Third year nursing students' viewpoints about circumstances which threaten safety in the clinical setting

Hallmarks of nursing students exhibiting unsafe clinical practices: a qualitative study

BACKGROUND

Maintaining and promoting patient safety is a shared responsibility among all participants in the health care system. Educators are required to balance patients' rights to receive safe care and create a suitable and safe environment for nursing students to learn. Therefore, early identification of students with unsafe clinical practice and intervention may be important measures for improving patient safety. Therefore, the present study was conducted with the aim of identifying the main hallmarks of nursing students with unsafe clinical practice.

METHODS

This qualitative study was conducted with 19 faculty members, nursing students, and supervisors of medical centers. Data collection was performed through purposive sampling and semi structured interviews. Data analysis was performed via conventional qualitative content analysis via MAXQDA10 software.

RESULTS

The results of the study led to the identification of 2 main categories, "Underdeveloped knowledge and cognitive capacity" and "Underdeveloped personal-professional capacity", and 6 and 4 subcategories, respectively, as the main hallmarks for identifying students with unsafe clinical practice.

CONCLUSION

The findings of this qualitative study expand our understanding of the hallmarks of nursing students with unsafe clinical practice. Undergraduate nursing students with unsafe clinical practice may not have acquired sufficient development and progress in terms of knowledge, skills, and personal-professional characteristics or may not be able to demonstrate them in their practices. Nursing schools must ensure that students have the necessary knowledge, skills, competencies, and personal-professional characteristics to participate in clinical training programs. It is recommended that students with unsafe clinical practices be identified early so that patient safety is maintained and that students are supported in order to correct their weaknesses and improve.

Identifying self-presentation components among nursing students with unsafe clinical practice: a qualitative study

BACKGROUND

Maintaining patient safety is a practical standard that is a priority in nursing education. One of the main roles of clinical instructors is to evaluate students and identify if students exhibit unsafe clinical practice early to support their remediation. This study was conducted to identify self-presentation components among nursing students with unsafe clinical practice.

METHODS

This qualitative study was conducted with 18 faculty members, nursing students, and supervisors of medical centers. Data collection was done through purposive sampling and semi-structured interviews. Data analysis was done using conventional qualitative content analysis using MAXQDA10 software.

RESULTS

One main category labelled self-presentation emerged from the data along with three subcategories of defensive/protective behaviors, assertive behaviors, and aggressive behaviors.

CONCLUSION

In various clinical situations, students use defensive, assertive, and aggressive tactics to maintain their professional identity and present a positive image of themselves when they make a mistake or predict that they will be evaluated on their performance. Therefore, it seems that the first vital step to preventing unsafe behaviors and reporting medical errors is to create appropriate structures for identification, learning, guidance, and evaluation based on progress and fostering a growth mindset among students and clinical educators.

Nursing students' perception of medical errors: A cross-sectional study in a university

AIM

To assess the perception of nursing students on medical errors.

DESIGN

A descriptive cross-sectional survey.

METHOD

Data were collected from March-April 2019 in a university in Ghana from two hundred (200) students using simple random sampling and analysed with SPSS version 21.

RESULTS

Mean age of respondents was 22.64 years. Medication error was perceived as the most common medical errors (MEs; 76%). Negligence was perceived as the most common cause of MEs (80.5%); nurses and doctors (84.5%-89.5%) were considered as staff who make most MEs. Respondents perceived that students commit MEs due to less knowledge about procedures (79%) and inadequate supervision (77%) in the clinical setting.

CONCLUSION

Medication errors were observed as the most common of MEs that can affect patients' safety. Taking prudent measures in addressing this can reduce MEs in health facilities. Enhanced supervision and effective ways of teaching drug administration are recommended.

The knowledge about patient safety among undergraduate nurse students in Cyprus and Greece: a comparative study

BACKGROUND

The Patient safety movement contributed to the reduction of preventable adverse events associated with health care. Although patient safety issues have received the attention of educators in the health care studies, there is evidence that in nursing education and the associated curricula it is not well-incorporated. This may not allow students to acquire scientific knowledge and develop strong competencies to assure patient safety throughout their professional life. The aım of the study was the exploration of the undergraduate nursing student perspectives regarding knowledge received during their training about patient safety-related issues.

METHODS

A descriptive comparative study was conducted with three and four-year undergraduate nursing students from the Cyprus Republic (n = 243) and Greece (n = 367). All students were surveyed using the Health Professional Education Patient Safety Survey (H-PEPSS) to describe students' knowledge in the classroom and clinical setting.

RESULTS

Students' Knowledge about patient safety was expressed significantly higher (p < 0.001) in the classroom (mean = 4.0) than the clinical setting (3.7) (1-5 scale). The knowledge in the dimension "clinical aspects" received the highest score and "working in teams" received the lowest. Also, differences were recorded between countries wıth Cypriot students reporting hıgher level of knowledge than the Greek students in most of the dimensions. CONCLUSıON: The findings revealed the gap between theory and practice and the need for collaboration between the two settings. Also, students reported relatively higher knowledge with regards to the technical aspects of patient safety. Still, they were less knowledgable about the sociocultural aspects of the patient, such as working in teams.

