Learning From Student Experience: Development of an International Multimodal Patient Safety Education Package.

BACKGROUND: Patient safety is a global concern. Learning to provide safe, high-quality care is core to nursing education. PROBLEM: Students are exposed to diverse clinical practices, and experiences may vary between placements and across countries. Student experience is seldom used as an educational resource. APPROACH: An international, European Union-funded project, Sharing Learning from Practice for Patient Safety (SLIPPs), aimed to develop an innovative online educational package to assist patient safety learning. Based on student reported data and educational theory, multiple elements were iteratively developed by a multicountry, multidisciplinary group. OUTCOMES: The educational package is freely available on the SLIPPs Web site. Materials include a student reporting and reflection tool, virtual seminars, student reports data set, pedagogical game, high-fidelity simulation scenarios, scenario development and use guidelines, debriefing session model, and videos of simulations already performed. CONCLUSIONS: E-learning enables removal of physical barriers, allowing educators, professionals, and students from all over the world to collaborate, interact, and learn from each other.

Development of an International Tool for Students to Record and Reflect on Patient Safety Learning Experiences.

BACKGROUND: Underpinning all nursing education is the development of safe practitioners who provide quality care. Learning in practice settings is important, but student experiences vary. PURPOSE: This study aimed to systematically develop a robust multilingual, multiprofessional data collection tool, which prompts students to describe and reflect on patient safety experiences. APPROACH: Core to a 3-year, 5-country, European project was development of the SLIPPS (Sharing Learning from Practice for Patient Safety) Learning Event Recording Tool (SLERT). Tool construction drew on literature, theory, multinational and multidisciplinary experience, and involved pretesting and translation. Piloting included assessing usability and an initial exploration of impact via student interviews. OUTCOMES: The final SLERT (provided for readers) is freely available in 5 languages and has face validity for nursing across 5 countries. Student reports (n = 368) were collected using the tool. CONCLUSIONS: The tool functions well in assisting student learning and for collecting data. Interviews indicated the tool promoted individual learning and has potential for wider clinical teams.

Alexithymic traits predict the speed of classifying non-literal statements using nonverbal cues.

There is increasing interest in exploring the impact of alexithymia on interpersonal interactions. This study explored relationships between alexithymia and the complex mentalising skills needed to infer how a speaker intended a non-literal statement to be understood. A sample of university students (N = 70) viewed videotaped exchanges and attempted to classify remarks as literal, sarcastic, jocular, or white lies. Alexithymia was not associated with less consistent labelling of statement types. However, after accounting for variance due to verbal intelligence and sex, we found that those who reported more difficulties identifying their own feelings needed more time to distinguish between different statement types on the basis of the speaker's nonverbal cues. These findings highlight the value of examining response times, and of accounting for individual differences in specific alexithymic traits, when assessing social perception and cognition.

Alexithymia and the Evaluation of Emotionally Valenced Scenes.

Alexithymia is a personality trait characterized by difficulties identifying and describing feelings (DIF and DDF) and an externally oriented thinking (EOT) style. The primary aim of the present study was to investigate links between alexithymia and the evaluation of emotional scenes. We also investigated whether viewers' evaluations of emotional scenes were better predicted by specific alexithymic traits or by individual differences in sensory processing sensitivity (SPS). Participants (N = 106) completed measures of alexithymia and SPS along with a task requiring speeded judgments of the pleasantness of 120 moderately arousing scenes. We did not replicate laterality effects previously described with the scene perception task. Compared to those with weak alexithymic traits, individuals with moderate-to-strong alexithymic traits were less likely to classify positively valenced scenes as pleasant and were less likely to classify scenes with (vs. without) implied motion (IM) in a way that was consistent with normative scene valence ratings. In addition, regression analyses confirmed that reporting strong EOT and a tendency to be easily overwhelmed by busy sensory environments negatively predicted classification accuracy for positive scenes, and that both DDF and EOT negatively predicted classification accuracy for scenes depicting IM. These findings highlight the importance of accounting for stimulus characteristics and individual differences in specific traits associated with alexithymia and SPS when investigating the processing of emotional stimuli. Learning more about the links between these individual difference variables may have significant clinical implications, given that alexithymia is an important, transdiagnostic risk factor for a wide range of psychopathologies.

Action after Adverse Events in Healthcare: An Integrative Literature Review.

