An integrative review of the literature on registered nurses’ medication competence

Final year nursing students' preparedness for medication administration during COVID-19: A multi-site survey study

AIM

To examine final-year undergraduate nursing students' characteristics and their perceived preparedness for medication administration across three universities during COVID-19.

BACKGROUND

Medication administration is a complex process and medication errors can cause harm to the patient. Nurses are at the frontline of medication administration; therefore, nursing students must be well-prepared to administer medicines safely before graduation. Little is known about final-year undergraduate nursing students' perceived medication administration preparedness during COVID-19.

DESIGN

A multi-site study using a cross-sectional survey of student demographics, the 'Preparedness for Medication Administration' (Revised) tool and an open-ended question.

METHODS

The questionnaire was distributed to nursing students in their final semester of the program in 2022 across two universities in Australia and one in New Zealand. Completed surveys n=214. Descriptive statistics were used to analyse the demographic data. Differences in demographic data and preparedness scores between the three universities were analysed using ranked means, correlation coefficient, Chi-Square, Mann- Whitney U and Kruskal- Wallace H. Directed content analysis was used to analyse the data from the open-ended question.

RESULTS

Overall, students reported high preparedness scores for medication. International students reported significantly higher preparedness scores (Md =119, n=29) compared with domestic students (Md=112.00, n=164), U=1759.50, z=-2.231, p=02, r=.16. Mean ranked scores for each item were above average across the three universities. The impact of COVID-19 on curriculum and students' opportunity to practice may be one explanation for the difference in preparedness scores between universities. International participants reported significantly higher scores on the Preparedness for Medication Administration (Revised) tool than domestic participants. Older students were more confident in applying principles of pharmacology to practice. Students' comments generated three major categories and five subcategories indicating preparedness gaps.

CONCLUSION

This study provides insights into students' medication management preparedness during restrictions and before transitioning to the role of Registered Nurse. It highlights the need to provide integrated and comprehensive medication education and assessments throughout the curriculum and the need for additional support for newly graduated nurses in medication management due to the restrictions.

Call for Decision Support for High-Alert Medication Administration Among Pediatric Nurses: Findings From a Large, Multicenter, Cross-Sectional Survey in China

Background: Children have a higher risk of medication errors (MEs) than adults. The Institute for Safe Medication Practice (ISMP) defined high-alert medications (HAMs) as a group of medications that could cause significant patient harm or even death when they are used in error. Nurses are actively involved in and responsible for patient care, especially in medication administration. This study aimed to estimate the knowledge, decision-making basis and confidence and decision support needs related to HAMs among pediatric nurses in China.

Methods: A web-based, cross-sectional survey was conducted among pediatric nurses who were recruited from 14 member hospitals of the Pediatric Nursing Alliance of National Children’s Medical Center in China using a convenient sampling technique. Data were collected using a self-administered instrument composed of four parts: the demographic characteristics of participants, participants’ knowledge about HAMs, participants’ self-evaluation of the basis of and confidence in decision-making, and decision support needs regarding HAMs. Among the participants, the maximum score for HAM knowledge was 100. All data were entered and analyzed using SPSS 20.0.

Results: A total of 966 nurses participated in this study. Nurses were found to have insufficient knowledge about HAMs, with a median (IQR) of 75.0 (70.0, 80.0), out of a maximum score of 100. Knowledge about HAM administration was significantly higher than that about HAM regulation, with a p value < 0.001. The three lowest-scoring items concerned HAM regulation, and the “Treat fentanyl skin patches as a regulated narcotic” item obtained the lowest score, with only 1/5 of respondents answering it correctly. Most participants reported that their basis for decision-making about HAMs was drug instructions (90.0%) or drug handbooks (81.9%) and evaluated their confidence in decision-making about HAMs as high or relatively high (84.6%). The decision-making difficulties when encountering HAMs focused on most stages of HAM administration, especially the appropriateness of prescriptions, checks, preparation and administration. The vast majority of participants assessed decision support as necessary or very necessary (92.0%), and the most popular options for decision support were computerized clinical decision support systems (46.4%) and real-time online communication with pharmacists (23.9%).

Conclusion: Our study demonstrated the inadequacies in HAM knowledge, the basis and difficulty of decision-making, and decision support needs regarding HAMs in Chinese pediatric nurses. Nurses need greater support in HAM administration, including not only training but also adequate technology, mutually beneficial interprofessional collaboration, and a positive institutional culture.

