students how to identify and categorize the underlying factors
by using a structured team approach, known as a root cause
objectives)
analysis. Students then learn that by breaking it down and
understanding the factors that contribute to or cause systemsbased failure, they will be in a better position to help develop
an idea that will resolve the problem and lead to better
outcomes.
NAME OF LEARNING
Egg Drop Soup: Whats your strategy?
ACTIVITY
Learning Activity This activity takes place in two phases. First, students will be
Summary
divided into teams and have to build a package to protect an
egg from an 8 ft drop. Various items to be used for the
package will be provided to the students. Students will record
the types of materials used and then test their package. In
phase 2, the same teams will now be told that the goal is to
develop the lightest, smallest, cheapest package that will
protect the egg from the 8 ft drop and instead of just having 1
egg, each team will receive 4 eggs 3 for trials and 1 for
competition. They will have the list of how much each type of
material costs and will also be required to complete a plando-study-act worksheet after each of their trials. Scores will
be given based on the size of the package, weight of material,
and the calculated cost of the package. The team with the
lowest score wins.
Cognitive (identify level): Apply, Analyze, Evaluate,
Create
Domain of Learning
(Blooms Taxonomy Affective: Receiving, Responding, Valuing, Organization
Revised)
Psychomotor: Manipulation, Precision, Articulation

Student-Centered
At the completion of this learning activity, the learner will:
Learning Objective(s)
Understand how the plan-do-study-act framework
supports QI
Describe how having clear goals established prior to
beginning a QI project impacts the outcome
Preparation Required Development of a PDSA worksheet. Adequate work space
by Teacher/Facilitator including area for the actual egg drop. Materials needed: 5
and Materials Needed eggs per team, straws, masking tape, rubber bands, index
cards, panty hose, cotton balls, ziplock bags, scissors,
measuring tape, clipboards, pens, scale, watch/timer,
calculator, chair/stool (for dropping).
Time Allotted
Phase 1: Two minutes for instructions, 10 minutes for
building, 3 minutes for testing. Phase 2: Five minutes for
instructions, 20 minutes for trials, 15 minutes for final drop
and debrief
Learning Styles
Information Presentation: _X_sight _X_sound __text
Addressed by Activity
Modality:
_X_visual
_X_verbal
Approach:

_X_active

__reflective

Understanding:
__sequential _X_holistic
How is content connected Students will be able to use their knowledge of how the PDSA
to prior learning?
framework applies to the QI process to successfully complete
this learning activity. By already being familiar with the steps
of the PDSA sequence, students can quickly analyze their
efforts to determine if what type of action to take next to
further improve their product.
Reflective Debriefing Debriefing will take place by calculated the scores of each
with Learners (post- teams final product and comparing the results. This will lead
learning activity) How into a discussion with the class about examples of what the
will it be accomplished? egg breaking could represent or be related to in
nursing/health care something that should always be
avoided or prevented such as unsafe medication
administration, for example. Students will be asked to
compare and contrast the major points of the planning
discussions in phase 1 and phase 2 and to write down 2
reasons why knowing the goals at the start of the project such
as in phase 2, made a difference in the development of their
product. Additionally they will be asked to reflect on what it
was like to work as a team and address the skills that were
required to be successful as a team as well as list 1 thing they
learned about themselves as an individual team member.
Evaluation of
Review of the PDSA worksheets that each team completes as

Learning (How will it they work through the activity will demonstrate if they
be accomplished?)
achieved the learning objectives.
Teacher Reflection This is another great team building, interactive exercise in
which students can have fun while learning and practicing the
(justify choice of learning basics of a QI project. Given that this activity is time limited,
activity and good fit for students will be forced to work together to quickly complete
the identified learning the worksheets and revise their plans for improvements to
prepare for the final competition. Practicing this sequence
objectives)
allows for better preparation to apply these steps in the
clinical environment. Additionally, it will allow them to
master the objectives by having experience completing a
project both with and without specific guidelines and being
able to compare the results of each process which directly
transfers to the work flow of systems-based improvements in
the clinical setting.
NAME OF
Clinical Area Questioning: Myth Busters
LEARNING ACTIVITY
Learning Activity Students determine a clinical problem or issue present in
Summary
their clinical settings to examine and bring forth the latest
research regarding that topic. They will then present their
findings to the group and facilitate a group discussion to
answer questions and generate new ideas on how that issue
could be improved.
Cognitive (identify level): Analyze, Evaluate, Apply
Domain of Learning Affective: Receiving, Responding, Valuing, Organization
(Blooms Taxonomy
Revised)
Psychomotor: Manipulation, Precision
Student-Centered
At the completion of this learning activity, the learner will:
Learning Objective(s)
Conduct a mini literature search to find the latest
evidence for a chosen clinical practice problem
Determine if current practices match best practice
recommendations
Identify risks and effectiveness of current practices
Preparation Required The ability to instill an inquiring nature in each nursing
by Teacher/Facilitator student. Identification of a common clinical question/issue or
and Materials Needed support for students in identifying their own recognized
clinical problems. Development of an outline for students to
follow in discovering the most relevant points of any given
clinical issue.

