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New Graduate Nurses' Knowledge and Skills in Medication Management: Implications for Clinical Settings
Abstract
Background
Medication management has long been a role for nurses. Yet how new graduate nurses apply pharmacology knowledge to practice has been an issue not well identified in the literature. This article reports a survey undertaken in 2013 in one large urban New Zealand hospital that explores new graduate nurse's perception of applying their pharmacology knowledge to the clinical practice of medication management.
Method
Survey research was employed for this study with a postal survey in 2013 distributed to 128 nurses who had graduated within the previous 24 months. Twenty-five questionnaires were returned, giving a response rate of 19.53%.
Results
Newly graduated nurses were found to understand the importance of applying pharmacology knowledge in their practice but also acknowledged the need to increase their knowledge of the medications they are administering. However, understanding of how medications work and are eliminated was a concern.
Conclusion
This study highlights the need for ongoing support and education for newly graduated nurses as they continue to develop and apply their pharmacology knowledge.
J Contin Educ Nurs. 2017;48(6):276–281.
... Tento přehled pak mohou využívat lékaři a redukují již zmiňované generické záměny léčivých přípravků prováděné sestrou 41) . Hammoudi Literatura tervenci považují využití znalostí farmakologie od nově nastupujících sester, které mají vysokoškolské vzdělání, a vytvoření farmakologických kurzů pro sestry, které již v klinické praxi pracují 43) . Studie Holmqvist et al. a Bell et al. potvrzují výše uvedené faktory i problematická místa a doporučují vytvořit kurzy managementu podávání perorálních léčivých přípravků. ...
... Zahraniční autoři se shodují, že napříč všemi zdravotnickými systémy je pro redukci medikačního pochybení vhodné využít moderní technické zázemí s možností digitalizace preskripce a záznamu do dokumentace, záznam časových stop při podání léčivých přípravků, využití čárových kódů apod. Je také velice diskutabilní, zda jsou tato opatření vhodná pro zdravotně sociální zařízení, ve kterých není hlavní službou léčba pacientů [37][38][39][40][41][42][43][44][45] . ...
A medication error is one of the most common causes of patients’ complications or death in healthcare facilities. In the United States, 7,000 out of 9,000 patients die because of medication errors each year. Known factors are generally divided into four groups – human factor, intervention, technical factor, and system. Our study includes 17 studies from the OVID, Web of Science, Scopus, and EBSCO databases, in the range of 2015–2020. After a selection of professional publications, 2 categories were created – factors leading to medication errors and interventions to reduce medication error and testing their effectiveness. It has been found that human factor always plays a role, often supported by a poorly set-up system. The most mistakes are made in documentation, administration technique or accidental interchange of patients. The most frequently mentioned factors include nurses’ overload, high number of critically ill patients, interruptions in the preparation or in the administration of medications, absence of the adverse event reporting system, non-compliance with guidelines, fear, and anxiety. Another evidence of medication error is in the application of intravenous drugs, where an interchange of drugs or patients due to interruption occurs as well. Sufficient education of nurses and an adequate system of preparation and administration of drugs, for example using bar codes, are considered as an appropriate intervention.
... Feelings of incompetence make the adaptation process difficult and increase the level of stress (Fink et al., 2008;Lin et al., 2014;Parker et al., 2014;Phillips et al., 2014;Laschinger et al., 2016). In the literature, NGNs have the most difficulty in nonroutine nursing interventions such as care of terminal patients and general palliative care, (Kajander-Unkuri et al., 2014;Phillips et al., 2014;Zheng et al., 2016;Lee et al., 2019), advanced life support (Fink et al., 2008;Theisen and Sandau, 2013), medication administration (Kajander-Unkuri et al., 2014;Lim and Honey, 2017), and aspiration, drain management, and wound care (Karahan et al., 2012;Kajander-Unkuri et al., 2014). Fink et al. (2008) indicated that only 10% of NGNs were able to execute nursing interventions independently. ...
... Although a majority of the NGNs defined themselves competent in "treatment monitoring and administration," almost half stated that they needed to improve in "medication administration." Lim and Honey (2017) determined that "unfamiliarity with the drugs, lack of experience, and different drugs specific to every field" were the reasons for their difficulties with the drugs. ...
