Predicting behavioural intentions towards medication safety among student and new graduate nurses across four countries

Instruments for Measuring Healthcare Professionals' Medication Safety Competence: A Scoping Review

Elderly patients with chronic diseases often use several drugs (polypharmacy). The more drugs a patient uses, the greater the risk of medication errors. To ensure a safe medication process, healthcare professionals must have a high level of medication safety competence (MSC). Hence, instruments are needed to measure healthcare professionals' MSC and identify areas where improvement is required. A scoping review was conducted to obtain a comprehensive overview of existing instruments. The scoping review was carried out in accordance with the JBI methodology for scoping reviews and in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). An a priori protocol was registered on Open Science Framework https://osf.io/73dmq. The search, performed in January 2024 in six databases, yielded 3740 results, duplicates were removed and 2499 titles and abstracts were screened. Full text screening of 28 articles resulted in the inclusion and analysis of 15 articles. A total of six instruments were identified, all instruments were designed for nurses or nursing students. However, no instrument to assess, eg physicians' or pharmacists' MSC was identified. Five of the six instruments were used in clinical setting and three in educational setting. The Medication Safety Competence Scale (MSCS) and the Medication Safety Scale cover the multidimensionality of MSC. The MSCS's psychometric properties were considered acceptable. Thus, the MSCS can be used to assess nurses MSC in clinical and educational settings.

Nursing students' perceptions of patient safety culture and barriers to reporting medication errors: A cross-sectional study

BACKGROUND

Patient safety is critical to high-quality patient care. However, it is liable to medication errors (MEs).

OBJECTIVE

Therefore, this study assessed perceptions of patient safety culture (PSC) and barriers to reporting MEs among nursing students in Hail City, Saudi Arabia.

METHODS

The researchers conducted a cross-sectional study among 360 convenience students at the College of Nursing, University of Hail, in 2023. We collected data using questions about the characteristics of students, the Health Professional Education in Patient Safety Survey (H-PEPSS) questionnaire, and the Medication Error Reporting questionnaire. Students' mean PSC perception scores were calculated and compared based on their characteristics using the independent-samples t-test or one-way analysis of variance (ANOVA) was used as appropriate. We used Paired samples t-test to compare the mean scores of self-reported perceptions of PSC between classroom and clinical settings, with a significance level of <0.05.

RESULTS

The overall PSC perception score was significantly higher in the classroom than in the clinical setting (p = 0.017). Students in the classroom setting scored significantly higher on the domains of "clinical safety skills" (p < 0.001), "effective communication" (p = 0.039), and "safety risk management" (p = 0.008) than those in the clinical setting. Conversely, students in the clinical setting scored significantly higher on the domains of "teamwork with other HCPs" (p < 0.001), "understanding human and environmental factors" (p = 0.039), and "recognizing and responding to immediate hazards" (p < 0.001). Female students and those who were in their second level, had PSC training, desired to participate in PSC training, and reported the presence of an error reporting system scored significantly higher on PSC perceptions in both settings. Most students (95.8 %) believed in the benefits of discovering and reporting MEs. However, a considerable proportion also expressed concerns about ME reporting, including fears of disciplinary action (87.5 %), blame for errors (87.2 %), and loss of respect from colleagues (85.6 %). Most students (97.5 %) also believed that MEs should be reported. However, only 11.1 % of students reported the occurrence of MEs, and 6.7 % experienced these errors.

CONCLUSION

Discrepancies exist in PSC perceptions among nursing students in Hail City between academic and real-world contexts, being consistently higher in the classroom compared to the clinical setting. PSC training and the presence of an error reporting system should be considered when developing interventions to improve PSC perceptions. This study revealed that many barriers were rated in a high percentages for reporting the medication, particularly fears of disciplinary action, blame for errors and loss of respect from colleagues, should be addressed.

Assessing self-perceptions related to safe medication management among nursing students: an analytical cross-sectional study in Iran

BACKGROUND

Ensuring patient safety is critical, with safe medication management being a key aspect. However, nursing students often lack the necessary skills for effective medication management. These students need to acquire the required competencies during their undergraduate studies.

OBJECTIVE

This study aimed to investigate the self-perceived status of Iranian nursing students in medication safety management.

DESIGN

An analytical cross-sectional study.

METHOD

The study involved 221 nursing students who completed surveys assessing their self-perception of drug management and dosage calculation. Demographic data were also collected. The data collection forms included a self-perception questionnaire and a dosage calculation test. Analytical tests such as independent sample t-tests, one-way ANOVA, Pearson's correlation coefficient, and descriptive statistics were employed for data analysis using SPSS 22.0 software.

