Evaluating the Effectiveness of Two Teaching Strategies to Improve Nursing Students Knowledge, Skills, and Attitudes in Quality Improvement and Patient Safety

Maxwell, Karen

Purpose: Since the Institute of Medline Report to Err is Human: Building a Safety Health System (1999), and the establishment of Quality and Safety Education for Nurses (QSEN) (2005), nurse educators have been challenged with discovering effective teaching strategies to infuse the QSEN competencies into the nursing curricula. The Future of Nursing Report(2011) has called for a need to transform nursing education. Nurse educators are being challenged to break away from traditional established patterns of teaching and consider new innovative teaching strategies. The purpose of this study was to evaluate the effectiveness of two teaching strategies, online modules only versus online modules in conjunction with a flipped classroom discussion seminar on nursing students’ knowledge, skills, and attitudes about quality improvement (QI) and safety.

Methods:

This study utilized a quantitative pretest-posttest control group design. The following six research questions were addressed:

Is there a significant difference in pre-licensure nursing students’ knowledge of quality improvement as measured by test scores based on type of educational program on quality improvement (online module in conjunction with a flipped discussion classroom seminar vs. online modules only)?
Is there a significant difference in pre-licensure nursing students’ knowledge of patient safety as measured by test scores based on type of educational program on patient safety (online module in conjunction with a flipped discussion classroom seminar vs. online modules only)?
Is there a significant difference in pre-licensure nursing students’ attitudes about quality improvement as measured by self-reported attitude scores based on type of educational program on quality improvement (online module in conjunction with a flipped discussion classroom seminar vs. online modules only)?
Is there a significant difference in pre-licensure nursing students’ attitudes about patient safety as measured by self-reported attitude scores based on type of educational program on patient safety (online module in conjunction with a flipped discussion classroom seminar vs. online modules only)?
Is there a significant difference in pre-licensure nursing students’ comfort with skills of quality improvement as measured by self-reported skill scores based on type of educational program on quality improvement (online module in conjunction with a flipped discussion classroom seminar vs. online modules only)?
Is there a significant difference in pre-licensure nursing students’ comfort with skills of patient safety as measured by self-reported skill scores based on type of educational program on patient safety (online module in conjunction with a flipped discussion classroom seminar vs. online modules only)?

The research was conducted within a college of nursing at a private university in the southeastern United States. A total of 97 students consented to participate in the study. The final sample size that completed both the pre-test and the posttest was 64 students, 31 in the experimental group and 33 in the group. Participants in both groups completed a pre-test to assess their current knowledge, skills, and attitudes about QI and safety. The experimental group completed 10 online modules on QI and patient safety through the Institute of Healthcare Improvement (IHI) Open school and participated in an eight week flipped classroom discussion seminar that met for 2 hours each week. The control group completed the 10 online modules on QI and patient though the IHI open school only. Participants than completed a posttest to assess any change in their knowledge, skills, and attitudes of QI and safety. The study used an adapted version of the Quality Improvement Knowledge, Skills, and Attitudes (QulSKA) questionnaire, and adapted version of the Healthcare Professional Patient Safety Assessment(HPPSACS) questionnaire. Prior to administering the adapted version of the QulSKA and HPPSACS five doctorally-prepared nurse educators were asked to establish content validity of the adapted tool. The content validity index (CVI) was used to measure content validity. For the adapted tool the S-CVI-AVE was .97 and the S-CVI/UA was .83

Results: Data were analyzed using Statistical Product and Service Solutions (SPSS). Two MANOVA analysis used to examine group differences demonstrated a statistically significant similar omnibus effect (p=.028) between the experimental group and the control for knowledge, comfort with skills, and attitudes of quality improvement. A MANOVA examining group differences between the experimental group and the control group on knowledge, comfort with skills, and attitudes of patient safety was not statistically significant (p=.59). Due to a small sample size and low observed power of .72 these finding should be interpreted with caution.

Conclusion: The results of this study demonstrated that the online modules through the IHI open school in conjunction with the flipped classroom discussion seminar had more effect on nursing students’ knowledge of QI and patient safety, and comfort with skills of QI and patient safety than the online modules only. Neither teaching strategy had an effect on students’ attitudes of QI and patient safety. Although the online modules in conjunction with the flipped classroom discussion seminar proved to be more effective, participants who completed the online modules only did raise their comfort with skills of QI and safety scores showing the online modules did have some effect. The adapted QulSKA and HPPSACS tool demonstrated reliability with a Cronbach’s alpha of the entire tools of .88. The present research grows to a growing body of research on effective teaching strategies to incorporate the QSEN competencies into the nursing curricula. It is one of only a few studies that measure student’s current knowledge, skills and attitudes of the QI and safety competencies.