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Abstract

Objetivo Verificar a compreensão dos estudantes de graduação da área da saúde sobre a segurança do paciente. Método Estudo transversal descritivo, realizado em 2015, com 638 estudantes do Centro de Ciências da Saúde, da Universidade Federal de Santa Maria, RS, Brasil. Foi utilizado um questionário com variáveis relativas à caracterização dos estudantes, aos aspectos conceituais e atitudinais sobre o erro humano e à segurança do paciente, disponibilizado online no Portal do Aluno. Resultados Maior percentual de estudantes relatou não ter tido aprendizado formal sobre o tema. Evidenciaram-se aspectos fundamentais para a cultura de segurança como a importância da análise sistêmica do erro, a preocupação com o ambiente de trabalho e a valorização do trabalho em equipe. Algumas atitudes demonstraram incerteza na forma correta de agir. Conclusão Os estudantes demonstraram percepções favoráveis à segurança do paciente. A formalização do tema nos diferentes níveis do ensino é necessária.
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Original Article
How to cite this article:
Cauduro GMR, Magnago TSBS, Andolhe
R, Lanes TC, Dal Ongaro J. Patient safety in
the understanding of health care students.
Rev Gaúcha Enferm. 2017;38(2):e64818.
doi: http://dx.doi.org/10.1590/1983-
1447.2017.02.64818.
doi: http://dx.doi.org/10.1590/1983-
1447.2017.02.64818
Patient safety in the understanding
of health care students
Segurança do paciente na compreensão de estudantes da área da saúde
Seguridad de los pacientes en la percepción de los estudiantes de la área de la salud
a Universidade Federal de Santa Maria (UFSM), Santa
Maria, Rio Grande do Sul, Brasil.
Graziela Maria Rosa Cauduroa
Tânia Solange Bosi de Souza Magnagoa
Rafaela Andolhea
Taís Carpes Lanesa
Juliana Dal Ongaroa
ABSTRACT
Objective: To verify the understanding of graduate health care students on patient safety.
Method: Descriptive cross study, held in 2015 with 638 students at the Health Sciences Center of the Federal University of Santa
Maria, State of Rio Grande do Sul, Brazil. The study used a questionnaire with variables related to the characterization of students, the
conceptual and attitudinal aspects of human error and patient safety, made available online in the Student Portal.
Results: A higher percentage of students reported having no formal training on the subject. The study revealed aspects conside4red
fundamental to the safety culture, such as the importance of systemic error analysis, the concern with the work environment and
appreciation of teamwork. Some attitudes demonstrated uncertainty in the correct way of acting.
Conclusion: Students showed perceptions that were favorable to patient safety. The formalization of the subject at different levels
of education is needed.
Keywords: Patient safety. Health sciences students Higher education.
RESUMO
Objetivo: Verificar a compreensão dos estudantes de graduação da área da saúde sobre a segurança do paciente.
Método: Estudo transversal descritivo, realizado em 2015, com 638 estudantes do Centro de Ciências da Saúde, da Universidade
Federal de Santa Maria, RS, Brasil. Foi utilizado um questionário com variáveis relativas à caracterização dos estudantes, aos aspectos
conceituais e atitudinais sobre o erro humano e à segurança do paciente, disponibilizado online no Portal do Aluno.
Resultados: Maior percentual de estudantes relatou não ter tido aprendizado formal sobre o tema. Evidenciaram-se aspectos fun-
damentais para a cultura de segurança como a importância da análise sistêmica do erro, a preocupação com o ambiente de trabalho
e a valorização do trabalho em equipe. Algumas atitudes demonstraram incerteza na forma correta de agir.
Conclusão: Os estudantes demonstraram percepções favoráveis à segurança do paciente. A formalização do tema nos diferentes
níveis do ensino é necessária.
Palavras-chave: Segurança do paciente. Estudantes de ciências da saúde. Educação superior.
RESUMEN
Objetivo: Verificar la comprensión de estudiantes de graduación sobre la seguridad del paciente.
Método: Estudio transversal descriptivo realizado en 2015 con 638 estudiantes del Centro de Ciencias de la Salud, de la Universidad
Federal de Santa Maria, RS, Brasil. Fue utilizado un cuestionario con variables relativas a la caracterización de los estudiantes, aspectos
conceptuales y actitudinales sobre el error humano y la seguridad del paciente, online en el portal de estudiante.
