Patient Safety Competence and Attitude towards Patient Safety Policies among students Nurses in Kerala: A Cross-sectional Survey

 

Namitha Subrahmanyam¹, Isha M Aboobacker²*, Susan Mathai

¹Professor, Department of Obstetrics and Gynaecological Nursing, MOSC College of Nursing, Kolenchery.

²Assistant Professor, Department of Medical Surgical Nursing, MOSC College of Nursing, Kolenchery.

³Associate Professor, Department of Medical Surgical Nursing, MOSC College of Nursing, Kolenchery.

 

ABSTRACT:

 

 

INTRODUCTION:

Within the changing healthcare systems, the provision of safer and higher quality care is emphasized for nursing professionals¹ The core aim of nursing education is to equip nursing professionals with a sufficient level of competency to ensure Patient safety and quality care.²

 

It is not only important to provide continued Patient Safety education to nurses who are currently working in the field, but also to educate nursing students to become future nurses with Patient safety competencies.³

 

Identifying nursing students’ patient safety competency levels and their attitude towards this concern are of paramount importance and should take precedence to enhance the quality of PS education, which has a direct impact on fostering highly qualified future nursing professionals. Studies in this regard are limited in Indian context. Hence this self report survey has been undertaken to assess patient safety competence and attitude towards patient safety policies among nursing students in Kerala.

 

MATERIALS AND METHODS:

A quantitative descriptive survey was carried out among 332 student nurses undergoing undergraduate or postgraduate nursing programmes two self financing nursing colleges in Kerala. After obtaining informed consent, Student nurses were enrolled to the study by using convenient sampling. Data were collected using self report technique in a single appointment by using Structured Demographic perform and structured attitude scale and Health Professional Education in Patient Safety Survey (H-PEPSS). The data were coded in Microsoft Excel and analyses using R software.

 

RESULTS:

Section A: Distribution of demographic variables

Table 1: Frequency distribution (f) and percentage (%) of student nurses based on personal characteristics n=332

Socio personal characteristics		Student nurses
		(f)	(%)
Age	>22 years <22 years	261 71	78.61 21.39
course	Basic B.Sc(N) Post Basic B.Sc(N) M.Sc Nursing	290 36 6	87.35 10.84 1.81
Year of study	I Year B.Sc Nursing II Year B.Sc Nursing III year B.Sc Nursing Iv year B.Sc Nursing I PPBSC II PPBSC I M.Sc Nursing II M.Sc Nursing	115 58 41 76 23 13 2 4	34.64 17.47 12.35 23.90 6.93 3.92 00.60 1.2
The setting where Clinical experience is provided during the course	Parent hospital Affiliated Hospital Both	251 00 81	75.60 00.00 24.40
Preceptorship program	yes No	251 81	75.60 24.40

 

Among the 332student nurses, majority (78.61%) were in the age group below 22years. Majority of the subjects (87.35%) belonged to Basic B.Sc(N) course and the least (1.81%) were enrolled for M.Sc (N) course. More than athird (34.64%) of the students were studying in first year B.Sc Nursing and the least (00.60%) belonged to first year M.Sc Nursing. Same proportion of (75.60%) of the students had their clinical experience from the parent institution and had Preceptorship program.

 

Table 2: Patient safety competence score among nursing students n=332

Nurses	Median	IQR	Wilcoxon Sign Rank test	p value
Clinical competence	21	17, 24	0.965	<0.001 *
Theoretical competence	22	18, 25

level of significance <0.05 *

Student nurses’ theoretical competence patient safety was significantly higher 22(18,25) (p<0.001) than clinical competence 21(17,24).

