Facilitation And Education Skills For Practice Development In Nursing And Medication Administration Errors

Clinical Issue of Medication Administration Errors

Discuss about the Facilitation and Education Skills for Practice Development.

Nurses work in an environment where they experience numerous issues. These issues may affect the client and the quality of care. These problems can create tension between the staff and also negatively affect the morale, relationships and productivity. Nurses all over the world are challenged to adapt and change to meet the needs of the populations they serve. Over the past two decades nursing is has been a part of the movement that had gone through a lot of change. It was realized only in the mid 90’s that knowledge was not enough but transformation of this knowledge in the clinically useful form is needed for better patient outcomes. In the report “Future of nursing” it is clearly mentioned that it is crucial that we focus on the convergence of quality, new functions and knowledge in nursing. In this essay we would look into the clinical issue of “medication administration errors” and how an understanding of adult learning theory may assist the facilitation of practice development in this clinical issue. We will also learn how facilitation can assist in approaching this issue.

Medication administration errors (MAE’s) is a scenario that not only costs in financial terms but it can also cost a patient life. These errors can range from inaccurate dosage, missed dosage, wrong timing and dose omission. According to a study done in the US medication administration errors are responsible for about 7000 preventable deaths each year.  According to study conducted by Berdot, et al in the year 2012 medication errors do occur in healthcare fields such as anesthesia and medicine but shockingly they are fairly common in nursing (Berdot, 2012). The consequences of these errors are not limited to the patient but can affect the health professional that is involved in these types of medication administration error. Professionals who commit these errors are at a high risk of psychological issues and distress and have been reported to suffer episodes of self-harm. These errors occur in 20% of doses in hospitals worldwide (Cho, 2014). In case of medication errors data from National Patient Safety Agency shows that 1 out of 10 patients experience drug related harm. MAE’s are reported to be second in risk areas that account for unnecessary harm to the patients in the study conducted by Lap Fung Tsang, Tak Kwan Yuk, So Yuen Alice Sham titled “How to change nurses’ behavior leading to medication administration errors using a survey approach in United Christian Hospital” (Tsang, 2014). They stressed that nurses spend one third of their time on medication administration activities. Over the past decade many educational researchers and psychologists have developed many theories to explain how adults acquire, deploy and organize knowledge and skills. Given that medical education involves adults it is quite logical to focus on adult learning theories to assist in approaching this clinical issue. The facilitation of the learning process involves assisting adults to act and make sense of occupational, political, personal and social environment. Learning can be defined as a permanent change in the mental processing, emotional behavior and emotional functioning as a result of an experience. This is dynamic lifelong process through which the individual acquires new skills or knowledge and alter their feelings, attitudes, actions and thoughts.   

Use of Adult Learning Theory to Assist in Approaching Medication Administration Errors

Whether the learning theories are used in combination or they are used singly they have too much to offer to healthcare. Medical administration errors are often human errors (Ebrahimipour H, 2016).Human activities are cognitive activities. Therefore it is not surprising to say that human errors occur due to the inadequate processing of information in cognitive tasks. Thus the use of cognitive learning theory for the prevention of medication administration errors is well understood. Cognition as the word means is “ the process of thought”. Cognitive psychologists believe that learning process is an internal process that focuses on consciousness, thinking, organizing and understanding (Owen, 2016).Cognitive leaning theory can help in reducing medication administration errors as learning is not done by only changing behavior. But according to Wertheimer and other Gestalt psychologists memorizing is an ineffective method to learn, as it won’t work in real life. Instead according to them the real learning occurs through discovery and understanding of the underlying issues. Bruner define the cognitive learning process with three modes that are practical, abstract and visual. For example if a nursing student is being taught about blood pressure monitoring without  being told about the importance of normal blood pressure they would learn this in an inactive stage (Collins, 2013).Thus for future they would get an image of a rubber pump, with numerous tubes as an image for taking blood pressure as they motion through the process. In comparison the student who reaches each stage gradually can define blood pressure, knows its importance and would even know the effect of environmental resistance. Why we think that medical errors are more of a cognitive errors it is because cognitive factors are important in medical errors. For example sometimes when medical administration errors occurs due to human computer interaction, in which the cognitive factors of interactions between a human and a computer affect the human behavior. Another level at which these MAE’s occur are when the social dynamics in a group of people in a distributed cognitive system is interacted with complex technology (LYNCH, 2011). The issue arises when the computer support and distributed cognitive functions due not work to result in a positive cooperative work. There are other factors like communications, organizational structure, standardization of work, national regulations, institutional functions (guidelines and policies) and coordination that can lead to MAE’s.

