Using quality and safety education for nurses to guide clinical teaching on a new dedicated education unit

Gaps exist in health professional education versus the demands of current practice. Leveraging front-line nurses to teach students exemplary practice in a Dedicated Education Unit (DEU) may narrow this gap. The DEU is an innovative model for experiential learning, capitalizing on the expertise of staff nurses as clinical teachers. This study evaluated the effectiveness of a new academic-practice DEU in facilitating quality and safety competency achievement among students. Six clinical teachers received education in clinical teaching and use of Quality and Safety Education for Nurses (QSEN) competencies to guide acquisition of essential knowledge, skills, and attitudes for continuous health care improvement. Twelve students assigned to the six teachers completed daily logs for the 10-week practicum. Findings suggest that DEU students achieved QSEN competencies through clinical teacher mentoring in interdisciplinary collaboration, using electronic information for best practice and patient teaching, patient/family decision making, quality improvement, and resolution of safety issues.     

Evidence‐based medicine: A cornerstone for clinical care but not for quality improvement

Quality improvement (QI) as a clinical improvement science has been criticized for failing to deliver broad patient outcome improvement and for being a top‐down regulatory and compliance construct. These critics have argued that the focus of QI should be on increasing adherence to clinical practice guidelines (CPGs) and, as a result, should be consolidated into research structures with the science of evidence‐based medicine (EBM) at the helm. We argue that EBM often overestimates the role of knowledge as the root cause of quality problems and focuses almost exclusively on the effectiveness of care while often neglecting the domains of safety, efficiency, patient‐centredness, and equity. Successfully addressing quality problems requires a much broader, systems‐based view of health‐care delivery. Although essential to clinical decision‐making and practice, EBM cannot act as the cornerstone of health system improvement.     

对护理实习生进行安全文化教育的方法及效果

目的探讨对护理实习生进行安全文化教育的方法及效果。方法在359名护理实习生临床实习岗前培训中加入28学时安全文化教育培训,在实习期间组织学生参加院内的安全分析及护理不良事件讨论会。比较培训后3个月与培训前学生的患者安全文化知识及护理不良事件认知情况;与上届学生对比临床实习前6个月发生患者安全及护理不良事件的情况。结果培训后3个月学生的患者安全文化知识及护理不良事件认知情况优于培训前(P<0.01);经过培训的学生临床实习前6个月患者安全及护理不良事件发生率低于上届未经过培训的学生(P<0.05)。结论院校和教学医院应积极对护理实习生进行安全文化教育,以提高学生对患者安全文化知识及护理不良事件认知,减少护理不良事件的发生。     

Second-year undergraduate nursing students’ experiences with clinical simulation training in mental health clinical practice: A focus group study

AimThe aim of this focus group study was to investigate second-year undergraduate nursing students’ experiences with clinical simulation training as part of their clinical practice in acute mental health care.BackgroundThe quality of bachelor programmes in nursing has been criticised for lacking theoretical and experiential learning in the mental health modules. Novice nurses feel unprepared to care for patients with mental health challenges and graduate nurses are reported to lack the necessary knowledge and skills to manage patients with mental health issues confidently and competently. Clinical simulation training can facilitate the teaching of clinical and non-clinical skills simultaneously and is a highly suitable method within mental health care for addressing gaps in knowledge and skills in communicating with patients. Clinical simulation training may enhance nursing students' competence and thereby reduce the risk of adverse events and increase safety. However, we know little about undergraduate nursing students’ experiences with clinical simulation training as an integrated part of nursing students’ clinical practice in acute mental health wards.DesignExplorative qualitative focus group study.MethodThree focus group interviews were conducted using a semi-structured interview guide with second-year undergraduate nursing students from a university in Norway during spring 2020. In total, 14 students who had experienced clinical simulation training as part of their mental health clinical practice participated in the study. The collected data were analysed using systematic text condensation.ResultsClinical simulation training as part of the clinical practice increased the students’ preparedness, coping and self-awareness. Most of the participants had positive perceptions of the use of high-fidelity simulation-based learning. Furthermore, they highlighted three elements that increased the value of the training. First, the simulation felt authentic and increased their professional skills. Second, the standardised patient had clinical qualifications, which made the simulation feel authentic and close to realistic situations. Third, not having a former relationship with the person acting as the standardised patient enhanced authenticity.ConclusionClinical simulation training as part of clinical practice contributed to increasing the students’ self-awareness and in-depth reflection and to broadening their nursing competence. The present study lays the groundwork for future studies on clinical simulation training in mental health clinical practice for nursing students.     