Resultados: El mayor porcentual de estudiantes relató que no tuvo enseñanza formal sobre el tema. Se evidenciaron aspectos
fundamentales para la cultura de seguridad, como la importancia del análisis sistemático del error, preocupación con el ambiente de
trabajo y valoración del trabajo en equipo. Algunas actitudes demostraron incertidumbre para actuar correctamente.
Conclusión: Estudiantes demostraron percepciones favorables a la seguridad del paciente. La formalización del tema en los distintos
niveles de enseñanza es necesaria.
Palabras clave: Seguridad del paciente. Estudiantes del área de la salud. Educación superior.
Cauduro GMR, Magnago TSBS, Andolhe R, Lanes TC, Dal Ongaro J
2Rev Gaúcha Enferm. 2017;38(2):e64818
INTRODUCTION
Patient safety has permeated many debates in the
global health scenario, with the intention of institutional-
izing best practices in patient care environments. Address-
ing this issue at various levels of education is fundamental
to build the safety culture. Such action allows the devel-
opment of skills throughout training, encouraging the stu-
dents to have proactive mitigation attitudes when faced
with health incidents.
In this context, the World Health Organization (WHO)
has developed a multidisciplinary guide to the organiza-
tion of patient safety curriculum to assist academic health
institutions in the training of professionals in this field(1).
Still, the National Patient Safety Program (PNSP), launched
in 2013 by the Ministry of Health (MS) reinforces this as-
sumption because one of its goals is to foster the inclusion
of patient safety in technical, undergraduate and graduate
education in the health field(2).
The importance and challenge of training institutions
to discuss and extend this theme to the academic and pro-
fessional environment to implement actions that can pre-
vent the occurrence of incidents in the provision of care
was proven through this action.
In this perspective, students need to understand that
failures happen, but that learning from the error is an es-
sential strategy for safety. In face of this new point of view
regarding safer care, health care courses have a key role
since they enable the association of teaching and practice,
risk identification and analysis, seeking strategies to im-
prove work processes.
Changes in this scenario mainly happens through prac-
tice-theory aptitude derived from the knowledge and skills
acquired from the training and perfected in the daily work
of the health team. In this context, considering that the
PNSP is recent, the inclusion of patient safety as a subject
to be learned and practiced among students, especially for
those in graduate courses, can still be considered fragile in
training scenarios.
In addition, a literary review was performed by search-
ing LILACS (Latin American and Caribbean Health Scienc-
es), MEDLINE (System Search and Medical Literature Anal-
ysis) and Scopus (Elsevier) databases in June 2014, from
which it was concluded there is a low percentage of Brazil-
ian publications addressing the subject patient safety with
university students (3). When performed, it was mainly with
nursing and medicine students.
In light of these considerations, the question is: what
is the understanding of graduate health care students of
a public university in the state of Rio Grande do Sul on pa-
tient safety? The next objective of the study was outlined
based on this question: to check the understanding of un-
dergraduate health care students on patient safety.
METHOD
This is a descriptive cross-sectional study carried out
with students in the Health Sciences Center (CCS) of the
Federal University of Santa Maria (UFSM), Rio Grande do Sul,
extracted from the dissertation entitled “Patient safety in
the understanding of graduate health care students”(3) pre-
sented to the UFSM Graduate Nursing Program (PPGEnf/
UFSM) in 2016.
Two thousand and one hundred students (2,100) were
enrolled when the study took place. Considering the esti-
mated percentage of 50%, a sample error of 0.05 and a sig-
nificance level of 5%, from the formula: n =
α/2 . p . q . N
e² (N – 1) + Z²
α/2 . p . q,
a minimum 326 student sample was estimated. Comply-
ing with the proportional stratified sample of students per
course, 638 students participated in the study.
Inclusion criteria were: being enrolled in one of the fol-
lowing course: nursing, medicine, dentistry, occupational
therapy, physiotherapy and pharmacy and to have had
contact with patients during practical classes or intern-
ships. Students younger than 18 years old were excluded.
The selection was by convenience, i.e., students were told
about the research and sensitized to access the search tool
on the Student Portal. Access was free.
