Structured Observation Form Research Articles

Assessment of Medication Labeling Compliance in Outpatient Pharmacy: A Study in Riyadh, Saudi Arabia

Abstract This study assessed outpatient medication labels in 19 hospitals in Riyadh, Saudi Arabia, focusing on critical information necessary for safe and effective medication use. The study utilized a structured observation form based on guidelines from the Saudi Food and Drug Authority and the Institute for Safe Medication Practices. The form included indicators related to label identification, instructions, and layout. Compliance rates for each indicator were calculated, revealing varying levels of adherence across different hospitals. High compliance rates were observed for indicators such as the date of dispensing (100%), directions of use (100%), and typing directions in Arabic (100%). However, lower compliance rates were noted for physician and pharmacist information, drug information, and additional medication details, with rates ranging from 0 to 78.9%. Specifically, the inclusion of physician and pharmacist registration numbers had a compliance rate of 0%. The study highlighted significant gaps in standardizing medication labels, emphasizing the need for including essential information such as total quantity dispensed, number of refills, warning labels, medication indication, and storage conditions. Additionally, the use of barcodes, hospital logos, and Tallman letters was found to be inconsistent. In conclusion, the findings underscore the necessity for standardizing outpatient medication labeling practices to improve patient safety and medication management. This study calls for collaborative efforts, knowledge sharing, and the implementation of best practices to achieve consistent and accurate medication labeling in Saudi Arabia.

Content and Duration of Doctor-Patient Communication in Outpatient Oncology Follow-Up Consultations in China.

Purpose This study aimedto analyze the content of counseling between cancer patients and physicians during outpatient follow-up, assess the duration of different communication content, and explore the influencing factors. Patients and methods We observed consecutive cancer patients without a first diagnosis of malignancy who presented to the oncology outpatient clinic of a public hospital from October through December 2023. A structured observation form was used to record the content and duration of doctor-patient communication. All variables were electronically recorded and stored on a data management platform. Multiple linear regression was used to examine the determinants of consultation duration. Results Our study included 620 cancer patients, of whom 281 individuals had distant metastasis. The average consultation duration for 620 cancer patients was 4.85 minutes (standard deviation of 3.09 minutes). The category of doctor-patient communication was routine outpatient follow-up, involving 182 patients, with an average consultation duration of 3.81 minutes (standard deviation of 2.24 minutes). The main communication content for 51 patients was about the admission procedures, with an average consultation duration of 3.00 minutes (standard deviation of 1.92 minutes). For 67 patients, the primary communication involved the prescription of anti-tumor medications, with an average consultation duration of 3.70 minutes (standard deviation of 2.30 minutes). Symptom control discussions were the main communication content with 107 patients, with an average consultation duration of 5.91 minutes (standard deviation of 3.44 minutes). The main communication content of 24 patients involved medical insurance reimbursement, with an average duration of 7.75 minutes (standard deviation of 4.63 minutes). Consultations accompanied by caregivers and the presence of metastatic tumors were positively associated with consultation duration, whereas female patients with genital malignancies were negatively associated with consultation duration. Communication about symptom management and communication about medical insurance reimbursement waspositively associated with the duration of medical consultations. Communication about administering the formalities requisite for patient admission was negatively associated with the consultation duration. Conclusion We classified the main contents of doctor-patient communication in the oncology outpatient clinic and found that the contents of doctor-patient communication tended to be monotone and systematized. Oncology outpatient models should consider the integration of caregiver involvement. The reason for the shorter outpatient consultation duration in female patients of cancer primary in the reproductive system needs further investigation. The intricate medical insurance reimbursement process poses an increasing time challenge for outpatient clinicians. In addition, the adequacy and effectiveness of symptom management services provided to cancer patients during oncology outpatient follow-up requirefurther evaluation and review.

