Confronting Life and Death Responsibility: The Lived Experiences of Nursing Students and Nursing Faculty Response to Practice Breakdown and Error in Nursing School
As a part of the 2007 Carnegie Foundation National Nursing Education Study, this study describes the lived experiences of nursing students and faculty members with errors and practice breakdowns. Questions on errors and practice breakdowns were included in focus group and individual interview questions during site visits and phone interviews to the nine nursing schools in the study. Using interpretive ethnography this study takes into account the culture, context and situational aspects of the experiences.
In three separate articles, presented here as chapters two, three and four the study explores errors and breakdowns within student learning communities where students are developing habits, practices, skills and ethical comportment suited for the practice of nursing. It addresses the question asked by the Institute of Medicine Report (2001): How do nursing students learn about errors in practice? It demonstrates that although not always labeled as "promoting patient safety" concern about patient safety is central in nursing education. Students see themselves as being the patient's last line of defense for preventing errors in a health system that is fraught with potential hazards (Benner, Hooper-Kyriakidis, Stannard, 1999).
Chapter two identifies different ways that students may experience errors or practice breakdowns. The theme of being pulled up short in learning was described by Gadamer (1975) and explicated by Kerdeman (2004). Chapter three reveals that there are a number of practices, skills, habits, formal and informal structures and processes in nursing school that are designed or in place to help nursing students avoid making errors. The chapter also discusses how once an error is made or a breakdown in practice occurs, nursing faculty members use the experience to teach students ethical responses and responsibilities in relation to keeping patients safe, and preventing practice breakdown.
In the fourth chapter a pedagogy common to all nine nursing schools is disclosed Instructors use first person experience-near stories of breakdowns to teach students about patient safety. The faculty stories of their own errors and breakdowns further illustrate that the experience of being pulled up short is a powerful transformative experience as these cautionary tales extend to new generations of nurses.