Practical Considerations of PRN Medicines Management: An Integrative Systematic Review

Background and objectives: Highly widespread use of pro re nata (PRN) medicines in various healthcare settings is a potential area for improper medication prescription and administration leading to patient harm. This study aimed to summarize and integrate the findings of all relevant individual studies regarding the practical considerations of PRN medicines management including strategies and interventions by healthcare professionals for safe prescription, dispensing, administration, monitoring, and deprescription of PRN medicines in healthcare settings. Methods: An integrative systematic review on international databases were performed. Electronic databases including Web of Knowledge, Scopus, PubMed (including MEDLINE), and Cinahl were searched to retrieve articles published until end of May 2021. Original qualitative, quantitative, and mixed methods studies written in English were included with a focus on PRN medicines management in healthcare settings. Research synthesis using the narrative method was performed to summarise the results of included studies. Results: Thirty-one studies on PRN medicines in healthcare settings by different healthcare providers were included after the screening of the databases based on eligibility criteria. They were published from 1987 to 2021. The majority of studies were from Australia, the United States, Canada, and the United Kingdom and were conducted in psychiatric settings. Given variations in their purposes, methods, and outcomes, the research synthesis was conducted narratively based on diversities and similarities in findings. Eight categories were developed by the authors as follows: "PRN indications and precautionary measures," "requirements of PRN prescription," "interventions for PRN administration," "monitoring and follow up interventions," "deprescription strategies," "healthcare professionals' role," "participation of patients and families," and "multidisciplinary collaboration." Each category consists of several items and describes what factors should be considered by healthcare professionals for PRN medicines management. Conclusion: The review findings provide insights on the practical considerations of PRN medicines management in clinical practice. The suggested list of considerations in our review can be used by healthcare professionals for optimal PRN medicines management and safeguarding patient care.

Assessing Nursing Students' Self-Perceptions about Safe Medication Management: Design and Validation of a Tool, the NURSPeM

Objective: The objective was to design and validate a tool for assessing nursing students’ self-perceptions about safe medication management. Methods: A descriptive instrumental study was conducted involving construct definition, development of the tool, analysis of the content validity, and psychometric evaluation. Consensus regarding the content was obtained through a two-round Delphi process, and the resulting tool (the NURSPeM) was administered to nursing students to examine its internal consistency, temporal stability, and construct validity, the latter through exploratory factor analysis. Results: Thirteen experts participated in the Delphi process, which yielded a tool comprising two questionnaires: (1) Self-perceptions about safe medication management (27 items) and (2) the frequency and learning of drug-dose calculation (13 items). The tool’s psychometric properties were then examined based on responses from 559 nursing students. This analysis led to the elimination of three items from questionnaire 1, leaving a total of 24 items distributed across seven dimensions. All 13 items in questionnaire 2 were retained. Both questionnaires showed good internal consistency (Cronbach’s alpha = 0.894 and 0.893, respectively) and temporal stability (ICC = 0.894 and 0.846, respectively). Conclusions: The NURSPeM is a valid and reliable tool for assessing nursing students’ self-perceptions about safe medication management. It may be used to identify areas in which their training needs to be enhanced, and to evaluate the subsequent impact of new teaching initiatives.

Older Adults Living in Sheltered Housing's Experiences of Involvement in Pro Re Nata Decisions. A Narrative Positioning Analysis

Decisions regarding pro re nata medications might be challenging due to the complex nature of the practice. The aim of this study was to expand our understanding of the experiences of older people living in sheltered housings with regard to shared decision-making concerning pro re nata medications. In this study, we conducted in-depth interviews with residents living in Norwegian sheltered housings. The analysis was inductive, based on a narrative positioning analysis. Twelve residents were interviewed, and three narratives representing participants’ variation are presented. People take different positions in shared decision-making of pro re nata medication, and they position themselves variously at different levels and situations. Prevailing master narratives affect the residents’ positions in shared decision-making. Contrasts in older adults’ experiences indicate that shared decision-making is not straightforward and is highly reliant on the context. Seemingly, they wish to be involved and not involved at the same time, a contradiction that healthcare providers need to consider.

