Preregistration nursing students’ motivation to communicate for safety and their lived experience of using graded assertiveness to speak-up during work integrated learning

Background: This thesis reports on the findings of a research study that explored the motivation and lived experiences of preregistration nursing students who speak up for patient safety during work-integrated learning (WIL). It was important this research be undertaken as current literature frequently found this group of students lack the motivation, knowledge and confidence to voice their concerns about breaches in patient safety during WIL. Aims: The thesis had three aims. These were: To uncover what motivates preregistration nursing students to speak up for patient safety during work-integrated learning. To develop an evidence-based patient safety motivation framework for use by educators, clinicians, and preregistration nursing students. To describe the lived experiences of preregistration nursing students who used graded assertiveness to speak up for patient safety during work integrated learning. Review and Research Questions: The thesis addressed two questions, a review question and a research question. The review question was: What motivates preregistration nursing students to speak-up for patient safety during work-integrated learning? The research question was: What is the lived experience of preregistration nursing students who used graded assertiveness to speak-up for patient safety during work-integrated learning?Methods and Results: To address study aim one and the review question, Whittemore ii and Knafl’s five stage integrated review framework was applied to explore what motivates preregistration nursing students to speak-up for patient safety during WIL. The use of Whittemore and Knafl’s framework enabled a structured approach to the search and identification of relevant research literature, data evaluation, data analysis, and synthesis of the literature. The outcome was the uncovering of three key motivators that explained why preregistration nursing students speak-up for patient safety during WIL. These three key motivators were: authentic learning, view of self as a nurse, and a positive WIL experience. The findings of the integrative literature review were developed into an evidence-based Safety Motivation Framework for Preregistration Nursing Students during WIL. The developed framework addressed study aim two and included the three key motivators. The outcomes of this integrative literature review are underpinned by self-determination theory, a well-established framework for exploring human motivation. To address study aim three and the research question a qualitative research study guided by Husserl’s descriptive phenomenology was conducted. Participants were seven preregistration nursing students who had used graded assertiveness, a technique requiring gradual increase in the urgency of communication, to speak up for patient safety during WIL. Data were collected via semi-structured interviews and analysed using Colaizzi’s seven step approach to qualitative data analysis. The findings of this study uncovered four key themes that describe the lived experience of preregistration nursing students who used graded assertiveness to speak-up for patient safety during WIL. These themes were patient safety before self, being the patient advocate prevents harm, please hear me, and speaking up is rewarding.Conclusion: The thesis concludes with a discussion of the shared commonalities between self-determination theory, the developed Safety Motivation Framework for Preregistration Nursing Students during WIL and the findings of the descriptive phenomenology study. The shared commonalities show preregistration nursing students motivation and lived experience in speaking up for patient safety is based on how well they were prepared for WIL, the tools provided, such as graded assertiveness, self-belief, and rewards when advocating for their patients.