Shared learning from national to international contexts: a research and innovation collaboration to enhance education for patient safety

The influence of supervisory support on clinical learning as experienced by Czech Nursing and health professional students in the context of patient safety events: A qualitative study

AIM

To explore the influence of supervisory and mentoring relationships on the clinical learning experiences of Czech Nursing and health professional students in the context of patient safety events BACKGROUND: Clinical experience is integral to healthcare education, shaping skills, behaviours, values and professional identity. During clinical placements, students may encounter memorable patient safety events and experience varied reactions from mentors/supervisors/others. Some research has highlighted challenges faced by students on clinical placement. Few studies involve multiple professions, most emanating from Western Europe, the UK, the USA and Australia with little relating to central European countries such as the Czech Republic.

DESIGN

Two stage interpretivist qualitative study based in social constructionism METHODS: Convenience sample across 13 undergraduate and 18 postgraduate health professions courses. Stage 1 (2022): using SLIPPS Learning Event Recording Tool translated into Czech. 20 students' (Midwifery=11, Nursing=1, Paramedic=1, Occupational therapy =7) submitted 21 patient safety learning event narratives. Stage 2 (2022): Focus group with 2 nursing and nine midwifery students. Phased thematic analysis involving multiple researchers.

RESULTS

Three themes illustrate the circumstances and impact of placement mentoring/supervision experiences, conceptualised as: 'Clinical and Emotional Companionship', 'Clinical and Emotional Abandonment' and 'Sense of agency - Professional and personal growth'. 'Companionship' reflected the students' feelings of being welcomed, respected, heard, trusted and supported. Conversely 'abandonment' emerged from feelings of being unheard, vulnerable, humiliated, afraid, leaving students feeling abandoned, lonely and 'useless'. Notwithstanding these conditions, students showed the ability to identify patient safety issues with agency evident in reactions such as stepping-in to try to ameliorate a situation, rather than speaking-up. Professional and personal growth was also apparent in their narratives and a conceptual diagram illustrates the students' learning journeys in a patient safety context.

CONCLUSION

The findings and new conceptualisations around abandonment and companionship emerging from this study expand the evidence base regarding the profound impact of clinical experience and mentorship/supervision on learning and students' emotional wellbeing. A sense of companionship appears to play a buffering role even in challenging circumstances of involvement in or witnessing compromised patients' safety. Allowing students a sense of belonging, to vent, grow, feel supported and safe to ask/learn - contributing to 'emotional safety for learning', promotes students' behaviour that may prevent/minimize hazards or ameliorate the aftermath. However, we must not simply blame mentors/supervisors, staff, or the students themselves- they are simply part of a much larger complex environment of professional education encompassing hidden curriculums, power dynamics and professional socialisation.

Nursing students' evaluation of patient safety culture in three central European countries: a cross-sectional study

OBJECTIVES

This cross-sectional study aimed to investigate and compare the perceptions of nursing students regarding patient safety culture (PSC) during the COVID-19 pandemic in three Central European countries.

METHODS

Data were collected from 624 nursing students between April and September 2021 using the Hospital Survey on Patient Safety Culture.

RESULTS

The evaluation of the PSC dimensions did not reach the expected level of 75 %. Significant associations were found between the perception of the dimensions of the individual PSC and age, student status, study year, and clinical placement. The overall patient safety grade, the number of events reported, and the number of events reported by nursing students were significantly predicted by several dimensions of the PSC (p<0.05).

CONCLUSIONS

The evaluation of patient safety culture by nursing students offers a unique perspective. Students come with 'fresh eyes' and provide different perspectives that can provide healthcare leaders with a practical opportunity to identify blind spots, review and improve safety protocols, and foster a more inclusive culture that prioritizes patient safety.

Quality and safety education for nurses: A bibliometric analysis

PURPOSE

Since its origin in the United States in 2005, Quality and Safety Education for Nurses (QSEN) has guided nurses' preparation for alleviating preventable harm and improving quality safe care. QSEN's value is illustrated through specific inclusion in the competency-based 2021 American Association for Colleges of Nursing (AACN) Essentials. The purpose of this bibliometric analysis is to explore publication patterns of the extant QSEN literature to assess QSEN's spread and global penetration and to map the available knowledge and data regarding quality and safety education for nurses.

DESIGN

Bibliometric analysis.

METHOD

Two QSEN investigators and two health science librarians completed database searches to identify articles with keywords QSEN or Quality and safety education for nursing. Inclusion criteria were (1) QSEN-specific and (2) published in a peer-reviewed journal. Using PRISMA screening, the final sample included 221 articles between 2007 and 2021.

