Adverse events witnessed by nursing students during clinical learning experiences: Findings from a longitudinal study

Preregistration nursing students' motivation for speaking up for patient safety: An integrated literature review

AIM

The aim of this review was to uncover what motivates preregistration nursing students to speak up for patient safety during work integrated learning (WIL) and to develop an evidence-based safety motivation framework for use by educators, clinicians, and preregistration nursing students.

DESIGN

This study used an integrative literature review design guided by Whittemore and Knafl's methodological framework.

DATA SOURCES

Five research databases, CINAHL, MEDLINE, PubMed, Scopus, and Web of Science, were searched for relevant peer reviewed research literature published in English between January 2011 and January 2024. The use of MeSH terms "undergraduate nursing student," or "preregistration nursing student" and "speaking up," "patient safety," and "motivation," resulted in 489 search returns. Following application of filters and inclusion criteria fifty-four (n = 54) studies were identified as being relevant to the research aim.

REVIEW METHODS

The fifty-four (n = 54) research studies were reviewed using the JBI Critical Appraisal tool relevant to the study methodology. The JBI critical appraisal tools are checklists used to determine research quality, validity, results, and meaning. Following appraisal, 27 studies were included in the integrative literature review.

RESULTS

Authentic learning, view of self as a nurse, and positive work integrated learning experiences were found to be the primary motivators for preregistration nursing students to speak up for patient safety during work integrated learning. These three motivators provided the foundation for an evidence-based framework, underpinned by self-determination theory, that can be used to enhance preregistration nursing students' motivation to speak up for patient safety.

CONCLUSIONS

The integrative review design enabled the development of the evidence-based Safety Motivation Framework to support preregistration nursing students' during work integrated learning however missing from the literature was information about the lived experience of this group of students when speaking up for patient safety.

Second victim phenomenon among healthcare students: A scoping review

AIM

This study aims to explore the "second victim" phenomenon in healthcare professions students following an adverse event.

BACKGROUND

In healthcare settings, adverse events affect not only patients but also the involved healthcare personnel, who experience a wide range of physical and psychological responses, a situation known as the second victim phenomenon. This phenomenon also extends to students in health-related professions during their clinical training, yet there needs to be more research specifically addressing this group.

DESIGN

A scoping review METHODS: This scoping review was guided by Arksey and O'Malley's methodological framework. In December 2023, we conducted a comprehensive database search in PubMed, the Cumulative Index of Nursing and Allied Health Literature (CINAHL) Complete, Web of Science (WoS), Scopus and the Virtual Health Library (VHL). The review included original research studies of any design that focused on the second victim phenomenon among students, published in English, Spanish, German or Portuguese, with no restrictions on the publication date. The review was reported according to PRISMA-ScR guidelines.

RESULTS

Seven studies were selected, primarily involving nursing and medical students. Common triggers of the second victim phenomenon in students were medication errors, patient falls and procedural errors. Described symptoms ranged from emotional distress, such as stress and hypervigilance, to physical symptoms, like sleep disturbances. Among the factors that influenced how this "second victim" phenomenon manifested in students were the reactions of their peers and the lack of support from supervisors. Contrary to the three possible outcomes described for professionals as second victims (surviving, thriving, or leaving), students are only described with two: giving up or moving on.

CONCLUSION

The studies highlighted the crucial role of peer and supervisor support in managing such difficult situations. The results suggest that additional research is necessary in other healthcare disciplines. Educational and healthcare institutions should improve their preventive and management strategies to address the phenomenon's impact on students.

Development and Implementation of a Safety Incident Report System for Health Care Discipline Students During Clinical Internships: Observational Study

BACKGROUND

Patient safety is a fundamental aspect of health care practice across global health systems. Safe practices, which include incident reporting systems, have proven valuable in preventing the recurrence of safety incidents. However, the accessibility of this tool for health care discipline students is not consistent, limiting their acquisition of competencies. In addition, there is no tools to familiarize students with analyzing safety incidents. Gamification has emerged as an effective strategy in health care education.

