A survey and multilevel analysis of nursing unit tenure diversity and medication errors

Original Research: Exploring Medication Safety Practices from the Nurse's Perspective

BACKGROUND

Medication preparation and administration are complex tasks that nurses must perform daily within today's complicated health care environment. Despite more than two decades of efforts to reduce medication errors, it's well known that such errors remain prevalent. Obtaining insight from direct care nurses may clarify where opportunities for improvement exist and guide future efforts to do so.

PURPOSE

The study purpose was to explore direct care nurses' perspectives on and experiences with medication safety practices and errors.

METHODS

A qualitative descriptive study was conducted among direct care nurses employed across a large health care system. Data were collected using semistructured interview questions with participants in focus groups and one-on-one meetings and were analyzed using qualitative direct content analysis.

RESULTS

A total of 21 direct care nurses participated. Four major themes emerged that impact the medication safety practices of and errors by nurses: the care environment, nurse competency, system influences, and the error paradigm. These themes were often interrelated. Most participants depicted chaotic environments, heavy nursing workloads, and distractions and interruptions as increasing the risk of medication errors. Many seemed unsure about what an error was or could be.

CONCLUSIONS

The complexity of medication safety practices makes it difficult to implement improvement strategies. Understanding the perspectives and experiences of direct care nurses is imperative to implementing such strategies effectively. Based on the study findings, potential solutions should include actively addressing environmental barriers to safe medication practices, ensuring more robust medication management education and training (including guidance regarding the definition of medication errors and the importance of reporting), and revising policies and procedures with input from direct care nurses.

Scaffolding safety in nursing simulation: A grounded theory

BACKGROUND

Simulation-based learning is a teaching technique that allows learners to apply theoretical knowledge to enhance patient safety. Despite limited evidence about the relationship between simulation and patient safety outcomes, nursing programs continue using simulation to improve student competencies.

PURPOSE

To explore the processes driving the actions of nursing students while providing care for a rapidly deteriorating patient during a simulation-based experience.

METHOD

Following the constructivist grounded theory method, the study recruited 32 undergraduate nursing students to explore their experiences during simulation-based experiences. Data were collected using semi-structured interviews over 12 months. Interviews were recorded, transcribed and analyzed using constant comparison and simultaneous data collection, coding, and analysis.

RESULTS

Two theoretical categories emerged from the data to explain the processes driving the students' actions during simulation-based experiences: Nurturing and contextualizing safety. The themes revolved around a core category of "Scaffolding Safety" in simulation.

CONCLUSION

Simulation facilitators can use the findings to build effective and targeted simulation scenarios. Scaffolding safety steers students' thinking and contextualizes patients' safety. It can be utilized as a lens to guide students and assist them with transferring skills from simulation to the clinical practice setting. Nurse educators should consider deliberately integrating the concepts of scaffolding safety into simulation-based experiences to connect theory and practice.

A Quantitative Research Study Protocol to Advance Simulation Science in Nursing Education

AIM

This article describes a quantitative simulation study protocol and identifies important methodological considerations for future high-level, rigorous quantitative simulation studies.

BACKGROUND

Quantitative simulation research studies have been found to be lacking in their conceptualization, study design, and measurement of outcomes, with small samples and lack of rigor in overall study methods.

METHOD

This protocol reflects research priorities of organizations that drive simulation science and nursing education, published standards of simulation best practice, and use of research methodology within and outside the simulation literature, which includes psychometrically sound instruments and outcomes of importance to cognitive and simulation science.

RESULTS

The protocol was a multisite, longitudinal study, guided by the integrative model of clinical judgment, with a high degree of intervention fidelity to measure the study outcomes of clinical judgment and clinical competence.

CONCLUSION

To advance simulation science, rigorous study protocols, reflective of the one described in this article, are needed.

Internal Reliability Estimates of the Lasater Clinical Judgment Rubric Among New-to-Practice Nurses in a Simulated Setting

ABSTRACT

Clinical judgment among new-to-practice nurses is critical for safe patient care. The Lasater Clinical Judgment Rubric (LCJR) is a known instrument in undergraduate nursing education research. This study evaluated the internal consistency reliability and changes in the LCJR in a sample of 17 new-to-practice nurses in a simulated setting across four measurements. Cronbach's alpha reliability for the LCJR was .90. Effect sizes (η2) ranged from .01 to .45, with only the reflecting subscale demonstrating an effect. Study team and study participants' self-ratings on the LCJR were compared; team members' ratings were significantly lower than participants' self-ratings.

Efficacy of a Simulation Program to Improve Clinical Judgment and Clinical Competence Among Graduate Nurses

AIM

This two-group feasibility study tested the efficacy of a four-scenario simulation program to improve clinical judgment and clinical competence among graduate nurses.

BACKGROUND

Clinical judgment and clinical competence are underdeveloped among new-to-practice nurses.

METHOD

Clinical judgment was compared between the intervention group (n = 17) and a control group (n = 26) in the practice setting at two time points.

RESULTS

The simulation program had a large effect on the intervention group's clinical judgment (η2 = .143) and clinical competence (η2 = .153). There were no statistically significant differences for each outcome at baseline as compared to the final scenario for the intervention group. There was no statistical significance between the intervention and control groups in clinical judgment in the practice setting at each measurement time.

CONCLUSION

Replication of the study with a randomized controlled trial and large sample size is warranted.

The Realities of Collaboration: An Academic and Practice Partnership in Simulation Education With Nurse Residents

This article details the collaborative effort between a team of academic nurse educators with educators in a practice setting in the planning and implementation of a simulation-focused study to develop clinical judgment and clinical competency among new-to-practice nurses enrolled in a nurse residency program. Competing priorities between achieving the aims of the study and initiatives within the healthcare system are detailed, and suggestions for future joint research-focused efforts between academic and practice-based educators are offered.

RISK FACTORS IN MEDICATION ERRORS IN A HIGH-COMPLEXITY CHILEAN PUBLIC HOSPITAL

ABSTRACT Objective: to identify the risk factors in medication errors in a high-complexity chilean public hospital. Method: a research study with a quantitative approach; an exploratory, descriptive and cross-sectional study, with retrospective temporal cuts. The study population consisted of 50 reports of adverse events related with the medication administration process generated between 2014 and 2017 in the Medical and Surgery services of the Magallanes Clinical Hospital, Chile. The classification of the National Coordinating Council for Medication Error Reporting and Prevention was used for data collecting, performed during May and June 2018, and the data were analyzed by means of descriptive statistics. Results: among those involved in the medication errors, the following professions are predominant: nurses, 21 (42%); Medical and Surgery nursing technicians, 18 (36%), and nursing technicians working in the Pharmacy, 7 (14%). The most frequent medication errors were the following: medication transcription, 16 (32%); preparation, 13 (26%); and administration, 11 (22%). The following risk factors stand out in the notified cases: communication and interpretation problems, 13 (26%); incorrect interpretation of the prescription at dispensation, 7 (14%); factors associated with work organization such as insufficient compliance with the priority safety practices, 11 (22%), and individual factors, 9 (18%). Conclusion: more information is required about medication errors to identify the risk factors and to establish strategies for their prevention; consequently, the notification of adverse events must be promoted as a preventive measure.