RESULTS

Average annual QSEN publications was 14.5 articles; the highest was 26 publications in 2017. Article types were 84 research, 77 descriptive/reviews, 28 quality improvement projects or case studies, 20 statements, and 12 editorials. Focus analysis revealed 165 education articles, 35 clinical practice, 17 professional development, and 4 leadership/administration. Fourteen journals published three or more; eight were education journals. Nine topic clusters indicated areas of publication focus, including clinical teaching, simulations, performance, context, and criteria of analysis, factors of efficacy, innovation and advanced practice, patient care and outcomes, academic concepts, and research frameworks.

CONCLUSIONS

Results reveal far less QSEN penetration for guiding professional practice, research measuring outcomes and impact, and global collaboration to examine cultural implications for diversity and inclusion. Results present future recommendations to assure all nurses worldwide have access to competency development to alleviate preventable healthcare harm.

CLINICAL RELEVANCE

Originating in the United States (US), the QSEN project provided the seminal framework for transforming education and practice through defining the six quality and safety competencies (patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics) essential to alleviate preventable healthcare harm. Results reveal opportunities to advance QSEN penetration in developing professional practice, guiding research measuring outcomes and impact, and extending global collaboration to examine cultural implications for diversity and inclusion.

Patient safety topics, especially the second victim phenomenon, are neglected in undergraduate medical and nursing curricula in Europe: an online observational study

This study aims to assess the inclusion of second victims and other patient safety issues in the curricula of undergraduate medical and nursing degrees in the countries participating in the European Researchers' Network Working on Second Victims (The ERSNT Consortium, COST Action 19,113). A review of medical and nursing school curricula in 206 universities was carried out, using their websites to search for subjects addressing "patient safety", "quality of care", "risk management", "safe practices", "interprofessional communication", "adverse events", and "second victims". There was substantial variability in the extent of training for patient safety. Forty-four out of 88 nursing schools and 74 of 118 medical schools did not include any of the patient safety topics studied. The most frequent in both nursing and medicine was "interprofessional communication", followed by "quality of care" and basic aspects on "patient safety". The second victim phenomenon was present in only one curriculum of the total sample. Our study showed that patient safety, especially the second victim phenomenon, is still neglected in medical and nursing curricula in European universities, although positive initiatives were also found. Given the frequency with which adverse events occur in health centres and the need to prepare students to deal with them adequately, additional efforts are needed to introduce patient safety elements into medical and nursing education.

Prehospital nursing students' experiences of patient safety culture in emergency medical services-A qualitative study

AIMS AND OBJECTIVES

To describe prehospital nursing students' experiences of patient safety culture in emergency medical services during their internship.

BACKGROUND

Patient safety culture in the emergency medical services is a complex phenomenon including more than organisational policies and practices and professionals' technical skills.

DESIGN

The descriptive qualitative approach used the Sharing Learning from Practice to improve Patient Safety Learning Event Recording Tool, which includes both open-ended and structured questions.

METHODS

Purposeful sampling was used, and data were collected from graduating prehospital nursing students (n = 17) from three Finnish Universities of Applied Sciences. Open-ended questions were reviewed using thematic analysis, and frequencies and percentages were derived from structured questions. COREQ guidelines were used to guide this study.

RESULTS

Four themes were identified during the thematic analysis: environmental and other unexpected factors in emergency medical services, working practices and professionalism in emergency medical services, teamwork in emergency medical services and feelings related to patient safety events in emergency medical services. Patient safety events described by students were seldom reported in the healthcare system or patient files. According to the students, such events were most likely related to communication, checking/verification and/or teamwork.

CONCLUSIONS

This study shows that prehospital nursing students can produce important information about patient safety events and the reasons that contributed to those events. Therefore, emergency medical services organisations and managers should use students' observations to develop a patient safety culture in emergency medical services.

RELEVANCE TO CLINICAL PRACTICE

Understanding how prehospital nursing students have experienced patient safety culture during their internships on ambulances can support educational institutions, together with emergency medical services organisations and managers, to improve policies for students to express patient safety concerns as well as patient safety successes.

A qualitative exploration of undergraduate nursing students' experience of emotional safety for learning during their clinical practice

BACKGROUND

During their clinical practice, nursing students learn to manage patient safety through their experiences, emotions, and interpersonal relationships.

OBJECTIVES

To explore contextual and mechanistic factors that facilitate a sense of emotional safety for learning in nursing students, particularly regarding patient safety events experienced during their placements.

