Finnish nurses' and nursing students' pharmacological skills

Evaluation of Medication Errors in a Tertiary Care Hospital of a Low- to Middle-Income Country

Introduction Medication errors (MEs) are a major public health concern as they are detrimental to patient safety, compromise patients' confidence in the healthcare system, increase healthcare costs, and adversely affect the patient's quality of life. This is especially true in low to middle-income countries where the significance of MEs is largely undervalued. This study aims to investigate the prevalence of MEs and analyze the causes, medicines involved, reporting, and severity of MEs in a tertiary care setting. Methods A prospective observational study was conducted from March 2020 to February 2021 in a tertiary care teaching hospital in South India. The data was collected after reviewing patient medical records, by interviewing patients and healthcare professionals. National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) index was used to evaluate MEs. Results A total of 557 MEs were identified from 3798 patients with a prevalence of 14.6%. Prescribing errors were the most commonly observed ME followed by errors related to documentation of medical records, administration-related errors, and dispensing errors. Lack of time for documentation of medication records, shift change and work overload were common causes of MEs. The majority of MEs were category A and B of the NCC MERP severity index. Conclusion Antibiotics and proton pump inhibitors were the most common medicines involved in MEs. Prescribing and documentation errors were most prevalent. Implementation of systems like strict adherence to treatment guidelines, computerized provider order entry (CPOE), barcode medication administration, and closed-loop electronic medication management systems may greatly help reduce MEs. All healthcare institutions should undertake routine audits to determine the prevalence and causes of medication errors.

'To give or not to give medication, that is the question.' Healthcare personnel's perceptions of factors affecting pro re nata medication in sheltered housing for older adults - a focus-group interview study

Background

Residents living in sheltered housing depend on help from healthcare personnel (HCP) with medication management, regarding regular long-term and pro re nata (PRN) medication. The HCP assess the need for PRN medication prior to administration to the residents. The purpose of this study was to describe HCP’s perceptions of factors affecting PRN medication management in sheltered housing for older adults.

Method

This was a qualitative study with five focus-group interviews with 22 HCP working in sheltered housing for older adults. The HCP were heterogenous regarding scholarly education and experiences, working in four different municipalities in mid-Norway, representing urban, sub-urban and rural districts. The analysis was inductive, based on qualitative, manifest, content analysis. The main outcome was HCP perceptions of the factors affecting PRN medication management in sheltered housing.

Results

Four main factors affecting the PRN medication management were identified in the data and were related to either: 1) the medication; 2) the resident; 3) the HCP; or 4) the organisation. These categories included 14 subcategories. Overall, the HCP described the management of PRN medication as a complex process, where the above factors all have impact on the residents’ health and safety.

Conclusion

HCP working in sheltered housing describe that PRN medication management is affected by numerous human factors, that consequently may affect patient outcomes and safety. HCP involved in PRN medication management should be aware of factors that affect their decision-making, and safe management requires a professional practice built on medicines competence, practical skills and experience.

Nurses' perspectives on pharmacology: why, what and at which point of the curricula should education be delivered?

AIMS AND OBJECTIVES

the study aimed to capture the views of nursing students and qualified nurses about pharmacology education and at which point the subject should be taught.

BACKGROUND

drug errors are common in clinical practice. However, the presence of pharmacology education in nursing curricula varies, with few higher education institutes focusing on the topic in pre-registration years.

DESIGN

a cross-sectional survey was carried out with 46 pre-registration, 18 post-qualification and 15 post-qualification nurse prescribing course students.

RESULTS

most agreed that pharmacology education was crucial for practice. Post-qualification participants ranked the topics of ethics and law as applied to pharmacology higher than pre-registration students. Qualified nurses ranked the topic of pharmacokinetics statistically higher than pre-registration students. Equal numbers of qualified participants favoured having pharmacology education as part of pre- and post-qualification programmes, either as a discrete module or incorporated in core modules. Pre-registration participants thought pharmacology education should be integrated throughout the programme. Most participants thought it should be taught face to face in the classroom.

CONCLUSION

pharmacology education is valued by all nurses. Respondents mostly favoured a gradual integration of the subject in a programme of study, face to face.

