Development and Validation of the Just Culture Assessment Tool for Nursing Education

Nursing Students' Perception of Just Culture and Development of Self-Confidence With Clinical Judgment: A Scoping Review

AIM

The aim of this study was to determine what is currently known about just culture's impact on nursing students' development of self-confidence with clinical judgment.

BACKGROUND

Graduates of nursing programs must execute sound nursing judgment to provide safe client care.

METHOD

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guided the scoping review. The review elicited 1,411 sources and included 18 data sources.

RESULTS

Just culture was found to provide elements of trust, fairness, and psychological safety needed by nursing students to be self-confident in learning and executing clinical judgments that promote client safety.

CONCLUSION

Just culture promotes client safety in nursing education. Limited information exists on just culture's influence on student self-confidence with clinical judgment; more research is therefore required.

Creating a Community of Nurse Educator Scholars: The QSEN Academic Task Force Success

BACKGROUND

Engaging in scholarship is a critical component of being an effective nurse educator and can have a significant impact on the nursing profession as a whole.

PROBLEM

Nurse educators are expected to teach and simultaneously engage in scholarship. Barriers include heavy workloads and lack of resources including faculty mentors. Evidence supports that organized work groups support success.

APPROACH

Members of the Quality and Safety Education for Nurses (QSEN) Academic Task force were queried about scholarly activity as a result of engagement with fellow task force members.

OUTCOMES

Scholarly outcomes included numerous peer-reviewed publications, teaching tips, presentations, and grants.

CONCLUSION

Participating in national work groups can serve as a platform for fostering a community of scholars to make meaningful contributions to the profession.

National Study of Quality, Safety, and Just Culture in Prelicensure Nursing Education

AIM

The study's aim was to evaluate the integration and application of quality and safety competencies and concepts of fair and just culture in prelicensure nursing education.

BACKGROUND

Health care organizations support a safety culture by encouraging error reporting without fear of punishment and by conducting investigations to determine causes to improve quality and learn from mistakes. In prelicensure nursing education, the response to errors is often punitive and threatens dismissal.

METHOD

Members of the National Student Nurses' Association were recruited to participate in an electronic assessment through the organization's mailing system.

RESULTS

Students representing all prelicensure program types (BSN, ADN, diploma, accelerated) and 46 states ( N = 268) completed the survey.

CONCLUSION

Nurse educators were found to have a positive impact on student quality and safety competency. Improvement is possible in developing and supporting just culture within nursing programs to bridge the gap between academia and practice.

Development and evaluation of a sepsis simulation with undergraduate nursing students

BACKGROUND

In 2016, the Centers for Disease Control found that more than 1.5 million people develop sepsis each year and about 250,000 Americans die from it. Early identification and treatment of sepsis can decrease mortality and morbidity, yet studies have shown student nurses are not prepared to rescue deteriorating patients.

METHOD

The purpose of this pilot study was to create and test a response to rescue simulation for use with undergraduate nursing students. The simulation depicted a patient deteriorating from sepsis. The Martinez Sepsis Competency Evaluation Tool (MSCET) developed to rate student behaviors during the simulation. Promoting Excellence and Reflective Learning in Simulation (PEARLS) debriefing model was used post simulation.

RESULTS

The overall content validity of the MSCET was 0.88. Each item that scored a I-CVI of 0.78 or less were revised. The total percentage of behaviors met was 68 %. The inter-rater reliability of the MSCET conciseness was 0.47 (X = 67.508, df = 48, p ≤ .05).

CONCLUSION

The results indicate the simulation based experience was effective in preparing students to care for patients with early signs of sepsis. Students were complimentary about the experience, and preliminary data on the MSCET psychometrics were positive. Limitations of the study and recommendations for further revision of the simulation were made.

Clinical Stress and Clinical Performance in Prelicensure Nursing Students: A Systematic Review

BACKGROUND

Stress within clinical learning environments often has been associated with nursing education. However, in the past decade, the perceived stress levels of prelicensure nursing students have not only been sustained, they have actually increased. Increased and sustained stress levels negatively affect nursing students' perceptions of their competence, confidence, and ultimately, their clinical performance.

METHOD

A systematic review of the relationship between nursing students' perceived clinical stress and perceived clinical performance was conducted following PRISMA guidelines.

RESULTS

The review highlighted what is currently known about the relationship between perceived clinical stress in prelicensure nursing students and perceived clinical performance, providing implications for future research in clinical education. Three main themes were identified: nursing student gender, academic year, and clinical skill preparation.

CONCLUSION

Future research with rigorous methodological designs is necessary to examine the relationship between perceived clinical stress in prelicensure nursing students and perceived clinical performance. [J Nurs Educ. 2023;62(1):36-41.].

