Patient Safety Competencies Among Nursing Students of DMC College Foundation, Inc.

Patient Safety Competencies among Nursing Students of DMC College
Foundation, Inc.
An Undergraduate Thesis
Presented to the Faculty of the College of Nursing
DMC College Foundation, Inc.
Dipolog City, Zamboanga del Norte
In Partial Fulfillment
of the Requirement for the Degree of
BACHELOR OF SCIENCE IN NURSING
By:
MUNDING, MYRA ALLYSSA E.

PIÑERO, HANNAH LEAH M.
REFAMONTE, KISHA CLAIRE S.
May 2023
DMC COLLEGE FOUNDATION, INC
Sta. Filomena, Dipolog City, 7100, Philippines
(065) 212-3287 dmc.edu.ph
APPROVAL SHEET
This research paper entitled “Patient Safety Competencies among Nursing

Students of DMC College Foundation, Inc.” is prepared and submitted by:
MUNDING, MYRA ALLYSSA E.

PIÑERO, HANNAH LEAH M.
REFAMONTE, KISHA CLAIRE S.
In partial fulfillment on the requirements of the course Nursing Research II, has
been examined, accepted, and approved for oral examination.
HAROLD S. NABOR, RN, USRN, MAN-CAR

Research Instructor
Approved by the panel of examiners with the grading of _________________.
Panel of Examiners
MA. GRACE F. GURDIEL, RN, MAN, DM

Dean, College of Nursing and AMS
__________________________ _________________________
Statistician Grammarian
__________________________
Panel Member
Approved and accepted, in partial fulfillment on the requirements of Nursing

Research II.
MARIDOL B. CLARO, RN, MAN MA. GRACE F. GURDIEL, RN, MAN, DM

BS Nursing Coordinator Dean, College of Nursing and AMS
Acknowledgment
ii
Dedication
iii
Abstract
iv
Objective. The main goal of the study is to determine the level of patient
safety competence among fourth-year nursing students of DMC College
Foundation and to determine the differences of their competence. Methods. A
descriptive, quantitative research design was employed with the use of an
adopted instrument, which was the Health Professional Education in Patient
Safety Survey (H-PEPSS) being applied to student nurses. All the 55 fourth-year
nursing students were part of the sample size of the study and data gathered
from them was analyzed through percentage, weighted mean, and Kruskal-Wallis
H test. Results. The level of patient safety competence among fourth-year
nursing students were found to be very high, having found that they are very
confident with all the factors of patient safety, having an overall weighted mean of
4.62, which implies very strong agreement. The fourth-year nursing students
specifically strongly agreed that they are confident, which implies high
competence level, on the factors of patient safety in terms of clinical safety,
culture of safety, working in teams, effective communication, managing safety
risks, understanding human and environmental factors, and recognizing,
responding to, and disclosing adverse events and close calls. There was no
significant difference found in the level of patient safety competence of the fourth-
year nursing student as analyzed to their age and marital, while, a significant
difference was found in the level of patient safety competence of the fourth-year
nursing student as analyzed to their sex and practiced safety learning method.
Conclusion. The study concludes that female nursing students and that female
nurses have higher patient safety competence compared to that of males. This
conclusion is supported that women are generally more sensitive than men to
safety, quality of patient care, and the use of safety principles. The study also
concludes that fourth-year nursing students of DMC have higher confidence
when it comes to patient safety, which implied higher level of competence as
well. Lastly, the study concludes that the nursing program and the College of
Nursing of DMC is successful in inculcating patient safety learning and
competence to the students
Table of Contents
v
Page
Title Page i
Approval Sheet ii
Acknowledgment iii
Dedication iv
Abstract v
Table of Contents vi
List of Figures viii
List of Tables ix
Chapter 1 The Problem and Its Scope
Background of the Study 1
Theoretical Framework 4
Conceptual Framework 8
Statement of the Problem 10
Hypothesis 11
Scope and Delimitations of the Study 11
Significance of the Study 12
Operational Definition of Terms 14
Chapter 2 Review of Related Literature
Patient Safety and Patient Safety Competencies 16
Related Studies 22
Synthesis 29
vi
Chapter 3 Research Methodology
Research Design and Sampling 31
Research Environment 31
Research Respondents 33
Research Instrument 34
Validation of Instrument 35
Data gathering Procedure 35
Scoring Procedure 36
Statistical Treatment 36
Ethical Considerations in Research 37
Chapter 4 Results and Discussion 38
Chapter 5 Summary of Findings, Conclusion, and Recommendations
Summary of Findings 52
Conclusion 55
Recommendations 56
References 58
Appendix A (Letter to the College Dean) 70
Appendix B (Letter to the School Registrar) 71
Appendix C (Consent for Respondents) 72
Appendix D (Gantt Chart) 73
Appendix E (Budget Chart) 74
Appendix F (Survey Questionnaire) 75
Curriculum Vitae 80
vii
List of Figures
Figure No. Title Page No.
1 Schematic Diagram of the Study 9
2 Location Map of DMC College Foundation, Inc. 32
viii
List of Tables
Table No. Title Page No.
1 Scoring Scale that will be Used in the Study 36

