<p> Medication administration is an important task performed daily by nurses and is one of the key aspects of safe patient care. The multiple and varied roles of nurses, complexity of workplace, chaotic and technical nature of the work environment may result in cognitive overload that may overwhelm nurses, which may possibly lead to medication errors. All medication errors committed are considered serious events but some may consequently be harmful to patients. Research indicates that when medication errors occur the concern is usually for the patients involved in the incident. However, making a medication administration error has a lasting effect on the nurse as well as the patient (Schelbred &amp; Nord, 2007; Treiber &amp; Jones, 2010).</p><p> This study examined what it was like to make a medication error for eight registered nurses through in-depth and focused face to face interview using the descriptive phenomenological approach rooted in the philosophical tradition of Husserl. Two interviews were carried out with each participant and the research data were generated from a total of sixteen interviews and field notes. The transcripts were analyzed using the seven-step methodological guidelines developed by Colaizzi for data interpretation to understand the meaning of the nurses lived experiences of making medication errors.</p><p> Five theme categories emerged: Immediate <i>Impact: Psychological and Physical Reactions; Multiple Causes within Chaos: Cognitive Dimensions; Embedded Challenges: Healthcare Setting; Organizational Culture: Within the Place/Within the Person; Dynamics of Reflection: Looking Forward</i>. The essential structure of the phenomenon of making a medication administration error included the realization that a profound experience had happened to them. This resulted in physical and emotional upheavals, a threatened professional status, with low self-esteem and confidence. An overwhelming workload, a stressful work environment and ill-treatment by peers were descriptions of the cause of the errors. Nurses did offer ways to improve the system but felt their concerns were often not valued. Implications for nursing practice to improve patient outcomes, and for nursing education, to radically change the teaching of medication administration were formulated.</p>

<p> Fibromyalgia (FMS) goes undiagnosed in as many as 3 out of 4 people who have the disease. Primary care providers (PCPs) are the first to evaluate patients; therefore, PCPs need to be able to recognize FMS, implement initial treatment, and refer for further consultation. The Fibromyalgia Diagnostic Screening Tool (FDST), a validated instrument to identify FMS, can improve the speed and accuracy of FMS diagnosis. The purpose of this project was to familiarize PCPS with the FDST, evaluate their receptiveness to the tool, and train them in its use. The Leventhal, Diefenbach, and Levanthal, common sense model of illness provided the theoretical framework to guide this quality improvement project. A 45-minute in-service and accompanying reference manual was given to 4 participating PCPs, along with a demographic questionnaire asking about their age, race, gender, marital status, and years in practice. Following the in-service, a 10-question self-completed questionnaire consisting of a combination of open-ended and nominal scale yes/no questions, was administered. A thematic analysis revealed 2 primary barriers for diagnosis without the FDST: lengthy screening time and trouble differentiating FMS from a patient&rsquo;s other conditions. In response to one of the yes/no questions, the participants all replied that the in-service on FDST was helpful in diagnosing FMS. Implications for social change include improved diagnosis with a diagnostic screening instrument, improved quality of health care, and cost effectiveness at the system level for chronic disease prevention and management. This project demonstrates in a localized primary care setting that the FDST may offers PCPs a reliable method to diagnose FMS.</p>

<p> Heart failure readmissions place a significant financial burden on the healthcare system. Stakeholders of this system have utilized many approaches to reduce the number and costs of heart failure readmissions, without significant improvement. The purpose of this practice improvement project was to determine whether education on the financial impact associated with readmissions improved a patient&rsquo;s measured quality of life, encouraged adherence to a therapeutic regimen, and thereby reduced readmission rates in Medicare and Medicaid patients diagnosed with heart failure. Theoretical support is derived from the theory of self-care of chronic illness, which recognizes the complex self-care processes a patient with chronic illness negotiates. The project used a quantitative methodology with a pre-test/post-test design. A convenience sample was enrolled of 10 Medicare and Medicaid patients who had recurrent heart failure readmissions. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) was used to collect pre/ post-intervention data which was then analyzed by two-tailed paired t-test. There was no statistically significant difference from the intervention to determine any impact on the participant&rsquo;s measured quality of life (<i>p</i> = .953; &alpha; = .05). However, none of the participants were readmitted during the 30 day period of this project. The findings indicate heart failure patients acknowledge their financial constraints but quality of life is not as impacted by finances as anticipated. Polypharmacy and uncertainty with managing daily regimens during symptom exacerbation were the greatest concerns. It is recommended that heart failure patient education should be persistent and individualized to address the patient&rsquo;s unique needs. </p><p>