... This highly desired competence requires practical and theoretical skills, including medication calculation and knowledge of pharmacology (Karttunen et al., 2020). However, several studies indicate that nurses have low levels of competence in pharmacology (Boggs et al., 1988;Brady et al., 2009;Gigi & Honey, 2017;Meechan et al., 2011;Ndosi & Newell, 2009;Simonsen et al., 2011). Elderly patients exhibit an age-dependent decline in physiological functions and changes in the composition of the organism leading to altered pharmacokinetic and pharmacodynamic mechanisms. ...
Introduction
The administration of drugs is an important part of nurses’ professional practice. A basic knowledge of pharmacological principles is required to make accurate decisions about drug management and conduct patient medication education. However, several studies have suggested that nurses have inadequate knowledge of pharmacology and medication management.
Objective
To explore the level of knowledge in pharmacology and medication management among nurses working in nursing homes (NHs).
Methods
We conducted a cross-sectional study at 24 NHs in Norway. The nurses took a multiple-choice test in pharmacology with 35 questions at their workplace. Each question had four alternative answers with one answer being correct. One point was awarded for a correct answer and zero for a wrong answer. The test included categories in general pharmacology, clinical pharmacology, and medication management.
Results
In total, 145 nurses completed the questionnaire. In the range of 0–35 correct responses, the mean score for the sum of all questions was 22.5, which equates to 66% of responses being correct. Linear multiple regression showed no association regarding gender, age distribution among the nurses, years since completing basic education in nursing, years of work experience in NHs, postgraduate education, and knowledge of pharmacology and medication management. Knowledge was better in the category medication management (p < 0.001) than in the category's general pharmacology and clinical pharmacology. When evaluating specific test questions, 38.9% of the nurses answered a question on opioids correct, 64.1% a question on anticoagulants correct, 33.5% knew the prerequisites for generic substitution, and 45.5% did not know the difference between agonists and antagonists.
Conclusion
Our results are in line with previous findings. The participating nurses working in the NHs have insufficient knowledge in pharmacology and medication management. This may cause harm and undermine patient safety.
... A study in the China identified that medication management was a source of stress for NQNs [43]. Nurse graduates require ongoing support to apply pharmacological knowledge in practice [44]. Similarly, Irish researchers acknowledged that limited opportunities to practice medication management resulted in interns entering their final internship feeling inadequately prepared for their role in medication management [45,46]. ...
Aim
The aim of this study was to examine Newly Qualified General Nurses' (NQGNs’) experiences of and the value of the internship period.
Background
Internship was introduced as the final part of the undergraduate nursing degree in Ireland in 2002. The aim was to provide students with clinical experience, whereby they work more independently and in doing so, seamlessly progress their transition to the role of registered nurse.
Design
A cross-sectional, quantitative, descriptive study.
Setting and Participants
Newly Qualified General Nurses who completed their undergraduate degree in general nursing and graduated from Higher Education Institutions (HEIs) in the Republic of Ireland between 2018 and 2020 were eligible for inclusion in the study.
Methods
Participants were recruited using snowball sampling. Data were collected anonymously using the electronic Experience of Internship Questionnaire. Analysis was undertaken using the Statistical Package for Social Sciences (SPSS 27).
Results
Pre-internship preparation experiences differed across hospitals. The NQGNs would have preferred more support with their caseloads and help with understanding the rationale for care delivery. However, internship provided good opportunities to link theory to practice and was considered valuable by most in preparing them for practicing as a registered nurse.
Conclusion
Internship assists intern nursing students to link theory to practice. Further, support in internship is crucial when managing a caseload and to enhance understanding of the care provided. The value of internship was identified with suggestions on ways to strengthen the experience of internship.
... These residency programs focus on retention and increasing job satisfaction among new RNs by providing strong support and mentorship throughout the first year (Perron et al., 2019). In regard to medication administration, nurses have a low understanding of pharmacological implications (Escrivá Gracia et al., 2019), and it has also been found that new RNs have acknowledged the need to increase their medication administration knowledge and knowledge of pharmacologic implications (Lim & Honey, 2017). ...