2 Profile of the Fourth-year Nursing Students 38
3 Patient Safety Issues being addressed in Health
Professional Education 39
4 Comfort Speaking up about Patient Safety 41
5 Level of Patient Safety Competence among Nursing
Students: CLINICAL SAFETY 41
Students: CULTURE OF SAFETY 42
Students: WORKING IN TEAMS 44
Students: COMMUNICATING EFFECTIVELY 45
Students: MANAGING SAFETY RISKS 46
Students: UNDERSTANDING HUMAN AND ENVIRONMENTAL
FACTORS 47
Students: RECOGNIZING, RESPONDING TO AND
DISCLOSING ADVERSE EVENTS AND CLOSE CALLS 48
12 Summary of the Level of Patient Safety Competence
among Nursing Students 49
13 Difference on the Level of Patient Safety Competence
among Fourth-year Nursing Students when Grouped to their
Profile 50
ix
CHAPTER 1
THE PROBLEM AND ITS SCOPE
Background of the Study
Because of the possibility of preventable harm occurring during medical
care, patient safety (PS) is constantly under scrutiny (Hwang et al., 2016).
According to the findings of the Pasco et al. (2017) study, the overall prevalence
of medication errors was found to be 97.8%. The most (63.3/chart) were in
pediatrics, followed by medicine, obstetrics, and surgery (7.3/chart). The most
common types of errors discovered were prescribing, compliance, and
administration errors. As a result, it is critical that healthcare providers are
sufficiently knowledgeable to identify potential safety hazards and protect
patients from harm or avoidable injuries (Usher et al., 2017). Nurses represent
the front line of care and the largest group of healthcare providers; consequently,
they play a vital role in improving the safety and quality of patient care (Palese et
al., 2018).
Nursing students are an important part of the healthcare provider reserve
force. The importance of assisting nursing students in reflecting on their PS
knowledge and competence in a variety of clinical settings and circumstances is
emphasized (Kim et al., 2018). The first step toward this goal is to assess nursing
students' PS competence's strengths and weaknesses (Doyle et al., 2015; Usher
at al., 2017). Contributing to patient safety culture, working in teams,
communicating effectively, managing safety risks, optimizing human and
environmental factors, and recognizing and responding to adverse events are all
part of the PS competence. Previous research has looked into the PS knowledge
and skills of students in nursing, pharmacy, and traditional medicine (Hwang et
al., 2016; Doyle et al., 2015; Usher et al., 2017) and new graduate healthcare
professionals (Castello et al., 2019; VanDenKerkhof et al., 2017), but little is
known about final-year nursing students or interns, who are the most likely to
make medical errors (Hwang et al., 2016). According to a Chinese study, nursing
interns directly or indirectly cause one or more adverse events (Song & Guo,
2019). Previous research has found that nursing students have moderate levels
of confidence in the majority of PS competence domains (Doyle et al., 2015;
Usher at al., 2017; Lukewich et al., 2015). However, the evidence for PS
competence varies by academic year of study; some publications report that
confidence in PS competence declines as students are increasingly exposed to
the clinical environment (Usher et al., 2017; Lukewich et al., 2015), while others
report findings that are directly contradictory to those opinions (Alquwez et al.,
2019). More research is thus required to better understand the PS competence
of this vulnerable group of nursing students.
Notably, nursing students' PS competence in the classroom is lower than
that gained in the clinical setting (Usher at al., 2017). Undergraduate nursing
students in Australia, for example, reported greater confidence in their clinical
safety skills than in their classroom skills, though their confidence in teamwork
skills and managing safety risks was lower in the clinical setting (Usher at al.,
2017). When comparing different countries, the specific domains of PS
competence that show discrepancies between the classroom and clinic are
2
heterogeneous; this may be due to differences in PS cultures. However, most of
the existing evidence was gathered in developed countries (Usher et al., 2017),
with fewer datasets from developing countries (e.g., Korea, Saudi Arabia, and
Jordan). There is little known about the development of nursing students' PS
knowledge and confidence in the Philippines, where PS strategies and education
lag behind those in developed countries, according to the researchers.
There is growing evidence that explicit PS competence is becoming more
important in undergraduate nursing education and learning (Usher at al., 2017).
Age, gender, region, academic year, and employment status have previously
been linked to nursing students' PS competence (VanDenKerkhof et al., 2017;
Alquwez et al., 2019). These findings, however, were obtained through univariate
inferential statistical analyses (Suliman, 2019); confirmatory regression analysis
is still required. Furthermore, knowledge and experience are known to support
PS competence (Castello et al., 2019). Hospital rank (Hwang et al., 2016),
educational background, adverse event experiences, and reporting behavior may
all influence nursing students' PS competence.
In the local setting, DMC College Foundation, Inc. is the first institution in
the province of Zamboanga del Norte to offer the nursing program and have
produced graduates and nurses every year that are now members of the
workforce of nurses locally and internationally. With the advent of COVID-19 and
the widespread pandemic, educational system of the country was greatly
affected. Traditional classes were shifted to online learning and clinical practices
were put to halt for almost 2 years. Senior nursing students, who are graduating
3
this academic year, have become products of both online and face-to-face
learning modalities. With this experience of the pandemic and the status of being
graduating nursing students, soon to become professional nurses, there is a
need to determine and evaluate the PS competencies of the fourth-year nursing
students. Evaluating the PS competencies of the fourth-year nursing students will
benefit the students and the institution as it will reflects readiness of the nurse
aspirants and the competitiveness of the nursing program in the institution.
Theoretical Framework of the Study
The study is grounded on the different Nursing Theories on Patient Safety
Practices. According to Almeida et al. (2022), nursing theories provide the
essence of decision-making about patient care with different approaches,
whether in environment development, relationships, or a philosophical
perspective, reducing the distance between theoretical models and practice.
As a shared theory used by nurses, Social Cognitive Theory provides a
framework for developing unique patterns. Nursing students who receive
education and intervention that boosts confidence and proficiency have higher
self-efficacy, which plays a significant role in encouraging action. This theory is
consistent with simulation training principles, and the concept of self-efficacy has
been the subject of simulation research, an active learning method that
influences student behavior (Konicki & Miller, 2016).
Besides being a tool for the development of health care, nursing theories
offer structure and organization to nursing knowledge and give nurses a look at
what is most important, leaving aside irrelevant data, thus facilitating the
4
interpretation of data and the systematic planning of nursing interventions
(Almeida et al., 2022).
Researchers have developed a specific instrument to promote patient
safety based on established international goals, given the lack of specific
documents to document nursing surgical care in a Mexican hospital. Orem’s
Self-Care Deficit Theory was used as a theoretical foundation in the
aforementioned study (Morales, 2015).
Investigating the consonance between difficulties described by nurses and
the exercise of professional practice is necessary to expose the complexity of the
phenomena present in the field and factors that facilitate or compromise the
quality of care. However, the context of care provision in health institutions has
changed significantly in recent years, mainly due to technological advances. In
addition, the nurse has become one of the main professionals engaged in risk
management by spending more time in contact with the patient (Almeida et al.,
2022).
The nursing workforce must remain for longer periods with the patient
given their care actions. As a key player in risk management, the nurse promotes
safe care. Therefore, the proposal to associate nursing theories with patient
safety helps to qualify the actions of nursing professionals, providing
systematized interventions capable of improving results and visibility of the
nursing work (Almeida et al., 2022).
Nursing is challenged to expand and maintain its disciplinary bases
around the world while also fulfilling its social commitment. Thus, while the
5
nursing discipline is unique, it intersects with other disciplines such as sociology,
which justifies the use of references from other areas in the nurses' work. This is
necessary because the nurse's work takes place in various spaces that comprise
an individual's integrality (Sun et al., 2019). Nursing, as a health profession, is
defined as a discipline that studies human care, and it manifests as work
performed in evolving societies. Thus, nurses must know and appropriately use
theories that support their practice, allowing them to perform sustained and
systematized care (Kneafsey et al., 2015; Vinckx et al., 2018).
The profession largely uses theories from other areas within its research,
such as data-based theory (Grounded Theory), which originated in sociology
and is adopted on a large scale today because it is based on field data collection
and interventions, as highlighted in the literature (Almeida et al., 2022). It was
possible to identify that the theory has been used as a contribution to qualitative
analysis in studies that explore the perceptions, understandings and interactions
of nursing professionals with concepts that permeate patient safety and quality of
care. Following the methodological proposal of Grounded Theory theorists, the
studies included in this review have used the theory in the search for the
construction of theoretical frameworks for the culture of patient safety. In an area
that is still building its own knowledge, this becomes very important (Soares et
al., 2017; Vinckx et al., 2018).
Similarly, the Theory of Human Error, the second most cited in the
reviewed studies, is largely used by nurses, especially in direct patient care. Its
object of study is defined as any act that directly interferes with patient safety,
6
with relevant impacts on nursing care (Duarte et al., 2016). James Reason’s
theory has great prominence in patient safety studies, being recognized as the
first to theoretically support much of the knowledge in the area that has been
developed in the last two decades (Almeida et al., 2022). According to the
findings of Almeida et al.’s (2022) review, it supports the analysis of human
errors in different contexts (surgical center, intensive care unit) with a focus on
systemic causes that may have conditioned such an occurrence, being applied
inclusively in the analysis of ethical-disciplinary processes (Duarte et al., 2016;
Gillespie et al., 2018; Kongsvik et al., 2016). Understanding that people make
mistakes for issues involving systemic failures is one of the main foundations that
James Reason built with his theoretical approach. Therefore, it becomes
ineffective to recognize specific errors and their consequences without carrying
out in-depth analyzes of how working conditions have influenced their occurrence
(Almeida et al., 2022).
Theories from other areas focused on the culture of patient safety based
on effective communication and practices involving managers, organizations,
nursing professionals, and patients, supporting the planning of actions and the
need to prevent errors and injuries (Dufault et al., 2020). It is also worth noting
the efforts to improve processes and enhance patient safety in public hospital
settings through management strategies and institutional initiatives (Morales,
2015). Assistance actions have also been focused on in studies. The promotion
of patient safety has been addressed through error identification strategies based
7
on ethical-legal nursing principles (Silva-Santos et al., 2018), and the
identification of causes associated with errors (Forte et al., 2018).
In this sense, it would be important to adopt, from the academy, teaching
strategies that enhance the appropriation of theoretical references, based on
current realities and needs, inserting students in this universe and demonstrating
its essentiality in the most varied contexts, with emphasis on the hospital (Sun et
al., 2019; Norwood, 2018) for patient safety, a current trend and an essential
element for decreasing morbidity, mortality, and health care costs.
Conceptual Framework of the Study
The conceptual framework of the study is shown in figure 1, the schematic
diagram. The figure shows the main variables that will be explored in the study.
The main focus of the study is to determine the patient safety competencies
among the fourth-year nursing students. These competencies were determined
and differentiated based on the classroom setting and the clinical setting, during
their clinical practices in hospitals. The significant difference of these patient
safety competencies was determined based on the analysis with their
demographic profile. Moreover, the evaluation of the patient safety competencies
of the fourth-year nursing students were based through the categories identified
by the Health Professional Education in Patient Safety Survey (H-PEPSS), which
were in terms of clinical safety, culture of safety, working on teams with other
health professionals, effective communication, managing safety risks,
understanding human and environmental factors, and recognizing, responding to
8
and disclosing adverse events and close calls. The fourth-year nursing students’
patient safety competencies with respect to each category were statistically
compared to the classroom and clinical settings.
Recognizing, Responding
to and Disclosing Adverse
Understanding
Managing Safety Events and Close Calls
Human and
Risks Environmental
Factors
CLASSROOM SETTING
Working In Teams
PATIENT SAFETY Communicating
with Other Health
COMPETENCIES Effectively
Professionals
CLINICAL SETTING
Clinical safety Culture of safety
DEMOGRPAHIC PROFILE OF THE

FOURTH-YEAR NURSING STUDENTS
Figure 1. Schematic Diagram of the Study
Statement of the Problem

9
The study that was undertaken has a goal on evaluating the patient safety
competencies (PSC) among fourth-year nursing students of DMC College
Foundation, Inc., for the academic year 2022 – 2023.
Specifically, the study aimed to evaluate the PSC among fourth-year
nursing students through addressing the following questions:
1. What is the demographic profile of the nursing students in terms of:
1.1. Age;
1.2. Sex;
1.3. Marital Status;
1.4. Prior experience of patient safety education; and
1.5. Practiced Safety Learning Methods?
2. To what extent do the nursing students agree to how broader patient
safety issues being addressed in nursing education and how comfortable
are they speaking up about patient safety?
3. What is the level of patient safety competence among nursing students in
terms of:
3.1. Clinical safety;
3.2. Culture of safety;
3.3. Working In Teams with Other Health Professionals;
3.4. Communicating Effectively;
3.5. Managing Safety Risks;
3.6. Understanding Human and Environmental Factors; and
10
3.7. Recognizing, Responding to and Disclosing Adverse Events and
Close Calls?
4. Is there a significant difference on the level of patient safety competence
among fourth-year nursing students when grouped according to their
profile?
Hypothesis
The study has the null hypothesis based from the statement of the
problem:
H0: There is no significant difference on the degree of patient safety
competencies among fourth-year nursing students when grouped according to
their profile.
Scope and Delimitations of the Study
The study aimed to evaluate the patient safety competencies among
fourth-year nursing students of DMC College Foundation, Inc., for the academic
year 2022 – 2023. The study was solely for the fourth-year nursing students only
since they are the students who will be graduating and soon will become member
of the nursing work force; thus, their PSC needs to be evaluated as they will be
joining the nursing profession. The study gathered data from the fourth-year
nursing students by adopting the Health Professional Education in Patient Safety
Survey (H-PEPSS), as the study’s instrument, which was administered
personally by the researchers. All the fourth-year nursing students were
11
considered as potential respondents of the study. The study did not determine
the level of intelligence of the nursing students nor determined their overall skill
and competency as a nursing intern, it evaluated only their readiness to nursing
by identifying their patient safety competencies acquired in the nursing program.
Moreover, the data gathering of the study was conducted in the second semester
of the academic year 2022 – 2023, within the scheduled timeframe for data
gathering, from the month of January to April, 2023.
Significance of the Study
The study would be beneficial to many, since the results will give authentic
data and information as to the degree of patient safety competencies of the
fourth-year nursing students. To be specific, the study and its future findings and
results will benefit the following entities:
Clinical Instructors. The results and findings of the study will benefit
clinical instructors of the College of Nursing in DMC College Foundation, Inc.
since information from the study can be used by the clinical instructors to assess
the patient safety competencies of their senior nursing students. With the last
stretch of their student lives under the nursing program, clinical instructors can
use the data to fully hone and prepare the graduating students before they
become licensed nurses. The degree of patient safety competencies which was
found from the senior nursing students will also serve as a reflection for the
clinical instructors as to the type of instruction and training they have given to the
students.
12
College of Nursing. The College of Nursing will benefit the outcome of
the study since the result is a reflection of the performance of the college. The
higher the degree of patient safety competencies among senior nursing students
may illustrate success to the college. The findings can be used to intensify
instruction methods and can be basis for curriculum and instruction improvement.
Hospital Nurses/Staff. The study will provide information to staff nurses,
of where the fourth-year nursing students are having their clinical practices, as to
the degree of their patient safety competencies. Whatever the results are, staff
nurses will be informed as to how the senior nursing students view working with
them during clinical rotations. Hospital nurses can share their expertise on their
profession based on their experience which will also reflect as to what type of
nurse professional they are to work with.
Parents. The study will benefit parents by providing information as to how
their children, students, are doing with their chosen career. To whatever will be
the degree of the students’ patient safety competencies, parents’ awareness to
this will allow them to guide, support, and motivate the senior nursing students on
becoming better. Their guidance and support will benefit them in the future by
having a competitive nurse one day, as realization of their dreams, and the
nursing students’.
Future Researchers. The results and findings of the study can help future
researchers, who are interested of studying similar topics, serving as a local
related literature. The study’s findings can serve as a good source for
researchers who wished to continue or enhance the study in the future.
13
Definition of Terms
The following terms are purposively chosen and operationally defined as
to their usage in the study, to provide a clearer and better understanding and to
what and how they meant in the study.
Clinical safety. This refers to the competency learned by the fourth-year
nursing students that focus on clinical practice safety handling during clinical
practice.
Culture of safety. This refers to the competency learned by the fourth-
year nursing students that focuses on the safety concerning the nature of the
chosen program and career.
Health Professional Education in Patient Safety Survey (H-PEPSS).
This is the adopted tool used in the study to gather the desired data on patient
safety competencies among fourth-year nursing students.
Managing Safety Risks. This is used in the study as one of the
competencies on patient safety that pertains to the learning on handling and
managing risks associated in clinical practice and the nature of the profession.
Patient Safety Competencies. This term refers to the competencies on
patient safety that was identified among the fourth-year nursing students, which
is divided into six domains: (1) clinical safety, (2) culture of safety, (3) working on
teams with other health professionals, (4) effective communication, (5) managing
safety risks, understanding human and environmental factors, and (60
recognizing, responding to and disclosing adverse events and close calls.
14
Patient Safety. This is used to refer health care discipline that emerged
with the evolving complexity in health care systems and the resulting rise of
patient harm in health care facilities, which was evaluated and determined
specifically among senior nursing students.
Fourth-year Nursing Students. This refers to the graduating nursing
students of DMC College Foundation, Inc. They are the identified respondents of
the study whose data was gathered from.
15
CHAPTER 2
REVIEW OF RELATED LITERATURE
This review presents related literature that expounds and discuss patient
safety competencies among nursing students. This review contains literature and
studies both from the local and international publications.
Patient Safety and Patient Safety Competencies
With medical errors becoming more common and prevalent around the
world, a focus on patient safety (PS) is critical for reducing unnecessary harm to
patients (Walton & Barraclough, 2015; Walton, Shaw, Barnet, & Ross, 2016). PS
is defined as minimizing the risk of harm associated with health care practices
and reducing a patient's exposure to error and near-miss errors (Institute of
Medicine, 2015). According to the World Health Organization (WHO) curriculum
guide (2016), "patient safety" is defined as "the prevention of unnecessary harm
to a patient during the process of health care and the reduction to an acceptable
minimum of the risk of unnecessary injury associated with health care." PS
knowledge, skills, and behaviors are critical components of nursing education.
The curriculum should include topics such as what PS means, human
engineering and its impact on PS, the system and its impact on patient care,
teamwork, and communication about PS (Walton & Barraclough, 2015). Nursing
students will gain PS knowledge and skills that will assist them in identifying high-
risk situations and adhering to safe medical practices (Pearson, Steven, &
Dawson, 2019; Wade et al., 2020).

