Extent of skill of student nurses on QI. Table 1.

b presents the extent of skill of student

nurses on QI. An overall average of 2.72 shows that student’s nurses are skilled on the concepts
of QI which means that student nurses are competent in demonstrating the competencies/skill in
Quality improvement.
Table 1b. Extent of Skills of Student Nurses on QI (N=261)
Skills X I
1. Find information about outcomes of care for populations served in care setting 2.67 S

2. Seek information about quality improvement projects in the healthcare setting 2.65 S

3. Use tools (such as flow charts, cause-effect diagrams) to make processes of care explicit 2.74 S

4. Participate in a root-cause analysis of a sentinel event 2.51 S

5. Use quality measures to understand performance 2.73 S

6. Use tools (such as control charts and run charts) that are helpful for understanding 2.74 S
variation

7. Identify gaps between local and best practice 3.10 S

8. Design small test of change in daily work (using an experiential learning method such as 2.62 S
Plan-Do-Study-Act)

9. Practice alignment of the aims, measures and changes involved in improving care 2.72 S

10. Use measures to evaluate the effect of change 2.76 S

AVERAGE 2.72 S
Legend: 3.25-4.00 Highly Skilled (HS), 2.51-3.25 Skilled (S), 1.76-2.50 Moderately Skilled (MS), 1.00-1.75 Not Skilled (NS

As gleaned from the table the scores are almost the same value in, Nevertheless these

items are all interpreted as Skilled with slight differences in the mean values, which can be

interpreted as the student nurses are competent in demonstrating the competencies / skills in

Quality Management/improvement.

With the above result, the students show that they are skilled in doing some of the skills

in their quality improvement project. Based on the domains of the items in the table, it is seen

that student nurses are skilled to identify gaps. Gaps that may alter the students’ performance in

the clinical setting. The lack of resources may affect the impact on students’ performances. A

study of Gemuhay, Kalolo, Mirisho, Chipwaza, & Nyangena1 (2019), shows that there are some
barrier and gaps that may affect the student in performing nursing care, these barriers to effective

clinical practice are absenteeism, lack of confidence, inadequate supervision, and lack of

resources. In relation with the present study, that lack of basic and advance equipment and

supplies for nursing care procedures may affect the performance of ideal nursing care procedure.

However, students may become more resourceful and still try to provide a proper nursing care

procedure. On the other hand, the lack of computer and technology in the classroom and

hospitals may also affect the performance of QI skills. Certain hospitals have already upgraded

their facilities by adding computers in to the system, but the student nurses are not permitted to

use the computers due to lack of protocol on how would this be integrated in their curriculum.

Although, the BSN curriculum, offers a subject like the Nursing informatics, which may help the

students in the classroom and into the clinical area about knowledge and skills on QI. Further,

student nurses are skilled to measure and evaluate the effect of change and skilled to use tools

(such as flow charts, cause-effect diagrams) to make processes of care explicit and to assess and

evaluate the students, patients, and tools (such as control charts and run charts) that are helpful

for understanding variation. These activities are specifically seen in the hospital duty, like

application of nursing process, how to analyze pathophysiology and psychopathology, how to do

nurse patient interactions, and in the classroom setting like; doing self-directed learning’s,

applying course learning outcomes (CLO), and students are required to do and submit their

course portfolio. Supporting the results, the study of Korver et al. (2008), shows that student

nurses are skilled in quality improvement processes, such as assessing gaps in practice,

flowcharting, implementing of quality improvement tools and methods to assess performance,

reassessing for a different outcomes or changes, and monitoring efficiency of improvement

efforts. Additional similar findings from the study of Sherwood and Zomorodi (2014), quality
improvement helps the student nurse measures variance between ideal and actual care, and

implement strategies to address the gaps.

Clinical performance measures are instruments that estimate the extent to which a health

care provider delivers clinical services that are appropriate for each patient's condition; provides

the services safely, competently, and in an appropriate timeframe; and achieves desired outcomes

in terms of those aspects of patient health and patient satisfaction that can be affected by clinical

services and the students practice alignment of the aims, measures and changes involved in

improving care, to their patients whether in the hospital setting or in home care based practice.

Student nurses are competent to know what are interventions needed for their patients. Student

nurses utilize tools namely; Patient Safety Measures in which the students will know if a patient

will incur a specific illness in a patients hospital stay or in going to surgery. Student nurses do

effectiveness measures of patients receiving recommended hospital care for specific conditions

such as heart attack, pneumonia care, and prevention of surgical infection. And the students’

most favourable measure is always the patient-centeredness measures, where the students gives

their out most care to patients, making a plan to make the patients recover, and giving out

teaching and interventions for a faster recovery, and provision of care instructions upon hospital

discharge. To the study of Roberts (2017), states that process measures provide evidence to

encourage student nurses to follow best practices. Structure measures can help health care

providers in maximizing the effectiveness of the interventions given and that the students may

provide the best possible care to their patient populations. Health care providers such as the

student nurses have made it their explicit goal to deliver excellent outcomes. The students

commonly cite quality, research, or education as goals, as to measure their patients’ treatment

outcomes or report them – to their respective clinical instructors (Akerman, & Stowell 2015).
 Students have access to the patients chart, knowing the patients conditions, diagnosis,

medications and the like. And knowing of the patients has been recovered from the treatments,

medications given. Students are engaged with QI projects when they reached level 4 of the BSN

curriculum. Wherein they will ask or inspect on what can be approved in the hospital setting,

which will give an impact on the safety of patients. Utilizing the PDSA model student nurses do

small test in order to facilitate the patients’ conditions, an example would be the nursing process.

To help the students giving nursing care to patients in the lecture setting it is based on the

students learning styles and on how the student survive in nursing school.

A sentinel event is defined as any unanticipated event in a healthcare setting resulting in

death or serious physical or psychological injury to a patient or patients, not related to the natural

course of the patient's illness (Hipskind & Rodziewic, 2019). Fortunately, in the current practice

of related learning experiences, the students are somehow not involved in such events, since

careful supervision is being done by their respective clinical instructors in the clinical areas.

However, if the students are involved or have done or witnessed an error or variance, they are

mandated to submit an incident report within 24 hours. Unfortunately, most incidents, if not all,

will never be investigated, more so on conducting a root cause analysis. This implies that root

cause analysis should be integrated as part of the activities of the faculty and students.

The concepts of quality improvement are implemented in the classroom and into the

clinical area, through their journal sharing activities, through the nursing process, advance

readings, and through their nursing research I and II. According to the study of Cooper, &

O’Neil (2013), having good academic results are not sufficient to provide enough foundation for

the students to enhance their own evolving foundation of quality improvement. The same authors
proposed that detailed attention needs to be addressed to the implementations of these

competencies in clinical practice. Additionally, the level 4 student nurses had quality

improvement courses namely Nursing Leadership and Management as mandated in the BSN

program.