Nurse Education Today 34 (2014) 434–440

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Nurse Education Today

journal homepage: www.elsevier.com/nedt

Nursing students' perspectives of the cause of medication errors

Mojtaba Vaismoradi a, c, Sue Jordan a,⁎, Hannele Turunen b, Terese Bondas b, c
a
Department of Nursing, College of Human and Health Sciences, Swansea University, Swansea, United Kingdom
b
Department of Nursing Science, Kuopio Campus, University of Eastern Finland, Kuopio, Finland
c
Faculty of Professional Studies, University of Nordland, Bodø, Norway

a r t i c l e i n f o s u m m a r y

Article history: Background: Medication errors complicate up to half of inpatient stays and some have very serious consequences.
Accepted 16 April 2013 To our knowledge, this is the first qualitative study of Iranian nursing students' perspectives of medication errors.
Objectives: To describe nursing students' perspectives of the causes of medication errors.
Keywords: Design: Four focus groups were held with 24 nursing students from 4 different academic semesters in the nursing
Medication errors school in Tehran, between November 2011 and November 2012. Using a qualitative descriptive design, themes
Nursing
and subthemes were identified by content analysis.
Qualitative research
Students
Results: Two main themes emerged from the data: “under-developed caring skills in medication management”
Patient safety and “unfinished learning of safe medication management”, which was subdivided into “drifting between being
worried and being careful”, and “contextualising pharmacology education”. All respondents felt that their educa-
tion programmes were leaving them vulnerable to “drug errors” and cited incidents where patient safety had
been jeopardised.
Conclusion: Nursing curricula need to increase investment in medicines management. If nursing students are to
become competent, skilful and safe practitioners, their learning will require extensive support from their
academic institutions and clinical mentors.
© 2013 Elsevier Ltd. All rights reserved.

Introduction As the product of nurses' shared values and beliefs, medication safety
can be taught, developed and internalised in undergraduate nursing
Medication errors are defined as any preventable event related to programmes (Butterworth et al., 2011) to transform safety culture
healthcare products, professional practice, and procedures including (Reid and Catchpole, 2011; Vaismoradi et al., 2011).
prescribing, order communication, compounding, dispensing, distri- There is limited evidence that healthcare educators explicitly incor-
bution, administration, education, and monitoring that may lead to porate medication safety into professional education programmes
patient harm (NCC MERP, 2005). (Attree et al., 2008). Thus, nursing students may receive relatively little
Avoiding medication errors is a vital component of patient safety education in error management techniques (Page and McKinney, 2007).
(Kaushal et al., 2010). The true incidence of errors in preparation Much of the evidence emanates from developed countries, leaving
and administration of medicines is unknown: 54.4% of 983 US nurses the understanding of and solutions for unsafe medication for devel-
surveyed indicated that not all drug errors were reported, due to fear oping countries under-researched (Carpenter et al., 2010; Jha et al.,
of managers and peers (Mayo and Duncan, 2004). Estimates of errors 2010). Current literature on medication errors focuses on registered
of varying clinical importance, range from 24% to 94% of doses admin- nurses, while nursing students' contribution to medication manage-
istered (Hoefel et al., 2008) and 52 (IQR 8–227) per 100 admissions ment remains unreported (Valdez et al., 2012).
(Lewis et al., 2009).
Aims

Nurse Education and Medication Errors

The aim of this study was to describe nursing students' perspectives
of medication errors.
Nurses are the professionals closest to patients, and are the final
link in the medication administration chain (Sulosaari et al., 2012).
Methods

Study Design
⁎ Corresponding author at: The College of Human and Health Sciences, Swansea
University, Singleton Park, Swansea SA2 8PP United Kingdom. Tel.:+44 01792 518541;
fax: 01792 295487. A qualitative descriptive design using a content analysis was used
E-mail address: [email protected] (S. Jordan). to generate information about the complexities of perspectives and

0260-6917/$ – see front matter © 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.nedt.2013.04.015
 M. Vaismoradi et al. / Nurse Education Today 34 (2014) 434–440 435

behaviours. The value of qualitative description lies not only in the that participation was entirely voluntary and that students could refuse
knowledge generated, but also as a vehicle for practice change to participate or withdraw from the study at any time. Participants were
(Sandelowski, 2010). reassured that their responses would be treated in confidence and their
identities would not be revealed. Participants provided informed written
Settings and Participants consent.