Best practices for teaching pharmacology to undergraduate nursing students: A systematic review of the literature

OBJECTIVE

In this systematic review we describe best practices for teaching pharmacology to undergraduate baccalaureate nursing students based on the available evidence. Numerous teaching strategies employed in undergraduate pharmacology courses for nursing students have been summarized and compared for their impact on pharmacology knowledge retention, application of pharmacology theory to practice, and student satisfaction. Future directions for research are discussed.

DESIGN

The review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews and meta-analyses.

DATA SOURCES

The Cumulative Index of Nursing and Allied Health Literature (CINAHL), Academic Search Complete, Education Resources Information Center (ERIC), and Education Source and Health Reference Centre Academic were searched using key search terms and phrases. Twenty studies, conducted between 2001 and 2017, met the inclusion criteria.

METHOD

Quality assessment was made in accordance with two appraisal tools: Kirkpatrick's framework and the Medical Education Research Quality Instrument (MERSQI) for quantitative studies.

RESULTS

Online, simulation, and integrated methods of teaching pharmacology were most beneficial for pharmacology knowledge acquisition and student satisfaction. Traditional lecture, problem-based learning, and a flipped classroom were least effective strategies for teaching pharmacology to undergraduate students.

CONCLUSIONS

This systematic review will contribute to the body of knowledge used by nurse educators who teach in undergraduate nursing programs, may be particularly useful for undergraduate nursing program directors/administrators who are considering undergoing curricular changes, and may be a conduit for future researchers who wish to design studies aimed at improving teaching and learning within undergraduate nursing education.

A national approach to medicines information research: A systematic review

BACKGROUND

The Finnish Medicines Agency Fimea published the first National Medicines Information (MI) strategy in 2012. For the purpose of implementing the MI strategy into practice by the national MI Network, a comprehensive inventory of MI research in Finland was needed.

OBJECTIVE

To systematically review literature on MI research conducted in Finland by analyzing and classifying the studies, and identifying the gaps in MI research.

METHODS

Medline, Scopus and Medic databases were searched for peer-reviewed MI publications by using key word screening criteria. The search and extraction process followed PRISMA Guidelines and covered the period from January 2000 to June 2016. Included studies were content analyzed according to MI practices identified, trends over time in research methodology and theory.

RESULTS

Included publications (n = 126) applied a variety of research methods, most often cross-sectional surveys (n = 51, 40% of all studies), but more than half of the studies were qualitative (n = 68, 54%). Twelve were intervention studies of which 6 were randomized and had a control group. Studies were categorized into: patient counseling in different settings (n = 45); MI sources and needs of medicine users (n = 25); healthcare professionals' (HCPs) competence in patient counseling and pharmacotherapy (n = 25); MI sources and needs of HCPs (n = 23); MI education and literacy (n = 13); and MI policies and strategies (n = 3). Most of the studies were descriptive, and only 6 studies applied a theory.

CONCLUSIONS

Regardless of some methodological pitfalls, MI research conducted in Finland since 2000 provides multifaceted understanding of MI practices and their development needs. Research should shift towards larger research lines having a stronger theory base and study designs to deepen the understanding of MI practices and behaviors, and effectiveness of MI in different healthcare settings. Future research should cover also the use of electronic MI sources and services which apply modern information technology to clinical decision making and medication reviews, national MI policy, MI literacy, MI needs of HCPs and consumers.

The psychotropic education and knowledge test for nurses in nursing homes: striving for PEAK performance

OBJECTIVES

The psychotropic education and knowledge test for nurses in acute geriatric care (PEAK-AC) measures knowledge of psychotropic indications, doses and adverse drug reactions in older inpatients. Given the low internal consistency and poor discrimination of certain items, this study aims to adapt the PEAK-AC, validate it in the nursing home setting and identify factors related to nurses' knowledge of psychotropics.

METHOD

This study included nurses and nurse assistants employed by nursing homes (n = 13) and nursing students at educational institutions (n = 5) in Belgium. A Delphi technique was used to establish content validity, the known groups technique for construct validity (n_respondents = 550) and the test-retest procedure for reliability (n_respondents = 42). Internal consistency and item analysis were determined.

