An Appreciative Inquiry into Medication Administration by Registered Nurses: The Untold Story

Abstract

Registered nurses (RNs) worldwide are educated and authorised to administer medications as part of their role. The framework used to guide the practice of safely administering the right dose of the right medication by the right route to the right patient at the right time is known internationally as the 'five rights'. The five rights framework is pervasive in the nursing literature and has underpinned a plethora of research studies focused on medication error identification and management. Most of these studies seek error rates and causes and rarely explore the actions or experiences of nurses who administer medications, other than in relation to their adherence to the five rights framework. This study offers a different perspective. This two-phase qualitative, appreciative inquiry used Medication Services Queensland's (2009a) rights framework as the basis for observing the medication administration practices of RNs in a regional hospital in Queensland, Australia. The five rights framework in this region has been extended for public health system employees by the addition of a sixth right that requires the nurse to offer the patient the right to refuse the medication. The observation phase provided a rich contextual backdrop for the next phase, in which the participants were interviewed about their experiences. The participants were asked to explain their observed practices. The study found that by taking an appreciative inquiry approach to medication administration, person-centred nursing practices that contribute to the safe administration of medication emerged. This alternate view of medication administration has the potential to encourage further research and development of hidden strengths in nursing practices such as coordination and management of medication related processes.