Nurses’ decision‐making, practices and perceptions of patient involvement in medication administration in an acute hospital setting

Abstract

Aims To describe nurses’ decision‐making, practices and perceptions of patient involvement in medication administration in acute hospital settings. Background Medication errors cause unintended harm to patients. Nurses have a major role in ensuring patient safety in medication administration practices in hospital settings. Investigating nurses’ medication administration decision‐making and practices and their perceptions of patient involvement, may assist in developing interventions by revealing how and when to involve patients during medication administration in hospital. Design A descriptive exploratory study design. Methods Twenty nurses were recruited from two surgical and two medical wards of a major metropolitan hospital in Australia. Each nurse was observed for 4 hr, then interviewed after the observation. Data were collected over six months in 2015. Observations were captured on an electronic case report form; interviews were audio‐recorded and transcribed verbatim. Data were analysed using descriptive statistics and content and thematic analysis. Results Ninety‐five medication administration episodes, of between two and eight episodes per nurse, were observed. A total of 56 interruptions occurred with 26 of the interruptions being medication related. Four major themes emerged from the interviews: dealing with uncertainty; facilitating, framing and filtering information; managing interruptions and knowing and involving patients. Conclusion Nurses work in complex adaptive systems that change moment by moment. Acknowledging and understanding the cognitive workload and complex interactions are necessary to improve patient safety and reduce errors during medication administration. Knowing and involving the patient is an important part of a nurses’ medication administration safety strategies.

Promoting patient engagement: a scoping review of actions that align with the interactive care model

“…This research was mainly conducted in Europe (n = 26) (34, 37, 39–43, 45, 46, 48–50, 52, 55, 57, 62, 63, 65–72, 74); 69% (n = 18) of the European studies were conducted in Sweden (34, 37, 39, 41, 42, 45, 46, 48, 49, 52, 55, 57, 66, 67, 69–72). The remaining studies were conducted in Australia (n = 8) (47, 51, 54, 58–60, 64, 75), North America (n = 5) (33, 38, 53, 61, 76), Asia (n = 3) (44, 73, 77) and the United Kingdom (n = 1) (56) (See Table 3). Samples consisted of patients (n = 17) (41, 45–47, 49, 51, 53, 55, 56, 61, 62, 64, 65, 67–69, 76), nurses (n = 15) (33, 34, 37, 39, 40, 43, 50, 52, 57, 60, 70–73, 75), or patients and nurses (n = 11) (38, 42, 44, 48, 54, 58, 59, 63, 66, 74, 77), and an ‘a theoretical’ approach was undertaken in 86% (n = 37) of studies (33, 34, 37–48, 51, 53–61, 63, 64, 66, 67, 69–77).…”

“…Both interventional and noninterventional research studies were retrieved. Thirty‐three studies were noninterventional (33, 34, 37, 39–44, 46, 48, 50–52, 54, 56–65, 68–71, 73, 75–77). The focus of most noninterventional research was exploring patient and/or nurses perceptions’/experiences’ of general patient participation/engagement/empowerment/involvement processes (n = 14) (33, 34, 37, 39–41, 44, 46, 50, 56, 57, 62, 70, 76).…”

“…The focus of most noninterventional research was exploring patient and/or nurses perceptions’/experiences’ of general patient participation/engagement/empowerment/involvement processes (n = 14) (33, 34, 37, 39–41, 44, 46, 50, 56, 57, 62, 70, 76). Some other examples of study foci included exploring patient and/or nurses perceptions’/experiences’ of patient engagement in safety practices (60, 64, 69, 71), medication‐related care (43, 54, 58, 59, 75) and discharge preparation (48, 65, 68). A qualitative design was most commonly used in noninterventional studies (n = 18) (33, 34, 39, 40, 42, 43, 51, 58, 60, 61, 64, 69–71, 73, 75–77), followed by cross‐sectional (n = 4) (37, 41, 57, 63), case study (n = 3) (54, 59, 68) and phenomenological hermeneutic (n = 3) (56, 62, 65).…”

“…Assessing specific patient factors was identified as the most common action for this phase of the Interactive Care Model in 83.7% studies. Patient factors that were most frequently suggested as requiring assessment included patient ability to communicate in the same language as the nurse, age, coping style, current health status and symptoms, current needs and needs postdischarge, level of education, family member involvement, fears and concerns, knowledge of condition, motivation, preference for engagement in care, physical and mental ability/capability, previous experience with illness and hospitalisation, resources available, social and emotional status, timepoint in illness/treatment journey, and usual routines and everyday life (34, 38–43, 4547–51, 55, 58–62, 64–69, 71–75, 77). In noninterventional studies, nurses (24.2%) and patients (6.1%) perceived nurses’ communication as an action that promoted assessment of patient factors, such as actively listening, encouraging patient story‐telling and using tactics to build relationships with the patient.…”

Nurses’ perceptions of high‐alert medication administration safety: A qualitative descriptive study

“…Although studies often cite the patient and family as contributing to distractions, there is little research into the potential advantage of forming a partnership between the patient/family and nurse to improve medication safety (Wimpenny & Kirkpatrick, ). Several nurses in this study identified the potential safety ramifications of pursuing greater patient–nurse collaboration around HAM safety, a topic that merits further research (Bucknall et al, ).…”