DESIGN

A descriptive qualitative study using narratives and thematic analysis.

SETTINGS

A university in Northern Italy.

PARTICIPANTS

Undergraduate nursing students recruited through purposive sampling.

METHODS

Twenty cases relevant to the present study were selected from the "Sharing LearnIng from Practice for Patient Safety" (SLIPPS) project database containing 100 narratives collected using the patient safety learning Event Recording Tool. The data were analysed using thematic analysis according to Braun & Clarke's methodology. The themes that emerged from the thematic analysis were rearranged in Context-Mechanism-Outcomes.

RESULTS

Students identified clinical practice experiences as important occasions for their personal and professional development. Emotional safety and tutoring were the elements that effectively "govern" the students' learning and development process.

CONCLUSIONS

Emotional safety is key for nursing students because it enables them to constructively overcome any relational and emotional tensions that may develop during their clinical placements.

Learning From Student Experience: Development of an International Multimodal Patient Safety Education Package

BACKGROUND

Patient safety is a global concern. Learning to provide safe, high-quality care is core to nursing education.

PROBLEM

Students are exposed to diverse clinical practices, and experiences may vary between placements and across countries. Student experience is seldom used as an educational resource.

APPROACH

An international, European Union-funded project, Sharing Learning from Practice for Patient Safety (SLIPPs), aimed to develop an innovative online educational package to assist patient safety learning. Based on student reported data and educational theory, multiple elements were iteratively developed by a multicountry, multidisciplinary group.

OUTCOMES

The educational package is freely available on the SLIPPs Web site. Materials include a student reporting and reflection tool, virtual seminars, student reports data set, pedagogical game, high-fidelity simulation scenarios, scenario development and use guidelines, debriefing session model, and videos of simulations already performed.

CONCLUSIONS

E-learning enables removal of physical barriers, allowing educators, professionals, and students from all over the world to collaborate, interact, and learn from each other.

Development of an International Tool for Students to Record and Reflect on Patient Safety Learning Experiences

BACKGROUND

Underpinning all nursing education is the development of safe practitioners who provide quality care. Learning in practice settings is important, but student experiences vary.

PURPOSE

This study aimed to systematically develop a robust multilingual, multiprofessional data collection tool, which prompts students to describe and reflect on patient safety experiences.

APPROACH

Core to a 3-year, 5-country, European project was development of the SLIPPS (Sharing Learning from Practice for Patient Safety) Learning Event Recording Tool (SLERT). Tool construction drew on literature, theory, multinational and multidisciplinary experience, and involved pretesting and translation. Piloting included assessing usability and an initial exploration of impact via student interviews.

OUTCOMES

The final SLERT (provided for readers) is freely available in 5 languages and has face validity for nursing across 5 countries. Student reports (n = 368) were collected using the tool.

CONCLUSIONS

The tool functions well in assisting student learning and for collecting data. Interviews indicated the tool promoted individual learning and has potential for wider clinical teams.

Development of a clinical learning model to enhance patient safety awareness competency among Thai nursing students

Background

Enhancing patient safety awareness competency in nursing students is a necessity as they will be the next generation of professional nurses to take care of patients. One of the strategies is to create an innovative learning model using questioning as part of the metacognitive thinking concept.

Objective

This study aimed to develop a clinical learning model to enhance patient safety awareness competency among Thai nursing students and determine its effectiveness.

Methods

The study used a research and development design with two phases: (1) the development of a clinical learning model to enhance patient safety awareness competency among nursing students, and (2) the evaluation of the effectiveness of the developed clinical learning model. The evaluation was done quantitatively and qualitatively. In the quantitative strand, a quasi-experimental method using repeated measures design was used in 24 students. While in the qualitative strand, a qualitative descriptive design was employed in 24 students and three teachers.

Results

In the first phase, the DUIR clinical learning model was developed, consisting of four processes: 1) Doubt (D), 2) Understanding (U), 3) Insight (I), and 4) Reflected value (R). The patient safety awareness competency included two components: managing patient safety and solving problems related to unsafe patient care. In the second phase, the model was evaluated by the students and the teachers. It revealed that nursing students' patient safety awareness competency was very high, and the competency was statistically different before and after the learning model.

Conclusion

The developed DUIR learning model using a questioning strategy is considered effective to encourage students to reflect critically on their own clinical experiences in order to achieve quality and safe care outcomes, thereby enhancing patient safety awareness for nursing students in a sustainable way. This model serves as an input for Thai nursing education and beyond.