Data collection occurred from March to June 2015
through an online questionnaire available on the Student
Portal. Before being initiated, several awareness strategies
were conducted with students (classroom visits, banners,
distribution of folders, email delivery and dissemination on
social network) to promote the research and encourage
student to participate in the study.
The questionnaire consisted of two parts. The first, re-
lating to sociodemographic (sex, age, origin) and academ-
ic (semester course, if the student has scientific initiation
scholarship, it has formal guidance on patient safety) ques-
tions. The second, consisting of 20 questions relating to
conceptual (7) and attitudinal (13) aspects on human error
and patient safety, built by Brazilian researchers(4). These
questions were measured by the Likert scale and respons-
es varied: strongly agree, agree, disagree, strongly disagree
and have no opinion.
Data were collected after authorization was provided
by the authors of the instrument, agreement by the under-
graduate courses’ coordination and approval by the Ethics
Committee of the Federal University of Santa Maria (CEP/
UFSM) under CAAE (Certificate of Presentation for Ethics
Patient safety in the understanding of health care students
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Rev Gaúcha Enferm. 2017;38(2):e64818
Assessment) No. 40248714.4.0000.5346. The database was
organized in an Excel® spreadsheet and analyzed in the Pre-
dictive Analytics Software® program, using descriptive statis-
tics. Results are presented as absolute (n) and relative (%)
frequencies.
All the requirements contained in National Health
Council Resolution 466/2012 were met, ensuring the
voluntary nature of each person’s participation, their an-
onymity and confidentiality of the data. The Free and In-
formed Consent Form was made available online, along
with the questionnaire.
RESULTS
The sample consisted of 638 students enrolled in the
first half of 2015, whereas 101 were from the nursing course
(15.8%), 167 were medical students (26.2%), 65 were study-
ing Physical Therapy (10.2%), 76 were enrolled in Dentistry
(11.9%), 83 in Occupational Therapy (13%), 34 in Speech
Therapy (5.3%) and 112 in Pharmacy (17.6%).
Female students (n = 496; 77.7%), aged between 18 and
22 years (n = 358; 56.1%) and from cities in Rio Grande do
Sul (84.8%) prevailed. As for the academic profile, students of
the seventh, third, fifth and sixth semesters were those with
largest participation in the survey. When asked about having
had a formal patient safety discipline in the course, 64.3%
(n = 410) answered no. As for the academic scholarship,
42.6% (n = 272) answered yes. Among these, 14.7% (n = 94)
were students with tuition scholarships and 13.3% (n = 85),
were students from the research mentorship program.
Table 1 presents the distribution of students responses
on the conceptual aspects related to human error and pa-
tient safety.
Regarding the conceptual aspects, most students dis-
agree that making mistakes in health care is inevitable and
that competent professionals and committed students do
not make mistakes. A higher percentage agrees that there
is a big difference between what the professionals know
to be right and what is seen in practice, and that when the
error occurs, all of those involved should discuss the event.
Table 2 shows the distribution of students responses on
attitudinal aspects related to human error and patient safety.
Regarding the attitudinal aspects, students agree that
workers should not tolerate working in places that do not
offer suitable work conditions (285; 44.7%), agree or strong-
ly agree that to implement preventive measures a systemic
analysis of the facts should always be held (551; 86.4%) and
that preventive measures need to be taken whenever any-
Conceptual aspects SD D NO A SA
N % N % N % N % N %
Making mistakes in health care is inevitable. 69 10.8 305 47.8 32 5.0 203 31.8 29 4.5
There is a big difference between what the
professionals know as being right and what is
seen in daily health care practices.
7 1.1 81 12.7 31 4.9 374 58.6 145 22.7
Competent professionals do not make mistakes
that cause harm to patients. 34 5.3 354 55.5 29 4.5 182 28.5 39 6.1
Committed students do not make mistakes that
cause harm to patients. 40 6.3 353 55.3 37 5.8 175 27.4 33 5.2
In the presence of an error, all involved
(professionals, students, managers, patient and
family) should discuss the event.
3 0.5 33 5.2 27 4.2 280 43.9 295 46.2
For the human error analysis, it is important to
know what the individual characteristics of the
professional who made the mistake are.
