Why do nursing students make medication errors? A qualitative study in Indonesia

Nursing students' and faculty's experiences of first medication administration: A phenomenological inquiry

BACKGROUND

Learning medication administration is essential for nursing students, but the first time can be stressful and shape their clinical development. Previous research primarily focused on student knowledge and technical aspects.

PURPOSE

This phenomenological study helped explore the lived experiences of nursing students and faculty during student's first medication administration in the clinical setting to gain a deeper understanding of their thoughts, feelings, and perspectives.

METHOD

Semi-structured interviews were conducted with female student and faculty informants (N = 12). Using a phenomenological study, data were analyzed using van Manen's hermeneutic six-step research activity method.

RESULTS

Five overarching themes were found: administrating medication, (un)preparedness for complexities in the clinical environment, transformative experience, overcoming fears, and reaping the rewards.

CONCLUSION

First-time medication experiences are greater than an exercise in skill proficiency and may be improved if faculty provides more structured learning experiences and take sufficient time for student preparation in relating medication knowledge to the skill, technology usage, and supporting students' attitudes toward nurse-patient interactions. These are essential aspects of the medication administration learning process as nursing programs shift toward competency-based education. Clinical faculty also need support in their role as educators and to be facilitated to find this time, considering their multiple responsibilities.

Strategies to prevent medical errors by nursing interns: a qualitative content analysis

BACKGROUND

Nursing interns often face the serious challenges and stress of clinical training. Identifying effective strategies in reducing medical errors can improve student performance and decrease patient risk and injury from errors. The purpose of this study was to identify strategies to prevent medical errors by nursing interns in Medical Universities in Sistan and Baluchistan, Southeast of Iran.

METHODS

This is a qualitative study using a content analysis approach. Purposive sampling was used. The study was conducted in 3 medical universities. Ten nursing interns participated in this study. Open-ended, semi-structured, and face-to-face, interviews were used to explore the experience of nursing interns about strategies to prevent medical errors during their internship.

RESULTS

Findings include 20 subcategories, 6 categories and one theme. The main theme is "strategies to prevent medical errors during internship". Six categories included "strategies to prevent medical errors during internship". These included "Professional acceptance and support", "Revision of the implementation of the educational curriculum", "Retraining courses for challenging skills", "Creating learning opportunities" "Professionalization", and "Facilities and requirements".

CONCLUSIONS

Preventing medical errors requires different strategies before and during nursing internship. Error prevention strategies include retraining and preparatory courses for challenging areas, evaluation of students' performance, and accepting students as members of the health care team, respecting and supporting them and protecting their rights. Learning from medical errors, analysis and reflection on errors should be part of the curriculum during the internship.

Evaluation of nurses' knowledge and performance regarding preparation and injection of intravenous drugs in pediatric wards in Iran

BACKGROUND

A error in intravenous injection in pediatric wards can cause irreparable injuries. This study aimed to determine the level of knowledge and performance of nurses in terms of preparation and injection of intravenous drugs in pediatric wards of hospitals affiliated to Isfahan University of Medical Sciences.

METHODS

This cross-sectional study was conducted in 2022 on 156 nurses working in pediatric wards. The data was collected with demographic information questionnaire and the knowledge and performance of the participants were determined using a researcher-made questionnaire, including the five rights of medication administration (preparation and injection, medication error, drug side effects, family empowerment, and documentation) using self-reporting and observation methods. Formal and content validity was calculated using the opinions of 10 experts and Cronbach's alpha with 40 samples.

RESULTS

The mean and standard deviation of total nurses' knowledge and performance scores were 58.31 + 10.1 and 66.1 + 14.4, respectively. Moreover, the mean and standard deviation of nurses' knowledge scores were 63.55 + 14.3 for documentation, 46.1 + 7.9 for preparation and injection, 73.9 + 12.3 for drug side effects, 58.4 + 10.2 for medication error, and 69.4 + 9.4 for family empowerment. Besides, the mean performance was 69.1 + 17.6 for documentation, 61.3 ± 9.9 for preparation and injection, 78.21 + 12 for drug side effects, 58.6 + 15 for medication error, and 65.4 + 17.7 for family empowerment.

CONCLUSION

The results showed that the mean knowledge and pharmacological performance of nurses working in pediatric wards in different areas of the principles of medicine were not at the desired level, and this can affect children adversely.

Nursing Students' Medication Administration: A Focus on Hand Hygiene and Patient Identification

BACKGROUND

Procedural failures during medication administration include a lack of appropriate hand hygiene and failure to verify patient identification prior to administration of medication. Procedural failures are common among nurses and nursing students and can lead to serious patient harm.