OBJECTIVE

This study aims to develop an incident reporting system tailored to the specific needs of health care discipline students, named Safety Incident Report System for Students. Secondary objectives included studying the performance of different groups of students in the use of the platform and training them on the correct procedures for reporting.

METHODS

This was an observational study carried out in 3 phases. Phase 1 consisted of the development of the web-based platform and the incident registration form. For this purpose, systems already developed and in use in Spain were taken as a basis. During phase 2, a total of 223 students in medicine and nursing with clinical internships from universities in Argentina, Brazil, Colombia, Ecuador, and Spain received an introductory seminar and were given access to the platform. Phase 3 ran in parallel and involved evaluation and feedback of the reports received as well as the opportunity to submit the students' opinion on the process. Descriptive statistics were obtained to gain information about the incidents, and mean comparisons by groups were performed to analyze the scores obtained.

RESULTS

The final form was divided into 9 sections and consisted of 48 questions that allowed for introducing data about the incident, its causes, and proposals for an improvement plan. The platform included a personal dashboard displaying submitted reports, average scores, progression, and score rankings. A total of 105 students participated, submitting 147 reports. Incidents were mainly reported in the hospital setting, with complications of care (87/346, 25.1%) and effects of medication or medical products (82/346, 23.7%) being predominant. The most repeated causes were related confusion, oversight, or distractions (49/147, 33.3%) and absence of process verification (44/147, 29.9%). Statistically significant differences were observed between the mean final scores received by country (P<.001) and sex (P=.006) but not by studies (P=.47). Overall, participants rated the experience of using the Safety Incident Report System for Students positively.

CONCLUSIONS

This study presents an initial adaptation of reporting systems to suit the needs of students, introducing a guided and inspiring framework that has garnered positive acceptance among students. Through this endeavor, a pathway toward a safety culture within the faculty is established. A long-term follow-up would be desirable to check the real benefits of using the tool during education.

TRIAL REGISTRATION

Trial Registration: ClinicalTrials.gov NCT05350345; https://clinicaltrials.gov/study/NCT05350345.

Unveiling the hidden struggle of healthcare students as second victims through a systematic review

BACKGROUND

When healthcare students witness, engage in, or are involved in an adverse event, it often leads to a second victim experience, impacting their mental well-being and influencing their future professional practice. This study aimed to describe the efforts, methods, and outcomes of interventions to help students in healthcare disciplines cope with the emotional experience of being involved in or witnessing a mistake causing harm to a patient during their clerkships or training.

METHODS

This systematic review followed the PRISMA guidelines and includes the synthesis of eighteen studies, published in diverse languages from 2011 to 2023, identified from the databases MEDLINE, EMBASE, SCOPUS and APS PsycInfo. PICO method was used for constructing a research question and formulating eligibility criteria. The selection process was conducted through Rayyan. Titles and abstracts of were independently screened by two authors. The critical appraisal tools of the Joanna Briggs Institute was used to assess the risk of bias of the included studies.

RESULTS

A total of 1354 studies were retrieved, 18 met the eligibility criteria. Most studies were conducted in the USA. Various educational interventions along with learning how to prevent mistakes, and resilience training were described. In some cases, this experience contributed to the student personal growth. Psychological support in the aftermath of adverse events was scattered.

CONCLUSION

Ensuring healthcare students' resilience should be a fundamental part of their training. Interventions to train them to address the second victim phenomenon during their clerkships are scarce, scattered, and do not yield conclusive results on identifying what is most effective and what is not.

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.

Negative association between workplace violence and patient safety behaviour in male, but not female, nursing interns: A cross-section study

AIM

The aim of the study was to compare the associations between workplace violence and patient safety behaviour between male and female nursing interns.

DESIGN

A cross-sectional survey.

METHODS

A cross-sectional survey was carried out at three general hospitals in Shandong Province in China to collect data from 466 nursing interns. We evaluated the associations between workplace violence and patient safety behaviours in men and women using multiple linear regressions.

