Patient safety content and delivery in pre-registration nursing curricula: A national cross-sectional survey study

Missed nursing care among nursing students: A scoping review

BACKGROUND

Nursing students report facing inconsistencies between theoretical knowledge and actualities of clinical practice, and research indicates they witness missed nursing care during clinical practice. Understanding nursing students' experiences can inform improved clinical learning environments and enhance patient care quality. Recently, research has focused on students' views regarding missed care, yet comprehensive understandings of this phenomenon are lacking.

OBJECTIVE

This review explored what is known about missed nursing care from perspectives of nursing students.

DESIGN

A scoping review according to Arksey and O'Malley's framework and Joanna Briggs Institute methodology was undertaken.

DATA SOURCES

Key databases were searched, including Medline, Embase, CINAHL, Scopus, ProQuest, PsycINFO and Web of Science in August 2023.

REVIEW METHODS

The review included qualitative, quantitative, and structured literature reviews published in English between 2006 and 2023. Inclusion and exclusion criteria and keywords guided the search. Data screening and extraction were independently performed by two reviewers. Included studies were analysed using descriptive statistics and narrative synthesis. Findings are reported in accordance with the PRISMA-ScR.

RESULTS

Of the 5873 articles identified, nine were included in the review. Studies were conducted in seven countries. Themes in students' perceptions included negligence of patients' rights and dignity, living in limbo, and pragmatic acceptance. Reasons for missed care included ineffective teamwork, lack of interest in caring, and inefficient leadership. Missed nursing care adversely affected patient health, hindered student learning and professional growth. Strategies for improvement included enhancing teamwork, enforcing ethical issues, increasing supervision, and creating commitment to work.

CONCLUSION

Missed nursing care affects patient safety and education of nursing students. Incorporating practical training modules into curricula, establishing preceptorship programs, and incorporating ethics education into clinical practice are crucial to address missed nursing care. Further research in diverse settings is warranted.

Effects of the small private online course combined with simulation-based training in a patient safety education program among nursing students: A quasi-experimental study

Objective

This study aimed to explore the effects of the small private online course (SPOC) combined with simulation-based training in a patient safety education program among nursing students in China.

Methods

A quasi-experimental design was conducted. A total of 219 nursing students from four parallel classes were selected from the nursing department of a health vocational college in Zhengzhou, China, from November 2020 to June 2021 and allocated to the intervention group (n = 113) and control group (n = 106). Based on SPOC, nursing students in the intervention group implemented simulation teaching in small groups, with three class hours each time, a total of two times, divided into three stages: pre-class preparation, teaching implementation, and after-class reflection. The control group received theoretical patient safety education through SPOC, implemented on the DingDing platform for two class hours each time, four times. All participants were invited to complete a demographic questionnaire and the Chinese version of Patient Safety Competency Self-Evaluation (PSCSE) before and after the intervention.

Results

A total of 103 and 102 students from the intervention and control groups completed the study. The total scores of PSCSE in the post-test of the intervention group (176.24 ± 13.73 vs. 144.64 ± 13.75) and the control group (160.87 ± 14.88 vs. 142.57 ± 15.66) were higher than those in the pre-test (P < 0.01), and the total scores of PSCSE of the intervention group were higher than those of the control group (176.24 ± 13.73 vs. 160.87 ± 14.88, P < 0.01). After intervention, the scores of PSCSE in all dimensions were increased in the intervention group (P < 0.01); in the control group, the scores of patient safety competency in most dimensions were increased (P < 0.01), except for the dimensions of reporting and response to error and communication related to error (P＞ 0.05). Except for the dimensions of knowledge and attitude of error reporting and disclosing (P＞ 0.05), the scores of other dimensions in the intervention group were higher than those in the control group (P < 0.01).

Conclusion

The patient safety education program using the SPOC combined with simulation-based training can effectively improve the patient safety competency of nursing students in terms of attitude, skills, and knowledge.