METHOD

A descriptive cross-sectional research design was used to collect observational data from a simulation-based experience of a medication administration scenario.

RESULTS

Thirty-five senior baccalaureate nursing students from two geographically distant universities in the United States participated in the study. All of the participants made at least one procedural failure during the simulated experience. Hand hygiene compliance was 40.3%, and patient identification compliance was 43.8%.

CONCLUSION

Students often failed to comply with medication administration safety guidelines. Nursing programs must make changes to the methods used to teach safe medication administration to prepare students for this critical skill. [J Nurs Educ. 2023;62(7):403-407.].

Predicting behavioural intentions towards medication safety among student and new graduate nurses across four countries

AIMS AND OBJECTIVES

To identify final-year undergraduate students and new graduate nurses' behavioural intentions towards medication safety across four countries.

BACKGROUND

Medication errors are a common and avoidable occurrence, being costly for not only patients but also for health systems and society.

DESIGN

A multi-site cross-sectional study.

METHODS

A self-administered survey was distributed to students and new graduate nurses in South Africa, India, Turkey and Australia. Descriptive statistics were calculated for all survey items. Multiple linear regressions were performed to predict behavioural intentions using the three Theory of Planned Behaviour constructs: attitudes, behavioural control and subjective norms. This study adheres to the STROBE guidelines.

RESULTS

Data were analysed for 432 students and 576 new graduate nurses. Across all countries, new graduate nurses reported significantly higher scores on all the TPB variables compared with student nurses. Attitudes towards medication management were found significantly and positively related to intention to practice safe medication management for both student and new graduate nurses. Total perceived behavioural control was significantly and negatively related to intention to practice safe medication management for students.

CONCLUSION

Student and new graduate nurses showed favourable attitude, subjective norm, perceived behaviour control and intention in practising medication safety. However, differences in countries require further exploration on the factors influencing attitudes towards medication safety among student nurses and new nurse graduates.

RELEVANCE TO CLINICAL PRACTICE

Understanding student and new graduate nurses' medication administration practices is important to inform strategies aimed at improving patient safety. The findings of this study highlight the need for an internationally coordinated approach to ensure safe medication administration by student and new graduate nurses.

Nursing students' experiences of service-learning at community and hospital pharmacies in Belize: Pedagogical implications for nursing pharmacology

OBJECTIVES

Many students seem to find pharmacology learning very challenging due to the complexity and variety of drugs they have to study. The number of drugs the students have to learn, the duration of time to learn the medications, and the evolving nature of diseases demanded learning beyond the classroom walls. This study explored and described nursing students' experiences in community and hospital-based pharmacy practice sites during their service-learning and its implications for pharmacology pedagogical practices.

METHODS

Kolb's learning theory provided the framework to explore nursing students' 48-hour service-learning experiences at community/hospital-based pharmacies in Belize and its implications for pharmacology pedagogy. The study utilized two qualitative approaches, reflective journals and focus group interviews, to collect data from 46 second-year nursing students. NVivo software and coding schemes were employed to analyze the data from the interviews and reflective journals.

RESULTS

Students reported learning medications, integrating classroom pharmacological knowledge at pharmacy practice sites, acquiring and enhancing communication skills, interpreting prescriptions, dispensing medications, drug calculations, taking inventory, doing vital signs, and patient education. In addition, students reported experiencing inter-professional relationships as healthcare team members. Anxiety was a major challenge experienced by many students at the beginning of the service-learning experience.

CONCLUSIONS

This study highlights the importance of experiential learning of pharmacology amongst second year nursing students, offering the opportunity to inform and support pharmacotherapeutics educators in designing strategies for more effective teaching of medications to nursing students. It also supports the addition of pharmacy placements to the nursing curriculum' as it shows that nursing students can learn medications, skills, and teamwork from experiential pharmacy site posting. Combining classroom instruction with pharmacy experiential service learning might be an effective complement for teaching nursing pharmacology.

Medication administration and anxiety: an observational study with nursing students

BACKGROUND AND AIM

Medication administration errors represent a topic of great scientific interest. Medication administration is considered by nursing students a complex process during which it is easy to make mistakes; therefore, institutional measures have been adopted in order to reduce medication errors. However, it remains a critical issue in nursing practice for which several causes have been identified, including environmental factors and individual knowledge. Mistakes can be made by nurses and especially by students who must cope with additional causal factors including anxiety management. The aim was to investigate state anxiety levels among nursing students when it comes to medication administration.

