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+ Nursing Students’ Perceptions of Patient Safety Cathleen C. Santos DNP, RN Susan James PhD, RN

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Page 1: Nursing Students’ Perceptions of Patient Safety - QSEN · Nursing Students’ Perceptions of Patient Safety ... Patient Safety Culture Quality and Safety Education for Nurses

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Nursing Students’ Perceptions of Patient Safety

Cathleen C. Santos DNP, RN Susan James PhD, RN

Page 2: Nursing Students’ Perceptions of Patient Safety - QSEN · Nursing Students’ Perceptions of Patient Safety ... Patient Safety Culture Quality and Safety Education for Nurses

+ Purpose of the Study

To examine the perceptions baccalaureate nursing students have about their knowledge, skills and attitudes regarding patient safety.

To examine the effects of QSEN strategies on students’ patient safety knowledge, skills, and attitudes.

Page 3: Nursing Students’ Perceptions of Patient Safety - QSEN · Nursing Students’ Perceptions of Patient Safety ... Patient Safety Culture Quality and Safety Education for Nurses

+ Problem Statement

Maintaining patient safety is one of the most critical issues facing the U.S. Healthcare system.

Nurses are indispensible in providing safe patient care.

Nursing education must be focused on patient safety competencies.

Improvements in nursing education are critical to ensure safe patient care.

Difficulty in “ADDING” new material to an already overloaded curriculum.

Page 4: Nursing Students’ Perceptions of Patient Safety - QSEN · Nursing Students’ Perceptions of Patient Safety ... Patient Safety Culture Quality and Safety Education for Nurses

+ Background and Significance

Institute of Medicine (1999, 2001, 2003) History of Patient Safety Patient Safety Culture

Quality and Safety Education for Nurses (QSEN) (2007)

Institute of Medicine Future of Nursing (2010)

Page 5: Nursing Students’ Perceptions of Patient Safety - QSEN · Nursing Students’ Perceptions of Patient Safety ... Patient Safety Culture Quality and Safety Education for Nurses

+ Literature Review

Safety in Medical Education Madigosky et al. (2006) Varkey et al. (2009) Van Geest & Cummins (2003)

Safety in Nursing Education Smith et al.(2007) Cronenwett et al. (2007) Schnall et al. (2008) Dycus & McKeon (2009) Sullivan et al. (2009)

Page 6: Nursing Students’ Perceptions of Patient Safety - QSEN · Nursing Students’ Perceptions of Patient Safety ... Patient Safety Culture Quality and Safety Education for Nurses

+ Relationship to QSEN – Curry College

QSEN pilot school since 2007 One of 15 pilot schools chosen nationwide Initial infusion of 10 teaching strategies

throughout the undergraduate curriculum

Doctoral study compared Curry with 4 private non-QSEN schools in MA

Need to evaluate success of curriculum infusion -Second year of data collection at Curry College

Page 7: Nursing Students’ Perceptions of Patient Safety - QSEN · Nursing Students’ Perceptions of Patient Safety ... Patient Safety Culture Quality and Safety Education for Nurses

+ Curry College QSEN Strategies

1. “Level of Evidence”designations incorporated into each clinical course (class and clinical) when clinical studies are discussed (EBP).

2. Developed a modified PowerPoint presentation of When Things Go Wrong: Responding to Adverse Events to integrate into several nursing courses (S, QI).

3. Adopted practice partner (BIDMC) resources (e.g., adverse event flow sheets) as teaching tools in selected nursing courses (S, QI).

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Page 8: Nursing Students’ Perceptions of Patient Safety - QSEN · Nursing Students’ Perceptions of Patient Safety ... Patient Safety Culture Quality and Safety Education for Nurses

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4. Developed resource cards for medication rights, SBAR, Rapid Response Team triggers (S).

5. Designated one clinical conference on quality improvement projects in the assigned care setting in each clinical rotation (QI).

6. Revised the Critical Objectives for Clinical Evaluation (S, PCC).

7. Developed clinical assignments to assist students in identification of potential unsafe nursing practices including “work arounds”(S).

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8. With the practice partner, facilitated student participation in quality assurance projects (or committees) as part of senior precepted clinical practicum (QI).

