Medication errors may result in patients’ harm and even death. The improvement of nursing students’ competence in the administration of medication through education and training can contribute to the reduction of medication errors.
This study aimed at describing the Bachelor of Nursing students’ perceptions about clinical learning opportunities and competence in the administration of oral medication.
A quantitative descriptive design was employed. An all-inclusive sample of 176 nursing students registered at a university in the Western Cape, South Africa, in 2014 was considered for the study, of whom 125 students consented to participate and completed the questionnaires. Statistical Package for the Social Sciences (SPSS) version 22 was used for data analysis and descriptive statistics were conducted.
The findings showed that a minority of students did not have opportunities to rotate in all specific types of wards. The findings indicated that a total of 92% (115) and 86.4% (108) of the 125 respondents were placed in medical and surgical wards, respectively, where they more likely had opportunities to practise the administration of oral medication. However, 59.2% (74) did not practise administration of oral medication on a daily basis. Only 19.2% (24) of respondents perceived themselves as competent in the administration of oral medication.
The findings indicated that many students perceived their education and training as not providing sufficient learning opportunities to practise the administration of oral medication, whilst the majority of respondents perceived themselves as competent in some of the aspects related to the administration of oral medication, and very few perceived themselves as competent overall in the administration of oral medication.
Medication errors remain a major concern in hospitals worldwide and contribute to the patients’ severe harm and mortality (Tshiamo et al.
In South Africa, studies addressing medication errors made by nurses and nursing students seem to be limited. However, the South African Nursing Council (SANC) disciplined 105 professional nurses who made medication errors between 2003 and 2008 (South African Nursing Council
In the School of Nursing where this study was undertaken, the Bachelor of Nursing students have learning opportunities in a general hospital during their second year of study to practise and develop competence in the administration of oral medication. A challenge, the consequence of clinical facilities in the Western Cape accommodating large numbers of students from different nursing schools for clinical learning, is the competition for learning opportunities. Moreover, students do not get enough time to labour on one competency as they are expected to move on to other core competencies in which second year students must prove competence. According to Benner (
Several studies, such as the study conducted in Iran by Cheragi et al. (
Studies have shown that nursing students’ knowledge and competence in medication administration is lacking (Mariani et al.
There is a lack of studies in South Africa focusing on administration of oral medication, particularly related to students’ clinical placement, orientation, allocation of duties and supervision in specific clinical settings. Clinical placement forms a key component of nursing education and it is considered as crucial as it helps the students perceive the reality of nursing and gain experience (Hilli, Salmu & Jonsén
According to their scope of practice, the administration of medication by nursing students should be conducted under the supervision of a registered nurse (South African Nursing Council
Clinical supervisors assess nursing students’ competence through the use of an observation check as used in the United States (Cant, McKenna & Cooper
The SANC disciplined nine nursing students who were involved in medication errors between 2003 and 2008 (South African Nursing Council
Nursing students at a university in the Western Cape province of South Africa are expected to be competent in the administration of oral medication at the end of the second year level of the Bachelor of Nursing programme. However, the nature of nursing education programmes seems to pose challenges for students to become competent in the administration of oral medication. Although during their fourth year level of study, the students are placed in a general hospital for consolidation of the skills learnt in their second year level, the clinical learning programme of the third and fourth years might not allow the students to continue the practice of oral medication administration and achieve the level of competence as described by Benner (
The findings of this study will inform the School of Nursing about the adequacy of clinical learning and competence of the students in the administration of oral medication. Moreover, the study will contribute to improve the alignment of clinical learning with the learning outcomes of the Bachelor of Nursing programme. In this regard, patients will benefit from this study as the improved training of the students will contribute to the reduction of medication errors.
[
In this study, clinical learning opportunities refer to the opportunities which students have during a clinical placement within a general hospital with regard to orientation, allocation of the task, supervision and practice of administration of oral medication.
The study aimed to describe the fourth year Bachelor of Nursing students’ perceptions regarding clinical learning opportunities and their competence in the administration of oral medication at a general hospital.
A quantitative cross-sectional descriptive design (Brink, Van der Walt & Rensburg
Population, defined as a group of people or subjects in their entirety who are of interest to the researcher (Brink et al.
