Strategies to prevent medical errors by nursing interns: a qualitative content analysis

BACKGROUND

Nursing interns often face the serious challenges and stress of clinical training. Identifying effective strategies in reducing medical errors can improve student performance and decrease patient risk and injury from errors. The purpose of this study was to identify strategies to prevent medical errors by nursing interns in Medical Universities in Sistan and Baluchistan, Southeast of Iran.

METHODS

This is a qualitative study using a content analysis approach. Purposive sampling was used. The study was conducted in 3 medical universities. Ten nursing interns participated in this study. Open-ended, semi-structured, and face-to-face, interviews were used to explore the experience of nursing interns about strategies to prevent medical errors during their internship.

RESULTS

Findings include 20 subcategories, 6 categories and one theme. The main theme is "strategies to prevent medical errors during internship". Six categories included "strategies to prevent medical errors during internship". These included "Professional acceptance and support", "Revision of the implementation of the educational curriculum", "Retraining courses for challenging skills", "Creating learning opportunities" "Professionalization", and "Facilities and requirements".

CONCLUSIONS

Preventing medical errors requires different strategies before and during nursing internship. Error prevention strategies include retraining and preparatory courses for challenging areas, evaluation of students' performance, and accepting students as members of the health care team, respecting and supporting them and protecting their rights. Learning from medical errors, analysis and reflection on errors should be part of the curriculum during the internship.

Evaluation and improvement of workplace vertical violence of nursing interns based on the Importance-Performance Analysis method

Purpose

To analyze the key factors related to workplace vertical violence among nursing interns in China and to propose strategies to improve the nursing practice environment.

Methods

A cross-sectional study was conducted using the Importance-Performance Analysis (IPA) method to analyze the key factors and significance of workplace vertical violence for nursing interns. The data were obtained by administering a workplace vertical violence survey, designed specifically for this study, to 120 nursing interns at a tertiary general hospital in Zhejiang Province, China.

Results

The results demonstrated that the variables "I was ordered to do something beyond my ability and lacked guidance (C3)," "Errors in work have been repeatedly emphasized, spread, or exaggerated (C8)," "I was unjustly criticized (C9)," "I was withheld or blocked information purposefully (C1)," and "I was belittled at work (C2)" were the most crucial variables for determining the presence of workplace vertical violence of nursing interns. Moreover, they are priority improvement variables.

Conclusion

Managers must prioritize the use of relevant resources during internships to minimize false reinforcement and unfair criticism. Efforts should focus on improving information sharing, emphasizing the role of nursing interns in clinical work, providing better guidance when arranging for nursing interns to do work that exceeds their capacity, reducing workplace vertical violence, and improving nursing intern practice environments.

Nursing students' experience of workplace violence in clinical practice: A qualitative systematic review

AIMS

To systematically identify, appraise and synthesise qualitative studies investigating Registered Nurse students' (RNS) experiences of workplace violence (WPV) while on clinical placement. It is expected that the literature review findings will guide the development of targeted programs and policies to address WPV against RNS.

BACKGROUND

WPV affects RNS during clinical placements as they are vulnerable to violence due to their limited experience and skills to challenge abusive behaviour. In this review, RNS are students enrolled in a Bachelor of Nursing program to become registered nurses and exclude students who are enrolled in nursing program that does not lead to registration as a registered nurse. For example, enrolled in nursing programs and postgraduate nursing programs. RNS are chosen for their scope of practice and the training requirements. RNS reported experiencing WPV mainly from colleagues, staff, teachers, doctors and supervisors, which resulted in leaving nursing practice, impacting students' progression and healthcare systems. This review examines all types of violence RNS face irrespective of the abuser.

