Nurse perspectives of nurse-sensitive indicators for positive patient outcomes: A Delphi study

BackgroundPatient safety, quality of care, and nurse-sensitive indicators are common areas of focus in international research relating to patient outcomes. Recent literature relating specifically to nurse-sensitive indicators has leaned towards an emphasis upon negative outcomes, such as ‘missed care’, ‘delayed care’, ‘failure to rescue’ or a reduction in adverse events rather than focus on nursing activities that lead to positive outcomes. In addition, little is known about nurse perspectives of nurse-sensitive indicators for positive patient outcomes.ObjectiveTo identify and describe priority nurse-sensitive indicators linked to positive patient outcomes in the acute care setting.DesignA modified Delphi Technique consisting of three rounds of electronic questionnaires to 90 Clinical Nurse Specialists and Charge Nurse/Managers working in acute care settings in New Zealand.MethodsDelphi round one survey collected data on key nursing activities and tools important to patient outcomes. Delphi round two survey presented round one data for rating importance to patient outcomes using a rating scale question design. Delphi round three survey presented round two data to participants within the ‘Patient Experience Indicators’ identified by the New Zealand Health Safety and Quality Commission’s domains for ranking in order of importance via a ranking question design. Round one data were analysed to discover themes emerging from the responses to formulate activity options. In round two, responses were given an average rating score, calculated on the weight assigned to each answer choice. In round three the ranking average was calculated using weighting and response count.ResultsThe results from the third round presented activities from each domain and these were ranked from highest to least importance, with 75% or greater indicating consensus. Of highest importance within each domain were: Communication: Listening; Partnership: Establishing trust, building relationships; Coordination: The threshold of 75% consensus was not reached; Physical and Emotional Needs: Identification of rapid change/deterioration, observation/identification of patient status, and increased assessment skills.ConclusionSome nursing activities were difficult to rank in terms of importance as nurses perceived they were inter-related and of equal importance. The soft applied skills of nursing practice have been highlighted as important nursing activities by experienced nurses in this research, which poses a challenge for health care and nursing education sectors to label, value and support enactment of these skills in the nursing workforce as legitimate contributions to positive patient outcomes.     

Nursing students' self-reported experiences and attitudes regarding patient safety: A cross-sectional study comparing the classroom and clinical settings

BackgroundPatient safety education varies in nursing schools and therefore it is crucial to identify the educational needs of students by determining their skills, attitudes, and competencies regarding patient safety and medical errors.AimThis study was conducted to determine nursing students’ patient safety education competencies in the classroom and clinical settings, their attitudes towards medical errors, and the relationship between them.MethodsThis was a cross-sectional questionnaire study conducted with 204 nursing students. The participation rate was 96%. Data were collected using the Health Professional Education in Patient Safety Survey (H-PEPSS_TR), and the Medical Errors Attitude Scale (MEAS). A STROBE checklist was used to report findings.FindingsStudents’ patient safety knowledge and competence scores obtained from the H-PEPSS_TR were the highest for the ‘communicating effectively’ subscale in the classroom and for the ‘culture of safety’ subscale in the clinics while their ‘understanding human and environmental factors’ subscale scores were the lowest. The total H-PEPSS_TR scores in the classroom, ‘working in teams with other health professionals,’ ‘communicating effectively,’ ‘managing safety risks,’ and ‘understanding human and environmental factors’ subscales scores of the students who had positive attitudes according to MEAS were higher (p < 0.05).DiscussionStudents with positive attitudes towards medical errors had higher patient safety knowledge in the classroom; however, it did not affect patient safety competence in the clinical setting.ConclusionNursing students had positive attitudes towards medical errors. Their patient safety knowledge and competencies gained in the classroom were more than that developed in the clinical settings.     

