ARCHIVES OF

PSYCHIATRICNURSING

Vol. 26 No. 5 October 2012

GUEST EDITORIAL

Taking Charge of Our Future: CurricularApproaches to Improve Quality and

Safety in Psychiatric Nursing Practice andHealth Care

Published by Elsevier Inc.0883-9417/1801-0005$34.00/0doi:10.1016/j.apnu.2012.06.007

IN THIS TUMULTUOUS, yet opportunistic,time of reform, we have the ability and

responsibility to reflect on and transform graduatepsychiatric–mental health nursing education if weare to change the mental health care delivery systemto be integrated, patient-centered, recovery orient-ed, collaborative, and delivered effectively basedon evidence (Hanrahan, Delaney, & Stuart, 2012).Moreover, as educators, we need to preparegraduates that deliver care as members of aninterprofessional team with a focus on qualityimprovement practices (Disch, 2012). We positQuality and Safety Education for Nurses (QSEN)(Cronenwett et al., 2007) as a framework to guideour educational transformation and prepare nurseswith the knowledge, skills, and attitudes (KSAs)necessary to continuously improve the quality andsafety of patient care and of our health care systemsthrough the development of the following compe-tencies: patient-centered care, teamwork and col-laboration, evidence-based practice, qualityimprovement, safety and informatics.

As Weber et al. (2012) state in their article, weare in the middle of a paradigm shift and are in apivotal position to respond to the changes in healthcare by integrating the QSEN competencies intoour curricula. Although by its very nature psychi-atric–mental health education has for decadestranslated many of the tenets of QSEN intoeveryday practice, the authors give us a blueprintfor how to bring renewed focus and energy to the

Archives of Psychiatric Nursing, Vol. 26, No. 5 (October), 201

KSAs and incorporate missing content. If we areable to subscribe to the authors' suggestions anddevelop meaningful learning experiences in under-graduate education, perhaps we can draw moregraduate students to our specialty. With a dearth ofprescribers in almost 96% of U.S. counties (Sarvet,Gold, Bostic, et al., 2010), the overwhelming publicneed for mental health services (Stuart, Hoge,Morris, et al., 2009), and the shrinking workforce(Hoge, Morris, Daniels, et al., 2007), the timing forchange is critical, and psychiatric-mental healthnursing is in a position to lead this transformation.

Yearwood and Riley's (2012) study on curricularinfusion provides a specific educational strategy tostrengthen students' well-being and sense of self asa conduit to leadership and decision-making skillsthat promote intent and facilitate the developmentof five of the six (patient-centered care, teamworkand collaboration, evidence-based practice, qualityimprovement, and safety) quality care indicators ofQSEN through the use of reflective pedagogies.Their work also highlights the need for additionalattention to self-care practices in nursing educationand supports an evidence-based teaching practice(Hanrahan et al., 2012) to develop strong nursingleadership essential for shaping national workforce

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policy. Leadership will enable us to have increasedvisibility on committees that develop these policiesso that quality and safety issues are not inadequate-ly addressed (Rudner Lugo, O'Grady, Hodnicki, &Hanson, 2010).

Along with these five competencies, role pre-paration must include informatics with attentionto the electronic health record and tools for makingclinical decisions if nursing is to be a leaderin designing and using information technology(McNelis & Horton-Deutsch, 2012). The ability tomonitor and track performance measures in nursingwill facilitate autonomous practice and reimburse-ment. In a recent Robert Wood Johnson report(Robert Wood Johnson, 2012), adoption of theelectronic health record within the United Stateshas only reached 57%. Although teaching andurban health care settings have modernized,nonteaching and rural facilities lag far behind.Because graduate psychiatric nursing programsaim to increase the number, diversity, anddistribution of advanced practice psychiatric-men-tal health nurses in rural and underserved areasby making advanced education available throughthe development of distance-accessible programs(Horton-Deutsch, McNelis, & O'Haver Day, 2012;McNelis & Horton-Deutsch, 2008), it is imperativethat they are prepared to use information andtechnology to communicate, manage knowledge,and mitigate error. In this way, graduates are poisedto lead and expand the development of electronicmedical records and monitor patient quality andsafety nationwide.

Viewed collectively, these studies raise aware-ness and provide direction for curricular revision inpsychiatric-mental health programs to preparenurses whose practices are embedded in theQSEN competencies. Reflective practice peda-gogies coupled with QSEN competencies providean opportunity for nurses and students to exploretheir professional and individual commitment toquality and safety in their emerging practice(Sherwood & Horton-Deutsch, 2012). Althoughmany factors contribute to health care quality andsafety, health care education has been identified as amajor force (Institute of Medicine, 2003). Theunparalleled changes in practice mandate transfor-mation in how we educate and foster continueddevelopment of nurses. The QSEN competenciesare road maps to ensure ongoing improvement inquality and safety.

Angela M. McNelisSara Horton-Deutsch

EditorsIndiana University School of Nursing

Indianapolis, INE-mail address: ammcneli@iupui.edu

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Disch, J. (2012). QSEN?What's QSEN?NursingOutlook, 60, 58–59.Hanrahan,N. P., Delaney, K. R.,& Stuart, G.W. (2012). Blueprint

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Hoge,M.A.,Morris, J.A.,Daniels, A. S., et al. (2007).An action planfor behavioral health workforce development. In R. W.Manderscheid & F. L. Randolph (Eds.), US Department ofHealth and Human Services (pp. 1–343). Bethesda, MD:SubstanceAbuse andMentalHealth ServicesAdministration.

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Rudner Lugo, N., O'Grady, E. T., Hodnicki, D., & Hanson, C.(2010). Are regulationsmore consumer-friendly when boardof nursing are the sole regulators of nurse practitioners?Journal of Professional Nursing, 26(1), 29–34.

Sarvet, B., Gold, J., Bostic, J. Q., et al. (2010). Improving access tomental health care for children: The Massachusetts ChildPsychiatry Access Project. Pediatrics, 126, 1191–1200.

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