Patient Safety Competencies in Rural ASN Students: An Evidence Based Curricular Innovation Janeen Berndt, MSN, RN, CNS, CNE DNP Student 2011 NLN Health Information Technology Scholar

Problem Institute of Medicine (2003) –Call for educational reform to improve quality and safety –Call for evidence-based pedagogy Nursing’s role in Quality and Safety –Most likely to recognize, interrupt and correct potentially life-threatening errors (Chenot & Daniel, 2010) –Routine examination of patient safety issues as part of daily practice is not included in education (Chenot & Daniel, 2010) QSEN (2008) –Response to the IOM /Defined 6 competency domains with KSAs Facility clinical experiences – Advantages and Challenges High fidelity patient simulation (HFPS)

PICOT: In rural ASN prelicensure students, what is the effect of a series of multiple patient simulations as compared to baseline competency on patient safety over four weeks?

Review of the Literature Key WordsCINAHLMEDLINEJBIERIC Hand Search Nursing Education QSEN Patient Safety Patient Simulation Safety Articles with inclusion criteria: (a)2005 – 2012; (b)English language; (c)prelicensure nursing education; (d)patient simulation; (e)patient safety; and (f)safety management Articles with exclusion criteria: (a)articles pertaining to staff development; (b)medical education; (c)graduate nursing education; (d)computer simulation; (e)conference proceedings; and (f)editorials Duplicates removed8300- Total Articles 83204

Levels of Evidence Level I (3) Level II (1) Level III (0) Level IV (1) Level V (1) Level VI (10) Level VII (1)

Best Practice Recommendation In rural ASN nursing programs, a series of multiple patient simulations should be implemented to allow repeated exposure to patient safety concerns.

Planning Frameworks: Project: PARiHS framework (Rycroft-Malone, 2004) Simulations:NESF (Jeffries & Rogers, 2005) Simulations: 2 students caring for 4 patients 20 minute simulations Distractions or interruptions at 7 and 10 minutes Patient care handoff at 15 minutes IRB approval from both institutions Informed consent

Implementation Setting: Rural 2 year private college in the Midwest Sample: 3 rd Semester ASN Students in 2 nd medical-surgical nursing course

Measures Tool developed by Ironside, Jeffries & Martin (2009) Based on 16 KSAs from the QSEN competency domain of Safety Chronbach’s alpha = 0.89 (Ironside et al., 2009) and 0.81 for this project

Sample ParticipantAgeGenderEthnicityProgram 139MaleAfrican-AmericanASN 236FemaleCaucasianASN 326FemaleAfrican-AmericanLPN-RN 434FemaleAfrican-AmericanLPN-RN 528MaleCaucasianASN 629FemaleCaucasianASN 750FemaleCaucasianLPN-RN 847FemaleCaucasianLPN-RN 927FemaleCaucasianLPN-RN 1023FemaleCaucasianLPN-RN 1127FemaleCaucasianLPN-RN 1250FemaleCaucasianLPN-RN Mean = (SD=10.14) 83% Female75% Caucasian66.7% LPN-ASN n=8 Attrition = 4

OR = 2.6 = Positive Association AR = 55% Safety errors attributed to nonparticipation McNemar’s test: χ² (1, n=120) = 13.36, p<0.05

Evaluation Project Outcomes The use of a series of multiple patient simulations to improve patient safety competency in prelicensure nursing students was supported. Organizational and Individual Feedback Program Director Plan for future inclusion in curriculum Faculty Recognize the impact on patient safety competency Student Participants “Helpful” “Should stay in the class”

Recommendations Project Strengths Congruency of frameworks Purchased simulations Project Weaknesses Timeframe LPN-ASN ratio

Implications Practice Evidence-based intervention Supported by NLN Nurse Educator Competencies Theory/Research NESF concepts and relationships Teacher factors Education Expanded application Complement hospital clinicals

Conclusion A series of multiple patient simulations is an effective intervention to improve patient safety competency in prelicensure nursing students. This project expands the existing evidence supporting simulation to teach patient safety competencies and provides nurse educators a means to apply best-practice teaching strategies.

Acknowledgements Dr. Amy Cory – Valparaiso University Faculty Advisor Dr. Pam Jeffries – 2011 NLN HITS Program Mentor