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Abstract
Patient safety is a critical and long-standing issue in nursing research. The purposes of this study were to explore the knowledge structure of patient safety and to provide a direction for future research by offering new perspectives and a theoretical clarification of patient safety in nursing. Keyword network analysis was performed by extracting keywords from abstracts of 6072 published articles. To reflect nursing perspectives, focus group interviews were conducted and Kim's typology consisting of four domains was used as the framework of analysis. Visualized knowledge structure showed avoiding medication error and preventing pressure ulcers or falls remain important topics within this research field. The distribution of core keywords as per four domains was in the following order: practice, client, environment, and client-nurse domain. Within the client domain, patients' harm-related core keywords were limited to physical harm. The detailed knowledge structure consisted of five themes: patient, preventable patient harm, practice, error, and environment. It comprised risk assessment for patients' characteristics and environmental elements surrounding patient and nursing practice, and risk management using information as knowledge-based nursing practice. Regarding further research, we suggest a multidimensional approach to patient harm, and the utilization of the client-nurse relationship and information systems as strategies for patient safety.
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Implementing a quality improvement program to reduce falls and increase patient medication satisfaction in an academic medical center. Geriatr Nurs 2023; 49:207-211. [PMID: 36207230 DOI: 10.1016/j.gerinurse.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Hospitalized older adult medication-related falls are common and understudied. LOCAL PROBLEM There were organizational educational gaps identified in assisting nurses to recognize and mitigate medication associated side effects that may predispose hospitalized older adults to fall. METHODS A quality improvement project that utilized pre and post-test design. An eLearning module was developed and distributed to registered nurses in a medical unit. INTERVENTIONS Eighty registered nurses participated in an eLearning module that included patient and family centered evidence-based guidelines and teach-back guides related to medication fall safety. RESULTS An increase in overall (2.2%) medication patient satisfaction scores and decrease (8%) in falls for patients > 65 years old over a 4-month period. CONCLUSIONS There is benefit of implementing a structured medication fall risk education program for nurses on a medical unit. Patient satisfaction related to communication about medications and a reduction in falls was impacted by this interdisciplinary intervention.
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Impact of 3D Simulation Game as a Method to Learn Medication Administration Process: Intervention Research for Nursing Students. Clin Simul Nurs 2022. [DOI: 10.1016/j.ecns.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Fuster-Linares P, Alfonso-Arias C, Gallart Fernández-Puebla A, Rodríguez-Higueras E, García-Mayor S, Font-Jimenez I, Llaurado-Serra M. Assessing Nursing Students' Self-Perceptions about Safe Medication Management: Design and Validation of a Tool, the NURSPeM. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084663. [PMID: 35457531 PMCID: PMC9028847 DOI: 10.3390/ijerph19084663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/28/2022] [Accepted: 04/08/2022] [Indexed: 02/01/2023]
Abstract
Objective: The objective was to design and validate a tool for assessing nursing students’ self-perceptions about safe medication management. Methods: A descriptive instrumental study was conducted involving construct definition, development of the tool, analysis of the content validity, and psychometric evaluation. Consensus regarding the content was obtained through a two-round Delphi process, and the resulting tool (the NURSPeM) was administered to nursing students to examine its internal consistency, temporal stability, and construct validity, the latter through exploratory factor analysis. Results: Thirteen experts participated in the Delphi process, which yielded a tool comprising two questionnaires: (1) Self-perceptions about safe medication management (27 items) and (2) the frequency and learning of drug-dose calculation (13 items). The tool’s psychometric properties were then examined based on responses from 559 nursing students. This analysis led to the elimination of three items from questionnaire 1, leaving a total of 24 items distributed across seven dimensions. All 13 items in questionnaire 2 were retained. Both questionnaires showed good internal consistency (Cronbach’s alpha = 0.894 and 0.893, respectively) and temporal stability (ICC = 0.894 and 0.846, respectively). Conclusions: The NURSPeM is a valid and reliable tool for assessing nursing students’ self-perceptions about safe medication management. It may be used to identify areas in which their training needs to be enhanced, and to evaluate the subsequent impact of new teaching initiatives.
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Affiliation(s)
- Pilar Fuster-Linares
- Nursing Department, Universitat Internacional de Catalunya, 08195 Barcelona, Spain; (C.A.-A.); (A.G.F.-P.); (E.R.-H.)
- Correspondence: (P.F.-L.); (M.L.-S.); Tel.: +34-93-504-20-00 (ext. 5631) or +34-626-838-951 (P.F.-L.); +34-93-504-20-00 (ext. 5634) or +34-665-033-050 (M.L.-S.)
| | - Cristina Alfonso-Arias
- Nursing Department, Universitat Internacional de Catalunya, 08195 Barcelona, Spain; (C.A.-A.); (A.G.F.-P.); (E.R.-H.)
| | | | - Encarna Rodríguez-Higueras
- Nursing Department, Universitat Internacional de Catalunya, 08195 Barcelona, Spain; (C.A.-A.); (A.G.F.-P.); (E.R.-H.)
| | - Silvia García-Mayor
- Nursing Department, Faculty of Health Sciences, University of Malaga, 29071 Malaga, Spain;
| | | | - Mireia Llaurado-Serra
- Nursing Department, Universitat Internacional de Catalunya, 08195 Barcelona, Spain; (C.A.-A.); (A.G.F.-P.); (E.R.-H.)
- Correspondence: (P.F.-L.); (M.L.-S.); Tel.: +34-93-504-20-00 (ext. 5631) or +34-626-838-951 (P.F.-L.); +34-93-504-20-00 (ext. 5634) or +34-665-033-050 (M.L.-S.)
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Najafi Ghezeljeh T, Rahnamaei F, Omrani S, Haghani S. The effects of interactive E-learning on delirium recognition ability and delirium-related strain of care among critical care nurses. J Intensive Care Soc 2022; 23:44-52. [PMID: 37593534 PMCID: PMC10427842 DOI: 10.1177/1751143720972627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
Background Nursing care for patients with delirium is very complex and stressful and is associated with considerable care strain for nurses. Delirium recognition is the first step to the prevention and management of delirium and reduction of strain of care. Education is one of the strategies for improving nurses' delirium recognition ability. Objectives This study aimed to evaluate the effects of interactive E-learning on delirium recognition ability and delirium-related strain of care among critical care nurses. Methods This quasi-experimental study was conducted in 2019 using a two-group pretest-posttest design. Participants were 98 critical care nurses recruited through a census from two hospitals in Iran. They were non-randomly allocated to an intervention and a control group. Study intervention was an interactive E-learning program with four parts on delirium, its prevention, its treatment, and its diagnostic and screening procedures. The program was uploaded on a website and its link was provided to participants in the intervention group. Before and two months after the intervention, data were collected using the Strain of Care for Delirium Index and five case vignettes. For data analysis, the Chi-square, Fisher's exact, independent-sample t, and paired-sample t tests were performed usingthe SPSS software (v. 16.0). Findings Groups did not significantly differ from each other regarding the pretest mean scores of delirium recognition ability and strain of care. After the intervention, the mean score of delirium recognition ability in the intervention group was significantly greater and the mean score of strain of care was significantly lower than the control group (P < 0.05). Conclusion Interactive E-learning is effective in significantly improving critical care nurses' delirium recognition ability and reducing their strain of care. As nurses' heavy workload and limited free time are among the main barriers to their participation in face-to-face educational programs, interactive E-learning can be used for in-service education.