Characterization of adverse events occurring during nursing clinical rotations: A descriptive study

INTRODUCTION

Patient safety is a pillar of quality health care. Nursing students may commit errors during clinical practice, compromising patient safety.

OBJECTIVE

Analyze the adverse events, as well as the factors associated with the errors, reported by students from a private university in Santiago, Chile during nursing clinical rotations.

METHODS

Quantitative cross-sectional descriptive study. A total of 68 errors by first- through fifth-year nursing students were reported between 2012 and 2018. The data collection instrument was the Adverse Events Notification Form from the School of Nursing. This form documented information about the study as well as about the event.

RESULTS

After this reporting system was established in 2012, the number of events reported increased steadily each year. The greatest numbers of reported errors were committed by fifth-year students (73.5%), and the most common type of error was associated with medication administration (94.2%), including incorrect dose (27.9%) and incorrect medication (17.6%). The major factors contributing to errors were failure to review the "10 rights of medication administration" (85.3%) or lack of critical judgment (7.4%). Most of the errors occurred in public institutions (72.1%).

CONCLUSION

The results suggest that it would be beneficial to re-evaluate how safety and quality of care are taught at the school of nursing, with an emphasis on understanding the learning styles of students and teaching strategies of instructors. It is crucial that the academic institution remain actively involved in teaching safety-related skills to future nursing professionals. Furthermore, we suggest modifications to the adverse events reporting system that would avoid the need for personal interpretations of the event by the student.

Social determinants associated with the quality of life of baccalaureate nursing students: A cross-sectional study

BACKGROUND

There is a paucity of studies that have explored the quality of life (QoL) of nursing students in the Philippines.

OBJECTIVES

The study assessed the QoL and identified the social determinants associated with the four domains of QoL among nursing students.

METHODS

This cross-sectional study was conducted among 444 randomly selected baccalaureate nursing students in a university in the Philippines. The QoL was determined using an adapted WHOQOL-BREF questionnaire (∝ = 0.89). Multiple linear regression determined the association between the variables of the study.

RESULTS

The students exhibited better scores in social relationships and environment than psychological and physical health domains of QoL. Physical health was significantly correlated to sex, hours of sleep, and medical condition, whereas sex, year level, academic load, hours of sleep, and medical condition were correlated to psychological domain. However, no significant association was noted between the factors and social relationships, but monthly allowance was positively correlated with the environment domain.

CONCLUSIONS

Various social determinants influence the QoL; thus, it is essential to be considered as a critical element in planning the curriculum to improve the QoL among baccalaureate students.

Priorities for Supportive Housing Services: Perspectives of People With Mental Illness in Northeastern Ontario

Background

Accessible, appropriate, and affordable housing is recognized as essential for the well-being of all Canadians. Securing and maintaining housing tenure for individuals living with chronic health and social challenges can be compromised without appropriate services. There has been limited research into the priorities to enhance supportive housing services from the perspective of individuals living with mental illness in smaller urban and rural communities.

Purpose

The purpose was to describe the priorities for supportive housing from the viewpoints of tenants recovering from mental illness in northeastern Ontario.

Methods

This descriptive study used Q methodology to engage 52 adults regarding their impressions about enhancing supportive housing services. Participants ranked 39 housing and support priority statements on a nine-point Likert-type scale.

Results

Four discrete viewpoints about priorities for supportive housing were building a home, letting others in, moving outside the walls, and accessing personalized services. Common across these viewpoints was the need to increase financial assistance offered through existing programs.

Conclusions

Fostering individual pathways to recovery involves mitigating health and social disparities, relative to supportive housing, one size does not fit all. Service providers and decision makers are compelled to situate each individual within an evidence-informed supportive housing system for citizenship.

Multi-level analysis of national nursing students' disclosure of patient safety concerns

CONTEXT

Error reporting is considered one of the most important mediating factors for patient safety (PS). However, reporting errors can be challenging for health care students.

OBJECTIVES

The aims of the study were: (i) to describe nursing students' opportunity to report errors, near misses or PS issues that emerged during their clinical learning experience; and (ii) to explore associated factors of the process of reporting itself.

METHODS

A national survey was conducted on 9607 (91.7%) undergraduate nursing students. The endpoint was to have reported PS issues in the last clinical learning experience (from 0 'never' to 3 'always'). Explanatory variables were set individual, nursing programme and regional levels.

RESULTS

A total of 4004 (41.7%) nursing students reported PS issues from 'never/rarely' to 'sometimes'. In the multi-level analysis, factors increasing the likelihood of reporting events affecting PS have been mainly at the nursing programme level: specifically, higher learning opportunities (odds ratio [OR] = 3.040; 95% confidence interval [CI], 2.667-3.466), self-directed learning opportunities (OR = 1.491; 95% CI, 1.364-1.630), safety and nursing care quality (OR = 1.411; 95% CI, 1.250-1.594) and quality of tutorial strategies OR = 1.251; 95% CI, 1.113-1.406). By contrast, being supervised by a nurse teacher (OR = 0.523; 95% CI, 0.359-0.761) prevented the disclosure of PS issues compared with being supervised by a clinical nurse. Students attending their nursing programmes in some Italian regions showed a higher likelihood (OR from 1.346 to 2.938) of reporting PS issues compared with those undertaking their education in other regions.