RESULTS

The psychotropic education and knowledge test for nurses in nursing homes (PEAK-NH) (n_items = 19) demonstrated reliability (κ = 0.641) and internal consistency (Cronbach's α = 0.773). Significant differences between-group median scores were observed by function (p < 0.001), gender (p = 0.019), educational background (p < 0.001), work experience (p = 0.008) and continuing education (p < 0.001) for depression, delirium and pharmacotherapy topics. Items were acceptably difficult (n_items = 15) and well-functioning discriminators (n_items = 17). Median PEAK-NH score was 9/19 points (interquartile range 6-11 points). Respondents' own estimated knowledge was related to their PEAK-NH performance (p < 0.001).

CONCLUSION

The PEAK-NH is a valid and reliable instrument to measure nurses' knowledge of psychotropics. These results suggest that nurses have limited knowledge of psychotropic use in nursing homes and are aware of their knowledge deficits. The PEAK-NH enables educational initiatives to be targeted and their impact on nurses' knowledge to be tracked.

Performance of Clinical Nurse Educators in Teaching Pharmacology and Medication Management: Nursing Students' Perceptions

Background

Pharmacological knowledge and medication management skills of student nurses greatly depend on the clinical nurse educators’ performance in this critical issue. However, the Iranian nurse educators’ performance in teaching pharmacology and medication management are not adequately studied.

Objectives

The current study aimed to investigate the nursing students’ perceptions on the status of clinical pharmaceutical and medication management education.

Materials and Methods

A cross-sectional study was conducted on all 152 nursing students registered in the seventh and eighth semesters at the Qom and Naragh branches of Islamic Azad University, and Kashan University of Medical Sciences in 2013 - 2014 academic year. The students’ perceptions on the performance of clinical nurse educators in teaching pharmacology and medication management were assessed using a researcher made questionnaire. The questionnaire consisted of 31 items regarding clinical educators’ performance in teaching pharmacology and medication management and two questions about students’ satisfaction with their level of knowledge and skills in pharmacology and medication management. Descriptive statistics was employed and analysis of variance was performed to compare the mean of scores of teaching pharmacology and medication management in the three universities.

Results

Among a total of 152 subjects, 82.9% were female and their mean age was 22.57 ± 1.55 years. According to the students, instructors had the weakest performance in the three items of teaching pharmacology and medication management based on the students’ learning needs, teaching medication management through a patient-centered method and teaching pharmacology and medication management based on the course plan. The students’ satisfaction regarding their own knowledge and skill of pharmacology and medication management was at medium level.

Conclusions

Nursing students gave a relatively low score in several aspects of their instructors’ performance regarding teaching pharmacology and medication management. It seems that many clinical nurse educators in the studied settings were incompetent especially in teaching pharmacology and medication management, while these are critical areas and need special attention.

Effectiveness of the training material in drug-dose calculation skills

AIM

The aim of study was to evaluate the effectiveness of the training material based on low-level environmental fidelity simulation in drug-dose calculation skills in senior nursing students.

METHODS

A quasi-experimental design with one group. The sample included senior nursing students attending a nursing school in Turkey in the period December 2012-January 2013. Eighty-two senior nursing students were included in the sample. Data were obtained using a data collection form which was developed by the researchers. A paired-sample t-test was used to compare the pretest and post-test scores.

RESULTS

The difference between the mean pretest score and the mean post-test score was statistically significant (P < 0.05).

CONCLUSION

This study revealed that the training material based on low-level environmental fidelity simulation positively impacted accurate drug-dose calculation skills in senior nursing students.

Factors associated with nursing students' medication competence at the beginning and end of their education

BACKGROUND

In previous studies, deficiencies in nursing students' medication competence have been highlighted. However, the focus of research has been limited especially to medication calculation competence and factors associated with it. In order to develop undergraduate nursing education and research, an understanding of the individual and learning environmental factors associated with medication competence from a broader approach is warranted. Our aim was therefore to evaluate the theoretical, practical and decision-making competence of nursing students and to identify factors associated with their medication competence at the beginning and end of their education.

METHODS

We used a descriptive, correlational study design with a structured instrument including a set of potential associated factors, knowledge test, medication calculation test and patient vignettes. The participants were nursing students at the beginning (n = 328) and at the end of their education (n = 338). Data were analyzed statistically.