The self-report questionnaire developed by the researcher was based on the reviewed literature and an observational checklist borrowed, with permission, from Zare et al. (
Rigour, in terms of validity and reliability, was ensured. The researcher obtained an alphabetical list of the students and booked a suitable venue where the data would be collected. One week before the collection of data, the researcher invited all the 176 students through their e-mails to participate in the study and the participant information sheet was sent to them. The students were informed that the data would be collected on 30 November 2014; time and venue were also communicated. On the day of data collection, the researcher explained the purpose of the study to the participants who were allowed to ask questions. All the ethical aspects were explained to the participants (Grove, Burns & Gray
A check was conducted by the researcher to determine whether all the self-report questionnaires were legible and complete. According to Babbie (
All the principles of research ethics were applied. The study was approved by the Senate Research Committee of the University of the Western Cape (registration number 14/6/24).
According to the School of Nursing included in this study, clinical placement for the second year nursing students was on a rotational basis through medical, surgical, paediatric, orthopaedic, theatre, trauma, urology, neurology wards as well as gynaecology and dermatology wards within the general hospital. However, the results of this study indicate that 125 respondents did not have equal opportunities to rotate through these wards. Each student was however placed in more than one ward (see
Respondents’ clinical placement opportunities.
Clinical placement | % | |
---|---|---|
Medical ward | 115 | 92.0 |
Surgical ward | 108 | 86.4 |
Paediatric ward | 70 | 56.0 |
Orthopaedic ward | 61 | 48.8 |
Theatre ward | 59 | 47.2 |
Trauma ward | 58 | 46.4 |
Urology ward | 28 | 22.4 |
Neurology ward | 27 | 21.6 |
Gynaecology ward | 26 | 20.8 |
Dermatology | 12 | 9.6 |
Furthermore, the students expected to be orientated during their clinical placement especially with regard to the competencies that were part of their expected clinical learning outcomes. In this regard, a total of 24.8% (31) participants strongly agreed and 44.8% (56) agreed that they were orientated to ward routines in the administration of oral medication. The results also showed that a total of 60.8% (76) of participants were orientated by a professional nurse on duty in the ward. In this regard, the researcher also had to establish whether the professional nurse-in-charge of the ward was informed about their learning needs. Of the 125 respondents, 20.8% (26) strongly agreed and 43.2% (54) agreed that the professional nurse-in-charge was informed. Furthermore, the results of this study indicated that the majority of the students (89.6%, 112) were orientated by a clinical supervisor who was able to align the practice with theory.
A cumulative total of 20% (25) of the 125 respondents strongly agreed and agreed that they were allocated to administer oral medication on a daily basis. Overall, this minority of the 125 respondents would have been able to develop their level of competence and confidence therein. As students do not enjoy supernumerary status in the ward, they are allocated to other patient care activities as required in the ward. Students are often challenged by the fact that clinical competencies are performed differently in practice than in the skills laboratory. The findings of this study indicated that a total of 28.8% (36) of respondents strongly agreed and 47.2% (59) agreed that they had the opportunity to administer many types of oral medication at one time to the same patient. With respect to an opportunity to administer oral medication to all the patients in the ward during a medication round, a total of 24.8% (31) of respondents strongly agreed and 40.8% (51) agreed that they had an opportunity. Of the 125 respondents, 30.4 % (38) strongly agreed and 37.6% (47) agreed that they had more than two practice opportunities to administer oral medication. Aggar and Dawson (
Clinical supervisors who are experienced professional nurses must ensure that nursing students meet the clinical learning outcomes regarding the practice of oral medication administration, which is currently not occurring. The study findings revealed that the minority (30.4%, 38) of the 125 respondents were mostly supervised by the clinical supervisor, who was skilled in aligning clinical learning with the theory learnt in the classroom. With regard to engaging in a practical session in the presence of the supervisor prior to clinical assessment, 8.8% (11) of respondents collectively strongly disagreed and disagreed, whilst 9.6% (12) were uncertain that this occurred; 38.4% (48) of respondents strongly agreed and 43.2% (54) agreed that they had a practice session. Regarding the feedback from the clinical supervisor on their performance, a total of 38.4 % (48) of respondents agreed and 48.8% (61) strongly agreed that they received feedback. A combined total of 87.2 % (109) of the 125 respondents strongly agreed and agreed that they were assessed on one patient in order to be found competent. This study did not investigate students who were not supervised by the clinical supervisor during administration of oral medication. It would however be concerning if students are not guided by a clinical supervisor in the administration of oral medication. This challenge was confirmed in the study conducted in Cape Town by Klerk (
The findings of this study showed that 68.8% (86) of respondents confirmed that the practice related to the administration of oral medication was aligned with the theory. The importance of the alignment of clinical teaching, by nursing schools, to correct and current practice cannot be over-emphasised. However, it is not always the case that competencies are practised correctly in the clinical setting. This is supported by the study conducted in Australia by Reid-Searl et al. (
The items in
Perceived competence in medication administration.
