Post-Exam Wrappers: A Tool for Critical Reflection.

BACKGROUND: Post-exam review sessions that reveal a completed exam to students can be time-consuming and ineffective. Additionally, the review may jeopardize exam integrity by exposing the individual items. METHOD: To promote critical reflection, an exam wrapper, without the return of a completed exam, was implemented. Students were encouraged to take deeper ownership of learning and be active in the process of exam review. RESULTS: Most students strongly agreed or agreed that they adjusted their study strategies based on their self-reflection (68.5%) or on the instructor feedback (66.7%) provided through the wrapper. All faculty stated the process of using wrappers was much more or more valuable and efficient, compared to prior post-exam feedback methods. CONCLUSION: Using an exam wrapper as a stand-alone, post-exam debrief, students assume a more proactive role by reflecting on individual exam preparation and learning strategies without the return of a completed exam. [J Nurs Educ. 2024;63(X):XXX-XXX.].

An Interruption Management Education Bundle: Feasibility Testing With Nursing Students.

BACKGROUND: Interruptions and distractions are pervasive in health care settings, increase risks for errors, and decrease task efficiency. Researchers recommend the use of strategies to mitigate their negative effects. PURPOSE: The purpose was to assess the feasibility and acceptability of (1) an education bundle that included an interruption management strategy and (2) simulated scenarios with embedded interruptions and distractions. METHODS: Nineteen undergraduate nursing students participated in this repeated-measures, multimethods feasibility study. Data on interruption management behaviors were collected across 3 timepoints via direct observation of individual-simulated medication administration. Participants' perceptions of the education bundle were explored via semistructured interviews. RESULTS: Participants described the simulated scenarios as realistic and interruption management strategy as easy to use and remember. Participants voiced increased confidence in handling interruptions after learning the strategy. The strategy averaged 4 seconds to apply. CONCLUSIONS: Findings support the feasibility and acceptability of the bundle and need for studies to investigate the impact of the strategy on errors and task durations.

Undergraduate nursing student experiences in American clinical learning environments: A descriptive study.

BACKGROUND: Newly qualified nurses are often considered inadequately prepared for practice. During nursing students' educational preparation, clinical learning environments are intended to provide experiences for students to develop skills and clinical judgments needed for safe practice. Yet, a recent systematic review found no quantitative evidence that clinical education models facilitate student learning. In addition, little is known about the frequency and type of skills students perform when in clinical settings. OBJECTIVE: To investigate undergraduate nursing student experiences with skills and the quality of supervision and feedback received when performing skills in clinical settings. DESIGN: Retrospective descriptive. SETTING: A mid-sized private university in the Midwestern part of the United States. METHODS: Students completed an online survey after clinical days during one semester. Students self-reported their experiences with medication administration, psychomotor skills and physical assessments via multiple choice items. Descriptive statistics were calculated using Microsoft 365 Excel. Content analysis was performed of one open-response survey item. RESULTS: A total of 496 surveys were completed. On average, during one clinical day, 13.5 % of students administered medication, 20.5 % performed a psychomotor skill, and 64 % completed a physical assessment. Students were most frequently supervised by bedside nurses and reported the quality of their supervision and feedback as "very good" or "good". Some students reported being restricted from administering medication and performing other skills due to a clinical site policy. CONCLUSIONS: In this study, students performed few skills and assessments when in clinical settings. Increased clinical experiences are needed for students to develop competencies to better prepare them for safe practice. The findings contribute to the dearth of knowledge related to the clinical learning experiences of undergraduate nursing students, and can guide strategies to improve new nurse preparedness.

Nursing Students' Medication Administration: A Focus on Hand Hygiene and Patient Identification.

