Teaching the Culture of Safety

Jane Barnsteiner, PhD, RN, FAAN

Disclosures

Online J Issues Nurs. 2011;16(3) 

In This Article

Integrating a Culture of Safety into the Curriculum

Sherwood (2011) recently described worldwide initiatives for integrating quality and safety science into both nursing education and practice. These initiatives include the development of patient safety educational standards, incorporation of safety competencies into the 'essentials documents' of accrediting organizations, and curriculum mapping for spreading the competencies across the curriculum.

However, nurse educators are not able to teach what they don't know and many nurse educators have had limited exposure to the Institute of Medicine reports and/or the QSEN competencies. With funding from the Robert Wood Johnson Foundation, the American Association of Colleges of Nursing has held a series of regional institutes across the country using a train-the-trainer faculty development model to provide content on patient safety and to assist educators in transforming their curriculum so that it incorporates the QSEN competencies into their pre-licensure education (American Association of Colleges of Nursing, 2011). The Robert Wood Johnson Foundation has also sponsored an annual QSEN National Forum where nurse educators have been able to come together to share patient safety teaching strategies. Additionally, the QSEN website (http://www.qsen.org/) offers resources to assist nurse educators in planning course content. Resources include annotated bibliographies, learning modules, and teaching strategies.

Although the integration of these competencies across the curriculum can seem overwhelming, some early guidance can already be offered. Barton and colleagues (Barton, Armstrong, Preheim, Gelmon, & Andrus, 2009) conducted a Delphi study, using a developmental approach involving beginning, intermediate, and advanced stages of the curriculum, to identify where in the curriculum the various 162 QSEN competencies should be introduced and where they should be emphasized. Respondents recommended that patient safety competency be introduced early in the curriculum and emphasized during the intermediate and advanced phases of the curriculum. Many schools are indeed introducing the concept of patient safety in their Fundamentals of Nursing courses. This content may include The Joint Commission National Patient Safety Goals (Joint Commission, 2011) which enable students to learn about the categories of errors and hazards in care, the 5 Million Lives Campaign (Institute for Healthcare Improvement, 2011), and the Patient Identification with a Wrist Band Toolkit (Maryland Hospital Association, 2009). Intermediate and advanced content activities may include discussing research regarding the effects of interruptions on medication errors in a pharmacology course, practicing SBAR communication during handoff in a medical-surgical clinical rotation, and attending a root cause analysis during a capstone clinical experience. The National Council of State Boards of Nursing (2010), in their Transition to Practice model, has recommended that the QSEN competencies be incorporated into nurse residency programs for new-to-practice nurses. Although it is important to teach about cultures of safety in pre-licensure programs, the content should also be a component of ongoing, professional development programs across all healthcare agencies.

For educators to teach about the culture of safety, they must be knowledgeable and current regarding the components of a safe culture. Activities that may facilitate their being up-to-date include (a) becoming a member of a clinical agency quality improvement, patient safety, pharmacy, and/or other safety-related committee, (b) holding quarterly or twice yearly meetings among clinical agency chief nursing executives, clinical leaders, deans/directors of schools of nursing, and key faculty, and (c) gaining familiarity with resources to use when teaching, including the QSEN website. It is important to include a variety of strategies in teaching about a culture of safety. These strategies can be taught in classrooms, simulation laboratories, and/or during clinical activities. Table 3, Table 4, and Table 5 list multiple examples of teaching strategies for each of these areas.

For educators to teach about the culture of safety, they must be knowledgeable and current regarding the components of a safe culture. Activities that may facilitate their being up-to-date include (a) becoming a member of a clinical agency quality improvement, patient safety, pharmacy, and/or other safety-related committee, (b) holding quarterly or twice yearly meetings among clinical agency chief nursing executives, clinical leaders, deans/directors of schools of nursing, and key faculty, and (c) gaining familiarity with resources to use when teaching, including the QSEN website. It is important to include a variety of strategies in teaching about a culture of safety. These strategies can be taught in classrooms, simulation laboratories, and/or during clinical activities. Table 3, Table 4, and Table 5 list multiple examples of teaching strategies for each of these areas.

In summary, making progress on moving the healthcare system to a culture of safety begins with students learning how to learn about safety. Safe, effective delivery of patient care requires that nursing students understand the complexity of healthcare systems, the limits of human factors, safety design principles, characteristics of high reliability organizations, and patient safety resources. These components are critical to the preparation of safe clinicians and essential for 21st Century healthcare delivery.

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