9. Encouraged clinical participation in a Root Cause Analysis experience (QI, S).

10. Incorporated First, Do No Harm, Josie King video and Lewis Blackman into several courses (S, QI, PCC).

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Page 10: Nursing Students’ Perceptions of Patient Safety - QSEN · Nursing Students’ Perceptions of Patient Safety ... Patient Safety Culture Quality and Safety Education for Nurses

+ Study Purpose

To evaluate the success of the infusion of focused patient safety education in a baccalaureate curriculum, as perceived by students.

To describe the relationship of various demographic factors to students’ perception of their patient safety knowledge, skills and attitudes.

Page 11: Nursing Students’ Perceptions of Patient Safety - QSEN · Nursing Students’ Perceptions of Patient Safety ... Patient Safety Culture Quality and Safety Education for Nurses

+ Research Questions

In what courses do students perceive that safety principles are emphasized?

Do students report that safety competencies are sufficiently infused into the nursing curriculum?

Do Curry College students demonstrate positive Knowledge, Skills and Attitudes about patient safety, as measured by a patient safety assessment scale?

What factors most correlate with student scores on the patient safety assessment?

Is there a difference between sophomore, junior, and senior students in their perception of patient safety Knowledge, Skills and Attitudes?

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Page 12: Nursing Students’ Perceptions of Patient Safety - QSEN · Nursing Students’ Perceptions of Patient Safety ... Patient Safety Culture Quality and Safety Education for Nurses

+ Methodology

Quantitative non-experimental, descriptive design

Sample 229 Sophomore, Junior and Senior

baccalaureate nursing students 2011 – 92 students 2012 – 137 students

Page 13: Nursing Students’ Perceptions of Patient Safety - QSEN · Nursing Students’ Perceptions of Patient Safety ... Patient Safety Culture Quality and Safety Education for Nurses

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Procedure (2011) Patient safety scale constructed – modified from

Schnall et al. (2008) and Chenot (2010) (both previously modified from Madigosky et al. , 2006)

Three subscales measuring Knowledge, Attitudes, and Skills (K,S,A)

Validity and reliability of scales described previously

Because of possible lack of programmatic exposure to skills, subscale was changed from assessing competence to assessing confidence ( Bandura, 1994)

Page 14: Nursing Students’ Perceptions of Patient Safety - QSEN · Nursing Students’ Perceptions of Patient Safety ... Patient Safety Culture Quality and Safety Education for Nurses

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Procedure 2012

Attitude scale problematic for reliability

revised to exclude items of “best care” and “physicians should be the health care professionals to report”

Items appeared unclear

Slightly improved reliability

New attitude scale constructed and tested

Page 15: Nursing Students’ Perceptions of Patient Safety - QSEN · Nursing Students’ Perceptions of Patient Safety ... Patient Safety Culture Quality and Safety Education for Nurses

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Procedure 2011 and 2012 Spring semester - E-mail requesting study

participation sent to all students enrolled in nursing courses, beginning with Adult Medical/Surgical Nursing 1

Link provided to Survey Monkey Voluntary participation, anonymity assured One month given to respond Reminder after 2 weeks and again several days

before the study closed

Page 16: Nursing Students’ Perceptions of Patient Safety - QSEN · Nursing Students’ Perceptions of Patient Safety ... Patient Safety Culture Quality and Safety Education for Nurses

+ Results – Sample Characteristics

2011 2012

Number (return rate) 92 students (38%) 137 students (50%)

Class (percent of sample) Seniors 28 (30%) Seniors 57 (40%)

Juniors 29 (32%) Juniors 50 (37%)

Sophomores 34 (37%) Sophomores 29 (21%)

Mean age 21 years 22 years

Gender Female 88 Male 2 Missing 2

Female 121 Male 13 * Missing 3

Mean years in program 2.5 years 2.3 years

Mean weekly hours worked in health care (excluding clinical)

7.8 hrs (51% report none)

8.4 hrs (50% report none)

Mean years worked 1.2 years 1.4 years

Page 17: Nursing Students’ Perceptions of Patient Safety - QSEN · Nursing Students’ Perceptions of Patient Safety ... Patient Safety Culture Quality and Safety Education for Nurses

