A national Delphi to determine developmental progression of quality and safety competencies in nursing education.

Quality and Safety Education for Nurses (QSEN) faculty outlined 6 competency domains: patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. In this study, 18 subject matter experts participated in a web-based modified Delphi survey between October 2008 and February 2009 to determine whether there was consensus on the developmental progression of knowledge, skill, and attitude elements within the QSEN competencies. Support for creation of curricular threads to facilitate student progressive achievement of the QSEN competencies was validated. Competency development related to the individual patient was emphasized early in the curriculum, whereas teams and systems were emphasized later. Complex concepts such as teamwork and collaboration, evidence-based practice, quality improvement, and informatics were emphasized in advanced courses. Experts outlined a developmental approach in curriculum design, which would potentially encourage practice, reinforcement of learning, and recognition of context of care.