Nursing students' errors in clinical learning. Qualitative outcomes in Mixed Methods Research

Abstract

Objective: to analyze factors associated with nursing students' errors during clinical learning, and their perceptions regarding these events and the opportunity for learning and development provided by them. Method: Convergent Mixed Method design according Creswell and Clark. Qualitative dimension included face to face and internet interviews. Data analysis followed Miles and Huberman method. Results: Nursing student's errors were revealed according to their perceptions. They occurred in all phases of the nursing process and in transversal skills. Errors were acknowledged as learning and developmental opportunities. Final considerations: Students acknowledged their errors and ascribe to themselves reasons and what could have prevented what happened. Mixed Method was a very adequate design to study phenomena. Qualitative dimension was essential to reveal and achieve the objectives. Suggestions founded on the findings are presented.

Nursing students’ experiences of patient safety incidents and reporting: A scoping review

“…Overall, students witnessed or reported 3.8 PSIs per 1000 days of training in a clinical setting and most PSIs were related to medication administration. [30] Similarly, Santos [31] found that students most often committed medication errors, but the largest proportion of PSIs were related to care implementation, which encompasses skills such as adhering to guidelines and knowledge application. In examining only medication errors, Walsh et al [32] reported the three most common error types, which were: (1) not administering a medication within the appropriate time frame, (2) administering the medication at the wrong time, and (3) inaccurately documenting medication administration.…”

“…[34] Nursing students struggle with skills related to following procedures or interpreting policies, including medication preparation. [31,35] Additionally, students described their involvement in medication errors of omission. [7,36] Nursing students have also reported witnessing unsafe incidents by health professionals.…”

“…[32] Second year students were likely to view errors as a learning opportunity, whereas fourth year students perceived errors as a barrier to their learning. [31] Despite good intentions to report errors, barriers exist to actual student reporting. Barriers include fear of negative consequences from nurses or faculty, [7,[41][42][43]45] administrative barriers such as a focus on individual rather than system factors, or no positive feedback for giving medication correctly, [41] high perceived workload, [46] and other nurses' perceptions of the incident as unimportant.…”

“…[49] Students believed they were the main contributor to error occurrence, specifically in regard to their stress, fear of failure, lack of attention, or limitations related to experience, managing activities and knowledge. [31] Similarly, student deficits in performance, in which workload was a contributing factor, was noted as the most common cause of error. [36,38] Students described additional causes for incidents, such as interpreting the PSI as a pharmacist's mistake or as an unimportant issue.…”

“…Students struggle with interpreting policies and other actions related to care implementation. [31,35] Training regarding incident reporting policies (including effective, accessible organizational reporting systems) could be helpful. Further, students have difficulty disclosing PSIs to faculty or clinical instructors.…”