Patient safety is the result of both system effectiveness and individual
performance design to reduce the risk of patients being injured as a result of the
care that is intended to help them (Albrecht, 2015). This includes shifting from
thinking of patient safety as a technical issue to thinking of system-related factors
and the involvement of many people. These are known as non-technical or
sociocultural patient safety skills (Ginsburg et al., 2017; Frank & Brien, 2019).
Non-technical skills are defined as "a set of social and cognitive (analytical and
personal behavior) skills that enable high-quality, safe, effective, and efficient
interprofessional care within the complex healthcare system" (Gordon et al.,
2015). Key elements, included in sociocultural skills, are effective
communication, teamwork, skills of recognizing and managing risky situations,
optimizing human and environmental factors and contributing to a culture aware
of the importance of reporting and learning from incidents (Frank & Brien, 2019).
It is important to note that nurses are the largest group of health providers,
accounting for more than half of the practicing health workforce, and they play a
critical role in protecting patient safety because they have the most prolonged
and direct patient contact (Vaismoradi et al., 2016). As a result, nurses are more
likely than other health professionals to detect, prevent, and correct errors in
workflow and communication (Vaismoradi et al., 2016). Much recent emphasis
has been placed on preparing health care professionals to deliver safe practices
while possessing the necessary PS knowledge and competencies. International
efforts, for example, have been made to reform PS education for undergraduate
health care professionals (Mansour, 2015). WHO recommended that all health
17
care students be taught 11 PS themes (Walton & Barraclough, 2015). The
following dimensions were chosen based on the evidence-based Australian
Patient Safety Education Framework: communicating effectively, using evidence
and information, avoiding adverse events, working safely, being ethical,
continuing learning, teaching, and specific issues (Australian Council for Safety
and Quality in Health Care, 2016).
In response to the growing emphasis on the significance of PS, nursing
educational institutions and other health organizations have strategic mandates
in the provision of an effective patient safety education among the undergraduate
nursing students. Notably, there is a necessity to improve the students’ patient
safety behaviors through the emerging influence of the clinical working
environment (WHO, 2015; Flin et al., 2019).
In preparing future nurses, undergraduate nursing education is an
important starting point in advancing patient safety in the domains of knowledge,
attitude, and skills (Frank & Brien, 2019; Vaismoradi et al., 2016; Kirwan et al.,
2019). Students are regarded as an integral and indispensable component of the
health-care system, contributing to safety care as stated in the statements "fresh
pair of eyes, eager to learn, and the future safety leaders" (Francis, 2015). As a
result, early exposure to the concept of patient safety is encouraged by two facts:
first, nurses make more preventable errors shortly after graduation than later in
their careers (Duckett & Moran, 2018), and second, new graduates bring current
evidence-based theory and vigor to the workplace (Murray et al., 2018). Nursing
education is associated with patient mortality (Aiken et al., 2016; Schubert et al.,
18
2015) and the number of nurse-reported adverse events (Aiken et al., 2016).
(Bruyneel et al., 2015). There is still a gap in evidence about the extent and type
of role of nursing education in patient safety improvement (Vaismoradi et al.,
2016; Steven et al., 2019), as well as undergraduate nursing students' perceived
confidence in specific patient safety areas (Rebeschi, 2020).
Patient safety is always a priority in nursing education and learning around
the world (Mansour, 2015; Sokol & Cummins, 2015). The importance of early
engagement of students in patient safety and error reduction learning for the
purpose of developing competence is emphasized in educational literature.
Because expertise develops through multiple patient encounters, learning
through clinical practice has long been considered the gold standard of
professional health care education. Students retain 5% of lecture information, but
75% retention is evident after 6 months of "practice" (WHO, 2019). Nursing
students' clinical education and the responsibility to the health care consumer
place a tremendous burden on the faculty at the bedside to provide practical
opportunities and promote safe practice (Ziv, 2019). It has been suggested that
nurses are more likely than other health care professionals to recognize,
intercept, and correct potentially fatal errors (Flin et al., 2019).
Curricula for health care professionals have traditionally focused on
clinical skills such as diagnosis, treatment, medication administration, and
aseptic techniques (Vaismoradi et al., 2016; WHO, 2019). Unintended patient
harm, on the other hand, is primarily the result of system failure. In order for
patient safety learning to be delivered in an integrated manner, educational and
19
organizational challenges extended the Individual responsibility to include
effective teamwork, information sharing, collaboration between professions, and
respect for each other's roles and perspectives (Steven et al., 2019). Many
studies from around the world have emphasized the importance of changing
current nursing curricula in order to educate students about safe nursing
practices (Gregory et al., 2019; Henneman et al., 2020; Mossey et al., 2021).
WHO guidelines emphasize the importance of health care workers possessing
knowledge, skills, behaviors, and attitudes that guide all of their actions. A focus
on sociocultural and contextual education competencies that are important for
reducing errors, such as teamwork and interprofessional communication, is also
required (Walton & Barraclough, 2015).
Patient safety awareness has emerged in undergraduate education, with
the goal of changing organizational culture and recommending patient safety
teaching and learning skills. They are all focused on professional competency
development and extend patient safety beyond the actual technical provision of
care (i.e., administration of medicine) to the improvement of the system that
underpins practice (Dimitriadou et al., 2021). They identified human factors, as
well as how these factors relate and interact within the system, as a critical
component of the patient safety domain.
Patient safety education for health professionals is currently the least
implemented of all initiatives (Kirwan et al., 2019). Teaching patient safety to
undergraduate nursing students has been identified as a necessity in the
literature; however, there is still no consistency in the teaching methods, nor
20
agreement on which areas to focus or prioritize. Over the years, patient safety
has remained a "hidden element" in the curriculum (Kirwan et al., 2019). It is
gradually and sporadically incorporated into an already overwhelming nursing
curriculum (Dimitriadou et al., 2021). As a result, students have few opportunities
to clarify and comprehend the role of non-technical human factors over technical
competencies in patient safety (Vaismoradi et al., 2014).
Earlier evidence suggested that students were more confident in technical
aspects of patient safety than in sociocultural aspects (Huang et al., 2020;
Levett-Jones et al., 2020). Students, for example, reported less knowledge about
teamwork issues, particularly during clinical placements (Huang et al., 2020),
despite the fact that they valued teamwork, including patient participation in
health care planning. Furthermore, students' knowledge of patient safety was
limited outside of the formal classroom in the actual workplace (Bianchi et al.,
2016).
Students believed that more time in class was spent on teaching
pathophysiology and treatment rather than on nursing interventions (Vaismoradi
et al., 2014). As a result, there was insufficient time to discuss nursing care and
patient safety issues. As a result, students perceived themselves as unsafe and
lacking in patient knowledge in actual practice (Tella et al., 2015). Other evidence
indicated a lack of faculty familiarity with teaching such courses, as well as a lack
of educator confidence or interest in incorporating patient safety into the
curriculum (Lee et al., 2016). According to a qualitative study, the WHO 11 topics
21
were either not addressed at all (i.e., human factors) or were taught in a way that
failed to link patient safety (Mansour, 2015).
It is difficult to rebuild nursing education. The growing body of literature
indicates a knowledge gap regarding where and how patient safety is effectively
taught in the pre-registration nursing program, as well as the level of knowledge
students should obtain in specific patient safety areas (Bianchi et al., 2016; Tella
et al., 2015). Evaluation of nursing students' perceptions of what they have
learned about patient safety in both the classroom and clinical practice could be
a good starting point, especially if these students come from different
nationalities and cultures and their perspectives are brought to the table (Patient
Safety and Quality of Care Working Group, 2014). Studying multiple students’
perceptions is the best way for educators to understand the weaknesses and
omission of the education system (Dimitriadou et al., 2021).
Related Studies
A study conducted in China on self-reported PS competence and
influencing factors among undergraduate nursing students found that clinical
safety had higher levels of PS competence than sociocultural aspects of safety
(Huang et al., 2020). The study also discovered a disparity in nursing students'
confidence in what they learned in the classroom and in clinical settings (Huang
et al., 2020). When considering the dimensions of "clinical safety skills,"
"communicating effectively about PS issues," and "working in teams with other
health professionals," nursing students were more confident in what they learned
22
in the classroom compared to what they learned in clinical practice. Increased
application of approaches for nursing education reform, such as simulation,
team-based learning, or problem-based learning, is one way to develop clinical
safety knowledge, teamwork, and communication. However, nursing students'
confidence in other intangible dimensions of PS ("managing safety risks" and
"understanding human and environmental factors") was higher in clinical practice
than in the classroom (Huang et al., 2020). This implies that a hospital's culture
and clinical practice can help nursing students understand the human and
environmental factors that contribute to PS, as well as how to manage safety
risks (Colet et al., 2015). As nursing students spend more time in the clinic, they
become more aware of knowledge gaps, such as how to communicate effectively
and work in teams with other health professionals. Collaboration between nursing
faculty and clinical nurses to teach PS content could help bridge the theoretical
and practical divide in PS education (Doyle et al., 2015). Improving the overall
integration and implementation of PS issues in the classroom and clinical
settings are critical issues for nursing educators and clinical instructors to
address. In other words, we must comprehend what is taught in both contexts
(Huang et al., 2020).
Notably, Huang et al. (2020) discovered that nursing students' perceived
PS competence varied significantly depending on region, self-assessment of PS
competence, PS training methods (i.e., self-study and theoretical classroom
study), and previous experience with PS education or adverse events. Despite
the fact that the correlation values were small, their analyses help to explain the
23
factors that influence PS competence among Chinese undergraduate nursing
students. The findings of Huang et al. (2020) corroborated those of other multi-
center PS studies (Usher et al., 2017; Alquwez et al., 2019), in that the
universities and hospitals where nursing students learn and practice play an
important role in influencing the students' PS competence.
Suliman (2019) conducted another study on measuring patient safety
competence among nursing students and discovered that nursing students were
moderately confident in most of the PS education dimensions, with lower rates of
confidence in all PS dimensions. In his study, students were most confident in
their knowledge of clinical safety. They were, however, the least confident about
working together with other health care professionals and disclosing adverse
events. Similarly, Doyle et al. (2015) discovered that medical students were more
confident in what they had learned about clinical safety skills, such as hand
washing, drug administration, and infection control precautions, and were least
confident in sociocultural and contextual aspects of PS, such as teamwork,
safety culture, and risk management. Inadequate attention in the nursing
curriculum to the sociocultural aspects of PS may help explain why nursing
students are more confident in their clinical safety skills than in their collaboration
with other teams and in communicating effectively. The findings suggest that the
nursing curriculum should emphasize the sociocultural and contextual
dimensions of PS (Suliman, 2019). Suliman (2019) confirmed that nursing
students have difficulty questioning unsafe practices performed by other health
care professionals, which is consistent with the findings of Lukewich et al. (2015).
24
However, Raymond et al. (2017) discovered that in their study, nursing students
felt more comfortable approaching those who engaged in unsafe medical
practices. Because nursing students are still unsure about their clinical
experience, it may be difficult for them to question unsafe practices. This finding
is significant because it is the nurse's responsibility to protect patients' rights.
Another important finding in Suliman's (2019) study is the disparity in students'
confidence in what they learned in the classroom and in clinical settings. The
findings highlight the magnitude of the gap between theory and practice in the
nursing curriculum. The study discovered that, in most dimensions, nursing
students were more confident in what they learned in the classroom than in
clinical practice. This suggests that PS education may not be transferable to
clinical practice, which may lead to decreased confidence in PS competencies in
the clinical setting (Colet et al., 2015). Ginsburg et al. (2017) discovered
differences in nurses' confidence in PS learning between the classroom and the
clinical setting, implying that the contextual influence of nurses' clinical training
weakens their perceptions of their confidence in PS education. Suliman (2019)
discovered a significant inverse relationship between nurses' total grades and
their confidence in PS competencies. In other words, as students' overall grades
improve, their satisfaction with safety education in both the classroom and clinical
settings decreases. This finding could be explained by stating that as students
learn more about patient care and safety, they prioritize PS practice. This finding
is similar to the findings of Colet et al. (2015) in Saudi Arabia, who suggested the
need for more studies to better understand this phenomenon.
25
Rebeschi's (2020) study discovered that student confidence in patient
safety learned in the clinical setting was higher than confidence in what was
learned in the classroom setting. This finding runs counter to the findings of
Dimitriadou et al. (2021), who found that students were more confident in their
knowledge of patient safety gained in the classroom than in the clinical setting.
The classroom is perceived as a safe environment for learning about working in
multi-professional teams, understanding the systemic nature of patient safety
issues (Tella et al., 2015), and becoming more confident to speak up (Mbuthia &
Moleki, 2019). Because clinical practice accounts for 50% of the student
program, its contribution to professional socialization is identified. Students, on
the other hand, felt unprepared when they entered a clinical practice setting. In
clinical practice, the incompetence of the nurse educator (a member of university
staff) and mentor (an experienced clinical nurse), as well as a defensive,
concealing, and blaming work environment, were among the critical challenges to
involving students in practice safety (Fisher & Kieman, 2019). Inadequate
support from nurse educators was reflected in the encouragement to do things
outside of their scope of practice or that were contrary to the student's ethics and
theory. Additional barriers emerge after nursing students realize that their
mentors do not devote enough time to teaching patient safety or adequately
assessing them (Montgomery et al., 2015). The prevalent attitude in the ward of
"getting the work done" and "following the rules" discourages students from
questioning the procedures because they prefer to conform rather than challenge
the practices (Raso et al., 2019). Students simply perform routine tasks without
26
regard for caring principles or a patient-centered approach (Fisher & Kieman,
2019). This method is incompatible with the structure of systemwide patient
safety knowledge. In the study of Dimitriadou et al. (2021), the least agreement
was found in teamwork across all dimensions across countries and years of
study, whereas effective communication was valued higher in both settings.
These findings support Cresswell et al(2013) .'s conclusion that students were
taught about safety in isolation from other healthcare students. The suggestion,
on the other hand, is that "interprofessional team training of nurses, physicians,
and other health care providers should begin when they are students and
continue throughout their careers." Team culture was viewed as a strong
influence in students' decisions to speak up or remain silent, and it is reflected in
their relationships with their mentor and other team members (Fisher & Kieman,
2019), and it was regarded as a strong ethical responsibility to prevent errors.
Effective interprofessional collaboration has been shown to reduce adverse
patient safety events [68] by challenging any gaps or misconceptions about the
role and responsibility of each discipline in problem solving (Samuriwo et al.,
2019).
Alidousti-Shahraki et al. (2022) discovered that patient safety levels in the
six domains of health professions education ranged from weak to moderate in a
recent study that assessed patient safety competence among senior health
professions students in Isfahan, Iran. The mean total patient safety score in the
classroom was moderate (0.51) and poor (0.47) in the clinical setting. In both the
classroom and the clinical setting, students had not received adequate patient
27
safety education (Alidousti-Shahraki et al., 2022). The domain with the highest
mean score was communicating effectively (61% in the classroom and 57% in
the clinical setting). Effective communication is a necessary tool when conversing
with the patient to identify medication problems, treatment effects, interactions,
and adverse effects. As the most serious threat to patient safety, ineffective
communication is one of the leading causes of medication errors. As a result,
communication skills in health profession education must be emphasized and
applied upon entry into the clinical setting. Working in teams with other health
professions resulted in the lowest mean score (0.39 in the classroom and 0.38 in
the clinical setting). Due to the ever-changing nature of health care and the gap
between health professions, students are required to receive the necessary
education in teamwork; interprofessional education (IPE) can improve
interprofessional collaboration (IPC) and patient care. Indeed, the
interprofessional education (IPE) and interprofessional collaboration (IPC) are a
dimension of the theory and practice of patient safety. The study of Alidousti-
Shahraki et al. (2022) further showed that patient safety education primarily
occurs in the classroom, while patient safety education in the clinical setting is
likewise of particular importance due to direct communication with the patient and
potential patient safety hazards. It needs to be considered in clinical education.
Alidousti-Shahraki et al. (2022) also found a correlation between the classroom
and clinical setting scores, contradicting to the findings of Hwang et al. (2016)
where there was a significant difference found between the scores of the
classroom and the clinical setting, and the mean scores in the domain of
28
‘understanding human and environmental factors’ and ‘managing safety risks in
the clinical setting’ were significantly higher compared to the classroom. These
results imply that the patient safety competencies among students may be
influenced by the curriculum, the school’s clinical practice and training provided,
and varies from one country to another.
Synthesis
The Patient safety movement contributed to the reduction of preventable
adverse events associated with health care. Although patient safety issues have
received the attention of educators in the health care studies, there is evidence
that in nursing education and the associated curricula it is not well-incorporated
This may not allow students to acquire scientific knowledge and develop strong
competencies to assure patient safety throughout their professional life
(Dimitriadou et al., 2021).
The review of related literature and studies presented have revealed that
the patient safety competence among health programs students, not just the
nursing students, were varied and inconsistent from one other. Some studies
have revealed higher PS competence in the classroom while other studies have
revealed a higher PS competence in the clinical setting. With the contradicting
results and findings among studies, evaluating PS competencies among nursing
students is a need, especially to those nursing students who are one step away
in becoming a professional nurse, the senior or the graduating nursing students.
Knowing and evaluating these competencies among nursing students will not
29
only be beneficial to the students themselves, but also to the clinical instructors
concerned, to the college and to the institution, and to the locality and health
facilities where the nursing students will be working in the future.
30
CHAPTER 3
RESEARCH METHODLOGY
This chapter presents the methodology that was employed and observed
in the conduct and process of the study.
Research Design and Sampling
The study employed a descriptive, quantitative research design in
determining the patient safety competencies among fourth-year nursing students
of DMC College Foundation, Inc. Descriptive design was used for the
identification of the nursing students’ confidence and agreement to the patient
safety competencies, which determined their level of competence in the
classroom and clinical setting, and at the same time, the comparative research
design was used to compare results of their patient safety competence between
the classroom and clinical setting. Additionally, Purposive sampling was used in
the identification of the sample for the study, who are the fourth-year nursing
students only of DMC College Foundation, Inc.
Research Environment
The data collection of the study was conducted in DMC College
Foundation, Inc., specifically in the College of Nursing.
The DMC-College Foundation, Inc. (DMCCFI) is the pioneer CHED-
accredited paramedical institution of the province of Zamboanga del Norte. It is
situated in suburban Dipolog City, specifically in Fr. Patangan Road, Sta.

