Help with nursing students' pharmacological knowledge

lkwashington · Feb 15, 2011

I am not an expert educator, but I usually ask my students why is the patient taking this medication. I inform students a patient medications can tell you a lot about the patient past or present medical history. I explain doctors order medications for a different reason than what the drug book states. I lecture and have clinicals. I teach Med-Surg I. Students have pharm before coming to me. It is still hard because you have to find out each student baseline of knowledge with medications.

Whispera, MSN, RN · Feb 16, 2011

I agree. Ask the students why the patient is taking the medications. Also, you could ask them how they would explain, to the patient, how the medication works. That's something a patient might ask, and it's very pharmacological. Ask them to put it in words a non-medical person could understand and to leave out the big words. If they can do that, they understand much better than they might if they give the big words. See if they pronounce things correctly. If they don't, it's pretty possible they don't understand the meaning behind the words. Ask them what a receptor is. Ask what the medication does at a receptor. How about explaining how the medication might cause side effects?

TooterIA · Feb 17, 2011

Ditto to asking them why the pt is on the med, action, usual dose, nursing implications.

Depending on the level of the student, some of them like games. My first year students love when I use crosswords, word finds, jeopardy, etc in postconference of clinical to learn drugs. Second level, not so much.

And I am, HUGE on pronunciation. They need to know how to say it (especially since there are so many drugs that have similar names)

SheaTab · Feb 17, 2011

This is an enormous soapbox for me!

I have worked with all levels of students and have had them come to me in their final semester still not having a solid grasp on the basics of safely administering meds (rights of med admin) or even a general feel for the most commonly administered meds. Most of my students have felt like this is one of their most significant weaknesses. I don't know about other programs, but the ADN program I taught at has threaded pharm throughout the curriculum instead of having a dedicated class. This was a big mistake in my opinion.

I start by having them memorize this ... in fact, I want them to know it like the back of their hand and require them to check it prior to administering meds.

PADRRT! Pronounced, Pa-Dirt! Patient, allergy, drug, dose, route, time. So many nurses in practice have let these few simple rules slide and our students are watching. So before we even start administering, my students need to use two identifiers to ID the patient. Then are to check allergies against each med they are to admin. Then drug, dose, route, time. In that order without any variance. I teach them to be methodical and watch for them to do it the same way, time after time. They spend so little time in the lab practicing. I think about it like this ... would you rather have your 13-year-old attend a sex education class or a sex practice course? The answer is obvious. There seems to be more of an emphasis on the didactics than on the practice in nursing school these days and I'm afraid we will continue to see more adverse events in practice if we don't change our emphasis. There are many things I am very flexible about. They can add their own flare or style to teaching or making a bed, for example, but they can not vary from this.

When I start clinical, I will borrow a MAR or computer and make up fake drugs on alcohol swabs or something. I will let one student be a pretend patient and then let each student run through the process over and over and over (ad infinitum) until they are confident in the process of PADDRT! ;o) At the bedside, I also look for them to be able to tell me about the drug and any nursing implications. I also want them to tell the patient each drug they are about to take and what it is for. For example, "this is lisinopril 20 mg and it is for your blood pressure." This gives the patient the opportunity to say, "No, I usually take 40 mg" or "I can't take that, it makes me cough like a smoker!" It also helps them learn the indications for the meds and gain comfort in educating and talking with patients.

I also provide them with a list of must know meds with implications at the start of clinical. This is something we go over during admin and in post-conference. I start from first semester up. One problem I have seen is that students just don't take it seriously unless they are tested on it. You know, if they are going to be tested, they will learn it! If not, they will casually look at it if they have time. I have considered making up mini tests and having them take one each clinical day. Any thoughts? I'd be happy to share the list of meds if anyone is interested and you are more than welcome to alter it for your own personal needs.

Additionally, in terms of comfort with the patients and gaining skill in teaching and promoting well-being and safety in patient care, I require students to teach each of their patients 4 things each day. I verify it when I check them off on assessments and also when I observe their care of the patient. I look for them to be able to show the patient how to do it (Not just educate! Practice!) and for them to be able to get the patient to return demo. If they forget and don't ask the patient to return-demo, I will gently ask for the return demo myself. They are often shocked and surprised how often the patient has NO IDEA how to do what they have been told. Actually, the patients most often don't remember what the students have said at all. This is a really great reality check for them.

I approach it like this - some of the most significant risks of hospitalization include skin breakdown, pnemonia, DVT, and infection. Teaching your patients these few things can save their life! AND, I also tell them that what the patient can't do for themselves, you must do for them or ensure than it gets done by delegating and following up.

1. Pneumonia & skin-breakdown prevention - T, C, DB at least every two hours while in bed and get up an walk as often as you can (of course, if they are safely able to) & drink plenty of fluids (barring any fluid restrictions or NPO status).

2. DVT Prevention - Walk and pump your legs (like gas pedals) at least everey couple of hours.

3. Infection Prevention - Encourage patients and their families to wash their hands or use hand sanitizer and to remind each healthcare staff to do the same before they provide any care.

This helps the students to learn to teach and also to encourage patients to take active part in their own care. I call these topics "THE BIG 3!"

Last, I require them to learn "THE BIG 5!" For patient safety always check the following 5 things before you leave the room! Check your patient, the bed, the table, the wall, the floor!" (patient, table, bed, wall, floor) Patient in a position of comfort, breathing, and CALL LIGHT IN HANDS OR WITHIN REACH. Bed in lowest position and HOB in appropriate position. Table right next to bed so patient does not fall out when reaching for phone or glasses. The wall is equipped with whatever you might need in the event that you need to save the patient's life including (per facility protocol) O2, ambu or CPR device, suction, etc. The floor is clear of garbage and obstacles that the patient may trip or slip on.

I want them to become methodical and second-nature about these things so that they will continue these things in practice. I also teach them to tell patients why they are doing certain things so that the patients are able to connect intention with action. For example, "I am lowering the bed to the lowest position for your safety. I am pulling the table to your bedside so that you can safely reach it," etc. etc. This helps the student to teach and also the patient to advocate for their own safety. So often patients have no idea why we do the things we do and may rate us poorly in terms of protecting their safety and privacy even though we are constantly (but quietly) doing so all the time. For example, we close the door and curtain to protect privacy but the patients don't always see it that way.

Thoughts?

Good luck! Tabitha

Fatmah Jabr · Feb 19, 2011

wounderful work everyone thank you so much for your help :)

skicheryl · Feb 20, 2011

Tabitha,

Could you share the list of drugs you use for teaching? Thanks!

Cheryl

Fatmah Jabr · Feb 21, 2011

Yes Tabitha it would be great idea to share them with us.

Regards

Fatmah

SheaTab · Feb 22, 2011

Attached.

The only thing I would add are important teaching for antibiotics ... for example - Metronidazole - No ETOH during treatment, dark urine. Vancomycin - nephro, red man, slow, etc. Quinolones (avelox, levaquin, cipro, etc.) Adults only. Black box - tendon rupture. Small risk of cross-sensitivity with PCN and cephalosporins. etc etc etc.

Important Drugs to Remember.doc

Fatmah Jabr · Feb 25, 2011

:up:

Thank you so much SheaTab I really do appreciate your help. :nurse:

Regards Fatmah