Family and Community Responses to Mental Illness

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) found that 65% of medical sentinel events or medical errors are associated with communication breakdowns. In addition to the JCAHO, The Institute of Medicine, in their Core Competencies for health care professional education, recommend improvement in professional communication, collaboration, and a patient-centered approach to provide safety. Consistency of opportunities for students to practice their communication and collaboration skills is limited based on the variety of clinical experiences that are available. Simulation would provide consistency in students’ experiences. Students can practice giving a structured report, providing and receiving peer feedback, and obtaining patient feedback in a safe setting through a simulation experience. A structured hand-off shift report using a technique such as SBAR communication has been found to improve patient safety in health care environments. This paper examines the implementation of a simulation experience for students taking a Mental Health course in a Bachelor of Science in Nursing (BSN) Program to support their practice of patient and professional communication, as well as, collaboration skills with a patient-centered approach using a standardized patient simulation.     

Clinical leadership: using observations of care to focus risk management and quality improvement activities in the clinical setting

In an era when patient safety and quality of care are a daily concern for health care professionals, it is important for nurse managers and other clinical leaders to have a repertoire of skills and interventions that can be used to motivate and engage clinical teams in risk assessment and continuous quality improvement at the level of patient care delivery. This paper describes how a cohort of clinical leaders who were undertaking a leadership development program used a relatively simple, patient-focused intervention called the 'observation of care' to help focus the clinical team's attention on areas for improvement within the clinical setting. The main quality and safety themes arising out of the observations that were undertaken by the Clinical Leaders (CLs) were related to the environment, occupational health and safety, communication and team function, clinical practice and patient care. The observations of care also provided the CLs with many opportunities to acknowledge and celebrate exemplary practice as it was observed as a means of enhancing the development of a quality and safety culture within the clinical setting. The 'observation of care' intervention can be used by Clinical Leader's to engage and motivate clinical teams to focus on continuously improving the safety and quality of their own work environment and the care delivered to patients within that environment.     

Safety Culture and Care: A Program to Prevent Surgical Errors

Surgical errors are under scrutiny in health care as part of ensuring a culture of safety in which patients receive quality care. Hospitals use safety measures to compare their performance against industry benchmarks. To understand patient safety issues, health care providers must have processes in place to analyze and evaluate the quality of the care they provide. At one facility, efforts made to improve its quality and safety led to the development of a robust safety program with resources devoted to enhancing the culture of safety in the Perioperative Services department. Improvement initiatives included changing processes for safety reporting and performance improvement plans, adding resources and nurse roles, and creating communication strategies around adverse safety events and how to improve care. One key outcome included a 54% increase in the percentage of personnel who indicated in a survey that they would speak up if they saw something negatively affecting patient care.     

The moral imperative of designating patient safety and quality care as a national nursing research priority

Since the early 1990s, research studies conducted respectively in the USA, UK and Australia have found that between 4 and 16.6 per cent of patients suffer from some kind of harm (including permanent disability and death) as a result of human errors and adverse events while in hospital. It has been further estimated that approximately 50 per cent of these human errors/adverse events resulting in harm could have been prevented. In response to the significant financial, social, and political implications of these figures, a range of processes have been put in place in an attempt to improve patient safety and quality care in Australia. Nonetheless, it is evident that more can be done to improve the status quo. One process that warrants consideration is that of peak health professional groups and organisations providing active leadership in the promotion of patient safety, such as by making a visible and recognisable commitment to patient safety as a strategic research priority area. In this paper it is contended that, given the moral importance of patient safety and quality care in nursing and related health care domains, the inseparable link between nursing practice and patient safety, and the central role that research has to play in driving safety improvements in these domains, it is morally imperative that the nursing profession gives sustained and focussed public attention to patient safety and quality care as a national research priority.     

Teaching quality improvement in the classroom and clinic: getting it wrong and getting it right

The world in which today's graduates will provide care is changing, as are expectations about caregivers' performance. Learning how to improve quality of care must occur during, and as part of, learning about patient care. In this article, I describe a continuous quality improvement learning program that was integrated into nursing students' education and a study evaluating the students' experiences with the implementation of the program through open-ended questions and focus groups. The program consisted of three parts: participating in a personal improvement project; observing and describing a patient process from the patient's perspective; and working in teams with process improvement in clinical practice. The findings indicated the students learned improvement methods and tools during their personal improvement projects, but their ability to translate that knowledge into action, and thereby improve patient care, was insufficiently developed through coaching, reflection, and role modeling. In other words, the experience was not integrated into the students' general education. In addition, faculty and clinical staff did not seem to be adequately informed and had limited knowledge of the students' clinical improvement projects.     

