Maintaining Patient Safety: Improved Communication in Clinical Education Settings

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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

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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 health-care
  system.
• Inpatient clinicals on diverse services.

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Problem areas

• Problems identified by faculty and hospital-based
  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.

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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.

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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.

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Design

• 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.

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Question One

• What are the initial levels of concern
  reported by health-care system staff and academic
  faculty during student nurse clinical rotations?

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Staff Survey Items

1. I know when clinical students will be on the
   unit.
2. I know what patients the clinical students are
   assigned.
3. I know what skills the students are able to
   perform.
4. I feel satisfied with the time it takes to locate
   the clinical instructor.
5. I feel satisfied with the time it takes to locate
   the clinical students.

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Staff Assessment

• Each item response measured on 1 to 5 scale, with
  1 seldom and 5always
• 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.

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Pretest Average Ratings by Staff n 37
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Pretest Conclusions Staff

• 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 plt.005)
• Greater comfort with patient assignments than
  with student skills

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Faculty Survey Items

1. I feel satisfied with the time it takes to locate
   the staff nurse assigned to the patient.
2. I feel satisfied with the time it takes for my
   students to locate me.
3. I feel satisfied with the time it takes to access
   the clinical lead for patient assignments or
   issues.
4. I feel satisfied with the time it takes to access
   the educator.

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Faculty Assessment

• Each item response measured on 1 to 5 scale, with
  1 seldom and 5always
• 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).

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Pretest Average Ratings by Faculty n 10
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Pretest Conclusions Faculty

• No overall variation among the item means, and no
  individual differences between means
  (p-valuesgt.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 gt 4.0.

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Intervention Program

• Communication Board for assignments.
• Standardized location, appearance, format
  with uniform assignment sheets.
• 2. Zone Phones provided for faculty by
  health-care system, comparable to existing phones
  already used by unit staff.
• Standardized procedure for phone check-out
  and return.

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Question Two

• What are the observed changes in
  communication problems experienced by unit staff
  and faculty during clinical rotations AFTER the
  Intervention Program?

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Results Staff ChangesPost-test n 58

• 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 (lt.1 on 5 point scale) on 3
  items.
• Improvement in staff time to find instructor
  reached significance (pretest2.8, post-test3.3
  t1.95 plt.05) others non-significant.
• Even after intervention, staff ratings reflect
  ongoing areas of concern.

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Staff Item Changes Locating Instructor ratings
significantly improved.
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Results Faculty ChangesPost-test n 10

• Independent-sample one-tailed t-tests used to
  assess improvements in the 4 items.
• Improved means for all 4 items one items change
  reached significance (student time to find
  faculty) t 2.8 plt.01.
• Relevant improvement noted by faculty 3 of 4
  items now in acceptable range (gt 4 on 5 point
  scale).

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Faculty Item Changes Student locating faculty
ratings significantly improved.
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Future Questions

• 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?

• Design
• Large difference in staff
• sample sizes (pre37
• post58) may reflect
• sample bias.
• Assess staff awareness of
• program interventions?
• Staff concerns remain
• significant after intervention
• other strategies and goals?

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Thanks to the Thedacare system, and to nursing
collaborators from Fox Valley Technical College
and the University of Wisconsin Oshkosh