Author: Carol F. Durham, Ed.D.(c.), RN
Title: Director Clinical Education & Resource Center and Clinical Associate Professor
Institution: UNC-Chapel Hill School of Nursing
Coauthors: Joan Williams, RN, MSN, Clinical Assistant Professor, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Darlene Baker, RN, MSN, Assistant Director Clinical Education & Reso
Skills or Simulation Laboratories
The teaching strategy is designed to evaluate the following KSAs: Knowledge: Examine human factors and basic safety design principles as well as commonly used unsafe practices, including work-arounds and dangerous abbreviations. Attitude: Appreciate the cognitive and physical limits of human performance. Skill: Use appropriate strategies to reduce reliance on memory. Knowledge: Delineate general categories of errors and hazards in care. Attitude: Recognize the value of open communication from the patient family and healthcare team. Skill: Communicate observations or concerns related to hazards and errors to patients, families and/or healthcare team.
If other examples or information are desired please contact Carol Durham, Director, Clinical Education & Resource Center at Carol_Durham@unc.edu and be CERTAIN to list in the subject line “QSEN teaching” otherwise the request may not be received.
This synthesis/learning activity requires first semester pre-licensure nursing students to apply their nursing knowledge and skills associated with the planning, administration, and evaluation of medication therapeutics. This pass/fail competency exam goes far beyond demonstrating knowledge or skill. The expectation for this exam is for the student to demonstrate synthesis of the pharmacology knowledge as they integrate it with the performance of the requisite psychomotor skills.
The competent demonstration of these skills is very important as they enter clinical in the next semester. So, as part of the pharmacology course, they demonstrate their proficiency through this psychomotor/cognitive exam. They are required to demonstrate the 6 Rights of Medication Administration (Right Medication, Right Patient, Right Dose, Right Time, Right Route, and Right Documentation) and the 3 medication checks. They are also expected to perform patient identification using two identifiers.
Strategy Implementation: At the beginning of the semester the students are given logistic and preparatory instructions (see Basic Pharm Comp log and prep). They are asked to sign up for a time for open lab to review skills as they desire and a 30-minute block for the exam. This is a pass/fail assignment associated with their pharmacology course.
The Basic Pharmacology Exam was developed in response to a curricular change. The flow of the courses and the pharmacology competency exam changed in Spring 2007. As planning ensued for the pharmacology exam it became evident to the educators that the students would not be able to pass the Advanced Pharmacology in Nursing Practice Competency Exam and that an additional basic exam needed to be designed. This basic exam is intended to allow first semester pre-licensure nursing students to integrate classroom information with the psychomotor skills they have learned in their fundamental skills labs. The content was leveled to allow the students success while challenging them to think critically.
The Basic Pharmacology in Nursing Practice Competency Exam takes a total of 30 minutes for a given student. We run two cases (two students) in each room for the 30 minutes. They have to complete 2 patient care scenarios (see Basic Pharm Comp Ampicillin as an example) acting as a medical-surgical nurse. The students have 12 minutes to assess, interview, utilize available resources, and implement interventions with their patient. Between cases, they have 3 minutes to rotate to the RIGHT and prepare to begin the next case. This activity has been designed to mirror the activities as a nurse in the hospital or clinic involved with medication administration. A timekeeper using automatic timers manages the rotation in each room. No feedback is provided between cases.
At the end of the third case, in the remaining 5 minutes the evaluators provide feedback. To facilitate efficient use of time, the students are instructed to receive feedback from the current station and then rotate to the LEFT, visiting the previous 2 stations to receive feedback on their performance. Each evaluator has a form where they record their comments to facilitate accurate and informative feedback. The timekeeper in the room holds the master P/F list and lets the students know of their pass/fail status as they exit.
Students are expected to pass both of the medication administration simulations and have to return if they fail any one. This exam’s counterpart has historically been a very challenging exam for the students because it is timed and they have to respond as in a real medication administration situation. Each of the scenarios requires different cognitive and psychomotor skills, requiring critical thinking and implementation.