Items | Agree |
Strongly agree |
Total ( |
Mean | SD | |||
---|---|---|---|---|---|---|---|---|
% | % | % | ||||||
Checking time and frequency of medication on prescription chart | 52 | 41.6 | 68 | 54.4 | 120 | 96.0 | 4.49 | 0.64 |
Checking doctor’s prescription | 55 | 44.0 | 64 | 51.2 | 119 | 95.2 | 4.44 | 0.67 |
Checking the name of medication on prescription chart | 45 | 36.0 | 74 | 59.2 | 119 | 95.2 | 4.51 | 0.70 |
Checking the route of medication administration on prescription chart | 40 | 32.0 | 78 | 62.4 | 118 | 94.4 | 4.54 | 0.69 |
Checking medication dose on prescription chart | 43 | 34.4 | 74 | 59.2 | 117 | 93.6 | 4.51 | 0.67 |
Checking previous time of medication administration | 54 | 43.2 | 61 | 48.8 | 115 | 92.0 | 4.40 | 0.66 |
Checking the expiry date of medication | 46 | 36.8 | 60 | 48.0 | 106 | 84.8 | 4.25 | 0.92 |
Checking for indication of allergy on prescription chart | 50 | 40.0 | 55 | 44.0 | 105 | 84.0 | 4.19 | 0.93 |
Washing hands before setting medication trolley | 60 | 48.0 | 44 | 35.2 | 104 | 83.2 | 4.11 | 0.89 |
Taking the container of medication against the prescription chart | 42 | 33.6 | 60 | 48.0 | 102 | 81.6 | 4.17 | 1.03 |
Identifying scheduled drug if applicable | 57 | 45.6 | 45 | 36.0 | 102 | 81.6 | 4.11 | 0.86 |
Checking medication a second time against the prescription chart | 43 | 34.4 | 59 | 47.2 | 102 | 81.6 | 4.18 | 0.98 |
Identifying the alternative name of the medication if needed | 61 | 48.8 | 38 | 30.4 | 99 | 79.2 | 3.99 | 0.94 |
Checking the name and signature of medical practitioner | 41 | 32.8 | 58 | 46.4 | 99 | 79.2 | 4.14 | 1.02 |
Cleaning used items | 52 | 41.6 | 40 | 32.0 | 92 | 73.6 | 3.92 | 1.02 |
Cleaning medication trolley | 54 | 43.2 | 37 | 29.6 | 91 | 72.8 | 3.85 | 1.09 |
Checking the side-effects | 44 | 35.2 | 28 | 22.4 | 72 | 57.6 | 3.56 | 1.11 |
Checking drug interaction, e.g. with/before/after meals | 38 | 30.4 | 24 | 19.2 | 62 | 49.6 | 3.42 | 1.10 |
Taking the correct medication prior to be given | 48 | 38.4 | 72 | 57.6 | 120 | 96.0 | 4.51 | 0.66 |
Administration of correct dose to the patient | 51 | 40.8 | 68 | 54.4 | 119 | 95.2 | 4.46 | 0.73 |
Offering of water to the patient | 52 | 41.6 | 66 | 52.8 | 118 | 94.4 | 4.42 | 0.78 |
Calculation of correct dose of medication | 49 | 39.2 | 65 | 52.0 | 114 | 91.2 | 4.41 | 0.73 |
Reporting abnormalities to the sister-in-charge | 50 | 40.0 | 62 | 49.2 | 112 | 89.2 | 4.36 | 0.76 |
Ensuring patient swallows the medication | 46 | 36.8 | 63 | 50.4 | 109 | 87.2 | 4.30 | 0.92 |
Making the patient comfortable | 58 | 46.4 | 48 | 38.4 | 106 | 84.4 | 4.15 | 0.89 |
Ensuring the patient’s safety, for example, bed cots raised and bell in reach of patient | 57 | 45.6 | 47 | 37.6 | 104 | 83.2 | 4.14 | 0.86 |
Identification of prescription chart by checking patient’s name against patient’s identification band | 43 | 34.4 | 57 | 45.6 | 100 | 80.0 | 4.12 | 1.06 |
Giving health education to the patient | 56 | 44.8 | 41 | 32.8 | 97 | 77.6 | 4.03 | 0.89 |
Checking contra-indications, for example, NPO, nausea, HB, HGT and bradycardia | 46 | 36.8 | 47 | 37.6 | 93 | 74.4 | 4.03 | 0.95 |
Monitoring any immediate side-effect of medication | 49 | 39.2 | 41 | 32.8 | 90 | 72.0 | 3.92 | 1.02 |
Obtaining verbal consent from the patient | 47 | 37.6 | 42 | 33.6 | 89 | 71.2 | 3.90 | 1.05 |
Checking the diagnosis of patient | 42 | 33.6 | 42 | 33.6 | 84 | 67.2 | 3.86 | 1.08 |
Explaining the procedure to the patient | 45 | 36.0 | 39 | 31.2 | 84 | 67.2 | 3.79 | 1.13 |
Assessing the patient’s basic needs | 45 | 36.0 | 33 | 26.4 | 78 | 62.4 | 3.73 | 1.05 |
Checking the vital signs of the patient | 33 | 26.4 | 37 | 29.6 | 70 | 56.0 | 3.68 | 1.09 |
Signing the prescription chart in the correct block | 48 | 38.4 | 69 | 55.2 | 117 | 93.6 | 4.44 | 0.77 |
