Patient Safety Competencies in Rural
ASN Students: An Evidence Based
Curricular Innovation
Janeen Berndt, MSN, RN, CNS, CNE
DNP Student
2011 NLN Health Information Technology Scholar
Problem
• Institute of Medicine (2003)
– Call for educational reform to improve quality and safety
– Call for evidence-based pedagogy
• Nursing’s role in Quality and Safety
– Most likely to recognize, interrupt and correct potentially life-threatening
errors (Chenot & Daniel, 2010)
– Routine examination of patient safety issues as part of daily practice is
not included in education (Chenot & Daniel, 2010)
• QSEN (2008)
– Response to the IOM /Defined 6 competency domains with KSAs
• Facility clinical experiences
– Advantages and Challenges
• High fidelity patient simulation (HFPS)
PICOT:
In rural ASN prelicensure students,
what is the effect of a series of multiple
patient simulations as compared to
baseline competency on patient safety
over four weeks?
Review of the Literature
Key Words
Nursing Education
QSEN
Patient Safety
Patient Simulation
Safety
Articles with inclusion criteria:
(a) 2005 – 2012;
(b) English language;
(c) prelicensure nursing education;
(d) patient simulation;
(e) patient safety; and
(f) safety management
CINAHL
MEDLINE
JBI
ERIC
Hand
Search
25
8
0
0
-
10
25
3
3
-
16
6
2
0
4
19
28
1
3
-
8
8
3
3
0
2
0
0
4
Articles with exclusion criteria:
(a) articles pertaining to staff development;
(b) medical education;
(c) graduate nursing education;
(d) computer simulation;
(e) conference proceedings; and
(f) editorials
Duplicates removed
Total Articles
Levels of Evidence
Level I
(3)
Level II
(1)
Level III (0)
Level IV (1)
Level V (1)
Level VI (10)
Level VII (1)
Best Practice Recommendation
In rural ASN nursing programs, a series
of multiple patient simulations should be
implemented to allow repeated exposure
to patient safety concerns.
Planning
• Frameworks:
• Project: PARiHS framework (Rycroft-Malone,
2004)
• Simulations: NESF (Jeffries & Rogers, 2005)
• Simulations:
•
•
•
•
2 students caring for 4 patients
20 minute simulations
Distractions or interruptions at 7 and 10 minutes
Patient care handoff at 15 minutes
• IRB approval from both institutions
• Informed consent
Implementation
• Setting:
• Rural 2 year private college in the
Midwest
• Sample:
• 3rd Semester ASN Students in 2nd
medical-surgical nursing course
Measures
• Tool developed by Ironside, Jeffries &
Martin (2009)
•
•
Based on 16 KSAs from the QSEN competency
domain of Safety
Chronbach’s alpha = 0.89 (Ironside et al., 2009)
and 0.81 for this project
Sample
•
•
n=8
Attrition = 4
Participant
Age
Gender
Ethnicity
Program
1
39
Male
African-American
ASN
2
36
Female
Caucasian
ASN
3
26
Female
African-American
LPN-RN
4
34
Female
African-American
LPN-RN
5
28
Male
Caucasian
ASN
6
29
Female
Caucasian
ASN
7
50
Female
Caucasian
LPN-RN
8
47
Female
Caucasian
LPN-RN
9
27
Female
Caucasian
LPN-RN
10
23
Female
Caucasian
LPN-RN
11
27
Female
Caucasian
LPN-RN
12
50
Female
Caucasian
LPN-RN
Mean = 34 .27
(SD=10.14)
83% Female
75% Caucasian
66.7% LPN-ASN
40
35
30
25
20
15
10
5
0
Sim #1
Sim #2
Sim #3
Sim #4
Safety Errors per 100 behaviors
OR = 2.6 = Positive Association
AR = 55% Safety errors attributed to
nonparticipation
McNemar’s test:
χ² (1, n=120) = 13.36, p<0.05
Safety errors by observed behavior
6
Safety Errors
5
4
Sim 1
Sim 2
Sim 3
Sim 4
3
2
1
0
1
2
3
4
5
6 7 8 9 10 11 12 13 14 15 16
Observed Behaviors
Evaluation
• Project Outcomes
•
The use of a series of multiple patient simulations
to improve patient safety competency in
prelicensure nursing students was supported.
• Organizational and Individual Feedback
•
Program Director
•
•
Faculty
•
•
Plan for future inclusion in curriculum
Recognize the impact on patient safety competency
Student Participants
•
•
“Helpful”
“Should stay in the class”
Recommendations
• Project Strengths
• Congruency of frameworks
• Purchased simulations
• Project Weaknesses
• Timeframe
• LPN-ASN ratio
Implications
• Practice
•
•
Evidence-based intervention
Supported by NLN Nurse Educator Competencies
• Theory/Research
•
•
NESF concepts and relationships
Teacher factors
• Education
•
•
Expanded application
Complement hospital clinicals
Conclusion
A series of multiple patient simulations is an effective intervention to improve
patient safety competency in prelicensure nursing students. This project
expands the existing evidence supporting simulation to teach patient safety
competencies and provides nurse educators a means to apply best-practice
teaching strategies.
Acknowledgements
Dr. Amy Cory – Valparaiso University
Faculty Advisor
Dr. Pam Jeffries – 2011 NLN HITS
Program Mentor