Evaluating a patient safety course for undergraduate nursing students: A quasi-experimental study

BackgroundAlthough it has long been recognised that prelicensure education is essential for preparing nurses with the necessary patient safety competencies, patient safety education tends to be inadequately addressed in nursing curricula in South Korea and elsewhere.AimThis study examined the effectiveness of a recently developed 8-week standalone course on patient safety by comparing the patient safety competencies, knowledge, and attitudes of students who attended and did not attend the course, after controlling for baseline levels of each outcome measure.MethodsThe study used a quasi-experimental pretest-posttest design with a non-equivalent comparison group, with 40 undergraduate nursing students in the intervention group, and 67 in the comparison group. Outcomes included the total score and six subscale scores measured with the Health Professional Education in Patients Safety Survey, and the Patient Safety Attitude scale developed by the WHO patient safety program. Additionally, there was an objective measure of patient safety knowledge using 15 multiple-choice questions.FindingsAfter adjusting for baseline scores, Time 2 scores on all outcome measures were significantly higher in the intervention group than the comparison group, indicating the intervention's effectiveness. We found that the largest effect of the course accrued to patient safety knowledge. Overall, the students’ assessment of the course was highly positive.DiscussionOur patient safety course could be a model for teaching patient safety in undergraduate nursing curriculum.ConclusionThis study shows the potential for a standalone patient safety course to increase undergraduate nursing students’ patient safety competencies, knowledge, and attitudes towards patient safety.     

A cross-sectional survey of nursing students' patient safety knowledge

BackgroundKnowledge provides a foundation for safe and effective nursing practice. However, most previous studies have focused on exploring nursing students' self-reported perceptions of, or confidence in, their level of patient safety knowledge, rather than examining their actual levels of knowledge.ObjectiveThe overarching objective of this study was to examine final year nursing students' levels of knowledge about key patient safety concepts.DesignA cross-sectional design was used for this study. Data collection was undertaken during 2018 using a web-based patient safety quiz with 45 multiple choice questions informed by the Patient Safety Competency Framework for Nursing Students. A Modified Angoff approach was used to establish a pass mark or ‘cut score’ for the quiz.Setting and participantsNursing students enrolled in the final year of a pre-registration nursing program in Australia or New Zealand were invited to participate in the study.ResultsIn total, 2011 final year nursing students from 23 educational institutions completed the quiz. Mean quiz scores were 29.35/45 or 65.23% (SD 5.63). Participants achieved highest scores in the domains of person-centred care and therapeutic communication, and lowest scores for infection prevention and control and medication safety.Based on the pass mark of 67.3% determined by the Modified Angoff procedure, 44.7% of students (n = 899) demonstrated passing performance on the quiz. For eight of the institutions, less than half of their students achieved a passing mark.ConclusionsGiven the pivotal role that nurses play in maintaining patient safety, the results from this quiz raise important questions about the preparation of nursing students for safe and effective clinical practice. The institutional results also suggest the need for increased curricula attention to patient safety.     

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.     

HI I CARE: A mnemonic device to frame safe patient encounters and support simulation experiences for novice nursing students

BackgroundRemembering the many safety behaviors and patient care activities expected during a patient encounter can be difficult for novice nursing students. The HI I CARE mnemonic device was created to assist novice nursing students to remember and organize key safety behaviors and patient care activities. Subsequently, the mnemonic device was drafted into a checklist to be used as a performance support tool for students’ first simulation experience.MethodsA survey was designed and administered to beginning nursing students to explore their perception if the HI I CARE mnemonic device helped to (1) reduce anxiety prior to simulation experiences; (2) plan, organize, and deliver care; and (3) integrate classroom learning into the simulated patient encounter.ResultsOverwhelmingly, participants agreed or strongly agreed that the HI I CARE mnemonic helped to achieve these goals.ConclusionThe HI I CARE mnemonic device and correlating checklists are effective performance support tools that can be used to help novice nursing students to recall key safety behaviors and organize patient care activities in the nursing skills laboratory and the simulation setting. This mnemonic device, as a performance support tool, offers associate degree nursing students the opportunity to develop optimal habits that exemplify the safe patient encounter.     

