(How) do we learn from errors? A prospective study of the link between the ward's learning practices and medication administration errors.

BACKGROUND: Attention in the ward should shift from preventing medication administration errors to managing them. Nevertheless, little is known in regard with the practices nursing wards apply to learn from medication administration errors as a means of limiting them. AIMS: To test the effectiveness of four types of learning practices, namely, non-integrated, integrated, supervisory and patchy learning practices in limiting medication administration errors. METHODS: Data were collected from a convenient sample of 4 hospitals in Israel by multiple methods (observations and self-report questionnaires) at two time points. The sample included 76 wards (360 nurses). Medication administration error was defined as any deviation from prescribed medication processes and measured by a validated structured observation sheet. Wards' use of medication administration technologies, location of the medication station, and workload were observed; learning practices and demographics were measured by validated questionnaires. FINDINGS: Results of the mixed linear model analysis indicated that the use of technology and quiet location of the medication cabinet were significantly associated with reduced medication administration errors (estimate=.03, p<.05 and estimate=-.17, p<.01 correspondingly), while workload was significantly linked to inflated medication administration errors (estimate=.04, p<.05). Of the learning practices, supervisory learning was the only practice significantly linked to reduced medication administration errors (estimate=-.04, p<.05). Integrated and patchy learning were significantly linked to higher levels of medication administration errors (estimate=-.03, p<.05 and estimate=-.04, p<.01 correspondingly). Non-integrated learning was not associated with it (p>.05). CONCLUSIONS: How wards manage errors might have implications for medication administration errors beyond the effects of typical individual, organizational and technology risk factors. Head nurse can facilitate learning from errors by "management by walking around" and monitoring nurses' medication administration behaviors.

Nursing students' stress during the initial clinical experience.

The purpose of this exploratory longitudinal study was to identify nursing students' perceptions of stress in their initial clinical experiences in a hospital setting. Guided by the relational view of stress, a Nursing Student's Stress Scale (NSSS) was developed to include six subscales: adequate knowledge, close supervision, averse sights, causing pain, insufficient resources, and reality conflict. The NSSS was administered three times during the clinical experience to 46 nursing students. Results showed significant differences between the students' preclinical expected stress levels and the actual levels of stress in the clinical setting. Theoretical, methodological, and practical implications of the findings are discussed. Nurse educators are encouraged to acknowledge students' perceptions of stressful situations as a basis for stress reduction intervention. Students must first cope with their own stress in the clinical reality before being expected to deal with patients' stress.

Stress intervention. A model of stress inoculation training.

1. The initial clinical experience in a hospital setting has been identified as a major area of threat for beginning nursing students. 2. A stress inoculation program, in which students were exposed to situation similar to future clinical experience, was used to help students develop confidence and coping skills. 3. The program was found to be an effective preparation for clinical experience, mainly in terms of the students clinical performance.

"Nothing to hide and nothing to advertise". Managing disease-related information.

The purpose of this study was to explore the process of managing disease-related information through various developmental stages from the inside perspective of those who live with a long-term health condition. The retrospective, longitudinal, life history method was used to generate a descriptive theory from accounts constructed with 21 informants: 10 adolescents and young adults with cystic fibrosis (CF) aged 16 to 25 years, and 11 of their significant family members. People chose a specific telling strategy according to the perceived ability of the audience to deal with the information and the situational context. Four strategies of managing disease-related information emerged: visibility, direct telling, silent telling, and concealment. The informants frequently chose information management strategies that enabled an ordinary style of living. These strategies neither reflect feelings of shame nor of pride, as it is suggested in the existing literature. Implications for theory, health care practice, and further research are discussed.