Pharmacology education: a theoretical framework of applied pharmacology and therapeutics

Developing a competence framework for nurses in pharmaceutical care: A Delphi study

BACKGROUND

Nurses play an important role in pharmaceutical care. They are involved in: detecting clinical change; communicating/discussing pharmacotherapy with patients, their advocates, and other healthcare professionals; proposing and implementing medication-related interventions; and ensuring follow-up of patients and medication regimens. To date, a framework of nurses' competences on knowledge, skills, and attitudes as to interprofessional pharmaceutical care tasks is missing.

OBJECTIVES

To reach agreement with experts about nurses' competences for tasks in interprofessional pharmaceutical care.

METHODS

A two-phase study starting with a scoping review followed by five Delphi rounds was performed. Competences extracted from the literature were assessed by an expert panel on relevance by using the RAND/UCLA method. The experts (n = 22) involved were healthcare professionals, nurse researchers, and educators from 14 European countries with a specific interest in nurses' roles in interprofessional pharmaceutical care. Descriptive statistics supported the data analysis.

RESULTS

The expert panel reached consensus on the relevance of 60 competences for 22 nursing tasks. Forty-one competences were related to 15 generic nursing tasks and 33 competences were related to seven specific nursing tasks.

CONCLUSIONS

This study resulted in a competence framework for competency-based nurse education. Future research should focus on imbedding these competences in nurse education. A structured instrument should be developed to assess students' readiness to achieve competence in interprofessional pharmaceutical care in clinical practice.

The Impact of Team-Based Learning on Nervous System Examination Knowledge of Nursing Students

INTRODUCTION

Team-based learning is one of the active learning approaches in which independent learning is combined with small group discussion in the class. This study aimed to determine the impact of team-based learning in nervous system examination knowledge of nursing students.

METHODS

This quasi-experimental study was conducted on 3(rd) grade nursing students, including 5th semester (intervention group) and 6(th) semester (control group). The traditional lecture method and the team-based learning method were used for educating the examination of the nervous system for intervention and control groups, respectively. The data were collected by a test covering 40-questions (multiple choice, matching, gap-filling and descriptive questions) before and after intervention in both groups. Individual Readiness Assurance Test (RAT) and Group Readiness Assurance Test (GRAT) used to collect data in the intervention group. In the end, the collected data were analyzed by SPSS ver. 13 using descriptive and inferential statistical tests.

RESULTS

In team-based learning group, mean and standard deviation was 13.39 (4.52) before the intervention, which had been increased to 31.07 (3.20) after the intervention and this increase was statistically significant. Also, there was a statistically significant difference between the scores of RAT and GRAT in team-based learning group.

CONCLUSION

Using team-based learning approach resulted in much better improvement and stability in the nervous system examination knowledge of nursing students compared to traditional lecture method; therefore, this method could be efficiently used as an effective educational approach in nursing education.

Differences in medication knowledge and risk of errors between graduating nursing students and working registered nurses: comparative study

BACKGROUND

Nurses experience insufficient medication knowledge; particularly in drug dose calculations, but also in drug management and pharmacology. The weak knowledge could be a result of deficiencies in the basic nursing education, or lack of continuing maintenance training during working years. The aim of this study was to compare the medication knowledge, certainty and risk of error between graduating bachelor students in nursing and experienced registered nurses.

METHODS

Bachelor students in closing term and registered nurses with at least one year job experience underwent a multiple choice test in pharmacology, drug management and drug dose calculations: 3x14 questions with 3-4 alternative answers (score 0-42). Certainty of each answer was recorded with score 0-3, 0-1 indicating need for assistance. Risk of error was scored 1-3, where 3 expressed high risk: being certain that a wrong answer was correct. The results are presented as mean and (SD).

RESULTS

Participants were 243 graduating students (including 29 men), aged 28.2 (7.6) years, and 203 registered nurses (including 16 men), aged 42.0 (9.3) years and with a working experience of 12.4 years (9.2). The knowledge among the nurses was found to be superior to that of the students: 68.9%(8.0) and 61.5%(7.8) correct answers, respectively, (p < 0.001). The difference was largest in drug management and dose calculations. The improvement occurred during the first working year. The nurses expressed higher degree of certainty and the risk of error was lower, both overall and for each topic (p < 0.01). Low risk of error was associated with high knowledge and high sense of coping (p < 0.001).

CONCLUSIONS

The medication knowledge among experienced nurses was superior to bachelor students in nursing, but nevertheless insufficient. As much as 25% of the answers to the drug management questions would lead to high risk of error. More emphasis should be put into the basic nursing education and in the introduction to medication procedures in clinical practice to improve the nurses' medication knowledge and reduce the risk of error.