Filomena, and occupies 22,500 square meters of land area. Its sprawling
expanse contains several buildings which include the DMC Hospital and its
laboratories, the four-storey Basic Education and School of Hotel Restaurant and
Institution Management Building, the six-room IT Center, the four-storey Nursing
Building with the Nursing Arts Center on the fourth floor and the library which
covers the entire ground floor, the Arts and Sciences building with separate
structures for a Zoology lab, the cafeteria, and the DMC Covered Court for sports
and other activities. DMC College Foundation Inc. offers undergraduate courses
like BS in Information technology, Nursing, Medical Technology, Midwifery,
Pharmacy, Physical Therapy, Radiologic Technology, Accountancy, Accounting
Information System, Business Administration, Hospitality Management, and
Bachelor of Secondary and Elementary education. Aside from that, the institution
also offers vocational courses, graduate courses and basic education program.
The BSN Program is a four-year program designed to prepare a
professional nurse to render nursing care to individuals, families, and groups in
any setting at any stage of the health-illness scale.
32
Figure 2. Location Map of DMC College Foundation Inc.
Research Respondents
The respondents of the study were the fourth-year nursing students in
DMC College Foundation, Inc., who were officially enrolled in the second
semester of the current academic year. They were identified purposively since
the goal of the study is focused to them, evaluating their PS competence before
becoming a member of the nursing profession. As of this semester, there is a
total of 55 senior nursing students enrolled in the College of Nursing. All these
senior nursing students are part of the sample size and researchers gathered
data from all the senior nursing students.
Research Instrument
The research instrument that was adopted and used for data gathering in
the study is the Health Professional Education in Patient Safety Survey (H-
33
PEPSS). The H-PEPSS focuses primarily on the socio-cultural aspects of patient
safety including culture, teamwork, communication, managing risk and
understanding human factors. In the study, the demographic information of the
nursing students will be modified from the original demographic data asked from
the H-PEPSS. The study determined the demographic profile of the senior
nursing students in terms of their age, sex, if they have prior experience of
patient safety education, and what are the safety learning methods employed by
the nursing students, which is the section 1 of the instrument. Section 2 and 3
are about determining the level of agreement of the students to how broader
patient safety issues being addressed in nursing education and how comfortable
are they speaking up about patient safety. Lastly, section 4 is the identification of
degree of patient safety competencies of the senior nursing students in the
following dimensions: (1) clinical safety, (2) culture of safety, (3) working on
teams with other health professionals, (4) effective communication, (5) managing
safety risks, (6) understanding human and environmental factors, and (7)
recognizing, responding to and disclosing adverse events and close calls.
Validation of Instrument
The questionnaire that was used in the study is a standardized instrument,
tested and utilized for evaluating patient safety competencies. The instrument
has been proven already of its effectiveness in assessing patient safety
competence among students and even professionals of the medical field. As
being a standardized instrument, a pilot-test was optional. However, the
34
instrument was still presented to the members of the board of panelists during
the research proposal for its appropriate usage in the study, and for further
validation on its use.
Data Gathering Procedure
Upon success in the proposal, the researcher sought approval and
endorsement to proceed to actual data collection. The actual enrolled fourth-year
nursing students in the second semester was then verified from the office of the
school’s registrar. After it was verified, researchers proceeded to communication
of all the fourth-year nursing students, informing them about the study and
requesting for their voluntary participation in the survey. Within the given
timeframe for data gathering, researchers conducted the survey in a face-to-face
setup, and a backup online survey was prepared for some cases that the
identified respondents were reachable in person. After all the responses were
collected, researchers proceeded to summarizing and encoding of the raw data
into the statistical software for the preparation of data analysis and interpretation.
Lastly, after data were analyzed and interpreted, presentation of the results and
findings followed.
Scoring Procedure
The Health Professional Education in Patient Safety Survey (H-PEPSS)
that was utilized as the research instrument to gather data from the students was
answered using the following scoring scale:
35
Table 1
Scoring Scale, Descriptor and Interpretation Used in the Study
Score Range Interpretation