RESULTS

In the evaluation of theoretical medication competence, the students' mean score over the semesters was 72 % correct answers in a knowledge test. In the evaluation of practical medication competence, the mean score was 74 % correct answers in a medication calculation test. In the evaluation of decision-making competence, the mean score was 57 % correct answers on deciding the best action in the situation given in patient vignettes. At the end of their education, students were able to solve patient vignettes significantly better. Individual factors were most evidently associated with medication competence. At the beginning of their education, students' previous academic success had a stronger association with medication competence. However, at the end of the education students' abilities in self-regulated learning and study motivation were more significant factors.

CONCLUSION

The core elements of medication competence are significantly interrelated, highlighting the need to provide integrated and comprehensive medication education throughout the undergraduate education. Students' learning style is associated with medication competence. There is a need for methods to identify and support students having difficulties to self-regulate their learning. To increase the safety of medication care of patients, research focusing on the development of effective teaching methods is needed. This study produced information for future nursing education research in this field, especially for interventional studies.

Nurses' self-reported medication competence in relation to their pharmacovigilant activities in clinical practice

RATIONALE, AIMS AND OBJECTIVES

Adverse drug reactions (ADRs) represent a major health problem and previous studies show that nurses can have an active role in promoting medication safety. The aim of this study was to describe and evaluate nurses' self-reported competence and pharmacovigilant activities in clinical practice and also to explore the impact of age, education, workplace and nursing experience on these matters.

METHODS

This cross-sectional study was based on a questionnaire covering areas related to nurses' medication competence, including knowledge, assessment and information retrieval, and pharmacovigilant activities within these areas, for example, the detection and assessment of ADRs. A 45-item questionnaire was 2013 sent out to 296 nurses in different settings and counties in Sweden. They were selected on the basis of having applied to a university course including pharmacovigilance during 2008-2011. One hundred twenty-four had participated in the courses (exposed) and 172 had applied to the courses but not participated (unexposed).

RESULTS

Completed questionnaires were obtained from 75 exposed (60%) and 93 unexposed (54%) nurses. Overall nurses rated themselves high in medication competence but low in pharmacovigilant activities. Significant (P ≤ 0.001) differences between groups were observed regarding medication competence. The exposure of completed dedicated courses in pharmacovigilance was the strongest factor for self-reported medication competence when adjusted for age, other education, workplace and experience. No significant differences between the groups were found regarding the number of pharmacovigilant activities during the 6 months prior to answering the questionnaire.

CONCLUSION

Dedicated university courses improved nurses' self-reported competence in pharmacovigilance but did not increase the number of related activities. Education per se seems to be not sufficient to generate pharmacovigilant activities among nurses.

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.

Effectiveness of a Clinical Skills Workshop for drug-dosage calculation in a nursing program

BACKGROUND

Mathematical and calculation skills are widely acknowledged as being key nursing competences if patients are to receive care that is both effective and safe. Indeed, weaknesses in mathematical competence may lead to the administration of miscalculated drug doses, which in turn may harm or endanger patients' lives. However, little attention has been given to identifying appropriate teaching and learning strategies that will effectively facilitate the development of these skills in nurses. One such approach may be simulation.

OBJECTIVES

To evaluate the effectiveness of a Clinical Skills Workshop on drug administration that focused on improving the drug-dosage calculation skills of second-year nursing students, with a view to promoting safety in drugs administration.

DESIGN

A descriptive pre-post test design.

SETTINGS

Educational. Simulation center.

PARTICIPANTS

The sample population included 77 nursing students from a Northern Italian University who attended a 30-hour Clinical Skills Workshop over a period of two weeks.

METHODS

The workshop covered integrated teaching strategies and innovative drug-calculation methodologies which have been described to improve psychomotor skills and build cognitive abilities through a greater understanding of mathematics linked to clinical practice.

RESULTS

Study results showed a significant improvement between the pre- and the post-test phases, after the intervention. Pre-test scores ranged between 0 and 25 out of a maximum of 30 points, with a mean score of 15.96 (SD 4.85), and a median score of 17. Post-test scores ranged between 15 and 30 out of 30, with a mean score of 25.2 (SD 3.63) and a median score of 26 (p<0.001).

