Challenge

Course evaluations by students revealed that they had difficulty seeing how  course concepts and processes applied to clinical scenarios they would likely experience after graduation. In particular, students perceived evidence-based practice as an “academic” competency that would not be utilized during the fast-paced clinical roles they expected to soon hold. Part of this perception may be due to the nature of the course’s main project, a semester-long project in which students paired into groups, identified a shared topic of interest, constructed a PICO question on that topic, assessed the relevant literature on the question, and presented a synthesis on their research as a conference-style poster that other students and faculty could view during an open poster session. While the project leveraged an intrinsic interest in a topic and attempted to support a community of practice, it was not deliberately organized to demonstrate evidence-based practice's  relevance to clinical scenarios. Rather, the project seemed to support a perception that evidence-based practice was disconnected from practice, and a means of investigating the efficacy of decisions related to personal interests, which students seemed to equate with research interests.

Approach

We developed simulations that compared the accuracy of medication administration in a normal hospital environment with distractions versus a clinical environment with a medication safe zone protocol implemented to reduce distraction. In the first simulation, a student volunteer was tasked with running a routine med admin simulation. Their simulation was being livestreamed to students in the classroom who were evaluating their peer. This volunteer student was operating in the "noisy" clinical environment that included interruptions, phone calls, etc. Research students were able to evaluate the volunteer student's simulation in real time with Google Forms, analyze the results, and engage in a discussion and ideation on things that could be implemented to improve med administration. Students debated the value of proposed interventions and what researched supported their claims. 

After the in class discussion, two additional students completed the same scenario with a medication safe zone protocol implemented (some of the ideas which students developed as interventions after we analyzed scores from the first simulation) which included the nurse wearing a do not disturb vest and healthcare providers avoiding interrupting the nurse during medication administration. In addition, the additional embedded distraction from the first simulation were removed. Students in the classroom also completed the same medication administration evaluation tool on the second group. At the end of the second simulation the results of the medication evaluation tolls were analyzed. A rich class discussion occurred and faculty facilitated a discussion about the methods used to test the intervention, analysis of the results of the medication administration tool, limitations of the study, significance of the study to the field of nursing, and recommendations for future research. 

Medication administration was selected as the simulation scenario because:

  1. The simulation’s balance of novelty and ability puts simulation on outer edge of competency, where it not too easy and not too difficult

Medication administration is a familiar process for students, however the inclusion of interruptions was new and put the scenario at the outer edges of their competency.

2. High Risk and ideally situationally interesting

Mistakes in medication administration have contributed to an alarming number of patient deaths (210,000-330,000 per year). We believed the topic’s seriousness would pique students interest. We hope this situational interest would in time develop into a personal interest  

3. The interruption/non-interruption set up provided a clear juxtaposition

Plus, it was easy to support as it only involved a few minor changes (no phone calls, no interruptions by standardized patients and colleagues.

 

Results