Transcript Faculty concerned that

Maintaining Patient Safety:
Improved Communication in
Clinical Education Settings
Suzanne Marnocha RN, MSN, PhD, CCRN
Becki Cleveland RN, MSN
Mark Marnocha MS, PhD
Wendy Seuss RN, MSN
Carrie Thompson RN, MSN
Barbara Timmons RN, MSN
The Setting
Quality & Safety Education for Nurses
(QSEN): Starts and Ends with
Communication
 Student nurses from 2 programs (ADN; BSN)
placed in 2 acute care facilities in same healthcare system.
 Inpatient clinicals on diverse services.
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Problem areas
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Problems identified by faculty and hospitalbased educators: group sessions w/ consensus
on areas of concern.
Five areas of concern for unit staff; Four for
clinical faculty.
All areas clearly related to quality of
communication.
Items developed to measure degree of concern
about each problem area.
Staff Concerns
Staff concerned that they did not know:
when clinical students will be on the unit.
what patients the clinical students are
assigned.
what skills the students are able to
perform.
how to locate the instructor or the
student.
Faculty concerns
Faculty concerned that :
they had difficulty locating the staff nurse assigned to
the patient.
students could not find faculty to give medications or
carry out procedures.
they did not know how to find the clinical lead.
they did not know how to locate the unit educator
regarding new policies & procedures.
Design
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Quasi-experimental pilot study with time I
and time II surveys.
Non-random samples of agency staff and
academic faculty at time I & time II.
Time I & time II separated by two academic
semesters.
Intervention program conducted at two
hospitals in the healthcare system.
Question One
What are the initial levels of concern
reported by health-care system staff and
academic faculty during student nurse
clinical rotations?
Staff Survey Items
1.
2.
3.
4.
5.
I know when clinical students will be on the unit.
I know what patients the clinical students are
assigned.
I know what skills the students are able to
perform.
I feel satisfied with the time it takes to locate the
clinical instructor.
I feel satisfied with the time it takes to locate the
clinical students.
Staff Assessment
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Each item response measured on 1 to 5 scale, with
1= ‘seldom’ and 5=‘always’
Due to anonymous nature of samples, no matching
was possible of same staff pre and post.
82% of pre-test staff were RN-level, and 78% at
post-test (p= .33; ns).
18 staff did not complete job classification item.
Unit assignment data were ambiguous.
Pretest Average Ratings by Staff
n = 37
5
4
3.2
3
2.8
2.8
2.9
2.6
2
1
when on
unit
patients
assigned
student
skills
locate
locate
instructor students
Pretest means
Pretest Conclusions: Staff
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At pre-test, all item means (range 2.6 to 3.2) are
below what could be considered acceptable (4 or
above).
Is there overall variation among the item means?
NO (ANOVA; p =.09)
Are there any individual differences between
means? YES (t-test; p<.005)
Greater comfort with patient assignments
than with student skills
Faculty Survey Items
1.
2.
3.
4.
I feel satisfied with the time it takes to locate the
staff nurse assigned to the patient.
I feel satisfied with the time it takes for my
students to locate me.
I feel satisfied with the time it takes to access the
clinical lead for patient assignments or issues.
I feel satisfied with the time it takes to access the
educator.
Faculty Assessment
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Each item response measured on 1 to 5 scale, with
1= ‘seldom’ and 5=‘always’
Due to anonymous nature of samples, no matching
was possible of same faculty pre and post.
Seventeen forms of 20 indicated academic
affiliation, 47% ADN, 53% BSN programs.
Percentages of ADN and BSN faculty not different
between pre and post samples (p=.82; ns).
Pretest Average Ratings by Faculty
n = 10
5
4
3.9
3.2
3.4
3.6
3
Pretest means
2
1
Faculty
Locate Staff
RN
Students
Faculty
Faculty
Locate Access Lead
Locate
Faculty
Educator
Pretest Conclusions: Faculty
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No overall variation among the item means, and
no individual differences between means (pvalues>.15).
Faculty appear more satisfied than are staff:
faculty item means range 3.2 to 3.9; staff 2.6 to
3.2.
Faculty means not in acceptable range: > 4.0.
Intervention Program
1.
Communication Board for assignments.
Standardized location, appearance, format
with uniform assignment sheets.
2. Zone Phones provided for faculty by healthcare system, comparable to existing phones
already used by unit staff.
Standardized procedure for phone check-out
and return.
Question Two
What are the observed changes in
communication problems experienced by
unit staff and faculty during clinical
rotations AFTER the Intervention
Program?
Results: Staff Changes
Post-test n = 58
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Independent-sample one-tailed t-tests used to assess
changes in the 5 staff items.
Improved means on all 5 items, though absolute
changes are minimal (<.1 on 5 point scale) on 3
items.
Improvement in staff time to find instructor reached
significance (pretest=2.8, post-test=3.3; t=1.95;
p<.05); others non-significant.
Even after intervention, staff ratings reflect ongoing
areas of concern.
Staff Item Changes
“Locating Instructor” ratings significantly improved.
5
4
3.2
3
2.8
3.3
3.3
2.9
2.8
2.8
2.9 2.9
2.6
2
1
when on
unit
patients
assigned
student
skills
locate
instructor
locate
students
Pre
Post
Results: Faculty Changes
Post-test n = 10
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Independent-sample one-tailed t-tests used
to assess improvements in the 4 items.
Improved means for all 4 items; one item’s
change reached significance (student time
to find faculty); t = 2.8; p<.01.
Relevant improvement noted by faculty: 3 of
4 items now in acceptable range (> 4 on 5
point scale).
Faculty Item Changes
“Student locating faculty” ratings significantly improved.
5
4.4
4
4.3
4.3
3.9
3.6
3.7
3.4
3.2
3
Pre
Post
2
1
Faculty
Locate Staff
RN
Students
Locate
Faculty
Faculty
Access Lead
Faculty
Locate
Educator
Future Questions
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Design
Large difference in staff
sample sizes (pre=37;
post=58) may reflect
sample bias.
Assess staff awareness of
program interventions?
Staff concerns remain
significant after intervention:
other strategies and goals?
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Future Questions
Are whiteboards located in the
right area for staff usage? Are
they an effective means of
communication between
faculty and staff?
How do we ensure all faculty are
using zone phones? Is more
education needed on how to
use the zone phone?
Does the student assignment
sheet provide enough
information to the staff?
Thanks to the Thedacare system, and to
nursing collaborators from
Fox Valley Technical College and the
University of Wisconsin Oshkosh