Nurses competence in the reporting of medication-related incidents: An intervention study

Objectives

Less than 5% of all harmful medicine‐related incidents (MIs) or adverse drug reactions received by the Spanish Pharmacovigilance system are notified by Registered Nurses (RNs). The main objective of this study was to determine the impact of a multifaceted institutional intervention (MII) in patient safety on the reporting competence of medication incidents of hospital RNs.

Design

One‐group pre‐test–posttest design.

Setting

Tertiary, public, teaching hospital in Spain.

Participants

A total of 139 RNs responded to pre‐ and postintervention questionnaires constituting the paired sample subjected to analysis.

Intervention

A MII, consisting of educational activities and materials, change in MI reporting form from paper to electronic and appointment of reporting support services, was designed and directed to all hospital RNs and midwifes.

Main outcome measures

Overall MIs reporting competence (OC) and its dimensions (attitudes, knowledge and skills) were measured through a synthetic variable (total OC value range: 34–170 points) by means of an electronic questionnaire.

Results

A statistically significant 7.96‐point increase in OC from baseline to the final measurement was obtained (CI: 5.05–10.85). There was an increase of 7.38 points in the skills dimension (CI: 5.06–9.68). After the MII, 73.4% nurses improved their OC and 33.8% reported at least one no‐harm MI postintervention compared to 4.4% pre‐intervention (p < .001). A one‐point increase in OC improved the probability of becoming reporter by 2.9% and a one‐point increase in skills by 6.4%.

Conclusion

MIs reporting competence among RNs increased after a multifaceted institutional intervention, due to an improvement in the skills dimension. The MII was also effective in raising both, the rate of RNs who become reporters and the number of no‐harm MIs reported.

Medication calculation skills of graduating nursing students within European context

AIM

The aim of this study is to evaluate the medication calculation skills of graduating nursing students in six European countries and analyse the associated factors.

BACKGROUND

Medication calculation skills are fundamental to medication safety, which is a substantial part of patient safety. Previous studies have raised concerns about the medication calculation skills of nurses and nursing students.

DESIGN

As part of a broader research project, this study applies a multinational cross-sectional survey design with three populations: graduating nursing students, nurse managers and patients.

METHODS

The students performed two calculations (tablet and fluid) testing medication calculation skills requiring different levels of conceptual understanding and arithmetic. The managers and patients answered one question about the students' medication kills. In total, 1,796 students, 538 managers and 1,327 patients participated the study. The data were analysed statistically. The STROBE guideline for cross-sectional studies was applied.

RESULTS

Almost all (99%) of the students performed the tablet calculation correctly, and the majority (71%) answered the fluid calculation correctly. Older age, a previous degree in health care and satisfaction with their current degree programme was positively associated with correct fluid calculations. The patients evaluated the students' medication skills higher than the nurse managers did and the evaluations were not systematically aligned with the calculation skills tested.

CONCLUSIONS

Nursing students have the skills to perform simple medication calculations, but a significant number of students have difficulties with calculations involving multiple operations and a higher level of conceptual understanding. Due to the variation in students' medication calculation skills and the unalignment between the managers' and patients' evaluations and the calculation tests, further research is needed.

RELEVANCE TO CLINICAL PRACTICE

Graduating nursing students enter clinical field as qualified professionals, but there is still room for improvement in their medication calculation skills. This calls for attention in the fields of clinical nursing, education and research.

The impact of online synchronous simulated clinical immersions on nursing students' pharmacology self-efficacy: A pre-test post-test intervention pilot study

BACKGROUND

Medication errors are fatally significant, posing considerable threats to patient safety. To date, there is a lack of literature and no consistent recommended nursing pharmacology curriculum design to improve nursing students' pharmacology self-efficacy.

PURPOSE

The purpose of this pilot study is to examine the effects of nursing pharmacology synchronous online scrabbling active learning classroom design with simulated clinical immersion experiences on the students' self-efficacy and perceived pharmacology knowledge acquisition.

METHODS

A pretest-posttest intervention design was used with a convenience sample of (n = 34) accelerated nursing students. The intervention included an online synchronous scrabbling active learning classroom design with simulated clinical immersion experiences for eight weeks. The Motivated Strategies for Learning Self-Efficacy Subscale (MSLQ-SE) questionnaire was applied before and after the intervention. The Survey for Knowledge Acquisition and Application (SKAA) was used post-intervention. The students also provided narrative, open-ended responses regarding their perceptions of the synchronous simulated clinical experiences.