Score Description
(Continuum)
5 4.21 – 5.00 Strongly Agree Has very high competence
4 3.41 – 4.20 Agree Has high competence
3 2.61 – 3.40 Neutral/Unsure Has moderate competence
2 1.81 – 2.60 Disagree Has low competence
1 1.00 – 1.80 Strongly Disagree Has very low competence
Statistical Treatment
In order to analyze the quantitative data that as gathered in the study,
electronic statistical applications were used with the following statistical tools:
Percentage. This was used to categorized the demographic profile of the
senior nursing students.
Weighted Mean/Average Weighted Mean. This was used to determine
the average response of the senior nursing students to each statement of the
instrument, which determined their patient safety competence.
Kruskal-Wallis H Test. This was used to determine the significant
difference on the level of patient safety competence among senior nursing
students when analyzed between the classroom and clinical settings
Ethical Considerations
The research adhered to honesty in terms of the data and information that
was gathered and presented. The study also adhered to confidentiality of data
gathered from the students and the privacy and anonymity of their responses
36
was highly considered. The findings of the study will be used for the benefit of
knowledge and for academic purposes only, and will not be used against any,
especially the nursing students. Data gathering followed stringent procedures
and actual data collection was done through proper protocol and submission of
formal letters for approval and permission to any office and authority it concerns.
Moreover, the researchers have observed the proper citation and referencing by
following the APA Manual 7th edition, to give credits and pay respect to authors,
to acknowledge their works, and to avoid the concerns of plagiarism.
37
CHAPTER 4
RESULTS AND DISCUSSION
This part of the study presents the results of the data gathering and its
analysis in a tabular form. The order of the presentation is in accordance to
questions stipulated in the statement of the problem.
Table 2
Profile of the Fourth-year Nursing Students
Variable Frequency Percentage

Age
< 30 years old 52 94.50
≥ 30 years old 3 05.50
Total 55 100.0
Sex
Male 6 10.90
Female 49 89.10
Total 55 100.0
Marital Status
Single 51 92.70
Married 4 07.30
Total 55 100.0
Practiced Safety
Learning Methods
Self-study
Yes 50 90.90
No 5 09.10
Theoretical Study in
classroom
Yes 53 96.40
No 2 03.60
Clinical Training
Yes 54 98.20
No 1 01.80
Experience of Adverse
events
Yes 52 94.50
No 3 05.50
Disclosing Behavior
Yes 45
No 10
Table 2 summarizes the profile of the respondents in terms of their age,
sex, marital status, and where they have practiced their safety learning methods.
Based on the data, majority of the fourth-year nursing students are less than 30
years old (f = 52), females (f = 49), and single (f = 51). In terms of where the
students have practiced safety learning methods, the fourth-year nursing
students have practiced it through self-study (f = 50), theoretical study in the
classroom (f = 53), through their clinical training (f = 54), through their experience
of adverse events (f = 52), and through a disclosing behavior (f = 45).
Table 3
Patient Safety Issues being addressed in Health Professional Education
Weighted
Statements Interpretation
mean
1. As a student, the scope of what was “safe”
for me to do in the practice setting was very 4.64 Strongly Agree
clear to me
2. There is consistency in how patient safety
issues were dealt with by different 4.40 Strongly Agree
preceptors in the clinical setting
3. I had sufficient opportunity to learn and
interact with members of interdisciplinary 4.29 Strongly Agree
teams
4. I gained a solid understanding that
reporting adverse events and close calls 4.35 Strongly Agree
can lead to change and can reduce
reoccurrence of events
5. Patient safety was well integrated into the 4.56 Strongly Agree
overall program
6. Clinical aspects of patient safety (e.g. hand
hygiene, transferring patients, medication 4.51 Strongly Agree
safety] were well covered in our program
7. “System” aspects of patient safety were 4.44 Strongly Agree
39
well covered in our program (e.g. aspects
of the organization, management, or the
work environment including policies,
resources, communication and other
processes)
Grand Weighted Mean 4.46 Strongly Agree
1.00-1.80 Strongly Disagree 2.61-3.40 Unsure/Uncertain 4.21-5.00 Strongly Agree
1.81-2.60 Disagree 3.41-4.20 Agree
Table 3 presents the data on the extent of fourth-year nursing students’
agreement on how broad patient safety issues being addressed in nursing
education. With a grand weighted mean of 4.46, overall, the fourth-year nursing
students strongly agreed that patient safety issues are being addressed in the
nursing education. The scope of what is “safe” for them to do in the practice
setting has been clear to them ( x=4.64), there has been consistency in how
patient safety issues were dealt with by different preceptors in the clinical setting
( x=4.40), nursing students had sufficient opportunity to learn and interact with
members of interdisciplinary teams ( x=4.29), they have gained solid
understanding about reporting adverse events and close calls which lead to
change and reduce reoccurrence of events ( x=4.35). Furthermore, fourth-year
nursing students strongly agreed that patient safety was well integrated into the
overall nursing program ( x=4.56), that clinical aspects of patient safety were also
well covered ( x=4.51), as well as “system” aspects of patient safety ( x=4.44).
The overall strong agreement of the fourth-year nursing students implies that
patient safety issues is well-addressed in the nursing program.
40
Table 4
Comfort Speaking up about Patient Safety
Weighted
Statements Interpretation
Mean
1. In clinical settings, discussion around
adverse events focuses mainly on system- 4.24 Strongly Agree
related issues, rather than focusing on the
individual(s) most responsible for the event
2. In clinical settings, reporting a patient safety
problem will result in negative 3.95 Agree
repercussions for the person reporting it
3. If I see someone engaging in unsafe care
practice in the clinical setting, I feel safe to 4.29 Strongly Agree
approach them
Grand Weighted Mean 4.16 Agree
1.81-2.60 Disagree 3.41-4.20 Agree
Table 4 reveals the extent of fourth-year nursing students’ agreement on
their comfort speaking up about patient safety. With a grand weighted mean of
4.16, the fourth-year nursing students agreed that they have comfort speaking up
about it. This overall agreement of the fourth-year nursing students implies that
they have the freedom and comfort speaking up about patient safety and
concerns related to it.
Table 5
Level of Patient Safety Competence among Nursing Students: CLINICAL
SAFETY
Clinical safety: Weighted

