Using High-Fidelity Simulation to Increase Nursing Student Knowledge in Medication Administration

Use of simulation to improve nursing students' medication administration competence: a mixed-method study

Background

Medication administration errors are among the most important adverse events in healthcare systems. To minimise the risk of this occurring, nursing training programmes should emphasise the overriding priority of patient safety. In this respect, simulation can be a valuable resource in teaching procedures, for patient safety in general and safe medication administration in particular. In this study, we evaluate the use of a simulation-based activity for students to acquire skills in safe medication administration, and consider the students’ perceptions of this activity.

Methods

Second-year nursing students enrolled in the subject of pharmacology at a Spanish university during the academic year 2018–2019 were invited to participate in this mixed-method study. Their acquisition of professional competencies via a simulation exercise was evaluated according to the ‘six rights’. Before the simulation, each student completed a researcher-developed online questionnaire. The simulation was evaluated by the students’ tutor, using a checklist. A descriptive analysis was made of the data obtained from the questionnaire and during the simulation. At the end of the semester, the students' opinions were recorded in the questionnaire, in response to an open question. A content analysis was made of the responses to the open question.

Results

The simulation exercise was performed by 179 students, of whom 73 had previously completed the questionnaire. Analysis showed that, in comparison with the pre-simulation questionnaire results, compliance with the six rights improved in all dimensions except data documentation: right patient (from 64.4% to 83.3%); right medication (from 60.3% to 95.8%); right dose (from 60.3% to 100%); right route (from 54.8% to 95.8%); right time (from 24.7% to 70.8%); the right documentation result fell from 54.8% to 45.8%. The students expressed their satisfaction with the simulation method, affirming that it brought them closer to the reality of health care.

Conclusions

Simulation is a useful tool for the acquisition of skills in medication administration. The students were satisfied with the simulation capacity to bridge the gap between theory and practice. Moreover, simulation represents an added teaching resource in the nursing degree curriculum and is expected to enhance patient safety.

Effects of Manikin Fidelity on Simulation-Based Nursing Education: A Systematic Review and Meta-Analysis

BACKGROUND

Few studies have examined whether higher-fidelity manikins are superior to lower-fidelity manikins in nursing simulation-based education.

METHOD

A database search initially yielded 2,656 studies written in English or Korean. Duplicates and irrelevant studies were excluded. Ancestry searches generated 3 additional studies, and 15 studies met the criteria.

RESULTS

Higher-fidelity manikins were more effective than lower-fidelity manikins in improving skill performance/clinical competence and perception of nursing students and nurses. In terms of learners' knowledge, satisfaction, and self-confidence, both higher- and lower-fidelity manikins were similarly effective for nursing students.

CONCLUSION

This article provides evidence that higher-fidelity manikins do not always ensure a superior educational effect compared with lower-fidelity manikins. [J Nurs Educ. 2022;61(2):67-72.].

Effect of High-Fidelity Simulation on Clinical Judgment Among Nursing Students

Introduction

Nursing education needs to be improved in order to bridge the gap between education and clinical practice. However, clinical placements for nursing students are limited and student nurses often take merely an observer role, especially in critical situations. High-fidelity simulation (HFS) is a teaching method that can bridge the gap between education and clinical practice. The purpose of this study was to evaluate the influence of using HFS as a teaching method on clinical judgment among pediatric nursing students at the Arab American University utilizing a bacterial meningitis case scenario.

Methods

A quasi-experimental study with a convenience sample of one hundred and fifty baccalaureate nursing students enrolled in a pediatric health nursing course. Nursing students were randomly assigned to high-fidelity simulation experience or traditional methods. The clinical judgment was assessed using Lasater Clinical Judgment Rubric Tool.

Results

Results revealed that the high-fidelity simulation experience has improved pediatric nursing students’ clinical judgment. The mean clinical judgment differed significantly at post-test in the intervention group after the simulation (t (148) = 7.20, P < .001).

Conclusion

The HFS can be an effective tool to provide a safe and effective learning environment for pediatric nursing students, consequently improving their clinical judgment

The Effect of Simulation Method on Nursing Students' Burn Patient Care Planning: A Randomized Controlled Trial

In nursing education, the rate of students to practice for burn patient care is low. This research was carried out as a single-blind randomized control group intervention trial to determine the effectiveness of simulation method performed using high-fidelity human patient simulator in nursing students' burn patient care planning. The research was conducted with randomly selected 61 students including 31 in intervention and 30 in control groups. In the application process of the research, knowledge tests were administered as a pretest, second test, and posttest, and the first and second applications of burn patient care plans were performed with all students. In the research, the application of burn patient scenario was performed only with the intervention group. As a result of the research, it was found that the posttest knowledge scores of the students in the intervention group increased significantly compared with the control group (P < .05). According to the intergroup evaluations, there was no significant difference between the intervention and control groups in terms of care plan scores (P > .05), whereas the scores for the second burn patient care plan of the intervention group were higher compared with those of the control group. The simulation method was found to increase students' knowledge levels, and the employment of the method in nursing education is recommended.