RESULTS

The results of the simulated clinical immersions presented an improvement in self-efficacy scores. A one tailed paired t-test presented a significant increase from MSLQ-SE pre-test scores (M = 31.2, SD = 4.8) to MSLQ-SE post-test scores (M = 32.9, SD = 4.3); (t(33) = -2.1, p = .02). The SKAA results presented that the students perceived that simulated clinical immersions were promoting authentic learning and confidence.

CONCLUSION

The finding of this study is significant to nursing pharmacology education. The online synchronous simulated clinical immersion experiences improved overall self-efficacy scores and provide an authentic teaching approach to connect pharmacology theory to the clinical practice.

Teaching bioscience to nursing students-What works?

AIM

To compare the effects of flipped classroom and traditional auditorium lectures, on nursing students' examination results in bioscience.

DESIGN

An educational intervention study.

METHODS

All the first-year students in the bachelor programme (N = 493) were entered into a database and randomly assigned to the intervention or the control group in a course in bioscience. The outcome measures are the proportion of students who passed the examination, and the distribution of grades from A to E. Chi-square tests and Mann-Whitney Wilcoxon test were used. The odds to pass versus fail were modelled using binary logistic regression.

RESULTS

The proportion of students who did not pass the final examination was very similar in the intervention and the control groups, 21.4% and 23.6% (p = .574). Our data did not reveal any statistically significant differences concerning the distribution of grades (p = .691). Students with biology and/or natural science had higher odds for passing.

A realist evaluation of a safe medication administration education programme

BACKGROUND

Continuing professional education (CPE) for nurses is deemed an essential component to develop, maintain and update professional skills. However, there is little empirical evidence of its effectiveness or factors which may influence its application into practice.

OBJECTIVE

This paper explores a continuing professional education programme on the safe administration of medication and how new knowledge and skills are transferred into clinical practice.

DESIGN

Realist evaluation provided the framework for this study. Realist evaluation stresses the need to evaluate programmes within "context," and to ask what "mechanisms" are acting to produce which "outcomes." This realist evaluation had four distinct stages. Firstly, theories were built as conjectured CMO configurations (Stage 1 and 2), then these cCMO were tested (Stage 3) and they were then refined (Stage 4).

METHODS

Data was collected through document analysis and interviews (9) to build and refine CMOs. The conjectured CMOs were tested by clinical observation, interview (7), analysis of further documents and analysis of data from reported critical incidents and nursing care metric measurements.

RESULTS

This study has shown the significant role of the ward manager in the application of new learning from the education programme to practice. Local leadership was found to enable a patient safety culture and the adoption of a quality improvement approach. The multi-disciplinary team at both organisation and local level was also found to be a significant context for the application of the education programme into practice. Reasoning skills and receptivity to change were identified to be key mechanisms which were enabled within the described contexts.

CONCLUSION

The findings from this study should inform policy and practice on the factors required to ensure learning from CPE is applied in practice. The realist evaluation framework should be applied when evaluating CPE programmes as the rationale for such programmes is to maintain and improve patient care.

Factors Related to the Clinical Competence of Registered Nurses: Systematic Review and Meta-Analysis

PURPOSE

To determine the factors associated with the clinical competence of registered nurses.

METHODS

Systematic review and meta-analysis was used. The search strategy was limited to 10 years, ranging from January 2009 to December 2019, in Science Direct, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, ProQuest, and Google Scholar. A meta-analysis was performed using R Studio with the metafor package (Boston, MA, USA; https://rstudio.com/products/rstudio/older-versions/).

RESULTS

A total of 22 studies were included, representing 33,961 nurses. There were 28 factors associated with clinical competence. Of those, 13 factors were significantly supported and included for meta-analysis, grouped into (a) individual-related factors, (b) job satisfaction, (c) bullying, (d) burnout, and (d) specific knowledge. The effect size of those factors ranged from -0.14 to 0.50.

CONCLUSIONS

Among individual-related factors, salary has the largest effect size on competence and is considered important. Clinical competence is positively affected by job satisfaction, but negatively influenced by bullying and burnout. Although specific knowledge has a large effect size, it does not significantly affect the clinical competence of registered nurses.

