Date of Award

2006

Degree Type

Thesis

Degree Name

Bachelor of Nursing Honours

School

School of Nursing, Midwifery and Postgraduate Medicine

Faculty

Faculty of Computing, Health and Science

First Advisor

Dr Sue Nikoletti

Second Advisor

Helen Myers

Abstract

The purpose of this quantitative descriptive research study was to investigate Enrolled Nurses' attitudes, intentions and behaviour in relation to independent medication administration (IMA). This research was necessary as a significant number of Enrolled Nurses (ENs) are now able to administer medications up to Schedule Four level, without supervision when they have completed a medication administration programme (MAP). This change in the scope of practice for the EN will eventually be introduced nationally as recommended by the National Review of Nursing Education (2002). Anecdotal reports suggest that IMA is causing concern for the EN but little or no research has been done to date on this issue. The target population for this study were ENs working in Western Australia (WA), who were members of the Australian Liquor, Hospitality and Miscellaneous Workers Union (n= 1820). ENs were invited to complete a postal survey that contained fixed response questions about attitudes, intentions and behaviour related to IMA and demographic questions. The survey questions were developed specifically for this study and were based on the theoretical framework of Ajzen and Fishbein's theory of reasoned action. Space was provided for additional comments. The response rate was 40% and the final sample size was 729. The instrument was pilot tested with five participants prior to administration. A test-retest was conducted with thirty participants to assess reliability using percent agreement and kappa statistics. The result of the pilot reliability testing indicated that the questionnaire was suitable for this study. Data related to research questions were analysed using descriptive statistics and chi-square tests. Descriptive statistics included frequencies, percentages, measurement of central tendency and dispersion. The findings of this study indicate that 51.4% ofENs (n=360) had completed the MAP and 16.9% (n=l19) intended to complete the programme within the next 12 months. The ENs' attitudes related to IMA were positive, the majority agreeing that administering medications independently should be part of their role. Significant facilitating factors and barriers have been identified affecting the intention and behaviour of ENs in relation to completing a MAP and practicing IMA. The facilitating factors include 'wages'; there was an expectation that ENs would be paid more for practicing IMA. Those who had not completed a MAP would consider doing a MAP if they were paid more. The second factor was related to 'future employment'; there was an expectation that those ENs that are deemed competent to practice IMA have improved their chances of future employment. The third factor related to 'confidence'; most ENs felt confident and enthusiastic about practicing IMA. The fourth factor related to the 'role of the EN'. There was an expectation that ENs should administer medications independently as part of their role, therefore expanding the scope of practice giving their role a more positive step. The fifth factor related to 'quality of care'. There was an expectation that the quality of care would improve if ENs were independently administering medications. Most ENs believe that administering medications independently would /does allow them to deliver holistic care to the patient. The sixth factor related to 'hospital policy'. Among those ENs employed in a work place where the policy allows them to practice IMA, if the employer offered the EN the opportunity to participate in an MAP they would more likely accept. The seventh factor related to 'employment'. Those ENs working in nursing specialities that are aged care or medical services were more likely to have completed a MAP. The barriers include stress for the EN, time issues to complete the MAP, work place support if medication error is made, and rural/regional/remote location. Fear about drug calculations was considered a problem for some ENs however not a barrier to commencing a MAP. Recommendations for clinical practice include all health care facilities in WA allowing ENs to practice IMA and all ENs to be given the opportunity to complete a MAP, not just those selected by management. External units need to be developed for rural/remote/regional areas. A short refresher course on drug calculations should be provided prior to commencing the MAP for those ENs that feel that drug calculations are a problem. To help facilitate a pathway for future career advancement it is recommended that the title of Enrolled Nurse should be changed to Registered Nurse Division 2 when a Diploma level of competency has been achieved. Implications for clinical practice include managers promoting a team approach due to the increase of different skill mix competencies achieved among nurses and eliminate barriers between RNs and ENs if they become evident. With the expected increase in numbers of ENs wanting to complete a MAP additional places will need to be made available. Staff Development nurses will need to provide supervision and support to this increase of numbers of ENs while the practice component of the MAP is completed on the wards. There will be many changes in the foreseeable future for the role of the EN as the scope of nursing practice increases and these changes may have an impact on health care provision. The most important thing to be monitored during these changes will be the quality of patient care.

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