Medication errors during medical emergencies in a large, tertiary care, academic medical center

Purpose

Evaluate the rate, type and severity of medication errors occurring during Medical Emergency Team (MET) care at a large, tertiary-care, academic medical center.

Methods

A prospective, observational evaluation of 50 patients that required MET care was conducted. Data on medication use were collected using a direct-observation method whereby an observer documented drug information such as drug, dose, frequency, rate of administration and administration technique. Subsequently, a team of three clinicians assessed rate, type and severity of medication errors using definitions consistent with United States Pharmacopeia MEDMARX system. Severity was assessed on a scale of minor, moderate and severe.

Results

One hundred eighty six doses were observed for 36 different medications. A total of 296 errors were identified; of these 196 errors (66%) were inappropriate aseptic technique. Of the remaining 100 errors, 46% were prescribing errors, 28% administration technique errors, 14% mislabeling errors, 10% drug preparation errors and 2% improper dose prescribing. Examples included: (1) prescribing errors, (2) administering wrong doses, (3) mislabeling, and (4) wrong administration technique such as not flushing intravenous medication through intravenous access. The rate of medication administration errors was 1.6 errors/dose including aseptic technique and 0.5 errors/dose excluding aseptic technique. A notable portion (14%) of errors was considered at least moderate in severity.

Conclusions

One out of 2 doses was administered in error after errors of using inappropriate aseptic technique were excluded. There is a need for education and systematic changes to prevent medication errors during medical emergencies as an effort to avoid harm.     

The ethics and practical importance of defining, distinguishing and disclosing nursing errors: a discussion paper

Nurses globally are required and expected to report nursing errors. As is clearly demonstrated in the international literature, fulfilling this requirement is not, however, without risks. In this discussion paper, the notion of 'nursing error', the practical and moral importance of defining, distinguishing and disclosing nursing errors and how a distinct definition of 'nursing error' fits with the new 'system approach' to human-error management in health care are critiqued. Drawing on international literature and two key case exemplars from the USA and Australia, arguments are advanced to support the view that although it is 'right' for nurses to report nursing errors, it will be very difficult for them to do so unless a non-punitive approach to nursing-error management is adopted.     

规避实习护生静脉输液安全隐患的做法与效果

目的解决临床实习护生在静脉输液安全中出现的问题。方法2005年以来,对在我院实习的52名护生开展静脉输液安全问题专题讲座及有效的临床带教,增加了实习护生的安全防范意识。结果实习护生的静脉输液技术提高,护理缺陷减少。结论临床实习期间应加强实习护生静脉输液安全知识培训,提高其静脉输液安全知识的能力,对预防护理风险具有重要意义。     

高职护理专业仿真实训教学及情境设置的实践

护理是一门艺术性、应用性很强的学科,随着社会的进步,科学的发展,对护理人员的要求越来越高。该文介绍了借助临床真实病例和各种仿真训练系统,对在校高职护理专业学生进行仿真实训教学,并在教师指导下编制情境的实践,从而缩小学校教育和临床实践之间的差距,培养学生自主学习能力、分析问题和解决问题的能力。     

护理本科机能学实验中融入护理程序的尝试

为了提高护理本科机能学实验教学质量,针对学生的专业特点,结合机能学实验与临床情景独特的相似性,在保留必要的基本技能训练的基础上,设计了能运用护理程序的综合实验项目,以典型的疾病模型为基础,模拟灾难现场常见的病例,按照评估、做出护理诊断、制订护理方案、实施方案、根据治疗后各指标变化做出综合评价等环节进行教学。此教学方法有利于护理本科生综合能力的提高,为学生后续的专业课程、毕业后的临床和科研工作打下良好基础。     

护理专业学生实习前对护理伦理认知的现状研究

目的调查护理专业学生实习前对护理伦理的认知水平,为实习中的护理伦理认知教育提供依据。方法采用自行设计的护理伦理认知问卷,对322名实习前护理专业学生进行问卷调查。结果实习前学生对护理伦理基础知识掌握情况相对较好,但对临床工作中的护理伦理问题认知不足,本科生护理伦理认知得分高于大专生(P<0.01)。结论实习前学生的护理伦理认知水平亟待提高,学校和医院应重视护理伦理学教育理论与实践的结合,针对其薄弱之处采取相应的培养措施。     

Learning strategies of first year nursing and medical students: A comparative study

Background

Interprofessional education (IPE), where two or more professions learn with, from, and about each other to improve collaboration and the quality of care, has been proposed as a curriculum strategy to promote mutual understanding between professions, thus helping to prepare health professionals to work in challenging contemporary health systems. Although there is support for IPE initiatives within health professional education, differences in student motivation and learning strategies are likely to contribute to the success of these initiatives.

Objective

To explore self-regulated learning strategies used by first year medical and nursing students, and to determine if these strategies were different among nursing students who were high achievers.

Design

A comparative survey design.

Setting

Nursing and medical nursing schools in a large university in the western region of Sydney, Australia.