13 2.0 92 14.4 88 13.8 351 55.0 94 14.7
After an error occurs, an effective prevention
strategy is to work more carefully. 1 0.2 31 4.9 21 3.3 311 48.7 274 42.9
Table 1 – Distribution of students answers on the conceptual aspects related to human error and patient safety. Rio
Grande do Sul, Brazil, 2015. (n=638)
Source: Research Data, 2015
Key: SD – Strongly Disagree D – Disagree; NO – I have no opinion; A – I agree; SA – Strongly Agree.
Cauduro GMR, Magnago TSBS, Andolhe R, Lanes TC, Dal Ongaro J
4Rev Gaúcha Enferm. 2017;38(2):e64818
Attitudinal aspects SD D NO A SA
N%N%N%N%N%
Professionals should not tolerate
working in places that do not offer
suitable conditions for patient care.
16 2.5 79 12.4 57 8.9 285 44.7 201 31.5
A systemic analysis of the facts should
always be performed to implement
human error prevention measures.
2 0.3 11 1.7 74 11.6 401 62.9 150 23.5
It is necessary to implement systemic
error analysis in the health field. but
preventive measures need to be taken
whenever anyone is injured.
5 0.8 48 7.5 73 11.4 369 57.8 143 22.4
I always inform my professor about the
presence of conditions that favor the
occurrence of errors.
7 1.1 46 7.2 107 16.8 321 50.3 157 24.6
I always inform the professor/
manager/person responsible for
the internship location about the
occurrence of an error.
4 0.6 34 5.3 91 14.3 332 52.0 177 27.7
I always communicate the occurrence
of an error to my colleague. 9 1.4 67 10.5 78 12.2 358 56.1 126 19.7
I always communicate the occurrence
of an error to the patient and his
family.
12 1.9 122 19.1 175 27.4 254 39.8 75 11.8
If no damage occurs to the patient, a
need to report the occurrence of the
error to the patient and family should
be analyzed.
33 5.2 129 20.2 120 18.8 303 47.5 53 8.3
Professors always perform corrective
actions with the student so that he or
she will not make new mistakes.
33 5.2 148 23.2 116 18.2 243 38.1 98 15.4
Systems to report the occurrence
of errors make little difference in
reducing future errors.
184 28.8 310 48.6 77 12.1 55 8.6 12 1.9
Only doctors can determine the cause
of the error. 286 44.8 280 43.9 51 8.0 14 2.2 7 1.1
I always perform internship activities in
places that promote good practices for
the promotion of patient safety.
38 6.0 158 24.8 183 28.7 207 32.4 52 8.2
Whenever I identify situations that
need improvement, I receive support
from the institution to implement
measures to promote safe practices.
87 13.6 199 31.2 216 33.9 110 17.2 26 4.1
Table 2 – Distribution of student responses on attitudinal aspects related to human error and patient safety. Rio Grande
do Sul, Brazil, 2015. (n=638)
Source: Research Data, 2015
Key: SD – Strongly Disagree D – Disagree; NO – I have no opinion; A – I agree; SA – Strongly Agree.
Patient safety in the understanding of health care students
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Rev Gaúcha Enferm. 2017;38(2):e64818
one is injured (512; 80.2%). Most disagree or strongly dis-
agree (494; 77.4%) that systems for reporting errors make
little difference in reducing future errors. Regarding the
question always conduct practical classes in local places
that promote good practice responses, the answers do not
show a consensus regarding agreement (207; 32.4%) and
disagreement (158; 24.8%), just as there was no consensus
about whether when they identify situations that need
improvement they are fully supported by the institution in
implementing safety measures.
DISCUSSION
The results showed a predominance of female students
aged between 18 and 22 years, corroborating the study
conducted at the Federal University of Triangulo Mineiro,
that showed 89% of female participants and 34% at 18
years of age(5). This predominant female profile also reflects
the inclusion of women in the work market of professions
recognized for being female market(6).
Regarding the presence of a formal discipline in the
curriculum, although students do not have a discipline on
patient safety, most of them showed favorable perceptions
of safety, corroborating the results of other studies (4,6-7).
Such evidence indicates a cross-thematic approach of the
evaluated courses in which teachers, although informally,
have been keen to develop the theme.