METHODS

A qualitative systematic review of existing literature was conducted through a comprehensive database search of eight databases MEDLINE, CINAHL, Web of Science, Scopus, Embase, Cochrane Central and ProQuest. Furthermore, reference lists of included studies were searched to identify further research. English language qualitative primary studies of any study design were searched from inception to 6th June 2022 and included if they met the inclusion criteria. Double review process utilised from screening until data synthesis reported according to PRISMA. JBI critical appraisal tools were used to assess the studies, and data extraction utilised JBI QARI tool and screened for credibility and confidence in findings.

RESULTS

A total of 18 studies met the inclusion criteria, and the studies were conducted in nine countries. Five main themes relating to RNS experiences of WPV while on clinical placement were identified, including: 'Types of workplace violence', 'Perpetrators', 'Causes', 'Consequences' and 'Management of workplace violence'.

CONCLUSIONS

This qualitative systematic review provides new and significant knowledge in understanding the phenomenon of WPV experienced by RNS while on clinical placement.

RELATIVE TO CLINICAL PRACTICE

This review highlights the unwillingness of RNS to reach out to instructors or clinical placement leaders in many situations and identifies avenues of support and awareness that are crucial to empower and enabling students to seek support.

Nursing students' experiences of workplace violence in clinical practice: a qualitative systematic review protocol

OBJECTIVE

The objective of this review is to investigate the experience of workplace violence against nursing students on clinical placement.

INTRODUCTION

Workplace violence affects nursing students during clinical placements in hospitals and other health care settings. Nursing students are uniquely vulnerable to workplace violence due to their limited experience and skills in challenging abusive behavior. Up to half of nursing students have reported experiencing horizontal or lateral physical or verbal violence during clinical placement, both from colleagues and patients. As a result of workplace violence, many students consider leaving nursing practice within their first year. This has implications for individual students' progression and for health care systems that rely on nursing graduates to deliver health care services.

INCLUSION CRITERIA

Only qualitative primary studies will be included. The population is registered nurse students, the phenomenon of interest is the experience of workplace violence, and the context is clinical placement.

METHODS

A comprehensive database search of MEDLINE, CINAHL, Web of Science Core collection, Scopus, Embase, Cochrane Central Register of Controlled Trials, ERIC, ProQuest Central, ProQuest Social Science Premium Collection, and ProQuest Dissertations and Theses. Databases will be searched from inception to present for English-language qualitative literature of any study design that meets the inclusion criteria. A search of unpublished and gray literature will also be conducted. The JBI critical appraisal checklist for qualitative research will be used to assess the studies. Findings and illustrations will be extracted and assigned a level of credibility. Meta-aggregation of findings will be performed, and a ConQual Summary of Findings will be presented.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42022337674.

The impact of bullying on the mental health and academic achievement of nursing students

PURPOSE

This study aimed to determine the prevalence of bullying and identify the perpetrators of bullying among nursing students. Further, the impact of bullying on their mental health and academic achievement was also examined.

DESIGN AND METHODS

A cross-sectional correlational design was adopted. A total of 180 undergraduate nursing students completed an electronic questionnaire.

RESULTS

Approximately half of the participants had experienced at least one or more bullying behaviors on a daily or weekly basis during nursing education. Classmates were the most frequently reported perpetrators of bullying behaviors. Bullying experience was associated with poor psychological health and perceived stress. A lower grade point average emerged as a significant predictor of exposure to bullying behaviors.

PRACTICE IMPLICATIONS

There is a need to create policies that delineate the legal implications of bullying to protect students. Faculty members and clinical service providers should work together to reduce the prevalence and impact of negative acts against students.

The impact of transition programmes on workplace bullying, violence, stress and resilience for students and new graduate nurses: A scoping review

AIMS AND OBJECTIVES

This scoping review aims to identify whether transition programmes support new graduate nurses and nursing students in terms of dealing with workplace violence, bullying and stress and enhance new graduate nurses' resilience during the transition from education to clinical practice.

