What clinical learning contracts reveal about nursing education and patient safety.

While it is widely accepted that adopting a systems perspective is important for understanding and addressing patient safety issues, nurse educators typically address these issues from the perspective of individual student performance. In this study, the authors explored unsafe patient care events recorded in 60 randomly selected clinical learning contracts initiated for students in years 2, 3, and 4 of the undergraduate nursing program at the University of Manitoba. The contracts had been drawn up for students whose nursing care did not meet clinical learning objectives and standards or whose performance was deemed unsafe. Using qualitative content analysis, the authors categorized data pertaining to 154 unsafe patient care events recorded in these contracts.Thirty-seven students precipitated these events. Most events were related to medication administration (56%) and skill application (20%). A breakdown of medication administration events showed that the highest number were errors related to time (33%) and dosage (24%). International students and male students were responsible for a higher number of events than their numbers in the sample would lead one to expect. The findings support further study related to patient safety and nursing education.

Patient safety: where is nursing education?

Patient safety is receiving unprecedented attention among clinicians, researchers, and managers in health care systems. In particular, the focus is on the magnitude of systems-based errors and the urgency to identify and prevent these errors. In this new era of patient safety, attending to errors, adverse events, and near misses warrants consideration of both active (individual) and latent (system) errors. However, it is the exclusive focus on individual errors, and not system errors, that is of concern regarding nursing education and patient safety. Educators are encouraged to engage in a culture shift whereby student error is considered from an education systems perspective. Educators and schools are challenged to look within and systematically review how program structures and processes may be contributing to student error and undermining patient safety. Under the rubric of patient safety, the authors also encourage educators to address discontinuities between the educational and practice sectors.

Case study: on the leading edge of new curricula concepts: systems and safety in nursing education.

The Nursing Division of the Saskatchewan Institute of Applied Science and Technology (SIAST) first included systems and patient safety as a priority in its institutional business and strategic plan in 2003. Three interrelated leading-edge, two-year projects (2004-2006) were launched: Best Practice, Mentorship and Patient Safety, with the intent that each project would enhance the others. This case study focuses on the work of the Patient Safety Project Team. The team developed a project framework and strategic plan, conducted a literature review and identified key concepts related to systems and patient safety. Strategies to integrate these concepts into the school's 15 nursing education programs are being implemented.