Care Coordination and Transition Management: A New Course to Prepare Prelicensure Students

BACKGROUND

There is a need for RNs to be skilled at coordinating care and improving transitions within and across a wide variety of clinical settings and in diverse populations. A care coordination and transition management (CCTM) course was developed to address this growing need.

METHOD

The course was designed to promote enhanced clinical reasoning as well as synthesis and application of CCTM concepts while focusing on the patient and family perspectives. Learning activities incorporated individual writing assignments, discussion board assignments, and a group project.

RESULTS

Students demonstrated the application of CCTM concepts in individual and group assignments and used prior and current clinical experiences to connect theory to practice.

CONCLUSION

This course helped preli-censure students learn and apply CCTM concepts. Learning activities within the CCTM course could be adapted to be effective in all forms of undergraduate programs as well as graduate nursing programs. [J Nurs Educ. 2023;62(8):471-474.].

AVOIDable medical errors in invasive procedures: Facts on the ground - An NHS staff survey

BACKGROUND

Never Events represent a serious problem with a high burden on healthcare providers' facilities. Despite introducing various safety checklists and precautions, many Never Events are reported yearly.

OBJECTIVE

This survey aims to assess awareness and compliance with the safety standards and obtain recommendations from the National Health Service (NHS) staff on preventative measures.

METHODS

An online survey of 45 questions has been conducted directed at NHS staff involved in invasive procedures. The questions were designed to assess the level of awareness, training and education delivered to the staff on patient safety. Moreover, we designed a set of focused questions to assess compliance with the National Safety Standards for Invasive Procedures (NatSSIPs) guidance. Open questions were added to encourage the staff to give practical recommendations on tackling and preventing these incidents. Invitations were sent through social media, and the survey was kept live from 20/11/2021 to 23/04/2022.

RESULTS

Out of 700 invitations sent, 75 completed the survey (10.7%). 96% and 94.67% were familiar with the terms Never Events and near-miss, respectively. However, 52% and 36.49% were aware of National and Local Safety Standards for Invasive procedures (NatSSIPs-LocSSIPs), respectively. 28 (37.33%) had training on preventing medical errors. 48 (64%) believe that training on safety checklists should be delivered during undergraduate education. Fourteen (18.67%) had experiences when the checklists failed to prevent medical errors. 53 (70.67%) have seen the operating list or the consent forms containing abbreviations. Thirty-three (44%) have a failed counting reconciliation algorithm. NHS staff emphasised the importance of multi-level checks, utilisation of specific checklists, patient involvement in the safety checks, adequate staffing, avoidance of staff change in the middle of a procedure and change of list order, and investment in training and education on patient safety.

CONCLUSION

This survey showed a low awareness of some of the principal patient safety aspects and poor compliance with NatSSIPs recommendations. Checklists fail on some occasions to prevent medical errors. Process redesign creating a safe environment, and enhancing a safety culture could be the key. The study presented the recommendations of the staff on preventative measures.

Effectiveness of educational interventions to develop patient safety knowledge, skills, behaviours and attitudes in undergraduate nursing students: a systematic review protocol

INTRODUCTION

Patient safety is a healthcare discipline that aims to prevent and reduce patient harm, risks and errors during the provision of healthcare. Given the size of the nursing workforce in the healthcare system the inclusion of patient safety in the undergraduate nursing curriculum is necessary to enhance a safe culture in the daily work of their future careers. To this end, it is essential to apply effective teaching strategies to develop patient safety competencies. This review will aim to evaluate the effectiveness of educational interventions in developing patient safety knowledge, skills, behaviours and attitudes in undergraduate nursing students within the existing topic areas of the WHO Multi-professional Patient Safety Curriculum Guide.

