Nurses critical to quality, safety, and now financial performance

Nursing students' perspectives and suggestions on patient safety--implications for developing the nursing education curriculum in Iran

BACKGROUND

Nursing students' close involvement in knowledge development about patient safety will enhance the integrity of the current content of nursing education and pave the way towards developing a nursing curriculum that facilitates achieving a safer health-care system.

OBJECTIVES

This study explores nursing students' perspectives and suggestions on developing patient safety aspects of the nursing curriculum in the context of Iranian culture.

DESIGN

A qualitative methodology involving three focus groups with a purposive sample of 18 nursing students from a large Iranian nursing school, utilising directed semi-structured interviews generated data, which was analysed using the content analysis process.

RESULTS

Two main themes emerged from content analysis: (1) "involving students fully in patient care" with subthemes 'building a trusting relationship between education and practice', and 'promoting inter-dependence between health-care providers', and (2) "structuring patient safety education" with subthemes 'transforming nursing routines to evidence-based care', and 'connecting care to patient safety issues'.

CONCLUSIONS

The extent of students' involvement in clinical practice and clinical nurses' roles in student education in practice requires clarification. The curriculum needs to incorporate patient safety aspects throughout, and include interdisciplinary education to ensure compliance with patient safety policies. Moreover, successful implementation of such a curriculum necessitates cooperation from nursing practice and instructors to meet nursing students' expectations.

The occurrence of adverse events potentially attributable to nursing care in medical units: cross sectional record review

BACKGROUND

Ensuring the safety of hospitalized patients remains a major challenge for healthcare systems, and nursing services are at the center of hospital care. Yet our knowledge about safety of nursing care is quite limited. In fact, most earlier studies examined one, or at most two, indicators, thus presenting an incomplete picture of safety at an institutional or broader level. Furthermore, methodologies have differed from one study to another, making benchmarking difficult.

OBJECTIVES

The aim of this study was to describe the frequencies of six adverse events widely considered in the literature to be nursing-sensitive outcomes and to estimate the degree to which these events could be attributed to nursing care.

METHOD

Cross-sectional review of charts of 2699 patients hospitalized on 22 medical units in 11 hospitals in Quebec, Canada. The events included: pressure sores, falls, medication administration errors, pneumonias, urinary infections, and inappropriate use of restraints. Experienced nurse reviewers abstracted patients' charts based on a grid developed for the study.

RESULTS

Patient-level risk for at least one of these six adverse events was 15.3%, ranging from 9% to 28% across units. Of the 412 patients who experienced an event, 30% experienced two or more, for a total of 568 events. The risk of experiencing an adverse event with consequences was 6.2%, with a unit-level range from 3.2% to 13.5%. Abstractors concluded that 76.8% of the events were attributable to nursing care.

CONCLUSION

While the measurement approach adopted here has limitations stemming from reliance on review of documentation, it provided a practical means of assessing several nursing-sensitive adverse events simultaneously. Given that patient safety issues are so complex, tracking their prevalence and impact is important, as is finding means of evaluating progress in reducing them.