Is it possible to have a dialogical English language classroom? Challenges and advantages

The research aims to investigate are opportunities and challenges in English language teaching classrooms for dialogic teaching. To achieve the aim of the research, a multiple case study design was chosen. The cases were determined by considering the socio-economic, socio-cultural, and success levels of the schools. The data are obtained from qualitative techniques which are observation of the class and interviews with teachers. The study group consisted of students in 5th grade and English Language Teachers. The findings of the article consist of observing the dialogues in the classrooms using a structured observation form and interviews with teachers using a semi-structured interview form. The research offers new insights for further practice and research, in terms of identifying challenges and advantages for the application of dialogic teaching. Keywords: Dialogy; dialogic classroom; dialogic teaching; English language; English language teaching

An Investigation of the Speech Skills of Children Living in Rural and Urban Areas

Communication is vital for children’s development, especially in differentiating rural and urban speech skills. The aim of this study is to investigate the speech skills of children living in rural and urban areas. The speech skills of 72 students attending the 8th grade in rural and urban areas of Iskenderun in the 2020-2021 academic year were examined. In the study designed with the screening model, the data were collected with a structured observation form. The video recordings of the speeches made by the students on the topic of “human and nature” according to their levels were taken and evaluated according to the “Speech Evaluation Form”. The results of the present research revealed that the highest average scores of the students belonged to the sub-dimensions of applying the external structural elements of the language, applying the internal structural elements of the language and the psychological state of the speaker. In addition, it was determined that the students’ speech skills were at a moderate level, whereas their ability to briefly introduce the parts of the speech, to start the topic with interesting expressions, to use appropriate tools such as pictures, graphs and photographs that can make the speech interesting, to use proverbs, idioms and aphorisms suitable for the topic, to benefit from literary devices suitable for the topic and to summarize the speech were very low. Urban students demonstrated comparatively stronger speech skills, highlighting the value of targeted improvements in communication education.

Kavram Öğretimi Sürecine Öğrenme Amaçlı Yazmayı Eklemlemek: Bir Müdahaleli Karma Desen Araştırması

Bu çalışmanın amacı, öğrenme amaçlı yazma etkinliklerinin sosyal bilgiler dersine özgü kavramların öğretimi üzerindeki etkisini incelemektir. Karma araştırma yaklaşımları içerinde yer alan müdahaleli karma desene göre tasarlanan bu çalışma, toplam 18 ilkokul dördüncü sınıf öğrencisinin katılımı ile gerçekleştirilmiştir. Uygulama sürecinde farklı kavramlara odaklanmış on farklı öğrenme amaçlı yazma etkinliğine yer verilerek, öğrencilerin kavram öğrenme süreçleri yakından takip edilmiştir. Araştırma verileri açık uçlu kavram bilgi testi, kavram akademik başarı testi, yapılandırılmış sınıf içi gözlem formu ve yarı yapılandırılmış görüşme formu ile toplanmıştır. Toplanan nicel veriler betimsel ve kestirimsel istatistikler kullanılarak analiz edilirken nitel veriler içerik analizi ile çözümlenmiştir. Öğrencilerin neleri öğrenip neleri öğrenmediğini somut bir şekilde yansıtan öğrenme amaçlı yazma etkinlikleri, bir yandan öğrenciye gizil bir dönüt sağlarken öte yandan öğretmenlerin kendi öğretim süreçlerine projeksiyon tutmuştur. Sağlanan bu projeksiyon öğrenciyi yazma, öğretmeni ise öğretme sürecinde öz düzenlemeye yöneltmiştir. Böylece araştırma sonucunda başta milli egemenlik, demokrasi, özgürlük gibi soyut ve öğrenilmesinde zorlanılan kavramlar olmak üzere etkin vatandaşlık öğrenme alanında yer alan kavramların öğrenme amaçlı yazma etkinlikleri ile daha kolay öğrenildiği görülmüştür. Benzer şekilde kavram öğrenimi sürecinde öğrencilerin harcadığı zihinsel çaba, farklı muhatapların anlayacağı şekilde dizayn edilen sosyal bilgiler dili, kavramların öğrenilme düzeyine ilişkin yapılan geri bildirimler, öğretmen ve öğrencilerin aktif katılımları ortaya çıkan başarının gerekçelerini oluşturmaktadır. Öğrenme amaçlı yazma etkinliklerinin kavram öğretim sürecine yaptığı bu katkılardan hareketle farklı disiplinlerin çok sayıda kavramını disiplinlerarası yaklaşımla bütünleştiren sosyal bilgiler dersinde öğrenme amaçlı yazma pedagojisi alternatif bir öğretim yolu olabilir.

