Nurses' decision making processes about lighting during medication administration

We know that human vision has limitations, medication administration is a high risk activity, and some nurses work in environments that do not meet recommended lighting standards. Lighting and human performance have been linked for centuries, yet limited guidance specific to the nursing domain and safe lighting environments is available. While the United States Pharmacopeia admonishes against administering medications in low lighting conditions, low lighting conditions likely still occur. The goal of this study was to inform safe medication administration practices and add evidence for establishing guidelines for lighting decisions by understanding registered nurses' (RNs) decision making about lighting during medication administration. Grounded theory methodology was used to identify and describe the processes and choices that RNs make as they decide to adjust or maintain the lighting environment when administering medications at the bedside in acute care. A theoretical sample of full time, acute care RNs from a variety of backgrounds and hospital settings participated in semi structured interviews. The results were presented in aggregate form to three experts for validation and comparison with their own experiences. Two of the researchers had significant expertise in medication administration errors. Data analysis culminated in the substantive theory It Depends. This theory describes a process of frequently automatic decision making about lighting whose aspects include Assessing Variation, Balancing Safety and Healing, and RN Bias. All RNs expressed concerns about perceived risks in relation to lighting, but had difficulty describing how they confirmed when the correct decision about lighting was made. Implications for nursing practice and research are identified. The results may inform safe medication administration practices, add to the evidence to establish reasonable guidelines for lighting decisions, and guide additional research.