Nursing Student and Faculty Perceptions of Just Culture

BACKGROUND

Just culture is essential for quality improvement and patient safety.

METHOD

This descriptive study measured perceptions of just culture among nursing students and faculty using the Just Culture Assessment Tool for Nursing Education (JCAT-NE).

RESULTS

There were no significant differences in JCAT-NE scores for students (M = 133.43, SD = 19.12) and faculty (M = 136.34, SD = 22.73) (t[159] = 0.82, p = .42); however, there were significant differences in JCAT-NE scores based on level of experience. For students, JCAT-NE scores were significantly higher for sophomores than for seniors (F[2, 114] = 4.9, p = .01). For faculty, advanced beginner and competent faculty had significantly higher scores compared with proficient and expert faculty (t[42] = 2.36, p = .02).

CONCLUSION

More needs to be done to establish a fair and just culture in schools of nursing. [J Nurs Educ. 2022;61(5):257-260.].

Effects of Just Culture and Empowerment on Patient Safety Activities of Hospital Nurses

This study investigated the relationship among hospital nurses' perceptions of a just culture, empowerment, and patient safety activities. It also determined the factors affecting the patient safety activities of nurses. This cross-sectional study included 189 nurses from four hospitals in South Korea. The survey was conducted from October to December 2019 using self-report questionnaires including items on socio-demographic characteristics, just culture, empowerment, and patient safety activities. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient, and multiple linear regression analysis with SPSS/WIN 25.0. Patient safety activities correlated positively with just culture (r = 0.369, p < 0.000) and empowerment (r = 0.38, p < 0.000). Additionally, empowerment (β = 0.213, p = 0.001) and just culture (β = 0.442, p < 0.000) had statistically significant effects on patient safety activities and explained about 19.5% of the variance in patient safety activities (F = 16.170, p < 0.001). The patient safety at medical institutions can be improved by cultivating a work environment that embraces a just culture and empowers nurses.

Just Culture for Medical Students: Understanding Response to Providers in Adverse Events

INTRODUCTION

Individual and organizational response to an adverse event is a key part of the life cycle of a patient safety event. Just culture is a safety concept that emphasizes system drivers of human behavior. We developed a learning activity for medical students to teach and discuss just culture as part of a patient safety curriculum.

METHODS

This small-group, discussion-based learning activity was aimed at third-year medical students. Over 5 years, 628 students participated in it. The session had three components: a presession case-based survey, a didactic lecture, and a facilitated small-group discussion. Participants evaluated the session using our institution's standard learner assessment. They also took a postcourse test that contained multiple-choice questions relating to the session.

RESULTS

On a 5-point Likert scale (1 = poor, 3 = good, 5 = excellent), students rated the large-group lecture (3.2) and small-group discussion (3.2) moderately. Over 85% of students answered all knowledge items on a course posttest correctly.

DISCUSSION

This learning activity provides an easy-to-implement case-based discussion to introduce the concepts of just culture.

Exploratory factor analysis of the Just Culture Assessment Tool for nursing education

Background

Just culture has been identified as a vital component of safety culture by national and international organisations. In a just culture, emphasis is not placed on blaming individuals for errors but rather on examining personal and system processes that can best support safety and prevent reoccurrence. Although those in the practice arena have worked to implement the concepts of just culture, the same is not true in nursing education, leaving nursing students lacking the pre-requisite knowledge, skills and attitudes to implement just culture in practice on graduation.

Aims

Assessment of this phenomena is the essential first step to align nursing education with practice in promoting just culture as a mechanism for patient safety. The purpose of this paper is to further refine the Just Culture Assessment Tool-Nursing Education through exploratory factor analysis.

Methods

The Just Culture Assessment Tool-Nursing Education was adapted from the Just Culture Assessment Tool, an instrument created for the practice setting. Validity and reliability were established for the Just Culture Assessment Tool-Nursing Education in a study of 800 nursing students to assess their perceptions and understanding of just culture with their nursing programmes. Using the previously conducted data, an exploratory factor analysis was conducted.

Results

Factor analysis supports six subscales, similar to that of the Just Culture Assessment Tool. However, individual items were loaded into different subscales. All subscales demonstrated good reliability. Factor analysis supported further refinement of two items to improve the instrument’s ability to capture data.

Conclusions

Perceptions of just culture differ between experienced providers and nursing students; nursing students have less experience with reporting errors. Factor analysis of Just Culture Assessment Tool-Nursing Education items demonstrated these differences, supporting modification of items by the instrument developers. An ‘if’ statement for students to consider their possible actions rather than experience was added to two items to better capture data from nursing students when completing the assessment.