Dental Health in Early Childhood: "I Can Do It If You Teach

This study aims to raise awareness of dental health and care activities with pre-school children and cause desired behavioural changes in children, is basic qualitative research. The study group of the research consisted of 13 children studying in a pre-school class according to convenient/easily accessible sampling, which is one of the non-random sampling methods. For the research, data were collected through observations, interviews and research diaries, and the results were obtained by applying descriptive analysis by the researchers. For the research, data were collected through observations, interviews and research diaries, and the results were obtained by analyzing them by the researchers. In this direction, according to the descriptive analysis results obtained from the semi-structured observation form, it was seen that the preschool dental health activities increased the awareness of the children about the tools and equipment used in dental health, and thus gave the children an important tooth brushing routine. According to the descriptive analysis of the structured observation form and research diaries, the tooth brushing routine continued in the follow-up period after the application and became a behavior in children. In line with these results, suggestions were made for future studies.

Young Children’s Ideas about Heat Transfer Phenomena

In this article, we present kindergarten children’s ideas about thermal phenomena before any educational intervention took place. In order to capture and account for the heterogeneity of the kindergarten group in this study, first teachers observed children’s exploration behavior, task orientation, science interest, and language comprehension in everyday kindergarten life using a structured observation form. Then, 24 children aged between 3.8 and 6.0 years were interviewed individually about three situations focusing upon water temperature and its changes. The results show that interest in science and language comprehension are significantly related to children’s understanding of thermal phenomena, while task orientation and exploratory behavior are not. In general, the kindergarten children did not yet use the word “heat” in their descriptions and explanations but were more or less able to describe the water temperature and its changes in a differentiated way.

Omissions and Deviations From Safe Drug Administration Guidelines in 2 Medical Wards and Risk Factors: Findings From an Observational Study.

This study aimed to record the type and frequency of errors, with an emphasis on omissions, during administration of medicines to inpatients and to investigate associated factors. This was a descriptive observational study. The medication process in 2 medical wards was observed by 2 observers using a structured observation form. χ2 Test, Kruskal-Wallis test, and regression analysis were used to explore associations between factors and errors. From the 665 administrations observed, a total of 2371 errors were detected from which 81.2% were omissions and 18.8% were errors of commission. Omissions in the infection prevention guidelines (46.6%) and in the 5 rights of medication safety principles (35.8%) were a predominant finding. In particular, omitting to hand wash before administering a drug (98.4%), omitting to disinfect the site of injection (37.7%), and omitting to confirm the patient's name (74.4%) were the 3 most frequently observed omissions. Documentation errors (13.1%) and administration method errors (4.5%) were also detected. Regression analysis has shown that the therapeutic class of the drug administered and the number of medicines taken per patient were the 2 factors with a statistical significance that increased the risk of a higher number of errors being detected. Errors during drug administration are still common in clinical practice, with omissions being the most common type of error. In particular, omissions in the basic infection and safety regulations seem to be a very common problem. The risk of a higher number of errors being made is increased when a cardiovascular drug is administered and when the number of medicines administered per patient is increased.

Second Life Application for Creativity in Art and Design Education

<p style="text-align:justify">This research aims at revealing the effects of Second Life (SL) application used in virtual environment in art and design education of creativity. This research is a qualitative study conducted evaluating the results of a group of 16 students studying art and design at universities, for a period of 12 weeks. For SL, a 3D, online, multi-user virtual environment was chosen as the study area. The process of the research was evaluated by the researcher with a Structured Observation Form (SOF). Student designs were evaluated by four graduated artists/educators and researchers with a Rubric. The study group discovered SL during the application process. They made numerous trials, took risks and tried different solutions in SL. The design process that started with an avatar creation continued with 3D design, adding texture, colour, and script to objects and creating a notecard. According to the researcher’s feedback based on SOF, the group is considered “Good” in the design process. According to the Rubric for creativity, applied by the experts is evaluated as “Accomplished.” As for the rubric applied by the researcher, the group is evaluated “Good.” Based on these results, it can be considered that the inclusion of SL in the art and design education curriculum will contribute to 21st century skills and develop imagination and creativity of students.</p>