Medication administration behaviors in prelicensure nursing students: A longitudinal, cohort study

AIM

This longitudinal study identified changes in safe medication administration behaviors in a single cohort of students followed over four semesters of nursing school.

BACKGROUND

Over 40% of a nurse's shift is dedicated to the processes of medication administration, placing them in a position to interrupt costly medication errors. Yet, despite efforts to decrease medication errors, including electronic medical records, smart pumps, and standardized processes, 5% of hospitalized patients experience adverse drug events and the sequela costs billions of dollars annually. One cognitive aid first introduced in nursing school to help nurses administer medications safely is the rights method, including the foundational five (patient, medication, dose, route, and time). However, facility restrictions, complicated electronic health records, and high faculty-to-student ratios are limiting opportunities to apply these rights and develop safe medication administration competency. Although nursing faculty and clinical partners expect competency when initially licensed as professionals, graduating nursing students are not competent and new graduates feel ill prepared to deliver medications safely. Previous studies report findings on safe medication administration in different cohorts of nursing students, but none has followed the same cohort of students throughout nursing school.

DESIGN

Using a non-experimental design, the same cohort of nursing students was followed over four semesters and observed independently administering medications in simulation scenarios.

METHODS

Each semester, this cohort of students self-selected into 10-12 simulation groups. One student from each group was randomized to the role of primary nurse. Guided by the NLN/Jeffries simulation theory and the International Nursing Association for Clinical Simulation and Learning's Standards of Best Practice: Simulation^SM, students participated in four simulations that required the primary nurse to deliver medications as part of clinical care. A single investigator completed an observational checklist during the simulations on verification of the foundational five rights in these students.

RESULTS

Verification of most rights varied each semester, but students consistently did poorly verifying right dose. One hundred percent of students observed in the first semester did not verify all five rights. At the time of graduation, 80% of students observed did not verify all five rights prior to medication administration.

CONCLUSIONS

These concerning findings align with previous research showing that students are not safely administering medications in patient care settings. Educators, administrators, and healthcare systems need to ensure that students receive consistent, high-quality experiences vital to training future nurses for competency in safe medication administration.

Effects of a Complex Case Study and High-Fidelity Simulation on Mechanical Ventilation on Knowledge and Clinical Judgment of Undergraduate Nursing Students

BACKGROUND

Improving nursing students' knowledge and clinical judgment related to mechanical ventilation (MV) is paramount, considering the heightened need for MV due to the current COVID-19 (coronavirus disease 2019) pandemic. High-fidelity simulation (HFS) provides students with real-life clinical experiences that they would rarely confront in clinical training, especially complex case scenarios (such as a patient needing MV).

PURPOSE

This study assessed students' clinical knowledge and judgment after including HFS involving MV in an undergraduate nursing program.

METHODS

This was a quasi-experimental design with a convenience sample of 151 nursing students using the Lasater Clinical Judgment Rubric.

RESULTS

There were significant differences between the intervention and control groups in knowledge (t = 20.42; P = .001) and total clinical judgment scores (t = 19.55; P < .001) post-HFS.

CONCLUSIONS

Including a complex case study using MV and HFS significantly improved students' clinical decision-making, clinical knowledge, and self-confidence and enhanced their critical thinking, noticing, interpreting, reflecting, and responding capabilities.

The Effects of High-Fidelity Simulation, Low-Fidelity Simulation, and Video Training on Nursing Student Anxiety in the Clinical Setting

Education in medication administration is essential to patient safety, but there is limited evidence to describe the best way to influence clinical practice by nursing students. In a medication administration pilot study, the state anxiety of 44 nursing students was evaluated presimulation and prior to giving medications in the clinical setting. Two-way analysis of variance for repeated measures indicated no significant differences between high-fidelity simulation, low-fidelity simulation, or video training groups. However, high- and low-fidelity simulation led to decreased anxiety in the clinical setting, whereas video training led to greater anxiety.

Psychometric design and validation of a tool to assess the medication administration process through simulation in undergraduate nursing students

BACKGROUND

Medication errors account for 38% of adverse events reported among undergraduate nursing students. Simulation provides training for nursing students in the medication administration process. However, there is a lack of reliable and valid instruments to measure its assessment.