CONCLUSIONS

Our study shows that Clinical Skills Workshops may be tailored to include teaching techniques that encourage the development of drug-dosage calculation skills, and that training strategies implemented during a Clinical skills Workshop can enhance students' comprehension of mathematical calculations.

Implementation and student evaluation of clinical final examination in nursing education

BACKGROUND

Clinical examinations have a distinct focus, the overall aim being to demonstrate through action whether nursing students have acquired the knowledge and skills necessary to be safe and accountable practitioners. This complexity of knowledge cannot be assessed using single examinations, thus there is a need to develop multiple assessment approaches.

OBJECTIVES

To describe the process of developing valid clinical examinations for nursing students at the end of the final semester and to evaluate students' perceptions of these examination formats.

OUTLINE OF THE DEVELOPMENTAL PROCESS

Based on earlier research, overall goals for the degree of Bachelor of Science in Nursing and guided by both task-related and relational aspects of nursing, two clinical final examinations were developed and tested. One was a standardized test of performance in vitro using Objective Structured Clinical Examination (OSCE) based on five specific areas in which newly graduated nurses had shown deficiencies. The other was a test of performance in real conditions, in vivo, using Bedside Observation Examination (BOE) assessing nurse-patient relation, entirely based on patients' needs.

NURSING STUDENTS' EVALUATION

Three classes of students (n=203) were asked to participate and answer a study-specific questionnaire. The students highly valued the two examinations and perceived that the knowledge and skills tested were relevant to nurses' work. They found the examinations stressful, but at the same time meaningful, and felt they could do themselves full justice through this form of examination.

RECOMMENDATIONS

The assessment test should be chosen depending on the preferred outcome. The OSCE, with its high degree of standardization, is appropriate to use to assess task-related aspects of nursing (show how), while the BOE, with its low degree of standardization, is suitable in real settings and has the potential to capture the relational aspects of nursing (does).

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.

Faculties' and nurses' perspectives regarding knowledge of high-alert medications

The incorrect administration of high-alert medications can have serious consequences. A previous study by the authors of this study developed and validated 20 true-false questions concerning high-alert medications and suggested that the topic be taught to nurses. The perspectives of faculty and nurses, however, needed to be assessed before such teaching could be implemented. The aim of this study was to understand the views of faculty and nurses about training in high-alert medications: its importance, the frequency with which it is provided, and the ideal stage at which it should be provided. A cross-sectional study was conducted in 2008 in Taiwan. A questionnaire was used to determine whether the 20 questions are important, whether its content was being taught, and the ideal time for teaching it. Snowball sampling and descriptive statistics were used. A total of 136 faculty and 199 nurses participated. From the perspectives of faculty and nurses, all 20 questions regarding high-alert medications were important (faculty vs. nurses: 4.65±0.35 vs. 4.45±0.67) but the issues to which they related were insufficiently taught (faculty vs. nurses: 3.88±0.87 vs. 3.06±0.94). Faculty believed that the ideal stage at which to provide training on high-alert medications was during formal, in-school nursing education (94.3%) while nurses believed that the ideal stage was during in-hospital continuing education (48.9%). For training in high-alert medications, the researchers recommended the inclusion of classes on the subject as part of formal, in-school nursing education, as well as of hospital-based continuing education. The instrument's questions highlight the important concepts concerning high-alert medications which should be taught to nurses and nursing students.

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.

Nurse students' medication competence--an integrative review of the associated factors

AIM

The aim of this review was to identify factors associated with nurse students' medication competence.

BACKGROUND

Registered nurses play an important role in safe and effective medication management. Previous nursing literature has highlighted deficiencies in nurse students' medication competence, yet little is known about specific factors which are associated with their medication competence.

METHOD

Integrative literature review.

RESULTS

Nineteen articles met the selection criteria for this review. The main competence area the reviewed articles focused on was medication calculation skills of nurse students. However, a total of twelve factors were identified to be associated with nurse students' medication competence. They constitute three main categories: factors associated with individual nurse students' particular circumstances, the clinical learning environment, and the educational institution. Individual factors such as students' attitudes towards mathematics and their self-confidence seem to be associated most strongly with medication competence.

CONCLUSION

First, based on this review, the focus in medication competence research has been strongly on nurse students' medication calculation skills. Therefore, in future research and practice, attention needs to be paid to other competency areas as well, such as medication administration and patient medication education skills. Second, overall, only a limited amount of research exists that explores what factors are associated with medication competence.

