Typology of undergraduate nursing students' unsafe clinical practices: Q-methodology

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.

Safe clinical practice in pre-licensure nursing students: A concept analysis

The aim of this paper is to provide a concept analysis for safe clinical practice for pre-licensure nursing students. Safe clinical practice is crucial to creating a safe environment. Defining the concept of safe clinical practice is important. Walker and Avant's concept analysis approach was used. Cumulative index to Nursing and Allied Health, Business Source Elite, Education Resources Information Center, and PsycINFO were searched for literature on safe clinical practice. The key words "student," "safety," "performance," and "unsafe student" were used. From a review of the literature, defining attributes, antecedents, and consequences of safe clinical practice were established and a definition of the concept emerged. The defining attributes identified are knowledge, skills, individual accountability, and professionalism. Students demonstrating appropriate knowledge levels and good technique with skills contribute to safe clinical practice. Taking accountability for one's actions and being professional also are important attributes to maintaining a safe clinical environment and ensuring safe clinical practice. Safe clinical practice in a patient-student situation occurs when pre-licensure nursing students who have been adequately prepared and practicing within a safe environment demonstrate knowledge of the clinical situation and its risks; communicate with faculty and staff members professionally; and develop appropriate relationships.

Measuring Patient Safety Competence Among Nursing Students in the Classroom and Clinical Settings

BACKGROUND

Little is known of the extent to which patient safety (PS) education is addressed in nursing curricula in the classroom and clinical settings in Jordan.

METHOD

An Arabic version of the Health Professional Education in Patient Safety Survey was administered to a convenience sample of 297 nursing students from two governmental universities in Jordan.

RESULTS

Nursing students were moderately satisfied about their knowledge and competencies regarding most PS dimensions; they also had more confidence about the knowledge and competencies they learned in the classroom than during the clinical training. Students in their advanced year had lower confidence about their PS knowledge and competencies than students in the earlier years.

CONCLUSION

The study suggests the need to close the gap between theory and practice in the nursing curriculum. The adoption of a comprehensive framework that integrates PS knowledge and competencies is recommended.

Unsafe clinical practices as perceived by final year baccalaureate nursing students: Q methodology

Background

Nursing education necessitates vigilance for clinical safety, a daunting challenge given the complex interchanges between students, patients and educators. As active learners, students offer a subjective understanding concerning safety in the practice milieu that merits further study. This study describes the viewpoints of senior undergraduate nursing students about compromised safety in the clinical learning environment.

Methods

Q methodology was used to systematically elicit multiple viewpoints about unsafe clinical learning from the perspective of senior students enrolled in a baccalaureate nursing program offered at multiple sites in Ontario, Canada. Across two program sites, 59 fourth year students sorted 43 theoretical statement cards, descriptive of unsafe clinical practice. Q-analysis identified similarities and differences among participant viewpoints yielding discrete and consensus perspectives.

Results

A total of six discrete viewpoints and two consensus perspectives were identified. The discrete viewpoints at one site were Endorsement of Uncritical Knowledge Transfer, Non-student Centered Program and Overt Patterns of Unsatisfactory Clinical Performance. In addition, a consensus perspective, labelled Contravening Practices was identified as responsible for compromised clinical safety at this site. At the other site, the discrete viewpoints were Premature and Inappropriate Clinical Progression, Non-patient Centered Practice and Negating Purposeful Interactions for Experiential Learning. There was consensus that Eroding Conventions compromised clinical safety from the perspective of students at this second site.

Conclusions

Senior nursing students perceive that deficits in knowledge, patient-centered practice, professional morality and authenticity threaten safety in the clinical learning environment. In an effort to eradicate compromised safety associated with learning in the clinical milieu, students and educators must embody the ontological, epistemological and praxis fundamentals of nursing.