Focus groups were conducted with twenty-four nursing students Data Analysis
from a nursing faculty in an urban area of Iran. Participants were chosen
by purposeful sampling, to include 2nd (5 students), 3rd (14 students), Transcripts were read through several times to obtain the sense of
and 4th (5 students) year students, to capture a range of perspectives the whole, then subjected to content analysis (Hsieh and Shannon,
(Coyne, 1997), based on length of theoretical and clinical learning expe- 2005). Content analysis as a qualitative descriptive approach offered
riences of causes of medication errors. Students with the highest grades a practical approach for understanding perspectives with minimum
in the research component of the course were invited to consider the artifice (Sandelowski, 2010). Drawing on Graneheim and Lundman
study's aim and participate in focus groups on the basis that they (2004), data were analysed iteratively:
would be best placed to critique the curriculum and analyse medication
safety issues. ○ The text was divided into words, sentences or paragraphs, related to
In the first year of the bachelor's degree nursing programme in each other through their content and context as units of meaning;
Iran, students are taught basic nursing skills related to medication ○ Units of meaning were condensed, with core meanings preserved;
administration such as preparation, administration, and documenta- ○ Condensed units were abstracted and labelled with codes (an ex-
tion in low fidelity skills' laboratories prior to clinical placements. ample of text coding is provided in Appendix Table 1);
Review of the institution's curriculum documentation shows no ○ Codes were sorted into sub-themes based on comparisons of their
distinct, separate time allocated to patient safety and the safety principles similarities and differences;
of medication administration. Fifty one teaching contact hours are ○ Finally, themes as the expression of the latent content of the text were
allocated to pharmacology in 4 years. Therefore, nursing students identified for each focus group before convening the next group.
often graduate without meaningful or practical knowledge of patient
safety (Vaismoradi et al., 2011). Rigour

Data Collection Member checking was undertaken by two student participants

from each focus group. Each focus group transcript and data analysis
Four focus groups, each with six students, were conducted. Focus report were read, to ascertain whether the researcher was representing
groups capitalise on communication between research participants to the students' perspectives. The authors reflected on the study's findings
generate data. This method is particularly useful for exploring knowl- and reached a consensus. The plausibility of the findings confirmed
edge and experiences and examining not only what people think, but that the analyses and interpretations were justifiable (Lincoln and
also how and why they think that way (Webb and Kevern, 2001). Guba, 1985).
Focus groups explore participants' experiences in an interactive format
(Lambert and Loiselle, 2008). The heterogeneous composition of each Results
group, in terms of academic semester, assisted exploration of diverse
perspectives. All students approached agreed to participate, and no students
Focus groups, each lasting an hour, were held in Farsi. The first were turned away. All respondents were female with mean age
author, as moderator, explained the aim of the study, encouraged 22.3 years, standard deviation 1.3 years. Two main themes emerged
discussion, facilitated interactions among members, interjected during data analysis: “under-developed caring skills in medication
probes, and summarised without interfering through note taking. A management”, and “unfinished learning of safe medication manage-
colleague managed the audio-tape recording, took notes, observed ment”. The latter comprised two subthemes: “drifting between
interpersonal interactions and encouraged quiet members to partici- being worried and being careful”, and “contextualising pharmacology
pate (McLafferty, 2004). The major explorative questions were: education” (Fig. 1).
○ From your knowledge and experience in clinical practice, what are
Under-developed Caring Skills in Medication Management
the causes of medication errors?
○ How does your nurse education programme prepare students to
All students agreed that in their pharmacology and medical-
administer and manage medication safely?
surgical courses, lecturers provided theoretical information about
Probing follow up questions were asked to improve the richness of medicines. The pathology and pharmacology of each disease were
the data. Questions progressed from general to specific as topics were introduced, and the main drugs and their indications were named.
explored to generate detail and examples (Tong et al., 2007). Inter- However, the practical aspects of medication management and rea-
views were transcribed verbatim and iterative data collection and sons for caution when administering the drugs were not discussed
analysis proceeded concurrently. Once themes were identified and in detail or only briefly explained at the end of classroom sessions.
data saturation was achieved, no further focus groups were convened.
Group dynamics were incorporated into the findings by presenting all “Students mostly learn little about practical aspects of medication,
nursing students' perspectives under each subtheme and theme and too long before their clinical placements.” (S1Y4)
(Webb and Kevern, 2001) (Appendix Table 1).
As taught, pharmacology was abstract, full of new names that were
Ethical Considerations difficult to pronounce, and focused on theoretical pharmacodynamics
and pharmacokinetics. Pharmacology was taught during the first year
The Research Council affiliated to Tehran University of Medical nursing programme, which was entirely college-based, therefore stu-
Sciences approved the research. The first author informed participants dents needed refreshing and further practical education to be prepared
of the study's purposes and methods by oral invitation in the college for safe medication practice during their clinical placements in years 2
in an open meeting. There was no coercion, and it was emphasised to 4 of the programme.
436 M. Vaismoradi et al. / Nurse Education Today 34 (2014) 434–440

