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: Darlene Baker, RN, MSN, Assistant Director Clinical Education & Resource Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Katherine S. Gallia, RN, PhD, AOCN Clinica
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.
This synthesis/learning activity requires last 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. 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 their last semester in the curriculum. So, as part of the capstone 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 2 patient identifiers to determine that you have the Right Patient. Strategy Implementation At the beginning of the semester that the Pharm Competency falls, the students are given logistic and preparatory instructions (see Adv 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 (see Adv Pharm Comp sign up). This is a pass/fail assignment associated previously with their pharmacology course but we are moving this strategy to their capstone because of curricular changes (see Basic Pharm Comp). The Advanced Pharmacology in Nursing Practice Competency Exam takes a total of 30 minutes for a given student. We run three cases (three students) in each room for the 30 minutes. They have to complete 3 patient care scenarios (see Adv Pharm DM_Insulin_Steriods as an example) acting as a medical-surgical nurse. The students have 7 minutes to assess, interview, utilize available resources, and implement interventions with your 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 (see Adv Pharm Comp PF station I S07 Eval1). The timekeeper in the room holds the master P/F list and lets the students know of their pass/fail status as they exit (see Adv Pharm Comp PF Master). Students are expected to pass two of the three demonstrations and have to return for a redo if they fail more than one. This is 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 three scenarios requires different cognitive and psychomotor skills requiring critical thinking and implementation.
Included in this teaching strategy demonstration is one of 8 basic pharmacology competency exercises. 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.
Evaluation – anecdotal This pass/fail evaluation of the integration of basic pharmacology content learned in class and the psychomotor skills of medication administration learned in skills lab creates lots of anxiety pre-examination. Once students are in clinical they report back that this exercise really helped them integrate what they knew and was a helpful exercise to better prepare them to safely administer medications.