Nurses’ Experiences and Perspectives on Medication Safety Practices: A Qualitative Study Review

This qualitative study review explores the experiences and perspectives of nurses on medication safety practices. It discusses the aim, significance, research design, sampling technique, data collection method, data analysis, findings, and limitations of the study.

Running head: QUALITATIVE STUDY REVIEW 1
Nurses’ experiences and perspectives on medication safety practices: an explorative
qualitative study Review
Name
Institutional Affiliation

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What was the aim and significance of the study?
Primarily, the study was aimed at exploring the experiences and perspectives of nurses on
prevention of medication administration errors (MAE). Since medication errors (MEs) are the
most prevalent type among various medical errors, they are attributed to a considerable health
care expenses. A medication error is any event that is preventable and has the potential of
causing patient harm or inappropriate use of medication. Out of all medication administrations,
estimates of medical errors are between 5% and 25% (Riga, 2017). It is also during the
preparation and administration of medication that one third of harm causing medication errors
occur. Violation of one or several of the seven medication administration rights subsequently
leads to medication administration errors. The seven rights are; right route, right dose, right
patient, right time, right documentation, right drug and right reason (Tex, 2012). Nurses
encounter endless workload as well as environmental issues rendering the process of medication
administration prone to errors. However, it is the role and responsibility of nurses to identify,
intercept and correct the errors before they adversely affects the nurses. Regardless of the origin
of errors, statistics attribute nurses to 86% interception rate of all medication errors and thus
justifying their significant role of error prevention.
Identify the research design used in the study and was it appropriate for the Issue
discussed?
The study employed a qualitative exploratory design. It was conducted at a tertiary care
university hospital in Amsterdam, Netherlands known as Academic Medical Center. For each
ward with a capacity of 30 beds, nurses prepare medications for administration in a medication
room which also acts as a drugs storage center. An electronic prescription system is used to
prescribe all medications. Subsequently, all prescriptions and administrations are recorded in a

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paper-based administration file. Every nurse in a ward is assigned to patients for which he/she is
responsible for preparing and administering medications. As such, exploratory research design
was appropriate for the study since there was adequate data on prescription and administration of
medication recorded in each ward.
Discuss the sampling technique, inclusion and exclusion criteria used for the selection of
sample in the study
With an aim of heterogeneity of the highest level, purposive sampling was implemented so as to
attain an extensive viewpoint (Benoot, Hannes, & Bilsen, 2016) from the operational as well as
the administration level. At first, two researchers approached quality and safety innovators,
nursing ward managers and nursing managers via e-mail to request their participation in a study
on practices to increase medication safety. For sufficient representation of different attitudes on
medication safety practices as well as different levels of seniority and training, the names of
nurses from various departments were obtained using snowball sampling (Ames, Glenton, &
Lewin, 2019). It was a requirement for all participants to be registered nurses for inclusion in the
study. As such, even the senior most members of the hospital’s management who were not
registered nurses did not qualify to be included in the study. All identified nurse participants
were invited and requested to participate in the study by e-mails.
Explore the data collection method and its appropriateness to the research design of the
study
In the period between March and December 2011, two researchers, Marian Smeulers and Astrid
T. Onderwater conducted 20 semi structured interviews. Each interview session lasted for a
duration of approximately sixty to ninety minutes. With the aid of a topic list, the interviewers

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offered structured guidance which gave room for the participants to speak freely in response to
the semi structured interviews (Jamshed, 2014). Potential facilitators and barriers related to the
organizational and social context, characteristics of involved professionals, as well as nature of
the innovation, must be put into consideration when planning for changes in clinical practice. As
such, the aforementioned literature formed the foundation of the topic list. Following the
collection and analysis of data from 12 and 9 interviews, the scope of the first topic list was
narrowed twice. As the interviews almost came to an end, all participants were requested to
reflect on a wide range of safety practices. The responses of the same were inscribed and
compiled and availed in the report of the study in the appendices section.
Additionally, for all the participating nurses, an email was sent to each of them clearly outlining
the purpose of the interviews. Also incorporated in the emails were the possibilities and freedom
of participants refraining from the study at any time of their choice as well as a guarantee of
anonymity. An assurance was clearly given to participants that the purpose of the study was not
to evaluate various departments in the hospital but rather to collect experiences as well as collect
personal opinions and perspectives of the nurses on medication safety policies and practices.
Following a clear explanation of the interview process, an informed consent in form of writing
was obtained from every nurse who participated. Recording and verbatim transcription of all
interviews was conducted with the consent of the nurses.
It is beyond reasonable doubt that use of interviews was the most appropriate data collection
method. First, interviews were a primary source of information (Mitchell, 2014) from nurses who
are directly and actively involved in prescription and administration of medication on a daily
basis. When medication errors as well as medication administration errors occur, they are
basically caused by actions of the nurses themselves (Ozcanarslan, Shapekova, & Sancar, 2018).