Adverse events are common in healthcare. Three types of victims of patient-related adverse events can be identified. The first type includes patients and their families, the second type includes healthcare professionals involved in an adverse event and the third type includes healthcare organisations in which an adverse event occurs. The purpose of this integrative review is to synthesise knowledge, theory and evidence regarding action after adverse events, based on literature published in the last ten years (2009-2018). In the studies critically evaluated (n = 25), key themes emerged relating to the first, second and third victim elements. The first victim elements comprise attention to revealing an adverse event, communication after an event, first victim support and complete apology. The second victim elements include second victim support types and services, coping strategies, professional changes after adverse events and learning about adverse event phenomena. The third victim elements consist of organisational action after adverse events, strategy, infrastructure and training and open communication about adverse events. There is a lack of comprehensive models for action after adverse events. This requires understanding of the phenomenon along with ambition to manage adverse events as a whole. When an adverse event is identified and a concern expressed, systematic damage preventing and ameliorating actions should be immediately launched. System-wide development is needed.

Critical Incident Techniques and Reflection in Nursing and Health Professions Education: Systematic Narrative Review.

BACKGROUND: The terms critical incident technique and reflection are widely used but often not fully explained, resulting in ambiguity. PURPOSE: The aims of this review were to map and describe existing approaches to recording or using critical incidents and reflection in nursing and health professions literature over the last decade; identify challenges, facilitating factors, strengths, and weaknesses; and discuss relevance for nursing education. METHODS: A systematic narrative review was undertaken. MEDLINE and the Cumulative Index to Nursing and Allied Health Literature were searched using MeSH terms, returning 223 articles (2006-2017). After exclusions, 41 were reviewed. RESULTS: Articles were categorized into 3 areas: descriptions of the development of an original tool or model, critical incidents or reflection on events used as a learning tool, and personal reflections on critical incidents. CONCLUSIONS: Benefits have been identified in all areas. More attention is needed to the pedagogy of reflection and the role of educators in reflection.

Shared learning from national to international contexts: a research and innovation collaboration to enhance education for patient safety.

BACKGROUND: Patient safety is key for healthcare across the world and education is critical in improving practice. We drew on existing links to develop the Shared LearnIng from Practice to improve Patient Safety (SLIPPS) group. The group incorporates expertise in education, research, healthcare, healthcare organisation and computing from Norway, Spain, Italy, the UK and Finland. In 2016 we received co-funding from the Erasmus + programme of the European Union for a 3-year project. AIM: SLIPPS aims to develop a tool to gather learning events related to patient safety from students in each country, and to use these both for further research to understand practice, and to develop educational activities (virtual seminars, simulation scenarios and a game premise). STUDY OUTLINE: The SLIPPS project is well underway. It is underpinned by three main theoretical bodies of work: the notion of diverse knowledge contexts existing in academia, practice and at an organisational level; the theory of reflective practice; and experiential learning theory. The project is based on recognition of the unique position of students as they navigate between contexts, experience and reflect on important learning events related to patient safety. To date, we have undertaken the development of the SLIPPS Learning Event Recording Tool (SLERT) and have begun to gather event descriptions and reflections. CONCLUSIONS: Key to the ongoing success of SLIPPS are relationships and reciprocal openness to view things from diverse perspectives and cultures.

Nursing workloads and activity in critical care: A review of the evidence.

OBJECTIVES: To review current methods for informing nurse workforce decisions in critical care. Many clinical outcomes are worse if staffing is inadequate. Workforce planning is usually according to guidelines developed from the opinions of expert groups. Objective systems for planning and distributing staff have been developed but their value is unclear. DESIGN: A rapid review methodology was employed. REVIEW METHODS: The search included research studies, guidelines and surveys within and outside United Kingdom since 1995. FINDINGS: Thirty-two studies met eligibility criteria. Studies originated worldwide, with considerable work undertaken in the United Kingdom and Brazil. Two were large multicentre studies. Tools examined fell into three groups: those focused on the condition and needs of the patient, those focused on the number and time for nursing activities and those that also took account of psycho-social factors. Many tools were not used beyond their country of origin. CONCLUSION: There is limited experience of using tools to determine nurse staffing. No one tool is likely to suit every application. More information is needed to clarify the practicalities of using the tools.

Collaborative child home injury prevention in Thailand: An action research study.