This study describes the use of simulation to increase medication administration knowledge and skill in new RNs enrolled in a residency program. The study sample consisted of 54 new RNs with less than 1 year of nursing experience who were enrolled in a nurse residency program, and it compared medication administration knowledge posttest scores between groups. The medication administration posttest scores for the simulation group were not significantly higher than the scores of the classroom-only group (p = .056), but the simulation group scored significantly higher on questions regarding timing and the rights of medication administration. Participants were also asked their perceptions of medication errors and why they think they occur. Simulation supported improved medication administration knowledge of some concepts; simulation participants were more satisfied with their learning experience; and the use of simulation helped to identify a consistent knowledge gap within the study sample. New RNs also desire earlier medication administration education in their career. [J Contin Educ Nurs. 2021;52(1):30-33.].
... Inter-observer agreement was high for the overall set and most of the indicators. However, five indicators relating to medication had a low or moderate correlation [34], which may indicate that medication-related issues also pose challenges to nurses [48,49]. Internal consistency was high and there was adequate correlation between the total and each of the indicators, with no scores suggesting that any indicator should be eliminated [41,50]. ...
Pain has a major impact on health and quality of life. Since the level of knowledge of painful conditions can influence how these are addressed and managed, assessing this knowledge in patients becomes crucial. As a result, it is necessary to have culturally adapted and validated instruments that specifically measure patients’ knowledge of chronic pain management. The objective of this study was to carry out the Spanish cultural adaptation and the validation of the outcome Knowledge: Pain Management of the Nursing Outcomes Classification (NOC) in patients with chronic pain, defined as extent of understanding conveyed about causes, symptoms, and treatment of pain. A three-stage study was designed: 1) translation and cultural adaptation through an expert panel, 2) content validation, 3) clinical validation. This study provides nurses with a Spanish version of this scale adapted to their context, as well as a set of structured indicators to measure patients’ knowledge about chronic pain. The results indicated that the culturally adapted Spanish version of the outcome Knowledge: Pain Management had a high level of content validity (CVI = 0.92), with 27 indicators being distributed between two factors. This version has been shown to be reliable in terms of inter-observer agreement (κ = 0.79) and internal consistency (α = 0.95). In conclusion, Knowledge: Pain Management has been shown to be reliable and valid to measure knowledge of chronic pain.
... This strategy was embraced as it would lighten the work of preceptors, who could see if the student's medication competency had been ticked off by a previous preceptor. Learning about medication is a complex process (Lim and Honey, 2017), and there is caution advised against reducing such education to a "tick-box" exercise (Bailey, 2012;Morris, 2014). While the standardised clinical assessment document introduced in Ireland in 2018 (NMBI, 2018) makes medication management explicit as a competency, it would be important to appreciate that a comprehensive, multi-factorial approach is crucial to optimising medication education. ...
Background: Registered mental health nurses report dissatisfaction with the level of medication knowledge demonstrated by undergraduate nurses. However, little is known about which particular areas staff nurses are concerned about, and how they feel education can be enhanced in both academic and clinical settings. Objective: To investigate the views of staff nurses on the delivery of medication education to undergraduate mental health nurses. Design: A qualitative descriptive design was adopted. Methods: Two focus groups were held with registered nurses in two acute mental health facilities. Data were analysed using qualitative content analysis. Results: The first theme reports on the difficulties staff nurses observed with both undergraduate and newly qualified nurses around medication. It was noted that these individuals had difficulties interpreting medication charts/Kardexes, and were unable to provide medication-related education to service users. The second theme reports on strategies to enhance medication education, as recommended by participants. It was suggested that more practical education should be delivered in academic settings, with a focus on simulation and presentations from clinical staff. In the clinical settings, it was suggested that preceptors should provide education at less busy times on the ward. Conclusions: This study gives insight into areas in which education needs to be strengthened, in order to improve the medication knowledge of undergraduate and newly qualified nurses. Further research is needed to develop evidence-based strategies to enhance this education.
... The need to improve nurses' knowledge in relation to pharmacology and medication management has been noted (Lim & Honey, 2017;Rhodes, Visker, Cox, Sas, Background: In cases where patients are overweight or obese, administration of intramuscular medications can be ineffective due to inappropriate sizes of needles used. This study investigated whether the size of needles used to administer intramuscular injections is appropriate for patients on the basis of their weight or body mass index. ...
Background:
In cases where patients are overweight or obese, administration of intramuscular medications can be ineffective due to inappropriate sizes of needles used. This study investigated whether the size of needles used to administer intramuscular injections is appropriate for patients on the basis of their weight or body mass index.
