Student nurses’ experiences of engaging in quality improvement in practice: an ethnographic study

Abstract

In the UK, the Nursing and Midwifery Council (NMC) stipulate that quality and safety proficiencies must be achieved to qualify as a registered nurse. The aim of this thesis was to explore the experiences of student nurses who were educated about quality improvement (QI) during their undergraduate degree and who undertook a QI project in the practice setting. The findings offer rich insights into the settings in which student nurses conducted QI projects by investigating what contextual factors influenced their QI experiences and whether QI engagement was sustained as registered nurses. A qualitative ethnographic design was used across two phases. In Phase One, 34 hours of field observations were undertaken with adult student nurses (n=31) across nine settings within an acute hospital in central Scotland. Informal interviewing, document analysis, semi-structured in-depth interviews (n=8) and focus groups (n=5) were conducted. A qualitative interpretative approach was used to conduct within-case and cross-case analyses of the contextual factors that influenced student nurses’ QI learning experiences. A conceptual model is presented to illustrate how the contextual factors inter-related and influenced students’ engagement with QI called the QI Nursing Engagement in Practice Model (QiNEP). In Phase Two, semi-structured interviews were conducted with the participants as registered nurses (n=10). The aim of this phase was to determine if they had remained engaged with QI activity and to identify what contextual factors influenced their engagement. The qualitative data in this phase was analysed using the QiNEP Model. The study revealed that student nurses in all settings were exposed to similar contextual factors. The interrelated and dynamic nature of how these factors were experienced by student nurses had an impact as a barrier or facilitator and consequently influenced the levels of engagement with students’ QI projects, and QI activity as registered nurses. Collaboration between academic and practice partners will be essential to develop innovative curricula which fosters early and ongoing QI educational activities in the practice setting. Student nurses’ QI behaviours will need to be a central focus of QI nurse education because they act as an indicator of long-term engagement as registered nurses. To equip the future nursing profession with adequate QI skills, knowledge and behaviours needed to initiate and lead improvements in the real world, faculties should look to expose student nurses to a range of practice contexts throughout their degree to undertake QI activities.