Role-play simulation to teach nursing students how to provide culturally sensitive care to transgender patients

ObjectiveIncrease student knowledge and comfort with caring for a transgender individual and confronting colleagues when exhibiting poor cultural intelligence.BackgroundTransgender patients often experience health care inequities, including heteronormative microaggressions in communication and policies. Simulation has been a successful means of providing students with the education, tools, and experience necessary to combat systemic injustice in health care. Simulation is an interactive pedagogy that allows nursing students to practice assessment, patient care, and difficult conversations in a controlled, risk-free environment.Design/ MethodsPrelicensure nursing students role-played a simulation created as an interactive learning strategy to promote culturally sensitive assessment of a transgender patient and their caregiver, including assessing for pronouns and providing patient-centered care. The simulation included preforming a difficult conversation between nurses to cultivate an environment of being an upstander. The simulation demonstrated holistic methods of assessing and supporting unique patient needs for the patient who is transgender.ResultsNursing students reported they felt that their comfort with advocacy and ability to communicate with transgender patients, as well as with their families, and health care team members was enhanced after completing the simulation.ConclusionSimulation has the ability to reduce discomfort and discrimination in health care for transgender patients by equipping students with culturally sensitive and inclusive communication tools and providing them with risk-free environment where they can learn to provide care for this vulnerable population in preparation for successful future encounters.     

Using simulation to prepare neophyte nursing students to deliver intimate patient care

BackgroundPreparing neophyte nursing students to deal with the intimate aspects of patient care including nudity and body excretions is challenging. Traditional simulation approaches that have been used to teach these skills require examination in the context of considering more realistic ways. Mask-Ed™ is a high fidelity modality of simulation that enables the educator to transform into a patient by donning silicone props such as masks and body torsos inclusive of genitalia. The hidden educator is able to coach and direct the learner throughout the simulation.AimThe aim of this study was to identify if Mask-Ed™ simulation enhanced students learning in the context of providing intimate patient care when undertaking the skills of showering and toileting.MethodsFirst year undergraduate nursing students were tasked with showering and toileting a Mask-Ed™ patient in a simulated learning situation within a laboratory context. Following the simulation students were invited to participate in focus groups. Data was recorded, transcribed and analysed using an inductive thematic analysis approach.FindingsFrom class preparation to debrief, participants experienced a safe journey of discovery enabling them to provide intimate care. The realism of the learning environment combined with the confidence students had in their educator, allowed students to overcome their nervousness and anxiety, discover the vulnerable person at the centre of their care, gain confidence and find comrades.DiscussionSimulations that provide neophyte nursing students with an opportunity to face real to life intimate care experiences should be apparent in all undergraduate nursing programs. Nursing students need not only to be prepared to implement skills around safe practice when showering and toileting patients but they also need to feel safe and confident to practice themselves.ConclusionMask-Ed™ is an effective and efficient simulation modality to teach neophyte nursing students about intimate human care.     

Patients’ involvement in nursing students’ clinical education: A scoping review

BackgroundActual contacts with patients are crucial in developing the skills that students need when working with patients. Patients are accustomed to the presence of students. The concept of learning from patients has emerged recently, shifting the focus from learning from professionals as role models to the relationship between the student and patient.AimWith focus on patients’ perspective in clinical practice placements, this scoping review aims to review and summarize the existing empirical literature regarding patients’ involvement in nursing students’ clinical education.Design and methodA broad search without time limitations was performed in the databases CINAHL, Medline, PsycINFO and ERIC. A manual search was also performed. Only empirical studies describing aspects of patient involvement in nursing education from the patient’s perspective were taken into account. Thirty-two studies published from 1985 to June 2016 met the selection criteria and were analysed using inductive content analysis.ResultsThe perspective of real patients focused on their role in students’ learning and assessment processes. In general, patients appreciated the opportunity to contribute to a student’s learning process and thus enhance the quality of patient care. However, the patients’ approaches varied from active to passive participants, comprising active participants contributing to students’ learning, followers of care and advice, and learning platforms with whom students practiced their skills. Some patients perceived themselves as active participants who facilitated students’ learning by sharing knowledge and experience about their own care and wellbeing as well as assessed students’ performance by providing encouraging feedback.ConclusionThe state and degrees of patient involvement in nursing students’ clinical education were made explicit by the literature reviewed. However, the number of studies examining the involvement of real patients in students’ education in clinical settings is very limited. To understand this untapped resource better and to promote its full realization, recommendations for nursing education and future research are made.     

Team improvement and patient safety conferences: culture change and slowing the revolving door between skilled nursing facility and the hospital

To improve the safety culture of a skilled nursing facility, we conducted multidisciplinary "Team Improvement for Patient and Safety" (TIPS) case conferences biweekly to identify causes of transfers to acute care hospitals and improvement opportunities. Staff perceptions of organizational patient safety culture were assessed with the Nursing Home Survey on Patient Safety Culture. Over the course of the year, we held 22 TIPS conferences. Mean item scores increased during the study, indicating improved staff perceptions of patient safety culture (P < .005).     

