Clinical Decision-Making in Undergraduate Nursing Students' Medication Management: A Verbal Protocol Study
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Susan Irvine1, Ian Irvine, Sharon Andrew
1About the Authors Susan Irvine, PhD, MN, RN, is associate professor, Victoria University, Australia. Ian Irvine, PhD, MMus, is senior research assistant, Victoria University. Sharon Andrew, PhD, RN, is academic lead, La Trobe University, Australia. Kelley Mumford, MHSc, is manager, Health Simulation, Victoria University. Caroline Cooper Blair, MHSc, RN, is a lecturer, Victoria University. Kelli Wain, MN, RN, is a lecturer, Victoria University. Lisa McKenna, PhD, RN, MBA, is professor, La Trobe University. Funding for this research was provided by a 2024 National League for Nursing (NLN) Education Research Grant. The authors thank Bhashika Bhattarai, RN, and Tatiana Zecher, RN, for their contribution to data collection, and Ifrah Shakeel, Ebony Borg, Laki Mavridis, Kieran Parboo, and Vincent Nham for technical support.
Aim:
To investigate second-year undergraduate nursing students' clinical decision-making (CDM) in medication administration using a verbal protocol.
Background:
CDM requires metacognitive ability. Little is known about the cognitive and metacognitive strategies employed by nursing students when administering medications.
Method:
A concurrent mixed-methods design employed a verbal protocol, a high-fidelity simulated medication administration scenario recorded on video and audio, and debriefing. Fourteen students participated in the study.
Results:
The quantitative data included 14 procedural and conceptual areas of knowledge to identify strengths and gaps in CDM. The qualitative data showed a higher proportion of cognitive than metacognitive operators, with greater evidence of metacognitive use in the debriefing.
Conclusion:
There is a need to investigate the characteristics of students who exhibit maladaptive cognitive and metacognitive processing and to shift from a task-focused approach to training toward methods that accelerate cognitive and metacognitive expertise.
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