Factors contributing to registered nurse medication administration error: a narrative review.

OBJECTIVE: To explore the factors contributing to Registered Nurse medication administration error behaviour. DESIGN: A narrative review. DATA SOURCES: Electronic databases (Cochrane, CINAHL, MEDLINE, BNI, EmBase, and PsycINFO) were searched from 1 January 1999 to 31 December 2012 in the English language. 1127 papers were identified and 26 papers were included in the review. Data were extracted by one reviewer and checked by a second reviewer. REVIEW METHODS: A thematic analysis and narrative synthesis of the factors contributing to Registered Nurses' medication administration behaviour. Bandura's (1986) theory of reciprocal determinism was used as an organising framework. This theory proposes that there is a reciprocal interplay between the environment, the person and their behaviour. Medication administration error is an outcome of RN behaviour. RESULTS: The 26 papers reported studies conducted in 4 continents across 11 countries predominantly in North America and Europe, with one multi-national study incorporating 27 countries. Within both the environment and person domain of the reciprocal determinism framework, a number of factors emerged as influencing Registered Nurse medication administration error behaviour. Within the environment domain, two key themes of clinical workload and work setting emerged, and within the person domain the Registered Nurses' characteristics and their lived experience of work emerged as themes. Overall, greater attention has been given to the contribution of the environment domain rather than the person domain as contributing to error, with the literature viewing an error as an event rather than the outcome of behaviour. CONCLUSION: The interplay between factors that influence behaviour were poorly accounted for within the selected studies. It is proposed that a shift away from error as an event to a focus on the relationships between the person, the environment and Registered Nurse medication administration behaviour is needed to better understand medication administration error.

Clinical skills education for graduate-entry nursing students: enhancing learning using a multimodal approach.

This paper discusses the development of a new clinical skills course at a school of nursing and midwifery in London. The course, part of a two year pre-registration programme for graduates in other disciplines, adopted an innovative multimodal approach. This comprised a range of teaching, learning and assessment strategies designed to maximise comprehensiveness, complementarity and flexibility. The background to the development is discussed and each component is described in detail. A brief summary of relevant feedback generated from anonymous student evaluations is included. This provides important insights into the perceived strengths and weakness of the module from a learner perspective. The paper concludes by identifying proposed future developments and recommending wider applications of the multimodal approach within nursing and healthcare education on an international level.