Fostering patient safety with multiple patients
The Ironside et al article is an article about safety in the nursing occupation. The safety of patients is important in any health facility. This research focused on how using experiences of multiple patient simulations affected the competence levels of nursing students. Apart from simulation, the simulation model also assessed how the students’ tolerance for ambiguity, age and grade point average related to simulation outcomes. The results are evidence to nursing educators on how multiple patient simulations impact on nursing students’ competence. The results also show the need to document student competencies inpatient safety before releasing them to enter the workforce. The authors conducted their research supported by a theoretical framework that backed up their research questions. The results were obtained after conducting statistical tests and making several assumptions.
The authors conducted their research using a theoretical and empirical framework to support their research questions. The Jeffries’ Simulation model was developed from empirical and theoretical material on simulation. This framework guided in the formulation of research questions and the whole research. The theoretical model helps identify the important aspects in simulation design that promote desirable student results. The Jeffries’ Simulation Model comprises of several factors. The factors include; student factors, teacher factors, student outcomes, particular simulation experience designs and educational practices, which influence student outcomes and simulation designs.
Factors that affected the design of the simulation such as complexity, objectives, debriefing and cues were held constant in all scenarios. This further helped in improving the reliability of simulation experiences. Some of the results identified by the Jeffries’ Model include skill performance, knowledge, critical thinking, learner satisfaction and self confidence. The faculty evaluated student performance based on their patient safety competencies, which are the skill performance and knowledge. Even though student performance was also done based on clinical judgments, it was reported in other separate reports.
The theoretical model used by the researchers also investigated additional student factors such as tolerance for ambiguity. Tolerance for ambiguity refers to a cognitive factor, which reflects an individual’s capability to make decisions or judgment without complete information at their disposal. An ambiguous situation is characterized by complexity, unfamiliarity, and uncertainty and confusing logic.
The participants in the research are the educational practices, teachers and students. The teachers are the people who provide guidance and instructions to the nursing students. The doctors in health facilities and nurses can be classified under this category. The students are the center of focus in this model and research. They are the nursing students, whose competencies in the simulation are evaluated and assessed by teachers. The students are classified based on three factors; their age, program and level of education. Finally, educational practices are the third components of the model. Educational practices are the conditions under which students work and the standards they are expected to achieve. They also include the responsibilities of students. Educational practices include; time taken on a task, collaboration, interaction, feedback, active learning and diverse learning. The high expectations and the faculty or student abilities are classified as practices of education.
The design of the research has five characteristics; fidelity, complexity, objectives, debriefing and cues. These characteristics identify the research as one that entirely focuses on simulation and tolerance for ambiguity. The design also takes a form that ensures the research is conducted to obtain accurate and reliable results. The research was conducted to answer the following research questions; does multiple patient simulation experience enhance students’ competence in patient safety? Secondly, what are the links between student factors such as tolerance for ambiguity, age and GPA and the attainment of competence in patient safety?
The research design included a sample where a section of final ear nursing students were identified. The students were drawn from different areas, with different ages between 21 and 56 years. Their mean GPA was 3.4. 91 percent of the sample students were female. Data collection was conducted when the students registered for a management course in all campuses. The data collection process took 10 weeks. The procedure included investigators working together with campus review boards to review each student.
The researchers used the Multiple Stimulus Types Ambiguity Tolerance Scale-I (MSTAT-I) as the tool of measurement in the study. The MSTAT-I comprises of 22 items used to assess a person’s cognitive ability. It is a short and psychometrically stable tool. This tool has reliability of 0.86, and its validity has a correlation with other scales such as MacDonald’s and Budner’s. This tool is adequate for this purpose because it provides measurements for all the required items in the study.
The researchers used a t-test as the main statistical test for the first research question. This was done to establish the improvement of competence in patient safety for each student. For the second research question, the researchers used the Pearson R correlations to relate student factors and the patient safety competencies being investigated. The two statistical tests were appropriate to use in the research because they established accurate results. Different tests were used for the two research questions because the two questions seek to achieve different objectives. The t-test is used to measure levels of improvement among students while the Pearson R seeks to establish a correlation between two variables. The tests were appropriate for both research questions because they helped obtain accurate results. In the second research question, the researchers made the assumption that the results were correct. This was because the study was exploratory and the results are not confirmatory. Therefore, they fixed a p-value for confirmatory purposes. However, this assumption was not discussed by the authors.
The results for the first research question were that the t-test was -4.00; a degree of freedom of 66 and p was less than 0.0002. The average score on the patient safety scale were 11.48 in the first experience and 13.88 in the second. Therefore, according to the study, student competence improves as they gain experience in multiple patient simulation. The results in the second research question were that there was no significant relationship between ages, tolerance for ambiguity or GPA with the attainment of patient safety competence. Therefore, the second hypothesis is discarded.
The researchers interpreted the results accurately because the values obtained in the t-test; the degrees of freedom and the value of P were correctly interpreted. The findings in the second research question were made based on an assumption but were correctly interpreted. In addition to their interpretation, the findings indicate that safety competencies are only perfected by working on multiple simulations of patients. This is because in the first experience, the students had less experience while in the second experience they got a high average because they had gained experience.
The limitations of the study are that it is exploratory in nature. This makes the findings hard to confirm because the influence of external factors such as teacher experience could create variations in the findings. Furthermore, simulation is only a mimic of reality. Therefore, it cannot be ascertained that using simulation improves the student’s competence. Finally, the research was conducted in institutions attached to one research body; this could have influenced the results to be similar. Therefore, these findings cannot be generalized for the whole country in terms of geography, education levels or types of programs.
If I were to replicate this study, I would increase the number of students taking part in the research. This would involve students from private and public institutions and students from other geographical parts of the country. I would also include students from other levels such as diploma, degree and postgraduate. Finally, I would make the research experimental so that the results are easy to confirm, this helps avoid making assumptions that can easily compromise the reliability of the findings.
References
Ironside, P. M., Jeffries, P. R., & Martin, A. (2009). Fostering patient safety with multiple patients. Nurse Outlook , 6.