Maintaining vigilance to promote best outcomes for hospitalized elders

This article presents contemporary evidence regarding the promotion of a culture of caring for hospitalized older persons through nursing vigilance. A summary of the literature regarding the need for vigilance, what to be vigilant about, and how vigilance can be enhanced for hospitalized older persons is provided, as well as recommendations for practice, education, research, and policy. Evidence indicates that vigilance is enhanced by having nurses who have specialized knowledge to differentiate normal aging from abnormal pathology, and who use point-of-care information, electronic health records, patient care information systems, and computerized adverse events detection systems to monitor symptoms and outcomes and prevent errors. The use of specialized models of patient care and adequate nurse-patient staffing also have been shown to prevent errors and improve patient outcomes.     

Exploring assessment policies for clinical practice: A scoping review of the literature

BackgroundAssessment of pre-registration nursing students in clinical practice is an essential process, ensuring students who graduate meet standards for practice and competently and safely care for patients under their care. However, such assessment remains challenging for individuals and organisations.AimWe aimed to investigate what is known about the application of clinical placement assessment policies guiding pre-registration nursing programmes.MethodsArskey and O’Malley’s five-stage method for scoping reviews was employed. Health and education databases were searched in July 2020 and December 2021. Identified papers were screened. The Joanna Briggs Institute’s critical appraisal tools were used to appraise the quality of the included articles. The Invitational Theory domains of people, processes, programmes, places, and policies were utilised to aid meaningful analysis of the findings.FindingsNineteen articles were appraised: eleven primary data studies, two that psychometrically tested a survey instrument, four discussion articles, and two literature reviews. Article quality varied widely. Three themes were identified: lack of processes around clinical practice, people and clinical practice, and policies and clinical practice.DiscussionAssessment within placement is complex and unique. Uncertainty permeates the literature around assessment of pre-registration students in clinical practice. There is a clear need to promote policies that highlight differences between theoretical and practice assessment, ensuring all stakeholders can access relevant governance processes that support patient safety.ConclusionMore empirical evidence is needed to develop policies and processes that reduce uncertainty and improve patient safety associated with student assessment within clinical placements.     

Catching and correcting near misses: the collective vigilance and individual accountability trade-off

Despite the focus on patient safety and quality health care for the last two decades, there is still limited understanding of how interprofessional interactions at an organizational or work unit level influence how clinicians perceive and respond to safety events and errors. Within the rubric of safety events, there has been a growing interest in near misses as precursors to adverse events in health care. Given the interactive nature of the variety of professionals working together in the delivery of health care, understanding how the different clinicians experience and respond to near misses in practice is important. A constructivist grounded theory approach was employed for this study which included semi-structured interviews with 24 participants in a large teaching hospital in Canada. Findings from this study provide a deeper understanding into how different clinicians experience and respond to near misses in clinical practice. This understanding indicates that collective vigilance can potentially create risk by eroding individual professional accountability through reliance on other team members to catch and correct their errors. Further research is needed to explore in more depth the trade-offs between collective vigilance and individual accountability by relying on others to catch and correct the potentially harmful errors and avert negative outcomes.     

Interprofessional education: Lessons learned from conducting an electronic health record assignment

Abstract

Ineffective collaboration and communication contribute to fragmented patient care and potentially increase adverse events, clinical errors, and poor patient outcomes. Improving collaboration and communication is essential; however, interprofessional education (IPE) supporting this cause is not a common practice. Most often healthcare profession students are educated in profession-centered silos limiting opportunities to develop effective communication and collaboration practices. Students from nursing, health informatics, and radiologic technology collaboratively populated an academic electronic health record (AEHR) using fictitious case study data. The assignment was designed to address the Quality and Safety Education for Nurses and IPE Collaborative competencies. The objective was to evaluate students’ informatics competency, teamwork behaviors, and communication skills while exploring the different roles and responsibilities for collaborative practice after participating in an interprofessional case study assignment. Students gained experience using the AEHR for data entry, analysis, and application increasing their informatics competency. The assignment required students to communicate and actively collaborate as an interprofessional team to achieve the assignment objectives. Clinical errors often occur during care transitions, so simulating this process in the assignment was essential. Nursing and radiologic technology students had to analyze patient data and develop a hand-off communication template supporting patient safety and optimizing outcomes. The assignment required students to work as an interprofessional team and demonstrate how communication and collaboration is an essential component to quality and safe patient care.     

Patient safety: do nursing and medical curricula address this theme?

