Nursing Student Medication Administration Performance: A Longitudinal Assessment

The mediating role of pediatric nursing competence in the relationship between pediatric drug administration self-efficacy and medical error tendency in nursing students

AIM

This study was conducted to determine the mediating role of pediatric nursing competence in the relationship between self-efficacy in pediatric drug administration and medical error tendency in nursing students.

BACKGROUND

The self-efficacy of nursing students towards drug administration knowledge and practices is one of the determinants of achieving the goals of nursing education programs related to drug administration.

DESIGN

The sample of the descriptive and correlational study consisted of a total of 303 3rd and 4th-year students taking the Pediatric Health and Diseases Nursing course at the Department of Nursing. Data were collected using the Pediatric Nursing Competency Scale (PNCS), the Medication Administration Self-Efficacy Scale in Children for Nursing Students (MASSC) and the Medical Errors Tendency Scale (METS). Pearson correlation analysis, linear regression analysis, independent groups t-test, one-way analysis of variance (ANOVA) and post hoc (Tukey, LSD) test were used to analyze the data. In addition, hierarchical regression analyses regarding the mediation effect were performed using PROCESS Model 4 developed by Hayes (2013) for SPSS.

RESULTS

When the correlation levels between the total scores of MASSC, PNSC and METS were analyzed, a positive moderate correlation was found between PNSC and MASSC total scores, a positive weak correlation was found between METS and MASSC total scores and a positive weak correlation was found between METS and PNSC total scores (p<0.05). As a result of the analysis, the model was found to be significant and the total change in METS was explained by 17.3 % of the total change in METS (F=63.289;p=0.000). It was found that PNSC was a partial mediator variable between MASSC and METS.

CONCLUSION

As a result of the study, it was determined that pediatric nursing competence had a partial mediating role in the relationship between pediatric drug administration self-efficacy and medical error tendency in nursing students.

Teaching Psychomotor Skills in Undergraduate Nursing Education: An Integrative Review

BACKGROUND

Psychomotor skills, a cognitive and fine motor process, are an essential component to undergraduate nursing education. Currently, no national guidelines exist to guide nursing programs on the best way to educate students to ensure competent and safe practice of psycho-motor skills in the clinical setting. This review sought to determine what methods of education, training, and practice of psychomotor skills enhanced psychomotor skill competency in undergraduate nursing students.

METHOD

An integrative review was conducted to determine teaching and practice strategies to support psychomotor skill competence.

RESULTS

Four significant categories were identified and included (1) simulation; (2) technology; (3) deliberate practice; and (4) theoretical and collaborative instruction. Overall, simulation and technology were found to be the most effective in psychomotor skill competence.

CONCLUSION

Additional research is needed to identify which teaching strategies best support nursing students' long-term knowledge acquisition and competency as they transition into professional practice. [J Nurs Educ. 2024;63(7):421-426.].

Evaluating the Effectiveness of Expert Modeling Videos on Nursing Student Competency Behaviors

BACKGROUND

Expert modeling videos (EMVs) have shown promise in improving students' performance in simulation. However, research evaluating the impact of EMVs is limited to major performance areas, lacking exploration into specific student competency behaviors.

PURPOSE

This study evaluated the effect of an EMV intervention on undergraduate nursing students' behavioral competencies as measured by the Creighton Competency Evaluation Instrument (CCEI).

METHODS

Using a quasi-experimental pragmatic evaluation design, students in a medical surgical nursing course (n = 160) viewed either an expert model demonstration video (experimental) or expert model discussion video (control). Students' behavioral competencies were measured and compared between groups using the CCEI.

RESULTS

Students who viewed an expert model demonstration video performed at a higher level of competency in 11 of the 18 CCEI behaviors.

CONCLUSION

Using EMVs in nursing simulation may improve students' ability to achieve clinical competency in nursing specific behaviors.

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

BACKGROUND

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

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSION

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

Nursing Students' Perceptions Regarding Teaching and Learning Practices That Promote Safe Medication Administration

ABSTRACT

This article reports on a study conducted to explore what helps and what complicates learning safe medication administration. In this study, nurse educators explored students' perspectives on effective teaching practices, what influences medication errors and near misses, and strategies for improving students' learning about medication administration. Students ranked nursing instructors, peers, and staff nurses as having the greatest positive impact on both their learning and patient safety. Good relationships, an appropriate pace of learning, and practice were also beneficial. Noise, time constraints, and interruptions were negatively associated with learning and patient safety.