Interpretation
“I feel confident in what I learned about… Mean
1. safe clinical practice in general 4.71 Strongly Agree
2. hand hygiene 4.73 Strongly Agree
3. infection control 4.69 Strongly Agree
4. safe medication practices 4.67 Strongly Agree
1.81-2.60 Disagree 3.41-4.20 Agree
41
Table 5 depicts the level of patient safety competence among nursing
students in terms of clinical safety, which is the first factor of the Health
Professional Education in Patient Safety Survey (H-PEPSS), which focuses
primarily on the socio-cultural aspects of patient safety including culture,
teamwork, communication, managing risk and understanding human factors. The
H-PEPSS is a self-evaluation tool and a parsimonious six-factor measurement
model of health professionals' perceptions of patient safety competency, which
was applied to the fourth-year nursing students in the study. With a grand
weighted mean of 4.70 and an equivalent descriptor of ‘strongly agree’, the
fourth-year nursing students were found to have a very high level of competence
of patient safety in terms of clinical safety. Specifically, they were very confident
in what they have learned about safe clinical practice in general ( x=4.71), hand
hygiene ( x=4.73), infection control ( x=4.69), and safe medication practices (
x=4.67).
Table 6
Level of Patient Safety Competence among Nursing Students: CULTURE OF
SAFETY
Culture of safety:
Weighted
Interpretation
1. the ways in which health care is complex
and has many vulnerabilities (e.g., 4.67 Strongly Agree
workplace design, staffing, technology,
human limitations)
2. the importance of having a questioning
attitude and speaking up when you see 4.47 Strongly Agree
things that may be unsafe
3. the importance of a supportive environment 4.65 Strongly Agree
that encourages patients and providers to
42
speak up when they have safety concerns
4. the nature of systems (e.g., aspects of the
organization, management, or the work
environment including policies, resources, 4.71 Strongly Agree
communication and other processes) and
system failures and their role in adverse
events
1.81-2.60 Disagree 3.41-4.20 Agree
students in terms of culture of safety. With a grand weighted mean of 4.63 and
an equivalent descriptor of ‘strongly agree’, the fourth-year nursing students were
found to have a very high level of competence of patient safety in terms of culture
of safety. Specifically, they were very confident in what they have learned about
the ways in which health care is complex and has many vulnerabilities ( x=4.67),
about the importance of having a questioning attitude and speaking up when you
see things that may be unsafe ( x=4.47), about the importance of a supportive
environment that encourages patients and providers to speak up when they have
safety concerns ( x=4.65), and about the nature of systems and system failures
and their role in adverse events ( x=4.71).
43
Table 7
Level of Patient Safety Competence among Nursing Students: WORKING IN
TEAMS
Working In Teams with Other Health

Weighted
Professionals: Interpretation
Mean
“I feel confident in what I learned about…
1. team dynamics and authority/power 4.64 Strongly Agree
differences
2. managing inter-professional conflict 4.38 Strongly Agree
3. debriefing and supporting team members 4.51 Strongly Agree
after an adverse event or close call
4. engaging patients as a central participant in 4.51 Strongly Agree
the health care team
5. sharing authority, leadership, and decision- 4.62 Strongly Agree
making
6. encouraging team members to speak up,
question, challenge, advocate and be 4.66 Strongly Agree
accountable as appropriate to address
safety issues
1.81-2.60 Disagree 3.41-4.20 Agree
students in terms of working in teams with other health professionals, or with the
nurses in the hospital, their clinical instructors and their co-students. With a grand
weighted mean of 4.55 and an equivalent descriptor of ‘strongly agree’, the
fourth-year nursing students were found to have a very high level of competence
of patient safety in terms of working in teams with other health professionals.
Specifically, they were very confident in what they have learned about team
dynamics and authority/power differences ( x=4.64), about managing inter-
professional conflict ( x=4.38), about debriefing and supporting team members
after an adverse event or close call ( x=4.51), about engaging patients as a
central participant in the health care team ( x=4.51), about sharing authority,
44
leadership, and decision-making ( x=4.62), and about encouraging team
members to speak up, question, challenge, advocate and be accountable as
appropriate to address safety issues ( x=4.66).
Table 8
Level of Patient Safety Competence among Nursing Students:
COMMUNICATING EFFECTIVELY
Communicating Effectively: Weighted

Interpretation
1. enhancing patient safety through clear and 4.71 Strongly Agree
consistent communication with patients
2. enhancing patient safety through effective
communication with other health care 4.64 Strongly Agree
providers
3. effective verbal and nonverbal
communication abilities to prevent adverse 4.53 Strongly Agree
events
1.81-2.60 Disagree 3.41-4.20 Agree
Table 8 reveals the level of patient safety competence among fourth-year
nursing students in terms of effective communication or communicating
effectively. With a grand weighted mean of 4.62 and an equivalent descriptor of
‘strongly agree’, the fourth-year nursing students were found to have a very high
level of competence of patient safety in terms of communicating effectively.
Specifically, they were very confident what they have learned about enhancing
patient safety through clear and consistent communication with patients ( x=4.71
), about enhancing patient safety through effective communication with other
health care providers ( x=4.64), and about effective verbal and nonverbal
communication abilities to prevent adverse events ( x=4.53).
45
Table 9
Level of Patient Safety Competence among Nursing Students: MANAGING
SAFETY RISKS
Managing Safety Risks: Weighted

Interpretation
1. recognizing routine situations and settings 4.45 Strongly Agree
in which safety problems may arise
2. identifying and implementing safety 4.52 Strongly Agree
solutions
3. anticipating and managing high risk 4.45 Strongly Agree
situations
1.81-2.60 Disagree 3.41-4.20 Agree
nursing students in terms of managing safety risks. With a grand weighted mean
of 4.48 and an equivalent descriptor of ‘strongly agree’, the fourth-year nursing
students were found to have a very high level of competence of patient safety in
terms of managing safety risks. Specifically, they were very confident what they
have learned about recognizing routine situations and settings in which safety
problems may arise ( x=4.45), about identifying and implementing safety
solutions ( x=4.52), and about anticipating and managing high risk situations (
x=4.45).
46
Table 10
Level of Patient Safety Competence among Nursing Students:
UNDERSTANDING HUMAN AND ENVIRONMENTAL FACTORS
Understanding Human and Environmental

Weighted
Factors: Interpretation
Mean
1. the role of human factors such as fatigue, 4.76 Strongly Agree
competence that effect patient safety
2. safe application of health technology 4.58 Strongly Agree
3. the role of environmental factors such as
work flow, ergonomics, resources, that 4.76 Strongly Agree
effect patient safety
1.81-2.60 Disagree 3.41-4.20 Agree
Table 10 depicts the level of patient safety competence among fourth-year
nursing students in terms of understanding human and environmental factors.
With a grand weighted mean of 4.70 and an equivalent descriptor of ‘strongly
agree’, the fourth-year nursing students were found to have a very high level of
competence of patient safety in terms of understanding human and
environmental factors. Specifically, they were very confident what they have
learned about the role of human factors such as fatigue, competence that effect
patient safety ( x=4.76), about safe application of health technology ( x=4.58), and
about the role of environmental factors such as work flow, ergonomics,
resources, that effect patient safety ( x=4.76).
47
Table 11
Level of Patient Safety Competence among Nursing Students: RECOGNIZING,
RESPONDING TO AND DISCLOSING ADVERSE EVENTS AND CLOSE
CALLS
Recognize, Respond to and Disclose

Weighted
Adverse Events and Close Calls: Interpretation
Mean
“I feel confident in what I learned about
1. recognizing an adverse event or close call 4.69 Strongly Agree
2. reducing harm by addressing immediate 4.58 Strongly Agree
risks for patients and others involved
3. disclosing the adverse event to the patient 4.69 Strongly Agree
4. participating in timely event analysis,
reflective practice and planning in order to 4.71 Strongly Agree
prevent recurrence
1.81-2.60 Disagree 3.41-4.20 Agree
nursing students in terms of recognizing, responding to, and disclose adverse
events and close calls. With a grand weighted mean of 4.67 and an equivalent
descriptor of ‘strongly agree’, the fourth-year nursing students were found to
have a very high level of competence of patient safety in terms of recognizing,
responding to, and disclose adverse events and close calls. Specifically, they
were very confident what they have learned about recognizing an adverse event
or close call ( x=4.69), about reducing harm by addressing immediate risks for
patients and others involved ( x=4.58), about disclosing the adverse event to the
patient ( x=4.69), and about participating in timely event analysis, reflective
practice and planning in order to prevent recurrence ( x=4.71).
48
Table 12
Summary of the Level of Patient Safety Competence among Nursing Students
Grand
Patient Safety Factors Weighted Interpretation
Mean
Clinical Safety 4.70 Strongly Agree
Culture of Safety 4.63 Strongly Agree
Working in Teams 4.55 Strongly Agree
Effective Communication 4.62 Strongly Agree
Managing Safety Risks 4.48 Strongly Agree
Understanding Human and Environmental 4.70 Strongly Agree
Factors
Recognizing, Responding to, and 4.67 Strongly Agree
Disclosing Adverse Events and Close Calls
Overall Weighted Mean 4.62 Strongly Agree
Table 12 summarizes the level of patient safety competence among
fourth-year nursing students. All factors of the Health Professional Education in
Patient Safety Survey (H-PEPSS) were responded by the fourth-year nursing
students with and equivalent description of ‘strongly agree’, which implies a very
high confidence on patient safety and a very high competence to it. Fourth-year
nursing students were found to have the highest confidence on Clinical safety
and understanding human and environmental factors, while the lowest is with
managing safety risks. Nevertheless, a high level of confidence and competence
can be found having an overall weighted mean of 4.62, implying strong
agreement of the instrument used and its factors.
49
Table 13
Difference on the Level of Patient Safety Competence among Fourth-year
Nursing Students when Grouped to their Profile
P- Interpretatio
Demographic Profile n X2 Decision
value n
< 30 years
52 Non- Ho is not
Age old 3.07 0.080
≥ 30 years significant rejected
3
old
Male 6 Ho is
Sex 4.43 0.035 Significant
Female 49 rejected
Single 51 Non- Ho is not
Marital 1.62 0.204
Status Married 4 significant rejected
Self-study 50
Theoretical 53
study
Practice Clinical 54 Ho is
d Safety training 8.34 0.015 Significant
Learning Experience rejected
Methods of adverse 52
events
Disclosing 45
behavior
*test difference at significance level α =0.05
Table 12 reveals the result on the test difference on the level of patient
safety competence among fourth-year nursing students when grouped to their
profile. Test difference was conducted with the use of Kruskal-Wallis H test,
which is a nonparametric approach to the one-way ANOVA, with a significance
level at α=0.05. The test difference on the level of patient safety competence
among fourth-year nursing students was found to be significant when analyzed to
the sex ( X 2=4.43 ; p−value=0.035) and their practice safety learning methods
(X ¿ ¿ 2=8.34 ; p−value=0.015)¿, which means that there is a significant difference