BACKGROUND: Procedural failures during medication administration include a lack of appropriate hand hygiene and failure to verify patient identification prior to administration of medication. Procedural failures are common among nurses and nursing students and can lead to serious patient harm. METHOD: A descriptive cross-sectional research design was used to collect observational data from a simulation-based experience of a medication administration scenario. RESULTS: Thirty-five senior baccalaureate nursing students from two geographically distant universities in the United States participated in the study. All of the participants made at least one procedural failure during the simulated experience. Hand hygiene compliance was 40.3%, and patient identification compliance was 43.8%. CONCLUSION: Students often failed to comply with medication administration safety guidelines. Nursing programs must make changes to the methods used to teach safe medication administration to prepare students for this critical skill. [J Nurs Educ. 2023;62(7):403-407.].

Association of external interruptions with increased medication administration duration and self-interruptions: A direct observational study: Empirical research quantitative.

AIMS: To examine task duration and frequency of self-interruptions among study participants during externally interrupted compared with externally uninterrupted simulated medication administration. BACKGROUND: Interruptions are prevalent during nursing medication administration and can lead to inefficient, delayed, omitted and unsafe patient care. Interrupted nursing tasks are shown to take longer to complete compared to uninterrupted tasks; however, studies seldom indicate if the time spent in the interruption was included or excluded in the reported task duration. It is unknown if the time spent in the interruption leads to longer task completion times or if other factors, such as the time needed to re-engage in the primary task and/or self-interruptions, are involved. Little is known about associations between external interruptions and self-interruptions during nursing tasks. Self-interruptions are caused by an individual's own decision to stop an activity to attend to something else. DESIGN: Cross-sectional within-subjects design. METHODS: This two-site study investigated task duration and frequencies of self-interruptions during externally interrupted and externally uninterrupted simulated medication administration. Data on medication administration duration, external interruption duration and self-interruptions were collected via direct observation from November 2019-February 2020. The time spent in the external interruption was deducted from the medication administration duration. RESULTS: Thirty-five participants were included in the study. The externally interrupted task had a significantly longer duration and significantly more frequent self-interruptions within-subjects compared to the externally uninterrupted task. Self-interruptions were most often due to forgotten supplies. CONCLUSIONS: The findings suggest that the time needed to re-engage with an externally interrupted task and/or self-interruptions may lead to longer task completion times. IMPACT: Researchers are encouraged to investigate mediators of interruptions that lead to longer task completion times and errors. Findings can be used to develop and implement interruption management strategies that aim to improve the safety and quality of patient care. REPORTING METHOD: Equator guidelines were followed using the STROBE reporting method. PATIENT/PUBLIC CONTRIBUTION: No patient or public involvement in this study. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Educators and researchers can use the study findings to guide teaching methods and direct future studies. By gaining a better understanding of the mediators of interruptions that create longer task completion times and increase the risk for errors, tailored interruption management strategies that aim to improve the safety and quality of healthcare can be developed and implemented.

Medication administration errors made among undergraduate nursing students: A need for change in teaching methods.

BACKGROUND: Systems factors, such as interruptions, contribute to nursing errors. Gaining an understanding of what contributes to nursing student errors can inform educational strategies aimed to improve patient safety. PURPOSE: The aims of this study were to investigate: (a) within-subjects differences in error rates among nursing students during interrupted compared to uninterrupted simulated medication administration, (b) types of medication administration errors made by nursing students, and (c) nursing students' perceptions of their ability to independently administer medication. METHODS: A descriptive comparative within-subjects design was utilized in this two-site study. Data on errors were collected via direct observation. Senior baccalaureate nursing student participants discussed their experience of interrupted and uninterrupted simulated medication administration during individual debriefing sessions. RESULTS: Nearly one-third of participants made errors. Error rates were similar in interrupted (19.4%) and uninterrupted (16.7%) conditions. Near-misses, which were not included in the error rates, were reported by 8% of participants. The most common error types were documentation and dose errors. Students attributed the interruption and lack of independent medication administration practice as causes for errors. CONCLUSION: Educational programs must adequately prepare nursing students for independent safe medication administration in complex work environments. The inclusion of systems factors in educational modalities is critical.

Undergraduate Nursing Students and Management of Interruptions: Preparation of Students for Future Workplace Realities.