Time Allotted

Learning Styles
Addressed by Activity

Unassigned amount of outside class time for one week from

the time a clinical issue is identified to the following class
period when the information is to be presented. 10-15
minutes per presentation to allow for thorough investigation
and discussion of presented issue.
Information Presentation: _X_sight __sound _X_text
Modality:

_X_visual

__verbal

Approach:

_X_active

__reflective

Understanding:
__sequential _X_holistic
How is content connected This content is linked to students prior knowledge of the
to prior learning?
importance of QI in the healthcare environment, patient
safety issues, and best practices for common nursing
activities. It further builds on students abilities to apply the
PDSA model with emphasis on different parts of the sequence
to discover what and how various practices can be changed to
better reflect current, best practice guidelines.
Reflective Debriefing Via class discussion, students will elaborate on what they
with Learners (post- expected the common nursing procedures to consist of and
learning activity) How what surprised them most after the most recent research was
will it be accomplished? presented on that topic. They will also express the beginning
ways in which they feel they could initiate a change in practice
and evaluate the subsequent outcomes.
Evaluation of
Following discussion of what is known about a given topic,
Learning (How will it students will be asked to write down three things they learned
be accomplished?)
that relate to the provided topic including at least one best
recommended practice or evidence based strategy to support
how nursing should manage that clinical issue.
Teacher Reflection This activity is key in aiding students to understand the
importance of QI in nursing practice as it forces students to
(justify choice of learning learn what the latest best practice recommendations consist
activity and good fit for of for the most commonly encountered clinical issues.
the identified learning Additionally through their experience of conducting
miniature literature searches, this activity allows students to
objectives)
evaluate whether what is currently taking place is adequate or
if there is a better recommendation for clinical nursing
practice available. Regardless of if they are the student
presenting or if they are part of the class receiving the
information, they will be able to understand new information
that is valuable to enhancing patient care and appreciate the
value of investigation to solve clinical problems and recognize
the potential for research to improve patient outcomes.

NAME OF
Mock Studies: Whats your QI Plan?
LEARNING ACTIVITY
Learning Activity In divided groups, students identify and plan different aspects
Summary
of a small-scale QI project that echoes their investigations
into nursing practice, policies, or procedures to reinforce
concepts of QI in nursing practice. The end results illustrate
the value of nursing participation in QI projects along with
the relevance of evidence-based nursing practice.
Cognitive (identify level): Apply, Analyze, Evaluate,
Create
Domain of Learning
(Blooms Taxonomy Affective: Responding, Valuing, Organization, Characterizes
Revised)
Value
Student-Centered
Learning Objective(s)

Psychomotor: Precision & Articulation

At the completion of this learning activity, the learner will:

Determine ways in which quality of care regarding a

specific topic could be improved
Learn that QI works best by using a team-based
approach

Preparation Required A dry erase board and markers to gather ideas generated from
by Teacher/Facilitator the class. Poster boards for each group to submit their work.
and Materials Needed An outline for each group to follow to complete their assigned
part of the QI process. Access to nursing practice policies,
guidelines, and evidence-based nursing literature.
Time Allotted
10 minutes for instruction, development of ideas. 30 minutes
for group work, 10 minutes for debriefing
Learning Styles
Information Presentation: _X_sight __sound _X_text
Addressed by Activity
Modality:
_X_visual
__verbal
Approach:

_X_active

__reflective

Understanding:
_X_sequential __holistic
How is content connected Students past experience of practicing the PDSA model and
to prior learning?
thinking of clinical issues will help them in developing the
mock studies to plan a QI project. Their prior experience with
other group projects will also aid in their abilities to work
together as a group to accomplish this assignment.
Reflective Debriefing After students present their parts and class discussion occurs,
with Learners (post- students will each receive an index card on which they will
learning activity) How anonymously write down 1-2 things that they understand the
will it be accomplished? least about this topic. Index cards will be collected and as
many points will be clarified by the facilitator as time allows.