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Affiliation(s)
- Tahereh Najafi Ghezeljeh
- Nursing Care Research Center, Department of Critical Care Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Rahnamaei
- Department of Critical Care Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Soghra Omrani
- Distance Education Planning, Iran University of Medical Sciences, Tehran, Iran
| | - Shima Haghani
- Statistic and Mathematics Department, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
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Ciapponi A, Fernandez Nievas SE, Seijo M, Rodríguez MB, Vietto V, García-Perdomo HA, Virgilio S, Fajreldines AV, Tost J, Rose CJ, Garcia-Elorrio E. Reducing medication errors for adults in hospital settings. Cochrane Database Syst Rev 2021; 11:CD009985. [PMID: 34822165 PMCID: PMC8614640 DOI: 10.1002/14651858.cd009985.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Medication errors are preventable events that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional or patient. Medication errors in hospitalised adults may cause harm, additional costs, and even death. OBJECTIVES To determine the effectiveness of interventions to reduce medication errors in adults in hospital settings. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, five other databases and two trials registers on 16 January 2020. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and interrupted time series (ITS) studies investigating interventions aimed at reducing medication errors in hospitalised adults, compared with usual care or other interventions. Outcome measures included adverse drug events (ADEs), potential ADEs, preventable ADEs, medication errors, mortality, morbidity, length of stay, quality of life and identified/solved discrepancies. We included any hospital setting, such as inpatient care units, outpatient care settings, and accident and emergency departments. DATA COLLECTION AND ANALYSIS We followed the standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care (EPOC) Group. Where necessary, we extracted and reanalysed ITS study data using piecewise linear regression, corrected for autocorrelation and seasonality, where possible. MAIN RESULTS: We included 65 studies: 51 RCTs and 14 ITS studies, involving 110,875 participants. About half of trials gave rise to 'some concerns' for risk of bias during the randomisation process and one-third lacked blinding of outcome assessment. Most ITS studies presented low risk of bias. Most studies came from high-income countries or high-resource settings. Medication reconciliation -the process of comparing a patient's medication orders to the medications that the patient has been taking- was the most common type of intervention studied. Electronic prescribing systems, barcoding for correct administering of medications, organisational changes, feedback on medication errors, education of professionals and improved medication dispensing systems were other interventions studied. Medication reconciliation Low-certainty evidence suggests that medication reconciliation (MR) versus no-MR may reduce medication errors (odds ratio [OR] 0.55, 95% confidence interval (CI) 0.17 to 1.74; 3 studies; n=379). Compared to no-MR, MR probably reduces ADEs (OR 0.38, 95%CI 0.18 to 0.80; 3 studies, n=1336 ; moderate-certainty evidence), but has little to no effect on length of stay (mean difference (MD) -0.30 days, 95%CI -1.93 to 1.33 days; 3 studies, n=527) and quality of life (MD -1.51, 95%CI -10.04 to 7.02; 1 study, n=131). Low-certainty evidence suggests that, compared to MR by other professionals, MR by pharmacists may reduce medication errors (OR 0.21, 95%CI 0.09 to 0.48; 8 studies, n=2648) and may increase ADEs (OR 1.34, 95%CI 0.73 to 2.44; 3 studies, n=2873). Compared to MR by other professionals, MR by pharmacists may have little to no effect on length of stay (MD -0.25, 95%CI -1.05 to 0.56; 6 studies, 3983). Moderate-certainty evidence shows that this intervention probably has little to no effect on mortality during hospitalisation (risk ratio (RR) 0.99, 95%CI 0.57 to 1.7; 2 studies, n=1000), and on readmissions at one month (RR 0.93, 95%CI 0.76 to 1.14; 2 studies, n=997); and low-certainty evidence suggests that the intervention may have little to no effect on quality of life (MD 0.00, 95%CI -14.09 to 14.09; 1 study, n=724). Low-certainty evidence suggests that database-assisted MR conducted by pharmacists, versus unassisted MR conducted by pharmacists, may reduce potential ADEs (OR 0.26, 95%CI 0.10 to 0.64; 2 studies, n=3326), and may have no effect on length of stay (MD 1.00, 95%CI -0.17 to 2.17; 1 study, n=311). Low-certainty evidence suggests that MR performed by trained pharmacist technicians, versus pharmacists, may have little to no difference on length of stay (MD -0.30, 95%CI -2.12 to 1.52; 1 study, n=183). However, the CI is compatible with important beneficial and detrimental effects. Low-certainty evidence suggests that MR before admission may increase the identification of discrepancies compared with MR after admission (MD 1.27, 95%CI 0.46 to 2.08; 1 study, n=307). However, the CI is compatible with important beneficial and detrimental effects. Moderate-certainty evidence shows that multimodal interventions probably increase discrepancy resolutions compared to usual care (RR 2.14, 95%CI 1.81 to 2.53; 1 study, n=487). Computerised physician order entry (CPOE)/clinical decision support systems (CDSS) Moderate-certainty evidence shows that CPOE/CDSS probably reduce medication errors compared to paper-based systems (OR 0.74, 95%CI 0.31 to 1.79; 2 studies, n=88). Moderate-certainty evidence shows that, compared with standard CPOE/CDSS, improved CPOE/CDSS probably reduce medication errors (OR 0.85, 95%CI 0.74 to 0.97; 2 studies, n=630). Low-certainty evidence suggests that prioritised alerts provided by CPOE/CDSS may prevent ADEs compared to non-prioritised (inconsequential) alerts (MD 1.98, 95%CI 1.65 to 2.31; 1 study; participant numbers unavailable). Barcode identification of participants/medications Low-certainty evidence suggests that barcoding may reduce medication errors (OR 0.69, 95%CI 0.59 to 0.79; 2 studies, n=50,545). Reduced working hours Low-certainty evidence suggests that reduced working hours may reduce serious medication errors (RR 0.83, 95%CI 0.63 to 1.09; 1 study, n=634). However, the CI is compatible with important beneficial and detrimental effects. Feedback on prescribing errors Low-certainty evidence suggests that feedback on prescribing errors may reduce medication errors (OR 0.47, 95%CI 0.33 to 0.67; 4 studies, n=384). Dispensing system Low-certainty evidence suggests that dispensing systems in surgical wards may reduce medication errors (OR 0.61, 95%CI 0.47 to 0.79; 2 studies, n=1775). AUTHORS' CONCLUSIONS Low- to moderate-certainty evidence suggests that, compared to usual care, medication reconciliation, CPOE/CDSS, barcoding, feedback and dispensing systems in surgical wards may reduce medication errors and ADEs. However, the results are imprecise for some outcomes related to medication reconciliation and CPOE/CDSS. The evidence for other interventions is very uncertain. Powered and methodologically sound studies are needed to address the identified evidence gaps. Innovative, synergistic strategies -including those that involve patients- should also be evaluated.