 

Table 3: Attitude towards patient safety policies among nursing students n=332 

Sl. No.	Item	Agree
		f	%
	Patient care is important at every context of health care profession	326	98.19
	Clinical setting is the best place to impart patient safety	283	85.24
	Reinforcing patient safety policies and procedures is the best strategy to reach the goal	252	75.90
	Practice of responding to an error need to be standardized	237	71.39
	Regular reviews and inspection can reduce the Health care errors	286	86.14
6.	Hospital incident report is the final step for correction of error	261	78.61
7.	Disclosing an error to a patient is an ethical responsibility	191	59.34
8.	Near miss events need to be reported even though it does not harm the patient	40	12.05
9.	Administrative support is essential to ensure patient safety	252	77.71
10.	Non punitive response to error is crucial to overall patient safety	98	29.52

 

Most of the subjects (98.19%) perceived that Patient care is important at every context of health care profession. 85.24% reported that clinical setting is the best place to impart patient safety. Approximately similar proportion (86.14) view that regular reviews and inspection can reduce the health care errors. Three quarter (75.9%) of the respondents asserted that Reinforcing patient safety policies and procedures is the best strategy to reduce patient safety issues in Clinical settings. Similarly most (71.39%) of the subjects responded favorably to the statement -Practice of responding to an error need to be standardized. A major proportion (77.71%) agreed that administrative support is essential to ensure patient safety. A higher proportion (59.67%) perceived that disclosing an error to a patient is an ethical responsibility. Surprisingly 78.61% of the respondents believed that hospital incident report is the final step for correction of error. Comparatively lesser proportion of subjects agreed with the idea that non- punitive response to error is crucial to overall patient safety (29.52%) and Near miss events need to be reported even though it does not harm the patient (12.05%).

 

Table 6: Association between theoretical competence on patient safety and selected variables of subjects n=332

Personal variables	Chi square/ Kruskal Wallis test	p value
Age	40.671	0.139
Course	94.833	0.007*
year	94.833	0.007*
The setting where Clinical experience is provided during the course	52.217	0.850
Preceptorship Programme	32.206	0.450

level of significancep<0.05 *

 

Significant association was found between theoretical competence on patient safety with course of study (p=0.007) and year of study (p=0.007) of student nurses.

 

Table 7: Association between clinical competence on patient safety and selected variables of subjects n=332

Personal variables	Chi square/ Kruskal Wallis test	p value
Age	30.904	0.420
Course	59.302	0.050
year	242.71	0.041*
The setting where Clinical experience is provided during the course	92.59	0.004*
Preceptorship Programme	25.544	0.698

P<0.05

 

Year of study (p=0.041) and clinical experience provided in the course (p=0.004) were the significant factors associated with clinical competence on patient safety among student nurses.

 

DISCUSSION:

Among the student nurses studied, majority were in the age group below 22years. Most of the subjects (87.35%) belonged to Basic B.Sc(N) course and the least (1.81%) were enrolled for M.Sc (N) course. More than a third (34.64%) of the students were studying in first year B.Sc Nursing and the least (00.60%) belonged to first year M.Sc Nursing The seat availability in various nursing course differ in Kerala and the trend is that the institutions conducting nursing programmes predominantly have more seats for Basic BSc Nursing course. This could the reason for the reflection of similar trend in the study. Proportions of of the students who had their clinical experience from the parent institution and had Preceptorship program were same (75.60%). Three forth of the students had their clinical experience from the parent institution and had exposure to Preceptorship program. Effective implementation of preceptorship programme is a known strategy to promote students’ learning process in the clinical setting. Teaching institutions having own clinical facility to provide exposure to students are better able to utilize preceptors for students’ learning.

 

Theoretical competence on patient safety communication and reporting was significantly higher among students as compared to clinical competence. The limited exposure to clinical situations and regular theory input in classroom might have contributed to this finding.

 

Most of the subjects perceived that Patient care is important at every context of health care profession and clinical setting is the best place to impart patient safety. Even though health professionals speak of being part of a team, they tend to work autonomously.⁴ Efforts to improve health care safety and quality are often jeopardized by the communication and collaboration barriers that exist between clinical staff. ⁵ Organizations must be able to assess the prevalence, context, and impact of behaviors to identify potential opportunities for improvement in this aspect.⁶ Recognition of patient safety as a prime concern is very crucial for further actions to safeguard this policy.

 

As reported in the study, regular reviews and inspection on patient safety risks and causes for patient safety pitfalls will throw light into strategies to prevent their happening in future, and thus reduces such kinds of health care errors.