OBJECTIVES

To design and validate a new tool (MEDICORRECT) to assess undergraduate nursing students in the medication administration process using a high-fidelity simulation scenario.

DESIGN AND METHODS

Study participants were fourth year undergraduate nursing students at the University of Barcelona. Phase 1 consisted of tool design and drafting, and content validity and feasibility analyses. Phase 2 covered construct validity and interrater reliability. A factor analysis was conducted, involving a principal component analysis and varimax rotation.

FINDINGS

Of 21 initial items, 11 were eliminated because of low content validity ratio, 4 of which assessed cognitive skills such as administering the right medicine at the right dose, which were impossible to observe in the simulation scenario. The final version of MEDICORRECT contained 10 items. The exploratory factor analysis identified a four-factorial model explaining 67.3% of the variance. Interrater agreement measured with Kappa was greater than 0.70 for 80% of items.

CONCLUSIONS

The 10 items in MEDICORRECT are relevant and feasible, have suitable psychometric properties and reflect the practical skills identified in the medication administration process. The tool excludes cognitive skills, which should be included and assessed during prebriefing.

Simulation strategies to increase nursing student clinical competence in safe medication administration practices: A quasi-experimental study

BACKGROUND

Nursing student medication errors often result from deficits in knowledge and application of fundamental safe administration practices. Factors such as high faculty-student ratios and legal restrictions have decreased clinical learning opportunities for nursing students to practice safe medication administration in the clinical setting. Evidence suggests that use of a structured medication safety enhancement (MSE) simulation program can significantly improve student knowledge and competency in safe medication administration.

PURPOSE

To examine the effects of an educational strategy using a MSE simulation program with integrated technology on the medication administration knowledge, competency, and confidence levels of undergraduate nursing students.

METHODS

This quasi-experimental replication study designed and implemented medication simulations enhanced by integrated information technologies in an undergraduate-nursing curriculum. Third-year BSN students (n = 83) were randomized into intervention or control groups. Control groups participated in standard training while the intervention group received additional clinical simulation experience and debriefing sessions focused on medication safety practices. Participant knowledge was measured using pre/post Medication Safety Knowledge Assessment (MSKA) and competency was evaluated using the Medication Safety Critical Element Checklist (MSCEC).

RESULTS

The MSKA and MSCEC were analyzed using two-sided independent t-tests. Post-test knowledge scores increased in both groups but results were not statistically significant (α = 0. 05). Students who received the medication safetfy enhancement intervention performed significantly better in a subsequent simulation than students who did not have prior simulation experience (p < .001).

CONCLUSION

Findings suggest that educators should consider high fidelity simulation as an evidence-based teaching strategy to engage students in understanding and implementing medication safety practices in the clinical setting.

Skill acquisition of safe medication administration through realistic simulation: an integrative review

OBJECTIVE

to investigate evidence that indicates the contribution of realistic high, medium or low fidelity simulation to acquire knowledge, skills and attitudes in safe medication administration by nursing students.

METHODS

an integrative review of experimental studies from MEDLINE, LILACS, Web of Science, Scopus and Science Direct. The descriptors "nursing students", "simulation", "high fidelity simulation training", "medication errors" and "pharmacology" were used to identify 14 studies that answered the research question, and were assessed for accuracy methodological level and level of evidence.

RESULTS

there was a sample of quasi-experimental studies, (level 3 of evidence; 78.6%) and randomized clinical trials (level 2 of evidence; 21.4%), whose expressive majority showed superiority of the simulation strategy over the traditional methodology (71.4%).

CONCLUSION

using low and high fidelity simulators, standardized patients and virtual simulation can promote acquisition of essential skills for patient safety.

Simulation as a Tool to Illustrate Clinical Pharmacology Concepts to Healthcare Program Learners

Purpose of Review

Recent Findings

Summary

Comparison of the effects of simulation training and problem-based scenarios on the improvement of graduating nursing students to speak up about medication errors: A quasi-experimental study

BACKGROUND

Medication administration errors are common among new nurses. Nursing students might be less willing to speak up about errors because of a lack of knowledge and experience.

OBJECTIVES

To examine the effects of simulation training and problem-based scenarios on speaking up about medication errors among graduating nursing students.

DESIGN

Prospective, controlled experimental study design.

SETTING

A university four-year nursing program in Taiwan.

PARTICIPANTS

In total, 93 graduating nursing students in their last semester were recruited. Sixty-six students who received both a problem-based scenario and medication administration simulation training comprised the experimental group, while 27 students who received problem-based scenarios alone comprised the control group.

