A Bundle of Care: Creating a New Teaching-Learning Model to Affect a Culture of Safety

Purpose:
Dialogue, using appreciative inquiry principles and the Theory U, uncovered new ways to enhance patient safety. A transformative nursing practice-education partnership, to guide teaching-learning interactions between patient-student-nurse-faculty-nurse leaders in practice and education, was created.

Significance:
The complexity of today's teaching-learning environments is challenged by many factors that affect patient care and safety. Teaching-learning environments are influenced by culture, patient-centered care, community and vitality, leaderful alliance, safe, reliable care, and professional development.

Strategy and Implementation:
A comparison crosswalk was conducted to determine key essentials from The Joint Commission (TJC), Magnet, undergraduate Quality, Safety, and Education in Nursing (QSEN) goals, The Nursing Leadership Academy Advisory Board, the National Council of State Boards of Nursing (NCSBN), and Transforming Care at the Bedside (TCAB). The recurrent themes that emerged in this process, as well as expected competencies for the practice of nursing, were identified as five dimensions for the Culture of Caring Model-which includes Patient-Centered Care, Community and Vitality, Leaderful Alliance, Safe, Reliable Care, and Professional Development. This conceptual framework provides structure for implementing a bundle of care to promote safety within a teaching-learning environment context. Implementation of such a concept involves critical engagement in all teaching-learning interactions between patient-student-nurse-faculty-nurse leaders in clinical practice where clinical education takes place.

Evaluation:
Student focus interviews noted favorable comments for learning. Pre-post medical-oncology nurses rated students higher in clear communication, mutual encouragement, genuine concern, response to risk, knowledge exchange, and interest in learning when comparing pre-post measures.

Implications for Practice:
Both nursing students and staff report overall support for implementation of the Culture of Caring Model. This model provides an innovative bundle of care to influence change towards a positive culture, supporting growth in safety measures and related education efforts.