Method:
This retrospective review examined 100 instances of intramuscular injection on a 50-bed ward.
Results:
In most instances, intramuscular medication was inappropriately administered. Needle sizes were not determined based on body mass index, and the possibility of true intramuscular penetration was minimal. Appropriate needle sizes were more likely to be chosen when instructions were provided with medications.
Conclusion:
Current available needle sizes may be inappropriate for certain patients. Nursing staff require further education to assist them in making correct needle choices. It is also important that health care settings have evidence-based policies in place and the necessary resources provided to ensure safe and correct administration of medication. J Contin Educ Nurs. 2018;49(11):519-525.
Aim
The aim of this review was to explore the influencing factors that contribute to medication administration errors (MAEs) made by novice registered nurses (NRNs).
Background
MAEs are a significant yet preventable risk to patient safety in healthcare settings, compromising both patient health and care quality. Evidence suggests that NRNs are more prone to MAEs, highlighting the importance of exploring the contributing factors to develop effective prevention strategies.
Design
An integrative review.
Methods
An electronic literature search was conducted in which articles were restricted to peer‐reviewed, full‐text articles published in the English language between January 2013 and December 2023. Quality assessments and data syntheses were conducted by two independent authors.
Data Sources
CINAHL Complete, MEDLINE, APA PsycArticles, APA PsycInfo, PubMed, Cochrane Library and Web of Science.
Results
Eleven studies met the inclusion criteria. The main influencing factors identified in this review were intrinsic factors (lack of confidence, reduced coping skills and reluctance to seek assistance) and extrinsic factors (time pressures, hectic workloads, low staffing and high‐stress environments). Clinical, educational and research implications were also identified.
Conclusion
This integrative review explored the various influencing factors contributing to MAEs by NRNs in healthcare settings. These included gaps in pharmacological knowledge, limited simulation‐based learning and challenges in using electronic medical records. Addressing these issues through targeted education and increased simulation experiences in undergraduate curricula could enhance NRNs' competence and confidence.
Reporting Method
Preferred Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines.
Patient or Public Contribution
No patient or public contribution was made due to the study design.
Implications for the Profession and/or Patient Care
Understanding the factors behind medication administration errors among new nurses helps organisations develop strategies to address these issues, reducing patient harm and enhancing nursing practice. Our findings offer recommendations to improve nursing education worldwide.
Background:
Nurses are instrumental in preventing medication errors that cause patient harm. Increased practice and educational interventions are suggested to prepare nursing students to safely administer medications. However, a quantified account of the reality of nursing student medication administration practice in the clinical setting is unknown.
Method:
This cross-sectional descriptive study assessed the frequency and quality of nursing student medication administration practice in the clinical setting. A convenience sample of prelicensure nursing students (n = 222) completed an electronic Nursing Student Medication Administration Survey after each clinical day for one semester.
Results:
Overall, participants on average had one medication administration experience, administered two drugs, and administered medications to one patient. Most medication administration experiences were supervised by bedside RNs.
Conclusion:
Medication administration opportunities in the clinical setting are unpredictable and vary by facility and nursing program policy. Further investigation is necessary. [J Nurs Educ. 2022;61(3):137-142.].
Background/Aims
The literature highlights gaps on how nurses apply pharmacology knowledge to their medication management, particularly in relation to knowledge on the mechanism of action and drug interactions. The aim of this study was to research a sample of mental health nurses to explore their confidence, knowledge and skills in applying their pharmacological knowledge.
Methods
A paper-based survey questionnaire was distributed to 209 mental health nurses working in direct patient care in Ireland. A total of 129 completed the questionnaire with a response rate of 61.7%.
Results
The vast majority of mental health nurses were confident in their knowledge of pharmacological principles to medication management, in relation to dosage, formulation, adverse effects, and predictable side effects, including patient education and medication information. Nurses were less confident in their knowledge of pharmacodynamics related to their knowledge on the mechanism of action, and on the pharmacokinetics of drug clearance. This may negatively impact on their ability to educate patients about their medications.
Conclusions
The findings suggest that there is need for an increased focus on continuing education on pharmacology for nurses at service level, particularly on the mechanism of action and clearance of commonly used medications in order for nurses to more effectively support patients to manage their medications.
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.
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).ResultsParticipants 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.
