Factors influencing a nurse's decision to question medication administration in a neonatal clinical care unit.
OBJECTIVE
The aim of this study was to identify factors that influence nurse's decisions to question concerning aspects of medication administration within the context of a neonatal clinical care unit.


BACKGROUND
Medication error in the neonatal setting can be high with this particularly vulnerable population. As the care giver responsible for medication administration, nurses are deemed accountable for most errors. However, they are recognised as the forefront of prevention. Minimal evidence is available around reasoning, decision making and questioning around medication administration. Therefore, this study focuses upon addressing the gap in knowledge around what nurses believe influences their decision to question.


METHODS
A critical incident design was employed where nurses were asked to describe clinical incidents around their decision to question a medication issue. Nurses were recruited from a neonatal clinical care unit and participated in an individual digitally recorded interview.


RESULTS
One hundred and three nurses participated between December 2013-August 2014. Use of the constant comparative method revealed commonalities within transcripts. Thirty-six categories were grouped into three major themes: 'Working environment', 'Doing the right thing' and 'Knowledge about medications'.


CONCLUSIONS
Findings highlight factors that influence nurses' decision to question issues around medication administration. Nurses feel it is their responsibility to do the right thing and speak up for their vulnerable patients to enhance patient safety. Negative dimensions within the themes will inform planning of educational strategies to improve patient safety, whereas positive dimensions must be reinforced within the multidisciplinary team.


CONCLUSIONS
The working environment must support nurses to question and ultimately provide safe patient care. Clear and up to date policies, formal and informal education, role modelling by senior nurses, effective use of communication skills and a team approach can facilitate nurses to appropriately question aspects around medication administration.
Neonatal Clinical Care Unit, King Edward Memorial Hospital WNHS, Subiaco, WA, Australia. Laurene.Aydon@health.wa.gov.au.|Department Nursing and Midwifery Education and Research, Women and Newborn Health Service, Subiaco, WA, Australia. Laurene.Aydon@health.wa.gov.au.|Centre for Research and Neonatal Education, School of Child and Paediatric Health, University of Western Australia, Perth, WA, Australia. Laurene.Aydon@health.wa.gov.au.
Laurene
L
Aydon
School of Nursing and Paramedicine, Curtin University, Perth, WA, Australia.|Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital WNHS, Subiaco, WA, Australia.
Yvonne
Y
Hauck
Neonatal Clinical Care Unit/Department Nursing and Midwifery Education and Research, King Edward Memorial Hospital WNHS, Subiaco, WA, Australia.
Margo
M
Zimmer
Neonatal Clinical Care Unit/Department Nursing and Midwifery Education and Research, King Edward Memorial Hospital WNHS, Subiaco, WA, Australia.
Jamee
J
Murdoch
D000328:Adult; D003657:Decision Making; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D008508:Medication Errors / Q000451:nursing / Q000517:prevention & control*; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology*; D061214:Patient Safety; D010371:Pediatric Nursing; D057184:Practice Patterns, Nurses'; D014904:Western Australia; D055815:Young Adult
clinical decision making; critical incidents; medication error; medication management; neonatal care