Food Purchasing Decisions in Overweight Mother-child Dyads in Malawi (FS01-05-19)

ObjectivesAs obesity increases in sub-Saharan Africa, information is needed about factors influencing food choices in households with overweight members. The objective of this study was to assess women’s food purchasing decisions in overweight mother-child dyads in Malawi. MethodsWe enrolled 50 mother-child (age 6–59 months) dyads in which either the mother, the child, or both were overweight in Lilongwe and Kasungu Districts. Research assistants accompanied each woman on a food shopping trip and filled out a structured observation form on the types of food purchased and locations of purchases. Upon returning to the woman’s home, research assistants conducted an in-depth interview about the factors that influenced the woman’s purchases, including asking them to sort 12 factors into piles that always, sometimes, or never influence their food purchasing choices. ResultsObservations showed that women most often purchased small quantities of foods needed to prepare relish (the dish accompanying the staple food), such as tomatoes (76%), green leafy vegetables (66%), cooking oil (56%), onions (44%), and fish (41%) at outdoor markets. Pile sorts and open-ended responses revealed that taste, cost, and food quality were the strongest factors influencing food purchases. Women explained that if a food is too expensive, they buy a smaller quantity or buy something else (e.g., fish instead of meat). Cooking food that their family enjoys eating influenced the foods women bought. Adding tomatoes, onions, and oil to relish was commonly described as making the food tastier. To make the child happy, >50% of the women said they buy food, such as sweets, packaged snacks, fruit, or fried food (e.g., doughnuts), specifically for their child. ConclusionsCost, taste, and food quality were the most important drivers of women’s food purchasing choices. Women used some of their minimal funds to buy unhealthy foods for their children, despite their overall emphasis on food cost and quality. These findings can be used by programs to reinforce healthy and decrease unhealthy food purchases. Funding SourcesDrivers of Food Choice (DFC) Competitive Grants Program, funded by the UK Government’s Department for International Development and the Bill & Melinda Gates Foundation, and managed by the University of South Carolina, Arnold School of Public Health.

Food Purchasing Decisions in Overweight Mother-child Dyads in Malawi (FS01-05-19)

ObjectivesAs obesity increases in sub-Saharan Africa, information is needed about factors influencing food choices in households with overweight members. The objective of this study was to assess women’s food purchasing decisions in overweight mother-child dyads in Malawi. MethodsWe enrolled 50 mother-child (age 6–59 months) dyads in which either the mother, the child, or both were overweight in Lilongwe and Kasungu Districts. Research assistants accompanied each woman on a food shopping trip and filled out a structured observation form on the types of food purchased and locations of purchases. Upon returning to the woman’s home, research assistants conducted an in-depth interview about the factors that influenced the woman’s purchases, including asking them to sort 12 factors into piles that always, sometimes, or never influence their food purchasing choices. ResultsObservations showed that women most often purchased small quantities of foods needed to prepare relish (the dish accompanying the staple food), such as tomatoes (76%), green leafy vegetables (66%), cooking oil (56%), onions (44%), and fish (41%) at outdoor markets. Pile sorts and open-ended responses revealed that taste, cost, and food quality were the strongest factors influencing food purchases. Women explained that if a food is too expensive, they buy a smaller quantity or buy something else (e.g., fish instead of meat). Cooking food that their family enjoys eating influenced the foods women bought. Adding tomatoes, onions, and oil to relish was commonly described as making the food tastier. To make the child happy, >50% of the women said they buy food, such as sweets, packaged snacks, fruit, or fried food (e.g., doughnuts), specifically for their child. ConclusionsCost, taste, and food quality were the most important drivers of women’s food purchasing choices. Women used some of their minimal funds to buy unhealthy foods for their children, despite their overall emphasis on food cost and quality. These findings can be used by programs to reinforce healthy and decrease unhealthy food purchases. Funding SourcesDrivers of Food Choice (DFC) Competitive Grants Program, funded by the UK Government’s Department for International Development and the Bill & Melinda Gates Foundation, and managed by the University of South Carolina, Arnold School of Public Health.