 

Reinforcing patient safety policies and procedures can be opted as one of the best approaches to reduce patient safety issues in Clinical settings. The burden of practice errors on patients, their family members, and the healthcare system can be reduced through implementing patient-safety principles based on preventive and quality-improvement strategies.⁷ Nurses’ adherence to the principles of patient safety is required for the success of interventions aimed at the prevention of practice errors and to achieve sustainable and safer healthcare systems.⁸ Reinforcement of the policies among stakeholders including hospital administrative authorities , health care personnel ,patients and their significant others promote accountability for service provided in the health care settings .

 

As perceived by majority of respondents in this study, practice of responding to an error needs standardization so that consistency can be ensured on actions taken for negative consequences of patient safety issues.

 

Both in public and private sector administrative support is an essential factor to ensure patient safety. The support may be in the form of physical infrastructure, updated policies and procedures, adequate manpower and intact appraisal system.

 

Disclosing an error to a patient is viewed as the ethical responsibility of health care provider by more than half of the respondents in the study. Ethical obligations and patient safety principles support prompt disclosure of harmful medical errors.⁹ However, fear of malpractice liability is a barrier to physician disclosure and that, healthcare providers fear disclosure will invite new claims or complicate the medical error incident and therefore acts as an inhibiting impulse to disclose.¹⁰ Disclosure and its elements are emphasized in ethical and professional guidelines. Since 2001, hospitals are required to disclose all unexpected outcomes as pper the guidelines of The Joint Commission. Disclosure allows a patient to obtain timely and appropriate treatment to correct problems; additionally, it enables better informed consent for any further treatment that may be required.¹¹

 

Surprisingly more than three quarters of the respondents in the study believed that hospital incident report is the final step for correction of error. The most important capability of a patient safety incident reporting and learning system must surely be its effectiveness in reducing future harm of the kind that is being reported to it. Unfortunately, there are few places around the world where there is a powerful flow of learning that moves from identifying instances of avoidable harm, through understanding why they did or could happen, to successful and sustainable elimination of the risk for future patients.¹² The ultimate outcome of effective incident reporting sydtem has to be tangible change in the way health care is provided to improve safety. This goal should be observable as a participatory process that engages people from muti sectors and involves active changes to individual and organizational behaviour on patient safety. Incident reports have limited value in health care environment unless it is associated with behavioural and organizational change aiming at sustainable quality improvement initiatives in patient safety dimensions.

 

Even though it was found in this study that only a lesser proportion of subjects agreed with the idea that non- punitive response to error is crucial to overall patient safety, it is essential to change the culture of blame and neglect in order to provide the health professionals with an environment in which they are free to express themselves and to put forward their point of view. It will enable the health care system to identify possible issues that threaten the safety of patients and there by utilize the opportunity to learn from these errors and to avoid their occurrence in future.¹³

 

In this study only few had the insight that near miss events need to be reported even though it does not harm the patient. Near misses are often precursors of adverse events, and analysis of their root causes can provide important insights into how to prevent adverse events from happening. In addition, near misses involve some planned or unplanned recovery procedures. These responses to system breakdowns are a key element of learning from near misses. Identifying what recovery procedures work in practice helps in developing better care delivery systems.¹⁴

 

CONCLUSION:

There is significant lacunae exist between clinical and theory competence with regard to patient safety among nursing students. The perception on safety communication and reporting also varied among different dimensions. The findings in the study suggest implementation of a system-based approach to deal with communication and safety reporting practices. To achieve the optimal perception of patient safety culture in health care settings, the work force and the beginners in the field need to be sensitized regarding patient safety, especially on standard treatment protocols, administrative framework of hospital, and communication mechanism through continuing education programmes and training. A persuasive reporting approach is needed to promote the patient safety culture in the care settings instead of following the traditional punitive approach.

 

ACKNOWLEDGEMENT:

Here we extend our sincere thanks to the administrative authorities of study settings, IEC members and study participants.

 

CONFLICT OF INTEREST:

The authors declare no conflict of interest in the study.

 

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Received on 29.12.2021         Modified on 14.06.2022

Accepted on 01.09.2022        ©A&V Publications All right reserved