1. Uncovering the Knowledge Embedded in Clinical Nursing Practice. 2. The Dreyfus Model of Skill Acquisition Applied to Nursing. 3. An Interpretive Approach to Identifying and Describing Clinical Knowledge. 4. The Helping Role. 5. The Teaching-Coaching Function. 6. The Diagnostic and Monitoring Function. 7. Effective Management of Rapidly Changing Situations. 8. Administering and Monitoring Therapeutic Interventions and Regimens. 9. Monitoring and Ensuring the Quality of Health Care Practices. 10. Organizational and Work-Role Competencies. 11. Implications for Research and Clinical Practice. 12. Implications for Career Development and Education. 13. The Quest for a New Identity and New Entitlement in Nursing. 14. Excellence and Power in Clinical Nursing Practice. Epilogue: Practical Applications. References. Glossary. Appendix. Index.
Aim This study sought to explore how new nurses develop their knowledge and skill over the first 18 months following graduation, as well as factors promoting or inhibiting their development. Background and Purpose The graduate year requires the new nurse to make the transition from student in an academic setting to nurse employed within the health workforce. To facilitate the transition, many public and private hospitals in Australia offer formalised twelve-month duration graduate nurse programs that provide graduates with rotations through a number of clinical areas; preceptor support; and study days. Initially twenty five participants were followed for a period of eighteen months, incorporating the graduate year as well as the next six months when they no longer had support from a structured program. Findings from the focus groups after completion of the final six months are reported in this study at which time nine participants from three hospitals continued in the study. Method A qualitative approach using focus groups was adopted to allow for rich data to emerge. Four different hospitals in Victoria, Australia allowed graduates to be recruited into the research project. These included public and private hospitals, as well as metropolitan and rural hospitals. For the phase of the study being reported here, focus group interviews were conducted between 16 and 18 months following commencement of the graduate program. Data from all focus groups were analysed using Colaizzi's (1978) framework. Findings Three main themes emerged from these focus groups: 'sense of belonging', 'knowing' and 'moving on'. It is only after the completion of a graduate year that new nurses gain a sense of belonging and are able to complete their socialisation into the clinical workplace. Conclusions The development of nurses beyond the graduate year does not end with the completion of their transition program. They may still be working to develop a sense of belonging, independence in their practice and exploring their future development. Further work is needed to explore the period beyond the graduate year in the development of the registered nurse.
With the shortfall of nurses, more health care organizations are actively recruiting new graduate nurses. To translate active recruitment to successful retention, however, these newest nurses need support to make the adjustment from the security of a protected academic environment to the demands of a professional nursing career. Nursing turnover occurs when their role transition is unsuccessful. A unique model implemented in 2003 transformed new graduate nurses into confident staff nurses in an acute care setting. The insights gained and the investments required for a "magnetic" strategy to make new graduate nurses successful new staff nurses who stay with the organization are revealed.
Learning to provide safe and quality health care requires technical expertise, the ability to think critically, experience, and clinical judgment. The high-performance expectation of nurses is dependent upon the nurses’ continual learning, professional accountability, independent and interdependent decisionmaking, and creative problem-solving abilities.
Although the phenomenon of reality shock has been acknowledged as part of the new graduate nurse transition for decades, there is evidence to suggest that the problems with the transition into practice are more serious today. This article presents findings about the new graduate nurse transition and learning needs from qualitative research conducted in a community-based novice nurse transition program. The new graduate nurse transition and learning needs are examined through the eyes of new graduates and the nursing leaders and preceptors who work with them. Recommendations are offered for continuing education initiatives that can be designed to meet these needs.
J Contin Educ Nurs 2009;40(9):403–410.
Core physician activities of lifelong learning, continuing medical education credit, relicensure, specialty recertification, and clinical competence are linked to the abilities of physicians to assess their own learning needs and choose educational activities that meet these needs.
To determine how accurately physicians self-assess compared with external observations of their competence.
The electronic databases MEDLINE (1966-July 2006), EMBASE (1980-July 2006), CINAHL (1982-July 2006), PsycINFO (1967-July 2006), the Research and Development Resource Base in CME (1978-July 2006), and proprietary search engines were searched using terms related to self-directed learning, self-assessment, and self-reflection.