METHODS AND ANALYSIS

The databases Medline, CINAHL, Scopus, Education Research Complete, The Cochrane Central Register of Controlled Trials, LILACS, Medes and Grey literature such as ClinicalTrials.gov, Google Scholar, DART-Europe, ProQuest Dissertations, CAPES thesis and dissertations, The Virginia Henderson Global e-Repository, Mednar and Thesis Canada will be searched from July 2011 to January 2022. Two independent reviewers will conduct the search, extract the data and assess the risk of bias for the included studies, using standardised critical appraisal instruments from the Joanna Briggs Institute. The quality of the evidence will be assessed using the Grading of Recommendations, Assessment Development and Evaluation methodology. Studies will be pooled in the meta-analysis. Alternatively, the findings will be presented in narrative form, including tables and figures, to aid in data presentation.

ETHICS AND DISSEMINATION

This study raises no ethical issues. The findings will be disseminated through presentations at professional conferences and publications in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42021254965.

Communication education regarding patient safety for registered nurses in acute hospital settings: a scoping review protocol

INTRODUCTION

The importance of correct and timely communication continues to be emphasised in the area of patient safety. Nurses play a key role in communicating with a variety of healthcare personnel to deliver safe care for patients. Many attempts have been made to improve nursing professionals' communication competencies regarding patient safety. However, the scope, method and effectiveness of communication education regarding patient safety for registered nurses have not been sufficiently reviewed. In order to understand the overall status of this field, a scoping review with a systematic framework is necessary. The objective of this study is to map the extent, range and nature of literature on communication education regarding patient safety for registered nurses in acute hospital settings and identify gaps to guide future research, policy and practice.

METHODS AND ANALYSIS

This study will be conducted in accordance with the methodology for scoping reviews developed by Arksey and O'Malley. To strengthen its rigour, the scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. The overall review process will involve an independent review by two reviewers to select and analyse literature. The databases to be explored are MEDLINE (Ovid), Embase, Education Resources Information Center (ERIC), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Korean Medical Database (KMBASE). In addition, we will endeavour to include the grey literature through manual searches on patient safety-related websites. This review will target literature on communication programmes for patient safety provided to registered nurses in acute hospital settings and will include peer-reviewed literature in English and Korean since 2000, when research in the field of patient safety started to increase rapidly.

ETHICS AND DISSEMINATION

Since this study is a review of previous studies, no ethics approval is required. The findings of the study will be disseminated in a peer-reviewed journal for publication.

Developing an integrated curriculum for patient safety in an undergraduate nursing program: a case study

BACKGROUND

Nursing students' practical training should begin when students can apply core knowledge, skills, and attitudes related to patient safety. This necessitates an integrated curriculum in nursing education that links practice to the theory concerning patient safety to enhance patient safety competencies and quality in nursing care. This study aimed to develop an integrated curriculum that incorporates patient safety factors in the existing curriculum to increase patient safety competencies in nursing students.

METHOD

A case study approach was adopted to explain the development processes of a new curriculum integrating patient safety in the existing outcome-based curriculum of a nursing college. Based on the existing outcome-based curriculum of a nursing college, a four-step process was performed to integrate patient safety component, including quality improvement, into the curriculum: 1) literature review, 2) analysis of course syllabus, 3) selection of courses related to patient safety topics, and 4) development of evaluation tool.

RESULTS

The integrated patient safety curriculum was based on six topics: patient safety principles, teamwork, communication, patient engagement, risk management and, quality improvement, and International Patient Safety Goals. Based on the characteristics of the course according to the level of students in each year, the curriculum was integrated to address patient safety topics in seven courses (four theoretical and three practical). A Patient safety Competency self-assessment checklist was developed for students to naturally acquire patient safety competencies in clinical settings.

CONCLUSIONS

This study demonstrated that patient safety topics should be addressed in both theoretical and practical settings across the entire nursing curriculum per the continuity and sequence of education principles.

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.