Investigation of Mathematical Concept Skills of Children Trained with Montessori Approach and MoNE Pre-school Education Program

<p style="text-align:justify">In this study, it is aimed to examine the mathematical conceptual skills of 48-72-month-old children attending pre-school education institutions providing a Montessori Approach and Ministry of National Education Pre-school Program (MoNE PSP). The study group consisted of 20 children, who were trained by the Montessori Approach, and 20 children, who continued to attend pre-school education institutions applying the MoNE PSP. The research was carried out in accordance with the state study design of the qualitative research methods, and the data of the study was collected by the structured observation method at the free play/individual work time in the learning centers of the children constituting the study group. A structured observation form was used as the data gathering tool, and mathematical concept skills such as counting, matching, grouping, comparison, positioning, measurement, pattern, part-whole, transactions and creating a graphic were included. Research data were analyzed with descriptive analysis method, and the frequency and percentage values of the obtained data were calculated. As a result of the study, it was observed that the students trained with the Montessori Approach and MoNE PSP could not create graphics in both groups, while the rhythmic counting and patterning skills were the most observed skills in children. It has been determined that children trained with the Montessori Approach perform more studies, especially on matching, grouping, comparison/ranking, and part-whole skills, compared to the children trained with MoNE PSP. In the light of the results obtained in this research, it is suggested that the play materials that had to be in classes where MoNE PSP was applied should be standardized, and children should be able to get through these materials; also mathematics center should be established in the class level.</p>

The Impact of a New Pedagogical Intervention on Nursing Students' Knowledge Acquisition in Simulation-Based Learning: A Quasi-Experimental Study.

Simulation-based learning is an effective technique for teaching nursing students' skills and knowledge related to patient deterioration. This study examined students' acquisition of theoretical knowledge about symptoms, pathophysiology, and nursing actions after implementing an educational intervention during simulation-based learning. A quasi-experimental study compared theoretical knowledge among two groups of students before and after implementation of the intervention. The intervention introduced the following new components to the existing technique: a knowledge test prior to the simulation, video-recording of the performance, and introduction of a structured observation form used by students and facilitator during observation and debriefing. The intervention group had significantly higher scores on a knowledge test conducted after the simulations in comparison to the scores in the control group. In both groups scores were highest on knowledge of symptoms and lowest on knowledge of pathophysiology; the intervention group had significantly higher scores than the control group on both topics. Students' theoretical knowledge of patient deterioration may be enhanced by improving the students' prerequisites for learning and by strengthening debriefing after simulation.

Opening the black box: An observational study of teaching and learning interactions for paediatrics trainees on consultant ward rounds.

Ward rounds are complex activities in which education must be balanced against service. Limited evidence exists regarding how to optimise ward round education. In order to improve the educational experience, we aimed to understand the teaching and learning interactions on ward rounds with a particular focus on the experience of paediatric trainees. We conducted an initial quantitative survey as a needs assessment regarding learning and teaching in clinical settings using a structured survey of 21 trainees. This was followed by an observational study using focused ethnography of 20 consultant ward rounds in a general medical department of tertiary paediatric hospital. We used a structured observation form to document ward round characteristics and educational interactions. Data were analysed using inductive content analysis to understand key influences on teaching and learning interactions. Trainees reported a discrepancy between the actual educational value of ward rounds (mean rating 2.7/5) and what they desired (mean 4.3/5). Ward round ethnography revealed examples of excellent education and practice alongside missed opportunities. Explicit education on rounds was dominated by technical content with little focus on other aspects of professionalism. Major influences on educational interactions were the ward round model - consultant-as-expert versus learner-centred - and the hidden curriculum. There are many examples of excellence in ward round education, yet there remains substantial scope to better harness the education potential of rounds. This requires us to challenge assumptions, enable feedback and reflection and make learning explicit - while putting the learner at the centre of educational opportunities.

