Nursing master students' experiences of and reflections on patient safety issues - a mixed-methods study using ecological momentary assessment.

backgroundPatient harm is a serious problem within healthcare services. New methods and technologies improve possibilities to capture students' experiences in clinical practice. Investigating nursing master students' experiences may provide important insights about patient safety issues and positive benefits in education. The aim of this study was to explore nursing master students' experiences and reflections on patient safety issues and adverse events during and after clinical practices.

methodsA mixed-methods convergent design was used, employing Ecological Momentary Assessment (EMA) combining ratings of six patient safety statements (Likert scales, 1 = totally disagree, to 5 = totally agree) with free-text reflections during clinical practice, and interviews after. Analyses of the quantitative data were combined with a thematic analysis of the qualitative data. In total, 16 nursing master students in nurse anaesthesia (n = 9), critical care nursing (n = 5) and operating room nursing (n = 2) participated in EMA during a 14-day period. In total, 105 EMA responses were obtained. All the students were invited to participate in the interviews afterwards, and 10 of them accepted.

resultsThe quantitative data indicated that, overall, the students considered their clinical practice as patient safe. Mean responses to the six statements were: Observed (Mean 2.5), Discussed (4.6), Avoided (2.5), Experienced (2.0), Safe work (4.6), Threatened (1.4). The participants, however, also provided accounts of events jeopardizing patient safety. Analysis of the students' reflections during clinical practice resulted in three themes: 1) Adverse events or near misses, 2) Communication and interactions in the team and 3) Using security procedures. Post-practice interviews indicated that the EMA led to increased awareness of patient safety issues.

conclusionsOverall, few adverse events and near misses were observed. However, our results indicated that such events do occur and thus need to be addressed. The participants reported that engaging in the daily data collection increased their awareness of adverse events, near-misses and things that go well. The EMA method could be useful as a patient safety reflection tool for master nursing students and other healthcare students.