According to Preston et al. (2019), the role of a registered nurse (RN) is of great significance in providing safe care services to the patents. They ensure that there are safe medication administrations; they conduct follow-ups, monitoring, and evaluation of the patient frequently. The nurse should engage in safe medicine practices, this will ensure a safe care service to the patient. The nurse should effectively acknowledge the feedback of the patients, as this feedback can give insight into the side effects of the medicine through effective verbal and non-verbal communications. Moreover, it is important the safe environment is maintained so that the safety and hygiene of the patient are ensured. The following sections will discuss the role of RN in safe medication administrations, patient-centered approach, and environmental impact in nursing care in safe medication administrations.
According to Bucknall et al. (2019), the registered nurse (RN) during medication administrations should be ensured that the environment should be culturally safe. This is so because it is a duty of the nurse to provide a safe and secure environment and comprehensive services to the patient calm and safe, there should be assessment and monitoring of vital signs like body temperature, blood pressure, blood glucose levels, and others should be frequently performed before and after medication administrations. The patient’s rights should be maintained during medication administrations like the patient should be taught or informed about the particular medication name, purpose, action, and potential side effects. As per the Nursing and Midwifery Board of Australia codes, the nurses should respect the acceptance or refusal decisions of the patient for any medication (Sessions et al., 2019). Environmental factors like high noise levels, poor lighting, inappropriate room temperature, and few others are some of the environmental factors that can impact medication administrations leading to errors and impact patient safety. According to Foged et al. (2018), the planning and assessments to maintain patient safety when preparing for medication administration can be ensured with the help of 10 rights of drug administrations, these are as follows: right drug, right dose, the right education, and information, right route, right patient, right frequency and time, frequent assessment and documentation.
The 2 priorities are assessment for allergy and post evaluation of vitals after drug administration to detect the effects of the drugs. According to Furunes et al. (2018), the patient should be educated about the health issues and the treatment so that she takes a decision that helps the patient to get a patient-centered care and consistent care services. If RN uses spiritual and cultural approaches like prayers, and others with safe, respectful, and continued care then the old adults will also get empowered to live their lives with healthy aging and without depending on others for their care. For this, the RN can introduce the patients to digital systems like My Health Records or others to get their visit or medication alerts, information about signs or symptoms of diseases, and other report or prescription-related information (Jennings et al., 2018). The patient should be examined for the vital signs as these get impacted by the effects of the drugs. If the patient shows allergic symptoms like cough, skin texture changes, redness, itchiness, anxiety, dry mouth, or other, then alternatives should be used to ensure patient safety. The patient-centered approach is of great importance in nursing care as it results in fast recovery and patent satisfactions well.
According to Armstrong et al. (2017), the RN should ensure that the needs and services of the patients are met and supported. This will ensure that the preferences are fulfilled and they are promoted for independency. If the RN performs effective monitoring, assessments, and evaluation of the patients then the signs of cognitive decline, functional decline, and other health-related deterioration can be timely reported and treated. If the patent is too young then the mother should be involved in the decision-making processes and if the patient is unable to speak a particular language then he/she should be explained about the treatment and management plans in simple language so that consent can be taken. It should be ensured that autonomy, beneficence, justice, and non-maleficent principles are maintained and the care should be delivered as per the codes of ethics in nursing.
If the patient decides to discontinue any of his/her medication than the nurse should respect the decision and inform the associated senior doctors to make a then effective alternate plan for the patient. During the administration of sedatives, opioids and other high alert drugs the nurse should be highly alert and accountable for the actions (Halcomb et al., 2018). The hand hygiene and other hygiene levels should always be maintained and the multidisciplinary team should also perform effective communication among themselves so that there are no chances of errors in the medication plans of the patient. Every health professional should document their evaluations so that there is an effective transfer of information about the patient’s success or health deteriorations rates. The use of effective communication in medication care is very important as it enables the patient and care provider to develop a strong relationship where the patient will give feedback and care providers will provide patient-centered care meeting the patient’s needs person (Bucknall et al., 2019).
The safe care builds diverse ways to provide excellent care, helps gain access to needed health care providers, supports the needs of the family members, looks after the emotional, social, mental, and psychological needs of the patients, and respects the goals, likes, and choices of the ill person (Foged et al., 2018). Good communication allows the nurses and other health care provides to understand the wishes, priorities, and needs of the patient, support them in shared decision-making discussions, and connect to the patient. If the communication is not effective then the patient will not give proper feedback, the nurse will not realize the needs or feelings of the patient and if the health care professionals did not communicate among themselves then quality care will not be ensured to the patient who is suffering from a life-threatening disease or is dying with the disease. During transitions of care, few factors should be considered so that patient-centered care is delivered. The factors are as follows: Involvement of health care multidisciplinary team, the involvement of the family of the patient id decision-making, effective communication within health staff, and with the patient (clinical narrative practice). As per the relationship-centered care model, the main focus is on the relationships that are enacted across all healthcare providers.
