Dolansky Mary A, Moore Shirley M
Frances Payne Bolton School of Nursing, Case Western Reserve University in Cleveland, OH, USA.
Online J Issues Nurs. 2013 Sep 30;18(3):1.
Over a decade has passed since the Institute of Medicine's reports on the need to improve the American healthcare system, and yet only slight improvement in quality and safety has been reported. The Quality and Safety Education for Nurses (QSEN) initiative was developed to integrate quality and safety competencies into nursing education. The current challenge is for nurses to move beyond the application of QSEN competencies to individual patients and families and incorporate systems thinking in quality and safety education and healthcare delivery. This article provides a history of QSEN and proposes a framework in which systems thinking is a critical aspect in the application of the QSEN competencies. We provide examples of how using this framework expands nursing focus from individual care to care of the system and propose ways to teach and measure systems thinking. The conclusion calls for movement from personal effort and individual care to a focus on care of the system that will accelerate improvement of healthcare quality and safety.
自医学研究所发布关于改善美国医疗体系必要性的报告以来，已经过去了十多年，但据报道质量和安全方面仅有轻微改善。护士质量与安全教育（QSEN）倡议旨在将质量和安全能力整合到护理教育中。当前的挑战在于，护士要超越将QSEN能力应用于个体患者和家庭的范畴，在质量和安全教育以及医疗服务提供中融入系统思维。本文介绍了QSEN的发展历程，并提出了一个框架，其中系统思维是应用QSEN能力的关键方面。我们举例说明了如何使用该框架将护理重点从个体护理扩展到系统护理，并提出了教授和衡量系统思维的方法。结论呼吁从个人努力和个体护理转向关注系统护理，这将加速医疗质量和安全的改善。
