The Role of The Student Nurse in Medicine Management

Effective medicine management is an important skill that adult nursing students must develop to provide safe care to patients. NHS defines medicines management as the evidence-based practice to prescribe medicines that balance the effectiveness, tolerability, cost, safety and simplicity in the treatment [NHS, 2015]. NMC (2015) mentions that student nurses must attain clear knowledge and skill in effective medicine management during their practice [NMC, 2015]. This essay is going to reflect on the roles of the student nurse in medicine management. Here the essay will use the Rolfe’s Reflective Model to reflect on why the competencies and strong professional knowledge of student nurses in medicine management are important to ensure the safe delivery of care to patients. Here the essay will also reflect on the skills that student nurses must develop to reduce the prescription error and medication errors thereby eliminating the chances of patient’s health risk. By using the Rolfe’s Reflective Model, this study will present the reflection through three stages such as what, so what and now what. In the first stages of the reflection, the essay will discuss what was the event or situation that has been experienced by the student nurse in relation to medicine management. In the second stage, the essay will reflect on the what the student nurse had learnt from the experiences. In the last stage, it will be discussed that what action plan needs to be made in case of the student nurse to seal the knowledge gaps on medicine management thereby shaping as well as improving nurse’s skill to conduct effective and safe management of different medicines. Rolfe’s reflective framework consists of three stages such as what, so what and now what (Roberts et al. 2021). The first stage describes the event or situation in which an individual can experience different aspects. The second phase discusses what the individual learned and realised throughout the event. The third stage is about setting the effective action plan, in which the individual can set strategies to meet his or her needs. In the first stage of Rolfe’s reflection model, ‘what’, I can describe the event that I had gone through during my first placement as a student nurse. During my first placement in the A & E unit, I was assigned to work as an assistant of the senior nurses in a multidisciplinary team. Here I was taking care of a 20-year-old boy who had been admitted into the ward following a fall from the motorbike. During the care delivery to this patient, I had played a crucial role in keeping the track of the right dose and time of medicine administration in patient to ensure the safe delivery of care. Here I was assigned to assist the senior nurses in providing the right medicine with right dose to the patient, check any health issues in patient after the medicine administration and maintain the track of the right quantity of medicine is administered to the patients on proper time (Di Simone et al. 2018). Under NMC (2015), student nurses must develop enough competencies in the administration of the right medicine to the patients based on their current health condition. [NMC, 2015]. During medicine management, I was assigned to provide different medicines to the patient such as morphine, paracetamol, ibuprofen and ramipril. Morphine is the analgesic drug that is administered in patients in managing the moderate to severe pain. On the other hand, the paracetamol is administered in managing the fever in patients. As mentioned by Heczková and Bulava (2018), there are different ways of medicine administration that student nurses must know. These ways are intravenous, intramuscular, infusion, intrathecal, subcutaneous, and epidural process. During medicine administration to the patient, I faced severe issues regarding medicine management. This is because there were some prescription and medication errors in the drug chart (DC) and the Medication Administration Record (MAR) of the patient. Here the dosage and the duration of medicine administration were described differently in these DC and MAR by the doctors which made me face difficulties to follow them accordingly. As mentioned by Doughty et al. (2017), effective medicines management is entirely dependent on how efficiently the health professionals will prescribe the medicines. Under NMC (20915) student nurses must develop the skill and competencies to find out any medication or prescription errors during their placement to provide safe care to the patient [NMC, 2015]. After finding out these errors I immediately informed the matter to my mentor (the senior nurse) who then informed the concerned physician who was assigned to prescribe the medicines on the DC and MAR (Garg and Wray, 2020). Other issue that I had faced was the process of medicine administration to the patient’ body. As the information regarding the way of Morphine administration was mentioned differently on the MAR and DC, I was confused regarding what would be the right administration process of Morphine in case of this patient. I found out that on the MAR it was mentioned that Morphine was administered through the intramuscular process, while on the DC it was mentioned as the intravenous administration. Being a student nurse, as I had no practical experiences in medicine administration and prescription errors, I faced severe issues in carrying out effective medicine management thereby providing safe care to the patient. On