Nurse Education Today 84 (2020) 104250

Contents lists available at ScienceDirect

Nurse Education Today

journal homepage: www.elsevier.com/locate/nedt

Medication error encouragement training: A quasi-experimental study T

Kyoungja Kim , Insook Lee
⁎

Department of Nursing, Hannam University, Daejeon, South Korea

ARTICLE INFO ABSTRACT

Keywords: Background: Medication errors are the most common clinical errors in healthcare practice and can lead to
Medication errors serious consequences. Medication error encouragement training (MEET) brings students face-to-face with po-
Safety tential errors in the medication process, in a safe environment where they are encouraged to understand both the
Education error and the context in which it occurred.
Nursing students
Objectives: The study aimed to examine the effects of a MEET intervention on medication safety confidence
among nursing undergraduates.
Design: This was a quasi-experimental study with a nonequivalent control group design.
Participants: Our sample was recruited from the nursing education department of a university, with 47 parti-
cipants randomly assigned to the experimental group, and 50 to the control group.
Methods: Both groups received theoretical training, followed by applied training. The experimental group re-
ceived the MEET intervention developed specifically for this study, while the control group received traditional
error avoidance training. Participants' medication administration confidence was measured pre- and post-in-
tervention.
Results: Following training, the experimental group's confidence was significantly higher than that of the control
group. With regard to individual medication administration procedures, the experimental groups' medication
safety confidence increased significantly after training compared to the control group in patient identification,
drug information confirmation, and drug preparation.
Conclusions: Introducing MEET into nursing curricula could reduce medication errors and related complications
in healthcare institutions. Further studies are needed to investigate the long-term effects of MEET interventions,
as well as the generalizability of our findings.

1. Introduction consumer” (National Coordinating Council for Medication Error

Medication administration is one of the most frequently performed
nursing tasks, accounting for about 40% of all nursing work (Hewitt
et al., 2015), and is a multidisciplinary, multistep process that requires
several types of professional knowledge, such as the pharmacological
characteristics of drugs. Medication administration in clinical practice
is becoming more complex as a result of medication route and medical
device diversification and increasing severity of patients' conditions.
For this reason, a large percentage of medical accidents are related to
medication errors (Natan et al., 2017). According to Australian statis-
tics, about 230,000 cases of medication-related accidents occurred from
2011 to 2012, which translates to about AUS $1.2 billion in hospital
stay costs (Roughead et al., 2013).
Medication error refers to “any preventable event that may cause or
lead to inappropriate medication use or patient harm while the medi-
cation is in the control of the healthcare professional, patient, or
Reporting and Prevention, 2018). It can occur at any stage of the
medication process—prescription, verification, preparation, delivery,
or administration. Given the significant number of work hours nurses
spend on medication administration, it is important to consider an Is-
raeli study's finding that 36% of nurses make medication errors (Natan
et al., 2017). Most medication errors are preventable (Hewitt et al.,
2015); therefore, more effective medication process management is
needed.
Training nurses to perform correct and accurate medication ad-
ministration is a crucial task. Although medication education is in-
cluded in most nursing curricula, current approaches fail to adequately
equip nurses with the required clinical competency levels (Page and
McKinney, 2007; Vaismoradi et al., 2014). Cleary-Holdforth and Leufer
(2013) pointed out that medication practice aspects, such as pharma-
cology, pharmacokinetics, pharmacokinetic calculation, and medica-
tion practice are taught independent of each other. The authors argued

⁎
Corresponding author at: Hannam University, Department of Nursing, 70 Hannam-ro, Daedeok-gu, Daejeon 34430, South Korea.
E-mail address: asteria43@hnu.kr (K. Kim).