Experiences of nurses as postgraduate students of pharmacology and therapeutics: a multiple case narrative study

BACKGROUND

Pharmacology and therapeutics are essential components of educational programmes in prescribing, yet little is known about students' experiences in studying these subjects for a prescribing role.

OBJECTIVE

To investigate the views and experiences of nurses as postgraduate students who were studying pharmacology and therapeutics in preparation for a prescribing role.

DESIGN

Qualitative study using a multiple case narrative approach.

SETTINGS

The participants were undertaking or had recently completed a Master's degree programme; they worked in a range of clinical areas and services in the Auckland region.

PARTICIPANTS

Twenty nurses, with advanced clinical backgrounds and experience engaged in postgraduate studies in pharmacology and therapeutics.

METHODS

A semi-structured interview of approximately 1h was undertaken with each participant. Transcripts were analysed within and across cases using Narralizer software to support thematic analysis.

RESULTS

There were four broad thematic areas. In the first, 'prescribing in the context of advanced nursing practice', participants reflected on why prescribing authority was important to them. In the second theme, 'adequacy of prior pharmacology knowledge' they discussed the relative lack of pharmacology in their undergraduate programmes and in nursing practice. In the third, 'drawing on clinical experience in acquiring pharmacology knowledge', participants discussed how, as they grappled with new pharmacological science, they drew on clinical experience which facilitated their learning. In the fourth theme, 'benefits of increased pharmacology knowledge' they discussed how their studies improved their interactions with patients, medical colleagues and as members of multi-disciplinary teams.

CONCLUSIONS

All nurses viewed their studies in pharmacology as fundamental to their roles as prescribers, through knowledge development and an increase in confidence. Although pharmacology theory was new to many participants, their learning was facilitated because they were able to reflect on previous clinical experience and apply this to theory.

A multi-disciplinary approach to medication safety and the implication for nursing education and practice

BACKGROUND

Medication management is a complex multi-stage and multi-disciplinary process, involving doctors, pharmacists, nurses and patients. Errors can occur at any stage from prescribing, dispensing and administering, to recording and reporting. There are a number of safety mechanisms built into the medication management system and it is recognised that nurses are the final stage of defence. However, medication error still remains a major challenge to patient safety globally.

OBJECTIVES

This paper aims to illustrate two main aspects of medication safety practices that have been elicited from an action research study in a Scottish Health Board and three local Higher Education Institutions: firstly current medication safety practices in two clinical settings; and secondly pre and post-registration nursing education and teaching on medication safety.

METHOD

This paper is based on Phase One and Two of an Action Research project. An ethnography-style observational method, influenced by an Appreciative Inquiry (AI) approach was adapted to study the everyday medication management systems and practices of two hospital wards. This was supplemented by seven in-depth interviews with nursing staff, numerous informal discussions with healthcare professionals, two focus-groups, one peer-interview and two in-depth individual interviews with final year nursing students from three Higher Education Institutions in Scotland.

RESULT

This paper highlights the current positive practical efforts in medication safety practices in the chosen clinical areas. Nursing staff do employ the traditional 'five right' principles - right patient, right medication, right dose, right route and right time - for safe administration. Nursing students are taught these principles in their pre-registration nursing education. However, there are some other challenges remaining: these include the establishment of a complete medication history (reconciliation) when patients come to hospital, the provision of an in-depth training in pharmacological knowledge to junior nursing staff and pre-registration nursing students.

CONCLUSION

This paper argues that the 'five rights' principle during medication administration is not enough for holistic medication safety and explains two reasons why there is a need for strengthened multi-disciplinary team-work to achieve greater patient safety. To accomplish this, nurses need to have sufficient knowledge of pharmacology and medication safety issues. These findings have important educational implications and point to the requirement for the incorporation of medication management and pharmacology in to the teaching curriculum for nursing students. There is also a call for continuing professional development opportunities for nurses working in clinical settings.

An evaluation of a course on the rational use of medication in nursing from the perspective of the students

BACKGROUND

The objectives of educational instruction on the rational use of medication are to teach students about frequent pharmaceutical applications, dosage calculations, observation of adverse side effects and patient training. A simulation project was used in nursing education/medical staff education to effectively gain knowledge and skills.

OBJECTIVES

In this study, our first aim was to investigate the effect of using a simulated patient as a teaching method on the performance of students in medication administration. Our second aim was to explore the students' views on the simulated patient teaching method in terms of the skills acquired in administering medication.

DESIGN

The study was designed and carried out as a quasi-experimental investigation in Turkey between September 2011 and December 2011.