However, research has identified that patient safety
tends to be implicit in the curriculum; learning occurs pre-
dominantly in isolation and with little chance of interpro-
fessional exchange(8). Therefore, establishing formal curric-
ulum in patient safety is essential for training(7).
When performing the analysis of students’ responses
regarding the conceptual aspects, it became clear that in
the affirmative making mistakes in healthcare is inevitable
and competent professionals and committed students do
not make mistakes that cause harm to patients, there was a
higher percentage of discordant responses. This leads to
the perception that mistakes can happen to any profes-
sional or students, but can be prevented through strate-
gies for patient safety. However, a considerable number
of students agreed with these statements revealing a still
traditional view of human error, with focus being put on
the individual and blame on the professional(9).
The perception of the possibility that the error can hap-
pen constitutes the first step to strengthen the safety actions
in education. Discussing the mistakes of students is also a
way of learning, as these can happen during training(10). Thus,
incorporating a safety culture in early training helps the stu-
dent to recognize faults and learn with them(11).
Historically, health care courses work in view of asser-
tiveness, considering that teachers teach students what
is right, virtually excluding the possibility of error. This ap-
proach, to some extent, affects the safety culture, since the
hospital is complex and presents many health risks, such
as overcrowding, inadequate working conditions, complex
treatments, advanced technologies that require updating
and constant attention, among others.
Thus, if this chain of factors that are necessary to es-
tablish a safety culture is explored from the beginning of
training, the better the results of these professionals after
graduation, resulting in effective actions for safe care(12).
The training process undergone by professionals should
include technical and scientific knowledge, which enable
them to intervene in the health/disease process through
tools that ensure the quality of health care. One of them is
the PNSP, which indicates guidelines and safety protocols
for the development of safe practices(2).
Most students agreed that, in the presence of an error,
this should be discussed among all stakeholders, includ-
ing professionals and managers. The incident analysis is
an extremely important moment, since together reflec-
tions and the construction of action strategies can take
place. In this process, it disseminates the principle that
the incident is opportunistic, but can be avoided by re-
viewing work processes and collective establishment of
a secure system.
A higher percentage of them agreed or strongly agreed
(519; 81.3%) that there is a difference between what the
professionals know to be right and what is seen in day-
to-day health care practices. A higher percentage (91.6%)
was shown in a study conducted at UNIFESP with nursing
and medical students(4). These results are corroborated by
a study conducted with nursing students at a university in
São Paulo, which revealed that many of the improved tac-
tics in patient safety addressed in undergraduate courses
were observed in hospital practice settings(13).
This analysis reflects the existing disconnect between
theory and practice, a fact further evidenced in education-
al institutions. Therefore, a pedagogical proposal that is
transformational in nature cannot ignore the theory/prac-
tice concurrency and should consider the reality of ser-
vices, different epidemiological profiles, the work of health
professionals and health conditions of the population(14).
A study evaluating the pedagogical projects (PPs) of
health courses determined that the teaching on patient
safety was fragmented, lacking depth and conceptual
breadth and yet it was realized that each course values the
specific aspects for the training it wants to give(15). In this
regard, authors point to the importance of patient safety
Cauduro GMR, Magnago TSBS, Andolhe R, Lanes TC, Dal Ongaro J
6Rev Gaúcha Enferm. 2017;38(2):e64818
teachers acting as course coordinators(8), as well as a review
of the pedagogical model adopted(10).
In this perspective, it is considered that not only the
academic environment, but practical scenarios also have
responsibility in the education of students. It is not enough
to learn best practices for patient safety in the classroom
if, when faced with the reality of health care, the student
finds an inflexible system that does not use or under-utiliz-
es the care protocols. In this context, it is common for stu-
dents to question themselves about why teachers require
compliance protocols, if in practice, some professionals do
not follow them.
In addition to the classroom environment and practice
example, changing individual and collective behavior and
the presence of professionals who serve as a model to be
followed are fundamental to learning in patient safety. This
because it helps students develop and maintain a con-
sistent safety ideal in mind(8). Still, strengthens behavioral
and attitudinal changes in their health team, qualifying
the work processes. With this, the more positive examples
students have during training, the greater the chances of
proactivity in those who have recently graduated.
