Investigating undergraduate nurse responses to simulated interruptions during medication administration : a qualitative multi-method study

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𝗔𝗶𝗺: The aim of this thesis is to explore undergraduate nursing student responses to interrupted medication administration and facilitate new insights into interruption management strategies. 𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱: Medication administration incidents and errors are a significant patient safety issue that often occur as a direct result of the inappropriate management of interruptions and distractions. Undergraduate nursing students are mostly taught how to administer medications in a calm and uninterrupted environment. In the clinical environment however, they are faced with the reality of administering medications amidst competing demands and multiple interruptions. Improving patient safety requires realistic, innovative and creative methods of teaching medication administration to undergraduate nurses. 𝗗𝗲𝘀𝗶𝗴𝗻: A qualitative multi-method research study was undertaken within a large Australian University. This study was designed to elicit student responses to a simulated role-play that purposefully placed students in an interrupted and pressured environment. Participants included second-year undergraduate nursing students (n=528) and nursing faculty (n=8). Data were derived from; student written reflective responses (n= 451), student semi-structured individual interviews (n=13), student feedback surveys (n= 28), and faculty email questionnaires (n=8). Data were subject to thematic analysis. 𝗙𝗶𝗻𝗱𝗶𝗻𝗴𝘀: Student participants reported that they had gained a new understanding of the impacts of interruptions while administering medications. Improved awareness of management strategies and an increased level of confidence was revealed. Students identified the role they played was significant to their individual experience and learning from the simulation. Some roles were reported to have contributed to increased levels of stress and others were reported to facilitate enhanced patient and team member empathy. Students expressed a desire to experience more complex scenarios during simulation experiences to enhance in their preparation for real-world clinical practice. Students also described the positive impact the written reflective experience had on their ability to consolidate and integrate prior and new knowledge and skills. Data collected from nursing faculty supported the findings from the student participant data. 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻: Study findings highlighted that student confidence and understanding of the impact of interruptions during the medication administration process improve if they are given the opportunity to practice in realistic and safe settings. Empathy for both patients and other members of the nursing team can be enhanced as a result of immersive role-play experiences. Simulated experiences that incorporate system and process complexities, together with opportunities for extended reflection to facilitate deeper learning, show promise in developing proficiency.
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