Nursing Assignment: Critical Analysis of an Education Session
Question
Task: You are asked to write a critical analysis of an educational session that you have undertaken. In order to achieve this you should seek feedback from both: ?your learners ? a peer reviewer (for NMC registered participants, this is usually done by your critical friend) You should also undertake a self-reflection which is included in addition to the feedback from learners and a peer reviewer.
The critical analysis presented in the nursing assignment should draw on robust evidence and literature as well as all THREE forms of feedback. Links to the UKPSF dimensions of practice (usually A1 plus either A2 or A4) must be included where appropriate.
Your assignment should include:
-an introduction setting the context of your essay and identifying your stage of learning as a teacher and the professional context you are working in.
-the main body of the work which should be a critical analysis of a learning situation you have experienced recently, either as a teacher or a learner. This analysis should include a summary of the situation, followed by a detailed analysis of what occurred using thecontemporary theories of learning and teaching to explain and offer suggestions for various aspects of the situation.
-finally you should draw the work to a conclusion.
Answer
1. Introduction
As discussed in the present context of nursing assignment, administering medications is a major part of a nurse's job, and it's also one of the most vital aspects of patient care and safety. In the electronic Medication Administration Record (MAR), nurses and other clinicians can see what medications they need to administer to a patient, find the details needed to prepare those medications, and record information about the administration. A well-designed barcoded medication administration (BCMA) process and proper warning setup can help protect patients from transcription, dispensing, and administration errors. BCMA technology supports nurses in confirming the five rights of medication administration in real-time. Doctors and pharmacists and nurses are the main players in this medication administration process. Within Electronic Medical Record, the core features of medication scanning (scanning wristbands, scanning medications, and accuracy checking) are also available. This assignment is a critical analysis of an education session that I have experienced as a teacher. Dispense preparation was the subject I had chosen for the education session. This analysis includes a summary of the situation, followed by a detailed analysis of what occurred using the contemporary theories of learning and teaching to explain and offer suggestions for various aspects of the situation. Besides that, local policies and guidelines will be discussed.
2. Summary of the situation
Since the opening of the hospital in 2015, based on the work instruction of medication administration in one of the restructured Hospital in Singapore, nurses are required to use Barcode Medication Administration (BCMA) concept (Bennett, Dawoud, and Maben, 2010, p 98). This BCMA includes the Scanning Patient Wristbands and Scanning Medication Labels.
Some medications must be given by an intravenous (IV) injection or infusion. Dispense Prep is a barcode-enabled activity to document the preparation of IVs.The Dispense Preparation activity is intended to be used with a barcode scanner, barcodes printed on the dispense labels, and manufacturers' NDC barcodes on the packages being used. It can also support site-specific custom NDC and repackaged products. While it's likely that some organization wants clinicians to scan manufacturer barcodes for most medications, there might be some medications which required clinicians to scan order barcodes (Prince, Bochenko, and Biagioli, Crisi Medical Systems Inc, 2013, p 278). For example, at many organizations, patient-supplied insulin pens might be stored in central nursing locations. Because order barcodes are patient-specific, requiring clinicians to scan order barcodes for these patient-supplied medications helps prevent them from accidentally administering another patient's medication.
The initial work instruction for this restructured hospital was to scan the intravenous medication components within the MAR (Pedersen, Schneider, and Scheckelhoff, 2012, p 780). However, there were many errors happened related to the wrong diluent/Reconstitute solution is being used. When reconstituting injectable medications, we must determine both type and amount of diluent to be used. Sterile water and 0.9 percentNaCl commonly used diluent however some drugs supplied with special diluent.
Scanning of diluent within MAR will happen only at the patient bedside. However, medication reconstitution should be done at the clean utility. To meet this requirement, they have a build a new toolbar in Electronic medical record which is called Dispense preparation (Chedoe et al 2012, p F449). This toolbar will help nurses in preventing medication preparation errors which are not reached to patient. As a student of Nursing Informatics, I have the knowledge to identify and integrate information related to dispensing medication within nursing practice. While teaching the dispensing process at the hospital, I ascertained that each of the nursing students possessed knowledge of medication dispensing and made certain to follow guidelines provided by the doctor while dispensing medications. The most important part of my teaching included enhancing knowledge of the student regarding labeling and reading barcodes. The teaching practice progressed with certain communicative lectures, followed by providing students handouts which could enhance knowledge related to various medication labeling. There were some cases that I taught towards the end of my teaching lessons; these were mainly connected with the common medication errors made by nurses during dispensing medication and their consequences thereof.
