'Speaking up for safety': A graded assertiveness intervention for first year nursing students in preparation for clinical placement: Thematic analysis

Background: The international literature highlights patient safety as a critical issue in contemporary health care. Poor interpersonal relationships and ineffective health care team communication are identified as dominant human factors contributing to clinical errors and adverse events. Of concern is that some students appear to lack the skills to speak up for themselves, their patients and others when witnessing unsafe practice on clinical placement. Study aims: To elicit student and staff perspectives on the quality, effectiveness and appropriateness of an assertiveness-based communication activity prior to clinical placement. Design: The study used a qualitative design. A communication module was offered in the second week of the practice laboratory and involved the use of two graded assertiveness frameworks. Setting: School of Nursing, Midwifery and Paramedicine, at a regional university in South East Queensland, Australia. Participants: Of the 535 first year undergraduate nursing students enrolled in the laboratory courses, 73 (13.6%) completed an anonymous online survey. Individual interviews were conducted with a university student wellbeing coordinator and student mentor to gain their perspectives of the data. Methods: An evaluation survey with seven qualitative questions and individual semi-structured interviews were employed. Data was analysed using a thematic approach. Results: Five major themes emerged from the survey data: vicarious learning, establishing boundaries, support in practice, advocacy awareness and practice utility. Three themes emerged from the interviews: empowerment and confidence; support and preparation for advocacy; and authentic learning. Conclusions: Findings indicate that teaching assertiveness skills and establishing a preparatory framework for 'speaking up for safety' early in a nursing students tertiary education can have important psychosocial implications for their confidence, empowerment and success. The activity provided an authentic learning experience with perceived practical application to the workplace and, has the potential to enhance first year curricula by improving communication tools used for students preparing for practice.