[Health care safety: The discrepancies between experience and degree of satisfaction of hospitalized patients observed in interviews performed by user representatives]. / La sécurité liée aux soins : écarts entre l'expérience et la satisfaction de patients hospitalisés à partir d'entretiens menés par des représentants d'usagers.

INTRODUCTION: The purpose of this article is to present the results of a qualitative survey conducted by user representatives (URs) focusing on the health care safety experience of hospitalized patients. The authors wished to identify factors associated with safety of care and, more specifically, with the possibly ominous medical events reported by patients. METHODS: After being trained with these objectives in mind, eight URs conducted semi-directive interviews with fourteen patients hospitalized in eleven separate hospital units in nine different hospitals. RESULTS: Eight types of factors consisting in 30 contributing factors liable to be reported by patients were identified: 1) factors related to patients' basic needs; 2) personalization of care; 3) professional factors; 4) organizational factors; 5) communication factors; 6) caregiver responsiveness; 7) infectious risks; 8) continuity of care. Patients' overall feelings about their hospitalization remained excellent notwithstanding more tempered, even negative experiences. CONCLUSION: This paradoxical result shows that the patients' actual experience is far more instructive than their degree of satisfaction. In light of this study, the acceptability of this type of research (i.e. research conducted by URs) is excellent and it also appears highly feasible, whatever the limitations imposed by organizational considerations.

Nurse teachers in higher education--without clinical competence, do they have a future?

The practice-theory divide between that which is taught in the classroom and which is performed in practice, is well documented. The role of the Registered Clinical Nurse Teacher was an attempt to overcome this, which failed. In many areas practitioners are being encouraged to become more educationally aware. However, many of the institutions which influence nursing in the United Kingdom expect teachers to be more clinically aware. This has led to a debate about the level of clinical competence or credibility a teacher requires. In this paper, two methods of achieving this are examined. First, the role of the Lecturer Practitioner, which provides clinical competence for a minority but which may not be appropriate for the majority, and can lead to isolation from other teachers. Second, the role of Link Teacher, which can provide clinical credibility, but where there are several reasons why the role is not being fulfilled adequately. The impending changes in the organisation of nurse education will affect teachers ability to bridge the practice-theory divide, as has already occurred in America. It is suggested that the role of the nurse teacher in the UK is being eroded by highly qualified specialists in higher education and more knowledgeable, articulate practitioners. Teachers need to establish their unique role which must lie in showing how academic knowledge can be integrated and applied to nursing practice. However, if nurse teachers do not maintain their clinical ability they will not be able to support their claim to do this, and not only will the practice-theory divide increase, but in the very near future nurse teachers will find it extremely difficult to justify their existence.