Use of an electronic Partograph: feasibility and acceptability study in Zanzibar, Tanzania

BackgroundThe ePartogram is a tablet-based application developed to improve care for women in labor by addressing documented challenges in partograph use. The application is designed to provide real-time decision support, improve data entry, and increase access to information for appropriate labor management. This study’s primary objective was to evaluate the feasibility and acceptability of ePartogram use in resource-constrained clinical settings.MethodsThe ePartogram was introduced at three facilities in Zanzibar, Tanzania. Following 3 days of training, skilled birth attendants (SBAs) were observed for 2 weeks using the ePartogram to monitor laboring women. During each observed shift, data collectors used a structured observation form to document SBA comfort, confidence, and ability to use the ePartogram. Results were analyzed by shift. Short interviews, conducted with SBAs (n = 82) after each of their first five ePartogram-monitored labors, detected differences over time. After the observation period, in-depth interviews were conducted (n = 15). A thematic analysis of interview transcripts was completed.ResultsObservations of 23 SBAs using the ePartogram to monitor 103 women over 84 shifts showed that the majority of SBAs (87–91%) completed each of four fundamental ePartogram tasks—registering a client, entering first and subsequent measurements, and navigating between screens—with ease or increasing ease on their first shift; this increased to 100% by the fifth shift. Nearly all SBAs (93%) demonstrated confidence and all SBAs demonstrated comfort in using the ePartogram by the fifth shift. SBAs expressed positive impressions of the ePartogram and found it efficient and easy to use, beginning with first client use. SBAs noted the helpfulness of auditory reminders (indicating that measurements were due) and visual alerts (signaling abnormal measurements). SBAs expressed confidence in their ability to interpret and act on these reminders and alerts.ConclusionsIt is feasible and acceptable for SBAs to use the ePartogram to support labor management and care. With structured training and support during initial use, SBAs quickly became competent and confident in ePartogram use. Qualitative findings revealed that SBAs felt the ePartogram improved timeliness of care and supported decision-making. These findings point to the ePartogram’s potential to improve quality of care in resource-constrained labor and delivery settings.

Training surgical residents to use a framework to promote shared decision-making for patients with poor prognosis experiencing surgical emergencies

Patients with poor underlying prognosis experiencing surgical emergencies face challenging treatment decisions. The Best Case/Worst Case (BC/WC) framework has improved shared decision-making by surgeons, but it is unclear whether residents can be similarly trained. We evaluated senior general surgical residents' acceptance of the BC/WC tool and their attitudes, confidence and actions before and after training. Two-hour training included a didactic session, live demonstration, small-group practice and debriefing. We developed questionnaires to evaluate residents' attitudes, confidence and actions at 3 time points: before the intervention, after the intervention and 6 months after the intervention. We used the Ottawa Decision Support Framework Acceptability questionnaire to evaluate acceptability and a structured observation form to evaluate performance. Eighteen (50%) of 36 invited residents participated. Most residents (83%) felt that a new communication tool would be useful. Almost all (94%) used BC/WC in practice. Residents found the tool acceptable and useful to enhance preference-sensitive communications. They felt that the training was valuable and that role play was its greatest strength but that these situations were challenging to simulate. Barriers to BC/WC use included time constraints and difficulty defining the best and worst cases precisely. Summative attitudes and confidence scores were not different before and after the intervention; however, actions scores were higher after the intervention (p = 0.04). Residents performed a median of 15 (interquartile range 13-17) of the 19 elements on the formative performance evaluation. Commonly missed items were narrating outcomes of palliative approaches, prompting deliberation and providing treatment recommendations. Senior residents found the BC/WC tool to be acceptable and useful, and are amenable to training in this type of communication. After training, self-reported actions scores increased, and observed performance was accurate.

Implementation of the Flipped Classroom Model in the Scientific Ethics Course

In the present study, the purpose was to determine students’ views about the application of Flipped Classroom Model (FL), in which, different from the traditional method, homework is replaced by in-class activities and which has frequently been mentioned recently. The study was carried out with 24 students from the department of Computer Education and Instructional Technologies within the scope of the Scientific Ethics Course for in a period of 11 weeks in 2016. In the research process, stud groups were formed to let the students carry out the in-class applications collaboratively. In the study, the research data were collected via structured observation form, observation, structured interview form and focus group interview. The study was carried out on qualitative basis with quantitative support. In the quantitative dimension of the study, descriptive statistics was applied, and in the qualitative dimension, thematic analysis method was used. In the study, for the collection and analysis of the data, Rogers’s Diffusion of Innovations Theory was used as the theoretical framework. In this respect, with the data collected from the participants, the advantages and disadvantages of the FL model were determined. The findings obtained in the study revealed that the participants had positive views about their collaborative learning thanks to the FL model within the scope of the Scientific Ethics Course; that the model increased their motivations; that the model should be used more commonly; and that they wanted to prefer to teach with this model in their future professional lives.