Studies were included if they compared physicians' self-rated assessments with external observations, used quantifiable and replicable measures, included a study population of at least 50% practicing physicians, residents, or similar health professionals, and were conducted in the United Kingdom, Canada, United States, Australia, or New Zealand. Studies were excluded if they were comparisons of self-reports, studies of medical students, assessed physician beliefs about patient status, described the development of self-assessment measures, or were self-assessment programs of specialty societies. Studies conducted in the context of an educational or quality improvement intervention were included only if comparative data were obtained before the intervention.
Study population, content area and self-assessment domain of the study, methods used to measure the self-assessment of study participants and those used to measure their competence or performance, existence and use of statistical tests, study outcomes, and explanatory comparative data were extracted.
The search yielded 725 articles, of which 17 met all inclusion criteria. The studies included a wide range of domains, comparisons, measures, and methodological rigor. Of the 20 comparisons between self- and external assessment, 13 demonstrated little, no, or an inverse relationship and 7 demonstrated positive associations. A number of studies found the worst accuracy in self-assessment among physicians who were the least skilled and those who were the most confident. These results are consistent with those found in other professions.
While suboptimal in quality, the preponderance of evidence suggests that physicians have a limited ability to accurately self-assess. The processes currently used to undertake professional development and evaluate competence may need to focus more on external assessment.
It has been established that medication errors are a significant cause for concern in healthcare settings. In Part 1 of this paper the gravity of this problem in addition to the some of the contributing factors were discussed. The shared nature of the problem across disciplines was highlighted in addition to the potential benefits of multi-disciplinary collaboration in resolution of the problem. The contribution that education can make in this regard is unquestionable both at pre-registration (undergraduate) and post-registration level. A variety of pragmatic proposals will be presented for consideration. In addition, clinical and educational measures that have been shown to reduce medication errors will also be proffered and the way(s) forward to ensure optimal medication management and patient safety will be explored from a nursing perspective. The specific aim of this paper is to illuminate the significant role that education, in both academic and clinical settings, can play in the preparation of nurses for their roles in medication management and the marked reduction in errors and improved patient outcomes in this area of practice that they can yield.
In the current climate of global economic chaos and increasing healthcare litigation, it is perhaps simultaneously unsurprising and yet perplexing that patients continue to fall foul of healthcare systems worldwide. Major incidents in patient care such as serious misdiagnoses, medication errors, the proliferation of superbugs and malpractice persist leading to injury or death of patients, emotional trauma to their families and, understandably, a reduction in the public's confidence in the healthcare system not to mention the financial consequences. Many, if not most or indeed all, of these incidents are preventable and should not happen. Yet the systems in place within healthcare permit their occurrence, with worrying regularity, it would appear. The area that this paper will focus on specifically is that of medication errors. The worrying trends with regard to medication errors will be presented. Potential contributing factors will be examined. The specific aim of this paper is to illuminate the extent and severity of the problem of medication errors in practice and to explore elements within the practice setting that can compound the problem. The multi-faceted nature of the problem will also be considered.
Registered nurses spend up to 40% of their professional clinical practice engaged in the art and science of medication dosage calculation problem-solving (MDC-PS). In advancing this patient safety critical discipline it is our position that as a profession we must first situate MDC-PS within the context of the wider features of the nursing numeracy, medicines management and clinical pharmacokinetic domains that inform its practice. This paper focuses on the essential relationship between numeracy, healthcare numeracy, medicines management, pharmacokinetics and MDC-PS. We present a taxonomy of generic numerical competencies for the pre-registration curriculum, with examples of essential medication dosage calculation requirements mapped to each skills domain. This is followed by a review of the symbols and measurement units that represent essential components of calculation competence in healthcare and medicines management practice. Finally we outline the fundamental pharmacokinetic knowledge that explains how the body deals with medication and we illustrate through clinical correlations why numeric and scientific knowledge and skills must be mastered to ensure safe dosage calculation and medicines management practice. The findings inform nurse education practice via advancing our understanding of a number of issues, including a unified taxonomy of generic numerical competencies mapped to the 42 revised UK Nursing and Midwifery Council (NMC) Essential Skills Clusters (NMC, 2010a; NMC, 2010b).
