Medication competence of nursing students
Nursing students’ medication competence has been a concern for many years. However, as shown here, medication competence evolves during the education. The students were generally well-motivated and participated actively in medication education. In contrast to prior studies, the students in our study perceived themselves as self-confident in medication management at the end of their education [6, 7, 10, 16, 32].
Theoretical medication competence includes students’ knowledge base on subjects necessary for safe medication management, such as laws and regulations, pharmacology, pharmacy and medication administration. In our study, the theoretical medication competence of the students was better than in previous studies [6, 10, 11], but deficiencies still existed at the end of education. This is worrying, since theoretical medication competence is essential for safe medication care and necessary for making rational decisions. The difference between the two groups was statistically different only on sum score of medication package information and common abbreviations used in medication care, indicating limited improvement of theoretical medication competence during education. For nurse educators, our study results highlight the need to integrate the theoretical studies throughout the education and conduct regular evaluations during undergraduate education.
The practical medication competence of the students, as evaluated by medication calculation test, was rather good compared to several previous studies [7, 9–11, 16, 17, 19]. However, comparisons must be made with caution due to the different methods used in the evaluation. In Finland, the pass rate requirement on medication calculations is 100 % correct answers, and only 17 % of the students would have passed the test. This result verifies the need for continuing the development of medication calculation education and the need for regular evaluations [7, 10]. Practical medication competence also involves areas other than medication calculations, such as administering medicines correctly via different routes . Further research is therefore warranted to explore students’ practical medication competence in authentic care or simulated situations of medication management. In order to improve the development of practical medication competence practically orientated, contextualized teaching and assessment methods and adequate possibilities to practice are necessary [4, 7, 10].
Decision-making integrates nursing students’ theoretical and practical medication competence. A sound knowledge base of pharmacology and medication management is required to understand and solve problems associated with patients’ treatment regimens in different care situations [4, 38, 39]. We introduced patient vignettes as an approach for medication competence evaluation. Patient vignettes provided us the possibility to evaluate students’ ability to integrate their knowledge base into decision-making. The results indicate a need for developing a deeper understanding of clinical pharmacology and patient education. However, students at the end of their education were significantly more able to make decisions, verifying the impact of education and clinical practice on medication competence. For nurse educators, the use of patient vignettes provides a possibility to contextualize medication care and management for the students. For future research, simulated patient vignettes in evaluation of medication competence with more qualitative methods could be useful.
Factors associated with nursing students’ medication competence
Most of the factors associated with students’ medication competence were individual factors, and many of them, such as age, gender and semester, are beyond the influence of nurse educators. Students over 25 years old were able to achieve better results, as has also been found by Hutton  and McMullan et al.  in relation to numeracy skills. Our findings also verify the relationship between students’ mathematical success and the results in a medication calculation test [7, 15, 16, 18, 20], and support the arguments for a relationship between academic success and medication competence [13, 22], especially at the beginning of studies. Therefore, information on students’ previous academic success might be used to identify students in need of supportive education.
Students’ self-confidence had no explanatory value on students’ results in the medication calculation test as reported by Glaister , Andrew et al. , and McMullan et al. . However, self-confidence in medication management was associated with better results in the knowledge test. Students who have better theoretical medication competence are also more self-confident in medication management. In future education, development of theoretical medication competence and confidence should therefore be supported. Thus, lack of confidence and feelings of anxiety may be more associated with fear of being tested [40, 41].
Nursing students are expected to be able to self-direct their learning, but they do not always use the time reserved for that in an efficient way. In our study, the students who were stronger in self-regulated learning achieved better results. This result supports the arguments on the importance of learning style in competence development [3, 30]. We also found a lack of regulation in learning to be associated with all areas of medication competence. Lack of regulation in learning indicates that students have difficulties to control the information load and self-direct their learning (35). Students with difficulties in learning due to information overload should be recognized . Globally, the number of students with learning disabilities is increasing , and we need methods to identify them and to enhance their learning and competence development. In the future, it would be interesting to explore the relationships between nursing students’ learning disabilities, lack of regulation in learning, and medication competence.
The factors associated with students’ medication competence at the beginning of education are mainly related to prior and current academic success, but the impact is less significant at the end of the education. This finding verifies the results of Hutton  on the predictive value of previous mathematical grades prior to nursing education. Our results indicate that professional experience, high study motivation and ability to self-regulate learning explain prior graduation medication competence better than academic success. Practice possibilities in clinical learning environment are important for medication competence development, as has been highlighted also previously [6, 7, 32]. Application of a more health care environment sensitive instrument, such as the Health Care Learning and Studying Inventory (26), might be a good choice in further studies on factors associated with nursing students’ medication competence.
The present study has some limitations. The low response rate has to be observed when generalizing the results. The sample size, however, was based on power analysis and the calculated sample size was achieved. The sample also represented well students with different socio-demographic factors, polytechnic schools and the overall number of nursing students in Finland. The deficiencies in nursing students’ medication competence seem to be similar globally, and our results may therefore indicate the possibility of the same associated factors existing also among students from other countries. However, caution needs to be observed when generalizing the results outside Finland, since the education varies internationally, as does the registered nurse’s role and responsibility in medication management.
Also methodological limitations exists. Not all individual or learning environment factors can be explored in one study and by using a highly structured method. However, we have explored students’ medication competence from a broader perspective than in prior studies and have included most of the factors we identified in the prior literature review .