Evaluation of
Students will complete a worksheet that brings each of the
Learning (How will it separate parts of the process together. With this, they will be
be accomplished?)
able to understand the big picture along with the role of the
supporting policies, procedures, and literature to determine
how patient care can be better improved.
Teacher Reflection This activity affords students the opportunity to piece each
aspect of the QI process together as they formulate how they
(justify choice of learning would carry out a QI project in the clinical setting. It teaches
activity and good fit for the learners where and how to look for the rationale to
the identified learning support the changes they wish to make to improve nursing
care, the data they would need to collect to determine its
objectives)
effectiveness, and demonstrate how a team-based approach is
necessary in QI projects.
NAME OF
Poster Session: Spread the Word
LEARNING ACTIVITY
Learning Activity In small groups, students will create a poster presentation to
Summary
demonstrate a QI project they have been involved with on the
unit in which they have their clinical experiences. The poster
will contain each aspect of the PDSA model to show how the
QI project took place. The posters will be presented by the
students to the class and then be put on display in the clinical
area and in the school of nursing.
Cognitive (identify level): Apply, Analyze, Create
Domain of Learning Affective: Valuing, Organization, Characterizes Values
(Blooms Taxonomy
Revised)
Psychomotor: Articulation, Naturalization
Student-Centered
At the completion of this learning activity, the learner will:
Learning Objective(s)
Educate others on the QI process and explain how
patient care is improved as a result of the developed QI
project
Produce a visually pleasing representation of the
application of the QI process
Preparation Required
by Teacher/Facilitator
and Materials Needed
Time Allotted

Development of a rubric that specifies the criteria for

inclusion in students poster presentations. Students select
their own preferred materials for development of the posters.
Students will be given an unassigned amount of time to
complete this project outside of class with their other group
members. Approximately 10 minutes per group presentation
of the poster will be allotted during one of the last classes.

Learning Styles
Addressed by Activity

Information Presentation:

_X_sight __sound _X_text

Modality:

_X_visual

_X_verbal

Approach:

_X_active

__reflective

Understanding:
__sequential _X_holistic
How is content connected This content is a culmination of all students have learned
to prior learning?
about the QI process as it incorporates each aspect of QI into
this final project and is reflective of the QI activity students
have been working on in the clinical setting.
Reflective Debriefing Students presenting the posters will facilitate a discussion
with Learners (post- with their peers regarding how the development of their
learning activity) How project and the impact it has on patient care. Following each
will it be accomplished? groups presentation will be a discussion about the nurses role
in QI along with what the challenges consisted of and how
they were overcome.
Evaluation of
A rubric will be used to evaluate the posters and determine
Learning (How will it the level of learning that occurred for each student.
be accomplished?)
Teacher Reflection This learning strategy is a good summative activity for
learners to demonstrate their knowledge of QI as it requires
(justify choice of learning students to be active learners and create a product that can be
activity and good fit for used as a tool to teach others about the role nurses have in QI.
the identified learning It links what is learned in the classroom about QI and how it
is performed to what is practiced in the clinical setting by
objectives)
applying the learned steps to an identified patient care issue.
It allows students to reflect back on what they have learned
and helps them feel proud of what they have accomplished.
References
Cronenwett, L. Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., Sullivan, D. T.,
& Warren, J. (2007). Quality and safety education for nurses. Nursing Outlook,55(3), 122-131.
Day, L. & Smith, E. L. (2012). Staff work-arounds assignment. Retrieved from
http://qsen.org/staff-work-arounds-assignment/
Dolansky, M. A. & Moore, S. M. (2013). Quality and safety education for nurses (QSEN): The
key is systems thinking. The Online Journal of Issues in Nursing, 18(3), Manuscript 1.

Hanson, E., Rosenbluth, G., & McPeak, K. (2013). QI Olympics: A game-based educational
activity in quality improvement. MedEdPORTAL. Retrieved from
https://www.mededportal.org/publication/9421
Kovner, C. T., Brewer, C. S., Yingrengreung, S., & Fairchild, S. (2010). New nurses views of
quality improvement education. The Joint Commission Journal on Quality and Patient Safety,
36(1), 29-35.
Muphy, B. Alper, E., & Dickson, E. (2014). Mr. potato head: A lean, mean quality improvement
teaching machine! Retrieved from http://qsen.org/mr-potato-head-a-lean-mean-qualityimprovement-teaching-machine/
Rodriguez, L. (2011). Using a fishbone (RCA) diagram to problem solve falls. Retrieved from
http://qsen.org/using-a-fishbone-rca-diagram-to-problem-solve-falls/