Discrete Self-Rated and Actual Competence of Safe Medication Administration Among Senior Baccalaureate Nursing Students

Purpose: To assess senior baccalaureate nursing students' self-rated competence of safe medication administration and their actual competence to do so by using simulation scenario.

Methods: This is a cross-sectional, descriptive study. 

A self-rated questionnaire of safe medication administration was developed. Participants were asked to rate levels of their knowledge, confidence, competence, and experience in safe medication administration by 5-point Likert scale (0 is none, and 5 is always) before the simulation scenario. The higher points the participants give, the higher levels of confidence the participants think that they have.

A simulation scenario was developed to assess participants’ competence in applying the six rights (right patient, right medication, right dose, right time, right route, and right reason) at the medication administration phase. Participants were expected to identify nine errors, including: 1). Use two-identifiers to identify patients (right patient); 2). Identify patient’s name is different from the prescription (right patient); 3). Identify patients’ medication allergy (right medication); 4). Identify medications are different from the prescription (right medication); 5). Identify the patient receiving wrong intravenous solution (right medication); 6). Identify inappropriate medication dose (right dose); 7). Identify ordered medication is not compatible with the intravenous solution (right medication); 8). Find medication dose are different from the prescription (right dose); and 9). Find no reason for the medication use (right reason). One point was given to each error identified. Descriptive statistics, and Pearson correlational statistics were used.

Participants and setting: 27 senior nursing students at their last semester before graduation were enrolled. Those students were from a simulation-based course in a university in northern Taiwan. The students have completed their required clinical practicums, including medical-surgical nursing, maternity and women health, pediatric nursing, critical care, psychiatric nursing, and community health. Their competence of medication safety was surveyed and evaluated at the time they entered this course.

Results: The average age of the participants was 23.11 (SD=0.577). Seven students (25.9%) are male. Their average self-rated scores in safe medication administration were: 4.67 (SD=0.480) in knowledge, 4.48 (SD=0.509) in confidence, 4.56 (SD=0.506) in competence, and 4.67 (SD=0.480) in experience.

The average actual safe medication administration score was 2.11 (SD=1.188, total score=9). Twenty-two (81.5%) participants used two-identifiers to identify patients before medication administration; 7 (25.9%) participants identified patient’s name is different from the prescription; no participant identified patients’ medication allergy; 6 (22.2%) participants identified medications were different from the prescription; 3 (11.1%) participants identified the patient receiving wrong intravenous solution; 1 (3.7%) identified inappropriate medication dose; 5 (18.5%) participants identified ordered medication is not compatible with the intravenous solution; 11 (40.7%) participants identified medication dose are different from the prescription; and 1 (3.7%) participants identified no reason for the medication use. There was no statistically significant correlation between self-rated and actual competence score (r =0.132, p=0.512). The scores of self-rated and actual competence were inconsistent.

Conclusion: Despite students’ high self-rated knowledge, confidence, competence, and experience score, their actual performance score was low. Discrete safe medication administration competence is challenging for nursing educators to rate the students’ performance without the use of direct assessments. Simulation scenario could be used to measure one's own performance and to give information regarding areas needed for additional training for clinical practice.