2. Criticism of teaching session
The teaching lessons I provided proved to be quite effective and I got many praises regarding the same. In this critical analysis of my teaching practice, I have undertaken peer review feedback, student feedback as evidence and self-review feedback.
Self-review feedback: I had organized my notes and deliverables beforehand and decided upon the class schedule priory. Such organization skills allowed me to comprehend my teaching plans and also accomplish my goals defined in teaching. I went through my lessons before my class in preparation such that I would not face any barriers while delivering my intended lectures to my students. The best part of my teaching was accomplishing the designated goals which I had ascertained prior to undertaking teaching practice. However, analyzing my self-feedback further I could understand that I could not include the varied cases of medication dispensing errors; it covered only a few domains of such errors. As a nursing informatics student, I feel that my students need to know the critical outcome as a result of erroneous medications (Chapuis et al 2010, p 2275). Hence my notes should have included more diversified and complex cases with topics covered. I also realized that I had delivered my presentation during teaching without any visual assistance which made it difficult for students to understand the topics that I was covering. I should have made using the board to display the points that I was going to teach during my teaching lessons. Overall since this was my first teaching practice, I would rate myself an effective teacher.
Peer-review feedback: Feedback from my peers was integral to undertake when especially I want to make progress and become a better teacher. I asked my peers to provide some reviews regarding my teaching One of my friends, said that I had spoken very softly during teaching and many people were unable to hear my voice. While delivering a lecture, it is pertinent that the student even sitting at the farthest distance is able to hear my voice, but I had been ineffective in this practice. This made difficult for students to understand the medical terms and medication names that I was using. Another friend of mine pointed out that I had not effectively covered the topic of MAR. As this is an integral component of the course yet I had covered this section in a brief manner only. This created dissatisfaction amongst many students, who wanted to learn regarding MAR. The handouts that I had provided did not contain many details regarding MAR hence students had to look upon the internet regarding the same to learn details. Student feedback: Student feedback is most crucial while undertaking teaching practice. My students were overall very happy with my teaching lessons. However, some students complained that they did not effectively grasp the topic well (Metsälä, and Vaherkoski, 2014, p 25). They wanted more details and foundation on the basis of which they could understand the domain of dispensing medication in a better way. Another major criticism that my students stated was that I did not take any test or review of the materials taught. This did not provide them an opportunity to get assessed and understand their skills and knowledge levels.
3. Analysis using literature
According to Fahimi, Ariapanah, Faizi, Shafaghi (2008), a study was carried out to determine the frequency of drug errors in the intensive care unit during preparation and administration. The results show that the number of errors detected is 380/4040 (9.4%). Of these, it was 33.6 percent in the preparatory process and 66.4 percent in the administrative process. Because the system does not have a well-organized reporting system, no errors are detected and errors cannot be avoided. Administrators should actively develop systems to provide safe medicines.
In addition, clinical modelling of Poly-O'Neill (2009) showed that students took medications before and after the procedure. The results of the pre-intervention showed that 4 out of 18 (22%) results of good medical treatment and 29% of safely diluted medicines. After the procedure, 96% (26 out of 26) successfully implemented the dilution technology. In short, intensive training in a simulated environment can improve the ability of nursing students to use the drug in exactly complex paediatric patients.
Medication testing should be too blaming preventive errors and investigating potential errors in a complex health environment. The number of errors avoided during the project highlights the need to improve the design of the work system and to adopt security measures. Particular attention should be paid to educational needs and projects that reduce the speed at which intravenous medicines are prepared and administrative errors.
Ong and Subasyini (2013) stated that intravenous (IV) drugs are injected directly into the patient's veins, triggering a rapid response system. This is a complex process that usually requires clinical training before the patient receives the drug. For this reason, errors occurring at any stage of the training and management process can result in serious side effects of drugs such as thrombosis, severe hypersensitivity and infection, which is 1.2, which can also result in morbidity and mortality. Therefore, drug defects should be considered to prevent similar incidents in the following 3.
The NSQHS Standards provides guidance in safety and quality improvement standards in health services. The governance system guides nurses towards quality assurance mechanisms and quality improvisation.