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Additionally, the highest percentage of medication errors are intercepted by nurses in hospital
settings and thus the need to interview them to collect their opinions, and perspectives and
techniques applied in relation to the topic.
How was data analyzed? And, was it appropriate for the study?
Data analysis was conducted in reference to qualitative research guidelines employing the
MAXQDA10 software (Humble, 2018). Data was also analyzed parallel to interviews conducted
by Marian Smeulers and Astrid T. Onderwater. Following an independent coding of interview
after each interviewing session, comparisons and discussions were conducted until a unanimous
coding tree was attained. For the first 15 interviews, iterative meetings were conducted for
coding and consensus purposes. For the remaining five interviews, coding was divided. One
author was tasked with interviewing while the other one was responsible for reviewing.
Identification of themes most relevant and related to perspectives and experiences of nurses in
prevention of medication administration errors was achieved through consensus meetings.
Additionally, according to identified themes, the researchers were able to sort and analyze
various text fragments. The other co-authors documented in the published study played a
significant role in supporting and verifying the entire interviewing process as well as peer-
reviewing the results.
What were the findings/results of the study?
20 nurses in total were approached and all voluntary agreed to participate in the study. They all
admitted to feeling responsible for the medications they prescribe and administer to their
patients. Majority of them expressed the significance of alertness during work time and more
importantly when handling medication. In addition to careful handling of medications, nurses

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deemed themselves as having a pivotal and irreplaceable role in the entire medication process as
well as in ensuring the safety of medications. Although it is a responsibility for physicians to
prescribe medications, it is also an expectations that nurses will display clinical reasoning in their
undertakings. As such, it subsequently becomes a responsibility for them to thoroughly evaluate
and check whether prescriptions from physicians are in line with the actual situations of their
patients.
As backed by (Riga, 2017), it was also established that the perception of medication
administration risks was largely determined by awareness of the consequences emanating from
medication errors. A key problem for some medications and consequently medication errors is
forgetting to administer medications or administering medications when it is too late. The nurses
also brought it into the limelight that occurrence of an incident or error created more awareness
on the risks associated with medication administration. Consequently, this awareness leads to
more attentiveness or creation of a safer working environment depending on the nature of the
incident or situation.
The participants additionally pointed out that there are certain circumstances that increased the
prevalence of medication errors in the work place. Dependency of others, the work environment
of nurses’ and work pressure were such circumstances that were highlighted as having an
influence on the ability of nurses to effectively and adequately perform their tasks. All nurses
unanimously conformed to the point that documentation and subsequent processing of
prescriptions was prone to numerous errors. The nurses however positively noted that
pharmacists’ advice from the pharmacy department in relation to medication preparation
protocols, medication interactions as well as doses was of great help to them as ascertained by
(Tex, 2012).

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Discuss the limitations and recommendations of the study?
The key limitation of this study is that it was conducted in only one setting; a tertiary care
university hospital called Academic Medical Center. The study also recommended that in future,
extensive roles of both nurses as well as the management teams in ensuring the safety of
medications should be focused by considering further investigations. Additionally, the most
effective incentives and required resources related to the aforementioned roles of managers and
nurses should also be considered. Another recommendation is that clinical pharmacists and
physicians should be included in the scope of future studies in order to bring out a larger
perspective and points of view on the role of nurses in ensuring safety of medications.

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References
Ames, H., Glenton, C., & Lewin, S. (2019). Purposive sampling in a qualitative evidence
synthesis: a worked example from a synthesis on parental perceptions of vaccination
communication. BMC Medical Research Methodology. doi:10.1186/s12874-019-0665-4
Benoot, C., Hannes, K., & Bilsen, J. (2016). The use of purposeful sampling in a. BMC Medical
Research Methodology, 16(21). doi:10.1186/s12874-016-0114-6
Humble, A. (2018). Qualitative Data Analysis Software: A Call for Understanding, Detail,
Intentionality, and Thoughtfulness. Journal of Family Theory & Review.
Jamshed, S. (2014). Qualitative research method-interviewing and observation. Journal of Basic
and Clinical Pharmacy, 87-88. doi:10.4103/0976-0105.141942
Mitchell, G. (2014). Use of interviews in nursing research. Nursing Standard, 44-48.
doi:10.7748/ns.29.43.44.e8905
Ozcanarslan, F., Shapekova, N., & Sancar, B. (2018). Recent Developments in Nursing and
Midwifery. Cambridge Scholars Publishing.
Riga, M. (2017). Impact of Medical Errors and Malpractice on Health Economics, Quality, and
Patient Safety. IGI Global.