CLINICAL RELEVANCE

It is critical to understand factors related to the clinical competence of registered nurses to maintain quality care and patient outcomes in clinical settings. The findings serve as data to help nurse managers find effective ways to improve the knowledge, skill, attitudes, and performance of registered nurses.

'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.

Psychometric Properties of the Brazilian Version of the Nurses' Knowledge of High-Alert Medications Scale: A Pilot Study

BACKGROUND AND PURPOSE

High-alert medication is considered to be a medication that presents a high risk of causing significant patient harm when used erroneously and its consequences can be fatal. The Nurses' Knowledge of High-Alert Medication scale (NKHAM) is a tool available to evaluate the knowledge of nurses in practice about this issue.

AIM

This pilot study aimed to measure the reliability and known-groups validity of the Brazilian version of the NKHAM.

METHODS

This pilot psychometric study was carried out at the Faculty of Nursing and University Hospital of the University of Campinas, São Paulo, Brazil. Forty nursing students and 44 registered nurses working in complex clinical or surgical settings completed a sociodemographic questionnaire and the Brazilian version of the NKHAM. The Kuder-Richardson 20 (KR-20) coefficient and Mann-Whitney test were used to establish reliability and known-groups validity. A significance level of ≤ 0.05 was adopted for all the analyses.

RESULTS

Analyses demonstrated preliminary acceptable reliability scores of 0.55 and 0.60 in domains A and B of NKHAM, respectively. A significant difference was found between the nursing students' and the registered nurses' knowledge of high-alert medications, demonstrating the scale's ability to discriminate between the two groups.

IMPLICATIONS FOR PRACTICE

Although this is pilot study, results suggest that the Brazilian version of the NKHAM might be a reliable and valid tool to measure nurses' knowledge of high-alert medications.

Registered Nurses' medication administration skills: a systematic review

AIMS

The aim of this review was to identify methods for measuring Registered Nurses' medication administration skills and to describe these skills.

DESIGN

A systematic literature review.

DATA SOURCES

The CINAHL, PubMed, Scopus, Cochrane, PsycInfo and Medic databases were searched for articles from the period 2007-2018.

REVIEW METHODS

Two researchers independently selected the articles and evaluated their quality using the National Heart, Lung and Blood Institute study quality assessment tools. The data were analysed using content analysis.

RESULTS

A total of 727 studies were identified of which 22 studies were included in this review. A total of six different measurement methods were identified: questionnaire or survey, observation, knowledge test or exam, focus group interviews, chart reviews and voluntarily reported errors. Different methods provided different information on medication administration skills. Medication administration skills were classified under nine areas: (1) safe ordering, handling, storing and discarding of medications, (2) preparing of medications, (3) the administration of medications to patients, (4) documentation, (5) evaluation and assessment of medication-related issues, (6) drug calculation skills, (7) cooperation with other professionals and (8) with the patients and (9) reporting of medication information. The results demonstrated that there are many areas that need to be improved to increase medication safety.

CONCLUSIONS

Medication administration includes many different phases, as a result of which nurses need to have many various skills to cope with medication administration as required by their profession. This review shows that nurses' medication administration skills need to be developed, and special attention should be paid to the preparation and administration phases. It is important to regularly utilise different teaching strategies and verify nurses' medication competence. As each research method has different limitations, it is vital that further studies combine different methods to form a comprehensive picture of nurses' medication administration skills.

Medication error encouragement training: A quasi-experimental study

BACKGROUND

Medication errors are the most common clinical errors in healthcare practice and can lead to serious consequences. Medication error encouragement training (MEET) brings students face-to-face with potential errors in the medication process, in a safe environment where they are encouraged to understand both the error and the context in which it occurred.

OBJECTIVES

The study aimed to examine the effects of a MEET intervention on medication safety confidence among nursing undergraduates.

DESIGN

This was a quasi-experimental study with a nonequivalent control group design.

PARTICIPANTS

Our sample was recruited from the nursing education department of a university, with 47 participants randomly assigned to the experimental group, and 50 to the control group.

METHODS

Both groups received theoretical training, followed by applied training. The experimental group received the MEET intervention developed specifically for this study, while the control group received traditional error avoidance training. Participants' medication administration confidence was measured pre- and post-intervention.