According to Happell et al. (2017), the following factors involved in the responsibilities of RN for effective nursing care which ultimately help in reducing medication errors: tracking of medication errors, being proactive, involving the patient, designing effective warning, alert, or alarm systems, performing double checks, performing follow-ups, educating the patient about look-alike and sound-alike drugs, using barcodes in checking the right drug or medication, verifying the medication and the administrations, minimizing clutter, and few others. Moreover, the following factors are also of great significance: Respect for personhood; minimize harm; maximize benefit; educating the patient and family members about the prescriptions before their discharge; reconciling the patient’s medication at every care transitions to reduce dosing errors; medication errors; use of programmable infusion devices; frequent monitoring of respiratory rates of catheter patients; measure and document patient’s weight; rectification of any discrepancies before medication administrations; being familiar with all rescue agents, reversal agents and antidotes; wear a special vest, gloves or masks; make sure that all documents are well-read and set before medication administration, and many others (Kerrigan et al., 2020). According to Johnstone et al. (2016), the responsibilities of RN in safe medication management and patient-centered safe care includes many other factors like Diagnosis - tailoring the information to individual and family needs and addressing psychosocial concerns; Plan of Care - Organizing and interpreting patient and family data; Pain and Symptom Management - educating patient and family about medication, side effects and teaching complementary and alternative techniques; Practical support - discussing home care needs, insurance, financial needs; Assess patient distress - Providing supportive counseling and reinforcing strengths and coping mechanisms.
The registered nurse should make sure that there is a culturally safe environment for the patient and the environment should have appropriate lighting and safety measures. There should be effective communication with health professionals and patients along with the family members to explain them well about the medication and prescriptions before their discharge from the hospital. The frequent monitoring and evaluation help in eliminating the unexpected results and the patient should be well monitored for vital signs before and after medication administrations. Moreover, the patient should be taught about the allergic or unexpected signs or symptoms of side effects of medicines so that he/she can immediately inform the doctors for alternative medication usage.
Armstrong, G. E., Dietrich, M., Norman, L., Barnsteiner, J., & Mion, L. (2017). Nurses’ perceived skills and attitudes about updated safety concepts: Impact on medication administration errors and practices. Journal of Nursing Care Quality, 32(3), 226. https://dx.doi.org/10.1097%2FNCQ.0000000000000226
Bucknall, T., Fossum, M., Hutchinson, A. M., Botti, M., Considine, J., Dunning, T., & Manias, E. (2019). Nurses’ decision‐making, practices and perceptions of patient involvement in medication administration in an acute hospital setting. Journal of Advanced Nursing, 75(6), 1316-1327. https://doi.org/10.1111/jan.13963
Foged, S., Nørholm, V., Andersen, O., & Petersen, H. V. (2018). Nurses’ perspectives on how an e‐message system supports cross‐sectoral communication in relation to medication administration: A qualitative study. Journal of Clinical Nursing, 27(3-4), 795-806. https://doi.org/10.1111/jocn.14109
Furunes, T., Kaltveit, A., &Akerjordet, K. (2018). Health‐promoting leadership: A qualitative study from experienced nurses’ perspective. Journal of Clinical Nursing, 27(23-24), 4290-4301.https://doi.org/10.1111/jocn.14621
Halcomb, E., Stephens, M., Bryce, J., Foley, E., & Ashley, C. (2016). Nursing competency standards in primary health care: An integrative review. Journal of Clinical Nursing, 25(9-10), 1193-1205. https://doi.org/10.1111/jocn.13224
Happell, B., Bennetts, W., Tohotoa, J., Wynaden, D., & Platania-Phung, C. (2017). Promoting recovery-oriented mental health nursing practice through consumer participation in mental health nursing education. Journal of Mental Health, 633-639. https://doi.org/10.1080/09638237.2017.1294734
Jennings, W., Bond, C., & Hill, P. S. (2018). The power of talk and power in talk: A systematic review of narratives of culturally safe healthcare communication. Australian Journal of Primary Health, 24(2), 109-115. https://doi.org/10.1093/bjsw/bcaa032
Johnstone, M. J., Hutchinson, A. M., Redley, B., & Rawson, H. (2016). Nursing roles and strategies in decision making concerning elderly immigrants admitted to acute care hospitals: An Australian study. Journal of Transcultural Nursing, 27(5), 471-479. https://doi.org/10.1177%2F1043659615582088
Kerrigan, V., Lewis, N., Cass, A., Hefler, M., & Ralph, A. P. (2020). “How can I do more?” Cultural awareness training for hospital-based healthcare providers working with high caseload. BMC Medical Education, 20, 1-11. https://doi.org/10.5694/mja17.00328
Preston, P., Leone-Sheehan, D., & Keys, B. (2019). Nursing student perceptions of pharmacology education and safe medication administration: A qualitative research study. Nurse Education Today, 74, 76-81. https://doi.org/10.1016/j.nedt.2018.12.006
Sessions, L. C., Nemeth, L. S., Catchpole, K., & Kelechi, T. J. (2019). Nurses’ perceptions of high‐alert medication administration safety: A qualitative descriptive study. Journal of Advanced Nursing, 75(12), 3654-3667. https://doi.org/10.1111/jan.14173
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