For nursing instructors teaching term 5 clinical at the Faculty of Nursing, University of Calgary, rolling out medication administration by students for the first time can be a daunting task. Once students have passed the requisite medication calculation exam, they are eligible to begin giving medications to their patients in the clinical environment, including all forms of medications except intravenous (a term six skill).
This presents a significant challenge and stress for instructors to ensure the medications are administered appropriately using the three checks and seven rights because they are supervising eight students at the same time administering medications the first time. Instructors must also ensure that the student can safely administer the medication (for example a subcutaneous injection for the first time), and understands the medication well.
Currently, the support for instructors on this task is limited, and new instructors have voiced the need for further support and structure in safely rolling out this skill in clinical. A learning activity that provides instruction on how to facilitate medication administration in clinical can lead to better outcomes, including safer medication administration by students, less medication errors, and the instructor feeling less stressed. Additionally, the instructor may be able to facilitate more students giving medications earlier, allowing the students to be challenged and have more time to perfect this skill.
We created an interactive video for new nursing instructors to provide instruction and tips on how to facilitate medication roll out in clinical efficiently and safely. This activity was created using H5P technology (H5P Group, 2013). A mix of narrative slides and clinical recreations are enhanced with checkpoints to assess the viewer’s knowledge.
For instructions on how to use this activity, please watch the video below.
This activity will support the Faculty of Nursing’s future faculty development initiatives to address the needs of learners (nursing instructors) who are both local and remote, as well as integrate technology and digital learning beyond the cumbersome D2L shell. It has the benefit of being available to the nursing instructor while they are onsite at the clinical environment on a moment’s notice. To assess this activity, the faculty could incorporate a short survey, or Likert scale at the pre-activity stage and at the completion and compare the two results to see if there is any change or benefit in either the instructor’s knowledge or satisfaction with the targeted skill, rolling out medication administration.
Benefits of the activity are that it could be accessed by remote instructors within the University of Calgary nursing community, such as Medicine Hat College, Wainwright, Old Sun College. The activity also meets a constructivist pedagogical approach (Bates, 2022) and furthers the digital literacy (Belshaw, 2014) of the learner (nursing instructor).
Please find the activity below:
Supporting Literature
This medication administration roll out has been studied in a laboratory and simulation context (Krautscheid, 2011) however no literature was found to support strategies in safely rolling out medication administration in the clinical environment. We also could not find literature on how particular schools of nursing teach their instructors how to roll out medication administration in clinical, so both are areas of potential future research. Nursing students in studies describe the experience of medication administration in the clinical environment as very different from laboratory or simulation, as there are competing priorities within clinical. Among these priorities are patients, significant distractions during medication administration, including multiple patients’ needs, and noise, including alarms which can increase the risk of error, especially in a novice. There are also time pressures that exist in clinical that do not in simulation and lab. Finally, students are under significant pressure to thoroughly research the medications, complete all the medication checks, provide patient education, and administer the medication correctly all under the watchful eye of the instructor, patient, and patient’s family.
For example, in Krautscheid, et al., (2011) students report their laboratory experiences were helpful to prepare them for clinical medication administration, however they felt the experience was inadequate for the acute care environment and wished to have preparation for distractions and interruptions. Eisenhauer, et al., (2007) described both distractions and interruptions as key components to a nurse’s potential for medication errors, particularly in the novice such as a student, who are also susceptible to information overload. It could then be extrapolated that novice nursing instructors, working with eight students in the clinical environment, could also be susceptible to these same factors as they attempt to ensure their students administer medications safely, often within the same time frame. By providing up front resources and learning activities for these instructors, they can better prepare and plan their medication administration roll-out.
Choosing a H5P format over a straight video allows the learner to interact and participate, potentially seeing various strategies as they are prompted throughout the video to make choices. Belshaw (2014) in Chapter 5 discusses the cognitive element of digital literacy and the use of branching logic, wherein choosing one option leads to a selection of sub options. Further, by providing this H5P video, the learner is exposed to different lenses or ways of approaching not only the subject matter, but of the digital learning, and potentially see this as a new tool in their teaching. This is consistent with Belshaw’s (2014) cultural element of digital learning.
A constructivist pedagogy, as discussed by Bates (2022), is maintained in this activity by layering this activity with the other resources and discussions in the other three activities on Microsoft teams. Nursing instructors can engage with and interpret the resources as they see fit. The H5P format also lends itself well to constructivist pedagogy by allowing the learner to interact with the resource and develop multiple strategies that would best suit their own experience and teaching environment.
References
Bates, T. (2022). Teaching in a Digital Age. 3rd Edition. Retrieved from https://pressbooks.bccampus.ca/teachinginadigitalagev3m/chapter/section-3-4-constructivism/.
Belshaw, D. (2014). The Essential Elements of Digital Literacies. Chapter 5. Retrieved from http://digitalliteraci.es.
Eisenhauer, L., Hurley, A., & Dolan, N. (2007). Nurses’ reported thinking during medication administration. Journal of Nursing Scholarship, First Quarter 2007; 82-87. doi:10.1016/j.ijnurstu.2009.05.021.
H5P Group. (2013, June 10). H5P Interactive video. H5P. Retrieved October 23, 2022, from https://h5p.org/interactive-video.
Krautscheid, L.C., Orton, V. J., Chorpenning, L., & Ryerson, R. (2011). Student Nurse Perceptions of Effective Medication Administration Education. International Journal of Nursing Education Scholarship, 8(1), 2178–2178. https://doi.org/10.2202/1548-923X.2178.