Effectiveness of a computer based medication calculation education and testing programme for nurses

The aim of the study was to evaluate the effect of an on-line, medication calculation education and testing programme. The outcome measures were medication calculation proficiency and self efficacy. This quasi-experimental study involved the administration of questionnaires before and after nurses completed annual medication calculation testing. The study was conducted in two hospitals in south-east Queensland, Australia, which provide a variety of clinical services including obstetrics, paediatrics, ambulatory, mental health, acute and critical care and community services. Participants were registered nurses (RNs) and enrolled nurses with a medication endorsement (EN(Med)) working as clinicians (n=107). Data pertaining to success rate, number of test attempts, self-efficacy, medication calculation error rates and nurses' satisfaction with the programme were collected. Medication calculation scores at first test attempt showed improvement following one year of access to the programme. Two of the self-efficacy subscales improved over time and nurses reported satisfaction with the online programme. Results of this study may facilitate the continuation and expansion of medication calculation and administration education to improve nursing knowledge, inform practise and directly improve patient safety.

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.

Registered nurses' everyday activities in municipal health care: a study of diaries

This study described the work content of registered nurses (RNs) employed in municipal health care. Diary notes of three working days from 34 RNs were analysed using content analysis, and a total of 3185 activities were identified. Of these, 2807 were analysed further and grouped by comparing similarities and differences. The content of the RNs' nursing activities consisted of assessing health, giving treatments and conducting check-ups, handling pharmaceuticals and teaching. In the administration category, the content comprised planning and reporting, followed by documentation. The RNs' role in municipal health care is consultative, which reinforces their need for competence in advanced nursing, as well as in leadership and pedagogy. RNs mostly work without colleagues and they are responsible for many seriously ill patients. In order to be confident in providing qualified nursing, specialist nursing education in elderly care is needed.

Learning for holistic care: addressing practical wisdom (phronesis) and the spiritual sphere

AIM

This paper is a discussion of practical wisdom (phronesis) and spirituality in holistic caring and strategies to facilitate their application in nurse education.

BACKGROUND

Phronesis, with its inherent spiritual qualities, is an established aspect of the persona of excellent clinical leaders. There is a strong case for recognizing the value of this characteristic in all nurses, and a strategy is required for engendering the development of phronesis during nurse education.

DATA SOURCES

Electronic searches of Google Scholar and CINAHL were conducted for English language publications in the period 1996-2008. Search terms included combinations of phronesis, spirituality, health, education, pharmacology, medicines and medication education, holistic care and spiritual care. Selection of items for inclusion was based on their pertinence to the arguments being developed and their value as leads to earlier material.

DISCUSSION

The links between the attributes of effective clinical leaders and those required for holistic caring are explicated and related to phronesis, the acquisition of which involves spiritual development. An explanatory account of phronesis and its applicability to nursing leads to an explanation of how its spiritual aspects in particular might be incorporated into learning for holistic care. Reference to research in medicines-related education illustrates how the principles can be applied in nurse education.

CONCLUSION

Nursing quality could be enhanced if adequate opportunities for acquiring phronesis through experiential learning were provided in nursing curricula. Phronesis and spiritual care could be incorporated into existing models of nursing care or new models devised to use these critical concepts.

Facing registration: the expectations and the unexpected

This paper reports on newly qualified nurses' experiences of the transition from being a nursing student to becoming a registered nurse. The aim of the study was to ascertain how newly qualified nurses perceived their role transition in an Irish general hospital. Data were gathered using in-depth interviews with 12 nurses who were within one year of qualification. A grounded theory approach was used to generate, analyse and synthesise the data. The findings revealed that newly qualified nurses have specific needs, many of which are unrealised. The vast and increased workload, which involved less patient-contact and more non-nursing duties, came as a surprise to participants in this study. The expectation of in-depth knowledge, coupled with feelings of increased responsibility and compounded by relatively little experience did little to ease the transition to becoming a newly qualified nurse. There is a need to contextualise the transition to registration so that expectations of newly qualified nurses are realistic. Management and staff must remain cognisant of the fact that many newly registered nurses have relatively limited clinical experience at the time of registration.