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Affiliation(s)
- Agustín Ciapponi
- Argentine Cochrane Centre, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
| | - Simon E Fernandez Nievas
- Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Mariana Seijo
- Quality of Health Care and Patient Safety, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - María Belén Rodríguez
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Ciudad Autónoma de Buenos Aires, Argentina
| | - Valeria Vietto
- Family and Community Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Sacha Virgilio
- Instituto de Efectividad Clínica y Sanitaria (IECS), Ciudad Autónoma de Buenos Aires, Argentina
| | - Ana V Fajreldines
- Quality and Patient Safety, Austral University Hospital, Buenos Aires, Argentina
| | - Josep Tost
- Urgencias � Calidad y Seguridad de pacientes, Consorcio Sanitario de Terrassa, Barcelona, Spain
| | | | - Ezequiel Garcia-Elorrio
- Quality and Safety in Health Care, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
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Zhu L, Reychav I, McHaney R, Broda A, Tal Y, Manor O. Extension to 'combined SNA and LDA methods to understand adverse medical events': Doctor and nurse perspectives. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2021; 31:221-246. [PMID: 32538872 DOI: 10.3233/jrs-190031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Physicians and nurses are responsible for reporting medical adverse events. Each views these events through a different lens subject to their role-based perceptions and barriers. Physicians typically engage with diagnosis and treatment while nurses primarily care for patients' daily lives and mental well-being. This results in reporting and describing medical adverse events differently. OBJECTIVE We aimed to compare adverse medical event reports generated by physicians and nurses to better understand the differences and similarities in perspective as well as the nature of adverse medical events using social network analysis (SNA) and latent Dirichlet allocation (LDA). METHODS The current study examined data from the Maccabi Healthcare Community. Approximately 17,868 records were collected from 2000 to 2017 regarding medical adverse events. Data analysis used SNA and LDA to perform descriptive text analytics and understand underlying phenomenon. RESULTS A significant difference in harm levels reported by physicians and nurses was discovered. Shared topic keyword lists broken down by physicians and nurses were derived. Overall, communication, lack of attention, and information transfer issues were reported in medical adverse events data. Specialized keywords, more likely to be used by a physician were determined as: repeated prescriptions, diabetes complications, and x-ray examinations. For nurses, the most common special adverse event behavior keywords were vaccine problem, certificates of fitness, death and incapacity, and abnormal dosage. CONCLUSIONS Communication and inattentiveness appeared most frequently in medical adverse events reports regardless of whether doctors or nurses did the reporting. Findings suggest feedback and information sharing processes could be implemented as a step toward alleviating many issues. Institutional management, healthcare managers and government officials should take actions to decrease medical adverse events, many of which may be preventable.
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Affiliation(s)
- Lin Zhu
- Industrial Engineering & Management Department, Ariel University, Ariel, Israel
| | - Iris Reychav
- Industrial Engineering & Management Department, Ariel University, Ariel, Israel
| | - Roger McHaney
- Daniel D. Burke Chair for Exceptional Faculty, Management Information Systems, Kansas State University, Manhattan, KS, USA
| | - Arik Broda
- Risk Management Department, Maccabi Healthcare Services, Israel
| | - Yossi Tal
- Risk Management Department, Maccabi Healthcare Services, Israel
| | - Orly Manor
- Risk Management Department, Maccabi Healthcare Services, Israel
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Bakhshi F, Mitchell R, Nikbakht Nasrabadi A, Javadi M, Varaei S. Clinician attitude towards safety in medication management: a participatory action research study in an emergency department. BMJ Open 2021; 11:e047089. [PMID: 34548346 PMCID: PMC8458336 DOI: 10.1136/bmjopen-2020-047089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Edication management is a process in which medications are selected, procured, delivered, prescribed, reviewed, administered and monitored to assure high-quality patient care and safety. This paper explores clinicians' attitudes towards medication management which is both open to influence and strongly linked to successful changes in mediation behaviour. We aimed to investigate effects of engaging in participatory action research to improve emergency medicine clinicians' attitudes to safety in medication management. SETTING Emergency department of one university affiliated hospital. PARTICIPANTS A total of 85 clinicians including nurses and physicians partook as participants. Eight managers and clinicians participated as representatives. DESIGN Data are drawn from two-cycle participatory action research. Initially, a situation analysis on the current medication management and clinician views regarding medication management was conducted using three focus groups. Evaluation and reflection data were obtained through qualitative interviews. All qualitative data were analysed using content analysis. RESULTS Clinicians initially expressed negative attitudes towards existing and new plans for medication management, in that they were critical of current medication-related policy and procedures, as well as wary of the potential relevance and utility of potential changes to medication management. Through the action research, improvement actions were implemented including interprofessional courses, pharmacist-led interventions and the development of new guidelines regarding medication management. Participants and their representatives were engaged in all participatory action research stages with different levels of involvement. Extracted results from evaluation and reflection stages revealed that by engaging in the action research and practice new interventions, clinicians' attitude towards medication management was improved. CONCLUSIONS The results support the impact of participatory action research on enhancing clinicians' positive attitudes through their involvement in planning and implementing safety enhancing aspects of medication management.
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Affiliation(s)
- Fatemeh Bakhshi
- Department of Nursing, Research Center for Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran (the Islamic Republic of)
- Macquarie Business school, Department of Management, Macquarie University, Sydney, New South Wales, Australia
| | - Rebecca Mitchell
- Macquarie Business school, Department of Management, Macquarie University, Sydney, New South Wales, Australia
| | - Alireza Nikbakht Nasrabadi
- School of Nursing and Midwifery, Medical-Surgical Nursing, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Mostafa Javadi
- Research center for Nursing and Midwifery care, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran (the Islamic Republic of)
| | - Shokoh Varaei
- School of Nursing and Midwifery, Medical-Surgical Nursing, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
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Examination of Nursing Students’ Medical Error Attitudes within Three Different Educational Models. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2021. [DOI: 10.30621/jbachs.974242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Avraham R, Shor V, Kimhi E. The influence of simulated medication administration learning on the clinical performance of nursing students: A comparative quasi-experimental study. NURSE EDUCATION TODAY 2021; 103:104947. [PMID: 33992957 DOI: 10.1016/j.nedt.2021.104947] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/12/2021] [Accepted: 04/22/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Medication administration is a main role of nurses, and by mastering this skill, medication errors can be reduced. Simulation provides a safe environment for learning and improving medication administration. Simulation design may influence the students' learning curve and ability to transfer skills into the clinical setting. OBJECTIVE To examine the influence of simulation-based learning of the medication administration process, on satisfaction, self-perception of preparedness, and clinical performance of students who practice simulation either individually or in a group. DESIGN A comparative quasi-experimental study. SETTING A public university in southern Israel. PARTICIPANTS Third-year nursing students in two consecutive academic years (78 in the individual sample and 50 in the group sample). METHODS Nursing students participated in a scenario-based simulation for medication administration either individually or in a group. Self-reported questionnaires evaluated participants' satisfaction with the simulation experience, and perception of preparedness before and after the simulation. Faculty members observed and evaluated participants' medication administration during the simulation and in the clinical setting. Paired t-tests were performed to compare preparedness before and after the simulation experience. Linear regression models were formulated to elicit the predictors of preparedness after simulation and evaluations for medication administration in the clinical setting. RESULTS The simulation experience increased participants' preparedness both when designed for an individual student and for a group of students. Simulation performance was the main contributor to the participant preparedness among the individual sample (β = 0.51, p < 0.01), whereas previous preparedness was the main contributor among the group sample (β = 0.42, p < 0.01). The association between simulation performance and clinical performance was mediated by preparedness after simulation in the individual sample, but not in the group sample. CONCLUSIONS Simulation improves students' preparedness for medication administration. Individual simulation also impacts clinical performance, via preparedness. Further research is needed to identify other factors that facilitate skills transfer into the clinical setting.
