Patient safety is central to the delivery of care and is, therefore, an essential component of the education of current and future health professionals (Health Education England, 2016; Nursing and Midwifery Council, 2023). Students need to acknowledge that, although the health service aims to do no harm, patients receiving health care come to harm every day (NHS England, 2022a). This can be upsetting for students and requires educational support and innovative teaching to prevent a negative learning experience and demotivation.
Rising incident figures and yearly recurrence of failures in patient safety continue, suggesting the need for innovative ways of embedding patient safety into education. The new Patient Safety Incident Response Framework (PSIRF) (NHS England, 2022b) uses a systems-based approach that moves away from individual blame and looks at how incidents happen and their impact on all those involved, including patients, relatives and staff. The framework aims to improve ways of working and enhance institutional memory by learning from incidents. Working to create a positive patient safety culture needs to start with undergraduate nurse training.
Nursing students need to understand the complex dynamics that contribute to patient care and practise responding to patient safety incidents using the PSIRF (NHS England, 2022b). Yet they often cannot see themselves as being able to speak up, and struggle to gain the confidence to rise to the challenges of dealing with an unpredictable healthcare environment. Educational innovations such as exposure to simulated patient journeys can enhance the acquisition of this skill set in the psychological safety of the classroom.
A third-year undergraduate leadership session explored serious incidents in health care using three anonymised scenarios based on a real clinical incident. The incident involved an elderly patient's unwitnessed fall on a ward, resulting in a traumatic, fatal injury. The session aimed to increase students' awareness of protocols and frameworks and develop skills in handling challenging situations, escalating patient safety concerns and implementing change to reduce patient harm. This aligned with the four-part focus of the NHS Patient Safety Syllabus: systems, safety culture, risk, and raising concerns (NHS England and Academy of Medical Royal Colleges, 2022).
The session encouraged students to identify multifactorial causes of the incident to formulate an action plan using quality improvement methodology. Methods used to escalate concerns were explored through the Plus Delta debriefing framework and role play, applying advanced communication techniques. Peer-to-peer feedback was an important aspect of the learning process for students to effectively communicate ideas, opening the opportunity for self-evaluation and problem-based learning. They could explore their feelings about the incident through reflective practice and were encouraged away from blaming individuals. This approach meant that they could identify their own agency as they were asked to explore ways in which the outcome could have been avoided.
A post-session reflection activity enabled students to further explore how their feelings had changed through the learning process. The students stated that they enjoyed the interactive nature of the session and building on communication techniques.
Teaching patient safety at the undergraduate level is essential to equip students with the skill set to respond to similar events in practice. It requires the acquisition of these skills through practical application. With support, simulation allows students to develop and actively practice these skills in a safe and nurturing environment.