Nurses provide an important service to the elderly in long-term care facilities (LTCFs) by seeing to it that they receive the right medication and stay healthy in their twilight years. But these nurses also face several challenges as they try to take care of the elderly.
“We found that the nursing workforce in LTCFs is getting older, training is outdated, workloads increase, and information technology skills are lacking," say Emerentia Nicholson and Anneleen Damons from Stellenbosch University's Department of Nursing and Midwifery ahead of International Nurses Day (IND) on 12 May. They conducted a study on the age, experience and training, as well as the skill mix of nurses who care for the elderly in LTCFs in the Western Cape and the impact thereof on how they administer medication.
The findings of their study, which were published recently in Health SA Gesondheid, are particularly relevant given that, according to the International Council of Nurses, the 2022 IND theme Nurses: A Voice to Lead – Invest in nursing and respect rights to secure global health emphasises the need to protect, support and invest in the nursing profession to strengthen health systems globally.
Of the 203 nurses ̶ registered nurses (RNs), enrolled or staff nurses (ENs) and auxiliary nurses/assistants (ENAs) ̶ invited to participate in the study, 123 completed a self-administered questionnaire.
The researchers point out that the mean age of the nurses was 51,31 years with the majority aged between 51 and 60 years ̶ thus nearing retirement. A few were between the retirement age of 61 and 70 years. Some had been working in LTCFs for nine years or more, while others had less than four years work experience.
“The profile of the nurses in our study indicates an older workforce with experience in care for the elderly. A positive impact of a more aging nursing workforce with work experience is that their skills and knowledge increase as their work experience increase. Consequently, they are less likely to make errors while administering medication.
“On the negative side, older nurses experience diminishing physical abilities and struggled to cope with the job demands, paperwork and new technology. They also have an increased risk of acquiring severe illnesses because of Covid-19."
According to the researchers, the nurses reported that outdated medication training, pressure to complete drug rounds on time, a heavy workload, poor knowledge of the action and side effects of medications, and a lack of training were some of the common reasons for medication errors.
“Another reason for errors is a lack of accountability by nurses such as not signing for medication that was indeed administered, not recording reasons for non-administration, omission of times for as needed (pro re nata) medications, no witness available to sign changes in medication administration records, and not recording actual amounts."
The nurses also indicated that their outdated medication training had an impact on the processes they follow when administering medication, add the researchers.
“The majority of RNs were diploma qualified which were obtained years ago, with a limited total busy with further nursing studies. Only a few received the mandatory six-monthly in-service medication training prescribed by the Department of Health.
“Nineteen percent of the respondents indicated that they received medication training during the previous year, whilst 30,1% received medication training between one and five years ago, and just over one-third received their last medication training over five years ago. Some pointed out that they did not receive training on the effects, side effects of common medications and on pre-checks before administering them.
“The majority of RNs reported that they always knew the purpose the drugs, whilst 30% sometimes knew the purpose. Of the ENs, 45,7% always knew, and 54,3% sometimes knew the purpose of the drugs they administered. In contrast, all the ENAs indicated that they only sometimes knew the purpose of the drugs."
The researchers say the nurses' responses to questions about information technology skills, especially the use of computers, emphasise the need for improved training.
“Only a small number of nurses considered themselves fairly or very experienced in using computers. Most nurses were either very inexperienced or had average knowledge of how to use computers. The majority of ENAs and just over one-third of ENs never use a computer at work. Of the RNs, 75,0% used a computer daily at work. They primarily used computers for collating patient data and records and work emails.
“Nurses need information technology skills because healthcare professionals increasingly use technology and devices such as computers, mobile devices and software applications. Adequate training in information technology could lead to improved decision-making skills and better competencies."
According to the researchers, the findings of their study can serve as a guideline for creating succession plans, recruiting procedures, development, and training of nurses, and improving clinical practices.
- Source: Nicholson, E.C. & Damons, A., 2022. Is medication administration in the elderly influenced by nurses' demographics in South Africa? Health SA Gesondheid 27(0). DOI: https://doi.org/10.4102/hsag.v27i0.1750