Characterization of adverse events occurring during nursing clinical rotations: A descriptive study

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.

Factors contributing to medication errors: A descriptive qualitative study of Italian nursing students

BACKGROUND

It is estimated that 20-40 % of medication errors (MEs) made by nursing students are not reported, thus creating a gap in learning from mistakes. There is scarce literature on the reasons for the underreporting of MEs made by nursing students.

OBJECTIVES

The aim was to analyse the opinions of nursing students about MEs, types and causes and factors that facilitate or discourage ME reporting during clinical training.

DESIGN

Qualitative descriptive design.

SETTINGS

Nursing School affiliated with Milan University, Italy.

PARTICIPANTS

A purposeful sample of third-year or near-graduation nursing students.

METHODS

Data were collected between October and November 2019 through focus groups until data saturation. A semi-structured interview was used for conducting the focus groups and categories were identified by content analysis. Triangulation of researchers and member checking were performed to ensure result trustworthiness.

RESULTS

The study sample was 37 students assigned to four focus groups. Four ME categories were identified: type; cause(s); barriers; and facilitators of reporting. The most common errors were wrong drug, incorrect drug dosage and dilution, which were attributed to individual and/or organizational factors. The main barrier to ME reporting was fear of receiving a negative evaluation by the head nurse. Nonetheless, constructive reflexive evaluation was perceived as a facilitator of ME reporting.

CONCLUSIONS

Our findings show that MEs made by nursing students during their placement oftentimes go unreported to avert negative evaluation. Barriers to ME reporting may be reduced by enhancing risk awareness and error analysis with the support of clinical nurses and nursing mentors.

Medication errors by nursing students on clinical practice: An integrative review

BACKGROUND

Medication errors are a serious concern and often due to multiple factors. The largest workforce in healthcare are nurses. Nurses play a major role in medication management especially in medication administration. To become proficient in safe medication administration undergraduate nurses, need to be provided with adequate training in clinical settings. Aim This integrative review aims to identify literature that reports medication errors including prevalence, types, causes and barriers of reporting whilst nursing students are on clinical placement.

METHODS

A review was conducted of five electronic databases to identify original empirical research published between 2007 and 2021. An integrative review method using Strengthening the Report of Observational Studies in Epidemiology guidelines was used to direct this review.

FINDINGS

The initial search yielded 1574 articles. A total of six full text articles met the eligibility criteria were reviewed. The prevalence of medication errors made by nursing students on clinical placement was 6-1.1%. Causes were due to student, education and environmental factors. Types of errors medication calculations, incorrect name of patient, wrong medication and omission of medication administration.

DISCUSSION

This review confirms previous studies with 10-5% of all errors by nurses are medication errors in hospitals. Strategies to improve medication administration are increasing staffing, communication, education and supervision of students.

CONCLUSION

Medication administration is a multifactorial process that involves medication skills. Closer supervision, improved education on technology and consistency is required in number of rights of medication administration.

Medication administration behaviors in prelicensure nursing students: A longitudinal, cohort study

AIM

This longitudinal study identified changes in safe medication administration behaviors in a single cohort of students followed over four semesters of nursing school.

BACKGROUND

Over 40% of a nurse's shift is dedicated to the processes of medication administration, placing them in a position to interrupt costly medication errors. Yet, despite efforts to decrease medication errors, including electronic medical records, smart pumps, and standardized processes, 5% of hospitalized patients experience adverse drug events and the sequela costs billions of dollars annually. One cognitive aid first introduced in nursing school to help nurses administer medications safely is the rights method, including the foundational five (patient, medication, dose, route, and time). However, facility restrictions, complicated electronic health records, and high faculty-to-student ratios are limiting opportunities to apply these rights and develop safe medication administration competency. Although nursing faculty and clinical partners expect competency when initially licensed as professionals, graduating nursing students are not competent and new graduates feel ill prepared to deliver medications safely. Previous studies report findings on safe medication administration in different cohorts of nursing students, but none has followed the same cohort of students throughout nursing school.

DESIGN

Using a non-experimental design, the same cohort of nursing students was followed over four semesters and observed independently administering medications in simulation scenarios.

METHODS

Each semester, this cohort of students self-selected into 10-12 simulation groups. One student from each group was randomized to the role of primary nurse. Guided by the NLN/Jeffries simulation theory and the International Nursing Association for Clinical Simulation and Learning's Standards of Best Practice: Simulation^SM, students participated in four simulations that required the primary nurse to deliver medications as part of clinical care. A single investigator completed an observational checklist during the simulations on verification of the foundational five rights in these students.

RESULTS

Verification of most rights varied each semester, but students consistently did poorly verifying right dose. One hundred percent of students observed in the first semester did not verify all five rights. At the time of graduation, 80% of students observed did not verify all five rights prior to medication administration.

CONCLUSIONS

These concerning findings align with previous research showing that students are not safely administering medications in patient care settings. Educators, administrators, and healthcare systems need to ensure that students receive consistent, high-quality experiences vital to training future nurses for competency in safe medication administration.

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.

Attitudes of Undergraduate Nursing Students towards Patient Safety: A Quasi-Experimental Study

Improving nursing students' attitudes towards patient safety is a current and relevant topic. This study aims to evaluate the effectiveness of an educational intervention based on critical incident and root cause analysis (RCA) techniques regarding attitudes towards patient safety in nursing students. A quasi-experimental before and after study was developed between January 2018 and December 2019 in a sample of 100 nursing students at Universitat Jaume I (Spain). The intervention was developed in two phases. Phase I was at university, where students applied the RCA technique in a real case. Phase II took place during clinical practice. Students used critical incidents to identify a risk situation for the patients and applied RCA to detect its root causes. The measurement of attitudes was performed with the Attitudes to Patient Safety Questionnaire (APSQ-III). The global score of the questionnaire in the baseline measurement was 3.911 (±0.335), in the intermediate measurement it was 4.031 (±0.337) and in the final measurement it was 4.052 (±0.335), with significant differences (p = 0.03). However, intra-group differences were observed in the final measurement (p = 0.021). The teamwork dimension had the highest mean score on all three measures and the notification dimension had the lowest mean scores. An educational intervention combining critical incident and RCA techniques can improves nursing students' attitudes toward patient safety.