Perspectives of
causes of medication
errors

Under-developed caring skills in Unfinished learning of safe medication

medication management management

Drifting between being Contextualising

worried and being pharmacology
careful education

Fig. 1. An overview of themes and subthemes emerged during data analysis.

“The lecturer in the surgical ward asked me a question about a Development of caring actions in nursing students depended on
drug. I could hardly remember any information. Three semesters passed both classroom learning and what they witnessed during clinical
between the theoretical pharmacology course and starting on the ward.” placements. In other words, lecturers' practical teaching and clinical
(S6Y3) nurses' behaviours in real nursing situations collectively developed
student nurses' caring actions.
The students' practice focused on drug preparation and administra-
tion, and participants would have preferred more applied pharmacology “The nurse lecturer should accompany the student during medication
to equip them to administer drugs safely. rounds and practically show him/her how to act and react in real nursing
situations.” (S2Y2)
“I have not got enough confidence to administer intravenous drugs or to
check the doses of such drugs in practice, because I have not been taught Unfinished Learning of Safe Medication Management
this during my education.” (S8Y3)“I can explain how to prepare and
administer intravenous drugs in theory, but I have not practised it All second and third year students agreed that they were not ade-
yet.” (S4Y4) quately prepared to administer and manage medications safely, due
to shortfalls in their education. The students' lack of confidence also
Fourth year students said that core aspects of their education were arose from their difficulties in reconciling their theoretical and practical
missing. In addition to technical tasks, such as preparing and admin- learning. Their descriptions of why they felt their knowledge of drug
istering medication correctly, they needed to learn appropriate caring safety was incomplete, is described in two subthemes.
actions for patients receiving medication, including monitoring for
adverse effects and long-term adverse drug reactions, teaching patients
Drifting Between Being Worried and Being Careful
about their medicines and incorporating these practices into medica-
tion management.
During clinical placement, students were always warned against
All participants agreed that most medication errors and incidents
making any mistakes in medication administration. However, there
emanated from the common perspective that nurses had fulfilled
were no strategies to develop their self-confidence or capacity to rely
their caring duties once the drugs have been administered, and thus
on their own abilities and knowledge gained from classroom teaching
any adverse or long-term effects of medication were ignored.
and clinical placements. Therefore, their learning experiences in clinical
“The nurse's job is not finished after administering the drug. It is con- practice were characterised by worry over making mistakes. Fear of
tinued until the patient is discharged safely.” (S11Y3) errors discouraged students from gaining sufficient experience in med-
ication administration to become expert, self-confident or even fully
Medication management was envisaged as including caring actions, competent, which set the scene for future mistakes.
such as providing patients with jargon-free information about their
drugs, including their indications and possible adverse effects. “I do not like medication administration. I do not feel safe when I ad-
minister drugs. I am scared and check my movements frequently and
“The patients wanted to know about the drugs that the nurses were
even ask a lot of questions to be sure of my medication safety.” (S13Y3)
administering, but the nurses were silent, and only mentioned the
names of the drugs.” (S4Y2)
The students resented the lack of independence in medication
administration during their clinical placements, and the ensuing lack
Fourth year students added that updating patients about new
of self-esteem. They were not allowed to be fully involved in medica-
medication orders, and educating patients on how to use the drugs at
tion administration and management. In many cases, clinical staff
home were neglected aspects of caring and medication management.
only included students in risk-free aspects of medication management.
“The patient had a long history of cardiac disease and knew all her Practitioners were anxious to minimise healthcare services' expenses,
drugs. She surprised the nurse by asking about a new drug she had and clinical nurses were held responsible for the cost of medicines
just been given. I think the patient checked the accuracy of the nurse's wasted due to nursing students' errors. Consequently, nurses were
medication administration.” (S1Y4) not inclined to involve students in medication-related activities.
 M. Vaismoradi et al. / Nurse Education Today 34 (2014) 434–440 437