Comparing Virtual Simulations to Paper Case Studies in Combination With Manikin-Based Medication Administration Simulations: A Quasi-Experimental Study

BACKGROUND

Medication errors are among the most common preventable adverse events in health care.

METHODS

A quasi-experimental approach with a pre/posttest design was used to explore the effectiveness of an enhanced medication administration simulation bundle that included the use of manikin-based simulation-based experiences (SBEs) in combination with either virtual SBEs (V-SBEs) for deliberate practice (DP) or traditional paper case studies for DP on safe medication administration in undergraduate nursing students.

RESULTS

Nursing students (n = 101) participated in multiple medication administration-focused SBEs including DP via V-SBEs or DP via traditional paper case studies. Student performance in the medication administration SBEs improved after the third experience. There was no statistically significant difference between the V-SBE groups compared with the traditional paper case study groups across the 3 medication administration-focused SBEs.

CONCLUSION

Findings from this study highlight the importance of DP with medication administration for undergraduate nursing students.

Medication administration competency for clinical preparedness: Comparing testing modalities and test anxiety in undergraduate nursing students

BACKGROUND

Adverse drug events, which occur at various stages of the medication preparation and administration process, cause over half a million injuries or deaths yearly. Upon graduation, prelicensure nursing students lack the skill and competency required for safe medication administration. Therefore, it is essential to ascertain their medication administration proficiency throughout their curriculum prior to participation in clinical experiences. Historically, this has been a deeply embedded process of high-stakes testing. Aligned is cognitive test anxiety which can severely limit a student's performance. Thus, nursing student competency and control appraisal in medication administration can be linked to the Control Value Theory framework.

OBJECTIVES

The purpose of the research was to determine whether an e-simulated high-stakes medication administration test was associated with less anxiety than a standard high-stakes medication math assessment within and between two nursing tracks over three semesters to capture sequencing of medical-surgical clinical courses.

DESIGN

The prospective, quantitative, longitudinal study received Institutional Review Board approval.

PARTICIPANTS/SETTING

Students were recruited from a traditional BSN track and an online LPN-to-BSN track per course level over three semesters.

METHODS

Participants completed the State-Trait Anxiety Inventory prior to their course level high-stakes assessment modality.

RESULTS

For both tracks, testing anxiety remained a factor with no significant difference in the anxiety level between assessment modalities. There was a trend for anxiety scores to slightly decrease over time with each testing modality, but results were non-significant. There was a trend for traditional BSN students (n = 435) to have slightly lower anxiety scores than the LPN-to-BSN (n = 246) students.

CONCLUSIONS

Researchers must continue investigating teaching, learning, and testing modalities in medication calculation/administration that maintain rigor, enhance student self-efficacy, and provide accurate assessment. These can be aligned with research regarding study skills training and cognitive-behavioral interventions to help mitigate the challenge of cognitive test anxiety.

Nursing students' self-efficacy and clinical decision-making in the context of medication administration to children: A descriptive-correlational study

BACKGROUND

It is crucial for nursing students to possess self-efficacy in medication administration to children for correct drug implementation. It is expected that nursing students enhance their clinical application skills in the pediatric field before graduation, execute the clinical decision-making process, and acquire self-efficacy in medication administration.

AIM

This research was conducted to examine the self-efficacy and clinical decision-making levels of nursing students in the context of medication administration to children.

METHODS

This descriptive-correlational study was conducted with 368 students. The data were collected using the "Participant Information Form", the "Medication Administration Self-Efficacy Scale in Children for Nursing Students", and the "Clinical Decision-Making in Nursing Scale". Number, percentage, minimum and maximum values, mean and standard deviation, Independent Samples T-Test, ANOVA, and Pearson correlation test were used in the analysis of the data. In addition, Cronbach's Alpha coefficient was calculated to evaluate the reliability of the scales. The research report of the study followed the STROBE guidelines.

RESULTS

In the study, the mean score of the students on the Clinical Decision-Making in Nursing Scale was slightly low; the mean score of the Medication Administration Self-Efficacy Scale in Children for Nursing Students was found to be moderate; and a significant and negative relationship was determined between the two scales. The clinical decision-making levels of the male students, the fourth-year nursing students, and those who did not experience anxiety during medication administration were found to be significantly higher. The self-efficacy of the students who did not experience anxiety during medication administration to children was found to be significantly higher than the others.

