Carin Magnusson

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 Erauts 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.

The relationship between external and local governance systems: the case of Health Care Associated Infections and medication errors in one NHS trust

Background ‘Organisational governance’—the systems, processes, behaviours and cultures by which an organisation leads and controls its functions to achieve its objectives—is seen as an important influence on patient safety. The features of ‘good’ governance remain to be established, partly because the relationship between governance and safety requires more investigation. Aims To describe external governance systems—for example, national targets and regulatory bodies—and an NHS Trusts formal governance systems for Health Care Associated Infections (HCAIs) and medication errors; to consider the relationships between these systems. Methods External governance systems and formal internal governance systems for both medication errors and HCAIs were analysed based on documentary analysis and interviews with relevant hospital staff. Results Nationally, HCAIs appeared to be a higher priority than medication errors, reflected in national targets and the focus of regulatory bodies. Locally, HCAIs were found to be the focus of committees at all levels of the organisation and, unlike medication errors, a central component of the Trusts performance management system; medication errors were discussed in appropriate governance committees, but most governance of medication errors took place at divisional or ward level. Discussion The data suggest a relationship between national and local prioritisation of the safety issues examined: national targets on HCAIs influence the behaviour of regulators and professional organisations; and these, in turn, have a significant impact on Trust activity. A contributory factor might be that HCAIs are more amenable to measurement than medication errors, meaning HCAIs lend themselves better to target-setting.

An analysis of delegation styles among newly qualified nurses

Aim The aim of this research was to explore how newly qualified nurses learn to organise, delegate and supervise care in hospital wards when working with and supervising healthcare assistants. It was part of a wider UK research project to explore how newly qualified nurses recontextualise the knowledge they have gained during their pre-registration nurse education programmes for use in clinical practice. Method Ethnographic case studies were conducted in three hospital sites in England. Data collection methods included participant observations and semi-structured interviews with newly qualified nurses, healthcare assistants and ward managers. A thematic analysis was used to examine the data collected. Findings Five styles of how newly qualified nurses delegated care to healthcare assistants were identified: the do-it-all nurse, who completes most of the work themselves; the justifier, who over-explains the reasons for decisions and is sometimes defensive; the buddy, who wants to be everybodys friend and avoids assuming authority; the role model, who hopes that others will copy their best practice but has no way of ensuring how; and the inspector, who is acutely aware of their accountability and constantly checks the work of others. Conclusion Newly qualified nurses require educational and organisational support to develop safe and effective delegation skills, because suboptimal or no delegation can have negative effects on patient safety and care.

Putting knowledge to work in clinical practice : understanding experiences of preceptorship as outcomes of interconnected domains of learning

AIMS AND OBJECTIVES To explore how preceptor support can assist newly qualified nurses to put knowledge to work across interconnected forms of knowledge when delegating to healthcare assistants. BACKGROUND Current literature on preceptorship in nursing has failed to explore how competence is underpinned by knowledge frameworks in clinical practice. DESIGN An ethnographic case study in three hospital sites in England (2011-2014). METHODS Data collection included participant observation, interviews with 33 newly qualified nurses, 10 healthcare assistants and 12 ward managers. Data were analysed using thematic analysis. A tool to assist newly qualified nurses to delegate and supervise newly qualified nurses during the preceptorship period was developed and piloted with thirteen newly qualified nurses in the same sites. A process evaluation was undertaken. FINDINGS Focusing on a key task for newly qualified nurses, delegation to healthcare assistants, we argue that preceptorship can support newly qualified nurses as they put knowledge to work in the transition from qualifying student to newly qualified nurses. In supportive ward cultures, limited access to formal preceptorship can be bolstered by team support. newly qualified nurses in less supportive ward cultures may have both a greater need for preceptorship and fewer compensatory mechanisms available to them when formal preceptorship is not available. We argue that organisational learning contexts and individual learning styles (interconnected domains of learning) are key to understanding effective preceptorship. CONCLUSIONS We suggest that putting knowledge to work early in their careers with preceptorship support may assist newly qualified nurses to develop confidence and competence in delegation and supervision of healthcare assistants. RELEVANCE TO CLINICAL PRACTICE Our findings suggest that newly qualified nurses need to be supported by effective preceptorship in their learning as they transition from undergraduate to post graduate. Preceptorship programmes at ward and organisational level need to recognise the intensity of the learning required during this transition phase.