title: Self-reported confidence in patient safety knowledge among Australian undergraduate nursing students: A multi-site cross-sectional survey study.
abstract: BACKGROUND
  Patient safety is critical to the provision of quality health care and thus is an essential component of nurse education.
  
  
  OBJECTIVE
  To describe first, second and third year Australian undergraduate nursing students' confidence in patient safety knowledge acquired in the classroom and clinical settings across the three years of the undergraduate nursing program.
  
  
  METHODS
  A cross-sectional online survey conducted in 2015.
  
  
  METHODS
  Seven Australian universities with campuses across three states (Queensland, New South Wales, South Australia).
  
  
  METHODS
  A total of 1319 Australian undergraduate nursing students.
  
  
  METHODS
  Participants were surveyed using the 31-item Health Professional Education in Patient Safety Survey (H-PEPSS). Descriptive statistics summarised the sample and survey responses. Paired t-tests, ANOVA and generalized-estimating-equations models were used to compare responses across learning settings (classroom and clinical), and year of nursing course.
  
  
  RESULTS
  Participants were most confident in their learning of clinical safety skills and least confident in learning about the sociocultural dimensions of working in teams with other health professionals, managing safety risks and understanding human and environmental factors. Only 59% of students felt confident they could approach someone engaging in unsafe practice, 75% of students agreed it was difficult to question the decisions or actions of those with more authority, and 78% were concerned they would face disciplinary action if they made a serious error. One patient safety subscale, Recognising and responding to remove immediate safety risks, was rated significantly higher by third year nursing students than by first and second year students. Two broader aspects of patient safety scales, Consistency in how patient safety issues are dealt with by different preceptors, and System aspects of patient safety are well covered in our program, were rated significantly higher by first year nursing students than by second and third year students. One scale, Understanding that reporting adverse events and close calls can lead to change and can reduce recurrence of events, was rated significantly higher by third year students than first and second year students.
  
  
  CONCLUSIONS
  In order are to achieve meaningful improvements in patient safety, and create harm free environments for patients, it is crucial that nursing students develop confidence communicating with others to improve patient safety, particularly in the areas of challenging poor practice, and recognising, responding to and disclosing adverse events, including errors and near misses.
authors.affiliation: School of Health, University of New England, Armidale, NSW 2351, Australia. Electronic address: kim.usher@une.edu.au.
authors.forename: Kim
authors.initials: K
authors.lastname: Usher
authors.affiliation: School of Health, University of New England, Armidale, NSW 2351, Australia. Electronic address: cwood30@une.edu.au.
authors.forename: Cindy
authors.initials: C
authors.lastname: Woods
authors.affiliation: School of Health, University of New England, Armidale, NSW 2351, Australia. Electronic address: gparment@une.edu.au.
authors.forename: Glenda
authors.initials: G
authors.lastname: Parmenter
authors.affiliation: School of Health and Human Sciences, Southern Cross University, Hogbin Drive, Coffs Harbour, NSW 2450, Australia. Electronic address: marie.hutchinson@scu.edu.au.
authors.forename: Marie
authors.initials: M
authors.lastname: Hutchinson
authors.affiliation: School of Nursing & Midwifery, Western Sydney University, Penrith, NSW 2751, Australia. Electronic address: j.mannix@westernsydney.edu.au.
authors.forename: Judy
authors.initials: J
authors.lastname: Mannix
authors.affiliation: Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia. Electronic address: Tamara.Power@uts.edu.au.
authors.forename: Tamara
authors.initials: T
authors.lastname: Power
authors.affiliation: School of Nursing and Midwifery, Griffith University, Gold Coast campus, Southport, QLD 4222, Australia. Electronic address: W.Chaboyer@griffith.edu.au.
authors.forename: Wendy
authors.initials: W
authors.lastname: Chaboyer
authors.affiliation: School of Nursing and Midwifery, Griffith University, Logan campus, Meadowbrook, QLD 4131, Australia. Electronic address: s.latimer@griffith.edu.au.
authors.forename: Sharon
authors.initials: S
authors.lastname: Latimer
authors.affiliation: School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC 3083, Australia. Electronic address: jane.mills@jcu.edu.au.
authors.forename: Jane
authors.initials: J
authors.lastname: Mills
authors.affiliation: School of Nursing and Midwifery, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia. Electronic address: lesley.siegloff@flinders.edu.au.
authors.forename: Lesley
authors.initials: L
authors.lastname: Siegloff
authors.affiliation: School of Health, University of New England, Armidale, NSW 2351, Australia. Electronic address: djackson@brookes.ac.uk.
authors.forename: Debra
authors.initials: D
authors.lastname: Jackson
mesh_terms: D001315:Australia; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D006801:Humans; D061214:Patient Safety; D020377:Self Efficacy; D013338:Students, Nursing / Q000523:psychology*
keywords: Adverse events; Clinical learning; Close calls; Nursing education; Patient safety; Student perceptions