AIM: The aim of this study was to investigate interruption management strategies and associative cues used by nursing students when interrupted during simulated medication administration. BACKGROUND: Interruptions occur with high frequency in health care settings and are associated with increased medication errors and decreased task efficiency. The Altmann and Trafton memory for goals model, a cognitive-science model, proposes use of associative cues during an interruption to mitigate these negative effects. METHOD: A mixed-methods, two-site study explored associative cues and other management strategies that nursing students used when interrupted during simulated medication administration. Data were collected via direct observation and semistructured interviews. RESULTS: Students primarily multitasked (66.7 percent) during the interruption. Few students (5.5 percent) used associative cues. Students voiced the need for education and practice on how to manage interruptions. CONCLUSION: Evidence-based strategies are required to prepare nursing students for workplace interruptions. Use of associative cues during interruptions warrants further investigation.

Nurses' Perceived Causes of Medication Administration Errors: A Qualitative Systematic Review.

BACKGROUND: Medication administration errors (MAEs) are a critical patient safety issue. Nurses are often responsible for administering medication to patients, thus their perceptions of causes of errors can provide valuable guidance for the development of interventions aimed to mitigate errors. Quantitative research can overlook less overt causes; therefore, a qualitative systematic review was conducted to present a synthesis of qualitative evidence of nurses' perceived causes of MAEs. METHODS: Publications from 2000 to February 2019 were searched using four electronic databases. Inclusion criteria were articles that (1) presented results from studies that used a qualitative or mixed methods design, (2) reported qualitative data on nurses' perceived causes of MAEs in health care settings, and (3) were published in the English language. Sixteen individual articles satisfied the inclusion criteria. Methodological quality of each article was assessed using the Critical Appraisal Skills Programme (CASP) tool. Thematic analysis of the data was performed. Perceived causes of errors were labeled as knowledge-based, personal, and contextual factors. RESULTS: The primary knowledge-based factor was lack of medication knowledge. Personal factors included fatigue and complacency. Contextual factors included heavy workloads and interruptions. Contextual factors were reported in all the studies reviewed and were often interconnected with personal and knowledge-based factors. CONCLUSION: Causes of MAEs are perceived by nurses to be multifactorial and interconnected and often stem from systems issues. Multifactorial interventions aimed at mitigating medication errors are required with an emphasis on systems changes. Findings in this review can be used to guide efforts aimed at identifying and modifying factors contributing to MAEs.

Characteristics of interruptions during medication administration: An integrative review of direct observational studies.

AIMS AND OBJECTIVES: To synthesise and summarise data gathered by direct observation of the characteristics of interruptions in the context of nursing medication administration (MA) in hospital settings. BACKGROUND: Interruptions are prevalent during the MA process performed by nurses in hospital settings and have been found to be associated with an increase in frequency and severity of nursing MA errors. In addition, interruptions decrease task efficiency, leading to longer MA completion times. DESIGN: Integrative review. METHODS: The electronic databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, PsycARTICLES and Google Scholar were searched using the terms "interruptions" AND "medication administration" AND "direct observation." Nine articles met the inclusion criteria. RESULTS: Interruptions are likely to occur at least once during nursing MA processes in hospital settings. This finding applies to medication administered to one patient, termed a medication pass, and medication administered to multiple patients, termed a medication round. Interruptions are most commonly caused by another nurse or staff member or are self-initiated, and last approximately 1 min in length. CONCLUSIONS: A raised awareness among staff of the most common sources of interruptions may encourage changes that lead to a decrease in the occurrence of interruptions. In addition, nurse leaders can apply an understanding of the common characteristics of interruptions to guide research, policies and educational methods aimed at interruption management strategies. RELEVANCE TO CLINICAL PRACTICE: The findings from this review can be used to guide the identification and development of targeted interventions and strategies that would have the most substantial impact to reduce and manage interruptions during MA. Interruption management strategies have the potential to lead to a decrease in medication errors and an increase in task efficiency.