Views of second year nursing students on impediments to safety in the clinical setting: Q-methodology

Abstract

Background: Little is known about novice students’ perspectives of safety in clinical learning. This gap prevents a comprehensive understanding of their efforts to demonstrate clinical competence while securing safety for stakeholders in increasing complex practice environments. The purpose of this study was to describe impediments to safe clinical learning as perceived by second year students enrolled in a baccalaureate nursing program.

Methods: Q-methodology was used to systematically elicit multiple viewpoints about unsafe clinical learning circum-
stances. Across two program sites in northern Ontario, Canada, 73 second year students sorted 43 theoretical statement cards identifying unsafe clinical practices and situations. Centroid factor analysis and varimax rotation yielded correlations between participants who held similar and different viewpoints about impediments to safety in clinical learning.

Results: Three discrete perspectives and one consensus perspective constituted second year students’ description of unsafe clinical circumstances. The discrete viewpoints were unprepared for role enactment, unsupported learning, and breached standards. There was consensus that a failure to demonstrate patient protection compromised clinical safety. The findings characterized unsafe clinical milieus as a combination of student, educator and programmatic accountability issues.

Conclusions: The shared perspectives of novice learners call attention to student preparedness, learning support and adherence to disciplinary standards. Educators and clinicians are compelled to address these issues for the development of conscientious novices within a culture of safety.