Participants

Six hundred and sixty-five first year nursing (n = 565) and medical (n = 100) students in a large university in the western region of Sydney were surveyed to assess motivational and learning strategies using The Motivated Strategies for Learning Questionnaire (MSLQ). Data relating to sociodemographic characteristics and academic performance were also collected.

Results

Nursing students were significantly older than medical students (mean age: 24.4 years versus 19.4 years; p < 0.001), and there were also more females in the nursing student group (82% versus 56%; p < 0.001). Although nursing students had a higher mean score for extrinsic goal orientation compared to medical students (p < 0.001), medical students had higher mean scores for the other four learning strategies measured: peer learning (p = 0.003), help seeking (p = 0.008), critical thinking (p = 0.058), and time and study environment management (p < 0.001). Similarly, the grade point average (GPA) of medical students at the end of their first year was significantly higher (4.5, S.D. 1.4 versus 3.6, S.D. 1.3; p < 0.001) compared to that of nursing students.

Conclusion

While interprofessional education is seen to have many benefits for students, this study demonstrates differences in motivational and learning strategies between nursing and medical students that may impact on the success of interprofessional programs.     

临床医学和护理学专业实习学生医护合作态度的调查研究

目的 调查和比较临床医学和护理学专业实习学生对医护合作的态度,分析二者的主要差异,为开展医护合作教育提供参考依据.方法 采用Jefferson医护合作态度量表对郑州大学实习已满10个月的临床医学专业本科生88名、研究生66名,护理学专业本科生79名、研究生66名进行调查.结果 医学生和护生的医护合作态度得分均较高,护生高于医学生,差异具有统计学意义(P=0.036).医学生和护生主要差异在于对医生权利的认知,护生得分较高(P=0.000);两者在教育需求上表现出高度一致性.结论 应该有针对性地加强有关医护双方权利和职责的教育,使医学生和护生更好更多理解与尊重对方,为提供更好的医疗服务打下基础.     

The effect of a situation model nursing education action program on gender-bias awareness and gender-friendliness barriers in novice nursing students

AimThis study presents a workshop on the Situation Model Nursing Education Action program, examines how to promote gender awareness and decrease barriers related to differences in gender friendliness through the implementation of this program and tracks the trends of the relevant variables.DesignPre- and post-observations and a cohort study were conducted.MethodsA total of 58 nursing students (42 females and 16 males) were included. Nursing students were offered a gender-care intervention as two 90-minute workshops and surveys that measure gender awareness and gender friendliness were administered.ResultsThe results concerned gender-bias awareness and gender-friendliness barriers scores across the four weeks of the program intervention, with the generalized estimated difference score compared with the Week 1 baseline. Mean student scores showed that gender-bias awareness was significantly decreased at Week 2 (p < .001) and Week 4 (p < .001) and that mean gender-friendliness barrier scores significantly declined at Week 4 (p < .001).ConclusionsThe findings indicate that a faculty professional learning community workshop that facilitates intentional behavioral change can help faculty to become aware of gender bias, which can improve students’ gender awareness through clinical case discussion and lead to a decline in barriers to students’ gender friendliness.     

Effects of a multifaceted neurological assessment educational program in nursing students: A randomized crossover study

AimThis study aimed to verify the effects of a multifaceted neurological assessment educational program on neurological assessment-related knowledge, skills, communication ability and self-efficacy in nursing students.BackgroundNurses should be equipped with optimal neurological assessment competency to ensure quality care for patients with neurological symptoms.DesignThis study involved a waitlist control group with a randomized crossover design.MethodsFourth-year nursing students were randomly assigned to an intervention group (n = 28) or a waitlist control group (n = 27). Pre- and post-intervention differences in neurological assessment knowledge, skills, communication ability and self-efficacy between the intervention and the waitlist control group were analyzed using generalized estimated equations.ResultsThe nursing students in the intervention group showed significantly improved knowledge, skills, communication ability and self-efficacy scores compared with those in the waitlist control group. Scores related to knowledge, skills and communication ability were maintained and self-efficacy scores had further increased at 2 weeks after the educational program in the intervention group.ConclusionsOur multifaceted neurological assessment educational program is useful for improving nursing students' knowledge, skills, communication ability and self-efficacy.     

The effect of a structured empathy course on the students of a medical and a nursing school

OZCAN C.T., OFLAZ F. & BAKIR B. (2012) The effect of a structured empathy course on the students of a medical and a nursing school. International Nursing Review Aim: The study aims to determine the effect of an empathy course for medical and nursing school students in one university in Turkey. Being able to relate to others empathetically is important for health professionals who need to develop therapeutic relationships with people who are sick, weak, sensitive and vulnerable. Professionals need empathic communication skills and professionalism not only for patients and their families but also for colleagues and other members of the health team. Method: All first year students (257) from a medical and a nursing school in one Turkish university in 2008–2009 and 2009–2010 were enrolled to the study. The course included 10 h of lectures on empathy and communication skills given through five consecutive weeks with 2 h in a week in the first year of both schools. Data were collected by using the Empathic Communication Skills Scale (ECSS), and the Empathic Tendency Scale (ETS) before and after the course. There were 143 medical students and 83 nursing students (total: 226, 88%) who completed the ECSS and ETS in a pre‐/post‐test study. Findings: Results demonstrated that all students received significantly higher scores for the final application than for initial scores on both scales. This implied that the targeted educational programme could have a positive effect on learning empathy and gaining empathy skills and tendency. Conclusion: Effective educational programmes might facilitate and improve empathic skills and empathic tendency of medical and nursing students, and both male and female students benefitted from the empathy course.     