Patient safety educational interventions: A systematic review with recommendations for nurse educators

Aim

This study identified and evaluated tested patient safety educational interventions. This study also described the content, curricular structures and teaching strategies of the educational interventions and determined the methods used for evaluating patient safety learning outcomes.

Design

The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines directed this review.

Methods

Searches for articles describing and evaluating patient safety educational interventions were conducted using four scholarly databases. Study quality was assessed using the McMaster Critical Review Form.

Results

Seven studies met the inclusion criteria. Educational interventions were either presented as stand‐alone courses or as lessons embedded in an existing course. All studies employed a mixture of various teaching modalities and several evaluation methods and outcomes. Mixed results were observed in terms of the effects of educational interventions. Future researchers should continue to develop patient safety curricula and examine their effect on student competencies with stronger methodological rigour.

Nursing Students' Knowledge of Patient Safety and Development of Competences Over their Academic Years: Findings from a Longitudinal Study

Introduction

Future nurses should possess the knowledge and competences necessary to ensure patient safety. However, little evidence is available on the way in which students learn patient safety-related principles over time. This study explored the progress of a cohort of Italian undergraduate nursing students as they acquired patient safety knowledge and competences from time of enrolment to graduation.

Methods

A longitudinal study carried out between 2015 and 2018 enrolled a cohort of 90 nursing students from two Italian Bachelor of Nursing Science Degree Courses at the Udine University, Italy. The students were followed-up on an annual basis and data collection was performed three times: at the end of the 1st, 2nd and 3rd years. The validated Italian version of the Professional Education in Patient Safety Survey tool was used to collect data.

Results

At the end of the 1st year, students reported an average 4.19 out of 5 patient safety knowledge acquired in classrooms (CI 95%, 4.11-4.28), which was stable at the end of the 2nd (4.16; CI 95%, 4.06-4.26) and 3rd years (4.26; CI 95%, 4.16-4.32) and no statistical differences emerged over the years. With regard to the competences acquired in clinical settings, at the end of the 1st year the students reported an average 4.28 out of 5 (CI 95%, 4.20-4.37), which decreased significantly at the end of the 2nd year (4.15; CI 95%, 4.07-4.23; p=0.02) and increased at the end of the 3rd year (4.37; CI 95%, 4.27-4.47; p<0.01).

Conclusions

Nursing students' competences in patient safety issues increases over time, while their knowledge remains stable. Students are more vulnerable at the end of the 1st year, when they seem to be overconfident about patient-safety issues.

From policy to patient: Using a socio-ecological framework to explore the factors influencing safe practice in UK primary care

BACKGROUND

The recent and rapid changes in the model of primary care delivery have led to an increased focus on patient safety in what is one of the most diverse and complex healthcare settings. However, previous initiatives have failed to deliver the expected improvements, leading to calls for a better understanding of how a range of personal and contextual factors influence the decisions and behaviours of individual care providers.

METHODS

The socio-ecological framework, successfully used in public health settings to interpret the complex influences on individual behaviours, enabled a post-hoc deductive analysis of a series of semi-structured interviews conducted with clinical staff and senior managers at a range of practices across five geographically diverse regions in England to explore their perspectives on the factors that influence safe practice.

RESULTS

The five levels of the socio-ecological framework successfully helped unpick the myriad influences on safe primary care practice, including, at the Individual level, assumptions of responsibility and previous experience; at the Interpersonal, equitable communication in support of a team ethos; at the Organisational, the physical infrastructure, size and complexity of the practice; at the Community, the health profile and literacy of patients; and at the Policy, meeting the demands of competing local and national governing bodies.

CONCLUSIONS

Coherent, realistic and achievable goals are needed for improving patient safety in primary care addressing personal, organisational and environmental factors. Such goals and the tools and interventions designed to meet them must therefore be sympathetic to the demands on resources and the characteristics of patients, staff, and their organisations. Using the framework to interpret our findings provided much needed insight into the impact of these varying influences, and highlights the importance of recognising and communicating the relationship between specific contextual factors and the ability of individual providers to provide safe primary care.

