The impact of an innovative curriculum to introduce patient safety and quality improvement content

BACKGROUND

The Fuld Fellows Program provides selected pre-licensure nursing students with a foundation in the science of patient safety, quality improvement and leadership through coursework and a mentored experience working on a quality improvement project. We evaluated this program's impact on Fellows' patient safety competence and systems thinking.

METHODS

Cohorts I-VI (n = 116) completed pre-post program evaluation that included measurement of patient safety competence through the Health Professional Education in Patient Safety Survey (H-PEPSS) and systems thinking using the Systems Thinking Scale. Pre- and post-program H-PEPSS and Systems Thinking Scale scores were compared using the Wilcoxon Signed-Rank Test. The Fellows were compared to non-Fellows on patient safety competence and systems thinking using t-tests.

RESULTS

Patient safety competence on all H-PEPSS scales improved from baseline to end of program: teamwork (2.6 to 3.1), communication (2.1 to 3.2), managing risk (2.2 to 3.3), human environment (2.8 to 3.7), recognize and respond to risk (2.7 to 3.6), and culture (2.9 to 3.8) (p < 0.05). The Fellows, in comparison to the non-Fellows, reported a significantly higher (p < 0.05) mean change score in five of the six H-PEPSS subscales. Fellows' mean systems thinking score increased from 66 ± 7 at baseline to 70 ± 6 at program completion (p < 0.05), this mean post completion score was significantly higher than the non-Fellows reported mean STS score of 62 ± 7.

CONCLUSION

The Fuld Fellows Program effectively facilitated patient safety and quality improvement and systems thinking learning among pre-licensure nursing students. This program can serve as a model for integrating quality and safety concepts into health professionals' curricula.

[Effectiveness of educational interventions in children with chronic diseases and their parents]

OBJECTIVE

To evaluate the effectiveness of educational interventions in children with chronic illness and their parents.

METHODS

Fifty children with chronic illness and 75 parents participated in the study. Children who were hospitalized between August 2007 and January 2008 and their parents received educational sessions and those who were hospitalized between February and July 2007 and who did not receive the sessions served as the control group. The content of the educational sessions included knowledge of chronic disease, drugs and self-care, and coping skills. The knowledge level, stressors, coping strategies, and psychological conditions of children with chronic illness and their parents were evaluated before discharge and three months after discharge.

RESULTS

After educational interventions, the knowledge levels of children and their parents increased and the stressors decreased significantly in the intervention group compared with those in the control group. The children's parents in the intervention group used more active coping strategies (understanding the medical situations through communication with medical staff) than those in the control group. The differences in the medication compliance of children between the two groups were not found.

CONCLUSIONS

The educational interventions may result in an improved knowledge level and decrease stressors in children and their parents, and improve stress coping strategies in parents. There is no evidence that the educational intervention can improve the psychosocial conditions of children and their parents.

[Stressors, coping strategies and psychosocial state of children with chronic illness]

OBJECTIVE

Identifying the stressors, coping strategies, and psychosocial state of children with chronic illness would be very useful to help them to adapt to chronic medical conditions. This study aimed to investigate the stressors, coping strategies, and psychosocial state of Chinese children with chronic illness.

METHODS

Two hundred and three children with chronic illness and aged 8-16 years were administered a semi-structured interview for the identification of stressors. Children's coping strategies and psychosocial state were investigated by the Coping with a Disease (CODI) scale, the Screen for Child Anxiety Related Emotional Disorders (SCARED) scale, and the Depression Self-rating Scale for Children (DSRSC).

RESULTS

The stressors in children with chronic illness mainly included four aspects: school performance, medication and treatment, daily life, and peer relationships. "Wishful thinking" was the most common coping strategy, followed by "acceptance". "Negative emotional reaction" was rarely seen in children with chronic illness. The scores of anxiety and depression scales of children with chronic illness were higher than those of the norm. The prevalence of anxiety disorders was 43.8%, the prevalence of depression disorders was 30.0%, and 26.1% of the children had both anxiety and depression disorders.

CONCLUSIONS

Children with chronic illness have many stressors. Though they usually use active coping strategies, the prevalence of anxiety disorders and the prevalence of depression disorders were high.

Psychological adjustment in young children with chronic medical conditions

Children with chronic medical conditions are at higher risk for behavioral and emotional problems compared to physically healthy children. This study used a conceptual model to examine factors associated with psychological adjustment in children aged 7-11 years old with any of four chronic illnesses. The variables most closely associated with child adjustment included the following: mothers' evaluation of the impact of the child's illness on the family; child's perceptions of parental acceptance; and child's self-perceptions of physical appearance, social acceptance, and athletic competence. These findings confirm the importance of maternal and child perceptions in understanding the psychological adjustment of children with chronic conditions.