Patient safety in an english pre-registration nursing curriculum

doi:10.1016/j.nepr.2007.09.003

Nurse Education in Practice

Volume 8, Issue 4, July 2008, Pages 239-248

https://doi.org/10.1016/j.nepr.2007.09.003 Get rights and content

Summary

This study explored patient safety in an English pre-registration nursing curriculum. The need to improve patient safety has been recognised as a key priority, both nationally and internationally. Education has a crucial role in developing the knowledge, skills and attitudes that promote patient safety. However, evidence about how patient safety is addressed in healthcare professional curricula and how organisations develop safe practitioners is limited.

An organisational case study identified factors affecting patient safety educational provision. Content analysis revealed what aspects of patient safety featured in the formal pre-registration nursing curriculum. Interviews were conducted with students, lecturers and key education stakeholders from various levels of the educational organisation, to explore their perceptions of patient safety and its location in the curriculum and practice.

Patient safety was not explicit in the formal curriculum, but was included in teaching. Students reported gaining most knowledge and experience from clinical practice. The organisational culture of both education and practice was characterised as defensive and closed, and as having an individual versus a systems approach. Findings suggest the need for clarification of the concept of patient safety, as well as revision of curricula and teaching, learning and assessment strategies in order to address patient safety explicitly.

Section snippets

Background/ literature

Patient safety is defined as freedom from harm whilst receiving healthcare (DoH, 2000). Estimates of the frequency of patient safety incidents (PSI) vary from 3% to 16% of hospital admissions. The DoH (2000) estimated that 850,000 patients suffered PSIs, resulting in £2 billion extra expenditure. The vast majority of PSIs are categorised as preventable; nurses are the last line of defense between the healthcare system and the patient (Reason, 2000). There is considerable evidence that patient

Study aims

The study explored patient safety in an English pre-registration degree nursing curriculum, based on the Nursing and Midwifery Council (NMC) 2002 curriculum guidelines. Study objectives were to:

1.
Identify patient safety themes in the curriculum (formal and informal).
2.
Explore where and how patient safety themes are taught.
3.
Examine the assessment of patient safety in theory and practice.
4.
Explore factors in the educational milieu that affect the development of students’ knowledge, attitudes and

Findings

Analysis of data from students, educators and key stakeholders identified each group’s perceptions of patient safety and its place in the curriculum and practice. Perspectives of what is regarded as patient safety and what constituted threats to safety varied. Patient safety was not explicitly addressed in the curriculum, which focussed on the related concepts of safe practice, fitness for practice and risk. The educational milieu was characterised as defensive and closed, and as having an

Discussion

The finding that patient safety is not explicitly addressed in the pre-registration nursing curriculum is congruent with the limited amount of evidence in this field by Maddox et al., 2001, Aron and Headrick, 2002, Stevens, 2002, Weinger et al., 2003. Analysis of the current Nursing and Midwifery Council curriculum guidelines for pre-registration nursing education in the UK provides a rationale for the lack of emphasis on patient safety in the formal curriculum. The NMC, 2002 document outlining

Conclusions

The curriculum focus on the related, but not equivalent concepts of safe practice, competency, health and safety, safe environment and risk, rather than patient safety, reflects the NMC, 2002 curriculum directive. Curriculum guidance needs to be revised to reflect the primacy of patient safety in contemporary clinical practice and ensure that patient safety becomes a major, explicit theme developed consistently throughout healthcare professional curricula. Teaching, learning and assessment

Acknowledgement

This study was funded by a School of Nursing, Midwifery & Social Work Pump Priming Fund award.

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Cited by (60)

