Samantha A Walsh

Aim
To describe the lived experiences of preregistration nursing students who used graded assertiveness to speak up for patient safety during work-integrated learning.
Background
Most Australian preregistration nursing programs have introduced graded assertiveness education to on-campus student learning. Graded assertiveness is a communication technique that gradually increases communication intensity to express concerns and focuses on patient safety rather than team members' actions. Previous research has indicated that although provided with the tools to speak up for patient safety, preregistration nursing students often withdrew or stayed silent when facing challenging patient safety situation during work-integrated learning.
Design
A qualitative study using Husserlian descriptive phenomenology.
Methods
Seven preregistration nursing students enrolled in the Bachelor of Nursing Science program at a multicampus university in Queensland, Australia, took part in a semi-structured Zoom® interview. Consistent with Husserlian descriptive phenomenology interviews were transcribed verbatim and analysed using the Colaizzi seven-stage method.
Results
Four themes were gleaned from the data: i) patient safety before self, emphasised that patient safety must be placed above all other considerations, including themselves; ii) being the patient advocate prevents harm, a strong belief among participants that advocating for patient safety helped to ensure safe care; iii) please hear me, participants expressed feeling unheard when raising concerns about patient safety; and iv) speaking up is rewarding, participants described speaking up for patient safety using graded assertiveness during work-integrated learning as personally rewarding.
Conclusions
The four themes uncovered by this study highlighted the value of graded assertiveness to the lived experiences of preregistration nursing students who speak up for patient safety during work-integrated learning. Our findings indicate that these students can effectively use graded assertiveness to promote patient safety, providing valuable insights for future education and practice.

Aim
The aim of this review was to uncover what motivates preregistration nursing students to speak up for patient safety during work integrated learning (WIL) and to develop an evidence-based safety motivation framework for use by educators, clinicians, and preregistration nursing students.

Design
This study used an integrative literature review design guided by Whittemore and Knafl's methodological framework.

Data sources
Five research databases, CINAHL, MEDLINE, PubMed, Scopus, and Web of Science, were searched for relevant peer reviewed research literature published in English between January 2011 and January 2024. The use of MeSH terms “undergraduate nursing student,” or “preregistration nursing student” and “speaking up,” “patient safety,” and “motivation,” resulted in 489 search returns. Following application of filters and inclusion criteria fifty-four (n = 54) studies were identified as being relevant to the research aim.

Review methods
The fifty-four (n = 54) research studies were reviewed using the JBI Critical Appraisal tool relevant to the study methodology. The JBI critical appraisal tools are checklists used to determine research quality, validity, results, and meaning. Following appraisal, 27 studies were included in the integrative literature review.

Results
Authentic learning, view of self as a nurse, and positive work integrated learning experiences were found to be the primary motivators for preregistration nursing students to speak up for patient safety during work integrated learning. These three motivators provided the foundation for an evidence-based framework, underpinned by self-determination theory, that can be used to enhance preregistration nursing students' motivation to speak up for patient safety.

Conclusions
The integrative review design enabled the development of the evidence-based Safety Motivation Framework to support preregistration nursing students' during work integrated learning however missing from the literature was information about the lived experience of this group of students when speaking up for patient safety.