“I was given an ampoule full of a white fluid, the name of the patient Under-developed Caring Skills in Medication Management
and her bed number, and of course a little instruction for intramuscular
injection, but I wanted to do the job from its beginning. I mean the drug Providing patients with information about medicines, monitor-
preparation.” (S5Y2) ing and minimising or preventing medicines' adverse effects were
key caring actions in this study. Nurses need knowledge and skills
Fourth year students were worried that once their chance to learn to minimise patients' suffering. Integration of humanistic caring
medication administration had been lost during their second and perspectives into the teaching of pharmacology and medication
third years, there would be no further opportunities, leaving them management is required to meet patients' unique personal needs
vulnerable to unsafe practice in their future careers. for safe administration, monitoring and management of medica-
tions (Eriksson, 2007). Concepts and knowledge related to caring
“I liked helping the nurse with the preparation of the chemotherapy should be integrated into nursing curricula to develop humanist
drugs, but she did not allow me to work with her, because it was said thinking caring science, and models of care (Sherwood, 2011).
to be dangerous. So, how can I practise it to be competent, like a skilful For example, nurses should provide person-centred medication
nurse?” (S2Y4) management, monitoring and information (Brataas et al., 2009),
which contribute to patient safety (Wachter, 2010). Neverthe-
less, many healthcare professionals lack the knowledge, skills
Contextualising Pharmacology Education attitude to use nursing pharmacology theories in clinical practice
(Sherwood, 2011), suggesting the need to modernise nursing
The students were concerned that resources and equipment de- education.
scribed in their theoretical education were not available in practice. Development of caring actions to ensure medication safety required
Pharmacology lectures were adapted from Western textbooks, ac- nurse lecturers and clinical nurses to act as role models (Reid-Searl
centuating the gap between the theory and its application to practice et al., 2010), vital for promoting students' competence and confidence
in Iran. Medication management education needed to be compatible (Klunklin et al., 2011; Reid-Searl et al., 2010). Students' safe practice
with practice. For instance, computerised facilities for prevention of relied on the knowledge and skills of nurse mentors and role models
medication errors, advertised in textbooks, were unavailable in Iran. at the bedside (Dickson and Flynn, 2012).

“We are taught about ideal processes for medication management in Unfinished Learning of Medication Management: Pharmacology in Nursing
theoretical courses in our textbooks. These are very different from our
experiences in clinical placements.” (S5Y3) Practical aspects of medication management were not broached
in the classroom. Students felt they needed additional time in
From fourth year students' perspectives, the staffing pattern in the high-fidelity skills laboratories. In the international literature, the
Iranian healthcare settings was another barrier to safe medication most prevalent cause of students' errors is performance deficits
administration. (Wolf et al., 2006), which relate to practical aspects of medica-
“The nurse lecturer taught me to administer medication to one or two tion management, particularly administration (Gregory et al.,
patients, at maximum. I am not prepared to work as a nurse who 2009).
administers drugs to 10–15 patients at the same time.” (S3Y4) Incorporating experiential learning theories, such as the Kolb's,
into nursing curricula promotes critical thinking. By creating an
Students predicted that once employed, it would be impossible to opportunity for students to reflect on experiences for example by
apply the standard rules of medication management taught in the case study teaching, this promotes acquisition of knowledge from ex-
university. For instance, due to nursing shortages and problems of time perience (Jordan, 1997; Lisko and O’Dell, 2010). This recognises that
management, nurses administered medication hastily and started medi- nurse educators should ensure adequate theoretical knowledge of
cation administration too early. Students were aware that this could affect pharmacology and raise awareness of practical constraints and how
the drugs' plasma concentration, causing either sub-therapeutic or toxic these may contribute to medication errors (Page and McKinney,
concentrations, leading to either therapeutic failure or adverse effects. 2007; Bartley, 2011). While limited evidence exists regarding the ex-
tent to which the current content of undergraduate pharmacology
“It endangers patient safety to administer medications too soon and education prepares nurses for their role in the prevention of errors
hastily, but it is unavoidable because of nursing shortages.” (S5Y4) (Page and McKinney, 2007; Brady et al., 2009), future work should
explore whether the prescribed pre-licensure competencies are
Also, the terminology used by clinical nurses differed from the sci- adequate and appropriate for new graduates' transition to practice
entific terminology taught in the classroom. Jargon, used verbally or (Sherwood, 2011).
in writing, could endanger patient safety, for example by incorrect
drug substitution during medication administration. Drifting Between Being Worried and Being Careful