Intentional rounding in the context of student learning

Problem/backgroundIntentional rounding or regular patient checks were introduced in to healthcare settings to enhance patient safety and satisfaction. Patient and staff experiences have been explored in the literature, however the student nurse’ experience of this intervention has not been explored in the context of their learning on clinical placement.AimThis study aimed to explore students’ experience and understanding of intentional rounding in the clinical setting.MethodsSemi-structured interviews were conducted with 18 student nurses.FindingsIntentional rounding has raised many learning issues for students. The study found that intentional rounding creates a framework to reflect on the nexus between attending to patient need, and the learning student nurses undertake, and creates an avenue for them to be able to operationalise quality patient care.DiscussionStudent nurses need to be part of the ward ‘team’ to enhance their learning. There are limitations surrounding positive role modelling, sharing of information and formal education in such interventions, which impacts students’ confidence, involvement and understanding. If done effectively, participation in intentional rounding can increase students’ time management skills, assessment ability, and the safety of the patient.ConclusionModelling positive behaviours, and encouraging active and educated involvement in intentional rounding will enhance confidence and skill, and reduce the theory practice gap.     

Seeking autonomy: Grounded theory of clinical reasoning processes during simulation based experiences

AimTo conceptualize how undergraduate nursing students’ reason and think during Simulation-Based experiences (SBE) and explore the indicators of sound clinical judgment.BackgroundNursing students’ clinical reasoning processes during Simulation Based Experiences (SBE) are not well understood and underexplored. The purpose of this study is to conceptualize how undergraduate nursing students’ reason and think during SBE.DesignA constructivist grounded theory methodology was used to explore nursing students’ clinical reasoning during SBEMethodA grounded theory methodology was used to explore nursing students’ clinical reasoning during SBE. A purposive sample was used to recruit participants including 32 third-year nursing students. Data collection using semi-structured interviews conducted over 9 months in 2020–2021. The interviews were recorded and transcribed verbatim and the data were analyzed using the logic of constant comparison supported by memoing, theoretical sampling and conceptual mapping.ResultsSeeking autonomy is the core category that emerged from the participants’ responses that conceptualizes the students' reasoning process during SBEs.ConclusionEvidence from this grounded theory study adds validation to the practice of using SBEs to support students’ clinical reasoning process and prepare them to be competent in clinical practice.     

The effects of high-fidelity simulation training on empathy and attitudes toward older people among undergraduate nursing students: A quasi-experimental study

AimTo evaluate the effects of high-fidelity simulation training on attitudes towards older people and empathy among undergraduate nursing students.BackgroundPeople worldwide are living longer and, consequently, the number of older people is increasing globally. Geriatric syndromes are highly prevalent and associated with increased morbidity and mortality in this population. Positive attitudes towards older people and high levels of empathy are necessary for the provision of high-quality nursing care, which will contribute towards improving the quality of life of older patients affected by these syndromes.MethodsA quasi-experimental study was conducted using a longitudinal design with a single group and a pre- and post-intervention evaluation. The development of attitudes towards older people and empathy skills were evaluated using high-fidelity simulation-based training, comparing the levels obtained in these skills at baseline and after the simulation experience. The simulated scenarios recreated the great geriatric syndromes in older patients: instability, immobility, intellectual impairment and incontinence.ResultsAfter the simulation sessions, nursing students significantly improved their total scores for both attitudes toward older people and empathy, moreover, improvements were found in the three subscales of empathy. The effect size was large for the total scores of both the attitudes towards older people and the empathy scales and the ‘perspective taking’ subscale. The obtained effect size was small for the ‘compassionate care’ subscale, whereas for the ‘standing in the patient’s shoes’ subscale, the obtained effect size was medium.ConclusionsOur high-fidelity simulation-based training allows undergraduate nursing students to improve their empathy levels and positive attitudes toward older people. The development of these skills may provide benefits directly related to high-quality care for older patients. Therefore, the inclusion of simulation training programs in geriatric nursing study plans is necessary to train nursing students in the care of older people and to prepare them for real clinical practice.