In this literature review, we examine to what extent patient safety is addressed within medical and nursing curricula. Patient safety is the foundation of healthcare practice and education both in the UK and internationally. Recent research and policy initiatives have highlighted this issue. The paper highlights the significance of this topic as an aspect of study in its own right by examining not only the fiscal but also the human costs such events invite. In the United Kingdom patient safety issues feature prominently in the (Department of Health, 2000a. An organisation with a memory. The report of an expert group on learning from adverse events. The Stationery Office, London, Department of Health, 2000b. Handling complaints: monitoring the NHS complaints procedures (England, Financial year 1998-99). The Stationery Office, London.) policy documentation but this is not reflected within the formal curricula guidelines issued by the NMC and GMC. Yet if healthcare educational curricula were to recognise the value of learning from errors, such events could become part of a wider educational resource enabling both students and facilitators to prevent threats to patient safety. For this reason, the paper attempts to articulate why patient safety should be afforded greater prominence within medical and nursing curricula. We argue that learning how to manage errors effectively would enable trainee practitioners to improve patient care, reduce the burden on an overstretched health care system and engage in dynamic as opposed to defensive practice.     

Characteristics of unsafe undergraduate nursing students in clinical practice: an integrative literature review

Providing quality clinical experiences for nursing students is vital to the development of safe and competent professional nurses. However, clinical educators often have difficulty identifying and coping with students whose performance is unsatisfactory. The purposes of this integrative review were to examine the extent and quality of the literature focusing on unsafe nursing students in clinical settings and to describe the characteristics of nursing students considered unsafe in clinical settings. A structured literature search yielded 11 relevant articles: five theoretical articles and six research studies. Analysis of findings revealed three themes: ineffective interpersonal interactions, knowledge and skill incompetence, and unprofessional image. The themes reflected the attitudes, actions, and behaviors that influenced students' ability to develop a safe milieu for client care. The findings provide clarity for early identification of students in need of increased support and facilitate clinical educators in meeting students' learning needs to ensure patient safety.     

Catching and correcting near misses: The collective vigilance and individual accountability trade-off

Despite the focus on patient safety and quality health care for the last two decades, there is still limited understanding of how interprofessional interactions at an organizational or work unit level influence how clinicians perceive and respond to safety events and errors. Within the rubric of safety events, there has been a growing interest in near misses as precursors to adverse events in health care. Given the interactive nature of the variety of professionals working together in the delivery of health care, understanding how the different clinicians experience and respond to near misses in practice is important. A constructivist grounded theory approach was employed for this study which included semi-structured interviews with 24 participants in a large teaching hospital in Canada. Findings from this study provide a deeper understanding into how different clinicians experience and respond to near misses in clinical practice. This understanding indicates that collective vigilance can potentially create risk by eroding individual professional accountability through reliance on other team members to catch and correct their errors. Further research is needed to explore in more depth the trade-offs between collective vigilance and individual accountability by relying on others to catch and correct the potentially harmful errors and avert negative outcomes.     

Quality and Safety Education for Nurses

Quality and Safety Education for Nurses (QSEN) addresses the challenge of preparing nurses with the competencies necessary to continuously improve the quality and safety of the health care systems in which they work. The QSEN faculty members adapted the Institute of Medicine(1) competencies for nursing (patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics), proposing definitions that could describe essential features of what it means to be a competent and respected nurse. Using the competency definitions, the authors propose statements of the knowledge, skills, and attitudes (KSAs) for each competency that should be developed during pre-licensure nursing education. Quality and Safety Education for Nurses (QSEN) faculty and advisory board members invite the profession to comment on the competencies and their definitions and on whether the KSAs for pre-licensure education are appropriate goals for students preparing for basic practice as a registered nurse.     

Patient safety ethics and human error management in ED contexts: Part I: Development of the global patient safety movement

In recent years there has been increasing recognition internationally that health care is not as safe as it ought to be and that patient safety outcomes need to be improved. To this end patient safety has become the focus of a world-wide endeavour aimed at reducing the incidence and impact of preventable human errors and related adverse events in health care domains. The emergency department has been identified as a significant site of preventable human errors and adverse events in the health care system, raising important questions about the nature of human error management and patient safety ethics in rapidly changing environments. In this article (the first of a two-part discussion on the subject) an overview of the incidence and impact of preventable adverse events in ED contexts is explored. The development of a ‘culture of safety’ in other hazardous industries and the ‘lessons learned’ and applied to the health care industry are also briefly examined. In a second article (to be presented as Part II), some of the ethical tensions that have arisen in the context of implementing patient safety processes and their possible implications for ED contexts are explored.