the other hand, another important issue that found out was that there were no signatures of the prescriber on the DC in case of ibuprofen and ramipril which made me confused about whether these medicines would be administered or not. In the second phase of Rolfe’s reflection model, So What, I will discuss what I had learnt throughout the event that is described above (Heczková and Bulava, 2018). During the above-mentioned situation, I had learnt many aspects regarding effective medicine management and safe care delivery to patient. The prescription errors that I found out during the placement assisted me to understand what is the right dosage of morphine, ibuprofen and ramipril. I had identified that the information regarding the dose of morphine that was administered to the patient was different on the MAR and DC. On the DC it was mentioned that 300 mg Morphine is given to the patient, while on the MAR the mentioned dosage was 1 mg Morphine. These medication errors made me realise that while prescribing any medicine on the MAR or DC doctor must have proper clarification of doing so (Khan and Hood, 2018). Through dealing with the above-mentioned issues, I had learnt about the importance of the correct description of the dose, time, administration process and start date of medicine on both the DC and MAR. I understood that it is the responsibility of the nurses to check whether there is any prescription error and inform the error immediately to the prescriber for the correction. Like morphine, in case of Ibuprofen administration, the prescriber made the errors while mentioning the quantity and time of ibuprofen administration on the DC and MAR (Di Simone et al. 2018). On the MAR it was described that 300-gm ibuprofen had been administered to the patients, while on the DG the mentioned dose was 800 mg. In this context, student nurses must have enough professional knowledge on the right dose of any medicines that would be suitable for treating the health condition of a particular patient (Lheureux et al. 2019). Under NMC (2015), student nurses must develop strong professional to determines whether the mentioned dose and process of administration of medicines on the DC ad MAR are relevant to the current health condition of patients (Logan et al. 2020). The above-mentioned issues that I experienced severe confusion of ways of morphine administration to the patients, I had realised that I need to develop strong knowledge on the different ways of medicine administration and their usefulness to improve patient’s health condition. By discussing this issue with sector doctors and nurses I had learnt many aspects regarding how to choose the best-suited administration methods for a patient. The most important thing that I had learnt about morphine administration was that the intravenous or intramuscular administration is used to manage intolerable and severe pain patients. The patient who was cared for by my team was suffering from severe pain due to the accident. Therefore, I learned that in his case the intramuscular or intravenous administration would be relevant. However, I was confused that out of the intramuscular and intravenous administration of morphine which one would be suitable for the patient. As mentioned by Lheureux et al. (2019) intramuscular administration of medicine is more effective than the intravenous as the intramuscular dose is taken fewer times to mix with blood and reduce the affect of the pain. Through discussing with my mentors, I had also learned that another important thing in effective medicine management is making clear health assessment of a patient before administering the medicine. As mentioned by Logan et al. (2020), through assessing patients health condition nurses can inform all the health updates of patients to the doctors based on which doctors will prescribe the right dose of medicines. Under NMC (2015) guidelines, students nurses must know the ethical aspects that doctors need to follow while prescribing medicines, such as mention the right dose and right administration process of medicines, mention the right date, sign in each of the places in which medicines are mentioned. I had learnt about all these aspects of a prescription which improve my skill in identifying any prescriptions issues or medication errors during my practices. As mentioned by Long et al. (2017), for carrying out the effective medicine management, student nurses mist knows the condition and precaution that needs to be considered before administering any medicine for providing safe treatment to the patient. Through the above-mentioned events I had learnt that while giving any medicine such as Morphine, nurses need to check that whether the patient has the history of some health condition such as asthma, Acute Stroke Syndrome (ASC) and heart disease. While assessing the health condition of the patient during my placement I determined that the patient did not have such health condition therefore the use of 10 mg Morphine is relevant to his health condition. Under NMC (2015), student nurses should develop clear knowledge about the managing perfect balance between the dose of medicines when more than two medicines are administered to the patients [NMC, 2015]. Here I had learnt that for carrying out the effective medicines management to deliver safe care to patients, nurses must ensure that the combination of different medicines that are going to be used will not cause any adverse counteraction while administering into patient’s body. As