RESEARCH DESIGN AND METHODS

An observational study involving a convenience sample of 150 nursing students from a Northern Italy University has been conducted; they were asked to complete a questionnaire to measure the levels of state anxiety in relation to medication administration.   Results. There were no particularly high levels of state anxiety among students associated with medication administration; however, state anxiety levels were slightly higher in third-year students than in second-year students, and this is most likely due to the growing complexity of the medication administration process compared to the lack of experience.   Conclusions. Although the results don't show statistically significant data, the effectiveness of nursing education plays a crucial role in reducing medication errors, which is why it is essential to provide suitable tools for the professionals of the future and invest in clinical simulations.

Nursing students' perception of medical errors: A cross-sectional study in a university

AIM

To assess the perception of nursing students on medical errors.

DESIGN

A descriptive cross-sectional survey.

METHOD

Data were collected from March-April 2019 in a university in Ghana from two hundred (200) students using simple random sampling and analysed with SPSS version 21.

RESULTS

Mean age of respondents was 22.64 years. Medication error was perceived as the most common medical errors (MEs; 76%). Negligence was perceived as the most common cause of MEs (80.5%); nurses and doctors (84.5%-89.5%) were considered as staff who make most MEs. Respondents perceived that students commit MEs due to less knowledge about procedures (79%) and inadequate supervision (77%) in the clinical setting.

CONCLUSION

Medication errors were observed as the most common of MEs that can affect patients' safety. Taking prudent measures in addressing this can reduce MEs in health facilities. Enhanced supervision and effective ways of teaching drug administration are recommended.

Facilitators and barriers to the clinical administration of herbal medicine in Ghana: a qualitative study

BACKGROUND

Herbal medicine administration in conventional health care services is gaining popularity lately. Much has not been documented on the perceived enhancers and challenges to herbal medicine administration at the hospital. The study sought to explore the facilitators and barriers to the clinical administration of herbal medicine in Ghana.

METHOD

Qualitative descriptive exploratory design was employed. Fourteen participants among the consented and purposively sampled nurses were interviewed. Data was transcribed and analysed using content analysis.

RESULTS

The participants disclosed that facilitators to the clinical administration of herbal medicine include doctors' prescription, affordability of herbal medications by patients, patients' willingness to use herbal medicine and availability of herbal medicine. Barriers to the clinical administration of herbal medicine were inadequate knowledge on herbal medicine, lack of publicity, unclear integration, lack of collaboration and policies on herbal medicine administration at the hospital. Other barriers were negative mindset of patients and lack of national health insurance scheme (NHIS) coverage.

CONCLUSION

Clinical administration of herbal medicine is faced with an array of challenges. Doctor's prescription, nursing education on herbal medicine and NHIS coverage of herbal medicine are imperative to improve herbal medicine administration in hospitals. Herbal medicine addition into mainstream health care services is surging high in many countries. This study aimed at finding out what nurses consider as the issues that make it easy or difficult to serve herbal medicine in the hospital. Qualitative method was employed, in-depth face-to-face interviews were conducted and data collected was typed verbatim. The typed data was content analysed and findings supported with the nurses' statements. The findings of the study showed that facilitators to the clinical use of herbal medicine include doctors' prescription, affordability of the herbal drug, patient's willingness to use the herbal medication, patient's belief about herbal medicine and availability of herbal medicine. Challenges to the clinical use of herbal medicine disclosed were lack of knowledge on herbal medicine, lack of publicity, unclear integration, lack of collaboration between health professionals and herbal medicine providers. Other barriers include negative mindset of patients and lack of national health insurance (NHIS) coverage. The researchers came to a consensus that nurses need further training on herbal medicine to enhance herbal medicine use at the hospital. Health professionals need to collaborate with herbal medicine service providers and NHIS must be reviewed to cover herbal medications.

Improving Nursing Students' Medication Safety Knowledge and Skills on Using the 4C/ID Learning Model

Introduction

Learning medication-safety has become a focus in many countries to improve medication-safety competencies in nursing students. Research on instructional design for medication-safety is still limited, especially about the use of the Four Components Instructional Design (4C/ID) model. This study aimed to compare the knowledge and skills in medication safety of nursing students after the medication-safety training using four components of instructional design known as 4C/ID.

Methods

This was a posttest-only quasi-experimental study using an intervention and control group. The participants were the third-semester students of a nursing school at Yogyakarta, Indonesia (intervention: n=55, control: n=40). The intervention group was trained for five weeks using the 4C/ID approach with interactive lectures, small group discussions, reflections, and skills simulation sessions. An observational skills evaluation and Multiple-Choice Questionnaire were administered in the last week after the training completed. Independent sample t-test and Mann Whitney tests were used to analyze the mean differences of knowledge and skills in giving oral medicine and drug injections between the two groups.