BACKGROUND

Many new graduate nurses in their first year of employment experience issues at work such as violence, bullying and stress, which forces them to leave their jobs. Nursing students also experienced these issues during their clinical rotation. However, some hospitals and universities have developed transition programmes to help nursing students and new graduate nurses and ease their transition from education to clinical practice. Although transition programmes have been successful in increasing the retention rate for new graduate nurses, their impact on supporting new graduate nurses and nursing students in dealing with workplace violence, bullying and stress and in enhancing their resilience is unknown.

DESIGN

A scoping review of the current literature (with no date limit) using the PRISMA-ScR checklist for reporting scoping reviews was utilised.

METHOD

Following the scoping review framework of Arksey and O'Malley, a broad search (with no date limit) was performed in CINAHL, Scopus, Medline, Web of Science, ASSIA, PsycINFO, Embase, PROSPERO and ProQuest Dissertation databases. Reference lists of the included studies were searched.

RESULTS

This review found that most transition programmes provide support for new graduate nurses when dealing with workplace violence, bullying and stress. Transition programmes varied in length, content and implementation. Preceptors' support, educational sessions and safe work environments are the most beneficial elements of transition programmes for supporting new graduate nurses. Education sessions about resilience provide new graduate nurses with knowledge about how to deal and cope with stressful situations in the work environment. We found no studies that focused on nursing students.

CONCLUSION

The paucity of research on transition programmes' impact on workplace violence and bullying means that further research is recommended. This to determine which strategies support nursing students and new graduate nurses in clinical practice and to explore the effect of these programmes on experiences of workplace violence and bullying.

RELEVANCE TO CLINICAL PRACTICE

Evidence indicates that there is a worldwide gap in how universities and colleges prepare nursing students for transitioning from the education system to clinical practice. New graduate nurses and nurse managers regularly report that their education did not fully provide them with the skills required for their transition to clinical practice. Transition programmes support new graduate nurses to deal with workplace violence and bullying and need to have structured implementation. Ongoing evaluation is required to ensure that the programmes meet the needs of nursing students and new graduate nurses and health organisations, improve new graduate nurses' transition to clinical practice safely, enhance their resilience to overcome issues in the workplace (such as violence, bullying and stress) and reduce their turnover.

Creating safety in care: Student nurses' perspectives

Nursing is often hazardous work. Promoting safety and care requires nurses to apply knowledge, skill and creativity in patient encounters. Nurses' risk exposures are well documented, with research on student nurses' safety more limited. We studied final-year nursing students' risk perceptions using questionnaire-based vignettes involving four patient presentations on patient aggression, manipulating patient and resource risk factors. We found student nurses were most likely to ask for help and wait when managing high-risk patient aggression scenarios. Student nurses placed most importance on their own safety and patient condition in making decisions. Resource risk significantly interacted with gender, with male nurses more likely to seek help when risks were high. There is need to improve student nurse training on managing patient aggression by promoting creative approaches to problem solving and critical thinking using simulation techniques to enhance situation awareness and translate knowledge to practice.

The Development and Effectiveness of a Clinical Training Violence Prevention Program for Nursing Students

The study aimed to develop and evaluate a violence prevention program for nursing students to improve communication self-efficacy, problem-focused coping style, emotion-focused coping style, and the ability to cope with violence. Using an eight-session violence prevention program, the study was designed as quasi experimental, with a pretest, posttest, and follow-up assessment with a nonequivalent control group. Nursing students from the fourth year of a university were selected as participants; 22 students were assigned to the experimental group and 23 to the control group. Data analysis included Chi-square, Fisher's exact test, Levene's Test, Mann-Whitney U-test, and repeated measures ANOVA. Results showed that the experimental group showed significantly higher posttest scores for the problem-focused coping style (F = 20.77, p < 0.001), intra-individual and interaction effects for the emotion-focused coping style (F = 12.03, p < 0.001), and the ability to cope with violence (U = 70, p < 0.001) than the control group. Thus, the workplace violence prevention program was effective for nursing students.

