Prehospital nursing students' experiences of patient safety culture in emergency medical services-A qualitative study

Exploring Nursing Students' Perspectives on Patient Safety Culture in Clinical Settings: A Mixed-Method Study

BACKGROUND

Patient safety in undergraduate nursing studies is an indispensable component of the curriculum. The process of experiential learning from practice is of high value not only in terms of personal development but also enables students to identify and address critical areas of patient safety that require improvement.

AIM

To explore Czech undergraduate nursing students' perceptions of patient safety culture during clinical practice through a mixed-method sequential study.

METHODS

Data were collected between 2021 and 2024 using a mixed-method approach. The quantitative phase utilised the hospital survey on patient safety culture for nursing students. Four hundred and eighty-two undergraduate nursing students from 16 faculties across the Czech Republic participated. The subsequent qualitative phase employed semi-structured interviews with 12 undergraduate nursing students from one faculty in the Czech Republic. Descriptive and inferential statistical methods were used to analyse quantitative results, complemented by a reflective thematic analysis of qualitative data.

RESULTS

The most negatively rated survey dimensions were 'Frequency of events reported' (37.0%) and 'Nonpunitive responses to errors' (42.4%). Predictors for reporting adverse events in clinical practice were 'Indicators of good practice' (p ≤ 0.05). Based on the quantitative phase, the interpretive journey of nursing students' experiences from Exposure to adverse events, through Feeling disconnected and Cognitive dissonance, to the necessity of Speaking up for patient safety culture was captured in the qualitative phase.

CONCLUSIONS

Nursing students struggle to engage in a patient safety culture, particularly in reporting adverse events during clinical practice. Strengthening education on reporting and standards is essential for students, along with professional development for clinical staff to align practices and cultures.

Clinical education: nursing students' experiences with multisource feedback using a digital assessment instrument in the emergency medical Service - a qualitative study

BACKGROUND

Clinical education in Emergency services (EMS) is unique due to its dynamic environment, brief patient encounters, and unpredictable cases. EMS provides valuable learning opportunities for nursing students, fostering person-centered care approaches and a variation of clinical training and learning. Formative feedback is crucial to develop knowledge and skills. Multisource feedback (MSF) offers a comprehensive assessment by incorporating feedback from various individuals, promoting self-reflection and targeted learning. MSF has not, to our knowledge, been systematically evaluated in the context of EMS, and therefore, the aim of the study was to describe nursing students' experiences with MSF during their clinical education in the EMS, using a digital instrument as a facilitating tool.

METHODS

A qualitative design with an inductive approach was used. Data were collected in 2021, using focus group interviews (n = 4) with 31 final-semester nursing students in Stockholm, Sweden, who had conducted clinical education in the EMS and received MSF through a digital instrument. Data were analyzed using reflexive thematic analysis, guided by Braun and Clarke's methodology.

RESULTS

Three themes revealed: feedback from sources familiar with the student's learning objectives, feedback from sources unfamiliar with the learning objectives, and general perceptions of MSF in the EMS. Students valued self-reflection and feedback from peers and supervisors for personal and professional growth. Patient feedback was challenging due to their limited contextual understanding and emotional states, while feedback from other healthcare professionals was appreciated but hindered by the healthcare professionals' workload and timing constraints. Overall, students appreciated MSF's diverse perspectives, enriching their learning, performance, and development.

CONCLUSION

This study underscores the value of MSF in nursing students' clinical education within the EMS. Feedback from peers, supervisors, and self-reflection enhances self-awareness, professional growth, and mutual support. Despite challenges like stress and logistical barriers, structured support and a digital instrument improved accessibility and alignment with learning objectives for the students. Incorporating patient and healthcare professionals' feedback enriches education by promoting patient-centred care and collaboration. MSF supported reflective practice, and team dynamics and highlights the need for refined feedback processes to optimize learning and professional development for nursing students during clinical education.