“The nurse asked me: ‘will you administer K to that patient?’ I pre-
Students' learning in clinical practice was characterised by worry
pared potassium to be injected to the patient. In the middle of my
and anxieties over mistakes. Students' self-confidence appears to be
way to the patient room, I became suspicious that perhaps the nurse
associated with competence in medication management (Sulosaari
meant vitamin K. I rechecked it with the nurse and she confirmed she
et al., 2012). The factors associated with medication competence are
meant vitamin K. I was lucky that I did not administer potassium to
under-explored (Sulosaari et al., 2012), and little is known about mis-
the patient who was suffering from heart disease.” (S2Y4)
takes made by nursing students and any associations with education
programmes (Wolf et al., 2006).
Clinical nurses welcomed the students' partnership only in risk-free
Discussion aspects of medication management and did not allow students to
practise independently. To ensure success in training safe clinicians,
All respondents felt that their education programme was leaving students should be empowered to employ critical thinking skills in
them vulnerable to “drug errors” and cited incidents where patient safety practice and develop the confidence necessary for safe professional
had been jeopardised. practice (Papastrat and Wallace, 2003). A learning climate recognising
438 M. Vaismoradi et al. / Nurse Education Today 34 (2014) 434–440

Table 1
Suggestions for improving the nursing curriculum based on themes and subthemes.

Themes Subthemes Suggestions for improving the nursing curriculum

Under-developed caring skills in To consider the interrelationship between theory and practice, teachers should spend time teaching and
medication management applying pharmacology, and include case studies as one component of teaching pharmacology.
To learn the practical aspects of medication management, sufficient curriculum hours to teach and
practice practical medication administration, monitoring and management should be determined.
Revision sessions before clinical placements are required.
Incorporation of opportunities to practise medication administration, management, and monitoring
and patient teaching into clinical placements is advised.
Sufficient curriculum time to teach communication of the medication process to the patient is needed.
Designated role models for safe medication administration are needed in clinical areas.
Unfinished learning of safe Drifting between being Students' self-confidence in medication management should be improved through teaching that mistakes
medication management worried and being careful are unavoidable and mistakes are learning opportunities.
Students' worry and fear of medication process should be reduced by encouraging students to practice
medication administration and take responsibility for this.
Students should be involved and allowed to practice medication administration, management and monitoring
and patient teaching independently with supervision.
Contextualising Theoretical education should be integrated with practice through teaching in simulation labs and in real
pharmacology education healthcare settings.
Nursing textbooks should be compatible with each culture and context.

the value of learning from errors and feedback details of medication 1992) to form the basis of curriculum development and revision.
errors and near misses to both students and lecturers was seen as im- Accordingly, suggestions for improving the nursing curriculum,
portant (Chang and Mark, 2011). based on themes and subthemes developed in this study, are of-
fered in Table 1.
Contextualising Pharmacology Education

The association between nurses' poor working conditions and Conclusion

poor patient outcomes is hitherto unexplained, but these findings
suggest that suboptimal staffing and equipment engender medication To date, nursing research has focused on the extent of the ‘medi-
errors (Jordan, 2011). For instance, in the U.S. nurses may face occu- cation error’ problem, rather than its solutions. The importance of
pational hazards and workplace stress, and sometimes agitated or this study lies in presenting the perspectives, experiences and
uncooperative patients that may result in compromised patient safety recommendations of nursing students on causes of medication
(Bureau of Labor Statistics, 2011). These data indicate a relationship errors. These findings resonate with experience in developed and de-
between staffing patterns, curriculum and practical resources and veloping countries. Nursing curricula should be modified to support
application of theory to real world practice and medication errors, students' learning and caring, to ensure that students become com-
congruent with suggestions that staffing, time pressure and workload petent and skilful nurses, who administer, manage and monitor
negatively affect organisation of patient care (Anoosheh et al., 2008; medication safely. Further work is needed to develop and evaluate
Reid and Catchpole, 2011). nursing curricula uniting caring with safe medication management
Differences in terminology used by clinicians and lecturers led to near and monitoring.
misses, and could have resulted in serious errors. Poor understanding or
unclear and inconsistent medication labelling is a root cause of medica-
tion error. Health literacy and language concordance are important in Acknowledgements
developing appropriate and safe medication management (Bailey et al.,
2009). The authors would like to thank the nursing students that their
sincere cooperation enabled the production of this paper.

