Quality and Safety Self-Efficacy Scale

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Author of Tool: 

Debra A. Simons, Phd, CNE, CHSE, CCM

Key references: 

American Association of Critical Care Nurses. (2005). AACN standards for establishing and sustaining health work environments: A journey to excellence. Aliso Viejo, CA: Author

Bandura, A. (1982). Self-efficacy mechanism in human agency. American psychologist, 37(2), pp. 122-123.

Cardoza, M. P., Hood, P. A., Dillon, P. M. (2012). Comparative study of baccalaureate nursing student self-efficacy before and after simulation. Computers, Informatics, Nursing. 30(3), pp. 142–147

Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., … & Warren, J. (2007). Quality and safety education for nurses. Nursing outlook, 55(3), 122-131.

Institute of Medicine. (2004). Keeping patients safe.Washington, DC: National Academies Press.

Joint Commission. (2012). National Patient Safety Goals. Retrieved December 31, 2012 from https://www.jointcommission.org/about/JointCommissionFaqs.aspx#616

QSEN. (nd). Prelicensure KSAs. Retrieved from https://qsen.org/competencies/pre-licensure-ksas.

Wachter, R.M. (2010). Patient Safety At Ten: Unmistakable Progress, Troubling Gaps. Health Affairs. 29 (1) pp.1165-173

World Health Organization. (2007). Communication during patient hand-overs. Joint Commission International, Vol. 1. Geneva: WHO Press

Zhang, C., Thompson, S., Miller, C. (2011). A review of simulation based interprofessional education. Clinical Simulation in Nursing. 7, pp. e117-e126.

Primary use / Purpose: 

Measure Self-Efficacy related to Quality and Safety


Nursing is a caring profession, which practices alongside other disciplines. Communication amongst health care personnel has been implicated in the literature as a cause of most patient errors and sentinel events between 1995 and 2006 (American Association of Critical Care Nursing [AACN], 2005; Dillon et al., 2009; Joint Commission, 2012; Wachter, 2010; World Health Organization, 2007). The majority of nursing programs do not include interdisciplinary or collaborative educational experiences in their curricula (Lavin et al., 2001).

Quality and Safety Education for Nurses (QSEN) speaks to the challenge of preparing nurses with the competencies necessary to improve the quality and safety of the health care systems in which they work (Cronenwett, Sherwood, Barnsteiner, Disch, Johnson, Mitchell,… & Warren, J., 2007). Those competencies include: patient centered care, teamwork and collaboration, evidence based practice, quality improvement, safety, and informatics (QSEN, n.d.).

Bandura (1982) indicates that self-appraisals of competencies are one set of determinants of how people behave. People always make decisions about what courses of action to follow and how long to continue. Examining undergraduate nursing student performance through evaluation of behaviors can provide insight into whether behavior changes.
“There is a lack of psychometric testing regarding measuring student performance by evaluation. There is a need for evidence of positive learning outcomes from studies using methodical rigor and validated evaluation strategies” (Zhang et. al. 2011, pp. e117-e118). The literature is abundant regarding student perceptions of learning. However, there is a gap concerning the effectiveness of simulation learning on student learning outcomes.

The Quality and Safety Self-Efficacy Scale was designed to operationalize and define QSEN categories and competencies (QSEN, n.d.) related to self-efficacy. The Quality and Safety Self-Efficacy Scale includes 17 questions. See appendix A. The scale consists of four categories; Patient centered Care, teamwork and collaboration, safety and evidence-based practice. Students were asked about their confidence level as it pertained to behaviors related to skills, attitudes and knowledge. The instrument was validated for reliability post an interprofessional simulation with nursing students N = 15. Chronbach’s alpha = .920.


Chronbach’s Alpha .920



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