4. Critical reflection
My educational teaching session was effective in nature as I was effectively able to teach dispensing medication which is an essential component of nursing informatics and nursing education. There have been some positive and some negative reviews regarding my teaching practice and the UK Professional Standards Framework (UKPSF) will enable me to evaluate the professional dimension of practice against my capabilities (Rodriguez-Gonzalez et al 2011, p 77). The UKPSF enables recognizing quality and innovation in teaching and learning practice. Evaluating areas of activity (A1-Design and plan learning activities and/ or programs of study) I can say that I have been almost effective in accomplishing this domain. I have been able to design my lesson plan well and also design my handouts by picking out relevant topics for the sections of learning’s to be taught. During my teaching practice, I have been able to effectively include good practices, records, and ways of the safe, clean and organized working environment in my handouts as well as delivery of lectures. However, as per peer review and student review, there could have been some areas of MAR and background that should have been included. If I would have been able to include these topics into the lesson plan then my effort to provide the lectures would have been completely effective in nature. My teaching methodology had been to provide hands-on training to the nurse and pass on my expertise to them. I tried to combine my theoretical knowledge and practical skills with inclusion of examples to make them understand regarding the whereabouts of administering medication in an appropriate manner.
Reflecting upon another area of activity (A4- Develop effective learning environments and approaches to student support and guidance) it can be said that I have been successful in achieving this outcome as well. I have been able to successfully recreate tensed environment that often exists at the hospital while administering medication to patient. This environment helped the learners assess the situation and focus more on their learning such that they can reduce errors related to administering medications. While teaching my students I undertook a case study approach in order to provide them with relevant practical skills. Also, I had reviewed my lesson plans thoroughly and provided them examples from a practical background which assisted in developing an effective learning environment.
5. Conclusion
In conclusion, my overall teaching practice regarding medication dispensing had been quite effective in nature. I was able to clearly communicate my thoughts andlearning’s in a clear manner. However, from the feedback received and critical reflection is undertaken, there have been brought to the forefront many relevant areas that need to be improvised. Devising an action plan will enable undertaking an improvised teaching practice next time. I will maintain learned notes from my university in separate folders in my computer along with relevant cases and examples. For each topic, I will include some background information such that while teaching students are able to easily connects to such information. I will also try to maintain a self-reflective journal such that I can improvise upon each and every feedback received from students and peers. I will also try to follow and recollect the methodical teaching procedure used by my professor such that I am able to take up effective teaching next time.
6. References
Bennett, J., Dawoud, D. and Maben, J., 2010. Effects of interruptions to nurses during medication administration. Nursing Management-UK, 16(9).
Chapuis, C., Roustit, M., Bal, G., Schwebel, C., Pansu, P., David-Tchouda, S., Foroni, L., Calop, J., Timsit, J.F., Allenet, B. and Bosson, J.L., 2010. Automated drug dispensing system reduces medication errors in an intensive care setting. Critical care medicine, 38(12), pp.2275-2281.
Chedoe, I., Molendijk, H., Hospes, W., Van den Heuvel, E.R. and Taxis, K., 2012. The effect of a multifaceted educational intervention on medication preparation and administration errors in neonatal intensive care. Archives of Disease in Childhood-Fetal and Neonatal Edition, 97(6), pp.F449-F455.
Fahimi, F., Ariapanah, P., Faizi, M., Shafaghi, B., Namdar, R. and Ardakani, M.T., 2008. Errors in the preparation and administration of intravenous medications in the intensive care unit of a teaching hospital: an observational study. Australian critical care, 21(2), pp.110-116.
Metsälä, E. and Vaherkoski, U., 2014. Medication errors in elderly acute care–a systematic review. Scandinavian journal of caring sciences, 28(1), pp.12-28.
Ong, W.M. and Subasyini, S., 2013. Medication errors in intravenous drug preparation and administration.Med J Malaysia, 68(1), pp.52-57.
Pauly-O'Neill, S., 2009. Beyond the five rights: Improving patient safety in pediatric medication administration through simulation. Clinical Simulation in Nursing, 5(5), pp.e181-e186.
Pedersen, C.A., Schneider, P.J. and Scheckelhoff, D.J., 2012. ASHP national survey of pharmacy practice in hospital settings: dispensing and administration—2011. Nursing assignmentAmerican Journal of Health-System Pharmacy, 69(9), pp.768-785.
Prince, S.M., Bochenko, W.J. and Biagioli, C., Crisi Medical Systems Inc, 2013. Characterizing medication container preparation, use, and disposal within a clinical workflow. U.S. Patent Application 13/549,278.
Rodriguez-Gonzalez, C.G., Herranz-Alonso, A., Martin-Barbero, M.L., Duran-Garcia, E., Durango-Limarquez, M.I., Hernández-Sampelayo, P. and Sanjurjo-Saez, M., 2011.Prevalence of medication administration errors in two medical units with automated prescription and dispensing. Journal of the American Medical Informatics Association, 19(1), pp.72-78.