Interrupting the cycle of bullying witnessed or experienced by nursing students: An ethical and relational action framework

BACKGROUND

The prevalence of bullying experienced by nursing students continues to be a substantial concern for the profession, especially for nurse educators. It is also an issue in other health care professional programs.

OBJECTIVES

To explore how educational institutions address bullying experienced by nursing and other health care professional students, with the goal of creating a set of procedures for reporting bullying if students witness or experience it during their education.

DESIGN

Qualitative Description. Our central question was "What processes and resources do faculty members use when students disclose an experience related to bullying?"

SETTINGS

Educational institutions in Western Canada.

PARTICIPANTS

Nine faculty members and one staff member with a student service role from nursing and other health care profession programs.

METHODS

Semi-structured interviews.

RESULTS

We found significant variation in interviewees' conceptions of bullying and the policies, processes, and resources for addressing bullying within programs. We adopted an existing definition of bullying; designed a set of procedures focused on reporting mechanisms; and developed a guiding framework entitled Addressing Bullying in Nursing Education: An Ethical and Relational Action Framework.

CONCLUSIONS

Nursing and other health care professional programs should ensure they have 1) clear and transparent procedures to report bullying 2) education about bullying for students and faculty.

The Professional Behaviors New Nurses Need: Findings From a National Survey of Hospital Nurse Leaders

AIM

The purpose of this study was to survey hospital nurse leaders throughout the United States to determine which professional behaviors they believe are essential for nursing students to learn in the classroom.

BACKGROUND

This study was part of a multiphase study. The survey was revised from a previous survey administered to nurse leaders in the Midwest.

METHOD

Participants were surveyed using 46 items in the categories of Change, Communication, Conflict, Leadership, and Self-Awareness.

RESULTS

The highest ranked category was Communication, followed by Self-Awareness, Change, Leadership, and Conflict. The highest rated items in each category were communication with patients, accept constructive criticism, manage change, prioritization, and conflict resolution techniques.

CONCLUSION

Nurse educators and leaders can use the findings to continue to refine nursing education.

Addressing Workplace Incivility: Facilitating Nursing Students' Transition to the Health-Care Setting

Workplace incivility is a known cause of anxiety in the workplace, leading to the loss of many new members of the nursing field. This perpetual cycle of hiring and losing nurses, especially new graduates, contributes to the increasing nursing shortage. This study investigated whether the inclusion of prelicensure nursing education on workplace incivility is achievable and capable of improving the outcome for nurses when it occurs. Review of the literature revealed that inclusion of prelicensure education on this topic is possible through utilization of a zero-tolerance policy, Cognitive Rehearsal Technique (CRT), and simulation. Education on workplace incivility and the aforementioned formats for prelicensure education were presented to faculty of a Southeastern U.S. college. Respondents demonstrated interest in detailed instruction on incorporating it into their teaching.

Interventions addressing student bullying in the clinical workplace: a narrative review

BACKGROUND

Student bullying in the clinical environment continues to have a substantial impact, despite numerous attempts to rectify the situation. However, there are significant gaps in the literature about interventions to help students, particularly a lack of specific guidance around which to formulate an intervention program likely to be effective. With this narrative review about student bullying interventions in the clinical learning environment, we examine and draw together the available, but patchy, information about 'what works' to inform better practice and further research.

METHODS

We initially followed a PICO approach to obtain and analyse data from 38 articles from seven databases. We then used a general inductive approach to form themes about effective student bullying intervention practice, and potential unintended consequences of some of these, which we further developed into six final themes.

RESULTS

The diverse literature presents difficulties in comparison of intervention efficacy and substantive guidance is sparse and inconsistently reported. The final analytical approach we employed was challenging but useful because it enabled us to reveal the more effective elements of bullying interventions, as well as information about what to avoid: an interventionist and institution need to, together, 1. understand bullying catalysts, 2. address staff needs, 3. have, but not rely on policy or reporting process about behaviour, 4. avoid targeting specific staff groups, but aim for saturation, 5. frame the intervention to encourage good behaviour, not target poor behaviour, and 6. possess specific knowledge and specialised teaching and facilitation skills. We present the themed evidence pragmatically to help practitioners and institutions design an effective program and avoid instigating practices which have now been found to be ineffective or deleterious.

