Nursing and Midwifery Council (NMC) standards for pre-registration nursing and prescribing programmes were published in 2019 and, in the context of pharmacology and prescribing, there were two significant changes (NMC, 2019a; 2019b). First, registrants can progress to a prescribing qualification earlier in their career and second, pharmacology and prescribing preparedness in pre-registration programmes is a requirement for all fields of nursing practice. This standardised approach to pharmacology is aligned to recommendations from the Biosciences Quality Assurance Framework (B-QAF) (BiNE, 2016) and aims to:
- Reduce variation in pharmacology content across universities
- Provide all students with similar levels of prescribing preparedness at point of registration.
This research roundup will provide an overview of the research and opinion relating to pharmacological knowledge and teaching approaches in pre-registration and post-qualifying nurses. A keyword search of CINAHL, MEDLINE and Emerald databases yielded four articles, of which one was an opinion paper, and the remainder primary research. Two surveyed adult pre-registration and post-qualifying students (Khan and Hood, 2018; Preston et al, 2018), one paediatric post-qualifying students (Lan et al, 2014) and the opinion paper was related to mental health nursing (Pearson et al, 2018). The search did not yield any research relating specifically to learning disability nursing.
Nurses perspectives on pharmacology: why, what and at which point of the curricula should education be delivered?
This UK study used a quantitative approach to explore the need for greater pharmacology content in nursing programmes, acknowledging that most pre-registration programmes limit pharmacology content to drug administration and drug calculations. The participants were pre-registration (n=46) and post-qualifying (n=33) nurses, of whom 15 were prescribing students.
Across all participants, there was a recognised need for greater pharmacology content in pre-registration programmes. All groups rated pharmacokinetics and pharmacodynamics as a high priority, but acknowledged they were difficult concepts to grasp. Most backed face-to-face delivery, supported by e-learning, giving students the opportunity to seek clarification and explanation in the classroom. A gradual introduction of pharmacology concepts from second year onwards was viewed as an appropriate model for pre-registration education.
The sample size was small and participants only enrolled on the adult branch of a programme, which limits the transferability of findings to other fields of practice. Nonetheless, teaching core concepts to all pre-registration students and applying them to specific fields of practice would be in line with the new pre-registration and prescribing standards.
Nursing students perceptions of pharmacology education and safe medication administration
This study used content analysis to extrapolate themes from a mixed methods survey with 71 pre-registration students and 28 post-qualifying students. All were undertaking a baccalaureate or RN-BSN degree completion at a university in north eastern US. The students were invited to complete a 10-item questionnaire on completion of an 8-day blended pharmacology course. The questionnaire covered subjects such as safe drug administration and self-reported perceptions of pharmacology content. The article reported free-text qualitative responses from the survey.
Pre-registration students valued the pharmacology knowledge and were able to see a link between this and safe drug administration, whereas the post-qualifying participants valued this less. Nonetheless, all students viewed the pharmacology content and access to clinical resources as an effective foundation for development of clinical knowledge. Students also appreciated knowledge of how drugs work, and the positive impact on patient education, which increased confidence of, and in, the nursing student.
Some of the negative perceptions were associated with volume of content and overwhelming depth of material. Others believed that attainment of safe drug administration was not from theoretical learning instead through experience of drug administration. Others reported that drugs discussed in class were not relevant to their area of practice.
While the study design is limited by participant numbers and data collection methods, it suggests that, if pharmacology is delivered through a ‘clinical lens’, it is valuable for pre- and post-qualifying students. One issue highlighted in this article was that the format of one pharmacology course or module may be too specific and overwhelming for students. This is important for those designing pre-registration curricula in the UK and may provide evidence for dispersing pharmacology and medicines management throughout the curricula.
Pharmacology training in mental health nurse education: Justification for an increase in frequency and depth in the UK
This opinion paper suggested that there is a requirement for pharmacology in mental health nursing curricula. This need is growing due to surges in prescription rates and the necessity for nurses to manage medicines in a person-centred, evidence informed way. While the absence of pharmacology allows students to focus on psychosocial aspects of mental health, the authors purported that pharmacological knowledge is needed to support people with complex mental and physical conditions.
A newly qualified mental health nurse who is supporting a person prescribed psychoactive medication, such as clozapine, may have no formal pharmacological education outlining drug action, risks, benefits and alternatives to treatment. The authors suggest that this may be detrimental to the patient, particularly when the perception is that nurses are knowledgeable about medicines management. As a result, the authors support the integration of pharmacology content in pre-registration curricula. They also suggested that there was a need for knowledge of drugs relating to physical health that supports the move by the NMC to standardised pharmacology curricula.
‘If pharmacology is delivered through a ‘clinical lens’, it is valuable for pre- and post-qualifying students’
Medication errors in paediatric nursing: assessment of nurses' knowledge and analysis of the consequences of errors
This article reported a study that was conducted with registered paediatric nurses in Taiwan (n=60). Using a 20-point survey, the researchers assessed pharmacological knowledge of those who frequently administer medicines to children. The questionnaire was in four parts: high alert medicines, common use medicines, demographics, and self-evaluation including the need for further education.
Results suggested that staff had very limited knowledge on pharmacology and 99% identified a need for more pharmacology knowledge. Level of nursing qualification was not a discriminator for enhanced knowledge, and nurses reported most of the knowledge the acquired was post-qualification ‘on the job’ learning.
Despite no specific research on pre-registration paediatric knowledge, this study suggests that knowledge of pharmacology in post-qualifying staff was variable. Participants appeared to have acquired a reasonable level of knowledge, but the absence of pharmacology in the pre-registration curriculum may result in inconsistencies in medicines management, and a higher risk of drug errors. While it is unclear of the transferability of these findings to the UK, by standardising approaches to pharmacology and medicines management this variation may be reduced.
Conclusion
The research presented in this month's roundup appears to support changes to pharmacology content in NMC pre-registration programmes. Teaching pharmacology through a ‘clinical lens’, dispersed throughout the programme of study may have the greatest impact on clinical practice, yet the research evidence in this area is very limited. This paucity of evidence presents an opportunity for practice and education to collaborate and evaluate the effect of teaching strategies on pharmacology knowledge and medicines optimisation following implementation of the new NMC standards.