CONCLUSIONS

Nursing students continue to be reticent to report PS issues. Given that they represent the largest generation of future health care workers, their education regarding PS should be continuously monitored and improved; moreover, strategies aimed at developing a non-blaming culture should be designed and implemented both at the clinical learning setting and regional levels.

Perspectives on Patient Safety Among Practical Nursing Students

Background Practical nursing students are students enrolled in a two-year college practical nursing diploma program. They are responsible for providing safe patient care to the patients they care for. Assessing students' perceptions of their own patient safety competencies can help educators identify gaps in their knowledge and skills and identify, at a curricula level, the concepts and information required to improve the quality of their care. Purpose To explore practical nursing students' confidence in what they are learning about patient safety within their nursing education. Methods This cross-sectional descriptive study used a modified version of the Health Professional Education in Patient Safety Survey. Results Overall, students expressed the greatest confidence in their abilities to provide care in Clinical Safety topics. More than 75% of the students' feared punishment when making an error and 88% have difficulty questioning other healthcare providers. Less than 30% of students stated that a system-level focus on errors was taught to them in their education programs. Conclusions More investigation is needed to understand what practical nursing students' fear about the provision of safe care. Additional focus on systems aspects of hazard identification and the prevention of errors needs to be present in nursing education programs.

Nursing students' satisfaction of the clinical learning environment: a research study

Background

The acquisition of quality clinical experience within a supportive and pedagogically adjusted clinical learning environment is a significant concern for educational institutions. The quality of clinical learning usually reflects the quality of the curriculum structure. The assessment of the clinical settings as learning environment is a significant concern within the contemporary nursing education. The nursing students’ satisfaction is considered as an important factor of such assessment, contributing to any potential reforms in order to optimize the learning activities and achievements within clinical settings.

The aim of the study was to investigate nursing students’ satisfaction of the clinical settings as learning environments.

Method

A quantitative descriptive, correlational design was used. A sample of 463 undergraduate nursing students from the three universities in Cyprus were participated. Data were collected using the Clinical Learning Environment, Supervision and Nurse Teacher (CLES + T).

Results

Nursing students were highly satisfied with the clinical learning environment and their satisfaction has been positively related to all clinical learning environment constructs namely the pedagogical atmosphere, the Ward Manager’s leadership style, the premises of Nursing in the ward, the supervisory relationship (mentor) and the role of the Nurse Teacher (p < 0.001). Students who had a named mentor reported more satisfied with the supervisory relationship. The frequency of meetings among the students and the mentors increased the students’ satisfaction with the clinical learning environment. It was also revealed that 1st year students were found to be more satisfied than the students in other years.

Conclusion

The supervisory relationship was evaluated by the students as the most influential factor in their satisfaction with the clinical learning environment. Student’s acceptance within the nursing team and a well-documented individual nursing care is also related with students’ satisfaction. The pedagogical atmosphere is considered pivotal, with reference to students’ learning activities and competent development within the clinical setting. Therefore, satisfaction could be used as an important contributing factor towards the development of clinical learning environments in order to satisfy the needs and expectations of students. The value of the development of an organized mentorship system is illustrated in the study.

Learning to ensure patient safety in clinical settings: comparing Finnish and British nursing students' perceptions

AIMS AND OBJECTIVES

To explore and compare Finnish and British nursing students' perceptions of their learning about patient safety in clinical settings.

BACKGROUND

Patient safety culture and practices in different health care organisations and clinical units varies, posing challenges for nursing students' learning about patient safety during their clinical placements. Patient safety as a growing international concern has challenged health care professionals globally requiring a comprehensive review. International studies comparing nursing education about patient safety are lacking.

DESIGN

A cross-sectional comparative study.

METHOD

The participants were final year preregistration nursing students from two universities of applied sciences in Finland (n = 195) and from two universities in England, UK (n = 158). The data were collected with the Patient Safety in Nursing Education Questionnaire and analysed with principal component analysis, Pearson Chi-Square and Mann-Whitney U tests and logistic regression.

RESULTS

Finnish nursing students had significantly more critical perceptions on their learning about patient safety in clinical settings than their British peers. A strong predictor for differences was supportive and systems-based approaches in learning to ensure patient safety. Notably, fewer Finnish students had practiced reporting of incidents in clinical settings compared to British students. In both countries, the students held learning about patient safety in higher esteem compared to their learning experiences in clinical settings.

CONCLUSIONS

Nursing students appear to want more learning opportunities related to patient safety compared to the reality in clinical settings. Learning systematically from errors in a supportive environment and having systems-based approaches to ensure patient safety are essential elements for nursing students' learning about safe practice. Finnish students seem to experience more barriers in learning about safe practices and to report errors than the British students.

RELEVANCE TO CLINICAL PRACTICE

Health care organisations and professionals with responsibilities for patient safety should seek to standardise the preparation of nursing students incorporating requisite international standards and benchmarks.