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Affiliation(s)
- Rinat Avraham
- Department of Nursing, Recanati School of Community Health Professions, Faculty of Health sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | - Vlada Shor
- Department of Nursing, Recanati School of Community Health Professions, Faculty of Health sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Einat Kimhi
- Department of Nursing, Recanati School of Community Health Professions, Faculty of Health sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Identifying Risk Areas of Medication Administration Process for Developing an Interactive Three-Dimensional Game Intervention. Comput Inform Nurs 2021; 38:524-533. [PMID: 32732642 DOI: 10.1097/cin.0000000000000661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to describe identified risk areas related to the medication administration process in acute care in order to develop a three-dimensional-game intervention. A secondary analysis was conducted using (1) observed medication administrations (n = 1058) and identified medication errors in 2012 (n = 235), (2) a systematic review including a meta-analysis of previous medication administration educational interventions (n = 14) from 2000 to 2015, (3) incident reports of medication administration errors (n = 1012) from 2013 to 2014, and (4) focus group interviews with RNs' (n = 20) views in 2015. A qualitative content analysis was used to identify risk areas, and the data were organized according to the following main themes: (1) factors related to patients (patient identification, patients' characteristics or symptoms, and patients' allergies and interactions); (2) factors related to medications (medication information, changes in medications, generic substitutes, new drugs, look-alike/sound-alike drugs, demanding drug treatments, medication preparation, and administration techniques); (3) factors related to staffing (workload, skills, interruptions and distractions, division of work, responsibility, attitudes, and guidelines); and (4) factors related to communication (flow of information, communication with the patients, and marking of medication information). Identified risk areas could be used to develop interventions with the aim of increasing the safety of medication administration and nurses' skills.
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Bailey C, Jeffs L. Threats to Narcotic Safety-A Narrative Review of Narcotic Incidents, Discrepancies and Near-Misses Within a Large Canadian Health System. Can J Nurs Res 2021; 54:440-450. [PMID: 34229483 PMCID: PMC9597149 DOI: 10.1177/08445621211028709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Canada is currently experiencing an opioid crisis. Purpose Nurses are the largest number of frontline healthcare professionals in Canada
who administer narcotic pharmacotherapy, hence, they are ideally placed to
improve narcotic stewardship in hospitals. Our study aims to understand the
characteristics of narcotic incidents and hence recommend interventions for
narcotic stewardship. Methods Our study was conducted within a 442-bed academic health sciences center in
Ontario. We extracted anonymized narcotic incident reports which occurred
over a 3-year period from the SAFER System. Descriptive statistics were
utilized to analyze narcotic incidents and their contributory factors. Results 272 narcotic incident reports were submitted to SAFER within the study
period. Most incidents (51%) involved hydromorphone and morphine and were
primarily categorized as Level I (n = 154) and Level II (n = 60). Incorrect
narcotic dosing (44%), and narcotic count discrepancies (27%) were most
commonly reported with active failures being the most commonly reported
contributory factors such as failure to review medication orders prior to
narcotic administration. Conclusions Nurses have an important role in narcotic safety as an intermediary between
narcotic administration and incident reporting. Further research is needed
to understand the enablers, barriers and opportunities for nurses and other
healthcare professionals to improve narcotic stewardship.
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Affiliation(s)
- Chantelle Bailey
- Lawrence S. Bloomberg School of Nursing, University of Toronto, Toronto, ON, Canada
| | - Lianne Jeffs
- Lawrence S. Bloomberg School of Nursing, University of Toronto, Toronto, ON, Canada
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Thelen MA. The impact of online synchronous simulated clinical immersions on nursing students' pharmacology self-efficacy: A pre-test post-test intervention pilot study. NURSE EDUCATION TODAY 2021; 100:104833. [PMID: 33735750 DOI: 10.1016/j.nedt.2021.104833] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 02/08/2021] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Medication errors are fatally significant, posing considerable threats to patient safety. To date, there is a lack of literature and no consistent recommended nursing pharmacology curriculum design to improve nursing students' pharmacology self-efficacy. PURPOSE The purpose of this pilot study is to examine the effects of nursing pharmacology synchronous online scrabbling active learning classroom design with simulated clinical immersion experiences on the students' self-efficacy and perceived pharmacology knowledge acquisition. METHODS A pretest-posttest intervention design was used with a convenience sample of (n = 34) accelerated nursing students. The intervention included an online synchronous scrabbling active learning classroom design with simulated clinical immersion experiences for eight weeks. The Motivated Strategies for Learning Self-Efficacy Subscale (MSLQ-SE) questionnaire was applied before and after the intervention. The Survey for Knowledge Acquisition and Application (SKAA) was used post-intervention. The students also provided narrative, open-ended responses regarding their perceptions of the synchronous simulated clinical experiences. RESULTS The results of the simulated clinical immersions presented an improvement in self-efficacy scores. A one tailed paired t-test presented a significant increase from MSLQ-SE pre-test scores (M = 31.2, SD = 4.8) to MSLQ-SE post-test scores (M = 32.9, SD = 4.3); (t(33) = -2.1, p = .02). The SKAA results presented that the students perceived that simulated clinical immersions were promoting authentic learning and confidence. CONCLUSION The finding of this study is significant to nursing pharmacology education. The online synchronous simulated clinical immersion experiences improved overall self-efficacy scores and provide an authentic teaching approach to connect pharmacology theory to the clinical practice.
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Høghaug G, Skår R, Tran TN, Diep LM, Bredal IS. Three-month follow-up effects of a medication management program on nurses' knowledge. Nurse Educ Pract 2021; 51:102979. [PMID: 33588183 DOI: 10.1016/j.nepr.2021.102979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 12/21/2020] [Accepted: 01/24/2021] [Indexed: 10/22/2022]
Abstract
This quasi-experimental study examined the effects of a medication management program on nurses knowledge of medication management, three months after program completion. Fifty-seven nurses took a multiple-choice test both immediately after the program and three months later. Changes in test performance were assessed using McNemar's test and generalized estimating equations for binary outcomes. Test results were generally consistent from immediately post-program to three months later, though four items differed significantly. From immediately post-program to three months later, fewer nurses correctly answered the items: documenting no medication administration (98.2 vs 86.6, p = 0.04); documenting opioid administration (56.1 vs 33.3, p = 0.01); and observation after opioid administration (35.1 vs 19.3, p = 0.08. Significantly more nurses correctly answered the item concerning the pharmacology of medication administered with food (64.9 vs 77.2, p = 0.09). We recommend both continuous medication management training and focusing on the correspondence between theory-based knowledge and clinical practice routines.
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Affiliation(s)
- Grete Høghaug
- Department of Medicine, Health and Development, Oslo University Hospital, Oslo, Norway.
| | - Randi Skår
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
| | - Thien Ngoc Tran
- Hospital Pharmacy Enterprises, South Eastern Norway, Norway.
| | - Lien My Diep
- Oslo Centre for Biostatistics and Epidemiology (OCBE), Oslo University Hospital, Oslo, Norway.
| | - Inger Schou Bredal
- Department of Oncology, Oslo University Hospital, Institute for Health and Society, University in Oslo, Norway.
