Use of Simulators for Medication Training In Nursing Education
Simulator in Medication Administration
Nursing educators can use simulation to train students in the intricacies of medication administration, rather than practicing these high-risk skills solely on patients. Simulation is a controllable strategy that puts genuine equipment in the hands of students so that they can practice complex skills such as reconstitution from powder to intravenous solution, dilution to recommended concentration, and rate of infusion. Within a simulated environment, educators can allow performance errors so that there is subsequent “learn by doing” that is not feasible on acute care units.
Responsibilities of Faculty Members Regarding Medication Training
Faculty bear the responsibility of keeping patients safe while simultaneously offering nursing students the opportunity to experience authentic patient care situations. However, students are often not given the opportunity to administer complex medications during routine clinical rotations, and especially during critical events when accuracy is vital within the context of a high-stress situation. So rather than relying so heavily on random opportunity in clinical to practice this set of skills, virtual environments can be created that model actual medication requirements.
In simulation, students are presented with real medication orders, which may even include prescribing errors, so that both critical thinking and technical skill can be assessed.Scholars well entrenched in medication safety research have postulated that in order to improve the numeracy, calculation competence, and technical acumen needed for satisfactory medication administration, there must exist a culture of education that is adaptive to both evolving clinical environments and our the 21st century nursing students (Weeks, Sabin, Pontin, & Woolley, 2013).
It is time to move away from the model that includes classic didactic instruction followed by an assessment of numeracy via a conventional medication calculation exam. Evidence suggests that abstract word-based assessments that are void of contextual features present in clinical practice are not reliable indicators of student medication calculation ability (Wright, 2012). Poor performance on a written examination may be due to inability to visualize the problem, compounded by limited opportunity to handle the equipment and supplies (Sabin, 2013).
While nursing faculty may be able to teach formulas in classroom settings, simulation allows time and space for the student to see the problem in context. Building a mental image of the calculation through hands on practice allows the student to envision the problem in a concrete fashion. In using simulation, faculty can colocate the demands for conceptual calculation and technical requirements within authentic learning and assessment environments. Such review of calculation plus hands-on administration. using equipment may help to reinforce error reducing practices.
Educators have found that using simulation to practice medication administration is not only convenient, but successful in improving student ability to perform calculations (Costello, 2011; Pauly O' Neill & Prion, 2013). Analysis of a systematic literature search regarding the use of simulation to improve medication calculation skill revealed that using simulated scenarios that include real-life medication calculation examples allowed students to better develop critical thinking skills as well as decrease their anxiety (Zahara Such, 2013)
Medication Error Improvement and Use of Simulators
Non-adherence to the “Rights Method” causes medication errors. However, according to the Institute of Medicine's landmark report To Err Is Human: Building a Safer Health Care System (IOM, 1999), an error can be further defined as the wrong plan to achieve an aim. In other words, a registered nurse (RN) or nursing student may correctly identify the patient, drug, dose, route, and time, but fail to displace air bubbles from a syringe; hence, under dose can occur. Setting traditional pumps incorrectly or overriding smart pump technology (those devices programmed with drug-specific safety software) may result in delivering a medication too quickly.
In a study of smart pump technology and medication administration, authors report that success rates on secondary infusions were low (55.6%) regardless of the type of infusion pump used (Trbovich, Pinkney, Cafazzo, & Easty, 2010). Medication left in the dead space of infusion tubing is another pitfall in medication administration that is related to an inability to set the rate and volume correctly (Broselow, Luten, & Schuman, 2008).
Sears, Goldsworthy, and Goodman (2010) reports the results of a randomized controlled study showing that students made fewer errors in clinical rotations after exposure to simulation-based experiences than those without research that illustrates a significant relationship between authentic learning environments and success in medication calculation helps support the notion that this exposure is a vital step in the construction of knowledge (Weeks, Clochesy, Hutton, & Moseley, 2013).
Participating in drug administration within a simulated environment puts the emphasis on application and demonstration within a wider context that cannot be ensured during a clinical rotation (Sabin et al., 2013) Added benefits include the opportunity to model expert performance, scaffold learning, reflect on performance with support, and acculturate students to the essential features of safe practice (Macdonald, Weeks, & Moseley, 2013)
Teaching Strategies For Training by use of Simulators
Traditional didactic strategies based on word problems separated from real world context may be too abstract for many learners. Research has supported the use of more adaptive pedagogy including the use of simulation to capture expert practices and recreate them in a virtual setting, providing tangible materials that can be manipulated rather than formulas on a page. Syringes, infusion pumps, intravenous bags, labeled drug vials. and medication sheets can all be made available as the student extracts the important information from the medical orders and ultimately delivers a medication safely.
Give your opinion if have any.