Gestalt theory is called the leader of “cognitive theories” as this theory support the learning process through presentation of images or information that contain elements and gaps and should not fit properly (Weant, 2014).This will make the learner use their problem solving skills and critical thinking. Therefore the learner will not get answers easily but they must examine in order to find the answer. This theory purports that individual strategies will teach the learner to discover what was blocking them from further learning something new. Other theories are all derived from Gestalt theory of cognitive development. The individual that is administering the medicine is at the last of the chain and often these are nurses (Taylor, 2013)Although they may not be the root cause of these MAE’s they can successfully stop the error at this individual stage through the help of cognitive interventions. Here “metacognition” helps which is about “thinking about our thinking” which states that we should intervene in our thinking process and should rethink about the action. The goal here is to train our mind into recognizing inappropriate cognitive steps or shortcuts and immediately correct the course of thinking or action. What do cognitive theories have to say about adult learning and why facilitation and practice development crucial for adult learning. Although the cognitive stages are developing sequentially when we grow but some adults may not reach the operational stage. For these adults explicitly concrete approaches are needed. This is where practice development and facilitation helps. Practice development is a continuous process of developing person centered culture. For adult learners the question of “why the thing that they are learning is important is crucial”. In an adult learning atmosphere instructors have a facilitator role rather than being a teacher or lecturer. A facilitator can be described as a guide to learning and less of a transmitter of knowledge. Facilitators allow the adult learners to learn on their terms by only steering them towards critiquing, analyzing and assessing information. Many gerontologists and adult development psychologists support this as they say that adults have advanced stages of reasoning that are beyond formal operational stages. For example only when we are adults we are able to synthesize information, effectively integrate it and contradict it. This fully supports the facilitation process in adult learning as facilitators are allowing the adult learners to learn on their terms by only steering them towards critiquing, analyzing and assessing information. Thirdly the adult learners have experience which is demonstrated in their level of reasoning. Practice development is enabled by the facilitators who engage the teams and individuals to blend their creative imagination and personal qualities with practice wisdom and practice skills. (Rezaei-Adaryani, 2012)

Use of Cognitive Learning Theory to Reduce Medication Administration Errors

A significant advantage of cognitive theory in a healthcare setting is its recognition and appreciation of diversity and individuality about the learning process of different people. These theories highlight the variation in learners active structuring of their perceptions. But the challenge that comes with these theories for the facilitators and educators is that they have to identify each and every learner’s cognitive development and social influences that is affecting their learning (Karimi Moonaghi, 2014).For nursing these adult learning theories and practice development can help in reducing errors such as MAE’s. According to the data from UK alone it was seen that 9 % of inpatients who experience drug related harm suffer needlessly as there harm was preventable. These MAE’s are costing millions to the healthcare organizations. Practice development for double checking is a practice that can help in reducing these errors. Many times nurses fail to double check the doses as it is time consuming, which discourages them to take responsibility for the medicines (Seidling, 2013).A facilitator can discuss with nurses how double checking would reduce errors on their part (Chang, 2011).They have to make sure that the RN or physician that they are going to get it double checked is not only glancing and agreeing for the dose but is actually paying attention to the dosage. This would be called “talking each other through the mistakes”. This would ensure that the nurses that are administering the drugs would be more confident and therefore more happier. (Dror, 2011)

Practice development is getting recognized worldwide in using a systematic approach to deliver a person centered care and to transform work cultures. In healthcare and  nursing there are cultures that either “impede” or “invite” participation from patients and health professionals. Through the practice development methods everyone involved gets an opportunity to participate.

In a healthcare setting practice development takes into consideration the enabling factors and attributes of the workplace and also consider the clinical issue in order to provide effective and safe healthcare.

For MAE’s facilitators have to cooperatively inquire about the nurses schedule inquiring about their workload, shift timings etc. This would help them in understanding the factors that are contributing to these MAE’s. Strategies such as providing critical constructive feedback for oneself would help in self-learning. This will give the participant an ability to evaluate. This could be done in a group or individually (Kolanowski, 2015).

These group sessions can include debate and lively sessions alongside quite session for personal critical reflection. This kind of environment would provide challenge but with high support, receiving feedback would promote critical reflection. Facilitation is multifaceted and has to be robust and enlightening to the participants.

Facilitation and Practice Development for Adult Learning

The fundamental factor for any facilitation process for adults is the use of adult learning theories or principles in exploration and participation in a challenging but safe learning environment. The facilitators have the job of working with the staff to become unified and to make sense of their turbulent, and complex workplace (Vaughn, 2015).Through these sessions the nurses are exposed to their learning needs and are reviewed how they can use learning styles to address these needs. The concept of using facilitation, practice development and adult learning theories for MAE’s has face validity and still a lot of research is needed to determine whether interventions really have significant effect in reducing these errors. As information related to medication errors is sensitive and not always reported. Therefore the accuracy of the data can never be believed (Westbrook, 2015).There is an abundance of chance in the healthcare setting for medication errors therefore there is a need for fundamental directive that can improve the safety of patients worldwide.

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