Most students agreed that it is important to know the
individual professional characteristics of the professional
who made the mistake to analyze the human error and
that, once an error occurs, an effective prevention strategy
is to work more carefully. Generally, the errors are related to
several factors that corroborate for this to happen(9).
Therefore, it is understood that the more the students
understand the issues that are involved in the error, the
more they will know the importance of reporting and an-
alyzing incidents as a means of prevention. The curricu-
lum should therefore be developed through teaching and
learning activities in which the student and the educator
experience significant practices that resonate in a safe per-
formance over training and that are also sustained in pro-
fessional practice 16). This understanding enables students
to establish proactive attitudes as assistance in developing
strategies to control risk.
It is known that health services are often stress promot-
ers. It is common to see professionals working in more than
one service. Furthermore, there are students that besides
the theoretical / practical classes, are also research men-
torship students or have a job. Both situations can cause
fatigue, decreased concentration and sometimes sleep
deprivation. These are factors that can contribute to the
occurrence of errors in care.
Another factor that cannot be ignored is that in some
health institutions a culture of fear still exists, with the main
action being to punish the professional who made the mis-
take. The safety culture works from the perspective of how
an error happened and not who committed it. In addition,
we need to change a punitive environment for a fair and
transparent culture, enabling an approach that recognizes
the causes of the incident and establishes strategies to pre-
vent or minimize errors in health care(2).
The patient safety culture also provides for the safety of
the professional, which has been considered as the second
victim when an adverse event takes place. This is because
society and the media mainly reinforce the negative effects
of facts and, in many situations, massacre the profession-
als who lead the care. The term ‘second victim’ refers to the
health care professional who suffers emotional distress due
to an adverse event. A study held with health professionals
involved in incidents revealed that they had emotional re-
actions such as shock, sadness, anxiety, and many said they
mentally relived the sequence of events continuously(17).
Regarding the responses that refer to attitudinal as-
pects, most agreed (401; 62.9%) that, to implement measures
to prevent human error, one should always establish a systemic
analysis of the facts. Visualizing this perspective in the stu-
dent is very important as it indicates greater future possi-
bility of changing the individual assessment model for an
expanded evaluation model, supporting the safety culture.
Most of them agreed that they always inform a col-
league, professor/person responsible for the internship
location on the occurrence of an error, and that professors
always perform corrective action with the student so that
the student does not make new mistakes. In this regard,
the preparation of teachers should be contemplated, be-
cause although it is a professional with extensive experi-
ence in their specialty and work field, they have a role as a
trigger agent in the health system process improvement(15).
It is worth reflecting on the professor’s/supervisor’s role
of facilitator in the learning process, i.e., to help students
understand what happened within the complexity of the
care process; providing freedom of expression and helping
them in the process related to the transforming action.
Given the occurrence of an adverse event, the PNSP rec-
ommends an educational practice in which all stakehold-
ers discuss and learn together (18). It is important that there
be trivialization of error, but the reflection of the reasons
that led to the incident and what strategies to be imple-
mented to prevent recurrence(2). To do this, the faculty also
needs to have knowledge and attitudes that contribute to
safety, because the way the situation will be conducted
may produce different effects on the student. As for profes-
sionals, students can suffer a traumatic experience because
of failure in the care process. As a consequence is the omis-
sion of information, withdrawal from classes caused by a
Patient safety in the understanding of health care students
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Rev Gaúcha Enferm. 2017;38(2):e64818
feeling of guilt and even abandonment of the course. This
approach discourages the construction of a safety culture.
In the affirmation, I always communicate the occurrence
of an error to the patient and his family it was shown that 254
(39.8%) students agreed and 175 (27.4%) had no opinion. In
addition, 303 (47.5%) students also agreed that if no dam-
age occurs to the patient, a need to report the occurrence of
the error to the patient and family should be analyzed. Adopt-
ing transparent communication(10) on the occurrence of an
error is not easy. To minimize stress and develop behavior
that favors sharing information, research suggests, among
other strategies, that a mentoring and teaching system on
sharing information be created for medical students and
doctors who have recently graduated(19).