RESULTS

Following training, the experimental group's confidence was significantly higher than that of the control group. With regard to individual medication administration procedures, the experimental groups' medication safety confidence increased significantly after training compared to the control group in patient identification, drug information confirmation, and drug preparation.

CONCLUSIONS

Introducing MEET into nursing curricula could reduce medication errors and related complications in healthcare institutions. Further studies are needed to investigate the long-term effects of MEET interventions, as well as the generalizability of our findings.

Canonical correlations between individual self-efficacy/organizational bottom-up approach and perceived barriers to reporting medication errors: a multicenter study

Background

Individual and organizational factors correlate with perceived barriers to error reporting. Understanding medication administration errors (MAEs) reduces confusion about error definitions, raises perceptions of MAEs, and allows healthcare providers to report perceived and identified errors more frequently. Therefore, an emphasis must be placed on medication competence, including medication administration knowledge and decision-making. It can be helpful to utilize an organizational approach, such as collaboration between nurses and physicians, but this type of approach is difficult to establish and maintain because patient-safety culture starts at the highest levels of the healthcare organization. This study aimed to examine the canonical correlations of an individual self-efficacy/bottom-up organizational approach variable set with perceived barriers to reporting MAEs among nurses.

Methods

We surveyed 218 staff nurses in Korea. The measurement tools included a questionnaire on knowledge of high-alert medication, nursing decision-making, nurse-physician collaboration satisfaction, and barriers to reporting MAEs. Descriptive statistics, t-tests, analysis of variance (ANOVA), Pearson’s correlation coefficient, and canonical correlations were used to analyze results.

Results

Two canonical variables were significant. The first variate indicated that less knowledge about medication administration (− 0.83) and a higher perception of nurse-physician collaboration (0.42) were related to higher disagreement over medication error (0.64). The second variate showed that intuitive clinical decision-making (− 0.57) and a higher perception of nurse-physician collaboration (0.84) were related to lower perceived barriers to reporting MAEs.

Conclusions

Enhancing positive collaboration among healthcare professionals and promoting analytic decision-making supported by sufficient knowledge could facilitate MAE reporting by nurses. In the clinical phase, providing medication administration education and improving collaboration may reduce disagreement about the occurrence of errors and facilitate MAE reporting. In the policy phase, developing an evidence-based reporting system that informs analytic decision-making may reduce the perceived barriers to MAE reporting.

Nursing student perceptions of pharmacology education and safe medication administration: A qualitative research study

PURPOSE

This research study was performed to elicit student nurses' perceptions of the impact of pharmacology in education on safe medication administration.

OBJECTIVES

The purpose of this study was to describe student perceptions of the relationship between pharmacology education and safe clinical practice. Nurse educators will gain insights into students' perceptions of the significance of pharmacology in baccalaureate curricula.

BACKGROUND

A lack of adequate pharmacological knowledge in nursing has been shown to lead to increased medication errors. Safe administration of medication has been identified as a major area for focus in improving health care.

DESIGN

This study was an analysis of qualitative data collected as part of a larger study. Students provided narrative, open-ended responses describing how pharmacology education impacted safe medication administration.

PARTICIPANTS

The sample consisted of 28 RN-BSN students and 71 traditional BSN students.

SETTING

The research was conducted at a college in the Northeastern United States. Data was collected from students enrolled in the traditional baccalaureate and nontraditional RN-BSN hybrid programs.

METHODS

In the full study, students completed a brief survey instrument, which included both quantitative and open-ended items. The qualitative data presented in this article was analyzed using conventional content analysis.

RESULTS

Students described the impact of pharmacology education as either having a positive or negative effect on safe medication administration. The majority of students described a positive effect. Positive responses were characterized into the following themes: Knowing how medications work, Improving the nursing process, and Building a foundation of clinical knowledge. Negative responses were more heavily endorsed by RN-BSN students. The negative responses were substantiated by one theme: Inability to transfer from didactic to clinical practice.

CONCLUSIONS

The findings of this study are significant to education as nursing schools struggle to develop curriculum to prepare students for safe medication practice in today's fast-paced and demanding healthcare environment.

NMC consultation on proficiencies to be met for registration

Emeritus Professor Alan Glasper, from the University of Southampton, discusses the Nursing and Midwifery Council's public consultation on the efficacy of its new draft standards for pre-registration nursing education.

