Patient safety: Where is nursing education?
plied Science and Technology (SIAST), School of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, Alberta, Canada T1K 3M4. Journal of Nursing Education
(Impact Factor: 0.91).
Patient safety is receiving unprecedented attention among clinicians, researchers, and managers in health care systems. In particular, the focus is on the magnitude of systems-based errors and the urgency to identify and prevent these errors. In this new era of patient safety, attending to errors, adverse events, and near misses warrants consideration of both active (individual) and latent (system) errors. However, it is the exclusive focus on individual errors, and not system errors, that is of concern regarding nursing education and patient safety. Educators are encouraged to engage in a culture shift whereby student error is considered from an education systems perspective. Educators and schools are challenged to look within and systematically review how program structures and processes may be contributing to student error and undermining patient safety. Under the rubric of patient safety, the authors also encourage educators to address discontinuities between the educational and practice sectors.
Available from: Mark Pijl Zieber
- "Making a mistake in clinical is a traumatic experience for students ( Begley & White , 2003 ; Gregory et al . , 2007 ; Seiden , Galvan & Lamm , 2006 ) and participants demon - strated a willingness to explore and debrief their trau - matic experiences , including an exploration of antecedents and consequences . The principal investiga - tor struck a balance between allowing participants to freely express their experiences while occasionally re - direc"
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ABSTRACT: The experience of nursing students who make mistakes during clinical practice is poorly understood. The literature identifies clinical practice mistakes as a significant issue in nursing practice and education but there is very little research on the topic. This study used a grounded theory approach to explore the experience of undergraduate nursing students who had made at least one mistake in their clinical practice. What emerged is a theory that illuminates the process of how students move through the positive and negative elements of the mistake experience the core variable that emerged from the study was "living through the mistake experience." The mistake experience was clearly a traumatic process for nursing students and students reported feeling unprepared and lacking the capability to manage the mistake experience. A number of recommendations for nursing education are proposed.
International Journal of Nursing Education Scholarship 01/2015; 12(1). DOI:10.1515/ijnes-2014-0070
Available from: Alison Steven
- "Milligan (2007) argued that shifting UK healthcare towards a patient safety culture required changes to healthcare professional education and training. However concern was expressed regarding a focus on individual errors in nurse education (Gregory et al., 2007) with claims that nursing curricular competencies urgently needed changing to match the needs of the practice environment (Sherwood and Drenkard, 2007). Thus the place of learning, education and training in promoting and supporting a safety culture has long been recognised (Pearson et al., 2010; Sammer et al., 2010). "
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ABSTRACT: Education is crucial to how nurses practice, talk and write about keeping patients safe. The aim of this multisite study was to explore the formal and informal ways the pre-registration medical, nursing, pharmacy and physiotherapy students learn about patient safety. This paper focuses on findings from nursing. A multi-method design underpinned by the concept of knowledge contexts and illuminative evaluation was employed. Scoping of nursing curricula from four UK university programmes was followed by in-depth case studies of two programmes. Scoping involved analysing curriculum documents and interviews with 8 programme leaders. Case-study data collection included focus groups (24 students, 12 qualified nurses, 6 service users); practice placement observation (4 episodes=19hrs) and interviews (4 Health Service managers). Within academic contexts patient safety was not visible as a curricular theme: programme leaders struggled to define it and some felt labelling to be problematic. Litigation and the risk of losing authorisation to practise were drivers to update safety in the programmes. Students reported being taught idealised skills in university with an emphasis on 'what not to do'. In organisational contexts patient safety was conceptualised as a complicated problem, addressed via strategies, systems and procedures. A tension emerged between creating a 'no blame' culture and performance management. Few formal mechanisms appeared to exist for students to learn about organisational systems and procedures. In practice, students learnt by observing staff who acted as variable role models; challenging practice was problematic, since they needed to 'fit in' and mentors were viewed as deciding whether they passed or failed their placements. The study highlights tensions both between and across contexts, which link to formal and informal patient safety education and impact negatively on students' feelings of emotional safety in their learning.
Nurse education today 05/2013; 34(2). DOI:10.1016/j.nedt.2013.04.025 · 1.36 Impact Factor
Available from: Laura A Killam
- "Without such development, it is most unsafe in the clinical setting. This perspective is similar to a blame-oriented understanding of error causation by individual practitioners . Sole responsibility for clinical safety is problematic however, given that central role of educators in the development and evaluation of student competence. "
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Nursing education necessitates vigilance for clinical safety, a daunting challenge given the complex interchanges between students, patients and educators. As active learners, students offer a subjective understanding concerning safety in the practice milieu that merits further study. This study describes the viewpoints of senior undergraduate nursing students about compromised safety in the clinical learning environment.
Q methodology was used to systematically elicit multiple viewpoints about unsafe clinical learning from the perspective of senior students enrolled in a baccalaureate nursing program offered at multiple sites in Ontario, Canada. Across two program sites, 59 fourth year students sorted 43 theoretical statement cards, descriptive of unsafe clinical practice. Q-analysis identified similarities and differences among participant viewpoints yielding discrete and consensus perspectives.
A total of six discrete viewpoints and two consensus perspectives were identified. The discrete viewpoints at one site were Endorsement of Uncritical Knowledge Transfer, Non-student Centered Program and Overt Patterns of Unsatisfactory Clinical Performance. In addition, a consensus perspective, labelled Contravening Practices was identified as responsible for compromised clinical safety at this site. At the other site, the discrete viewpoints were Premature and Inappropriate Clinical Progression, Non-patient Centered Practice and Negating Purposeful Interactions for Experiential Learning. There was consensus that Eroding Conventions compromised clinical safety from the perspective of students at this second site.
Senior nursing students perceive that deficits in knowledge, patient-centered practice, professional morality and authenticity threaten safety in the clinical learning environment. In an effort to eradicate compromised safety associated with learning in the clinical milieu, students and educators must embody the ontological, epistemological and praxis fundamentals of nursing.
BMC Nursing 11/2012; 11(1):26. DOI:10.1186/1472-6955-11-26
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