RESULTS

Our research found that the average self-perception score of students in medication management was 57.65 ± 13.53 (range = 24-96). Linear regression analysis revealed that higher overall GPAs (F = 38.098, p < 0.001) and work experience in a hospital (t = 10.367, p < 0.001) were associated with improved self-perception skills in medication management. Additionally, individuals with increasing age demonstrated better self-assessment skills in managing safe medications.

CONCLUSION

This study underscores the importance of nursing education in enhancing students' competencies in safe medication management. Specific interventions are recommended to improve knowledge and skills, and sociodemographic factors can help identify students needing additional support. Increasing clinical exposure is also suggested to enhance their competencies.

"Busting the hidden curriculum" a realist and innovative perspective to foster professional behaviors

Contemporary health professions education has long delineated the desired attributes of medical professionalism in the form of standard curricula and their role in forming professional behaviors (PBs) among aspiring doctors. However, existing research has shown the contradictory and powerful role of hidden curriculum (HC) in negatively influencing medical students' PBs through unspoken or implicit academic, cultural, or social standards and practices. These contrasting messages of formal curricula and HC lead to discordance and incongruence in future healthcare professionals developing professional identity formation. There is little research on PB modifying educational strategies and their determinants that medical schools adopt to bust the impact of HC. Consequently, it is unclear how the right PBs can be influenced, entrenched, and inculcated in undergraduate medical students, especially in their early clinical placements. The lack of such insight highlights a critical gap in the literature, nudging educators to take a realist stance to deal with this problem. Behavior psychology stresses shaping medical students' values and beliefs as salient mediators that influence intentions to pursue future PBs. Curiosity prevails about what would guide the educational interventions to target this behavior change. To help understand this concept, we present our design-based innovative perspective about PROfessionalism in Partnership for Education Research (PROPER) shaped by pluralistic theoretical models in the context of two European medical schools with diverse medical students, highlighting its non-parochial and transferable nature.

Investigating pediatric nurses' perceptions of factors contributing to MAEs at Yendi hospital, Ghana

BACKGROUND

Medication administration errors (MAEs) are a critical concern in pediatric healthcare, contributing to adverse drug events (ADEs) and negatively impacting patient health.

OBJECTIVES

This study explores pediatric nurses' perceptions of factors contributing to MAEs at Yendi Municipal Hospital to develop interventions enhancing patient safety.

METHODS

A descriptive cross-sectional survey was conducted among 143 nurses at Yendi Municipal Hospital using structured questionnaires. Data were analysed using SPSS 26.0 and Excel 2016. Bivariate analysis examined relationships between socio-demographic characteristics and MAEs.

RESULTS

Contributing factors to MAEs included inadequate training (91.6%), misunderstanding medical abbreviations (88.8%), poor supervision (92.3%), eagerness to sign out shifts (70.6%), improper handover (88.8%), inadequate staff (77.6%), dosage miscalculations (83.9%), and illegible handwriting (81.8%). Significant associations were found between MAEs and the type of unit/ward (X²=6.25, p = 0.012) and educational level (Fisher Exact test = 4.20, p = 0.036).

CONCLUSION

Inadequate training, poor supervision, and communication issues are major contributors to MAEs in pediatric settings. Targeted interventions can significantly improve patient safety and care quality.

Clinical Simulation in Nursing Students' Safe Medication Administration: A Systematic Review

Background

Nursing students' safe medication administration is a crucial aspect of ensuring patient safety. Clinical simulation is a novel teaching method applied to reduce factors threatening medication safety in the education of nursing students. Therefore, the aim of the present study was to conduct a review study in this field.

Materials and Methods

The present review was conducted using keywords of education, clinical competence, medication safety, medication error, nursing student, clinical simulation, and educational strategies. Suitable articles published between 2000 and 2023 were systematically searched in various national and international online databases, including SID, Magiran, Ovid, Scopus, Web of Science, PubMed, ProQuest, and Google Scholar in both English and Persian languages.

Results

A total of 855 articles were retrieved from the initial search findings. After eliminating duplicate and irrelevant articles based on predetermined criteria, a qualitative selection was conducted using CONSORT, MMAT, and JBI critical appraisal checklists. Ultimately, a selection of 11 articles was made, specifically focusing on medication safety education for nursing students through clinical simulation. The findings showed that using clinical simulation improved medication safety and safety knowledge among nursing students. Additionally, this approach was found to enhance their competence in medication administration.

Conclusions

Based on the findings, clinical simulation is a safe and effective approach for enhancing nursing students' proficiency in medication safety and administration. Therefore, it is recommended that nursing education authorities implement these findings to improve nursing students' knowledge, performance, and competency in safely administering medications.

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.

Investigating safe nursing care and medication safety competence in nursing students: a multicenter cross-sectional study in Iran

BACKGROUND

Medication safety competence is very important as one of the clinical skills among nursing students to provide safe nursing care. The lack of medication safety competence in nursing students leads to occurrence of medication errors subsequently jeopardizing patient safety. Thus, the present study was conducted to investigate safe nursing care and medication safety competence among nursing students in the south of Iran.