+ Curriculum Evaluation – Clinical

2011 2012

Introduction to Nursing 94% 89%

Medical/Surgical Adult 1 74% 90%

Children 94% 93%

Maternity 91% 79%

Mental Health 93% 79%

Community 88% 82%

Medical/Surgical Adult 2 100% 97%

Synthesis 75% 81%

Page 18: Nursing Students’ Perceptions of Patient Safety - QSEN · Nursing Students’ Perceptions of Patient Safety ... Patient Safety Culture Quality and Safety Education for Nurses

+ Curriculum Evaluation – Non-Clinical

2011 2012

Contemporary Topics 32% 74%

Nursing Research 37% 39%

Other Courses Mentioned Care of Older Adult Health Assessment Pharmacology Pathophysiology

Sufficiency of safety taught overall – “My nursing program provided sufficient education on patient safety (1=Strongly Disagree; 5 = Strongly Agree)

Mean 4.3 Agree

Mean 4.5 Strongly Agree

Page 19: Nursing Students’ Perceptions of Patient Safety - QSEN · Nursing Students’ Perceptions of Patient Safety ... Patient Safety Culture Quality and Safety Education for Nurses

+ Perceptions of Patient Safety*

2011 2012

Mean total scale 3.9 (SD .37) 3.9 (SD .39)

Mean Knowledge 3.9 (SD .65) 4 (SD .71)

Mean Skill (Confidence)

3.8 (SD .55)

4 (SD .68)

Mean Attitudes 4 (SD .33) 4 (SD .28)

Error Detection and Reporting Observed error during clinical

26% Yes

34% Yes

Report error using incident report

7.6% Yes

6.2% Yes

Ever disclosed error 18.5% Yes 22% Yes

* Scores from 1 to 5, with a higher score being more positive

Page 20: Nursing Students’ Perceptions of Patient Safety - QSEN · Nursing Students’ Perceptions of Patient Safety ... Patient Safety Culture Quality and Safety Education for Nurses

+ Significant Correlations Significant Correlations (2011 and 2012 mean

scores) Total scale/weekly hours worked ( r = .16, p <

.05) Knowledge/age (r = -.14, p < .05) Knowledge/ weekly hours worked (r = .23, p <

.01) Skill/weekly hours worked (r = .14, p < .05) Skill/how long worked (r = .15, p < .05) No significant correlations with attitudes

Page 21: Nursing Students’ Perceptions of Patient Safety - QSEN · Nursing Students’ Perceptions of Patient Safety ... Patient Safety Culture Quality and Safety Education for Nurses

+ Comparisons Comparisons of mean patient safety scores according to

class

2011 Survey 2012 Survey

Total Scale No significant difference, expected progression (Sr > Jr> Soph)

No significant difference Jr* < Sr & Soph

Knowledge F = 6.3, p = .003 Sr > Soph p =.004 Jr > Soph p = .03

F = 4.3, p = .02 Sr > Jr p =.02 Soph > Jr (not significant)

Skill No significant difference, expected progression

No significant difference Sr > Jr but < Soph Jr < Sr and Soph

Attitude Not significant Sr < both Jr and Soph

Not significant Sr < both Jr and Soph Jr > both Sr and Soph

* First class of new curriculum

Page 22: Nursing Students’ Perceptions of Patient Safety - QSEN · Nursing Students’ Perceptions of Patient Safety ... Patient Safety Culture Quality and Safety Education for Nurses

+ Effectiveness of the Scale (n=229)

Reliability (Alpha) Overall scale .85 Knowledge .87 Skill .87 Attitude .48

Redeveloped attitude scale .63

Reliability of attitude scale needs improvement

Page 23: Nursing Students’ Perceptions of Patient Safety - QSEN · Nursing Students’ Perceptions of Patient Safety ... Patient Safety Culture Quality and Safety Education for Nurses

+ Implications for Nursing

Practice Students identify clinical experience impacts

KSAs of patient safety Need for greater clinical exposure

Research Reliable measure of student perceptions of KSAs

Education Feasible teaching strategies that can be

incorporated into curricula


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