50
on the level of patient safety competence among fourth-year nursing students
according to their sex and practiced safety learning methods. This further implies
that the null hypothesis is rejected in terms of sex and practiced safety learning
methods. On the other hand, there was no significant difference found on the
level of patient safety competence among fourth-year nursing students according

2
to their age (X =3.07 ; p−value=0.080) and to their marital status
2
(X =1.62; p−value=0.204). This implies that the null hypothesis is not rejected in
terms of the students’ age and marital status.
Age and marital status of the students do not contribute to the difference
of their competence level in patient safety, however, their sex does. The study
found that female students have significantly higher rating to the statemensta dn
factors of patient safety, implying a higher confidence and higher competence.
This difference is supported by Habibi Soola et al. (2022), in which the outcome
can be attributed to the participation of male and female nurses. Nursing is a
majority female-dominated profession and women are generally more sensitive
than men to safety, quality of patient care, and the use of safety principles
(Habibi Soola et al., 2022). These results suggest that women pay more attention
to patient safety than men.
51
CHAPTER 5
SUMMARY OF FINDINGS, CONCLUSION, AND RECOMMENDATIONS
This section of the paper presents the summary of the study and its
findings, the conclusion derived from the outcome, and the suggested
recommendations based also from the outcome of the study.
Summary of Findings
The main goal of the study is to determine the level of patient safety
competence among fourth-year nursing students in DMC College Foundation. A
descriptive, quantitative research design was employed with the use of the
Health Professional Education in Patient Safety Survey (H-PEPSS) as the main
instrument of the study. A total of 55 fourth year nursing students was the sample
size of the study and data gathered from them was analyzed through percentage,
weighted mean and Kruskal-Wallis H test. The study has the following major
findings:
1. On the profile of the fourth-year nursing students:
Majority of the fourth-year nursing students were younger than 30 years
old, mostly females and singles. Majority of them have practiced the safety
learning methods through self-study, theoretical study in the classroom,
during their clinical trainings, experiences of adverse events and their
disclosing behavior.
2. On the extent of nursing students’ agreement to how broader patient
safety issues are being addressed in the nursing education and how
comfortable they are speaking up about patient safety:
On how broad patient safety issues are being addressed in the nursing
program, the fourth-year nursing students strongly agreed that patient
safety issues are addressed in the nursing education, with a grand
weighted mean of 4.46, implying that patient safety related issues are
well-tackled and well-addressed in the nursing program.
On how comfortable are the fourth-year nursing students on speaking up
about patient safety, the grand weighted mean has a value of 4.16, which
implies their agreement being comfortable speaking up about patient
safety.
3. On the level of patient safety competence among fourth-year nursing
students:
The level of patient safety competence among fourth-year nursing
students were found to be very high, having found that they are very
confident with all the factors of patient safety, having an overall weighted
mean of 4.62, which implies very strong agreement. The fourth-year
nursing students specifically strongly agreed that they are confident, which
implies high competence level, on the factors of patient safety in terms of
clinical safety, culture of safety, working in teams, effective
communication, managing safety risks, understanding human and
environmental factors, and recognizing, responding to, and disclosing
53
adverse events and close calls, with grand weighted means of 4.70, 4.63,
4.55, 4.62, 4.48, 4.70, and 4.67, respectively. Fourth-year nursing
students were found to have the highest level of confidence and
competence on patient safety in terms of clinical safety and understanding
human and environmental factors.
4. On the difference in the level of patient safety competence among
fourth-year nursing students when grouped according to their
profile:
There was no significant difference found in the level of patient safety
competence of the fourth-year nursing student as analyzed to their age
and marital, which have Kruskal-Wallis X 2 values of 3.07 and 1.62,
respectively, with p-values of 0.080 and 0.204, respectively. This meant
non rejection of the null hypothesis in terms of age and marital status. On
the other hand, a significant difference was found in the level of patient
safety competence of the fourth-year nursing student as analyzed to their
sex and practiced safety learning method, which have Kruskal-Wallis X 2
values of 4.43 and 8.34, respectively, with p-values of 0.035 and 0.015,
respectively. This results implied rejection of the null hypothesis in terms
of sex and their practiced safety learning method. Female nursing
students were found to have a relative higher level of patient safety
competence compared to that of male nursing students.
54
Conclusion
The findings of the study and having the knowledge of nursing profession
as a female-dominated profession, the study concludes that female nursing
students and that female nurses have higher patient safety competence
compared to that of males. This conclusion is supported that women are
generally more sensitive than men to safety, quality of patient care, and the use
of safety principles. Nevertheless, the study also concludes that fourth-year
nursing students of DMC have higher confidence when it comes to patient safety,
which implied higher level of competence as well. This indicates readiness of the
fourth-year nursing students to be deployed in the actual field of nursing. The
study further concludes that patient safety related issues and concerns are well-
addressed in the nursing program and nursing education, which signifies
exemplary instruction and education from the clinical instructors of the College of
Nursing. Moreover, patient safety learning is not just acquired and practiced by
the fourth-year nursing students during instruction inside the classroom, but also
through self-study, through their clinical training, and even through their personal
experiences of adverse events. Lastly, the study concludes that the nursing
program and the College of Nursing of DMC is successful in inculcating patient
safety learning and competence to the students, having a very strong agreement
from the respondents themselves and having high confidence about their
learning towards patient safety.
55
Recommendations
The outcome of the study has led to the following recommendations:
1. Since the study used a self-evaluation tool for identifying the level of
patient safety competence among students, then the responses coming
from the are subjective of their own perception and not clinically
evaluated. The study recommends that these data and findings from the
study be used to further determine the actual patient safety competence of
the fourth-year nursing students, in relation to their actual clinical duties
and evaluation from clinical instructors and hospital’s assigned nurses,
regarding their performance. A comparison of their self-evaluation and
evaluation from CIs and nurses will further validate the outcome of this
study.
2. Further studies are suggested to be conducted focusing on the difference
found between male and female nursing students’ level of patient safety
competence. Though supported by studies that women are generally more
sensitive than men, a specific and more focused study in the nursing
profession is suggested to be conducted to further validate findings.
3. As it was found that the fourth-year nursing students have high confidence
and competence level on patient safety, lower year levels of the nursing
students’ patient safety competence may also be determined in future
studies.
56
4. The College of Nursing may use the findings of the study as baseline for
future enhancement of nursing program instructions, especially when it
comes to patient safety, and its related concerns and issues.
57
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Appendix A
Letter to the College Dean

Sta. Filomena, Dipolog City, 7100,
Zamboanga del Norte, Philippines
January, 2023
DR. MA. GRACE F. GURDIEL, RN, MAN

Dean, College of Nursing and School of Midwifery
DMC College Foundation, Inc
Madame:
Greetings of peace.
A group of third-year BS Nursing students led by the undersigned is currently

undertaking a study entitled “Patient Safety Competencies among Nursing
Students of DMC College Foundation, Inc.”, as a partial fulfillment leading to
the degree Bachelor of Science in Nursing and as partial fulfillment of the
requirements of the course Nursing Research II. The study seeks to determine
the patient safety competence of the fourth-year nursing students in DMC
College Foundation, Inc.
In connection with this, we humbly request your approval and endorsement for us
to proceed to the data gathering among the students in the in the said institution.
Your positive feedback on this request will contribute a lot to the success of this
undertaking. Thank you and more power.
Respectfully yours, Noted by:
PIÑERO, HANNAH LEAH M. HAROLD S. NABOR, USRN, MAN-CAR

Lead Researcher Research Instructor
Approved/Disapproved:
MA. GRACE F. GURDIEL, DM, RN, MAN

Dean, College of Nursing and Allied Medical Sciences
70
Appendix B
Letter to the School Registrar

Sta. Filomena, Dipolog City, 7100,
Zamboanga del Norte, Philippines
January, 2023
REY CORNILLO
OIC School Registrar
DMC College Foundation, Inc.
Sir:
A group of third-year BS Nursing students led by the undersigned is currently

undertaking a study entitled “Patient Safety Competencies among Nursing
Students of DMC College Foundation, Inc.”, as a partial fulfillment leading to
the degree Bachelor of Science in Nursing and as partial fulfillment of the
requirements of the course Nursing Research II. The study seeks to determine
the patient safety competence of the fourth-year nursing students in DMC
College Foundation, Inc.
In line with this, we humbly request from your good office the actual number of
enrolled fourth-year nursing students, in the second semester of the academic
year 202 – 2023, for the identification of the fourth-year nursing student
population and the sample of the study. They are identified respondents of the
study. Rest assured that their identity will be kept confidential.
Your positive feedback on this request will contribute a lot to the success of this
undertaking.
Thank you and more power.
Respectfully yours, Noted by:
PIÑERO, HANNAH LEAH M. HAROLD S. NABOR, USRN, MAN-CAR

Lead Researcher Research Instructor
71
Appendix C
CONSENT FOR RESPONDENTS
Date
Dear Participant,
Good day!
You have been selected as one of the respondents of the study “Patient Safety
Competencies among Nursing Students of DMC College Foundation, Inc.”
that we are currently conducting. There are no risks involved participating this
study. Privacy will be ensured through confidentiality. Participation is voluntary
and you have the right to terminate to answer the given survey questionnaire. A
summary of results will be available to participants upon request.
Respectfully yours,
The Researchers
Statement of Consent
I have read the above information. I agree to participate in this study and give
permission for taking picture during the survey process.
Name and Signature of Participant Date

(Optional)
Name and Signature of Participant Date

(Optional)
72
Appendix D
Gannt Chart
73
Appendix E
BUDGET CHART
74
Appendix F
Survey Questionnaire
“Patient Safety Competencies among Senior Nursing Students of DMC
College Foundation, Inc.”
Part I. Demographic Profile of the Respondents

Directions: Please put a check mark in the parenthesis with the words that best
describe you.
1. Age: 2. Sex:
( ) ≤ 30 years old ( ) Male
( ) > 30 years old ( ) Female
3. Marital Status:
( ) Single
( ) Married
4. Do you have a prior experience of patient safety education?