PARTICIPANTS

The participants in the study were senior nursing students at a nursing school in Turkey. The data from eighty-five nursing students were obtained both at pretest and posttest. The views of all eighty-two students regarding a course on the rational use of medications were taken into consideration. Simulated patients were used throughout the entire course.

SETTING

An objectively constructed evaluation form (OCEF) was administered both at pretest and posttest to obtain participant feedback on a course on the rational use of medication. Descriptive statistics and a paired sample t-test were used in the data analyses.

RESULT

The mean pre-test score on the evaluation form was 24.02 ± 16.06, whereas the mean post-test score was 54.28 ± 14.54. Therefore, there was a statistically significant difference between the mean pre- and post-test scores (p<0.01; t=14.35).

CONCLUSION

The use of a simulated patient in a course on the rational use of medication proved effective. Furthermore, the students gave positive feedback regarding the use of the simulated patient as a teaching method.

Knowledge and perspectives of Dutch home healthcare nurses regarding medication frequently used by older people

BACKGROUND

Home healthcare nurses in their roles as caregivers, educators and administrators of medications are particularly well positioned to act on a preventive way to be alert of adverse drug reactions. However, knowledge about medication and a professional attitude is required.

AIM

To describe medication-related knowledge and perspectives of Dutch home healthcare nurses regarding frequent used medication by older people.

METHOD

A cross-sectional study was conducted among home healthcare nurses (n=146) in the Netherlands based on the ten most frequently used drugs by older people.

FINDING

The mean score for total medication knowledge was 76.2% of the maximum score. Most home healthcare nurses (80.3%) felt responsible for improving older patients' medication use. Three-quarters of the home healthcare nurses agreed with the statement: "By taking appropriate action at the right time, I am able to prevent a medication-related hospital admission".

CONCLUSION

Although most home healthcare nurses felt responsible for their older patients' proper medication use and agreed with the statement that they played a role in preventing older patients' medication-related hospital admissions, their knowledge regarding medications could be improved.

IMPLICATIONS FOR PRACTICE

Home healthcare nurses should profit as a professional from gaining more knowledge of medication frequently used by older people.

Medication knowledge, certainty, and risk of errors in health care: a cross-sectional study

Background

Medication errors are often involved in reported adverse events. Drug therapy, prescribed by physicians, is mostly carried out by nurses, who are expected to master all aspects of medication. Research has revealed the need for improved knowledge in drug dose calculation, and medication knowledge as a whole is poorly investigated. The purpose of this survey was to study registered nurses' medication knowledge, certainty and estimated risk of errors, and to explore factors associated with good results.

Methods

Nurses from hospitals and primary health care establishments were invited to carry out a multiple-choice test in pharmacology, drug management and drug dose calculations (score range 0-14). Self-estimated certainty in each answer was recorded, graded from 0 = very uncertain to 3 = very certain. Background characteristics and sense of coping were recorded. Risk of error was estimated by combining knowledge and certainty scores. The results are presented as mean (±SD).

Results

Two-hundred and three registered nurses participated (including 16 males), aged 42.0 (9.3) years with a working experience of 12.4 (9.2) years. Knowledge scores in pharmacology, drug management and drug dose calculations were 10.3 (1.6), 7.5 (1.6), and 11.2 (2.0), respectively, and certainty scores were 1.8 (0.4), 1.9 (0.5), and 2.0 (0.6), respectively. Fifteen percent of the total answers showed a high risk of error, with 25% in drug management. Independent factors associated with high medication knowledge were working in hospitals (p < 0.001), postgraduate specialization (p = 0.01) and completion of courses in drug management (p < 0.01).

Conclusions

Medication knowledge was found to be unsatisfactory among practicing nurses, with a significant risk for medication errors. The study revealed a need to improve the nurses' basic knowledge, especially when referring to drug management.

Nursing students' pharmacological knowledge and calculation skills: ready for practice?

OBJECTIVES

To evaluate graduating students' pharmacological knowledge and calculation skills and describe their self-rated readiness to safe medication care in practice on two nurse educational levels. Additionally, the study describes some characteristics of pharmacology in nurse education in Flanders, Belgium.

METHODS

Thirty-eight nursing schools (bachelor's degree in nursing [N=18] and diploma in nursing [N=20]) were asked to provide details on their pharmacology curriculum and to let their graduating students participate in a cross-sectional survey using the Medication Knowledge and Calculation test in February/March 2009.

RESULTS

The 29 participating schools showed a large diversity in pharmacology curricula. Mean scores on the pharmacology section and calculation section were 55% and 66%, respectively, for bachelor's degree and 52% and 53% for diploma students. On a scale of 1-10, 27% had a self-rated readiness perception≤5. Results differed significantly between schools.

