Nursing Students' Perceptions of Safety and Communication Issues in the Clinical Setting

Abstract

Findings indicate educators have an opportunity to enhance nursing curricula with strategies to foster and embrace a culture of safety. [J Nurs Educ. 2018;57(5):287-290.].

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

“…[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. [7] Koohestani and Baghcheghi [41] found that the reporting process was the weakest perceived barrier.…”

“…Disclosure was linked to fear of being punished or questioned. [44,45,55] Nursing students described additional fears related to consequences, such as failing the educational program, not obtaining employment, and causing patient harm. [27,56] Further, students struggle with applying medication safety principles within the clinical practice setting.…”

“…[42] Professional development for nurse educators can include tools to effectively guide and role model patient safety for nursing students. [45,60] Implementation of more explicit patient safety education in the undergraduate curriculum may establish deeper patient safety knowledge and understanding prior to students entering clinical placements. [7,17,23,44,52] The curriculum could include educating nursing students in addressing, anticipating, and managing safety risks by developing effective strategies.…”

“…[52] The implementation of the principles of quality and safety education within the nursing curriculum has been suggested as a core component in the theoretical and clinical courses. [20,45] Additionally, it may require us to consider the language we use related to PSIs, specifically the term 'error', especially if we are to embed a human factors approach to safety curriculums. [66] We may need to be more sensitive and alert to the fact that while students will make mistakes, human factors and ergonomics principles helps us recognize the "inherent imperfections" within complex systems, wherein it is not possible to prevent all incidents, and we need to be assured as educators we are aware of and preparing students in appreciation of both of these circumstances (p. 2).…”

“…[66] Creating blame-free environments is important, so that a holistic, non-punitive view of incident analysis is estab-lished and incidents are evaluated systematically, rather than attributing errors to human failure. [7,41,45,50] A closer look at the context highlights the importance of building a "just culture", in which accountability and transparency are paramount. [67] Although typically referenced in relation to clinical settings, the shift toward a just culture can and should extend to nursing schools, wherein everyone has responsibilities (e.g., students must appropriately prepare for clinical and admit mistakes; educators must be apprised of current quality and safety principles and create safe learning environments for student incident disclosure; and organizational leaders must embed philosophies and processes reflective of a fair, just culture) and collaboration among students, faculty and organizational leaders is key (p. 44).…”