( ) Yes ( ) No
5. Practiced safety learning methods:
Practiced safety learning methods Yes No

1. Self-study
2. Theoretical study in Classroom
3. Clinical training
4. Experience of adverse events
5. Disclosing behavior
75
Part II. A. Agreement towards patient safety issues being addressed in
health professional education
Directions: Please put a check mark in the box (column) with the score that
corresponds your agreement to each statement. Refer to the scoring scale
below:
Score Description
5 Strongly Agree
4 Agree
3 Neutral/Unsure
2 Disagree
1 Strongly Disagree
Statements 5 4 3 2 1
8. As a student, the scope of what was “safe” for
me to do in the practice setting was very clear to
me
9. There is consistency in how patient safety issues
were dealt with by different preceptors in the
clinical setting
10. I had sufficient opportunity to learn and interact
with members of interdisciplinary teams
11. I gained a solid understanding that reporting
adverse events and close calls can lead to change
and can reduce reoccurrence of events
12. Patient safety was well integrated into the overall
program
13. Clinical aspects of patient safety (e.g. hand
hygiene, transferring patients, medication safety]
were well covered in our program
14. “System” aspects of patient safety were well
covered in our program (e.g. aspects of the
environment including policies, resources,
communication and other processes)
76
B. Agreement towards comfort speaking up about patient safety
corresponds your agreement to each statement. Refer to the scoring scale
below:
Score Description
5 Strongly Agree
4 Agree
3 Neutral/Unsure
2 Disagree
1 Strongly Disagree
Statements 5 4 3 2 1
4. In clinical settings, discussion around adverse
events focuses mainly on system-related issues,
rather than focusing on the individual(s) most
responsible for the event
5. In clinical settings, reporting a patient safety
problem will result in negative repercussions for the
person reporting it
6. If I see someone engaging in unsafe care practice
in the clinical setting, I feel safe to approach them
Part III. Patient Safety Competence (Health Professional Education in

Patient Safety Survey)
corresponds your perception of agreement to each statement. Refer to the
scoring scale below:
Score Description Interpretation
5 Strongly Agree Very Satisfied
4 Agree Satisfied
3 Neither Agree nor Disagree Neutral
77
2 Disagree Dissatisfied
1 Strongly Disagree Very Dissatisfied
Clinical safety:
5 4 3 2 1
5. safe clinical practice in general
6. hand hygiene
7. infection control
8. safe medication practices
Culture of safety:
5 4 3 2 1
9. the ways in which health care is complex and has
many vulnerabilities (e.g., workplace design,
staffing, technology, human limitations)
10. the importance of having a questioning attitude and
speaking up when you see things that may be
unsafe
11. the importance of a supportive environment that
encourages patients and providers to speak up
when they have safety concerns
12. he nature of systems (e.g., aspects of the
environment including policies, resources,
communication and other processes) and system
failures and their role in adverse events
Working In Teams with Other Health Professionals: 5 4 3 2 1
13. team dynamics and authority/power differences
14. managing inter-professional conflict
15. debriefing and supporting team members after an
adverse event or close call
16. engaging patients as a central participant in the
health care team
17. sharing authority, leadership, and decision-making
18. encouraging team members to speak up, question,
challenge, advocate and be accountable as
appropriate to address safety issues
Communicating Effectively: 5 4 3 2 1
78
19. enhancing patient safety through clear and
consistent communication with patients
20. enhancing patient safety through effective
communication with other health care providers
21. effective verbal and nonverbal communication
abilities to prevent adverse events
Managing Safety Risks: 5 4 3 2 1
22. recognizing routine situations and settings in which
safety problems may arise
23. identifying and implementing safety solutions
24. anticipating and managing high risk situations
Understanding Human and Environmental Factors: 5 4 3 2 1
25. the role of human factors such as fatigue,
competence that effect patient safety
26. safe application of health technology
27. the role of environmental factors such as work flow,
ergonomics, resources, that effect patient safety
Recognize, Respond to and Disclose Adverse
Events and Close Calls: 5 4 3 2 1
“I feel confident in what I learned about
28. recognizing an adverse event or close call
29. reducing harm by addressing immediate risks for
patients and others involved
30. disclosing the adverse event to the patient
31. participating in timely event analysis, reflective
practice and planning in order to prevent
recurrence
79
CURRICULUM VITAE
KISHA CLAIRE S. REFAMONTE
Pob. Titay, Zamboanga Sibugay Province. Formal with White Plain

Background or your
09065465255 Graduation Toga Pictorial
refamontekishaclaire@gmail.com
PERSONAL DATA
Date of Birth: November 26, 2001
Place of Birth: Pob. Titay, Zamboanga Sibugay Province.
Civil Status: Single
Religion: Protestant
Height: 152.40 cm
Weight: 45kg
Father’s Name: Agrifino C. Refamonte
Mother’s Name: Perlita S. Refamonte
Hobbies & Interest: None
EDUCATIONAL BACKGROUND
Primary Titay Special Education School

Pob., Titay, ZSP.
2014
Secondary Marian College
Climaco Street, Pobacion, Ipil, ZSP.
2020
Tertiary DMC College Foundation, Inc.
Fr. Patangan Road, Sta. Filomena, Dipolog City, Philippines
Present
80
CURRICULUM VITAE
HANNAH LEAH M. PIÑERO
Manawan Jose Dalman Zamboanga del Norte
09665473537
pinerohannahl@gmail.com
PERSONAL DATA
Date of Birth: December 1, 2001

Place of Birth: Dipolog City
Religion: Roman Catholic
Height: 155 cm
Weight: 53kg
Father’s Name: Mario Erie G. Piñero
Mother’s Name: Elsie M. Piñero
Hobbies & Interest: Baking
Primary Manawan Elementary School
2014
Secondary Manawan National Highschool
2020
Tertiary DMC College Foundation Inc.
Present
81
CURRICULUM VITAE
MYRA ALLYSSA E. MUNDING
Pob. Siocon. Zamboanga del Norte Formal with White Plain

Background or your
09050324659 Graduation Toga Pictorial
myndingmyraallyssa@gmail.com
PERSONAL DATA
Date of Birth: November 15, 2001

Place of Birth: Pob. Siocon, Zamboanga Del Norte
Religion: Muslim
Height: 152.40 cm
Weight: 73kg
Father’s Name: Abdulsaid S. Munding
Mother’s Name: Marissa E. Munding
Hobbies & Interest: None
Primary Siocon Central School

Poblacion, Siocon, ZDN
2014
Secondary Julian Soriano Memorial Comprehensive High School
Pobacion, Siocon, ZDN.
2020
Tertiary DMC College Foundation Inc.
Present
82

Patient Safety Competencies Among Nursing Students of DMC College Foundation, Inc.

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Patient Safety Competencies among Nursing Students of DMC College

Presented to the Faculty of the College of Nursing

DMC College Foundation, Inc.

Dipolog City, Zamboanga del Norte

of the Requirement for the Degree of

BACHELOR OF SCIENCE IN NURSING

MUNDING, MYRA ALLYSSA E.

This research paper entitled “Patient Safety Competencies among Nursing

MUNDING, MYRA ALLYSSA E.

HAROLD S. NABOR, RN, USRN, MAN-CAR

Approved by the panel of examiners with the grading of _________________.

MA. GRACE F. GURDIEL, RN, MAN, DM

Approved and accepted, in partial fulfillment on the requirements of Nursing

MARIDOL B. CLARO, RN, MAN MA. GRACE F. GURDIEL, RN, MAN, DM

List of Figures viii

Chapter 1 The Problem and Its Scope

Background of the Study 1

Statement of the Problem 10

Scope and Delimitations of the Study 11

Significance of the Study 12

Operational Definition of Terms 14

Chapter 2 Review of Related Literature

Patient Safety and Patient Safety Competencies 16

Research Design and Sampling 31

Data gathering Procedure 35

Ethical Considerations in Research 37

Chapter 4 Results and Discussion 38

Chapter 5 Summary of Findings, Conclusion, and Recommendations

Figure No. Title Page No.

1 Schematic Diagram of the Study 9

2 Location Map of DMC College Foundation, Inc. 32

Table No. Title Page No.

1 Scoring Scale that will be Used in the Study 36

THE PROBLEM AND ITS SCOPE

Background of the Study

Because of the possibility of preventable harm occurring during medical

of medication errors was found to be 97.8%. The most (63.3/chart) were in

pediatrics, followed by medicine, obstetrics, and surgery (7.3/chart). The most

common types of errors discovered were prescribing, compliance, and

administration errors. As a result, it is critical that healthcare providers are

sufficiently knowledgeable to identify potential safety hazards and protect

Nursing students are an important part of the healthcare provider reserve

force. The importance of assisting nursing students in reflecting on their PS

knowledge and competence in a variety of clinical settings and circumstances is

students' PS competence's strengths and weaknesses (Doyle et al., 2015; Usher

at al., 2017). Contributing to patient safety culture, working in teams,

communicating effectively, managing safety risks, optimizing human and

and skills of students in nursing, pharmacy, and traditional medicine (Hwang et

professionals (Castello et al., 2019; VanDenKerkhof et al., 2017), but little is

of confidence in the majority of PS competence domains (Doyle et al., 2015;

competence varies by academic year of study; some publications report that

confidence in PS competence declines as students are increasingly exposed to

2019). More research is thus required to better understand the PS competence

of this vulnerable group of nursing students.

Notably, nursing students' PS competence in the classroom is lower than

students in Australia, for example, reported greater confidence in their clinical

2017). When comparing different countries, the specific domains of PS

Jordan). There is little known about the development of nursing students' PS

knowledge and confidence in the Philippines, where PS strategies and education

lag behind those in developed countries, according to the researchers.

There is growing evidence that explicit PS competence is becoming more

important in undergraduate nursing education and learning (Usher at al., 2017).

been linked to nursing students' PS competence (VanDenKerkhof et al., 2017;