This study investigated the perspectives of newly graduated and experienced nurses concerning medication errors. This is a descriptive cross-sectional study conducted in a military education and research hospital in Turkey, which was performed between July and August 2009. Totally, 169 nurses were involved in this study: 87 were new graduates and 82 were experienced nurses. The Modified Gladstone's Scale of Medication Errors was used to collect data on rates, causes and reporting of medication errors. The two highest perceived causes of medication errors were nurse exhaustion and nurse distraction. Most medication errors were preventable errors. The reasons for error occurrence and failure to inform co-workers of medical errors were examined.
Implications: Training nurses to understand the causes of medication errors and related prevention methods should be provided to newly graduated nurses, and continuous training should be provided.
To explore the nurse's role in the process of medication management and identify the challenges associated with safe medication management in contemporary clinical practice.
Medication errors have been a long-standing factor affecting consumer safety. The nursing profession has been identified as essential to the promotion of patient safety.
A review of literature on medication errors and the use of electronic prescribing in medication errors.
Medication management requires a multidisciplinary approach and interdisciplinary communication is essential to reduce medication errors. Information technologies can help to reduce some medication errors through eradication of transcription and dosing errors. Nurses must play a major role in the design of computerized medication systems to ensure a smooth transition to such as system.
The nurses' roles in medication management cannot be over-emphasized. This is particularly true when designing a computerized medication system.
The adoption of safety measures during decision making that parallel those of the aviation industry safety procedures can provide some strategies to prevent medication error. Innovations in information technology offer potential mechanisms to avert adverse events in medication management for nurses.
To investigate the efficacy of a 14-month integrated pharmacology and medicines management curriculum for undergraduate nursing students on the acquisition of applied drug/pharmacology knowledge.
Despite considerable debate regarding nurses' ability to be able to fulfill their medication management responsibilities, little is known about how nurses should be educated in medicines management.
Two groups of nursing students were compared. The first group were exposed to the usual curriculum (control group), whilst a second group experienced a new integrated pharmacology and medicines management curriculum (intervention group) (N=120). The impact of the curriculum on applied drug knowledge was assessed using a 69 item short answer questionnaire relating to a vignette. Students also undertook a 42 item on-line test exploring principles of pharmacokinetics. Students were also asked to self-rate their knowledge using a four point likert scale which asked how confident they were in relation to the prescribed medication regime. The data were collected in July 2008. The intervention group was exposed to an integrated curriculum approach, whilst the control group undertook periods of supervised practice within a clinical environment supported with a workbook and practice assessment learning outcomes.
Students exposed to an integrated approach to pharmacology and medicines management demonstrated superior pharmacokinetic knowledge and were more able to apply drug knowledge to the patient vignettes than the control group.
An early introduction of an integrated approach to the teaching and assessing of pharmacological processes improves students' drug knowledge prior to qualification. A sound preparation will help to ensure safe and effective medicines management care for patients and will prepare nurses for post graduate education and further training.
Pharmacology, as a basic medical science discipline, provides the scientific basis of therapeutics, i.e. the scientific foundation for safe and rational prescribing of drugs. The public, lay media, and the medical profession have raised serious concerns over the high incidence of errors of drug prescribing which compromise patient safety, including death of some patients, attributed mainly to inadequate teaching of medical pharmacology and, consequently, to medical graduates lacking skills in safe and effective drug prescribing. There is also overwhelming evidence that the pervasive and prevalent doctor-drug industry relationships have a strong influence over the prescribing habits and drug education of doctors. The British Pharmacological Society and American Association of Medical Colleges have crafted some insightful guidelines, including the learning of desired attitudes, for designing a medical pharmacology curriculum aimed at enhancing patient safety. This article will critically review the major issues relating to errors of drug prescribing, including the need to nurture the early development of desired attitudes which foster safe and rational drug prescribing. A simple educational approach, using a task analysis of drug prescribing, is applied to identify desired attitudes which should be incorporated into a basic pharmacology course for medical students in the twenty-first century.
The purpose of this qualitative descriptive study was to explore final year undergraduate nursing student's perception of clinical practice situations where they applied, or were not able to apply, their pharmacology knowledge in medication management. Pharmacology knowledge is integrated into practice during medication administration, formulation, dosing and client education. A key finding is that the majority of students do use their pharmacology knowledge in the clinical setting. Despite these encouraging results lack of opportunities and preceptor direction in the clinical context are still barriers to fuller integration and consolidation of pharmacology knowledge. Moreover, students' perception of lack of pharmacology knowledge and the need for more knowledge as it applies to medication management remains an area for concern. Suggestions for improvement include a student workbook that would draw on both clinical and theoretical activities as different aspects of pharmacology knowledge are applied, as well as increasing preceptor involvement.