Child home accidental injury is a global health issue, and promoting child safety is a pediatric nursing challenge worldwide. Planning child home accidental injury prevention requires understanding of factors influencing parents' behavior. Evidence suggests that participatory health promotion positively influences behavior; however, research on Thai parents is limited. This qualitative, action research study aimed to understand Thai parents' experiences of participating in a collaborative child home accidental injury prevention program and its influence on their behavior. Eight parental mother/father couples from one Thai province consented to participate, providing a wide range of data via in-depth individual interviews and self-assessment questionnaires. Thematic analysis of interview transcripts yielded three themes: collaborative learning, parental behavior change, and reflective learning extends beyond families. Participants reported that workshop participation improved their child home accidental injury-prevention behavior. The present study can inform pediatric nursing, child health-care practice, and child health policy in Thailand and beyond.

New Ways of Working in UK mental health services: developing distributed responsibility in community mental health teams?

BACKGROUND: This paper examines the introduction and operation of a number of support roles in mental health services. This is done in the context of concerns about the effectiveness of CMHTs. AIMS: Three questions are addressed: the degree to which concern for the work of consultant psychiatrists informed the introduction of the new roles; what the reforms implied for the work of the psychiatrist and those in new roles; and the impact of any changes on the operation of CMHTs. METHOD: Data were collected as part of a national-level evaluation. The main means of collection was the semi-structured interview. RESULTS: The study shows: that reform was underpinned by concerns about the workload of psychiatrists; and that while in principle the responsibilities of the psychiatrist were to be distributed across other team members, those in new roles felt themselves to be isolated. CONCLUSIONS: Despite the intentions of policy, the creation of the new roles did little to extend the idea of distributed responsibility in CMHTs.

Interprofessional learning for medication safety.

BACKGROUND: Patient safety is a worldwide priority. Recommendations have been made that doctors, nurses and pharmacists could interact more effectively to improve patient outcomes, and that interprofessional education should be encouraged. In 2009, the North East Strategic Health Authority awarded Workforce Development Initiative funding to Northumbria Healthcare National Health Service (NHS) Foundation Trust to develop an undergraduate interprofessional training activity in medication safety for medicine, pharmacy and nursing students. CONTEXT: Interprofessional seminars for medication safety and therapeutics were developed that were delivered across the North East of England. The initial seminars took place between January and April 2011 at 10 teaching hospitals, and were attended by over 400 students (from medicine, pharmacy and nursing). INNOVATION: The majority of the workshops were facilitated by an interprofessional team comprised of pharmacists, doctors and nurses, with all students working in small groups with participants from each of the professional groups, where possible. All seminars had standardised materials, but it was up to individual facilitators to choose which of the five case studies were used within the seminar. The seminars lasted between 2 and 3 hours, and depending on which case studies were used, two or three cases could be discussed. Student feedback showed that the seminar was particularly successful in highlighting and improving the students' understanding of each other's roles and responsibilities in relation to medication safety. There are considerable organisational challenges in arranging interprofessional groups. Scenarios need to provide tasks that engage and challenge all of the professions involved. Facilitation is an important element. Interprofessional education should be encouraged.

Action learning sets in a nursing and midwifery practice learning context: a realistic evaluation.

Action learning sets (ALS) are used widely for organisational and workforce development, including in nursing (Anderson and Thorpe, 2004; Pounder, 2009; Young et al., 2010). In the United Kingdom, a multi-faceted educational Pilot programme for new nurses and midwives was implemented to accelerate their clinical practice and leadership development (NHS Education Scotland, 2010). Action Learning Sets were provided for peer support and personal development. The Realistic Evaluation study reported in this paper explored issues of context, mechanism and outcome (Pawson and Tilley, 1997) influencing the action learning experiences of: programme participants (recently qualified nurses and midwives, from different practice settings); and programme supporters. A range of data were collected via: online questionnaires from 66 participants and 29 supporters; three focus groups, each comprising between eight and 10 programme participants; and one focus group with three action learning facilitators. The qualitative data pertaining to the ALS are presented in this paper. Thematic data analysis of context, mechanism and outcome configurations, generated five themes: creating and sustaining a collective learning environment; challenging constructively; collective support; the role of feedback; and effectiveness of ALS. Study outcomes suggest nursing and midwifery action learning should (a) be facilitated positively to improve participants' experience; (b) be renamed to avoid learning methodology confusion; and (c) be outcome focused to evidence impact on practice.

Patient safety in nursing education: contexts, tensions and feeling safe to learn.

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.