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Abstract
BACKGROUND Medication errors are one of the leading avoidable sources of harm to hospital patients. In hospitals, a range of interventions have been used to reduce the risk of errors at each of the points they may occur, such as prescription, dispensing and/or administration. Systematic reviews have been conducted on many of these interventions; however, it is difficult to compare the clinical utility of any of the separate interventions without the use of a rigorous umbrella review methodology. OBJECTIVES The aim of this umbrella review was to synthesize the evidence from all systematic reviews investigating the effectiveness of medication safety interventions, in comparison to any or no comparator, for preventing medication errors, medication-related harms and death in acute care patients. METHOD The review considered quantitative systematic reviews with participants who were healthcare workers involved in prescribing, dispensing or administering medications. These healthcare workers were registered nurses, enrolled or licensed vocational nurses, midwives, pharmacists or medical doctors. Interventions of interest were those designed to prevent medication error in acute care settings. Eligible systematic reviews reported medication errors, medication-related harms and medication-related death as measured by error rates, numbers of adverse events and numbers of medication-related deaths. To qualify for inclusion, systematic reviews needed to provide a clearly articulated and comprehensive search strategy, and evidence of critical appraisal of the included studies using a standardized tool. Systematic reviews published in English since 2007 were included until present (March 2020). We searched a range of databases such MEDLINE, CINAHL, Web of Science, EMBASE, and The Cochrane Library for potentially eligible reviews. Identified citations were screened by two reviewers working independently. Potentially eligible articles were retrieved and assessed against the inclusion criteria and those meeting the criteria were then critically appraised using the JBI SUMARI instrument for assessing the methodological quality of systematic reviews and research syntheses. A predetermined quality threshold was used to exclude studies based on their reported methods. Following critical appraisal, data were extracted from the included studies by two independent reviewers using the relevant instrument in JBI SUMARI. Extracted findings were synthesized narratively and presented in tables to illustrate the reported outcomes for each intervention. The strength of the evidence for each intervention was indicated using 'traffic light' colors: green for effective interventions, amber for interventions with no evidence of an effect and red for interventions less effective than the comparison. RESULTS A total of 23 systematic reviews were included in this umbrella review. Most reviews did not report the number of participants in their included studies. Interventions targeted pharmacists, medical doctors, medical students and nurses, or were nonspecific about the participants. The majority of included reviews examined single interventions. All reviews were published and in English. Four interventions, medication administration education, medication reconciliation or review, specialist pharmacists' roles and physical or design modifications, reported effectiveness in reducing errors; however, heterogeneity between the included studies in these reviews was high. CONCLUSION For some interventions, there are strong indications of effectiveness in reducing medication errors in the inpatient setting. Government initiatives, policy makers and practitioners interested in improving medication safety are encouraged to adopt those interventions.
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Farzi K, Mohammadipour F, Toulabi T, Heidarizadeh K, Heydari F. The Effect of Blended Learning on the Rate of Medication Administration Errors of Nurses in Medical Wards. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:527-532. [PMID: 33747843 PMCID: PMC7968587 DOI: 10.4103/ijnmr.ijnmr_188_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 06/14/2020] [Accepted: 09/19/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Medication error is one of the most important and most common events threatening patient safety. This study was conducted with the aim to determine the effect of asynchronous hybrid/blended learning on the rate of medication administration errors of nurses in medical wards. MATERIALS AND METHODS This quasi-experimental study was conducted with a pretest-posttest design in 2019. The participants of this study included 57 clinical nurses working in the medical wards of a selected educational hospital affiliated to Lorestan University of Medical Sciences, Khorramabad, Iran. The study participants were selected through census method. An asynchronous hybrid/blended learning program was used in this study. Data collection was performed using a two-section researcher-made checklist. The collected data were analyzed using descriptive [Mean (SD)] and inferential (paired sample t-test) statistics in SPSS software. A p value of less than 0.05 was considered statistically significant. RESULTS The results showed that the mean score of total errors in medication administration in the medical wards after the intervention was significantly lower than before the intervention; the mean score of errors before and after the study was 61.67 and 50.09, respectively (t56= 11.41, p < 0.001). CONCLUSIONS Asynchronous hybrid/blended learning as a type of e-learning, simple, relatively inexpensive, and new educational strategy can improve nurses' performance and reduce medication errors.
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Affiliation(s)
- Kolsoum Farzi
- School of Nursing and Midwifery, Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Fatemeh Mohammadipour
- Department of Medical Surgical, School of Nursing and Midwifery, Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Tahereh Toulabi
- Department of Critical Care, School of Nursing and Midwifery, Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Khadijeh Heidarizadeh
- Department of Critical Care, School of Nursing and Midwifery, Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Fardin Heydari
- School of Nursing and Midwifery, Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
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Kallio H, Voutilainen A, Viinamäki L, Kangasniemi M. In-service training to enhance the competence of health and social care professionals: A document analysis of web-based training reports. NURSE EDUCATION TODAY 2020; 92:104493. [PMID: 32673934 DOI: 10.1016/j.nedt.2020.104493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/27/2020] [Accepted: 06/04/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To identify and describe what professional competencies have been addressed by in-service training for health and social care professionals and what kind of teaching and evaluation methods have been used. DESIGN Cross-sectional descriptive study. METHODS A document analysis design was used to explore 7817 in-service training project documents relating to 203 projects carried out from 2002 to 2020. The project data were obtained from the websites run by the relevant health and social care organizations. RESULTS The most frequent competencies that were addressed were health promotion and clinical skills (17%), preventing social problems (16%) and promoting the wellbeing of children and families (15%) and older adults (14%). The main target groups were general health and social care professionals (19%). A total of 222 training interventions were used by the 203 projects and the most frequently used methods were conventional classroom education (56%), followed by coaching and orientation (12%) and theme days (9%). Only 38% of the projects measured the effects of the training and the main method was collecting feedback from participants. We also found that collaboration between projects was necessary to ensure that training was not duplicated and transparent reporting played a central role in that process. CONCLUSIONS In order to achieve successful in-service training for health and social care professionals, projects needed to recognize topical competence needs and provide the most appropriate training methods. Collaboration and transparent reporting helped to avoid duplication in training.
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Affiliation(s)
- Hanna Kallio
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, PB 1627, 70211 Kuopio, Finland
| | - Ari Voutilainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Leena Viinamäki
- Lapland University of Applied Sciences, Social Services, Health and Sport, Kemi, Finland
| | - Mari Kangasniemi
- Department of Nursing Science, Faculty of Medicine, University of Turku, Finland.
