Abstract
Patient safety is a worldwide health priority. All healthcare professionals are required to provide good quality and safe patient care via their respective codes of conduct. However, medication errors [ME] remain a serious problem and many patients suffer unintended harm as a result of these errors. There are varying degrees of medication errors depending on the patient population, medication, and the clinical setting. Paediatric patients i.e. children and elderly people are both vulnerable to ME. Elderly people because they may take numerous drugs and their health may be already very fragile, and children due to their size: medication doses are individually calculated and can vary considerably based on the child’s age, weight or body surface area, and clinical condition.Nursing students’ numeracy skills, mathematical competencies and knowledge of pharmacology are vital in providing safe and effective patient care. However, research identifies a lack of medication dosage calculation competence amongst nursing students as well as registered nurses.
The aim of this programme of research is to evaluate the contribution of an authentic virtual, high-fidelity simulated environment and a range of clinical practice environments in the development of medication dosage calculation problem solving competence [MDCPS] among undergraduate children’s nursing students. Further to establish the views/perceptions/experiences of children’s nursing students of these three learning and assessment environments.
The research design is a longitudinal, cohort study of children’s nursing students using a mixed methods approach. The sample of participants is undergraduate children’s nursing students following a Bachelor of Nursing programme at a large school of nursing in the UK. A mixed methods convergent design was selected where quantitative and qualitative data were collected simultaneously, individually analysed and finally merged. There were three points of data collection: at the conclusion of year 1, year 2 and year 3 (point of registration) of the undergraduate programme as identified by the NMC in ESC 33. Data were collected in the authentic virtual environment of safeMedicate®, the high-fidelity clinical simulation environment and in the clinical practice environment. Students had continuous access to the e-learning environment of safeMedicate® and they completed three exams in safeMedicate®. High-fidelity simulation expert videos were created, and two individual clinical simulation sessions and one group simulation session took place. A total of three semi-structured in-depth individual interviews were conducted. Content and thematic analysis was used to elicit meaning, gain understanding and develop empirical knowledge.
A total of 17 students consented to this research study. The results showed that the engagement with safeMedicate® in terms of theory or practice tests varied greatly among the participating students. All undergraduate nursing students passed the safeMedicate® exam at year 1, year 2 and year 3 with the required 100%. Students had no prior MDCPS simulation experience and therefore all the high-fidelity clinical simulation sessions ended up being coaching and mentoring. Students appreciated the well designed authentic virtual environment of safeMedicate® but missed the interaction with faculty and having the opportunity to ask questions. Students enjoyed the hands-on experience in the realistic high-fidelity simulation environment. The opportunity to practice in a safe environment and to learn from their mistakes was regarded as extremely beneficial. Throughout their three-year undergraduate nursing education students were assigned to different hospital or community-based practice placements. The overarching theme in practice placements was that they had limited hands-on experience and very often lacked the opportunity to perform MDCPS for a child patient. Nursing students spoke about the atmosphere in their practice placements – positive welcoming and supporting healthcare teams as well as negative and condescending remarks were their described experiences. They expressed a real desire to belong and be part of the nursing team and reflected on the impact limited staff resources had on their learning.
This research will advance the nursing profession’s understanding and capability to improve professional education and clinical practice quality in this patient-safety critical domain.
| Date of Award | 9 Apr 2021 |
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| Original language | English |
| Supervisor | David Pontin (Supervisor) & Keith Weeks (Supervisor) |