Author: Diana Girdley, MS, RN
Title: Associate Clinical Professor
Institution: University of Wisconsin-Madison
Patient-Centered Care, Safety
New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN
Clinical Setting, Skills or Simulation Laboratories
The learner will be able to:
- Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care
- Communicate patient values, preferences and expressed needs to other members of health care team
- Value seeing health care situations ‘through patients’ eyes’
- Respect and encourage individual expression of patient values, preferences and expressed needs
- Demonstrate effective use of technology and standardized practices that support safety and quality
- Demonstrate effective use of strategies to reduce risk of harm to self or others
- Use appropriate strategies to reduce reliance on memory (such as. forcing functions, checklists)
The Clinical Assessment Tool (previously called the Safety Assessment Tool) was developed as a strategy to
- Provide a simple checklist to help students focus their attention of safety issues in the clinical setting
- Provide students with sample interview questions that will provide the patient with an opportunity to express their agenda, concerns and lead to more patient centered care.
Students seek structure and a 1-page checklist gives them a focus when they enter the patient’s room. The assessment tool consists of a list of potential safety concerns typically found in a patient room. These items were organized based upon patient identification, tubes and lines, and environmental safety issues. The patient interview section of the tool contains 3 open-ended questions that facilitate communication and assist the student in providing patient centered care.
Students are given the expectation during their orientation that the completion of the assessment tool is a priority and must be done with every patient, every clinical. The expectation is that this will be completed within the first 30 minutes of clinical. Students were to correct anything they could (clutter, patient ID, assistive devices) – otherwise notify instructor or staff for issues they couldn’t handle. Staff/system errors were reported to the appropriate nurse, nurse manager, and or event reporting.
Before leaving clinical, students must share their assessments and interview with their supervising staff nurse. The completed form is then given to their instructor after post conference.
The most important component of this tool is the debriefing that occurs after clinical. I have an extended post-conference with students – 3 hours. Post conference begins with my own acknowledgment of mistakes or near misses. Students then share their personal experiences as well as observations from the morning’s clinical experience. When students share their observations of identified safety concerns, it is helpful to remind them of the value of checklists as an alternative to the reliance on memory. Before encouraging students to talk about their mistakes, it is imperative to reflect upon your own teaching philosophy and personal values related to learning and learning from mistakes. It is a challenge to encourage students to share their errors and then refrain from negatively evaluating their clinical performance based upon their disclosure. As instructors, we need to acknowledge that errors will occur and we don’t want students hiding those errors. The clinical assessment tool was used to facilitate discussion in post conference with a primary goal of introducing students to the value of practicing in a “culture of safety” versus a “culture of blame”.
The clinical assessment tools were collected and reviewed continually. Students’ perceptions of the use of the tool were collected after each clinical rotation. Both the safety scan and the patient-centered interview were perceived as beneficial.
Students were quite anxious about the open-ended questions. They assumed all patients would be “bothered” by the questions and would respond with “I want to go home”. Students quickly realized the patients fully appreciated being asked these questions.
Throughout the semester – students provided feedback in their journals and through post-conference discussions. They began recognizing safe and unsafe practices. I posted an incident early in the year on the QSEN website about a student’s comment in post-conference.
I ask students to share their “highs” and “lows” for the day. The first student had gone with her patient to observe an ultrasound-guided paracentesis. Now – usually students would immediately begin talking about the actual procedure, the equipment, the people in the room, etc. This student began by stating her greatest insight was through observing the process by which the radiology team confirmed the correct patient and the correct procedure (by multiple ID’s and having the patient discuss the planned intervention). She then related to the rest of the class every step in their process. I was stunned. I have never had a student attend to that process, but of course – why would I? I’ve never before done anything to raise their consciousness around patient safety.