Just Culture: Nursing Students Transition to Practice-a Longitudinal Study.

BACKGROUND: Although just culture is reportedly integrated across education and practice, little is known about how perceptions may change across time as students transition from prelicensure education to registered nurse in the practice setting. PURPOSE: The purpose of this study was to describe and compare just culture perceptions of registered nurses at 2 time points: (1) as prelicensure students and (2) as new graduate nurses with a minimum of 6 months of experience. METHODS: Utilizing the Just Culture Assessment Tool for Nursing Education (JCAT-NE) and the Just Culture Assessment Tool (JCAT), this within-subject, longitudinal study measured just culture perceptions across time. RESULTS: Although there was no statistically significant change in total scores across time, 8 individual items demonstrated statistically significant change. CONCLUSIONS: Students use the knowledge, skills, and attitudes about just culture taught in prelicensure education as new graduate nurses. However, findings reveal areas where the practice environment has altered perceptions of just culture.

Exploratory factor analysis of the Just Culture Assessment Tool for nursing education.

BACKGROUND: Just culture has been identified as a vital component of safety culture by national and international organisations. In a just culture, emphasis is not placed on blaming individuals for errors but rather on examining personal and system processes that can best support safety and prevent reoccurrence. Although those in the practice arena have worked to implement the concepts of just culture, the same is not true in nursing education, leaving nursing students lacking the pre-requisite knowledge, skills and attitudes to implement just culture in practice on graduation. AIMS: Assessment of this phenomena is the essential first step to align nursing education with practice in promoting just culture as a mechanism for patient safety. The purpose of this paper is to further refine the Just Culture Assessment Tool-Nursing Education through exploratory factor analysis. METHODS: The Just Culture Assessment Tool-Nursing Education was adapted from the Just Culture Assessment Tool, an instrument created for the practice setting. Validity and reliability were established for the Just Culture Assessment Tool-Nursing Education in a study of 800 nursing students to assess their perceptions and understanding of just culture with their nursing programmes. Using the previously conducted data, an exploratory factor analysis was conducted. RESULTS: Factor analysis supports six subscales, similar to that of the Just Culture Assessment Tool. However, individual items were loaded into different subscales. All subscales demonstrated good reliability. Factor analysis supported further refinement of two items to improve the instrument's ability to capture data. CONCLUSIONS: Perceptions of just culture differ between experienced providers and nursing students; nursing students have less experience with reporting errors. Factor analysis of Just Culture Assessment Tool-Nursing Education items demonstrated these differences, supporting modification of items by the instrument developers. An 'if' statement for students to consider their possible actions rather than experience was added to two items to better capture data from nursing students when completing the assessment.

WARRIORS: An Educational Initiative Improving Clinical Judgment and Safety in Medication Administration.

BACKGROUND: Medication administration requires rigorous clinical reasoning leading to sound clinical judgment for positive patient outcomes. The National Council of State Boards of Nursing is implementing a clinical judgment model for the licensure examination. METHOD: To support the practice of clinical judgment in administering medication, improve patient safety, and better prepare nursing students for their licensure examination, a clinical reasoning initiative was developed to reflect the judgment needed for safe medication administration. An acronym, WARRIORS, captures the decision process exemplifying the knowledge, skills, and attitudes needed to keep patients safe. RESULTS: A free training tool (https://www.youtube.com/watch?v=YkBeGymEMuQ) and an online electronic health record (http://www.nursing.pitt.edu/aliceblazeckrn/) guiding deliberate practice provide interrelated cues to support nursing students in forming a hypothesis through taking action and evaluation. CONCLUSION: This learning initiative supports nursing students' safe and accurate medication administration and can continue to be used as they move into practice. [J Nurs Educ. 2020;59(4):231-234.].

Nursing Students' Perceptions of Just Culture in Nursing Programs: A Multisite Study.

BACKGROUND: While just culture is embraced in the clinical setting, just culture has not been systematically incorporated into nursing education. PURPOSE: The purpose of this study was to assess prelicensure nursing student perceptions of just culture in academia. METHODS: Following a quantitative, descriptive design, the Just Culture Assessment Tool for Nursing Education (JCAT-NE) was used to measure just culture across multiple (N = 15) nursing programs. RESULTS: The majority of JCAT-NE respondents (78%) reported their program has a safety reporting system, 15.4% had involvement in a safety-related event, and 12% submitted an error report. The JCAT-NE mean total score was 127.4 (SD, 23.6), with a statistically significant total score decline as students progressed from the beginning (133.6 [SD, 20.52]) to the middle (129.77 [SD, 23.6]) and end (122.2 [SD, 25.43]) of their programs (χ[2] = 25.09, P < .001). CONCLUSIONS: The results from this study are a call to action for nursing education to emphasize the tenets of just culture, error reporting, and quality improvement.

Development and Validation of the Just Culture Assessment Tool for Nursing Education.

BACKGROUND: Patient safety efforts in practice have focused on creating a just culture where errors can be identified and reported, and system remedies created to prevent reoccurrence. The same is not true of nursing education where student experiences with error and the sequelae that follow focus on individual performance. PURPOSE: The purpose of this study was to adapt the Just Culture Assessment Tool (JCAT) used in practice settings into a valid and reliable instrument to evaluate just culture in academic settings. METHODS: A 27-item instrument was adapted for academia. Content validity was established. Reliability was determined in a pilot study with 133 prelicensure nursing students. RESULTS: The scale content validity index (CVI) was calculated at 1. The reliability of the instrument is strong (α = .75). CONCLUSIONS: The CVI and pilot study findings support the use of the JCAT for Nursing Education as a valid and reliable instrument to evaluate student perception of just culture in academia.