stated by MacDonald et al. (2018), nurses must know the relevant combinations of medicines that are best suited to the patient’s health condition. While taking care of the patients, I gathered the knowledge about the administration of 10 mg Morphine in combination with the 500 g ibuprofen in case of patients suffering from moderate to severe pain. Under Standard for Medicine management (2008) has set the guidelines of medicines management, under which nurses and doctors must eliminate the chances of any meditation or prescription errors thereby prevent as well as minimize the risk of acute harm to the patient. During the practices, I had developed clear knowledge of all the ethical and legal guidelines regarding the medicines management that enhance my professional knowledge regarding carrying out safe and effective medication management. I also developed in-depth knowledge on how the intramuscular administration of Morphine or any others pain killer will impact the Ibuprofen (Millstine et al. 2018). My mentors also enhanced my knowledge regarding this matter by advising me to consider may other factors while administering more than one drug into the patient’s body. These factors are age, weight, current health condition, any specific chronic health issues of patients (asthma, ACS and pulmonary illness), pre-medical history and regular lifestyle of the patients. I learned that for eliminating the medication errors it is important to administer such medicines that will be highly suited to the age, weight and current health condition of the patients, I understood that in case of the patient in the A&S ward, 10 Morphine is prescribed with Ibuprofen 300 as this combination is best suited to his age (20 years ) and his current health condition. Under Medicines and Healthcare Products Regulatory Agency (MHRA), nurses must eliminate the chances of acute risk for patients due to the wrong dose of medicine (Naughton and Hayes, 2017). While informing the prescription errors on the DC and MAR, I had carried out good research on the appropriate dose of different medicines. Additionally, I also had attended an official conference along with my team members in which my mentors discuss the medication and prescription errors and the wrong dose medicines (Yawei and Fuyu, 2021). I had learnt that while administering any medicines I must ensure that I am aware of the right dose and administration process of medicines which are relevant to the health condition of patients. I had learnt that how the wrong dose of pain killers like morphine and ibuprofen can cause severe health complication such as breathlessness, cardiac failure and pulmonary dysfunction. As mentioned by Savoia et al. (2017), nurses are not only about the right dose of medicines but also, they have the expertise and skill in managing patient’s health if any wrong dose is administered. Here I had gathered clear knowledge on how the patients’ health condition can be improved of his or low dose is administered in the patient's body. Throughout the placement, I had gathers useful knowledge on the process of adjustment of the dose of medication in term of minimising the health risk of patients. I also learnt that while there is any case of diose adjustment, I must inform the concerned physicians and the senior nurses regarding the matter. . In the third stage of Rolfe’s refection model, So What, I will discuss the action plan that I had to develop to improves my skill regarding medicines management. Based on the realisation and experiences that I gained from the above-mentioned events, I had developed an action plan. The action plan included different objectives on which I had worked to archive them accordingly. The first objective was to improve my knowledge of determining the best-suited medicine administration process for the patient. For improving the knowledge I worked with several multidisciplinary groups which took care of different patients and noticed the administration process used by the senior nurses in different cases. Another objective included in the action plan is that I need to improve my knowledge regarding the right dose of different medicines. Here I had conducted interaction with my mentors and doctors about gathering in-depth knowledge on the right dose of medicine. Another important objective was to improve my knowledge of prescription errors. For improving this knowledge, I had worked with senior nurses to overhaul different prescription while taking care of different patients, here I discuss my questions regarding the dose, administration process and time mentioned on the prescription. Moreover, I also worked on shaping my professional skill such as communication skill, time management skill and quick decision-making skill that are important to take the effective decision and maintain effective communication with other nurses and doctors to carry out effective medical management. From the overall discussion, it can be concluded that medicines management is crucial in nursing to provide safe care to patients. student nurses must develop the skill in carrying out effective medicine management that will assist them to eliminate the risk of acute harm to patients. medicines management student nurse must develop knowledge on the dose, side effects, different ways of administration and pharmacology of different medicines, Additionally, nurses need to assess the health condition of patients to administer the right medicine.

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