METHODS

Experimental group students underwent 2 h of simulation training. This training class was designed based on Kolb's experiential learning theory for knowledge development and speaking up about errors. Students in both groups administered medications in problem-based scenarios with eight embedded errors. Students' performance in speaking up about medication errors was directly observed and graded using an objective structured checklist. The McNeamer Chi-squared test, paired t-test, Z test, t-test, and Hedges' g effect size were conducted.

RESULTS

The number of times participants spoke up about medication errors significantly improved in both the experimental group (pre-test: 2.05 ± 1.12 and post-test 6.14 ± 1.25, t = 22.85, p<0.001) and control group (pretest: 2.04 ± 1.16 and post-test: 4.26 ± 1.63, t = 6.33, p<0.001). However, after the intervention, the mean number of times participants spoke up about medication errors in the experimental group was significantly higher than that in the control group (t = 5.99, p<0.001) in the post-test.

CONCLUSIONS

Simulation training exhibited more-significant improvements than problem-based scenarios. Nursing schools and hospitals should incorporate simulation training or at least problem-based scenarios to improve medication safety.

Incorporating medication administration safety in undergraduate nursing education: A literature review

OBJECTIVE

The purpose of this review was to identify methods for incorporating medication administration safety in undergraduate nursing education.

DESIGN

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines directed this review.

DATA SOURCES

A search of four electronic databases (Cumulative Index to Nursing and Allied Health Literature, Education Resources Information Center, Google Scholar, and MedLine/PubMed MedLine/PubMed) as well as hand searches were conducted to identify original research published between 2005 and 2018.

REVIEW METHODS

Original empirical research describing a method for incorporating medication administration safety concepts in nursing education and examining its effectiveness on undergraduate nursing students' outcomes were selected for review. Articles describing medication safety education for graduate students, students other than those in nursing, and practicing nurses were excluded.

RESULTS

Twelve original research articles were included for review. Three methods for incorporating medication administration safety in undergraduate nursing education were identified: simulation experiences, technology aids, and online learning modules. Most studies were conducted in North America. The use of different interventions as well as different outcome measures was noted as a limitation to the collective body of research in this area. Also, there was a lack of information regarding psychometric properties of instruments used among the studies reviewed.

CONCLUSION

Simulation experiences, use of technology aids, and online learning modules helped increase medication safety competence of nursing students. However, simulation equipment, select technology aids, and online learning may not be available for all nursing programs; therefore, educators should consider developing and testing classroom-based educational interventions. Moreover, future researchers should use or develop psychometrically sound instruments to measure nursing students' outcomes including competencies about medication administration safety.

The effect of mannequin fidelity on the achievement of learning outcomes for nursing, midwifery and allied healthcare practitioners: Systematic review and meta-analysis

BACKGROUND

Simulation has demonstrated superiority over purely didactic instruction in multiple contexts, and educationalists have embraced this modality for enhancing access to clinical skills. However, there remains uncertainty if increasing the realism (fidelity) of simulation equipment heightens performance. To address this within nursing and allied health, this review examines if increasing equipment fidelity improves learning outcomes.

METHODS

A systematic search of; CINAHL, Academic Search Complete, AMED; British Education Index, ERIC, MEDLINE, PsycARTICLES, PsycINFO, Maternity and Infant Care, INTERMID, Google Scholar, American Doctoral Dissertations, EThOS, ClinicalTrials.gov and ISRCTN registers was conducted for trials comparing two or more fidelity levels for knowledge, psychomotor or affective/non-technical outcomes. Data extraction and quality appraisal were performed and independently verified. Subgroup meta-analyses were undertaken (where viable), at post-intervention, intermediate, and long-term assessment time-frames.

RESULTS

18 RCTs and quasi-experimental trials containing ~1192 participants met the inclusion criteria. Almost ¾ of included trials exhibited high risk-of-bias. Training on higher-fidelity mannequins was associated with improved performance immediately post-intervention when compared with training on lower-fidelity mannequins for knowledge (p < 0.00001) and psychomotor outcomes (p < 0.00001). A similar directional effect for affective/non-technical skills was considered less robust due to substantial weaknesses in available studies. During follow-up testing at intermediate (1-3 weeks) and long-term (1-6 months) data points, there was insufficient evidence to determine any advantage in the use of higher fidelity mannequins. Repeated-intervention training was also insubstantially reported.

CONCLUSION

Higher-fidelity mannequins exhibited modest advantages when testing closely followed training. However results need to be confirmed using a larger number of high quality RCTs. A greater body of research using repeated-interventions and extended time-frames is also required before the influence of sustained training with alternative mannequins can be fully elucidated.