“The damage I could do…”– Qualitative evaluation of a low-fidelity medication administration simulation that generates error as a learning experience for pre-registration nursing students

Abstract

Background: In recent years, nurse education has emphasised the development of high cost, high-fidelity simulations because they are considered to provide a more realistic learning experience. Integral is the facility to commit and learn from error. Error may provide a mechanism to make low cost, low-fidelity simulations more psychologically realistic and salient. We developed a web based medication administration simulation which included all essential cognitive elements of medication administration task, but was “low-fidelity” in engineering terms of its portrayal of the physical world. The simulation incorporated conditions designed to generate high rates of medication administration error. The purpose of this study was to determine if the low cost low-fidelity simulation provided a salient, effective and psychologically realistic learning experience for pre-registration nursing students over the long term.

Methods: Individual qualitative interviews were conducted with 12 pre-registration nursing students, from one UK university, from a group of 49 students who had received the simulation as trial participants 2-years previously. The interviews were analysed using thematic analysis.

Results: Most participants were able to reflect on their experiences of the simulation in depth, and considered the simulation to be a valuable component to their learning. The simulation encouraged students to question their practice and highlighted their vulnerability to medication administration error. It reinforced both the importance of completing checking procedures and the potential consequences of making an error in practice. Most students believed the low-
fidelity simulation provided a psychologically realistic representation of medication administration, which was underpin-
ned by the negative emotional reactions to making an error, for example, guilt.

Conclusions: Low-fidelity web based simulations can provide a sufficiently realistic psychological representation of medication administration to produce a salient, effective learning experience over the long-term. Low-fidelity simulations can provide a low cost alternative to high-fidelity simulations. Making error in a simulation should be transformed from a useful but passive by-product into an active component of the simulation learning approach.