The INSÉPArable portfolio tool to sustain continued education and the professional development of nurses for a full scope of nursing practice and enhanced patient safety competencies: An ethnographic study

BACKGROUND: Despite widespread recognition of the undeniable impact of nurses on patient safety, important barriers relating to the organization of health systems still hinder the full expansion of the role of these professionals. In Quebec (Canada), nurses work overtime and increased adverse events are preoccupying and point to a possible lack of contemporary tools for continuous professional development. Innovative training tools should foster a more reflective practice focused on a holistic view of the patient in order to support the full scope of nursing practice and ensure continuous improvement in the quality of care. Such tools would make it possible to better understand their practice, according to their own perception, as well as its applicability in the emergence of a professional conscience which is essential to lasting safety competencies. This study's overarching goal was to propose a model and a portfolio prototype to support nurses’ training. METHOD: Based on a humanistic and reflective perspective on patient care and safety competencies, a design approach was used to develop a portfolio prototype. Ethnography was used to collect and analyse data using shadowing observations of 10 nurse/patient dyads, followed by interviews about their care experience. The research was conducted in acute and long-term care settings of the Quebec City area. The iteration process resulted in a first version of the prototype that was then presented to various stakeholders during a co-design workshop aimed at better understanding the clinical applicability of this prototype. FINDINGS: The INSÉPArable project is illustrated in two interrelated figures, which reflects a complete inductive representation supporting sustainable patient safety from nursing practice experience. First, nursing practice status has been depicted as an iceberg metaphor where the essence of care, the « art of nursing » is hidden. Second, a sphere illustrates the direction to the full emergence of nursing practice that helps to enhance the hidden “art of nursing” by leading nurses towards optimal conditions conscience. DISCUSSION: INSÉPArable turned out to be more than an individual reflective tool as it also highlights the need for collective awareness among nurse managers regarding their responsibility in implementing and sustaining healthy work environments, in which optimal conditions are better supported. This also implies a renewed mode of governance and the implementation of more humanistic processes that redefine the contemporary professionalism of nurses, which are closely linked to patient safety.