Teaching Quality Improvement in Pre-Registration Nursing Education: Changing Thinking, Changing Practice

Abstract

Quality care and improving health outcomes are cornerstones of healthcare provision, yet quality improvement (QI) preparation and assessment in health-professional education has been found to inadequately prepare graduates for their future roles (Robb et al., 2017). Toi Ohomai Institute of Technology’s Bachelor of Nursing (BN) year three teaching team looked to address this by reviewing and improving QI teaching and assessment modules within a course in the programme. Alongside this redevelopment, research with students was undertaken to investigate the efficacy and outcomes of this work. This paper presents findings from reviews of QI assessment projects completed by BN students (n = 93), with particular attention to identifying student experiences and their approach to this project using a detailed content analysis (Krippendorff, 1989). Particular attention was paid to highlighting a shift in thinking from quality assurance (QA) approaches that prevailed in the prior teaching of this module, to QI. We found 41% of students selected and undertook projects that reflected QI concepts focused on improved patient outcomes, and 59% of students selected and undertook projects that were concerned with standards, auditing and compliance improvement, more in keeping with QA. In addition, seven student QI projects addressed enhancing te ao Māori (Māori worldview), including language activities through music and exercise, bilingual labelling, and culturally safe care for Māori residents. Key findings address the ongoing challenges of embedding QI concepts and engagement in practice and professional development needs; and policy, practice and procedural improvements and the need for more time to enact and evaluate QI projects. Recommendations from this study are: (1) enhancing te ao Māori and Te Tiriti o Waitangi responsiveness throughout the BN curriculum; (2) ongoing preparation for student-nurse educators to ensure they are confident to support student-led QI initiatives; (3) further shared professional development with agency staff prior to practice placements; and (4) replication of this research to identify longitudinal outcomes. This research reinforces the importance of education–practice partnerships to enhance effective QI education for preparing graduates to transition to their new roles in the workplace.