CONCLUSIONS

Despite challenges with the complexity of the literature and in determining a useful approach for analysis and reporting, results are important and ideas about practice useful. These inform a way forward for further, more effective student bullying intervention and research: an active learning approach addressing staff needs, which is non-targeted and positively and skilfully administered. (331w).

It's 'probably the teacher!' A strategic framework for clinical staff engagement in clinical student bullying intervention

BACKGROUND

Student bullying in clinical practice persists, and poor outcomes continue: for learning, academic achievement and career goals, for their mental and physical health and potentially affecting all staff and patients in a clinical workplace. We describe an emergent framework for the strategic design of a bullying intervention, presented as a staff development opportunity.

METHODS

CAPLE (Creating A Positive Learning Environment) was a bullying intervention designed around current best evidence about ameliorating student bullying in the clinical environment. CAPLE was also an action research project delivered in two eight- week cycles, one in 2016 & another in 2017. CAPLE's primary practical foci were to offer clinical staff in two separate hospital wards an opportunity to develop their clinical teaching skills and to guide them in reflection and cultivation of values around students and learning. Research foci were: 1. to gain insight into staff experiences of CAPLE as a development process and 2. to evaluate how CAPLE might best help staff reflect on, discuss and develop values around student learning, to include bullying. Staff undertook five active learning workshops combined with supportive contact with one researcher over the research period. Data include individual interviews, staff and researchers' reflective journals and a paper survey about staff experiences of the 2017 intervention.

RESULTS

We confirm the effectiveness of best evidence from the literature and also that a strategic four-part framework of approach, process, content and person can further enhance a bullying intervention by increasing the likelihood of participant engagement, learning and values change.

CONCLUSIONS

This research aggregates and adds weight to the current literature about student bullying and adds important pragmatic detail about best practice for bullying intervention design and delivery. Ultimately, this emergent framework offers insight to help move past some persistent barriers encountered by those wishing to improve workplace behaviour.

Peer Training Using Cognitive Rehearsal to Promote a Culture of Safety in Health Care

Nursing students need opportunities to prepare for real-world problems that they may encounter as they enter the profession. Incivility and bullying behaviors persist in health care. The purpose of this project was to increase students' awareness of incivility and prepare them to respond to it. Two teaching methods were compared. Results supported that interactive civility training using cognitive rehearsal provided by nursing student peers was as effective as instruction from an expert.

Nursing curriculum and bullying: An integrative literature review

OBJECTIVES

The purpose of this integrative review was to identify and synthesize key concepts that inform curriculum which increase nursing students' competence, skills and strategies when addressing bullying. Specifically, the authors sought to examine the concepts informing educational interventions, skills, and strategies, which addressed the bullying of nursing students.

DESIGN

Integrative literature review.

DATA SOURCES

A search of the electronic databases CINAHL, MEDLINE, ERIC, PsycINFO, Proquest, and PubMed was conducted in January 2016 using search terms such as 'bully' 'nursing student' 'education' and 'curriculum'.

REVIEW METHODS

Articles were screened for relevance and eligibility and extracted onto a table. Critical appraisal was conducted using multiple tools. Papers were analysed using constant comparison and concept mapping.

RESULTS

61 articles were included in the synthesis. Concepts identified included: empowerment, socialization, support, self-awareness, awareness about bullying, collaboration, communication, and self-efficacy. All concepts linked to empowerment. Social Cognitive Theory was used by many studies. Active teaching methods which gave students opportunities to practice skills were the most effective.

CONCLUSIONS

Empowered nursing students have the potential to address bullying more effectively and competently. Empowerment of nursing students is a powerful concept that educators must consider when developing curriculum and educational interventions to address bullying.