Patient safety in healthcare preregistration educational curricula: multiple case study-based investigations of eight medicine, nursing, pharmacy and physiotherapy university courses.

BACKGROUND: We sought to investigate the formal and informal ways preregistration students from medicine, nursing, pharmacy and the allied healthcare professions learn about patient safety. METHODS: We drew on Eraut's framework on formal and informal acquisition of professional knowledge to undertake a series of phased theoretically informed, in-depth comparative qualitative case studies of eight university courses. We collected policy and course documentation; interviews and focus groups with educators, students, health service staff, patients and policy makers; and course and work placement observations. Data were analysed thematically extracting emerging themes from different phases of data collection within cases, and then comparing these across cases. RESULTS: We conducted 38 focus groups with a total of 162 participants, undertook 82 observations of practice placements/learning activities and 33 semistructured interviews, and analysed 44 key documents. Patient safety tended to be either implicit in curricula or explicitly identified in a limited number of discrete topic areas. Students were predominantly taught about safety-related issues in isolation, with the consequence of only limited opportunities for interprofessional learning and bridging the gaps between educational, practice and policy contexts. Although patient safety role models were key to student learning in helping to develop and maintain a consistent safety ethos, their numbers were limited. CONCLUSIONS: Consideration needs to be given to the appointment of curriculum leads for patient safety who should be encouraged to work strategically across disciplines and topic areas; development of stronger links with organisational systems to promote student engagement with organisation-based patient safety practice; and role models should help students to make connections between theoretical considerations and routine clinical care.

Building community capacity using web-supported work-based learning.

Health visitors are a central component of policy to create strong, stable families and communities. The programme which is described here is intended to facilitate existing health visitors to gain confidence and extend or renew their skills in building community capacity (BCC). Networking and relationships are essential to effective community development. These are key skills for the health visitor, which along with professional principles support community capacity building. Learning in this programme is self-directed, supported by web-based resources over a 24 week period. Learning mainly takes place in practice. It involves carrying out a work based project through to completion. Participants register online, and follow a series of six phases. Evaluation of the pilot took place during 2011. Three main areas for improvement were identified: reflective software; signposting access to resources; and dealing with workload pressures. Community engagement for health improvement remains an important element of the vision for health visiting. The programme described is a core resource through which health visitors can build the skills and confidence of community groups and staff in other agencies to make a difference to health and wellbeing.

Maintaining equilibrium in professional role identity: a grounded theory study of health visitors' perceptions of their changing professional practice context.

AIMS: This article reports the study of a group of United Kingdom health visitors' interactions with their changing practice context, focusing on role identity and influences on its stability. BACKGROUND: United Kingdom policies have urged health visitors to refocus their role as key public health nurses. Reduced role identity clarity precipitated the emergence of different models of health visiting public health work. An inconsistent role standard can lead to role identity fragmentation and conflict across a group. It may precipitate individual role crisis, affecting optimum role performance. METHODS: Seventeen health visitors in two United Kingdom community healthcare organizations participated in a grounded theory study, incorporating constant comparative analysis. Direct observations and individual interviews were undertaken between 2002 and 2008. RESULTS/FINDINGS: Four interlinked categories emerged: professional role identity (core category); professional role in action; interprofessional working; and local micro-systems for practice; each influencing participants' sense of identity and self-worth. The Role Identity Equilibrium Process explains interactive processes occurring at different levels of participants' practice. CONCLUSION: Re-establishing equilibrium and consistency in health visiting identity is a priority. This study's findings have significance for other nurses and health professionals working in complex systems, affected by role change and challenges to role identity.

Learning about patient safety: organizational context and culture in the education of health care professionals.

OBJECTIVES: This study investigated the formal and informal ways pre-registration students from medicine, nursing, physiotherapy and pharmacy learn about keeping patients safe. This paper gives an overview of the study and explores findings in relation to organizational context and culture. METHODS: The study employed a phased design using multiple qualitative methods. The overall approach drew on 'illuminative evaluation'. Ethical approval was obtained. Phase 1 employed a convenience sample of 13 pre-registration courses across the UK. Curriculum documents were gathered, and course directors interviewed. Phase 2 used eight case studies, two for each professional group, to develop an in-depth investigation of learning across university and practice by students and newly-qualified practitioners in relation to patient safety, and to examine the organizational culture that students and newly-qualified staff are exposed to. Analysis was iterative and ongoing throughout the study, using frameworks agreed by all researchers. RESULTS: Patient safety was felt to have become a higher priority for the health care system in recent years. Incident reporting was a key feature of the patient safety agenda within the organizations examined. Staff were often unclear or too busy to report. On the whole, students were not engaged and may not be aware of incident reporting schemes. They may not have access to existing systems in their organization. Most did not access employers' induction programmes. Some training sessions occasionally included students but this did not appear to be routine. CONCLUSIONS: Action is needed to develop an efficient interface between employers and education providers to develop up-to-date curricula for patient safety.

