Open Access Research article

Unsafe clinical practices as perceived by final year baccalaureate nursing students: Q methodology

Laura A Killam1*, Phyllis Montgomery2, June M Raymond1, Sharolyn Mossey2, Katherine E Timmermans1 and Janet Binette1

Author Affiliations

1 School of Health Sciences and Emergency Services, Cambrian College, 1400 Barrydowne Road, Sudbury, Ontario, Canada

2 School of Nursing, Laurentian University, 935 Ramsey Lake Road, Sudbury, ON, Canada

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BMC Nursing 2012, 11:26  doi:10.1186/1472-6955-11-26

Published: 26 November 2012



Nursing education necessitates vigilance for clinical safety, a daunting challenge given the complex interchanges between students, patients and educators. As active learners, students offer a subjective understanding concerning safety in the practice milieu that merits further study. This study describes the viewpoints of senior undergraduate nursing students about compromised safety in the clinical learning environment.


Q methodology was used to systematically elicit multiple viewpoints about unsafe clinical learning from the perspective of senior students enrolled in a baccalaureate nursing program offered at multiple sites in Ontario, Canada. Across two program sites, 59 fourth year students sorted 43 theoretical statement cards, descriptive of unsafe clinical practice. Q-analysis identified similarities and differences among participant viewpoints yielding discrete and consensus perspectives.


A total of six discrete viewpoints and two consensus perspectives were identified. The discrete viewpoints at one site were Endorsement of Uncritical Knowledge Transfer, Non-student Centered Program and Overt Patterns of Unsatisfactory Clinical Performance. In addition, a consensus perspective, labelled Contravening Practices was identified as responsible for compromised clinical safety at this site. At the other site, the discrete viewpoints were Premature and Inappropriate Clinical Progression, Non-patient Centered Practice and Negating Purposeful Interactions for Experiential Learning. There was consensus that Eroding Conventions compromised clinical safety from the perspective of students at this second site.


Senior nursing students perceive that deficits in knowledge, patient-centered practice, professional morality and authenticity threaten safety in the clinical learning environment. In an effort to eradicate compromised safety associated with learning in the clinical milieu, students and educators must embody the ontological, epistemological and praxis fundamentals of nursing.

Nursing education; Q-Methodology; Safety; Clinical learning; Student perspectives