About the systems used to report the occurrence of er-
rors making little difference in the reduction of future errors,
there were disagreements among the highest percentage
of students (310; 48.6%). These scholars have a correct un-
derstanding that the systems are tools that enable decision
making for the implementation of improvements in work
processes and therefore should be used by health services
to assess and monitor complications in the provision of
care. However, limitations to this method can be found in
the underreporting due to time constraints, lack of appro-
priate information systems, fear of litigation, the reluctance
of people to report their mistakes, lack of knowledge about
the importance of the events, and the lack of change after
notification (20). Permanent education and encouragement
to notify errors should be common guidelines of both the
academy and the NSP.
Most students disagreed with the statement that only
doctors can determine the cause of the error, which shows a
change of paradigm centered care in the doctor, entering
other professions in this scenario. Patient safety crosses the
daily life of all professions, through the sharing of respon-
sibilities, adherence to protocols, effective communication,
among others.
A higher percentage of college students in this study
agreed (285; 44.7%) that professionals should not tolerate
working in places that do not provide adequate conditions
for the care provided, and there was no consensus on the
question I always perform internship activities in places that
promote good practices for the promotion of patient safety. This
perception reflects the concern with practical scenarios and
questions about the effective safety of these sites, which is
an important concern to reflect on teaching, because the
environment can also interfere with patient safety.
Half of the students responded that I always inform my
professor about the presence of conditions that favor (321;
50.3%). This diagnosis and communication are essential to
prevent incidents. However, a higher percentage had no
opinion (216; 33.9%) on the assertion whenever I identify
situations that need improvement, I receive support from the
institution to implement measures to promote safe practices.
This is an evident reality in health institutions, due to prob-
lems of institutional, managerial or financial nature.
In this respect, the recent integration of safety cores in
health institutions has allowed for environments promot-
ing socialization, claims and dissemination of patient safety
culture to arise. This has allowed the services and manag-
ing an ongoing review of work processes, the improve-
ment of care practices and the search for improvements
in health services, including training students to integrate
practice scenarios.
CONCLUSION
The study made it possible to verify the perception of
undergraduate health care students, which highlighted
key aspects of the safety culture, and the importance of
performing a systemic analysis of the error, the concern re-
garding the work environment and appreciation of team-
work, aspects that were considered by students of several
professions. An important fact to be observed in students,
as future professionals, participants of health care teams,
and that should constitute their aggregate and articulate
actions with other professionals focused on safety, not just
medical and nursing professionals.
Awareness of teachers and health professionals to this
safety culture is necessary so that they can instrumental-
ize students to actively experience the transition from a
punitive culture to one that stimulates a just, transparent
culture that recognizes and detects failures and adverse
events as a possibility of instituting structural and educa-
tional measures to combat unsafe care.
As a possible limitation to the study is the emphasized
difficulty of comparing the data because there are no stud-
ies including all health care students. The publications were
concentrated in nursing and medicine courses. This aspect
reflects a gap in knowledge and perhaps the mispercep-
tion that these are the professions that are more involved
in incidents.
On the analysis of data, and a possible limitation of
the instrument, emphasis is made that it is not valid to
analyze the levels of understanding (high/moderate/low)
on the knowledge and attitudes of students, which could
provide an inferential statistical analysis, with a correlation
or association study. In this sense, they suggest new stud-
ies with the instrument for the establishment of scores
and cut-off points for the two dimensions evaluated.
Cauduro GMR, Magnago TSBS, Andolhe R, Lanes TC, Dal Ongaro J
8Rev Gaúcha Enferm. 2017;38(2):e64818
A study to assess the internal consistency of the instru-
ment is also suggested, with factorial analysis of the items
and dimensions proposed.
Studies in this theme contribute to integrate and
strengthen it within teaching, research and extension in
their various levels, because it brings important insights
for program coordinators, teachers and students about the
skills that should be developed during one’s academic life,
strengthened and deepened daily to ensure safe and qual-
ity health care.