RESULTS

Sex moderated the association between workplace violence and patient safety behaviour (B = 1.046, [SE = 0.477]; p = 0.029). Among male nursing interns, there was a significant association between workplace violence and patient safety (B = -1.353, 95% CI [-2.556, -0.151]; p = 0.028). In male nursing interns, verbal violence and sexual violence were significantly negatively associated with patient safety (B = -1.569, SE = 0.492, p = 0.002; B = -45.663, SE = 5.554, p < 0.001). No significant association was found in female nursing interns.

PATIENT OR PUBLIC CONTRIBUTION

This study did not have a patient or public contribution.

Workplace violence against nursing interns and patient safety: The multiple mediation effect of professional identity and professional burnout

BACKGROUND

Most nursing interns have suffered some form of workplace violence in clinical settings, which has been linked to the jeopardizing of patient safety. Although previous research studies have examined the effect of workplace violence on patient safety, few studies have examined whether workplace violence is associated with patient safety through professional identity and professional burnout among nursing interns.

AIMS

To test whether professional identity and professional burnout play mediating roles in the relationship of workplace violence and patient safety among nursing interns.

DESIGN

Cross-sectional study.

METHODS

The study included 466 nursing interns from three tertiary grade A hospitals. The Workplace Violence Scale, the Professional Identity Scale, the Maslach Burnout Inventory-General Survey, and the Patient Safety Behaviour Scale were used to gather data. Associations among workplace violence, professional identity, professional burnout, and patient safety were assessed by correlation and the serial-multiple mediation analysis.

RESULTS

Workplace violence, professional identity, professional burnout and patient safety were significantly correlated. Workplace violence can have a direct positive impact on patient safety of nursing interns, but also an indirect impact on patient safety through three paths: the independent mediating role of professional identity, the independent mediating role of professional burnout, and the chain mediating role of professional identity and professional burnout.

CONCLUSIONS

Our findings suggest that workplace violence can affect patient safety through decreasing professional identity and increasing professional burnout among nursing interns. Interventions aimed at decreasing workplace violence among nursing interns would be beneficial for professional attitude and patient safety.

Healthcare Students and Medical Residents as Second Victims: A Cross-Sectional Study

BACKGROUND

The term second victim (SV) describes healthcare professionals who remain traumatized after being involved in a patient safety incident (PSI). They can experience various emotional, psychological, and physical symptoms. The phenomenon is quite common; it has been estimated that half of hospital workers will be an SV at least once in their career. Because recent literature has reported high prevalence (>30%) among nursing students, we studied the phenomenon among the whole population of healthcare students.

METHODS

We conducted a cross-sectional study with an online questionnaire among nursing students, medical students, and resident physicians at the teaching hospital of the University of the Piemonte Orientale located in Novara, Italy. The study included 387 individuals: 128 nursing students, 174 medical students, and 85 residents.

RESULTS

We observed an overall PSI prevalence rate of 25.58% (lowest in medical students, 14.37%; highest in residents, 43.53%). Of these, 62.63% experienced symptoms typical of an SV. The most common temporary symptom was the feeling of working badly (51.52%), whereas the most common lasting symptom was hypervigilance (51.52%). Notably, none of the resident physicians involved in a PSI spoke to the patient or the patient's relatives.

CONCLUSION

Our findings highlighted the risk incurred by healthcare students of becoming an SV, with a possible significant impact on their future professional and personal lives. Therefore, we suggest that academic institutions should play a more proactive role in providing support to those involved in a PSI.

Profiling nursing students' dishonest behaviour: Classroom versus clinical settings

Background

While academic dishonesty among nursing students is becoming a global problem, the instruments used in studies on this topic are heterogeneous and, in many cases, not even validated. This makes it difficult or impossible to compare the findings on a global scale.

Objectives

To investigate the profile of Croatian nursing students’ dishonest behaviour in classroom and clinical settings and to examine the relationship between the incidence of dishonest behaviour in both settings.

Research design

A quantitative cross-sectional study using a Croatian online version of the Nursing Student Perceptions of Dishonesty Scale (overall Cronbach’s alpha 0.933).

Participants and research context

446 nursing students from a higher education institution in Croatia, EU, in the academic year 2020/21.

Ethical considerations

The study was approved by the relevant committee of the higher education institution.

