title: Patient safety in nursing education: contexts, tensions and feeling safe to learn.
abstract: Education is crucial to how nurses practice, talk and write about keeping patients safe. The aim of this multisite study was to explore the formal and informal ways the pre-registration medical, nursing, pharmacy and physiotherapy students learn about patient safety. This paper focuses on findings from nursing. A multi-method design underpinned by the concept of knowledge contexts and illuminative evaluation was employed. Scoping of nursing curricula from four UK university programmes was followed by in-depth case studies of two programmes. Scoping involved analysing curriculum documents and interviews with 8 programme leaders. Case-study data collection included focus groups (24 students, 12 qualified nurses, 6 service users); practice placement observation (4 episodes=19 hrs) and interviews (4 Health Service managers). Within academic contexts patient safety was not visible as a curricular theme: programme leaders struggled to define it and some felt labelling to be problematic. Litigation and the risk of losing authorisation to practise were drivers to update safety in the programmes. Students reported being taught idealised skills in university with an emphasis on 'what not to do'. In organisational contexts patient safety was conceptualised as a complicated problem, addressed via strategies, systems and procedures. A tension emerged between creating a 'no blame' culture and performance management. Few formal mechanisms appeared to exist for students to learn about organisational systems and procedures. In practice, students learnt by observing staff who acted as variable role models; challenging practice was problematic, since they needed to 'fit in' and mentors were viewed as deciding whether they passed or failed their placements. The study highlights tensions both between and across contexts, which link to formal and informal patient safety education and impact negatively on students' feelings of emotional safety in their learning.
authors.affiliation: Faculty of Health and Life Sciences, Northumbria University, Coach Lane Campus (West), East Benton, Newcastle upon Tyne NE7 7XA, United Kingdom. Electronic address: alison.steven@northumbria.ac.uk.
authors.forename: Alison
authors.initials: A
authors.lastname: Steven
authors.affiliation: Centre for Research in Nursing and Midwifery Education, Faculty of Health and Medical Sciences, University of Surrey, Duke of Kent Building, Guildford, Surrey GU2 5TE, United Kingdom. Electronic address: c.magnusson@surrey.ac.uk.
authors.forename: Carin
authors.initials: C
authors.lastname: Magnusson
authors.affiliation: Nursing Studies, School of Health in Social Science, Edinburgh University, Teviot Place, EH8 9AG, United Kingdom. Electronic address: pam.smith@ed.ac.uk.
authors.forename: Pam
authors.initials: P
authors.lastname: Smith
authors.affiliation: Faculty of Health and Life Sciences, Coach Lane Campus, Northumbria University, Coach Lane, Benton, Newcastle upon Tyne NE7 7XA, United Kingdom. Electronic address: pauline.pearson@northumbria.ac.uk.
authors.forename: Pauline H
authors.initials: PH
authors.lastname: Pearson
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D004506:Education, Nursing / Q000379:methods*; D004644:Emotions; D017144:Focus Groups; D006801:Humans; D007858:Learning; D008611:Mentors / Q000523:psychology; D009726:Nurses; D061214:Patient Safety; D036301:Qualitative Research; D013338:Students, Nursing / Q000523:psychology*; D006113:United Kingdom
keywords: Education; Emotional safety; Mentors; Nurses; Patient safety; Students