Measuring the Effect of Dimensional Analysis on Nurses' Level of Self-Efficacy in Medication Calculation Errors

Aims of The Study: The main aim of this study is to improve the calculation of medicines in nurses and develop a master plan for drug calculation competencies which will be yearly renewable. Objective: To evaluate the effects of dimensional analysis on the self-efficacy levels of nurses, specifically regards to their medication calculation abilities. Methodology: Quasi experimental study design was used in this study. This quasi-experimental study was conducted at the teaching hospital of the University of Lahore. It is a tertiary care hospital with 450-bedded capacities where almost 113 registered nurses are performing their duties in different shifts. Results: the frequency and classification of gender, in which male were 22% and female were 78%, the classification of age in which 21- 25 years old participants were 12.45%, some participants age between 26-30 years were 28.3%, participants of 31-35 years were 37.2%, the participants whose age were 36-40 years were 15% and above 40 years participants age were 701%. Classification of education in which 16.8% participants were General Nurse, 36.3% participants were Post RN and 46.9% participants were Generic BSN. The classification of Designation also discusses such as, 47.8% participants were charge nurses, 32.7% were Shift In charge and 19.5% were unit In charge. Conclusion: This study focusses to enhance the mathematical skills of the nurses and minimize the calculation errors of nurses during medication which is a challenging issue among nurses. This study is to extend focus on improving nurse’s medication calculation accuracy. To accomplish the stated purpose, a single intervention dimensional analysis was used which provide a situation for health-care improvement and to find techniques for improving the rate of medication errors. Statistically 39.86% difference recorded in pre-and post-intervention data. Keywords: Self Efficacy, Dimensional Analysis, medication calculation, mathematical calculation confidence level

Medication Errors and Their Relationship with Care Complexity and Work Dynamics

BACKGROUND: Medication errors are currently known as the most common medical errors. Research shows that work environment and organisation management, in addition to the role of nurses, contribute to the occurrence of an error. AIM: Therefore, the present study was conducted to determine the rate of nurses’ medication errors and its relation to the care complexity and work dynamics in the Taleghani Pediatric Hospital of Gorgan in 2017. MATERIAL AND METHODS: This was a descriptive-correlational and cross-sectional study. Sampling was done through census method (N = 100). The data collection tools consisted of four questionnaires of demographic information, Salyer work dynamics, Medication Administration Errors, and Velasquez Nursing Care Complexity. Data were analysed in SPSS V.16 software using descriptive and inferential statistical methods including independent t-test and Pearson’s correlation. RESULTS: Medication calculation errors, wrong dose and wrong medication were the most common non-injectable medication errors, respectively. Drug incompatibility, wrong infusion rate and medication calculation errors were the most common injectable medication errors, respectively. There was a positive correlation between medication calculation errors (P = 0.02, r = 0.23), wrong solvent (P = 0.04, r = 0.21), and drug incompatibility (P = 0.01, r = 0.25) with amount of work dynamics. Also, there was a positive correlation between medication calculation errors (P = 0.03, r = 0.22) and wrong medication (P = 0.00, r = 0.31) with the nursing care complexity. CONCLUSION: Regarding the irrefutable impact of working conditions on the occurrence of errors, it appears that the study and complete recognition of nurses’ working conditions and their adjustment would lead to a reduction in medication errors.

Development of a Critical Skills Assessment for Military Medical Field Settings

Objectives: To develop a method of measuring medical decision making in a military field setting that would allow an evaluation of the impact of sleep deprivation, fatigue, and other stressors on critical skills deterioration. Methods: Thirty-seven students who were enrolled in a Doctor of Nursing Practice (DNP) program or a Bachelor of Science in Nursing (BSN) program participated in this study. Over the course of three days, student participants were sent five questions in the morning and five questions in the evening. On the fourth day, students were sent 10 questions in the morning and 10 questions in the evening. DNP students received medication calculation questions and BSN students received Basic Life Support (BLS) questions. All questions were drawn from standardized test bank sources, were multiple choice, and were thoroughly reviewed by the research team for relevant content prior to study testing. Results: Twenty-five (50%) and twenty-eight (56%) of the 50 BLS and medication calculation questions met the selection criteria of average response times between 10 and 50 seconds and accuracy of at least 80%. From these, 16 questions were selected from both sets with smaller standard deviations, minimum response times of at least 5 seconds and maximum response times less than 90 seconds. Implications: In order to test the impact of sleep deprivation, fatigue, or any other stressors on critical decision making skills of military medical personnel during field training operations it was necessary to develop a test battery of questions that are sensitive enough to detect variation due to human factors. Our study accomplished this objective, and the resulting medication calculation and BLS questions can be used to readily assess deterioration in critical decision making skills within a field setting. Key Words: Critical Skills, Disaster Training, Sleep and Fatigue

Use of Dimensional Analysis in an Associate Degree Nursing Program

The aim of this retrospective study was to show the use of dimensional analysis increased associate degree nursing students’ mathematical computation competency and may reduce nursing medication errors in practice. A recent report compiled by Mackary and Daniel from John Hopkins, stated that medical error is the third leading cause of death in the United States [1]. The most commonly cited estimate of annual deaths from medical error in the United States is a 1999 Institute of Medicine (IOM) report which is possibly limited and now outdated [2]. Medication errors contribute to patients’ deaths, whereas nurses administer either incorrect medication, or incorrect doses of medication. Human error is inevitable, however designing safer systems to administer medication such as the use of a bar code system, and the standardization of academic medication calculation teaching may decrease these errors. According to a report from a major insurance company that insures a large percentage of nurses, malpractice claims in nursing is on the rise [3]. Claim settlements and court judgments for 2015 against nurses include: failure to communicate, medication errors, charting by exception, and legal risks. Medication calculation errors can be one of three categories, conceptual, mathematical, and measurement, with conceptual errors (setup of the calculation equation) accounting for 68% of all errors [4]. Nursing textbook publications teaching dose calculation often use multiple methods: ratio-proportion, “desired over have”, and various formulas to calculate medication dosage. Students then need to use the appropriate formula to solve the problem with fractions often leading to miscalculations with added or dropped zeroes. The use of dimensional analysis (DA) only requires the student to use a single equation, and learn one calculation process, rather than several steps required by other methods or even memorization of multiple formulas [5].