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.

Implementing Just Culture to Improve Patient Safety

INTRODUCTION

The number of deaths in the United States related to medical errors remains unacceptably high. Further complicating this situation is the problem of underreporting due to the fear of the consequences. In fact, the most commonly reported cause of underreporting worldwide is the fear of the negative consequences associated with reporting. As health care organizations along the journey to high-reliability strive to improve patient safety, a concerted effort needs to be focused on changing how medical errors are addressed. A paradigm shift is needed from immediately assigning blame and punishing individuals to one that is trusting and just. Staff must trust that when errors occur, organizations will respond in a manner that is fair and appropriate.

MATERIALS AND METHODS

An extensive review of the literature from 2017 until January 2022 was conducted for the most current evidence describing the principles and practices of "just culture" in health care organizations. Additionally, recommendations were sought on how health care organizations can go about implementing "just culture" principles.

RESULTS

Twenty sources of evidence on "just culture' were retrieved and reviewed. The evidence was used to describe the concept and principles of "just culture" in health care organizations. Furthermore, five strategies for implementing "just culture" principles were identified.

CONCLUSIONS

Improving patient safety requires that high-reliability organizations strive to ensure that the culture of the organization is trusting and just. In a trusting and just culture, adverse events are recognized as valuable opportunities to understand contributing factors and learn rather than immediately assign blame. Moving away from a blame culture is a paradigm shift for many health care organizations yet critically important for improving patient safety.

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.].

Strategies and interventions for improving safety culture in Australian Emergency Departments: A modified Delphi study

BACKGROUND

Patient safety and safety culture are critical for quality healthcare delivery in general and in Emergency Departments (EDs) in particular. The aim of this study is to identify strategies that may contribute to the improvement and maintenance of patient safety culture and which are considered most feasible in the ED environment.

METHODS

A two-step modified Delphi method with 11 experts' panel was performed to establish consensus. A list of potential expert participants with a background in patient safety culture in EDs was compiled through the professional networks of the supervisory team. Snowball sampling was used to identify additional possible participants. The expert panel included key leaders in the emergency medicine community in Queensland, Australia: patient safety experts and researchers, patient safety directors, and healthcare providers in an Australian ED The study ran from September 2018 to December 2018. The tool used in Round 1 in this study was developed through triangulating the outcomes of a review of literature, results from a survey of ED staff and findings from semi-structured interviews with key stakeholders in ED. The results from Round 1 informed the development of the Round 2 tool. The responses from the Delphi Round 1 tool were analysed as both qualitative data and quantitative data. The responses from the Delphi Round 2 tool were treated as quantitative data and analysed with the SPSS software. Consensus was calculated based on more than 80% agreement in collapsed categories 1 and 2 (or 4 and 5) of the five-point Likert scale.

RESULTS

Only six strategies out of 17 (35%) achieved consensus for both importance and feasibility. These strategies may therefore be considered the most important and feasible key strategies for improving safety culture in EDs. Seven strategies (41.1%) achieved consensus for importance, but not for feasibility and four strategies (23.55%) did not achieve consensus for either importance or feasibility.

CONCLUSIONS

This study offers practical solutions for safety culture improvement in the ED context. Six key strategies were seen as both important and feasible and these grouped into three main themes; leadership through agenda setting, operational management approaches to reinforce the agenda and commitment, and systems and structures to reinforce the agenda and monitor progress.