护理专科生行为特征与觉知的相关性分析

目的 描述护理专科生A型行为类型和心智觉知水平,并探讨二者的关联.方法 采用A型行为类型评定量表和五因素心智觉知度量表对172名护理专科生进行问卷调查,并对调查结果进行分析.结果 172名学生中有112名属于B型行为,占65.1％,有60名属于A型行为,占34.9％;A型行为得分与心智觉知度的观察和描述维度呈正相关,与心智觉知度的有觉知的行动和不判断维度呈负相关.结论 不同行为特征的护理专科生其觉知度不同.护理教育者应根据学生的行为特征及时干预,以提高其心智觉知度,增进心理健康.     

广西护理人员对自愿报告护理差错和不良事件认知状况的调查

目的 通过调查,了解护理人员对自愿报告护理差错和不良事件的认知状况,分析其相关影响因素.方法 采用自行设计的问卷,2008年6-10月对广西25所二级、三级甲等医院275名护士进行便利抽样调查,对调查情况进行统计分析.结果 不同职称、是否管理人员与对定义、制度标准的认知状况差异显著;护理人员在对现行制度和拟实行非惩罚性制度报告差错和不良事件的态度上差异显著.结论 护理人员安全意识有待加强,现行的报告制度需要改进,有必要建立-个完善的护理差错和不良事件报告系统.     

Perceived academic-related sources of stress among graduate nursing students in a Jamaican University

BackgroundGraduate education is essential for the improvement of professions by facilitating advancements in career paths, personal growth and enhancing a country's economy. Graduate students frequently view graduate education as moderate to very stressful and this can have a negative impact on their lives. Stress can result in impaired coping, poor academic performance and reduction in cognitive functioning, resulting in the antithesis of academic success.ObjectiveA qualitative study was done to gain insight into the perception and sources of academic- related stress among graduate nursing students at an urban school of nursing in Jamaica.DesignA purposive sample of Master of Science in Nursing students in their penultimate semester for the academic year 2017/ 2018 were invited to participate in the study.MethodsNine students participated and each was assigned a selected pseudonym. Data were collected using one- to-one semi-structured interviews and interviews were transcribed verbatim. Thematic content analysis was used to determine emerging themes and coding was done manually.ResultsThe themes that emerged were: (1) Workload (2) Research (3) Prioritization (4) Lack of support (5) Lack of feedback (6) Balancing school life (7) Very stressful (8) Expectations of lecturers. Participants perceived that graduate education was very stressful to overwhelming. Academic-related stress was multi-factorial and predominantly due to the rigid curriculum structure. Contributing factors included increased workload; time constraints; the research course itself; lack of support and timely response from research supervisors and delayed responses from the Ethics Committee.ConclusionIt is very important for educators and curriculum developers to implement innovative strategies that are essential in providing an environment that will facilitate learning and to mitigate stress faced by graduate students.     

The mindfulness-based stress reduction program for improving sleep quality in cancer survivors: A systematic review and meta-analysis

IntroductionThis study aims to evaluate the efficacy and effectiveness of a mindfulness-based stress reduction (MBSR) program in improving sleep in cancer survivors.MethodsFour electronic databases (Cochrane Library, EMBASE, PubMed, and PsycARTICLES) were searched for randomized controlled trials evaluating the effects of MBSR on the sleep of cancer survivors from their inception to May 2020. The primary outcome was sleep quality measured by validated questionnaires such as the Insomnia Severity Index and Pittsburgh Sleep Quality Index. The secondary outcomes were sleep parameters obtained from a sleep diary, polysomnography, and actigraphy. The included studies were critically appraised by the Cochrane risk of bias tool and meta-analyzed.ResultsTen studies were included, and nine studies were analyzed quantitatively. MBSR significantly improved sleep quality compared to usual care (standardized mean difference −0.29, 95 % confidence interval −0.55 to −0.04, I² = 58 %). However, there were no favorable results with sleep parameters. Compared to active controls, MBSR presented mixed results with sleep quality according to the outcomes and negative results with sleep parameters.ConclusionThis review suggests that MBSR helps cancer survivors improve sleep quality. Our results support the possibility of using MBSR for cancer survivors. However, its efficacy and effectiveness in improving sleep quality and sleep parameters are inconclusive because the number of included studies was few with inconsistent results. Further studies with high methodological quality are required to establish conclusive evidence about the efficacy and effectiveness of MBSR in improving sleep quality and sleep parameters in cancer survivors.