Steven Alison, Magnusson Carin, Smith Pam, Pearson Pauline H
Faculty of Health and Life Sciences, Northumbria University, Coach Lane Campus (West), East Benton, Newcastle upon Tyne NE7 7XA, United Kingdom.
Centre for Research in Nursing and Midwifery Education, Faculty of Health and Medical Sciences, University of Surrey, Duke of Kent Building, Guildford, Surrey GU2 5TE, United Kingdom.
Nurse Educ Today. 2014 Feb;34(2):277-84. doi: 10.1016/j.nedt.2013.04.025. Epub 2013 May 28.
Education is crucial to how nurses practice, talk and write about keeping patients safe. The aim of this multisite study was to explore the formal and informal ways the pre-registration medical, nursing, pharmacy and physiotherapy students learn about patient safety. This paper focuses on findings from nursing. A multi-method design underpinned by the concept of knowledge contexts and illuminative evaluation was employed. Scoping of nursing curricula from four UK university programmes was followed by in-depth case studies of two programmes. Scoping involved analysing curriculum documents and interviews with 8 programme leaders. Case-study data collection included focus groups (24 students, 12 qualified nurses, 6 service users); practice placement observation (4 episodes=19 hrs) and interviews (4 Health Service managers). Within academic contexts patient safety was not visible as a curricular theme: programme leaders struggled to define it and some felt labelling to be problematic. Litigation and the risk of losing authorisation to practise were drivers to update safety in the programmes. Students reported being taught idealised skills in university with an emphasis on 'what not to do'. In organisational contexts patient safety was conceptualised as a complicated problem, addressed via strategies, systems and procedures. A tension emerged between creating a 'no blame' culture and performance management. Few formal mechanisms appeared to exist for students to learn about organisational systems and procedures. In practice, students learnt by observing staff who acted as variable role models; challenging practice was problematic, since they needed to 'fit in' and mentors were viewed as deciding whether they passed or failed their placements. The study highlights tensions both between and across contexts, which link to formal and informal patient safety education and impact negatively on students' feelings of emotional safety in their learning.
教育对于护士如何开展工作、谈论和书写保障患者安全至关重要。这项多地点研究的目的是探索预注册医学、护理、药学和物理治疗专业学生学习患者安全知识的正式和非正式方式。本文聚焦于护理专业的研究结果。采用了以知识背景概念和阐释性评价为支撑的多方法设计。首先对英国四个大学项目的护理课程进行了范围界定，随后对其中两个项目进行了深入案例研究。范围界定包括分析课程文件以及与8位项目负责人进行访谈。案例研究的数据收集包括焦点小组（24名学生、12名注册护士、6名服务使用者）；实习观察（4次=19小时）以及访谈（4名卫生服务管理人员）。在学术背景下，患者安全并非作为一个课程主题而显著存在：项目负责人难以对其进行定义，一些人认为进行标签化存在问题。诉讼以及失去执业授权的风险促使各项目更新安全内容。学生们报告称在大学中学习到的是理想化的技能，重点在于“不该做什么”。在组织背景下，患者安全被概念化为一个复杂问题，通过策略、系统和程序来解决。在营造“无责备”文化与绩效管理之间出现了矛盾。似乎几乎没有正式机制供学生了解组织系统和程序。在实践中，学生通过观察行为各异的榜样员工来学习；挑战实践存在问题，因为他们需要“融入”，而且导师被视为决定他们实习是否通过的关键人物。该研究凸显了不同背景之间以及背景内部的矛盾，这些矛盾与正式和非正式的患者安全教育相关联，并对学生在学习过程中的情感安全感产生负面影响。
