Date of Award
Spring 5-14-2025
Document Type
Doctor of Nursing Practice Final Manuscript
Degree Name
Doctor of Nursing Practice
Department
Nursing
First Advisor
Joseph Burkard, DNSc, CRNA, EBP-C, AACN Health Policy Fellow
Second Advisor
Kathy James, DNSc, FNP
Abstract
Background: Aesthetic nursing is a new branch of nursing practice. Formal nursing education and standards are lacking, making it challenging to assess competency of an aesthetic nurse. Adverse events (AEs) range from minor (bruising) to severe (vascular compromise and blindness) and can be associated with poor technique or lack of knowledge. Standardized practice using evidence-based (EB) protocols is necessary to provide safe, high-quality care. The Institute of Medicine (IOM) and the Joint Commission support the use of the Quality and Safety in Nursing (QSEN) programs to improve outcomes and promote safety. Due to varied training, “experienced” aesthetic nurses may or may not perform these techniques competently. After doubling our staff of “experienced” injectors, dermal filler AEs doubled over one year. AEs in our office are defined as anything that causes a client return visit post injection due to a complaint. Most AEs are lumps, asymmetry, and rarely vascular compromise.
Purpose: The purpose of this evidence-based project was to decrease AEs associated with dermal filler injections by creating a competency-based assessment and training program using existing dermal filler EB protocols, placed in QSEN and Benner's Novice to Expert theoretical frameworks. The IOWA model guided the implementation of this project.
Project Plan Process: QSEN competency statements are divided into categories of Knowledge, Skills, and Attitudes (KSAs). Competency assessment forms using EB protocols and QSEN competencies, structured into Benner’s Novice to Expert framework were developed. All medical staff (n=10) at two separate locations completed the assessment and training within a four-month period. All staff self-evaluated and were objectively evaluated on a Novice to Expert scale. Anything noted as less than Competent in the QSEN KSAs/Benner format was addressed using customized training programs. AEs were monitored monthly.
Evaluation/Results: AEs associated with dermal filler injections decreased by 65% (n=34) compared to the same period the prior year (n=97). Four of the ten providers participated in customized training sessions. Implementation cost was $5000, primarily payroll associated with assessment and training, with a savings of $12,000 in six months, associated with time saved managing AEs.
Conclusions: Assessing competency and addressing deficiencies in KSAs using a QSEN and Benner based program decreased AEs in dermal filler clients.
Implications for Practice: All aesthetic providers will be assessed, trained and annually evaluated using this program to promote safety, improve outcomes and decrease cost associated with AEs. Ensuring competency of aesthetic nurses will promote the goals of the IOM to promote consumer safety.
Digital USD Citation
Stephens Ross, Stacey D., "Decreasing Dermal Filler Adverse Events Using QSEN and Benner Theoretical Frameworks to Assess Competency" (2025). Doctor of Nursing Practice Final Manuscripts. 297.
https://digital.sandiego.edu/dnp/297
Copyright
Copyright held by the author
Creative Commons License
This work is licensed under a CC BY-NC License
