Abstract
The reviewed study describes the development, implementation and evaluation of three courses focused on safety competencies in a baccalaureate nursing programme in Japan as a pilot study preliminary to the implementation of safety content throughout the curriculum. Beyond the importance of this curricular change itself, the context of this project is significant. It is grounded in the recommendations of the United States Institute of Medicine (2003) that all health professional education should include a strong focus on competencies to reduce medical errors and improve the safety of patients, the seminal work on Quality and Safety Education for Nursing (QSEN) in the United States, and a mandate by the Ministry of Education, Culture and Sports in Science and Technology and the Ministry of Health, Labor and Welfare in Japan to strengthen all nursing curricula in Japan by the inclusion of safety education (2009). This programme highlights the international dissemination of trends and improvements to strengthen nursing and nursing education worldwide.
For the purpose of this pilot study, three courses were developed, two at the sophomore level and one at the senior level. Of the six areas of competency described by QSEN, these courses focused on safety. The two sophomore courses are required one credit didactic courses. The first course focuses on general content about safety, while the second course includes more specific content including QSEN and a culture of safety. The senior course is optional and includes both a didactic component and a 45-hour clinical component. For the evaluation of the senior course, eight categories of student learning were identified and cross-referenced with the 20 QSEN items related to safety. Although it is not clear how the eight categories of student learning were determined, the congruence of these categories to the QSEN items are well illustrated.
The method of evaluation of the effectiveness of the senior course and the rigor of the evaluation are well described. It was determined that the project met the requirements for a focus group as an evaluation method including: (a) specific questions to be answered; (b) a homogenous group; and (c) a group leader. The procedure for the recruitment of students into focus groups describes the steps taken to ensure that the students’ participation was free from coercion, and privacy and confidentiality are well protected. In addition, the systematic analysis of the focus group content is well described including the use of the Berelson content analysis method.
Two elements of the discussion of results were, I felt, particularly significant. First, the clinical component, focused on providing opportunities to use and observe strategies for maintaining patient safety, was a critical part of the students’ learning. Equally, the opportunity to identify potential for error in systems, other clinicians and in oneself provided valuable insights. Second, the authors highlight the importance of having a clinical partner with a congruent safety orientation to make it possible for students to see the clinical implementation of the principles they are discussing in class and allow them to identify the application of safety principles in their own future practice. Finally, the pilot project provides significant direction for the future implementation of safety education throughout the curriculum. I commend them for undertaking this important step in fulfilling the national mandate for safety education in nursing.