Student nurses' strategies when speaking up for patient safety: A qualitative study

The purpose of this study was to understand student nurses' perceptions and experiences of witnessing and responding to risks to patient safety during their integrated learning experiences. This qualitative study's two-phased approach included individual semi-structured interviews, followed by focus group discussions with students. Participants included 53 pre-registration nursing students recruited from the first, second, and third years of study at two Australian universities. All had attended at least one clinical placement experience. Interpretive Description was used as a framework to guide the study. The findings highlight that students engage in specific and deliberate strategies when attempting to speak up. Students weigh up the risk to the patient and themselves. They use questioning techniques and their knowledge, experiences, and resources when speaking up. Students highlighted the need for caution and persistence while aiming to reduce the risk of reprisal. Exposing the challenges and successes students experience will provide educators, managers, and clinicians with the understanding necessary to better support both students and clinicians to achieve safe outcomes for patients as well a students.

Major educational factors associated with nursing adverse events by nursing students undergoing clinical practice: A descriptive study

BACKGROUND

As the main group of healthcare providers in hospitals, nurses have more frequent contacts than any other clinician and thus are in a better position to improve patient safety. With the purpose of cultivating competent nurses, nursing educators have the responsibility to promote patient safety. A better understanding of educational factors affecting nursing adverse events by nursing students undergoing clinical practice can help nursing educators find appropriate ways to fulfil their duty.

OBJECTIVE

To examine the status quo of nursing adverse events and to discuss the major educational factors concerned in different regions of China.

DESIGN

A descriptive study design was undertaken in 2018.

PARTICIPANTS AND SETTING

A convenience sample of 1173 nursing students undergoing clinical practice was recruited from 22 hospitals in different regions of China.

METHODS

The Chinese version of the Medical Student Safety Attitudes and Professionalism Survey (MSSAPS) was administered to and demographic and professional data were collected from clinical nursing students after obtaining informed consent.

RESULTS

The incidence of nursing adverse events in clinical student nurses was 17.8%. Approximately 87.01% of nursing adverse events were near miss. The positive response rate of safety attitudes and professionalism by clinical nursing students ranged from 57.5% to 96.9%. Logistic analysis indicated that gender, educational level, hospital regions, safety culture and professional behavior experience dimensions were the major factors influencing nursing adverse events.

CONCLUSION

Attention should be paid to the situation in which clinical nursing students are prone to nursing adverse events. Cooperation between nursing colleges and hospitals should be strengthened to promote patient safety in clinical nursing students. We suggest that nursing educators implement patient safety education in both theoretical and practical teaching and use multiple forms, especially simulation-based training, to strengthen safe nursing behavior to reduce the incidence of nursing adverse events.

Perioperative nurses' experiences in relation to surgical patient safety: A qualitative study

Surgical patient safety remains a concern worldwide as, despite World Health Organization recommendations and implementation of its Surgical Safety Checklist, adverse events continue to occur. The aim of this qualitative study was to explore the views and experiences of perioperative nurses regarding the factors that impact surgical patient safety. Data were collected through five focus groups involving a total of 50 perioperative nurses recruited from four public hospitals in Spain. Content analysis of the focus groups yielded four main themes: personal qualities of the perioperative nurse, the surgical environment, safety culture, and perioperative nursing care plans. One of the main findings concerned barriers to the exercise of leadership by nurses, especially regarding completion of the Surgical Safety Checklist. Some of the key factors that impacted the ability of perioperative nurses to fulfil their duties and ensure patient safety were the stress associated with working in the operating room, time pressures, and ineffective communication in the multidisciplinary team. Targeting these aspects through training initiatives could contribute to the professional development of perioperative nurses and reduce the incidence of adverse events by enhancing the surgical safety culture.