Findings/results

Almost all participants (91.3%) performed dishonest behaviour on two or more occasions in the classroom and 32.5% did so in the clinical setting. The incidence of dishonest behaviour increased with the students’ year of BSc study (p = .008). All subscales of dishonest behaviour in the classroom were significantly and positively associated with dishonest behaviour in the clinical setting, except for the Not My Problem and Non-Compliance subscales.

Discussion

Based on these results, the following should be taken into consideration: 1) dishonest behaviour in the classroom is associated with dishonest behaviour in the clinical setting; 2) even the slightest occurrence of dishonest behaviour in the clinical setting can lead to fatal events.

Conclusions

The gradual increase in BSc nursing students’ dishonest behaviour with their year of study raises several questions regarding the development of ethical and moral values in this population. This raises the need for early and continuous exposure of students to ethical content from the beginning of their studies and support from competent educators.

Second victim phenomenon after patient safety incidents among Korean nursing students: A cross-sectional study

BACKGROUND

Perfectionism in the medical field turns healthcare professionals into second victims of patient safety incidents. They suffer physically and psychologically, which makes them consider changing occupations. Nursing students may also have similar negative experiences during clinical practice.

OBJECTIVE

To describe the second victim phenomenon among nursing students after patient safety incidents during their clinical practice.

DESIGN

A descriptive cross-sectional study using an online questionnaire.

SETTING AND PARTICIPANTS

Fourth-year nursing students (n = 354) who encountered patient safety incidents directly or indirectly during clinical practice. Participants were recruited through convenience and snowball sampling methods using personal contacts, professional networks, and online platforms.

METHODS

The questionnaire addressed the characteristics of patient safety incidents, and physical and psychological responses after the most significant patient safety incident. Descriptive statistics and a chi-square test were performed for data analysis.

RESULTS

Of the participants, 22.6% were directly involved in patient safety incidents and 77.4% had indirectly encountered patient safety incidents, such as witnessing incidents with colleagues or other healthcare professionals. After patient safety incidents, of those, 67.8% experienced shock at the time of the incident, 47.2% feared experiencing a similar incident, and 28.2% were still affected although time had passed. Additionally, 26.3% reported experiencing long-term embitterment; of them, 7.3% were experiencing severe embitterment. Furthermore, 31.9% and 27.1% of the students experienced sleeping and eating difficulties, respectively, and these rates were higher when incidents were encountered directly rather than indirectly.

CONCLUSIONS

Nursing students may become second victims of patient safety incidents during clinical practice. Therefore, nursing education institutions need to develop comprehensive support strategies to help nursing students cope with experiencing the second victim phenomenon.

What influences nursing safety event reporting among nursing interns?: Focus group study

BACKGROUND

Nursing safety events involving undergraduate nursing interns often occur but are under-reported. Only a few nursing schools have instituted formal reporting systems. The factors that affect reporting by undergraduate nursing interns are largely unknown.

OBJECTIVE

The study aimed to explore the barriers and incentives to nursing safety event reporting by nursing interns.

DESIGN

Focus groups were adopted to generate data for qualitative, thematic analyses.

SETTINGS

Focus groups were held in intern dormitories during evenings or weekends.

PARTICIPANTS

Purposive sampling strategies were employed. The participants were undergraduate nursing interns from one medical university in Fuzhou, China.

METHODS

A total of six focus groups were conducted. Semi-structured questions guided the groups.

RESULTS

Thirty-eight undergraduate nursing interns attended the groups. Barriers to nursing safety event reporting had five major themes: "Lack of knowledge," "Inconvenience of the reporting system," "Feeling of uncertainty and dishonor," "No benefit from reporting," and "Social influence." Incentives had three major themes: "Nursing safety event education," "Optimization of the reporting system," and "Anonymous reporting." Specific and targeted suggestions were considered, such as education by QQ or WeChat and the use of mobile devices.

CONCLUSIONS

Nursing schools need to establish nursing safety event reporting systems for interns, and this needs to be accomplished in cooperation with teaching hospitals to clarify duties and management responsibilities. Practical and targeted management strategies need to be developed to foster reporting, improve nursing safety culture, and promote hospital quality.