Nursing students who had the DML debriefing scored significantly higher in their clinical reasoning than nursing students who had usual and customary debriefing.

Although there is general agreement that noise in the neonatal intensive care unit should be reduced, there is controversy about the use of music as a developmental care strategy with prererm infants. Much literature supports using music with preterm infants, indicating that it enhances physiologic and neurobehavioral functioning, but some experts worry that music is overstimulating. This article presents evidence supporting the use of music with preterm infants as well as criticism of same. Recommendations for music interventions with preterm infants are discussed, although fUrther research is needed before specific guidelines can he established.

Background: The thought processes of student nurses during medication administration relative to prevention of patient harm or errors or promoting therapeutic responses are not well known. Nursing students may be focused more on the rules and procedures rather than anticipatory problem solving and concurrent patient teaching that occurs with practicing nurses. The Quality and Safety Education for Nurses (QSEN) project provides nursing faculty with a framework to assure that graduates are able to demonstrate quality and safety competencies, including that of medication administration.Methods: This qualitative study examined student nurses' reported thinking during medication administration in a simulated experience involving care of a post-operative patient reporting pain. Forty-eight students from 5 baccalaureate nursing programs participated in a video recorded simulation with a standardized post-operative patient. Students independently completed a patient assessment and administered pain medication from a variety of options. Following the simulation, semi-structured debriefing interviews containing 8 open-ended questions were conducted and audiotaped. Results:Students administered a variety of pain medication during the simulation. Analysis of transcriptions revealed five themes including 1) safety, 2) clinical reasoning, 3) uncertainty and need for validation, 4) lessons learned, and 5) perception of realism. Safety was the most predominant theme that emerged from the data. Conclusion:Students must be able to more fully understand clinical decision making around medication administration (e.g., best practice, individual experiences with pain, patient preferences, patient conditions, etc.). Implementing teaching strategies that integrate opportunities for several valid nursing interventions encourage students to move away from a linear perspective to examine their thinking and the complexity of clinical practice. Findings will inform faculty relative to curricular design, pedagogy, and evaluation in educating nursing students to become safe and competent nurses.

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