Emotions at work: what is the link to patient and staff safety? Implications for nurse managers in the NHS.

AIMS: This paper sets the discussion of emotions at work within the modern NHS and the current prioritisation of creating a safety culture within the service. BACKGROUND: The paper focuses on the work of students, frontline nurses and their managers drawing on recent studies of patient safety in the curriculum, and governance and incentives in the care of patients with complex long term conditions. METHODS: The primary research featured in the paper combined a case study design with focus groups, interviews and observation. RESULTS: In the patient safety research the importance of physical and emotional safety emerged as a key finding both for users and professionals. In the governance and incentives research, risk emerged as a key concern for managers, frontline workers and users. CONCLUSION: The recognition of emotions and the importance of emotional labour at an individual and organizational level managed by emotionally intelligent leaders played an important role in promoting worker and patient safety and reducing workplace risk. IMPLICATIONS FOR NURSE MANAGERS: Nurse managers need to be aware of the emotional complexities of their organizations in order to set up systems to support the emotional wellbeing of professionals and users which in turn ensures safety and reduces risk.

Ruthenium(II) complexes incorporating 2-(2'-pyridyl)pyrimidine-4-carboxylic acid.

A new bidentate ligand bearing a single carboxylate functionality, 2-(2'-pyridyl)pyrimidine-4-carboxylic acid (cppH), has been prepared and applied in the synthesis of a series of ruthenium(II) complexes. Reaction of this new ligand with Ru(II)(bpy)(2)Cl(2) led to the unexpected oxidation of the starting material to give [Ru(III)(bpy)(2)Cl(2)]Cl.H(2)O and a low yield of [Ru(II)(bpy)(2)(cppH)](PF(6))(2).H(2)O (1) on addition of an aqueous KPF(6) solution (bpy = 2,2'-bipyridine and cpp = 4-carboxylate-2'-pyridyl-2-pyrimidine). An X-ray crystal structure determination on crystals of 1a, [Ru(II)(bpy)(2)(cpp)](PF(6)), obtained from slow evaporation of an aqueous solution of 1 revealed that the nitrogen para to the carboxylate group in the cpp(-) ligand coordinates to the ruthenium(II) center rather than that ortho to this group. The same complex was prepared via decarbonylation of [Ru(II)(cppH)(CO)(2)Cl(2)].H(2)O in the presence of bpy and an excess of trimethylamine-N-oxide (Me(3)NO), as the decarbonylation agent. The coordination of cppH in the precursor is the same as in the final product. The related complex [Ru(II)(phen)(2)(cppH)](PF(6))(2).2H(2)O (2) (phen = 1,10-phenanthroline) was similarly synthesized. [Ru(II)(bpy)(dppz)(cppH)](PF(6))(2).CH(3)CN (3) (dppz = dipyrido[3,2,-a;2',3-c]phenazine) was also prepared by photochemical decarbonylation of [Ru(II)(bpy)(CO)(2)Cl(2)] giving [Ru(II)(bpy)(CO)Cl(2)](2) followed by bridge splitting with dppz to generate [Ru(II)(bpy)(dppz)(CO)Cl](PF(6)).H(2)O. This intermediate was then reacted with cppH to produce 3, as a mixture of geometric isomers. In contrast to 1, X-ray crystallography on the major product isolated from this mixture, [Ru(II)(bpy)(dppz)(cpp)](NO(3)).10H(2)O, 3(N3) indicated that the nitrogen adjacent to the carboxylate was coordinated to ruthenium(II). Full characterization of these complexes has been undertaken including the measurement of UV-visible and emission spectra. Electrochemical and spectroelectrochemical studies in acetonitrile show that these complexes undergo reversible oxidation from Ru(II) to Ru(III) at potentials of 983 +/- 3 mV, 1004 +/- 5 mV, and 1023 +/- 3 mV versus Fc(0/+) (Fc = Ferrocene) for 1, 2, and 3(N3), respectively.