Simulation strategies to increase nursing student clinical competence in safe medication administration practices: A quasi-experimental study.

BACKGROUND: Nursing student medication errors often result from deficits in knowledge and application of fundamental safe administration practices. Factors such as high faculty-student ratios and legal restrictions have decreased clinical learning opportunities for nursing students to practice safe medication administration in the clinical setting. Evidence suggests that use of a structured medication safety enhancement (MSE) simulation program can significantly improve student knowledge and competency in safe medication administration. PURPOSE: To examine the effects of an educational strategy using a MSE simulation program with integrated technology on the medication administration knowledge, competency, and confidence levels of undergraduate nursing students. METHODS: This quasi-experimental replication study designed and implemented medication simulations enhanced by integrated information technologies in an undergraduate-nursing curriculum. Third-year BSN students (n = 83) were randomized into intervention or control groups. Control groups participated in standard training while the intervention group received additional clinical simulation experience and debriefing sessions focused on medication safety practices. Participant knowledge was measured using pre/post Medication Safety Knowledge Assessment (MSKA) and competency was evaluated using the Medication Safety Critical Element Checklist (MSCEC). RESULTS: The MSKA and MSCEC were analyzed using two-sided independent t-tests. Post-test knowledge scores increased in both groups but results were not statistically significant (α = 0. 05). Students who received the medication safetfy enhancement intervention performed significantly better in a subsequent simulation than students who did not have prior simulation experience (p < .001). CONCLUSION: Findings suggest that educators should consider high fidelity simulation as an evidence-based teaching strategy to engage students in understanding and implementing medication safety practices in the clinical setting.

Predictors of Depression Symptoms Among Low-Income Women Exposed to Perinatal Intimate Partner Violence (IPV).

Women experiencing perinatal intimate partner violence (IPV) may be at increased risk for depression. Baseline data was analyzed from 239 low-income pregnant women participating in an intervention study designed to reduce exposure to IPV. Depression risk was assessed using the Edinburgh Postnatal Depression Scale (EPDS) and IPV factors were measured with the Conflict Tactics Scale-Revised (CTS-2). Stepwise regression was conducted to identify predictors of risk for depression. Race (p = 0.028), psychological IPV (p = 0.035) and sexual IPV (p = 0.031) were strongly associated with risk for depression. Regression results indicated that women experiencing severe psychological IPV were more likely to develop depression (OR 3.16, 95 % CI 1.246, 8.013) than those experiencing severe physical or sexual IPV. Experiencing severe psychological IPV during pregnancy is strongly linked to risk for depression. Routine screening for psychological IPV may increase identification and treatment of women at high risk for depression during pregnancy.

Posttraumatic stress disorder among low-income women exposed to perinatal intimate partner violence : Posttraumatic stress disorder among women exposed to partner violence.

Women exposed to intimate partner violence (IPV) and other forms of lifetime trauma may be at risk for negative mental health outcomes including posttraumatic stress disorder (PTSD). The purpose of this study was to examine potential predictors of PTSD among low-income women exposed to perinatal IPV. This study analyzed baseline cross-sectional data from 239 low-income pregnant women in the USA who participated in a nurse home visitation intervention between 2006 and 2012 after reporting recent IPV. PTSD was assessed with the Davidson Trauma Scale (DTS) in which participants answer questions about the most disturbing traumatic event (MDTE) in their lifetime that affected them the week before the interview. In total, 40 % of the women were identified as having PTSD (DTS ≥40). PTSD prevalence significantly increased with age to nearly 80 % of women ages 30 and older (n = 23). Age was also the strongest predictor of PTSD (p < 0.001). Most participants (65 %) identified non-IPV-related traumas as their MDTEs. Psychological (94 %), physical (82 %), and sexual (44 %) violence were not significantly associated with PTSD status. Despite recent exposure to IPV, most participants identified other traumatic events as more disturbing than IPV-related trauma. Further, the risk for PTSD increased with age, suggesting that the cumulative effect of trauma, which may include IPV, increases the risk for PTSD over a lifetime. Implementing comprehensive screening for trauma during prenatal care may lead to the early identification and treatment of PTSD during pregnancy in a community setting.

Self-Rated Mental Health: Screening for Depression and Posttraumatic Stress Disorder Among Women Exposed to Perinatal Intimate Partner Violence.

The purpose of the current study was to evaluate the validity of a single-item, self-rated mental health (SRMH) measure in the identification of women at risk for depression and posttraumatic stress disorder (PTSD). Baseline data of 239 low-income women participating in an intimate partner violence (IPV) intervention study were analyzed. PTSD was measured with the Davidson Trauma Scale. Risk for depression was determined using the Edinburgh Postnatal Depression Scale. SRMH was assessed with a single item asking participants to rate their mental health at the time of the baseline interview. Single-item measures can be an efficient way to increase the proportion of patients screened for mental health disorders. Although SRMH is not a strong indicator of PTSD, it may be useful in identifying pregnant women who are at increased risk for depression and need further comprehensive assessment in the clinical setting. Future research examining the use of SRMH among high-risk populations is needed.

Determinants of alcohol cessation, reduction and no reduction during pregnancy.

PURPOSE: Despite public health initiatives targeting the harmful effects of alcohol exposure on fetal growth, 12 % of pregnant women report current alcohol use. For women who reported drinking alcohol prior to pregnancy, we examined several factors as predictors of three alcohol use patterns during the third trimester of pregnancy: cessation, reduction and no reduction. METHODS: Using the 2002-2009 Pregnancy Risk Assessment Monitoring System (PRAMS) dataset (311,428 records), a multinomial logistic regression model was constructed to compare alcohol risk by category: (1) cessation vs. reduction (2) no reduction vs. reduction. RESULTS: In this sample, 49.4 % drank alcohol before pregnancy. Among those who drank before pregnancy, ~87 % quit drinking during pregnancy, 6.6 % reduced, and about 6.4 % reported no reduction. Older women and those with higher education were more likely to reduce than quit their alcohol use. Conversely, women who were black or Hispanic, overweight, obese, or multiparas were more likely to quit than to reduce their prenatal alcohol consumption. Several stressors such as abuse during pregnancy increased their risk of not quitting or not reducing alcohol during the last trimester of pregnancy. CONCLUSIONS: Differentiating prenatal alcohol use patterns can inform the design of targeted interventions and public health policies to meet the Healthy People 2020 objective for achieving a national rate of 98.3 % alcohol abstinence during pregnancy.