Measuring Registered Nurses' Medication Competence in Specialty Settings: An Operating Room Registered Nurse Example

Nursing professional development practitioners play an active, vital role in shaping, implementing, and evaluating competency models in their organizations. This article describes a process for developing and continuously improving knowledge assessment examinations, one component of a competency model. The article defends the use of specialty-specific medication knowledge assessment examinations. The authors recommend future investigations to link nurses' knowledge assessment results to performance in practice and to analyze costs and benefits of knowledge assessment examinations.

Learning outcomes associated with patient simulation method in pharmacotherapy education: an integrative review

STATEMENT

The aims of this systematic integrative review were to identify evidence for the use of patient simulation teaching methods in pharmacotherapy education and to explore related learning outcomes. A systematic literature search was conducted using 6 databases as follows: CINAHL, PubMed, SCOPUS, ERIC, MEDIC, and the Cochrane Library, using the key words relating to patient simulation and pharmacotherapy. The methodological quality of each study was evaluated. Eighteen articles met the inclusion criteria. The earliest article was published in 2005. The selected research articles were subjected to qualitative content analysis. Patient simulation has been used in pharmacotherapy education for preregistration nursing, dental, medical, and pharmacy students and for the continuing education of nurses. Learning outcomes reported were summarized as follows: (1) commitment to pharmacotherapy learning, (2) development of pharmacotherapy evaluation skills, (3) improvement in pharmacotherapy application skills, and (4) knowledge and understanding of pharmacotherapy. To develop effective teaching methods and ensure health care professionals' competence in medication management, further research is needed to determine the educational and clinical effectiveness of simulation teaching methods.

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.

Medication competency of nurses according to theoretical and drug calculation online exams: A descriptive correlational study

BACKGROUND

Medication administration is an important task of registered nurses. According to previous studies, nurses lack theoretical knowledge and drug calculation skills and knowledge-based mistakes do occur in clinical practice. Finnish health care organizations started to develop a systematic verification processes for medication competence at the end of the last decade. No studies have yet been made of nurses' theoretical knowledge and drug calculation skills according to these online exams.

OBJECTIVES

The aim of this study was to describe the medication competence of Finnish nurses according to theoretical and drug calculation exams.

DESIGN

A descriptive correlation design was adopted. Participants and settings All nurses who participated in the online exam in three Finnish hospitals between 1.1.2009 and 31.05.2014 were selected to the study (n=2479).

METHODS

Quantitative methods like Pearson's chi-squared tests, analysis of variance (ANOVA) with post hoc Tukey tests and Pearson's correlation coefficient were used to test the existence of relationships between dependent and independent variables.

RESULTS

The majority of nurses mastered the theoretical knowledge needed in medication administration, but 5% of the nurses struggled with passing the drug calculation exam. Theoretical knowledge and drug calculation skills were better in acute care units than in the other units and younger nurses achieved better results in both exams than their older colleagues.

CONCLUSION

The differences found in this study were statistically significant, but not high. Nevertheless, even the tiniest deficiency in theoretical knowledge and drug calculation skills should be focused on. It is important to identify the nurses who struggle in the exams and to plan targeted educational interventions for supporting them. The next step is to study if verification of medication competence has an effect on patient safety.

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.

Measuring the impact of an interprofessional multimedia learning resource on Japanese nurses and nursing students using the Theory of Planned Behavior Medication Safety Questionnaire

Interprofessional communication and teamwork are essential for medication safety; however, limited educational opportunities for health professionals and students to develop these skills exist in Japan. This study evaluated the impact of an interprofessional multimedia learning resource on registered nurses' and nursing students' intention to practice in a manner promoting medication safety. Using a quasi-experimental design, Japanese registered nurses and nursing students (n = 203) were allocated to an experimental (n = 109) or control group (n = 94). Behavioral intentions of medication safety and the predictor variables of attitudes, perceived behavioral control, and subjective norms were measured using a Japanese version of the Theory of Planned Behavior Medication Safety Questionnaire. Registered nurses in the experimental group demonstrated a greater intention to collaborate and practice in a manner that enhanced medication safety, evidenced by higher scores than the control group on all predictor variables. The results demonstrate the potential for interprofessional multimedia learning resources to positively impact the behaviors of Japanese registered nurses in relation to safe medication practices. Further research in other contexts and with other cohorts is warranted.

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.

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.

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.