Assessing unsafe behaviors and their relationship with work-related factors among EMS staff in Iran: a cross-sectional study

BACKGROUND

Emergency Medical Services (EMS) staff often encounter various safety incidents. Work-related factors can lead to unsafe behaviors and safety incidents. This study assessed unsafe behaviors and their relationship with work-related factors among EMS staff.

METHODS

This descriptive-correlational study used census sampling method to select 284 EMS staff in Ardabil Province, northwest of Iran, from April to June 2023. The data collection tools were demographic and occupational information form, Mearns Unsafe Behavior Scale, Cohen Perceived Stress Scale, Michielsen Fatigue Scale, and Patterson Teamwork Scale. The data were analyzed using the SPSSv-16, descriptive statistics, Pearson correlation, and multiple linear regression.

RESULTS

The mean of unsafe behavior, fatigue, perceived stress, non-conflict of teamwork, and conflict of teamwork were 15.80 (± 4.77), 20.57 (± 6.20), 16.10 (± 6.13), 117.89 (± 17.24), and 40.60 (± 9.59), respectively. Multiple linear regression analysis showed that "partner trust and shared mental models (PTSMM)," "physical fatigue," "age," "type of shift," "employment status," and "overtime hours per month" were predictors of general unsafe behavior (P < 0.001) and "mild task conflict (MTC)," "employment status," "partner trust and shared mental models (PTSMM)" were predictors of unsafe behavior under incentives EMS staff (P < 0.001).

CONCLUSION

The present study showed that some work-related factors were predictors of unsafe behaviors. The negative consequences of unsafe behaviors should be considered, and long-term planning should be done to reduce them. Developing specific guidelines for addressing unsafe behaviors, implementing measures to reduce fatigue, managing overtime hours in the workplace, and Establishing a system where novice staff work with experienced staff during their first year can be beneficial in reducing these behaviors among EMS staff.

An Integrative Systematic Review of Promoting Patient Safety Within Prehospital Emergency Medical Services by Paramedics: A Role Theory Perspective

Timely and effective prehospital care significantly impacts patient outcomes. Paramedics, as the frontline providers of emergency medical services, are entrusted with a range of critical responsibilities aimed at safeguarding the well-being of patients from the moment they initiate contact in the out-of-hospital environment to the time of handover at healthcare facilities. This study aimed to understand the multifaceted roles of paramedics in promoting patient safety within the context of prehospital emergency medical services. A systematic review with an integrative approach using the Whittemore and Knafl's framework was performed examining qualitative, quantitative, and mixed-methods research, then conducting data assessment, quality appraisal, and narrative research synthesis. Literature search encompassed PubMed (including MEDLINE), Scopus, Cinahl, ProQuest, Web of Science, and EMBASE, with the aim of retrieving studies published in English in the last decade from 2013 to 2023. To conceptualize the roles of paramedics in ensuring patient safety, the review findings were reflected to and analyzed through the role theory. The preliminary exploration of the database yielded 2397 studies, ultimately narrowing down to a final selection of 16 studies for in-depth data analysis and research synthesis. The review findings explored facilitators and obstacles faced by paramedics in maintaining patient safety in terms of role ambiguity, role conflict, role overload, role identity, and role insufficiency in the dynamic nature of prehospital care. It also highlighted the diverse roles of paramedics in ensuring patient safety, which encompassed effective communication and decision making for the appropriate management of life-threatening emergencies. The effectiveness of paramedics in playing their roles in promoting patient safety relies on acknowledging the contributions of paramedics to the culture of patient safety; training and educational initiatives focused on enhancing their decision-making abilities and both their non-technical and technical competencies; developing relevant guidelines and protocols; improving collaboration between paramedics and other healthcare peers; optimizing environmental conditions and equipment; fostering a supportive work environment.

Psychometric evaluation of the Persian version of Emergency Medical Services- Safety Attitudes Questionnaire (EMS-SAQ)

AIM

This study aimed to conduct a psychometric evaluation of the Persian adaptation of the Emergency Medical Services Safety Attitudes Questionnaire (EMS-SAQ).

