1. 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

2. The Setting Quality & Safety Education for Nurses (QSEN): Starts and Ends with Communication 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. Student nurses from 2 programs (ADN; BSN) placed in 2 acute care facilities in same health- care system. Inpatient clinicals on diverse services. Inpatient clinicals on diverse services.

3. Problem areas Problems identified by faculty and hospital- based educators: group sessions w/ consensus on areas of concern. 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. Five areas of concern for unit staff; Four for clinical faculty. All areas clearly related to quality of communication. All areas clearly related to quality of communication. Items developed to measure degree of concern about each problem area. Items developed to measure degree of concern about each problem area.

4. Staff Concerns Staff concerned that they did not know: when clinical students will be on the unit. what patients the clinical students are what patients the clinical students areassigned. what skills the students are able to what skills the students are able to perform. perform. how to locate the instructor or the how to locate the instructor or the student. student.

5. 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.

6. Design Quasi-experimental pilot study with time I and time II surveys. 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. Non-random samples of agency staff and academic faculty at time I & time II. Time I & time II separated by two academic semesters. Time I & time II separated by two academic semesters. Intervention program conducted at two hospitals in the healthcare system. Intervention program conducted at two hospitals in the healthcare system.

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

8. 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.

9. Staff Assessment Each item response measured on 1 to 5 scale, with 1= ‘seldom’ and 5=‘always’ Each item response measured on 1 to 5 scale, with 1= ‘seldom’ and 5=‘always’ Due to anonymous nature of samples, no matching was possible of same staff pre and post. 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). 82% of pre-test staff were RN-level, and 78% at post-test (p=.33; ns). 18 staff did not complete job classification item. 18 staff did not complete job classification item. Unit assignment data were ambiguous. Unit assignment data were ambiguous.

10. Pretest Average Ratings by Staff n = 37

11. 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). 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) Is there overall variation among the item means? NO (ANOVA; p =.09) Are there any individual differences between means? YES (t-test; p<.005) Are there any individual differences between means? YES (t-test; p<.005) Greater comfort with patient assignments than with student skills Greater comfort with patient assignments than with student skills

12. 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.

13. Faculty Assessment Each item response measured on 1 to 5 scale, with 1= ‘seldom’ and 5=‘always’ Each item response measured on 1 to 5 scale, with 1= ‘seldom’ and 5=‘always’ 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. 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). Percentages of ADN and BSN faculty not different between pre and post samples (p=.82; ns).

14. Pretest Average Ratings by Faculty n = 10

15. Pretest Conclusions: Faculty No overall variation among the item means, and no individual differences between means (p- values>.15). No overall variation among the item means, and no individual differences between means (p- values>.15). Faculty appear more satisfied than are staff: faculty item means range 3.2 to 3.9; staff 2.6 to 3.2. 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: > 4.0. Faculty means not in acceptable range: > 4.0.

16. Intervention Program 1. Communication Board for assignments. Standardized location, appearance, format with uniform assignment sheets. 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. Standardized procedure for phone check-out and return.

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

18. Results: Staff Changes Post-test n = 58 Independent-sample one-tailed t-tests used to assess changes in the 5 staff items. 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 (<.1 on 5 point scale) on 3 items. Improved means on all 5 items, though absolute changes are minimal (<.1 on 5 point scale) on 3 items. Improvement in staff time to find instructor reached significance (pretest=2.8, post-test=3.3; t=1.95; p<.05); others non-significant. Improvement in staff time to find instructor reached significance (pretest=2.8, post-test=3.3; t=1.95; p<.05); others non-significant. Even after intervention, staff ratings reflect ongoing areas of concern. Even after intervention, staff ratings reflect ongoing areas of concern.

19. Staff Item Changes “Locating Instructor” ratings significantly improved.

20. Results: Faculty Changes Post-test n = 10 Independent-sample one-tailed t-tests used to assess improvements in the 4 items. Independent-sample one-tailed t-tests used to assess improvements in the 4 items. Improved means for all 4 items; one item’s change reached significance (student time to find faculty); t = 2.8; p<.01. Improved means for all 4 items; one item’s change reached significance (student time to find faculty); t = 2.8; p<.01. Relevant improvement noted by faculty: 3 of 4 items now in acceptable range (> 4 on 5 point scale). Relevant improvement noted by faculty: 3 of 4 items now in acceptable range (> 4 on 5 point scale).

21. Faculty Item Changes “Student locating faculty” ratings significantly improved.

22. Future Questions Design Design Large difference in staff Large difference in staff sample sizes (pre=37; sample sizes (pre=37; post=58) may reflect post=58) may reflect sample bias. sample bias. Assess staff awareness of Assess staff awareness of program interventions? program interventions? Staff concerns remain Staff concerns remain significant after intervention: significant after intervention: other strategies and goals? other strategies and goals? 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?

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