Submitter Information
Author: Elizabeth C. Kudzma, DNSc MPH
Title: Professor, Division of Nursing
Institution: Curry College
Email: ekudzma@curry.edu
Competency Category(s)
Safety
Learner Level(s)
New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN, Staff Development
Learner Setting(s)
Clinical Setting
Strategy Type
Case Studies
Learning Objectives
- Communicate observations or concerns related to hazards and error to patients, families, and the health care team
- Describe factors that create a culture of safety, for example, open communication strategies and organizational error reporting systems
- Appreciate the cognitive and physical limits of human performance
- Value vigilance and monitoring by patients, families, and other members of the health care team
- Value own role in preventing errors
Strategy Overview
Submitted Materials
Additional Materials
Evaluation Description
The responses of the students indicated that many QSEN KSA’s can be addressed in one seminar exercise. The faculty were asked to mention that some parts of the document may be controversial and that nurses should be guided by the policies of their employing institution. Virtually all of the students indicated that it was important to have written guidelines about how (and who should) communicate with patients about adverse events. Many students mentioned that it was helpful to think ahead of time about what could go wrong in a patient situation and the best protocols to guide communication with patients and families. Others stated that the exercise made them more aware of different types of patient errors. Students commented that they would be more likely to ask employing agencies about their adverse event protocols. Most of the students mentioned the importance of appropriate communication with patients and families, use of teams to inform patients about adverse events, the importance of building trust with patients, general error prevention and greater individual situational awareness on clinical units. For a few students, this awareness probably increased their anxiety about involvement in a medical mistake, but the seminar format allowed faculty to probe students ‘ reactions and refocus the discussion on prevention of errors.