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Corresponding author:
Graziela Maria Rosa Cauduro
E-mail: grazi.cau25@gmail.com
Received: 05.18.2016
Approved: 12.05.2016
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La asistencia segura es el tema central de discusiones en el area de la salud en casi todas las partes del mundo. La Organizacion Mundial de la Salud (OMS) viene lanzando, aisladamente o en conjunto con otras organizaciones, varios desafios y directrices con el intuito de dar subsidios para la discusion de las realidades locales y, especialmente, para que las instituciones de salud tengan un punto de partida para implantar y promover medidas de seguridad imperativas y urgentes. El tema no es nuevo, al contrario, es tan antiguo como el cuidado a la salud. Sin embargo, su importancia y los altos riesgos asociados a la asistencia a la salud empezaron a ser reconocidos a partir de la publicacion, en 1999, del informe del Institute of Medicine de los Estados Unidos, To Err is Huma(1). En Brasil, el Ministerio de la Salud instituyo, en abril de este ano, el Programa Nacional de Seguridad del Paciente, en resonancia con el apelo individual y/o colectivo de los profesionales de la salud y de la poblacion en general por una atencion segura, libre de incidentes que puedan generar danos a la salud de la persona. En la enfermeria, profesionales vinculados a la ensenanza, asistencia, investigacion y estudiantes de grado/postgrado se viene movilizando voluntariamente desde 2008 para crear y desarrollar la Red Brasilena de Enfermeria y Seguridad del Paciente (REBRAENSP). Casi todos los estados del pais tienen polos y nucleos de REBRAENSP, creando espacios valiosos de debates con repercusion para las practicas asistenciales, de ensenanza y de investigacion. Para que el cuidado sea seguro, es necesario construir una cultura de seguridad, definida por el Programa Nacional de Seguridad del Paciente(2) como: cultura en la cual todos los trabajadores, incluyendo profesionales involucrados en el cuidado y gestores, asumen responsabilidad por su propia seguridad, por la seguridad de sus colegas, pacientes y familiares; cultura que prioriza la seguridad por encima de las metas financieras y operacionales; cultura que anima y recompensa la identificacion, la notificacion y la resolucion de los problemas relacionados a la seguridad; cultura que, a partir del acontecimiento de incidentes, promueve el aprendizaje organizacional; y cultura que proporciona recursos, estructura y responsabilizacion para el mantenimiento efectivo de la seguridad. Como se puede ver, los desafios para el desarrollo de la cultura de seguridad del paciente son inmensos, pero no insuperables, y engloban la necesidad de establecimiento de estrategias efectivas en tres ambitos: formacion de profesionales de la salud, asistencia en todos los niveles de atencion a la salud e investigacion. En la ensenanza el tema de la seguridad del paciente debe parar por todo el curriculo y enfocar especificidades de riesgos y medidas preventivas de dano en los variados escenarios de asistencia a la salud. Se lo debe desarrollar por medio de acciones de ensenanza aprendizaje en que el alumno y el educador experimenten practicas significativas, que repercutan en una actuacion segura a lo largo de la formacion y que se sustenten tambien en la actuacion profesional. Para tanto, los educadores necesitan mantener estrategias de educacion permanente/continuada y los proyectos pedagogicos de los cursos de grado/postgrado y tecnicos necesitan alineaciones claras, para que este aspecto no se minimice entre otros tan importantes en la ensenanza en salud.
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Rationale, aims and objectivesThis study aims to provide in-depth insight into the emotions and thoughts of physicians towards malpractice litigation, and how these relate to their incident disclosure behaviour. Methods Thirty-one Dutch physicians were interviewed and completed short questionnaires regarding malpractice litigation. We used hierarchical cluster analysis to identify physician clusters. Additional qualitative data were analysed. ResultsPhysicians vary largely in their attitude towards malpractice litigation, and their attitude is not straightforward related to their disclosure behaviour. Based on their responses physicians could be divided into two clusters: one with a positive and one with a negative attitude. Physicians with a negative attitude showed often, but also 6 out of 15 not, a reluctance to disclose, whereas the majority in the positive attitude cluster (12 out of 16) showed no reluctance. If, what and how physicians disclose incidents depends on a complex interplay of their emotions and thoughts regarding litigation, and not only on their fear of litigation as many studies assume. Conclusions Due to the variation among physicians in their litigation attitude and behaviour in terms of incident disclosure the oft-heard call for openness' about medical incidents will not be easy to achieve. A coaching system in which physicians can share and discuss their differing attitudes and disclosure principles, teaching medical students and junior physicians about disclosure, and explaining how to organize emotional and legal support for oneself in case of litigation could decrease stress feelings and support open disclosure behaviour.