Successful mentoring programs for new graduate nurses are designed to provide professional supports to ease the transition of these newcomers from student to practicing nurse. In the financially constrained health care environment, a resource-intensive program can be sustained only by leaders who see quantitative evidence of organizational impact over time. A descriptive study was undertaken at a pediatric academic medical center to compare the job satisfaction and retention rates of two cohorts of new graduate nurses: one before and one after the implementation of a Pediatric RN Internship Program. In this study overall job satisfaction was significantly higher in the post-internship group as compared to the pre-internship group. Improved job satisfaction was also reflected in a lower turnover rate (12% vs. 20% in the pre-internship group) that was sustained during the 2-year post-intervention study period. By lowering turnover rates, organizations avoid costs associated with recruitment, orientation, and temporary labor coverage for vacant RN positions.
Medication errors are a persistent problem in today's National Health Service (NHS). Many factors contribute to drug incidents occurring, from the initial prescription stage through to administration and arise from both individual and system failures. The literature identifies the multi-disciplinary nature of the problem and highlights the important contribution that nurses make with regards to ensuring medication safety. However limited evidence exists in the literature regarding the extent to which the current content of undergraduate pharmacology education prepares nurses for their role in the prevention of errors. The report "Building a safer NHS for patients-improving medication safety" [Department of Health, 2004. Building a Safer NHS for Patients: Improving Medication Safety. The Stationary Office, London] concludes that it is now imperative that undergraduate education should emphasise the issue of medication safety. An educational initiative was therefore introduced to address this problem. A "Medication Safety Day" which focused on the causes of medication errors was implemented to highlight how and why drug incidents may occur. This initiative recognises that nurse education should not only ensure adequate theoretical knowledge of pharmacology but should also equip students with an awareness of how many diverse factors may contribute to the occurrence of medication errors.
The aim of this paper was to review the current literature clinical decision-making models and the educational application of models to clinical practice. This was achieved by exploring the function and related research of the three available models of clinical decision making: information-processing model, the intuitive-humanist model and the clinical decision-making model.
Clinical decision making is a unique process that involves the interplay between knowledge of pre-existing pathological conditions, explicit patient information, nursing care and experiential learning. Historically, two models of clinical decision making are recognized from the literature; the information-processing model and the intuitive-humanist model. The usefulness and application of both models has been examined in relation the provision of nursing care and care related outcomes. More recently a third model of clinical decision making has been proposed. This new multidimensional model contains elements of the information-processing model but also examines patient specific elements that are necessary for cue and pattern recognition.
Literature review.
Evaluation of the literature generated from MEDLINE, CINAHL, OVID, PUBMED and EBESCO systems and the Internet from 1980 to November 2005.
The characteristics of the three models of decision making were identified and the related research discussed.
Three approaches to clinical decision making were identified, each having its own attributes and uses. The most recent addition to the clinical decision making is a theoretical, multidimensional model which was developed through an evaluation of current literature and the assessment of a limited number of research studies that focused on the clinical decision-making skills of inexperienced nurses in pseudoclinical settings. The components of this model and the relative merits to clinical practice are discussed.
It is proposed that clinical decision making improves as the nurse gains experience of nursing patients within a specific speciality and with experience, nurses gain a sense of saliency in relation to decision making. Experienced nurses may use all three forms of clinical decision making both independently and concurrently to solve nursing-related problems. It is suggested that O'Neill's clinical decision-making model could be tested by educators and experienced nurses to assess the efficacy of this hybrid approach to decision making.
Research methods in nursing and midwifery
- S Jirojwong
- M Johnson
- A Welch
Jirojwong, S., Johnson, M., & Welch, A. (2014). Research methods in
nursing and midwifery (2 nd ed.). South Melbourne, Australia: Oxford University Press.
Undergraduate nurses perception of applying their pharmacology knowledge to practice
- A G Lim
- M L L Honey
- T Mathew
- Lim A.G.
Lim, A.G., Honey, M.L.L., & Mathew, T. (2008, May). Undergraduate nurses perception of applying their pharmacology knowledge to
practice. Paper presented at the 10th International Conference on
Education, Athens, Greece.