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Luokkamäki S, Härkänen M, Saano S, Vehviläinen-Julkunen K. Registered Nurses' medication administration skills: a systematic review. Scand J Caring Sci 2020; 35:37-54. [PMID: 32168398 DOI: 10.1111/scs.12835] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/09/2020] [Indexed: 12/01/2022]
Abstract
AIMS The aim of this review was to identify methods for measuring Registered Nurses' medication administration skills and to describe these skills. DESIGN A systematic literature review. DATA SOURCES The CINAHL, PubMed, Scopus, Cochrane, PsycInfo and Medic databases were searched for articles from the period 2007-2018. REVIEW METHODS Two researchers independently selected the articles and evaluated their quality using the National Heart, Lung and Blood Institute study quality assessment tools. The data were analysed using content analysis. RESULTS A total of 727 studies were identified of which 22 studies were included in this review. A total of six different measurement methods were identified: questionnaire or survey, observation, knowledge test or exam, focus group interviews, chart reviews and voluntarily reported errors. Different methods provided different information on medication administration skills. Medication administration skills were classified under nine areas: (1) safe ordering, handling, storing and discarding of medications, (2) preparing of medications, (3) the administration of medications to patients, (4) documentation, (5) evaluation and assessment of medication-related issues, (6) drug calculation skills, (7) cooperation with other professionals and (8) with the patients and (9) reporting of medication information. The results demonstrated that there are many areas that need to be improved to increase medication safety. CONCLUSIONS Medication administration includes many different phases, as a result of which nurses need to have many various skills to cope with medication administration as required by their profession. This review shows that nurses' medication administration skills need to be developed, and special attention should be paid to the preparation and administration phases. It is important to regularly utilise different teaching strategies and verify nurses' medication competence. As each research method has different limitations, it is vital that further studies combine different methods to form a comprehensive picture of nurses' medication administration skills.
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Affiliation(s)
- Sanna Luokkamäki
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Marja Härkänen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | | | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.,Kuopio University Hospital, Kuopio, Finland
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Kirkpatrick AJ, Cantrell MA, Smeltzer SC. Palliative care knowledge and self-awareness in active and observing undergraduate nursing students after end-of-life simulation. Int J Palliat Nurs 2020; 26:133-142. [PMID: 32275477 DOI: 10.12968/ijpn.2020.26.3.133] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM The purpose of this quasi-experimental one-group repeated measure (pre-test/post-test) study was to determine the effect of an end-of-life (EoL) simulation-based experience (SBE) on active and observer nursing students' palliative care knowledge and self-awareness. BACKGROUND Baccalaureate nursing (BSN) graduates must demonstrate competence in EoL care; however, gaining EoL experience is challenging given constraints on nursing faculty and clinical sites. Research also is needed to determine whether similar outcomes are achieved by active and observer participants after EoL SBE. METHOD Senior-level BSN students' palliative care knowledge and self-awareness of active and observer participants were measured before and after an EoL SBE. RESULTS Knowledge and self-awareness increased (P<0.001) post-SBE in all participants, with equivalent post-test scores (P≥0.248) for active (Mattitude=130.1; Mknowledge=80.5) and observer (Mattitude=128.3; Mknowledge=77.9) participants. CONCLUSION EoL SBE is an effective method for increasing student palliative care competence. Student observers benefit as much as active participants on knowledge and self-awareness outcomes.
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Affiliation(s)
| | - Mary Ann Cantrell
- Professor and PhD Program Director, Villanova University, M Louise Fitzpatrick College of Nursing, Villanova, PA, USA
| | - Suzanne C Smeltzer
- Professor and Director, Center for Nursing Research, Villanova University, M Louise Fitzpatrick College of Nursing, Villanova, PA, USA
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20
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Millichamp T, Johnston AN. Interventions to support safe medication administration by emergency department nurses: An integrative review. Int Emerg Nurs 2020; 49:100811. [DOI: 10.1016/j.ienj.2019.100811] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 10/07/2019] [Accepted: 10/24/2019] [Indexed: 11/26/2022]
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21
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Chae D, Kim J, Kim S, Lee J, Park S. Effectiveness of cultural competence educational interventions on health professionals and patient outcomes: A systematic review. Jpn J Nurs Sci 2020; 17:e12326. [DOI: 10.1111/jjns.12326] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 11/26/2019] [Accepted: 12/19/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Duckhee Chae
- College of Nursing, Chonnam National University Gwangju South Korea
| | - Jinhee Kim
- Department of NursingChosun University Gwangju South Korea
| | - Suhee Kim
- School of Nursing and Research Institute of Nursing ScienceHallym University Chuncheon‐si South Korea
| | - Jina Lee
- Christian College of Nursing Gwangju South Korea
| | - Seojin Park
- Department of NursingDonggang University Gwangju South Korea
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22
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Khalil H, Poon P, Byrne A, Ristevski E. Medication safety challenges in the palliative care setting: Nurses' perspectives. Collegian 2019. [DOI: 10.1016/j.colegn.2019.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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23
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Rouleau G, Gagnon MP, Côté J, Payne-Gagnon J, Hudson E, Dubois CA, Bouix-Picasso J. Effects of E-Learning in a Continuing Education Context on Nursing Care: Systematic Review of Systematic Qualitative, Quantitative, and Mixed-Studies Reviews. J Med Internet Res 2019; 21:e15118. [PMID: 31579016 PMCID: PMC6777280 DOI: 10.2196/15118] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 12/22/2022] Open
Abstract
Background E-learning is rapidly growing as an alternative way of delivering education in nursing. Two contexts regarding the use of e-learning in nursing are discussed in the literature: (1) education among nursing students and (2) nurses’ continuing education within a life-long learning perspective. A systematic review of systematic reviews on e-learning for nursing and health professional students in an academic context has been published previously; however, no such review exists regarding e-learning for registered nurses in a continuing education context. Objective We aimed to systematically summarize the qualitative and quantitative evidence regarding the effects of e-learning on nursing care among nurses in a continuing education context. Methods We conducted a systematic review of systematic qualitative, quantitative, and mixed-studies reviews, searching within four bibliographic databases. The eligibility criteria were formulated using the population, interventions, comparisons, outcomes, and study design (PICOS) format. The included population was registered nurses. E-learning interventions were included and compared with face-to-face and any other e-learning interventions, as well as blended learning. The outcomes of interest were derived from two models: nursing-sensitive indicators from the Nursing Care Performance Framework (eg, teaching and collaboration) and the levels of evaluation from the Kirkpatrick model (ie, reaction, learning, behavior, and results). Results We identified a total of 12,906 records. We retrieved 222 full-text papers for detailed evaluation, from which 22 systematic reviews published between 2008 and 2018 met the eligibility criteria. The effects of e-learning on nursing care were grouped under Kirkpatrick’s levels of evaluation: (1) nurse reactions to e-learning, (2) nurse learning, (3) behavior, and (4) results. Level 2, nurse learning, was divided into three subthemes: knowledge, skills, attitude and self-efficacy. Level 4, results, was divided into patient outcomes and costs. Most of the outcomes were reported in a positive way. For instance, nurses were satisfied with the use of e-learning and they improved their knowledge. The most common topics covered by the e-learning interventions were medication calculation, preparation, and administration. Conclusions The effects of e-learning are mainly reported in terms of nurse reactions, knowledge, and skills (ie, the first two levels of the Kirkpatrick model). The effectiveness of e-learning interventions for nurses in a continuing education context remains unknown regarding how the learning can be transferred to change practice and affect patient outcomes. Further scientific, methodological, theoretical, and practice-based breakthroughs are needed in the fast-growing field of e-learning in nursing education, especially in a life-learning perspective. Trial Registration International Prospective Register of Systematic Reviews (PROSPERO) CRD42016050714; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=50714
