The Institute of Medicine identifies five core competencies for the delivery of quality health care. These core competencies serve as an overarching aim for quality health services. Interdisciplinary simulation exercises occur in the first semester of the program involving occupational therapy and nursing students. There are many advantages in using high-fidelity simulation. Through the use of standardized patients, occupational therapy students build on specific skills in a safe environment with a minimal safety risk. Simulation in occupational therapy education is gaining momentum and the International Nursing Association for Clinical Simulation and Learning (INACSL) standards provide guidance until the time that discipline-specific standards or expectations are established. INACSL best practice standards can offer design guidance to educators of many health care disciplines, particularly if they are new to simulation or curriculum design. These standards can provide a common language furthering the development of workforce relationships.

Cultural competency is considered an important skill for nurses and will aid in the elimination of health disparities, with the goal of increased quality of care and improved patient outcomes. Cultural competence is a contemporary issue in health care today and educators are seeking the best practice for teaching cultural competence in nursing education. This chapter discusses the problem and significance of cultural competence training for nursing students. Cultural immersion, or an experience of living among a culture different from one’s own, is a method of teaching cultural competence that appeal to the current generation of college students. To achieve patient-centered care, the chapter addresses the fact that American society, and the larger global society, is increasingly diverse in areas such as race, ethnicity, language, religion, gender, and sexual orientation. This diversity creates cultural gaps that must be bridged in order to provide quality health care.

Individuals with disability report poor communication, compromised care, negative attitudes on the part of health care professionals, lack of sensitivity, and fears related to quality of care all issues of universal concern to the nursing and medical professions. The inclusion of standardized patients with disabilities program (SPWD) in nursing education has the potential to improve the knowledge, attitudes and skills of students who will encounter individuals with disabilities in all health care environments, facilities, and home care settings throughout their professional careers. Simulations that incorporate SPWDs enable students to learn to communicate effectively, appropriately and sensitively with individuals with disabilities across the lifespan and with diverse types of disabilities. A well-planned strategy to integrate SPWDs in nursing education will enhance nursing students’ learning experiences and faculty members’ adoption of this innovative teaching approach with the goal of improving health care for persons with disabilities.

This chapter explains how chaos and confusion impacts staff as they move through the second phase of transition toward a new way of being. When departments or organizations merge, multiple policy and procedure manuals are supposed to merge as well, but this rarely happens fast enough. In the meantime when nurses are challenged by a practice issue and go looking for the correct policy or procedure to follow, they may find several or none. When this happens, staff can feel confused, anxious, frustrated, and fearful for patient safety. They may feel patients are being cheated of quality care and feel guilty about it, but not necessarily motivated enough to change. Mixed emotions, accommodating different practices, and mental and physical exhaustion can cause staff to more readily call in sick and feel less inclined to go the proverbial extra mile. The chapter provides tips for managing chaos and confusion.

Reinforcing reality is a principle learned in psychiatric and mental health nursing. It remains a useful tool for today’s nurse managers in helping staff understand the requirement for personal and professional change in order to thrive in today’s practice settings. In the past, changes in nursing practice resulted from internal requirements to improve patient care efficiencies, quality of care, and service delivery. Today, care provision is complex, being subjected to the influence of budgets, technology, acuity levels, changing demographics, intergenerational and culturally diverse workforces, dwindling human resources, and restructuring. This chapter explains the impact of transitioning from the “good ol’ days” to a new way of being. It discusses the key competencies that will positively influence nursing practice in a changing workplace. These competencies are already deeply embedded in nursing practice although not usually named as such. Rarely do nurses refer to themselves as innovators, risk takers, creative, or flexible.

This chapter introduces the concept of attitude, discusses the power it can have on the quality of care, work life, and workplace relationships, and provides tips for influencing positive change. Negative attitudes may be a by-product of change in the workplace and reflect what is really happening at a deeper level with respect to staff’s feelings, perceptions, and behaviors. Most often, such attitudes emanate from feelings of low self-esteem, powerlessness, low level of trust, a sense of betrayal, disrespect, mental and physical exhaustion, and mismanagement. More recently, compassion fatigue has surfaced as potential cause for negativity at work. Change comes in the form of a staff attitude menu with choices that include the good to great, the okay and so-so, and the downright ugly. Nurse managers are ultimately responsible and accountable for ensuring that staff behaviors are consistent with professionalism in practice.

Nurses are accountable in leading efforts to advance translational science, particularly in the development of clinical practices and care delivery systems that result in quality patient care and improved outcomes. To provide nurses a foundation for integrating science into practice and policy, this chapter provides a useful review and critique of current translational science models, implementation of intervention research, program evaluation, and translational science in the practice setting. The nursing profession has a long history with translating research findings into practice and is increasingly expected to engage in translating research evidence into clinical practice and healthcare policy. Translational theory may effectively guide the design of the intervention study to evaluate the effects of the intervention, interpret study results, and help translate the intervention to real-world settings. Key to these efforts is ensuring the presence of construct validity and having a structured project management approach.

This chapter helps the reader to identify characteristics of formal and informal leaders, describe ways nursing leaders encourage an organizational spirit of patient-centered inquiry and to outline a plan for implementing an evidence-based practice (EBP) healthcare culture. It addresses the roles of formal and informal leaders in developing and sustaining an organizational culture of EBP. Healthcare settings with an embedded EBP culture demonstrate the EBP process as normative and expected behavior of nurses' everyday work life. Effective nurse leaders understand the organization's overall purpose and goals for establishing an EBP culture. Nurse leaders are clear about the needs of the organization's participants to help EBP grow and thrive as a means of delivering high-quality patient care. The chapter highlights ongoing strategies that effective nurse leaders use to attain and uphold an EBP culture. It explores the underreported, yet vitally important, role that informal leaders have in fostering an EBP culture.

Providing the highest quality of care to clients, and keeping them safe, is a priority for all nurses. This chapter presents an evolving case scenario that will follow a nurse's exploration of quality and safety on her patient care unit. It helps the reader to define quality improvement and safety in healthcare. The chapter describes approaches that nurses can take to evaluate the quality of care through measurement and benchmarking. It helps the reader to explain the influence of variation on the quality of care and apply a framework to improve reliability. The chapter differentiates prepatient events, safety events, and serious safety events and describes how human factors contribute to events of harm. It defines the culture of safety and its elements, including event reporting, event disclosure, and accountability in a just culture. The chapter finally explains the process for determining actual and potential failures in processes.