Results

The majority of respondents were female (74.1%), aged 19–20 years (77.8%), with GPA >3 (87.37%) and, the majority had never received instruction about patient safety (69%). There were significant mean differences in overall knowledge (p<0.05) and also in the skills of oral drug and intramuscular drug administration (p<0.05) between the intervention and control groups.

Conclusion

Training in medication-safety using the 4C/ID approach could improve the medication-safety knowledge and skills of the nursing students based on simple to complex learning.

PRN Medicines Optimization and Nurse Education

Medicines management is a high-risk and error prone process in healthcare settings, where nurses play an important role to preserve patient safety. In order to create a safe healthcare environment, nurses should recognize challenges that they face in this process, understand factors leading to medication errors, identify errors and systematically address them to prevent their future occurrence. ''Pro re nata'' (PRN, as needed) medicine administration is a relatively neglected area of medicines management in nursing practice, yet has a high potential for medication errors. Currently, the international literature indicates a lack of knowledge of both the competencies required for PRN medicines management and the optimum educational strategies to prepare students for PRN medicines management. To address this deficiency in the literature, the authors have presented a discussion on nurses' roles in medication safety and the significance and purpose of PRN medications, and suggest a model for preparing nursing students in safe PRN medicines management. The discussion takes into account patient participation and nurse competencies required to safeguard PRN medication practice, providing a background for further research on how to improve the safety of PRN medicines management in clinical practice.

Evaluating the relationship between information literacy and evidence-based nursing and their impact on knowledge and attitude of nurses working in hospitals affiliated to Kerman University of Medical Sciences on medication errors

INTRODUCTION AND PURPOSE

Nowadays, due to the importance of information literacy in obtaining documented and credible information, the necessity of nurses to achieve high levels of information literacy to improve their performance in accessing documentary and scientific information has become more evident.

OBJECTIVE

The aim of this study was to investigate information literacy, evidence-based nursing, nurses 'attitudes, nurses' knowledge, medication errors, Kerman University of Medical Sciences.

METHODOLOGY

This study was a survey study. The study units were 164 nurses working in 4 hospitals of Kerman University of Medical Sciences. The participants were chosen by simple random sampling. The instrument used included four sections: demographic information, information literacy, evidence-based practice, and medication errors. Data were analyzed using software SPSS 22.

RESULTS

The results of this study showed that nurses were familiar with the terminology used in evidence-based medicine (p < 0.0001). Also, in this study, there was a significant increase in nurses' attitude level and their ability to implement and use evidence-based nursing was observed.

CONCLUSIONS

The result findings of the normal distribution of samples showed that 29% were male and 71% were female. The results show that there is a significant relationship between information literacy and evidence-based nursing. The direction of the relationship is positive (p < 0/05). This means that increased information literacy is associated with increased evidence-based nursing and on the contrary. The intensity of the relationship is moderate and it's equal to 0.37. The findings also showed that there is a significant relationship between information literacy and evidence-based nursing with the knowledge and attitude of nurses toward medication error.

Nursing students' perceptions of clinical learning opportunities and competence in administration of oral medication in the Western Cape

BACKGROUND

Medication errors may result in patients' harm and even death. The improvement of nursing students' competence in the administration of medication through education and training can contribute to the reduction of medication errors.

OBJECTIVES

This study aimed at describing the Bachelor of Nursing students' perceptions about clinical learning opportunities and competence in the administration of oral medication.

METHOD

A quantitative descriptive design was employed. An all-inclusive sample of 176 nursing students registered at a university in the Western Cape, South Africa, in 2014 was considered for the study, of whom 125 students consented to participate and completed the questionnaires. Statistical Package for the Social Sciences (SPSS) version 22 was used for data analysis and descriptive statistics were conducted.

RESULTS

The findings showed that a minority of students did not have opportunities to rotate in all specific types of wards. The findings indicated that a total of 92% (115) and 86.4% (108) of the 125 respondents were placed in medical and surgical wards, respectively, where they more likely had opportunities to practise the administration of oral medication. However, 59.2% (74) did not practise administration of oral medication on a daily basis. Only 19.2% (24) of respondents perceived themselves as competent in the administration of oral medication.

CONCLUSION

The findings indicated that many students perceived their education and training as not providing sufficient learning opportunities to practise the administration of oral medication, whilst the majority of respondents perceived themselves as competent in some of the aspects related to the administration of oral medication, and very few perceived themselves as competent overall in the administration of oral medication.