CONCLUSIONS

Just before graduation, nursing students' pharmacological knowledge and calculation skills are limited. Apart from the test results, students did not perceive themselves able to deliver safe medication care in practice. Schools need to address the shortcomings. In practice, awareness is needed regarding possible limitations of the newly graduated.

The impact of an integrated pharmacology and medicines management curriculum for undergraduate adult nursing students on the acquisition of applied drug/pharmacology knowledge

AIMS

To investigate the efficacy of a 14-month integrated pharmacology and medicines management curriculum for undergraduate nursing students on the acquisition of applied drug/pharmacology knowledge.

BACKGROUND

Despite considerable debate regarding nurses' ability to be able to fulfill their medication management responsibilities, little is known about how nurses should be educated in medicines management.

METHODS

Two groups of nursing students were compared. The first group were exposed to the usual curriculum (control group), whilst a second group experienced a new integrated pharmacology and medicines management curriculum (intervention group) (N=120). The impact of the curriculum on applied drug knowledge was assessed using a 69 item short answer questionnaire relating to a vignette. Students also undertook a 42 item on-line test exploring principles of pharmacokinetics. Students were also asked to self-rate their knowledge using a four point likert scale which asked how confident they were in relation to the prescribed medication regime. The data were collected in July 2008. The intervention group was exposed to an integrated curriculum approach, whilst the control group undertook periods of supervised practice within a clinical environment supported with a workbook and practice assessment learning outcomes.

RESULTS/FINDINGS

Students exposed to an integrated approach to pharmacology and medicines management demonstrated superior pharmacokinetic knowledge and were more able to apply drug knowledge to the patient vignettes than the control group.

CONCLUSION

An early introduction of an integrated approach to the teaching and assessing of pharmacological processes improves students' drug knowledge prior to qualification. A sound preparation will help to ensure safe and effective medicines management care for patients and will prepare nurses for post graduate education and further training.

Framework for teaching pharmacology to prepare graduate nurse for prescribing in New Zealand

The place of nurse prescribing and the preparation for this role is an educational challenge that has been heavily debated in New Zealand and overseas for the past 10 years. Nurse prescribing is relatively new in New Zealand and is related to the expanding roles and opportunities for nurses in health care. Opposition to nurse prescribing in New Zealand has been marked and often this has been linked to concerns over patient safety with the implication that nurses could not be adequately prepared for safe prescribing. The educational framework used to teach pharmacology to nurses by one university in New Zealand is presented, along with early findings on the effectiveness of this approach. Further research is required to confirm that nurse prescribers in New Zealand are well prepared and able to utilise effective decision-making processes for safe prescribing.

Approaches to teaching: current opinions and related research

Three approaches to teaching and learning are introduced. Each approach has its relative merits and disadvantages. Ideally, each approach should not be used in isolation. The use of facilitatory approaches to teaching and learning should be encouraged to assist the development of problem solving, decision making skills and creative and critical thinking in nurses, particularly those studying on competency-based education and training courses and programmes.

Nurse prescribing, nurse education and related research in the United Kingdom: a review of the literature

This literature review aims to explore nurse education and the impact this has had on preparing nurses to become nurse prescribers and nurse prescribing research. Research about the initial nurse prescribing education and training programme indicated that although patients were content with nurses prescribing medication, nurses lacked confidence in applied pharmacology and therapeutics and hence, required additional scientific education. With the implementation of extended nurse prescribing, it is conjectural to assume that nurses have been prepared more effectively until results from the national evaluation are available. One can suggest that pre-registration nurses should receive a comprehensive scientific foundation in applied pharmacology and therapeutics and professional knowledge in order to prepare them for post graduate education and training in medication management.

Enhancing older people's concordance with taking their medication

It has been shown that older people are more likely than younger people to be prescribed a variety and number of medications (Lindley and Tulley, 1992). Older people are especially vulnerable to the effects of medication, particularly because of the possibility of medication mismanagement and non-concordance with prescribed medication regiment. People become increasingly sensitive to the actions of drugs with increasing age and, added to the problems of memory deterioration and physiological changes, medication-taking behaviour can alter quite dramatically (National Prescribing Centre, 2000). Reductions in the quantity of prescribed medication and the use of prescribing indicators aim to improve concordance with medication in older people. Patient education should be an inclusive component of patient care, not a concern before patient discharge. Education can take numerous forms, both written and verbal, and it needs to be patient-centred and specific to the medication being discussed. As healthcare professionals, nurses, pharmacists and medical colleagues should work collaboratively to reduce the frequency of medication mismanagement in older people.