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Affiliation(s)
- Geneviève Rouleau
- Faculty of Nursing, Université Laval, Quebec, QC, Canada.,University of Montreal Hospital Research Centre, Montreal, QC, Canada
| | - Marie-Pierre Gagnon
- Faculty of Nursing, Université Laval, Quebec, QC, Canada.,Centre de Recherche sur les Soins et les Services de Première Ligne de l'Université Laval, Quebec, QC, Canada
| | - José Côté
- University of Montreal Hospital Research Centre, Montreal, QC, Canada.,Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
| | | | - Emilie Hudson
- School of Nursing, McGill University, Montreal, QC, Canada
| | - Carl-Ardy Dubois
- Public Health Research Institute, Université de Montréal, Montreal, QC, Canada.,Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montreal, QC, Canada
| | - Julien Bouix-Picasso
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada.,Education and Health Practices Laboratory, Paris 13 University, Sorbonne Paris Cité University, Paris, France.,Department of Education for Non-Medical Personnel, French Military Health Service Academy, École du Val-de-Grâce, Paris, France
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24
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Sessions LC, Nemeth LS, Catchpole K, Kelechi TJ. Nurses' perceptions of high-alert medication administration safety: A qualitative descriptive study. J Adv Nurs 2019; 75:3654-3667. [PMID: 31423633 DOI: 10.1111/jan.14173] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/28/2019] [Accepted: 08/05/2019] [Indexed: 11/27/2022]
Abstract
AIMS The aim of this study was to determine nurses' perceptions of supports and barriers to high-alert medication (HAM) administration safety. DESIGN A qualitative descriptive design was used. METHODS Eighteen acute care nurses were interviewed about HAM administration practices. Registered nurses (RNs) working with acutely ill adults in two hospitals participated in one-on-one interviews from July-September, 2017. Content analysis was conducted for data analysis. RESULTS Three themes contributed to HAM administration safety: Organizational Culture of Safety, Collaboration, and RN Competence and Engagement. Error factors included distractions, workload and acuity. Work arounds bypassing bar code scanning and independent double check procedures were common. Findings highlighted the importance of intra- and interprofessional collaboration, nurse engagement and incorporating the patient in HAM safety. CONCLUSIONS Current HAM safety strategies are not consistently used. An organizational culture that supports collaboration, education on safe HAM practices, pragmatic HAM policies and enhanced technology are recommended to prevent HAM errors. IMPACT Hospitals incorporating these findings could reduce HAM errors. Research on nurse engagement, intra- and interprofessional collaboration and inclusion of patients in HAM safety strategies is needed.
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Affiliation(s)
- Laura C Sessions
- College of Health Professions, Towson University, Towson, Maryland
| | - Lynne S Nemeth
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Kenneth Catchpole
- College of Health Professions, Towson University, Towson, Maryland.,College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Teresa J Kelechi
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
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Gil-Lacruz M, Gracia-Pérez ML, Gil-Lacruz AI. Learning by Doing and Training Satisfaction: An Evaluation by Health Care Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1397. [PMID: 31003414 PMCID: PMC6518038 DOI: 10.3390/ijerph16081397] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/11/2019] [Accepted: 04/15/2019] [Indexed: 12/04/2022]
Abstract
As one of the training methodologies employed in the health care context, 'Learning by Doing' prioritizes the transference of competence, control, and workplace motivation. However, there are few published works that consider the opinions of health care professionals in relation to the effects of this kind of training on their workplace competence. The goal of this research was to evaluate the level of satisfaction and impact on quality of care, as perceived by the health care professionals that participated in this training program (Formative Focus). The evaluation utilized an online questionnaire that assessed professional satisfaction through five dimensions: The training methodology; the training program; its economic impact; perceived improvement in professional competence; and, perceived improvement in quality of care. A total of 364 health professionals took part in the training course and were asked to complete an online questionnaire. The variables that contemplated satisfaction were related to quality of care and preferences regarding the training methodology. Participants preferred interactive methods for learning with emphasis on practical contents. In terms of application of learning to their jobs, health care professionals found Learning by Doing skills more useful to transfer to their workplace. This experience of Learning by Doing training indicates an interesting potential for impact on improvement: Quality of health care, health care competence of professionals, and organizational development.
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Affiliation(s)
- Marta Gil-Lacruz
- Health Science Faculty, University of Zaragoza, 50009 Zaragoza, Spain.
| | | | - Ana Isabel Gil-Lacruz
- School of Engineering and Architecture, University of Zaragoza, 50018 Zaragoza, Spain.
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26
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Davies KM, Coombes ID, Keogh S, Whitfield KM. Medication administration evaluation tool design: An expert panel review. Collegian 2019. [DOI: 10.1016/j.colegn.2018.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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27
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Kirkpatrick AJ, Cantrell MA, Smeltzer SC. Relationships among nursing student palliative care knowledge, experience, self-awareness, and performance: An end-of-life simulation study. NURSE EDUCATION TODAY 2019; 73:23-30. [PMID: 30472406 DOI: 10.1016/j.nedt.2018.11.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 10/13/2018] [Accepted: 11/05/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Palliative care education and experience are needed for student competence in delivering high-quality palliative nursing care. Simulation has been linked to acquired clinical competency among pre-licensure students. A known literature gap is measurement of students' performance during end-of-life simulations. OBJECTIVES The aim of this study was to determine relationships among previous palliative care nursing experience, knowledge, self-awareness, and performance in nursing students during an end-of-life simulation. DESIGN/SETTING/PARTICIPANTS A quasi-experimental pretest/posttest design was used to assess these variables with a convenience sample of 75 senior nursing students during an end-of-life simulation at a Midwest Jesuit university. METHODS Self-awareness was measured with the Frommelt Attitudes Toward Care of the Dying, Form B. The Palliative Care Quiz for Nursing measured participants' knowledge. Participants' performance during the simulation was measured using a modified version of the Creighton Competency Evaluation Instrument®. Palliative care nursing self-awareness and knowledge were assessed before and after the simulation. Previous end-of-life care experience was assessed with a single demographic question at pretest only. RESULTS The sample was highly experienced in end-of-life care (93.3% reporting experience pre-simulation). Although pretest self-awareness (M = 124.5; ±1.3) and knowledge (M = 57.1%; ±2.2) were higher in students with two or more types of end-of-life experience (n = 42), there were no significant differences (p > .10) in these outcomes by groups pre- or post-simulation. Self-awareness (M = 130.1; ±1.2), knowledge (M = 80.5%; ±2.6), and performance (M = 94.1%; IQR 87.5 to 100) scores were high for student participants (n = 36) post-simulation, with moderate correlations found between some scores (rpb < -0.40 or 0.40). CONCLUSIONS Findings support self-awareness and knowledge as antecedents of high quality palliative nursing care. Students demonstrated increased post-simulation knowledge, self-awareness, and quality performance of palliative nursing care regardless of previous end-of-life experience. End-of-life simulation is supported as an education method for increasing palliative care nursing competence and assessing student performance of palliative care nursing interventions.
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Affiliation(s)
- Amanda J Kirkpatrick
- Villanova University, M. Louise Fitzpatrick College of Nursing, Creighton University, College of Nursing, 222 Criss II Bldg., 2500 California Plaza, Omaha, NE 68178, United States.
| | - Mary Ann Cantrell
- Villanova University, M. Louise Fitzpatrick College of Nursing, 322 Driscoll Hall, 800 Lancaster Ave, Villanova, PA 19085, United States.
| | - Suzanne C Smeltzer
- Center for Nursing Research, Villanova University, M. Louise Fitzpatrick College of Nursing, 212 Driscoll Hall, 800 Lancaster Ave, Villanova, PA 19085, United States.