Limitations
Conflict of interest
Patient safety is a sensitive research area, which might have dis-
couraged participation and disclosure of errors; however, all those No conflict of interest has been declared by the authors.
approached in this study volunteered for the focus groups. This
study was conducted in one nursing faculty, the largest in Iran. Author contributions
Generalising findings from qualitative work and single site studies
rests on logical or theoretical, rather than statistical, inferences MV was responsible for the study conception and design. MV
(Mitchell, 1983). performed the data collection and analysis. MV, SJ, HT, and TB were
responsible for the drafting of the manuscript. SJ, HT, and TB made
Implications critical revisions to the paper for important intellectual content and
approved the final draft to be submitted and published.
Participants from a single geographical area, even if representa-
tive of that area, cannot be assumed to be representative of the Funding
target population as a whole. However, we feel that these findings
illuminate some of the problems underlying the global issue of This research received no specific grant from any funding agency
medication errors, and have sufficient practical adequacy (Sayer, in the public, commercial, or not-for-profit sectors.
 M. Vaismoradi et al. / Nurse Education Today 34 (2014) 434–440 439

Appendix A

An example of text coding of interviews four focus groups.

Coding Extract from interviews

Lack of knowledge on drugs' practical administration Focus group number 1

(Respondent S2Y3) I knew only what the name of the drug was and which diseases it would treat, but I knew nothing
about how it should be administered in practice.
Interviewer How about you [other participants]? Do you think the same?
(S4Y3) Yes it is…. I believe the same. I got an excellent score in the final exam of the pharmacology course, but I know
that my practical score is not excellent.
Interviewer What is the reason for this?
(S4Y3) I think it was the lecturer.
Interviewer Please elaborate it. What do you mean?
(S1Y2) She [the lecturer] did not teach us the practical aspect of medication…
Interviewer How was the medication process taught by nurse lecturers?
Time gap between medication education and (S3Y3) … Drug information was presented in the first year of the nursing programme, and I forgot them all by the
its practice time I started the clinical placement.
Interviewer Will you please give an example on this?
(S1Y4) I was asked about the drug of…. The name was familiar to me, but I remembered nothing of it.
Education just before practice Focus group number 2
Interviewer What is your suggestion for reducing the negative impact of the time delay?
(S2Y4) … I think the education can be repeated before entering the practice.
(3rd year student 6) Maybe it would be wise to begin the theoretical education right before entering practice.
Lack of confidence Interviewer Do you feel that you are able to practice medication safely?
(3rd year student 7) I have not got enough confidence to administer intravenous drugs or to check the doses of
such drugs in practice, because I have not been taught in this regard during my education.
(4th year student 3) Let me say that the medication process is not only about knowing drugs' names and their
applications in practice….
Wider scope of nursing duties Interviewer An interesting point!
Interviewer Please go on, what more should be taught to students?
(4th year student 2) I mean, the nurse's job is not finished just after administering the drug. It is continued until
the patient is discharged safely.
(3rd year student 7) I agree, nurses should take care about what happens after administrating the drug.
Providing information to the patient Interviewer Can you give me an example, please?
Reducing the patient fears (3rd year student 7) The patients wanted to know about the drugs that the nurses were administering, but the
nurses were silent, and only mentioned the names of the drugs.
Updating the patient information (3rd year student 8) The patients would not be so scared of the side effects of the infusions administered via the
intravenous line, if they were told about the risks of side effects.
(S3Y4) I have another example. For instance, nurses should always provide patients with information about changing
drugs and so on.
Being accompanied with the lecturer Focus group number 3
Interviewer Do you think that theoretical education is enough for teaching all these information?
Theory and practice incompatibility (S2Y2) The nurse lecturer should accompany the student during medication rounds and practically show him/her
how to act and react in real nursing situations.
(S10Y3) What I witness in clinical practice on medication should be the same as what I am taught in the classroom.
Sometimes I am confused when these two are so different.
Lack of knowledge application to practice Interviewer What do you mean by confused?
(S4Y4) In many cases, work condition hinders you to practice safely.
Interviewer Will you explain it more?
(S9Y3) I am not able to use my knowledge in practice, when the work condition is not suitable for safe medication…
Improving knowledge on risk-prone drugs Focus group number 4
Interviewer Was there any emphasis on the especial aspects of the medication process in nursing labs?
(S15Y3) We were asked to increase our knowledge on some especial drugs, which were mentioned to be the
sources of practice errors by clinical nurses.
Focus on important drugs Interviewer Will you bring an example for it?
(S12Y3) We were repeatedly educated on how to prepare and administer Insulin. This was an important drug
from the instructor's perspective, as far as I can remember.
Interviewer Is there any more example of such drugs?
(S5Y4) Nothing special.…

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