METHODS

In this cross-sectional study, the validity and reliability of the EMS-SAQ were assessed among 484 Iranian pre-hospital emergency department employees between February and June 2023.

RESULTS

Five factors were extracted namely safety climate, teamwork, job satisfaction, stress management, and working conditions with explained 38.75% of the total variance. The goodness of fit indexes confirmed the model (χ2 = 409.031, DF = 196, χ2 /df = 2.087, CFI = 0.900, IFI = 0.901, PCFI = 0.763 and PNFI = 0.701, and RMSEA = 0.069 [CI90% 0.059-0.078]).

CONCLUSION

The Persian version of the SAQ-EMS, comprising 22 items across five factors, demonstrated good validity and reliability. It is recommended to undertake qualitative studies focusing on the concept of patient safety in pre-hospital settings, considering diverse contexts and cultural nuances to develop more robust assessment tools.

Nursing students' handling patient safety incidents during clinical practice: A retrospective qualitative study

BACKGROUND

Nursing students may encounter patient safety incidents during clinical practice. Understanding the challenges and concerns of nursing students in handling with patient safety incident could contribute to informing nursing education and clinical practice training.

OBJECTIVES

The aim of this study was to investigate how nursing students handle patient safety incidents during clinical practice.

DESIGN

A retrospective descriptive qualitative study.

SETTING

Nursing school in Slovenia.

PARTICIPANTS

A snowball sampling technique was used to recruit nursing students (n = 15).

METHODS

Data were collected via guided self-reflection diaries in 2021. Collected data were analysed using thematic analysis.

RESULTS

We have generated the main theme of nursing students' handling patient safety incidents during clinical practice. The four primary thematic subthemes were: (1) emotional responses; (2) patient safety incident occurrence and actions taken; (3) contributing factors; and (4) consequences.

CONCLUSIONS

Our study highlights nursing students' handling of patient safety incidents during clinical practice, revealing a spectrum of emotional responses, immediate actions, contributing factors, consequences, and the importance of fostering a non-blaming culture through reporting and effective communication.

Finnish emergency medical services managers' and medical directors' perceptions of collaborating with patients concerning patient safety issues: a qualitative study

OBJECTIVES

This study aimed to describe emergency medical services (EMS) managers' and medical directors' perceptions of collaborating with patients concerning patient safety issues in the EMS.

DESIGN

The study used a descriptive qualitative approach. Five focus groups and two individuals were interviewed using a semi-structured guide with open-ended questions. The data were analysed using reflexive thematic analysis. Consolidated criteria for Reporting Qualitative research was used to guide the reporting of this study.

SETTING

EMS organisations from Finland's five healthcare districts.

PARTICIPANTS

EMS medical directors (n=5) and EMS managers (n=14). Purposive sampling was used.

RESULTS

Two main themes, 'Patient safety considered an organisational responsibility' and 'EMS patients' opportunities and obstacles to speaking up', were generated from the data. Under the main theme, 'Patient safety considered an organisational responsibility', were three subthemes: patient safety considered part of the quality in EMS, system-level models for handling and observing patient safety in EMS, and management's ability to find a balance when using patients' feedback for patient safety development. Under the other main theme were four subthemes: 'social and feedback skills of EMS personnel and management', 'managements' assumptions of patients' reasons for not speaking up', 'EMS organisations' different but unsystematic ways of collecting feedback' and 'management's openness to develop patient participation'.

CONCLUSIONS

The nature of the EMS organisations and EMS assignments could affect a patient's participation in developing patient safety in EMS. However, EMS managers and medical directors are receptive to collaborating with patients concerning patient safety issues if they have sufficient resources and a coherent way to collect patient safety concerns. The management is open to collaborating with patients, but there is a need to develop a systematic method with enough resources to facilitate the management's collaborating with patients.