Learning Objective 1: Identify seven crucial concerns in the workplace identified by senior BSN students.
Learning Objective 2: Discuss research, practice, leadership, and educational implications of a culture of silence.
Methods: Twenty three senior BSN students were asked to describe a time in their clinical experiences when they witnessed any one of the concerns delineated in Silence Kills and how the issue was handled. The sampling units were the text of their on-line postings. Written responses were analyzed qualitatively using abductive inference textual content analysis. Following individual textual coding, consensus was determined on thematic congruence.
Results: Each of the seven crucial concerns in Silence Kills were identified by students. Students observed the involvement of staff nurses, charge nurses, and nurse managers in these crucial issues. In most cases, the concerns were not addressed by managers, nurses, or students. The most common concerns were broken rules, disrespect and poor teamwork. Students were shocked by the breach of standards yet unwilling to speak up due to their status as students. One student indicated that she could see herself doing the same things as a clinician and another student described her difficulty remembering rules that are not modeled by nurses.
Conclusion: This study revealed a continued prevalence of the themes described in Silence Kills,, thus negatively impacting patient safety.. Nursing faculty, nurses and nurse leaders must educate and facilitate the empowerment of nurses to break the silence in order to promote a safe and healthy work environment.
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