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Integration of an Individual Simulation-Based Experience Into a Psychomotor Skills Course. Nurse Educ 2018; 43:117-120. [DOI: 10.1097/nne.0000000000000446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Eltaybani S, Mohamed N, Abdelwareth M. Nature of nursing errors and their contributing factors in intensive care units. Nurs Crit Care 2018; 24:47-54. [PMID: 29701274 DOI: 10.1111/nicc.12350] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/03/2018] [Accepted: 02/27/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Errors tend to be multifactorial and so learning from nurses' experiences with them would be a powerful tool toward promoting patient safety. AIM To identify the nature of nursing errors and their contributing factors in intensive care units (ICUs). METHODS A semi-structured interview with 112 critical care nurses to elicit the reports about their encountered errors followed by a content analysis. RESULTS A total of 300 errors were reported. Most of them (94·3%) were classified in more than one error category, e.g. 'lack of intervention', 'lack of attentiveness' and 'documentation errors': these were the most frequently involved error categories. Approximately 40% of reported errors contributed to significant harm or death of the involved patients, with system-related factors being involved in 84·3% of them. More errors occur during the evening shift than the night and morning shifts (42·7% versus 28·7% and 16·7%, respectively). There is a statistically significant relation (p ≤ 0·001) between error disclosure to a nursing supervisor and its impact on the patient. CONCLUSIONS Nurses are more likely to report their errors when they feel safe and when the reporting system is not burdensome, although an internationally standardized language to define and analyse nursing errors is needed. Improving the health care system, particularly the managerial and environmental aspects, might reduce nursing errors in ICUs in terms of their incidence and seriousness. RELEVANCE TO CLINICAL PRACTICE Targeting error-liable times in the ICU, such as mid-evening and mid-night shifts, along with improved supervision and adequate staff reallocation, might tackle the incidence and seriousness of nursing errors. Development of individualized nursing interventions for patients with low health literacy and patients in isolation might create more meaningful dialogue for ICU health care safety.
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Affiliation(s)
- Sameh Eltaybani
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, University of Alexandria, Alexandria, Egypt.,Department of Palliative Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nadia Mohamed
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, University of Alexandria, Alexandria, Egypt
| | - Mona Abdelwareth
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, University of Alexandria, Alexandria, Egypt
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Bagley KA, Dunn SE, Chuang EY, Dorr VJ, Thompson JA, Smith SK. Nonspecialty Nurse Education: Evaluation of the Oncology Intensives Initiative, an Oncology Curriculum to Improve Patient Care. Clin J Oncol Nurs 2018; 22:E44-E51. [PMID: 29547596 DOI: 10.1188/18.cjon.e44-e51] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND A community hospital combined its medical and surgical patients with cancer on one unit, which resulted in nurses not trained in oncology caring for this patient population. OBJECTIVES The Oncology Intensives Initiative (ONCii) involved the (a) design and implementation of a daylong didactic boot camp class and a four-hour simulation session and (b) the examination of nurses' worries, attitudes, self-efficacy, and perception of interdisciplinary teamwork. METHODS A two-group, pre-/post-test design was implemented. Group 1 consisted of nurses who attended the didactic boot camp classes alone, whereas group 2 was comprised of nurses who attended the didactic boot camp classes and the simulation sessions. FINDINGS Results of data analysis showed a decrease in worries and an increase in positive attitudes toward chemotherapy administration in both groups, as well as an increase in self-efficacy among members of group 2.
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Gracía-Pérez ML, Gil-Lacruz M. The impact of a continuing training program on the perceived improvement in quality of health care delivered by health care professionals. EVALUATION AND PROGRAM PLANNING 2018; 66:33-38. [PMID: 28987860 DOI: 10.1016/j.evalprogplan.2017.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 08/30/2017] [Accepted: 09/26/2017] [Indexed: 06/07/2023]
Abstract
There is abundant scientific literature concerning factors that affect patients' perceptions of the quality of health care. However, there are few published works that consider the opinions of health care professionals. This article aims to conjointly analyse two organisational strategies that determine professional health care practice: continuous training and quality of care. The objective is to examine the opinions of physicians and nurses on the improvement of the quality of care after a 'learning by doing' program. An evaluation method was designed that integrates the main variables that intervene in quality of care. An online questionnaire was utilised for collecting opinions on the effects of the training program. A total of 184 nurses and 180 other medical professionals participated in the program and all of them were asked to complete the questionnaire. A descriptive, and inferential statistical analysis was undertaken and results showed that there is a direct relationship between perceptions about: satisfaction, professional competence, training modality, optimisation of health resources and quality of care.
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Affiliation(s)
- María Luisa Gracía-Pérez
- Faculty of Social Sciences and Work, University of Saragossa, C. Violante de Hungria, 23, 50009 Saragossa, Spain.
| | - Marta Gil-Lacruz
- Faculty of Health Sciences, University of Saragossa, C. Domingo Miral s/n, 50009 Saragossa, Spain.
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Cantrell MA, Franklin A, Leighton K, Carlson A. The Evidence in Simulation-Based Learning Experiences in Nursing Education and Practice: An Umbrella Review. Clin Simul Nurs 2017. [DOI: 10.1016/j.ecns.2017.08.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Shin JY, Issenberg SB, Roh YS. The effects of neurologic assessment E-learning in nurses. NURSE EDUCATION TODAY 2017; 57:60-64. [PMID: 28734188 DOI: 10.1016/j.nedt.2017.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 02/06/2017] [Accepted: 07/10/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND A firm understanding of the preliminary assessment of a patient with neurological disorders is needed for ensuring optimal patient outcomes. OBJECTIVES The purpose of this study is to evaluate the effects of using e-learning on neurologic assessment knowledge, ability, and self-confidence among nurses. DESIGN This study used a non-equivalent control group pretest-posttest design. SETTINGS Nurses working in the neurology and neurosurgery wards, Republic of Korea PARTICIPANTS: A convenience sample of 50 nurses was assigned to either the experimental group (n=24) or the control group (n=26). METHODS The experimental group participated in the self-directed e-learning program related to neurologic assessment, and control group underwent self-directed learning with handout. Knowledge, ability, and self-confidence were measured at pretest and posttest. RESULTS There were no significant differences in knowledge (U=270, p=0.399) and self-confidence (U=241.5, p=0.171) between the two groups. Nurses in the experimental group showed higher neurologic assessment ability compared with those in the control group (U=199, p=0.028). CONCLUSIONS Self-directed neurologic assessment e-learning induced improvement in the neurologic assessment ability among nurses. Self-directed e-learning can be applied for improving competencies in neurologic assessment.
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Affiliation(s)
- Ji Yeon Shin
- Chung-Ang University Hospital, Seoul, Republic of Korea.
| | - S Barry Issenberg
- Gordon Center for Research in Medical Education, University of Miami Miller School of Medicine, USA.
| | - Young Sook Roh
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro Dongjak-gu, Seoul, 06974, Republic of Korea.
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