Nursing students' self-reported experiences and attitudes regarding patient safety: A cross-sectional study comparing the classroom and clinical settings
2022, Collegian
Patient 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.
This 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.
This 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.
Students’ 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).
Students 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.
Nursing 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.
Responding to the Unexpected: Tag Team Patient Safety Simulation
2019, Clinical Simulation in Nursing
Tag Team Patient Safety Simulation (TTPSS) was developed to prepare work-ready nursing graduates in the context of patient safety.
This descriptive study examined nursing students' (n = 721) satisfaction with the TTPSS and validated the Satisfaction with Patient Safety Simulation Experience Scale (SPSSES).
Students reported higher levels of overall satisfaction with TTPSS. Themes from open-ended responses, Observing and being observed and Learning to respond to unexpected, provided insight to the satisfying components of the learning experience.
The SPSSES is a valid survey instrument, verifying student's satisfaction with this large group simulation approach in preparing them to respond to patient safety issues.
Simulation-based learning for patient safety: The development of the Tag Team Patient Safety Simulation methodology for nursing education
2019, Collegian
Since the ground-breaking report ‘To Err is Human: Building a Safer Health Care System’ was published nearly two decades ago, patient safety has become an international healthcare priority. Universities are charged with the responsibility of preparing the future nursing workforce to practise in accordance with relevant patient safety standards. Consequently, simulation-based learning is increasingly used for developing the technical and non-technical skills graduates require to provide safe patient care.
Tag Team Patient Safety Simulation is a pragmatic group-based approach that enhances nursing students’ knowledge and skills in the provision of safe patient care. The aim of this paper is to describe the Tag Team Patient Safety Simulation methodology and illustrate its key features with reference to a medication safety scenario.
Informed by the National Safety and Quality Health Service Standards and the Patient Safety Competency Framework for Nursing Students, Tag Team Patient Safety Simulation methodology actively engage large numbers of nursing students in critical conversations around every day clinical encounters which can compromise patient safety.
Tag Team Patient Safety Simulation is a novel simulation methodology that enhances nursing students’ skills and knowledge, fosters critical conversations, and has the potential to enhance students’ resilience and capacity to speak up for safe patient care.
Regulation and current status of patient safety content in pre-registration nurse education in 27 countries: Findings from the Rationing - Missed nursing care (RANCARE) COST Action project
2019, Nurse Education in Practice
Citation Excerpt :
Usher et al., (2017) suggest that the patient safety voice in nursing graduates is currently not evident and that the nurse curriculum should endeavor to address this deficit. Attree et al. (2008) were clear that the lack of success of an integrated approach to patient safety across a curriculum does not necessarily mean that educators do not provide accurate information, but rather that students are unable to make the connections themselves. Therefore the authors recommend that patient safety becomes a major explicit theme in the nurse curriculum across the duration of the undergraduate programme.
Patient safety, as a contemporary health care concern, must remain a priority for nurse educators. This on-line consultation, carried out within the RANCARE COST Action project, determined to establish how patient safety teaching is incorporated into pre-registration education of nurses across 27 countries. How nursing is regulated within countries was examined, along with national guidelines related to nurse education. HEIs were asked to provide details of pre-registration nurse training and how patient safety is taught within programmes.
The results confirm that the topic of patient safety is generally not explicitly taught, rather it remains a hidden element within the curriculum, taught across many subjects. Variation in how nursing is regulated exists across the countries also, with the professionalization of nursing remaining a challenge in some states. No guidelines exist at EU level which address how patient safety should be taught to nursing students, and as yet regulatory bodies have not put forward criteria on the subject. As a result individual HEIs determine how patient safety should be taught.
The WHO guidelines for teaching patient safety are currently underutilized in nurse education, but could offer a structure and standard which would address the deficits identified in this work.
Performance based situation awareness observations in a simulated clinical scenario pre and post an educational intervention
2019, Nurse Education in Practice
This study compared final year nursing students’ error rate and use of strategies to maintain SA when undertaking specific nursing care in a simulated clinical environment pre and 10 weeks post a planned SA education intervention.
Students were observed using a Performance Based Situation Awareness Observation Schedule (PBSAOS) undertaking two tasks in a simulated clinical environment pre and post the SA education.
For task 1, post educational intervention, there was no significant increase in the error rate for any performance measures, and there were significant decreases in the error rates for three performance measures. For task 2, post educational intervention, there was a significant decrease in the error rate for two measures and a significant increase in the error rates for seven performance measures.
In considering the overall group error rate when excluding uncompleted tasks, there was a significant (x = .0001) decrease in the error rate for task 1 post educational intervention (41.4% compared to 26.6%), and significant (x = 0.01) increase in the error for task 2 post educational intervention (39.6% compared to 47.3%).
The findings of this study demonstrate that the implementation of an intervention designed to increase SA actually appear to have resulted in hyper-vigilance and subsequent non-completion of required tasks.
Patient safety content and delivery in pre-registration nursing curricula: A national cross-sectional survey study
2018, Nurse Education Today
Citation Excerpt :
Despite the increasing focus on patient safety in the clinical setting, patient safety content needs to be afforded greater significance, and be clearly and explicitly located in the undergraduate nursing curricula (Stevens, 2002; Weinger et al., 2003; Tella et al., 2014). In fact, previous researchers have identified a gap between our knowledge of the extent and nature of university nurse education and clinical practice relevant to patient safety (Attree et al., 2008; Vaismoradi et al., 2011). Patient safety is defined as, “the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum” (Runciman, Hibbert, Thomson, Van Der Shaaf, Sherman & Lewalle, 2009, p. 19; World Health Organization, 2009, p. 15).
Patient safety is a core principle of health professional practice and as such requires significant attention within undergraduate curricula. However, patient safety practice is complex requiring a broad range of skills and behaviours including the application of sound clinical knowledge within a range of health care contexts and cultures. There is very little research that explores how this is taught within Australian nursing curricula.
To examine how Australian nursing curricula address patient safety; identify where and how patient safety learning occurs; and describe who is responsible for facilitating this learning.
A cross-sectional study.
Eighteen universities across seven Australian States and Territories.
The sample consisted of 18 nursing course coordinators or those responsible for the inclusion of patient safety content within a Bachelor of Nursing course at Australian universities.
An online survey was conducted to evaluate the patient safety content included and teaching methods used in Australian pre-registration nursing curricula.
Approaches to teaching patient safety vary considerably between universities where patient safety tended to be integrated within undergraduate nursing course subjects rather than explicitly taught in separate, stand-alone subjects. Three-quarters of the surveyed staff believed patient safety was currently being adequately covered in their undergraduate nursing curricula.
Although there is consensus in relation to the importance of patient safety across universities, and similarity in views about what knowledge, skills and attitudes should be taught, there were differences in: the amount of time allocated, who was responsible for the teaching and learning, and in which setting the learning occurred and was assessed. There was little indication of the existence of a systematic approach to learning patient safety, with most participants reporting emphasis on learning applied to infection control and medication safety.

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Patient safety in an english pre-registration nursing curriculum

Summary

Section snippets

Background/ literature

Study aims

Findings

Discussion

Conclusions

Acknowledgement

Nurse Education In Practice

Nursing Outlook

Nurse Education Today

Journal of Biomedical Informatics

Cultural theory and organizations: analytical method and cases

Organization Studies

Working on the frontline: risk cultures and nursing in the new NHS

Sociological Review

Educating physicians prepared to improve patient care and safety is no accident: it requires a systematic approach

Quality and Safety in Healthcare

The Canadian adverse events study: incidence of adverse events amongst hospital patients in Canada

Canadian Medical Association Journal

A prospective study of the incidence of nurse self-reported identification of medication error during novel simulated ward medication safety orientation programme

Journal of Pharmacy Practice and Research

The concept of theme as used in qualitative nursing research

Western Journal of Nursing Research