METHODS

A descriptive cross-sectional multicenter study was conducted from September to December 2022. The research population included nursing students of three universities of medical sciences in Fars Province, Southern Iran. A total of 310 nursing students who were selected through convenience sampling participated in the study. The data collection instruments consisted of a demographics survey, Medication Safety Competence Scale (MSCS), and a Safe Nursing Care Scale (SNCS). The collected data were analyzed using descriptive statistics (absolute and relative frequency, mean and standard deviation) and inferential statistics (Independent t-test, Analysis of variance and Pearson correlation coefficient). The data were analyzed in SPSS 23 and the level of significance was considered 0.05.

RESULTS

The mean age of the participants was 22.53 ± 1.69 years. The total mean scores for medication safety competence and safe nursing care were found to be 111.97 ± 11.85 and 105.12 ± 11.64, respectively. There was a statistically significant positive correlation between safe nursing care and medication safety competence (r = 0.084, P < 0.001).

CONCLUSION

The mean scores of nursing students' medication safety competence and safe nursing care were at an average level. To maintain patient safety, nursing instructors and managers are recommended to employ appropriate strategies to improve medication safety competence and safe nursing care in nursing students.

Safety Behavior and Transition Shock among Newly Graduated Nurses: The Mediating Role of Feedback-Seeking Behavior

Aim

To determine the relationship between transition shock and safety behavior among newly graduated nurses (NGNs) and explore the mediating role of feedback-seeking behavior.

Background

The safety behavior of NGNs plays a vital role in improving patient safety in clinical situations. The direct effect of the transition shock experienced by these nurses on safety behavior remains limited, and little is known about the mediating effect of feedback-seeking behavior.

Methods

A descriptive correlational research design was conducted with a cross-sectional sample of nurses in China using an online survey. A convenience sample of 575 nurses from 17 hospitals completed the questionnaires. Correlation analysis and structural equation modeling were used to examine the hypotheses.

Results

The sampled NGNs' safety behavior score was 55.35 ± 5.46. Their transition shock was negatively associated with safety behavior (β = -0.225, p < 0.001). In contrast, feedback-seeking behavior was positively related to safety behavior (β = 0.502, p < 0.001). The feedback-seeking behavior partially mediated the relationship between transition shock and safety behavior, and the mediating effect was 58.29%.

Conclusions

The results emphasized that the relationship between NGNs' transition shock and safety behavior is mediated by feedback-seeking behavior. Implications for Nursing Management. Interventions focusing on transition shock relief could help improve NGNs' safety behavior. This study highlights the importance of encouraging feedback-seeking behavior to improve patient safety outcomes, especially for junior nurses. It can therefore be assumed that the nursing managers' training of NGNs in special skills, such as feedback-seeking, may be conducive to their positive coping and contribute to forming safety behaviors.

Reflective based learning for nursing ethical competency during clinical practices

BACKGROUND

A combination of theoretical and practical approaches is required to learn and acquire ethical competencies in caring. Occasionally, reflection on practical action differs from theoretical learning. In the context of reflective learning, issues such as ethical values can be discussed since they evoke conflict among nursing students.

AIM

To identify ethical conflicts encountered by nursing students during clinical placements and to determine their cooperation strategies.

RESEARCH DESIGN

Qualitative study with a content analysis according to Elo and Kinglas framework.

PARTICIPANTS AND RESEARCH CONTEXT

Students enrolled in a nursing program at a Spanish university aged between 22 and 35, mainly women.

METHODOLOGY

The study includes 134 ethical reflections from nursing students in the last year of the nursing program, written during their clinical practices in a variety of learning environments. The research team analyzed the reflections using an inductive content analysis method.

ETHICAL CONSIDERATIONS

Ethical permission was obtained by the management center according to Law 3/2028, and all the participants accepted to participate through the informed consent form.

FINDINGS

Three main categories emerged from the analysis of the ethical reflections: (1) evaluation of professional performance and patient care; (2) the student as the protagonist of the dilemma; (3) student coping. Student dilemmas and concerns are related to ignorance, student-patient communication, mistakes made and self-confidence. Some situations conflict with the autonomy of patients and their rights, and can contribute to stressful situations for patients. Stress factors include hospital routines, which the patient cannot modify, and asymmetric relationships with staff, which encourage passivity.

CONCLUSION

All ethical problems detected by the students begin with the professional-patient relationship, including issues related to bad news, errors or malpractice. Reflection on the ethical values of nursing, both in the classroom and in clinical practices, allows students to develop a greater ethical awareness of care, enhancing their decision-making skills in ethical dilemmas.