The influence of empowerment and incivility on the mental health of new graduate nurses

AIM

To test a model based on Kanter's theory of structural empowerment, which examines the relationships between new graduate nurses' perceptions of structural empowerment, workplace incivility and mental health symptoms.

BACKGROUND

The initial years of practice can be particularly stressful for new graduate nurses, who may be particularly vulnerable to uncivil behaviour as a result of their status in the work environment. Disempowerment and incivility in the workplace may compound the mental health symptoms experienced by new graduate nurses.

METHOD

A predictive, non-experimental design was used to examine the relationship between structural empowerment, workplace incivility and mental health symptoms in a sample of new graduate nurses working in hospital settings in Ontario (n = 394).

RESULT

High levels of structural empowerment were significantly associated with fewer negative mental health symptoms in new graduates. However, co-worker incivility and supervisor incivility partially mediated the effect of structural empowerment on new graduate nurses' mental health symptoms.

CONCLUSION

The findings suggest that empowering workplaces contribute to lower mental health symptoms in new graduate nurses, an effect that is diminished by incivility.

IMPLICATIONS FOR NURSING MANAGEMENT

Strategies that foster empowering work conditions and reduce uncivil behaviour are needed to promote positive mental health in new graduate nurses.

Intergenerational conflict in nursing preceptorship

BACKGROUND

Within the preceptorship model of clinical teaching/learning, the creation of a cohesive relationship between a preceptor and a nursing student highly influences the overall success of the experience. Invariably, preceptors and students tend to be of different generations and as such, there exists within this context the potential for generational misunderstandings and conflict.

DESIGN

A phenomenological study guided by van Manen's approach to human science research was conducted.

OBJECTIVE

The aim of this study is to explore the phenomenon of preceptorship in the intergenerational context.

PARTICIPANTS

A purposive sample of seven preceptors and seven nursing students was recruited from an undergraduate nursing program.

FINDINGS

The collective experience of all participants was illuminated through three key themes: being affirmed, being challenged, and being on a pedagogical journey. In this article we focus on encountering conflict, a key subtheme of being challenged, and one that emerged from the participants' narratives.

CONCLUSIONS

The study findings suggest that interpersonal conflict continues to be a reality in our profession, owing to which a collective effort must be made by nurse educators, practicing nurses, and nursing students to effect change and create a more cohesive culture. The findings have the potential to enhance generational understanding and foster a more cohesive culture in clinical practice settings.

Supporting newly hired nurses: a program to increase knowledge and confidence while fostering relationships among the team

BACKGROUND

It is important for newly hired nurses to be supported throughout their first year of employment by nurse leaders on their team. Newly hired nurses struggle with application of new clinical skills and critical thinking skills as well as integrating into unit culture.

PROGRAM DESIGN

The Post Orientation Education Program (POEP) provided 18 newly hired nurses with clinical knowledge and support through one-on-one meetings with the nurse leaders on their unit. The nurse leaders discussed common diagnoses, laboratory tests, and medications in addition to providing support to the newly hired nurses as they adapted to the newness of nursing. Early in their career the newly hired nurses developed relationships with the leadership team that may have taken longer if not for the POEP. The program gave the newly hired nurses an opportunity to experience different teaching styles of the nurse leaders and offered them the chance to engage in conversations about both clinical and nonclinical information.

OUTCOMES

The program was evaluated through pre/post tests and written evaluations. Evaluations revealed increased knowledge about common diagnoses, increased confidence in role, and the development of trusting relationships with the leadership team.

CONCLUSION

The newly hired nurses valued the time that they spent with the leadership team as it helped them to integrate into the unit and feel comfortable using the leaders as resources for patient care. The POEP proved to be a program that impacted not only relationships among the team, but it increased retention and quality of patient care as the nurses felt supported by the team, knowledgeable about the care they were delivering and confident in their ability to seek out resources. A program like the POEP could be adapted to various healthcare settings based on individual needs of the team.