Student outcomes of an international learning collaborative to develop patient safety and quality competencies in nursing

Background

Patient harm is a global crisis fueling negative outcomes for patients around the world. Working together in an international learning collaborative fostered learning with, from and about each other to develop evidence-based strategies for developing quality and safety competencies in nursing.

Aims

To report student outcomes from an international learning collaborative focused on patient safety using the Quality and Safety Education for Nurses competency framework.

Methods

A global consortium of nursing faculty created an international learning collaborative and designed educational strategies for an online pre-workshop and a 10-day in-person experience for 21 undergraduate and graduate nursing students from six countries. A retrospective pre-test post-test survey measured participants' confidence levels of patient safety competence using the health professional education in patient safety survey and content analysis of daily reflective writings.

Results

Statistical analysis revealed student confidence levels improved across all eight areas of safe practice comparing-pre and post-education (significance, alpha of P < 0.05). Two overarching themes, reactions to shared learning experiences and shared areas of learning and development, reflected Quality and Safety Education for Nurses competencies and a new cultural understanding.

Conclusions

The international learning collaborative demonstrated that cross-border learning opportunities can foster global development of quality and safety outcome goals.

Influence of "RAP" experiences on nursing students' career choices in aging: A qualitative exploration

BACKGROUND

Healthcare professions are ever challenged to meet the demands of a global aging society. Educators across the helping professions continuously explore ways to motivate students' interest in caring for older adults. Given new undergraduate nursing curriculum changes, increased demand for creative outpatient educational opportunities for clinical gerontological experiences has put tremendous urgency on all healthcare stakeholders.

OBJECTIVE

To analyze students' perceptions of clinical experiences at the Robust Aging Program clinic, a community wellness outpatient senior center.

DESIGN

Qualitative study using semi-structured interviews, exploring students' perspectives on whether they would consider gerontology/geriatrics-related careers.

SETTING

University extension senior clinic, serving Osher Lifelong Learning Center members who attend the Robust Aging Program, a School of Nursing community service.

METHOD

IRB-approved semi-structured interviews were conducted by phone and Zoom within a year of clinic experience. Preset questions centered on students' clinic experiences. Trained research assistants working under the guidance of a qualitative researcher collected and analyzed and categorized common and emergent themes.

PARTICIPANTS

13 undergraduate nursing students who volunteered in the clinic in current or previous semesters. Students were about to graduate or new alumni; working nurses came from different specialties, including pediatrics.

RESULTS

Clinical immersion in a nurse-led senior wellness clinic that entailed close interactions with robustly aging adults increased students' knowledge and skills and their willingness to work with the aged. Mentorship was noted as a key emergent theme.

CONCLUSIONS

Exposure to community outpatient clinical experiences can spark interest in working with older adults. This is especially true of advanced practice nurse-led wellness clinics where students receive mentorship and are empowered to exercise holistic care. Further research is needed to determine educators', clinicians', and administrators' roles in sustaining students' interest in gerontology-related careers.

The knowledge about patient safety among undergraduate nurse students in Cyprus and Greece: a comparative study

BACKGROUND

The Patient safety movement contributed to the reduction of preventable adverse events associated with health care. Although patient safety issues have received the attention of educators in the health care studies, there is evidence that in nursing education and the associated curricula it is not well-incorporated. This may not allow students to acquire scientific knowledge and develop strong competencies to assure patient safety throughout their professional life. The aım of the study was the exploration of the undergraduate nursing student perspectives regarding knowledge received during their training about patient safety-related issues.

METHODS

A descriptive comparative study was conducted with three and four-year undergraduate nursing students from the Cyprus Republic (n = 243) and Greece (n = 367). All students were surveyed using the Health Professional Education Patient Safety Survey (H-PEPSS) to describe students' knowledge in the classroom and clinical setting.

RESULTS

Students' Knowledge about patient safety was expressed significantly higher (p < 0.001) in the classroom (mean = 4.0) than the clinical setting (3.7) (1-5 scale). The knowledge in the dimension "clinical aspects" received the highest score and "working in teams" received the lowest. Also, differences were recorded between countries wıth Cypriot students reporting hıgher level of knowledge than the Greek students in most of the dimensions. CONCLUSıON: The findings revealed the gap between theory and practice and the need for collaboration between the two settings. Also, students reported relatively higher knowledge with regards to the technical aspects of patient safety. Still, they were less knowledgable about the sociocultural aspects of the patient, such as working in teams.