Interruptions Then and Now: Impact on Nurses’ Clinical Reasoning, Emotions, and Medication Safety

Experiences of clinical nurses with medication interruption: A systematic review and qualitative meta-synthesis

BACKGROUND

Managing medication interruptions is considered one of the biggest dilemmas for nurses in clinical settings. To improve medication safety, it was imperative to conduct a systematic review to get a deeper understanding of nurses' experiences with medication interruptions.

AIMS

A systematic review and qualitative meta-synthesis aimed to explore clinical nurses' experiences of interruption during medication in hospitals.

METHODS

Systematic searches were conducted in PubMed, CINAHL, Ovid Medline, Embase, Web of Science, and The Cochrane Library from inception to January 2024. The search strategy included four groups of keywords: (1) qualitative research, (2) nurses, (3) medication interruption, and (4) experience. Critical Appraisal Skills Programme was used to assess the quality of the studies. Meta-ethnography was utilized to synthesize the findings of the included studies.

RESULTS

Nine articles published between 2012 and 2023 were included; the number of participants varied from 5 to 40, aged 20-68 years, and the majority were female. Four synthesized findings were identified as follows: (1) an inevitable part of the routine, (2) a decision-making process, (3) working in a minefield, and (4) coping with interruption.

LINKING EVIDENCE TO ACTION

Nurses embraced interruptions as an inherent component of clinical care. Previous experience and nursing culture, encompassing personal and professional aspects, significantly influence nurses' attitudes toward medication interruptions. It is crucial to incorporate the distinctive work experiences of nurses into techniques aimed at efficiently handling interruptions in future research. The registration number in PROSPERO is CRD42023470276.

Clinical reasoning and clinical judgment in nursing research: A bibliometric analysis

AIMS

To characterize the thematic foci, structure, and evolution of nursing research on clinical reasoning and judgment.

DESIGN

Bibliometric analysis.

METHODS

We used a bibliometric method to analyze 1528 articles.

DATA SOURCE

We searched the Scopus bibliographic database on January 7, 2024.

RESULTS

Through a keyword co-occurrence analysis, we found the most frequent keywords to be clinical judgment, clinical reasoning, nursing education, simulation, nursing, clinical decision-making, nursing students, nursing assessment, critical thinking, nursing diagnosis, patient safety, nurses, nursing process, clinical competence, and risk assessment. The focal themes, structure, and evolution of nursing research on clinical reasoning and judgment were revealed by keyword mapping, clustering, and time-tracking.

CONCLUSION

By assessing key nursing research areas, we extend the current discourse on clinical reasoning and clinical judgment for researchers, educators, and practitioners. Critical challenges must still be met by nursing professionals with regard to their use of clinical reasoning and judgment within their clinical practice. Further knowledge and comprehension of the clinical reasoning process and the development of clinical judgment must be successfully translated from research to nursing education and practice.

IMPLICATIONS FOR THE PROFESSION

This study highlights the nursing knowledge gaps with regard to nurses' use of clinical reasoning and judgment and encourages nursing educators and professionals to focus on developing nurses' clinical reasoning and judgment with regard to their patients' safety.

IMPACT

In addressing nurses' use of clinical reasoning and judgment, and with regard to patient safety in particular, this study found that, in certain clinical settings, the use of clinical reasoning and judgment remains a challenge for nursing professionals. This study should thus have an effect on nursing academics' research choices, on nursing educators' teaching practices, and on nurses' clinical practices.

REPORTING METHOD

Relevant EQUATOR guidelines have been adhered to by employing recognized bibliometric reporting methods.

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.

Engaging Nursing Students in Quality Improvement: Teaching Safe Medication Administration

BACKGROUND

Safety and reduction of errors during medication administration is a prominent focus in nursing and nursing education. Developing simulated medication administration experiences that include opportunities for nursing students to manage interruptions in a realistic environment can help improved critical thinking and reasoning for safe administration practices.

METHOD

Sophomore nursing students voluntarily participated in a quality improvement project examining nursing management of interruptions during medication administration. Students observed medication administration activities for episodes of interruptions and conducted surveys in a real-time format that encouraged decision-making dialogue.

RESULTS

After the project, student learning outcomes included improved identification of interruptions, prioritization, critical reasoning skills, and development of management techniques for better safety.

CONCLUSION

Incorporating real-world experiences that allow nursing students to identify and manage interruptions during medication administration foster development of critical thinking and interruption management techniques. [J Nurs Educ. 2022;61(5):268-271.].

Healthcare personnel's working conditions in relation to risk behaviours for organism transmission: A mixed-methods study

AIMS AND OBJECTIVES

To investigate healthcare personnel's working conditions in relation to risk behaviours for organism transmission.

BACKGROUND

Healthcare personnel's behaviour is often influenced by working conditions that in turn can impact the development of healthcare-associated infections. Observational studies are scarce, and further understanding of working conditions in relation to behaviour is essential for the benefit of the healthcare personnel and the safety of the patients.

DESIGN

A mixed-methods convergent design.

METHODS

Data were collected during 104 h of observation at eight hospital units. All 79 observed healthcare personnel were interviewed. Structured interviews covering aspects of working conditions were performed with the respective first-line manager. The qualitative and quantitative data were collected concurrently and given equal priority. Data were analysed separately and then merged. The study follows the GRAMMS guidelines for reporting mixed-methods research.

RESULTS

Regardless of measurable and perceived working conditions, risk behaviours frequently occurred especially missed hand disinfection. Healthcare personnel described staffing levels, patient-level workload, physical factors and interruptions as important conditions that influence infection prevention behaviours. The statistical analyses confirmed that interruptions increase the frequency of risk behaviours. Significantly higher frequencies of risk behaviours also occurred in activities where healthcare personnel worked together, which in the interviews was described as a consequence of caring for high-need patients.

CONCLUSIONS

These mixed-methods findings illustrate that healthcare personnel's perceptions do not always correspond to the observed results since risk behaviours frequently occurred regardless of the observed and perceived working conditions. Facilitating the possibility for healthcare personnel to work undisturbed when needed is essential for their benefit and for patient safety.

RELEVANCE FOR CLINICAL PRACTICE

The results can be used to enlighten healthcare personnel and managers and when designing future infection prevention work.