A Comparison of Patient Safety Competencies between Clinical and Classroom Settings among Nursing Students

Background: As nurses play an important role in the implementation of patient safety in hospitals, competencies of patient safety should be developed and enhanced among nursing students. Self-assessment is a method that can be used to assess patient safety and its dimensions to help the students prepare themselves before entering the work life.Purpose: This study aimed to investigate differences in patient safety competencies between classroom and clinical settings among nursing students using a self-assessment method.Methods: A descriptive study using the Health Professional Education in Patient Safety Survey (H-PEPSS) questionnaire was conducted among 181 nursing students in a public university in Indonesia. Paired t-test, ANOVA, and independent t-test were performed to determine the comparison in the values of patient safety dimensions across classroom, clinical learning, and year of nursing course.Results: Nursing students showed a higher mean value in the classroom setting than the clinical setting. Out of the seven dimensions of patient safety competencies, “clinical safety” (M=4.36) and “communicate effectively” (M=4.29) obtained the highest score in classroom setting, while “adverse events” showed the lowest (M=4.03). In the clinical setting, “clinical safety” (M=4.19) and “communicate effectively” (M=4.12) obtained the highest score, while “working in teams” (M=3.82) was the lowest. The third-year students showed a better score than the fourth year in most dimensions.Conclusion: In this study, the patient safety competencies among nursing students were higher in the classroom setting than in the clinical setting. It is recommended to investigate the factors that can increase the achievement of patient safety competence among nursing student in the clinical setting.

Regulation and current status of patient safety content in pre-registration nurse education in 27 countries: Findings from the Rationing - Missed nursing care (RANCARE) COST Action project

Patient safety, as a contemporary health care concern, must remain a priority for nurse educators. This on-line consultation, carried out within the RANCARE COST Action project, determined to establish how patient safety teaching is incorporated into pre-registration education of nurses across 27 countries. How nursing is regulated within countries was examined, along with national guidelines related to nurse education. HEIs were asked to provide details of pre-registration nurse training and how patient safety is taught within programmes. The results confirm that the topic of patient safety is generally not explicitly taught, rather it remains a hidden element within the curriculum, taught across many subjects. Variation in how nursing is regulated exists across the countries also, with the professionalization of nursing remaining a challenge in some states. No guidelines exist at EU level which address how patient safety should be taught to nursing students, and as yet regulatory bodies have not put forward criteria on the subject. As a result individual HEIs determine how patient safety should be taught. The WHO guidelines for teaching patient safety are currently underutilized in nurse education, but could offer a structure and standard which would address the deficits identified in this work.

Medium-fidelity simulation in clinical readiness: a phenomenological study of student midwives concerning teamwork

Background

Teamwork during obstetric emergency ensures good outcomes for both the woman and her baby. Effective teams are characterised by mutual respect, support, and cooperation among team members.

Methods

This qualitative, interpretive, phenomenological analysis study was conducted on a purposive sample of five, fourth-year Bachelor of Nursing Science student midwives at the University of Fort Hare (UFH). In-depth semi-structured interviews were conducted. Data analysis applied the interpretative phenomenological analysis method.

Results

Superordinate theme demonstrated teamwork elicited four clustered themes namely delegation of duties, the importance of teamwork, team support, and confident team leader. The participants recognised that there should be a team leader who is capable of delegating duties to other team members in the management of an obstetric emergency, Participants were confident not only to assign duties but to be kept updated of the intervention. They expressed the need to work collaboratively as a team to achieve the desired goal of providing quality care to the woman. The participants maintained that the team must be supportive and be able to help in decision making during simulation of an obstetric emergency. A sense of mutual respect is echoed by some participants in the process of caring for the woman. Some participants were confident at being team leaders and could see themselves as leaders in the real-life clinical situation.

Conclusion

The participants acknowledge the importance of teamwork in resolving obstetric emergencies. The importance of delegating duties to other team members, providing updated progress report ensures better outcomes for the woman.