The factors associated with medication errors in adult medical and surgical inpatients: a direct observation approach with medication record reviews.

Observing real situations in clinical practice can provide undetected information regarding problems in the medication process. The aims of this study were to describe the frequency, types, and severity of medication errors in medical and surgical inpatients as well as to study the relationship between medication errors and associating factors. A cross-sectional study using direct observations and medication record reviews was conducted to assess how 32 registered nurses administered 1058 medications to 122 inpatients in four medical and surgical wards at a university hospital in Finland between April and May 2012. Observations were recorded using a structured observation form and patients' medication record reviews (n = 122) before and after the observations were conducted. A multiprofessional team analysed and classified all of the detected errors and assessed their severity. A logistic regression was used to analyse the factors (work environment, team, person-specific, patient-specific or medication-related) associated with medication errors. At least one error was found in 22.2% (235/1058) of administered medications, 63.4% of which were medication administration errors and 18.3% of which were documentation errors. Of the medication administration errors, 59.1% involved an incorrect administration technique. 3.4% of errors caused harm to patients. Statistically significant factors that increased the risk of medication errors included every other weekday, except Sunday; morning shifts; increased rushes; nurses asking for help; and increased number of medications that patients used. Factors that decreased the risk of errors included administering medications through an oral route, double-checking the drugs, and additional people in the medication room at the same time. Medication errors in inpatient care are frequent, and improvements to increase safety are vital. More attention to medication administration techniques, administration instructions and attitudes toward safety are needed to prevent problems.

Paediatric trainee supervision: Management changes and perceived education value

Supervision in postgraduate training is an under-researched area. We measured the amount, type and effect of supervision on patient care and perceived education value in a general paediatric service. We designed a structured observation form and questionnaire to document the type, duration and effect of supervision on patient management and perceived education value. Most supervision occurred without the paediatrician confirming the trainee's findings. Direct observation of the trainee was rare. Management was changed in 30% of patients seen on the inpatient ward round and in 42% of the patients discussed during the chart reviews but not seen by the paediatrician. Management was changed in 48% of the cases when the paediatrician saw the patient with the trainee in outpatients but in only 21% of patients when the patient was but not seen. Changes made to patient management, understanding and perceived education value, differed between inpatient and out patient settings. There was more impact when the paediatrician saw the patient with the trainee in outpatients; while for inpatients, the opposite was true. Trainees rated the value of the supervision more highly than their supervisors did. Trainees' comments on what they learnt from their supervisor related almost exclusively to clinical knowledge rather than professional behaviours. We observed little evidence of supervisors directly observing trainees and trainees learning professional behaviours. A review of supervisory practices to promote more effective learning is needed. Communicating to paediatricians the value their trainees place on their input could have a positive effect on their engagement in supervision.

Conhecimento acerca do processo transfusional da equipe de enfermagem da UTI de um hospital universitário

The study aimed to evaluate the knowledge of nurses in the Intensive Care Unit (ICU), on the transfusion process. This is a descriptive, quantitative approach, performed in the ICU of University Hospital Onofre Lopes (HUOL), between July and August 2008, with 27 nursing professionals. The research received favorable acquiescence of the HUOL Ethics Committee (n. 175/08). Data were collected through a questionnaire and structured observation form, in addition to consulting the medical records. Data showed a predominance of young professionals, aged between 21 and 32 years (63.0%), female (85.2%) and complete high school education (74.1%). Regarding the knowledge on the transfusion process, it was observed that was more appropriate in the pre-transfusion, blood transfusion, and inadequate post-transfusion. The trainees presented the lowest scores of knowledge on the 3 steps. The surveyed professionals, especially the nursing staff trainees, had serious deficiencies with regard to knowledge of the transfusion process, showing the inadequacy to develop this therapy. With knowledgeable and well-planned actions, it is possible to assess results, seek innovation, prevent errors and damage to the patient, improving the quality of care provided in health care.