Using Virtual Environments to Improve Clinical Competence of Nursing Students’ Medication Administration Practice

David Holloway

doi:10.25907/00113

Errors in medication administration represent up to 18% of all episodes of medication administration in the Australian hospital setting, making such errors a key contributor to hospital-based adverse events. Medication administration is a daily part of nursing practice and errors in medication administration remain an area of ongoing concern. The opportunity for nursing students to engage with patients and demonstrate competence in medication administration is however, limited. Thus, alternative learning activities that can improve competence in medication administration are needed. The use of learning tools such as virtual reality and serious games has generated some promising outcomes for learning and for developing confidence and competence among students of the health professions. This research evaluated the use of a web-based virtual environment as a learning tool to promote the confidence and competence of nursing students in the safe administration of medications. Using a virtual patient in the form of a three-dimensional avatar, 64 undergraduate nursing students from universities across Australia completed a clinical scenario involving both the procedural and interpersonal aspects of medication administration. Using a pragmatic mixed-methods approach with a convergent design, pre- and post-participation surveys and post-participation interviews were used to collect data to determine the impact of using virtual environments on both perceived confidence in safely administering medications and perceived competence in this task. The data were analysed to assess student performance in using virtual environments for learning the safe administration of medications. Quantitative demographic and survey data were analysed using IBM SPSS statistics for Windows, Version 24.0. Student performance in completing the medication administration scenario at the first and second attempts was also analysed to determine improvements in medication administration competence. A summative content analysis explored the interview data. The analysis identified five key themes, which formed the basis of a conceptual model that was specifically developed for the use of virtual environments in teaching safe administration of medications. Results showed that participants found the virtual environment engaging and reflective of previous learning and experience. Participant scores post exposure to the medication administration scenario suggest an increase in self-perceived competence in the safe administration of medications, as demonstrated by the mean improvement of 21.6 in the overall score out of 100 (SD, 11.5, t = 15.03, P < 0.001). This is reflected in the qualitative analysis with participants reporting they had greater confidence in undertaking medication administration tasks from both an interpersonal and procedural viewpoint. Those with limited experience with gaming or virtual environments found the scenario easy to use. Participants strongly agreed that virtual environments are a beneficial learning tool. Further, participants frequently nominated the ability to practise skills at a time and in a location of their choosing as a benefit of the tool. The research met its aims. The results showed that the virtual environment scenario engendered both competence and confidence among participants with and without previous experience in the use of virtual environments. Additionally, participant acceptance of the virtual environment simulation was high across the cohort. This study highlighted several areas for future research that may inform improvements in undergraduate nursing education to assist in preparing graduate nurses for clinical practice. These areas include: replicating these study results in different clinical domains and with different types of medication administration; improving the controls and navigation of virtual environments to minimise unintended errors; and undertaking research on integrating virtual environments into the toolkit for undergraduate nursing education.

Using Virtual Environments to Improve Clinical Competence of Nursing Students’ Medication Administration Practice

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