Locking medication trolley after ruse | 47 | 37.6 | 69 | 55.2 | 116 | 92.8 | 4.45 | 0.73 |
Recording the scheduled drugs in scheduled drug book | 48 | 38.4 | 67 | 53.6 | 115 | 92.0 | 4.43 | 0.72 |
Checking the balance of scheduled drug under supervision of a professional nurse | 60 | 48.0 | 51 | 40.8 | 111 | 88.8 | 4.25 | 0.79 |
Explain the role of witness to countersign for administered scheduled drug, if applicable | 44 | 35.2 | 59 | 47.2 | 103 | 82.4 | 4.20 | 0.98 |
Explaining the safe-keeping of the scheduled drug cupboard key, if applicable | 38 | 30.4 | 58 | 46.4 | 96 | 76.8 | 4.15 | 0.98 |
Explaining the role of witness before administration of scheduled drug, if applicable | 54 | 43.2 | 32 | 25.6 | 86 | 68.8 | 3.75 | 1.09 |
NPO, nothing per mouth; HB, Hemoglobin; HGT, Hemo gluclose test.
Regarding the identification of the right patient, the current study’s findings indicated that 80% (100) perceived themselves as competent in checking patients’ names against their identification bands; however, Schneidereith (
The majority of the 125 respondents affirmed that they were competent in checking the time and frequency of medication on prescription chart (96.0%, 120) and in checking the previous time of medication administration (92.0%, 115). It is crucial to comply with the frequency at which medication is prescribed by the doctor, to prevent medication overdose or missing a dosage (Perry et al.
This study is limited to the use of a self-assessment tool which has potential for bias. Therefore, the results regarding the students who perceive themselves competent in the administration of oral medication might not be the true reflection of the students’ competence if they were actually assessed in practice.
This study recommends that schools of nursing collaborate more closely with staff in clinical practice around designing clinical learning for nursing students. To enhance the competence of Bachelor of Nursing students in future and reduce medication errors, which contribute to the patients’ harm and death, an increase in clinical learning opportunities in medication rounds under supervision of professional nurses and an increased use of simulation related to administration of oral medication in the skills laboratory are recommended. It is recommended that the School of Nursing and the general hospital’s management give equal opportunities to all nursing students to rotate in different types of wards as required by the South African Nursing Council (
The findings of this study highlighted several areas of improvement with regard to students’ clinical learning opportunities; the involvement of both the nursing school and clinical facilities is needed to improve the practice of oral medication administration. The findings show that the majority of respondents perceived themselves as competent in some aspects related to the administration of oral medication;– however, few perceived themselves as generally competent in this competency.
The authors would like to thank Ms Zohre Ghamari Zare for permission to use the observation checklist which was modified for use in this study.
The authors declare that they do not have any financial or personal relationships that may have inappropriately influenced them in writing this article.
J.J.M. was the primary researcher who conducted this study as a mini-thesis. F.D. was the supervisor of this research and made conceptual contributions. Both J.J.M. and F.D. wrote the manuscript.
This study was not funded by any organisation.
Data sharing is not applicable to this article as no new data were created or analysed in this study.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors.