Student nurses’ knowledge acquisition on oral medication administration: comparison of lecture demonstration vs. video demonstration

To maintain standard nursing practices, the nursing staff must incorporate clinical competencies within themselves. Furthermore, high proficiency in nursing care increases the safety of the patient within the clinical context. Therefore, nursing students should be guided based on a practice-oriented way, and it will help in building up confidence and empower them to actively participate in the care of patients [1]. Obtaining the required clinical competency level is mandatory not only for practice as a professional but also it will enhance the problem solving and reasoning capabilities; inculcating dedication to the service, and ultimately increasing the quality patient care. Technical knowledge has created an impact on the teaching and learning process. Telecommunication allows the learners to collect more details to resolve the issues and to be competent enough in clinical practice [2].

Pre-registration nursing education was based on a 3 year diploma level nursing program in schools of nursing that are attached to the Ministry of Health, Sri Lanka. It was proposed that the entire nursing education should be upgraded to a degree level. As a result, the University Grants Commission (UGC) in Sri Lanka has established four-year degree programs leading to BSc (Honours) in Nursing in five universities. In 2012, General Sir John Kotelawala Defence University, Sri Lanka established the Faculty of Allied Health Sciences (FAHS), and FAHS caters civil nursing undergraduates by offering a four-year BSc (Honours) in Nursing degree programme.

The nursing curriculum encompasses scientific and humanistic foundation for nursing practice and enables students to develop competencies related to prevention, maintenance, cure, rehabilitation and promotion of health. The degree program is fulltime, and module-based with 126 credits allocated to modules. Out of 126 total credits, 59 credits are allocated for teaching theory and 54 credits are allocated to hospital-based clinical training. Before students are placed in-hospital training, they are supposed to learn and practice nursing procedures within the skills lab. The skills lab practical demonstrations are taught from the beginning of the first year to the final year. These range from basic nursing procedures to advanced nursing procedures.

Administrating oral medication to patients is one of the essential procedures supposed to be taught during the first year second semester. It is crucial to have excellent decision-making skills and clinical judgment for a nurse, and the nurse is responsible for making sense of medication administration and its implications for patient safety. Maintaining quality and safety care is essential to meet the needs of the patient [3].

Alterations of the teaching methodologies have become a challenge at present due to the rapid transformation of the nursing curriculum. Since students have different learning styles, the teachers should deliver the lessons according to the learning styles of the students. Therefore, teachers should implement different teaching methods and techniques other than the conventional talk and chalk method to teach different skills. A lecture-demonstration is a method where the instructor performs the procedure while explaining every step of the procedure with the rationale behind it. By using this method, the students will be able to develop essential qualities in learning science ─ independent thinking, power of observation and reasoning. Learning of nursing psychomotor skills has traditionally been associated with lecture- demonstrations in the skills laboratories. The skill laboratories help ensure all students acquire the necessary techniques before practicing on real patients [4]. Procedural videos can provide a valued teaching tool that allows better visualisation of procedural steps, offer media-rich audio and visual stimulation covering a wider spectrum of learning styles or preferences which allow students to review nursing procedures before, during, or after the sessions, and they can help overcome shortage of time for onsite learning. In terms of skills demonstrations, video-based education is used when demonstrations are impossible to be undertaken. Further, the students have the opportunity to listen to the voice and watch diagrams and figures in video-based education [5].

Clinical learning is an important aspect of nursing education. A clinical demonstration is a method of presentation of skills which shows how a particular procedure is performed in the clinical setting. Students’ exposure to clinical learning environment is one of the most pivotal factors that affects the teaching-learning process in clinical settings [6].

Opportunities for teachers to provoke the thinking and practical application of students for a particular subject is connected to new teaching methods and ideologies: this method will lead students to become creative thinkers and inventors. Identifying a better teaching method in oral medication administration is necessary for the teacher to enhance students’ performance and that can contribute more in the field of treatment skills. It will result in positive outcomes in future health indicators and quality of patient care.

Though there are many studies done in this area in other countries, few studies were found in Sri Lanka. The present study aims to determine the effectiveness of video demonstration in clinical skills education of medication administration for undergraduate nursing students compared to the lecture-demonstration method.

Teaching methods are based on principles and a variety of educational methods. They serve as suggestions, instructions, guidance and encouragement to learn. New methods and training materials are developing every day in research. A lecture-demonstration, a clinical demonstration, a video demonstration or combinations of these methods are used mostly. For better and quality patient care, the nurses should learn the nursing theories and clinical practice as they are updated with the time. Training programs are, therefore, essential in order to close the gap between theory and practice.

This study aimed to evaluate whether nursing students could learn and retain the theoretical aspects of oral medication administration when they were taught using a video demonstration compared to the conventional face-to-face teaching method. The findings of the study revealed that the students of lecture demonstration group increased the mean knowledge score from 47.20±14.08 to 60.25±15.80 and those learned through video demonstration has an improvement of mean knowledge score from 48.38±16.92 to 65.90 ±17.06. Both groups achieved considerable knowledge regarding medication administration after teaching the contents utilising different two types of teaching methods according to the paired sample t test results. Similar to the findings of the present study, another study was done to examine the effectiveness of video teaching (experimental group) over lecture-demonstration (control group) in increasing knowledge and skill of third-year nursing students on antenatal examination. There was a significant difference in the pre and post-test knowledge scores within experimental and control groups at 0.001 level of significance. It was noted that both groups were able to acquire a theoretical and practical understanding of antenatal examination [7].

Although, there was a significant improvement of knowledge on oral medication administration among both groups, we could not find a significant difference between post –test mean scores of the two groups, as per the results of independent sample t –test (p > 0.001). These results indicated that both lecture – demonstration and video-demonstration methods found equally effective for acquiring the theoretical aspects of oral medication administration. These findings were supported by a prospective study done in the University of London to assess the relative effectiveness of the two approaches of video demonstration and lecture-demonstration teaching methods for orthodontic auxiliary training. There was no significant difference between the teaching methods except for bracket positioning where video was slightly better (P < 0.05) [8]. Another study was done to compare two forms of teaching methods such as video and live lecture for education in clinical periodontology resulted that the live lecture group performed better than the video group during the in-depth post-test assessment and more students prefered video method. At the same time, most of the students prefered an ultimate combination of video and lecture also [9].

In contrast to the results of the present study, Devi (2019) reported that the traditional demonstration method was more effective than video demonstration in teaching obstetrical palpation [10].

A two-group quasi-experimental study was conducted on 165 baccalaureate nursing students to assess the effect of a video-based case study over a written case study. According to the findings, the video-based learners gained higher scores for knowledge testing, compared to the written case study group of learners. This study suggested that video-based education method could be used as an additional method to improve classroom teaching [11].

Most students viewed videos in an enjoyable way to study in the present study. Similarly, many students were of the opinion that the video and lecture demonstration methods motivated themselves for the preparation of skills practice at the actual clinical settings. Interestingly, 82% of students preferred lecture – demonstration method showing that they need to learn through observation and independent thinking. However, when considering the attitudes of the students they preferred both teaching methods and the reasons might be, they could learn the principles of oral medication administration through the lecture demonstration and they could use the video demonstration for the purpose of preview and review. These findings were supported by a randomized controlled trial with a pre-test and post-test design conducted among 71 nursing students. A video clip on how to perform urinary catheterization was developed, and the intervention group was able to download it on to their own mobile devices. All the students participated in the lecture on urinary catheterization. Results indicated that the intervention group showed significant learning motivation and class satisfaction [12].

A systematic review was conducted to identify teaching methods of medication administration safety of nursing undergraduates using four electronic databases. The three methods identified were: simulation experience, use of technology and online learning. However, they insisted that those three methods could not be implemented in all the nursing programmes, and the teachers should pay attention to preparing and confirming classroom-based teaching methods. Furthermore, it was suggested to conduct future studies on developing tools considering psychological aspects to assess nursing students’ compliance on medication administration safety [13].

This project has several limitations. The current study used a small convenience sample from a limited target population of nursing students. Therefore, our findings have limited generalizability. Another drawback was that there could be contamination as the post-test was done 8 days later. It should have been done on the same day after teaching and repeated on the 8th day. One of the strengths of the present study was none of the students learned the principles of oral medication administration through a lecture or a practical demonstration before. Therefore, the impact of prior knowledge for the mean knowledge score could be excluded and considered as minimal. As the future implications of this study, it is suggested to assess the skills acquisition and attitude development with regards to the oral medication administration using different teaching methods such as mobile applications, virtual reality simulations and also to conduct a similar study using a larger sample, involving nursing students of other universities and nurses training schools in Sri Lanka.

This study found that both conventional demonstration method and video-assisted teaching method were equally effective on knowledge acquisition of oral medication administration. Hence, it is recommended that a combination of teaching methods can be adopted to enhance the skill development of the students. A live demonstration is a traditional and preferred method, but a video can also be used. Future studies can be extended to other nursing procedures with the participation of other nursing faculties for uplift the arena of nursing education.