An Exploration of Pre-Registration Nursing Student’s Knowledge Acquisition and their Application of Medication Management in the Paediatric Setting Doris O’ Toole, Clinical Placement Co-ordinator RGN, RCN, RNT, MSc., BSc. Dip.

Background Children’s / General Integrated Programme (2006) Theory / practice gap evident (clinical practice) No regulatory guidelines re minimum theoretical hours (pharmacology) Medication Management Education Programme established by the CPC to enhance student’s learning Review of organisation’s Medication Policy – Introduction of ‘third-checker’ role for 3 rd year students & ‘second checker’ role in 4 th year

Aims / Objectives Explore student’s knowledge acquisition and their application of medication management (paediatric setting) Gain an understanding of how students perceive their education / training in practice prepares them for their role with medication management Gain an understanding of possible changing needs experienced by students regarding their role Generate data that will be valuable to clinical staff in supporting students in the future

Sample Students undertaking the BSc. Children’s / General Integrated Programme (n = 25) Single university Non-probability sampling (volunteer) Practice Module Co-ordinator (recruited volunteers) Random selection Focus group (n = 10)

Research Methodology Qualitative design Longitudinal approach Focus groups moderated (external facilitator) Ethical approval

Data Collection Krueger & Casey (2000) Framework Ice BreakerCareer IntroductoryDefinition / Concept TransitionExpectation KeyApplication, Knowledge Development, Challenges & Future role EndingIdeal System, Support Structures Summary

Data Analysis Tapes transcribed verbatim (moderator) Transcripts verified (two participants) Thematic Analysis: Participation Supports / Resources Influence of Registered Nurse’s Perceptions / Attitudes Ideal System

Key Findings: Participation Role Concept: primarily self-initiated “had to put yourself forward”, “not dependent on you (staff nurses)” Perception of Role: “we all saw it as a positive thing because we didn’t want to be dumped in the deep end” Level of Responsibility: “would prefer second- checker role much earlier (than 4 th year)” – mixed views re commencement phase, however “better to be third-checker before second-checker”

Key Findings: Participation Conflict: “you are actually slowing them down (staff) so we are a hindrance”, “ a lot of time you can be sent away to do something else”, “you’re kind of an extra on the trolley (drug)…annoying them (staff) Pace: “they (staff) are so use to the doses…flying through them”, “they (staff) expect a lot more of you as third-checker but don’t allow you time to do it properly”, “feel sorry for them (staff) as they are under time pressure”

Key Findings: Supports & Resources Clinical Practice: “very good overall”, “miss the workshops when on external placement…frustrating” Resources: Workbooks (“not compulsory so people don’t always do them”), Workshops (“facilitated well, really good for calculations”) Personnel: CPC “give huge support on the worksheets and the workbook”, “we don’t get any of that in General (branch) and I think they are doing all they can to support us”

Key Findings: Supports & Resources Personnel: Clinical Education Facilitators (CEF) “on certain wards they would be really into you and they would encourage you and the staff to get you involved” Staff / Preceptors: “depending on how often you worked with them”

Key Findings: Attitudes & Perceptions Personnel: “it’s the same people who won’t let you fully partake as a third-checker”, “a lot to do with the ward and staff”, “if people give you a positive attitude and give you the time”, “staff don’t always see the benefit initially”, “I am sure they (staff) would like to feel that the nurses that are going to be qualified soon are going to have the proper knowledge”

Key Findings: Ideal System Mock Drug Rounds: “go through what you might have learned that week (with the CPC / CEF)”, “easier to relate to certain conditions rather than learning off a name and what they (drugs) are for” Theory-Practice Integration: “so isolated the theory and practical…get this one module in second year in a class of 250”, “college too separated”

Key Findings: Ideal System Assessment Strategy: “have a continuous assessment and divide it up over 4 years so you are relating those drugs into everyday use…practically assessed on the ward, wouldn’t mind being, because it is the only way you will learn”, “might not be pleasant but the best way of learning”, “better to be assessed (in practice) rather than just an exam (college)” Medication Workbooks: Implement in Year 1 & 2 and introduce workbooks as compulsory element

Key Findings: Ideal System Early introduction of pharmacology in the curriculum (year 1) “this is what we really need to be learning, should be a lot more emphasis on it” Review of student role / responsibilities in practice (as second-checker) Reinforcement to staff re the value / benefits of student participation in practice

Limitations Single university site Non-probability sampling

Recommendations Replication study (on completion) Increase sample size (multiple sites) Randomised sample / probability sampling

Implications to Nursing, Education & Management Review / clarity of student’s role / responsibilities Increased integration of theory and practice / collaboration with the link university Impact on future role as a Registered Nurse (HSE, 2009) Introduction of a (student) core competency assessment framework (paediatric services) Value of support personnel / resources in clinical practice

Conclusion Student’s perception / attitudes towards ‘assessment’ identified in a positive capacity Value of learning resources / strategies in clinical practice Need for improved theory-practice integration Reinforcement to registered nurses re the benefits / value of student participation

Acknowledgements Nursing students and affiliated university Children’s University Hospital, Temple Street for funding the research study Further information / references available on request from