Student nurses’ thinking during medication administration

Background: The thought processes of student nurses during medication administration relative to prevention of patient harm or errors or promoting therapeutic responses are not well known. Nursing students may be focused more on the rules and procedures rather than anticipatory problem solving and concurrent patient teaching that occurs with practicing nurses. The Quality and Safety Education for Nurses (QSEN) project provides nursing faculty with a framework to assure that graduates are able to demonstrate quality and safety competencies, including that of medication administration. Methods: This qualitative study examined student nurses’ reported thinking during medication administration in a simulated experience involving care of a post-operative patient reporting pain. Forty-eight students from 5 baccalaureate nursing programs participated in a video recorded simulation with a standardized post-operative patient. Students independently completed a patient assessment and administered pain medication from a variety of options. Following the simulation, semi-structured debriefing interviews containing 8 open-ended questions were conducted and audiotaped. Results: Students administered a variety of pain medication during the simulation. Analysis of transcriptions revealed five themes including 1) safety, 2) clinical reasoning, 3) uncertainty and need for validation, 4) lessons learned, and 5) perception of realism. Safety was the most predominant theme that emerged from the data. Conclusion: Students must be able to more fully understand clinical decision making around medication administration (e.g., best practice, individual experiences with pain, patient preferences, patient conditions, etc.). Implementing teaching strategies that integrate opportunities for several valid nursing interventions encourage students to move away from a linear perspective to examine their thinking and the complexity of clinical practice. Findings will inform faculty relative to curricular design, pedagogy, and evaluation in educating nursing students to become safe and competent nurses.