CONCLUSION

Nursing students need to possess self-efficacy in administering medication to children and be able to make clinical decisions. Given the significant impact of the clinical decision-making process on patient outcomes and safety, it is necessary to develop educational programs to enhance the clinical decision-making abilities of nursing students. Different educational methods that will increase students' self-efficacy in medication administration to children need to be implemented.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

Effects of Microlectures on Nursing Students' Understanding of Key Medication Administration Concepts: A Quasi-Experimental Design

BACKGROUND

Microlectures comprise short audio or video presentations designed to provide a concise explanation of key concepts or topics.

PURPOSE

The study aimed to develop a microlecture module for a nursing course in medication administration and test whether it could improve learning.

METHODS

The study had a quasi-experimental design. Four classes of sophomore nursing students were divided into the treatment (n = 109) and control groups (n = 84). Pretests, posttests, integrated examinations, and simulated experiences were employed. Analysis of covariance were used to analyze the students' pretest, posttest, and integrated examination performances.

RESULTS

The treatment group performed better than the control group.

CONCLUSIONS

This study provides nursing educators with a different approach to traditional teaching and sheds light on how to design a microlecture.

Nursing Students' Perceptions of Learning With NGN-Style Case Studies

BACKGROUND

The National Council of State Boards of Nursing (NCSBN) developed Next Generation NCLEX (NGN) case studies and new test items, based on the NCSBN Clinical Judgment Measurement Model, to assess nurse graduates' clinical judgment and decision-making ability.

PURPOSE

This study investigated nursing students' perceptions of learning with NGN-style case studies.

METHODS

A mixed-methods approach collected nursing students' perceptions in a 6-item survey.

RESULTS

Overall respondents agreed that the case studies were helpful in learning (n = 45; 90%), applying course concepts (n = 46; 92%), learning clinical judgment (n = 46, 92%), and promoting active learning (n = 43, 86%), and were a useful learning strategy (n = 48, 96%). Themes identified in narrative comments were critical thinking, real-life application, and a learning tool.

CONCLUSIONS

NGN-style case studies were useful as an active learning strategy to promote clinical judgment and real-life application of course concepts.

Learning practical nursing skills in simulation centers - A narrative review

Background

Practical skills are complex procedures integrating communication and caring, as well as technical and manual aspects. Simulation at a simulation/skills center offers a wide range of learning activities and aims to imitate patient situations.

Objectives

To investigate the international research literature on practical skills learning in simulation/skills centers in nursing education. Research questions: 1. What are the range and type of practical skills studied? 2. What learning activities are focused on in the studies included in the review? 3. What are the learning outcomes and how are they assessed?

Design

Narrative review.

Methods

We searched electronically and included studies from Medline Ovid, CINAHL, Eric, Embase, Academic Search Premiere, and Cochrane. Unique indexing terms and search strategies were developed for each database. The criteria for inclusion were bachelor nursing students as the study population and practical nursing skills learning in simulation/skills centers. We used Rayyan QCRIt for the initial screening and the Mixed Method Appraisal Tool for quality assessment. We used a narrative approach to synthesize the diverse range of studies.

Findings

One hundred and twenty-one studies from 26 countries published between January 2013 and March 2022 were included. The amount of quantitative research was overwhelming (n = 108). A total of 50 different practical skills were represented. The studies focused on which learning modalities resulted in the best learning outcomes. Only 8.5% (n = 7) of the included studies concerned students' learning processes. Skill performance (n = 101), knowledge (n = 57), confidence (n = 34), and satisfaction (n = 32) were the main learning outcomes measured.

Discussion

The quality assessment indicated that 10 of the studies achieved 100% on the mixed method appraisal tool criteria. In many of the studies with quasi-experimental and randomized controlled trial designs, the intervention group received some form of educational treatment while the control group received no treatment. The choice of no treatment for the control group in pedagogical research seems to disregard the inherent purpose and effect of teaching and learning.

Conclusion

Heterogeneity in the use of learning modalities and measuring instruments precludes the possibility of building on other research. Technical skills were the preferred choice of skill, while skills that involved a fair measure of communication and collaboration were only sparingly studied. Students' learning processes were barely touched on in the included studies. More focus should be placed on this area in further research, since the choice of learning modalities may affect the students' learning processes in significant ways.

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.