https://doi.org/10.1016/j.nedt.2019.104250
Received 28 March 2019; Received in revised form 17 August 2019; Accepted 16 October 2019
0260-6917/ © 2019 Elsevier Ltd. All rights reserved.
K. Kim and I. Lee
that these knowledge areas should be integrated to equip students with
contextually sound medication safety competency.
2. Background
Existing approaches to medication education, such as the “five
rights” and “seven rights” models, focus on adherence to the correct
principles when engaging in the medication process. However, these
approaches fail to equip students with the practical medication com-
petence required in a clinical setting (Vaismoradi et al., 2014). More-
over, the narrow focus of this approach to applying the “right” princi-
ples, fails to foster the skills needed to cope with errors when they do
occur in a clinical setting (DaRosa and Pugh, 2012). Error training is
one attempt to overcome this limitation.
DaRosa and Pugh (2012) classified error training into three types:
error encouragement training, error guidance training, and error
avoidance training. The “right principle” approach described previously
can be classified as error avoidance training. In this type of training,
errors are understood to be the result of a performance failure, leaving
little room for students to learn from their errors. In contrast, error
encouragement training encourages students to make errors in a safe
and contained environment (D'Angelo et al., 2015; DaRosa and Pugh,
2012). This type of training enables students to observe, experience,
and reflect on the error, its causes and consequences, and strategies for
avoiding it in future (DaRosa and Pugh, 2012). When students under-
stand the context in which an error occurs, they are better equipped to
apply their theoretical knowledge to address it and prevent future oc-
currences (Gardner and Rich, 2014; Gardner et al., 2015). Error en-
couragement training may be particularly useful in aspects of medica-
tion practice with high error rates, and where errors may bear critical
costs (DaRosa and Pugh, 2012; Keith and Frese, 2008; King et al., 2013;
Gardner and Rich, 2014; Gardner et al., 2015).
One of the greatest challenges nursing undergraduates experience
after graduation is the practical application of what they have learned
(Becker et al., 2006; Holter, 2008). Despite prolonged hours of medi-
cation administration education, they fear medication errors in parti-
cular and report low confidence for performing medication techniques
they have been repeatedly trained on (Vaismoradi et al., 2014). When
faced with medication administration in the clinical setting, students
with low medication confidence become easily distressed by anxiety
and fear of making a mistake, which undermines their medication
competency and leads to medication errors (Sulosaari et al., 2011).
Confidence in their skills, on the other hand, has been pinpointed as a
factor that improves the outcome of nursing behaviors, with confident
nurses demonstrating high medication administration competency
(Andrew et al., 2009; Sulosaari et al., 2011).
Against this backdrop, our study aimed to investigate the effects of
error encouragement training on medication confidence among nursing
graduates who had previously received error avoidance training. Oral
medication administration was chosen as the training topic. This is a
relatively simple administration route in which it is unlikely that par-
ticipants' skills and level of knowledge would interfere; however, oral
medication error accidents occur regularly (Keers et al., 2013). We
assessed the effects of medication error encouragement training (MEET)
using clinical scenarios for oral medication administration procedures
vulnerable to error. The objective of this study was to compare the safe
medication administration confidence of a control group that received
general medication safety education, with an experimental group that
received MEET, before and after intervention.
3. Methods
3.1. Research design
We conducted a quasi-experimental non-equivalent control group
study aimed at identifying the differences in safe medication
2
Nurse Education Today 84 (2020) 104250
Table 1
Research design.
Measurements
Pre-intervention Intervention Post-intervention
Intervention group E1 X E2
Control group C1 X′ C2
Key: X: MEET; X′: General medication safety education, E, C: Confidence in
medication safety performance.
administration confidence before and after a medication error en-
couragement training intervention. We compared pre- and post-inter-
vention confidence levels (Table 1) between an experimental group that
received MEET, and a control group that underwent an existing edu-
cation program utilizing error avoidance training. Both groups con-
sisted of nursing undergraduates.
3.2. Participants
Study participants were undergraduate students who had completed
training on the standard oral medication administration technique
suggested by the Korean Accreditation Board of Nursing (KABONE,
2014). Convenience sampling was used to recruit prospective graduates
at a university nursing department located in a large city in South
Korea. This approach was intended to control for the exogenous vari-
ables that may affect the outcome and dependent variable of this study,
namely the differences in completed units of the nursing major; dif-
ferences in individual accomplishment regarding medication nursing;
and differences in nursing curricula across schools, such as extra-
curricular activities. The required sample size was computed to be 102
using G*Power software 3.1.9.4 (Faul et al., 2007), with α = 0.05,
power 0.8, and effect size 0.15. Students who provided consent to
participate were paired based on mean GPA in the preceding semester.
The resulting sample contained 97 participants, who were randomly
assigned to an experimental group (47) and control group (50) using a
random number table. Fig. 1 presents a CONSORT flowchart of the
sampling process (Consolidated Standards of Reporting Trials, 2010).
Data were collected from April 2016 to June 2017.
3.3. Procedures
The MEET program that was developed for and applied in this study
comprised 4 h of applied training using a clinical scenario that en-
compassed the entire medication administration process, from pre-
scribing to recording, in which oral medication administration errors
could easily occur. In this type of training, error is a component of the
learning process itself, encouraging students to engage in reflective
learning regarding the context in which the error occurs. This approach
provides students with a platform for learning about the causes and
presentation of the error, as well as the knowledge and skills necessary
to respond to it (Gardner and Rich, 2014).
The MEET scenario was developed by the research team in con-
sideration of nursing graduates' knowledge levels, and involved a si-
tuation requiring oral medication administration for adult patients with
major medical-surgical conditions, such as congestive heart failure,
pneumonia, general surgery, and orthopedic surgery. It was designed to
induce errors at each step of the medication process, including patient
information confirmation, drug information confirmation, interpreta-
tion and communication of drug prescription, drug preparation, ad-
ministration, recording, and post-administration patient monitoring.
The medication errors used in the scenario were designed based on the
results of a previous study and actual reports about medication-related
errors in a tertiary university hospital in South Korea. Each scenario
contained two or more error-prone situations for each stage of medi-
cation administration such that students could experience a variety of
K. Kim and I. Lee
Fig. 1. CONSORT flowchart.
medication errors. For example, the interpretation and communication
of the drug prescription stage included errors such as dosage, admin-
istration route, whether the medication was appropriate, potential al-
lergic components, drug interactions, and medications with similar-
sounding names. The communication stage included noise (e.g., diffi-
culty with phone communication); the environmental stage included
time pressure and the information seeking process; the drug adminis-
tration stage included medication settings, such as unusual dosage,
route, or time; and error-prone situations included patients' individual
situation (e.g., pre-administration assessments, changes in patient's
state, patient special demands). Expert validity of this MEET scenario
was established by one nursing professor and two nurses, each with
more than ten years' clinical experience. We chose oral medication
administration as the scenario topic because it was relatively unin-
fluenced by individual skill differences, which allowed us to assess the
effects of the intervention alone.
During the applied training component of the program, two to four
students practiced oral medication administration according to the
MEET scenario for 15 to 20 min. Students were exposed to various
medication errors during their practice, which was followed by a
twenty-minute debriefing by the instructor to facilitate internalizing
their experiences.
The control group received the traditional medication safety edu-
cation, which takes the “right principle” approach discussed above. The
program consists of 4 h of applied training using a scenario designed
not to induce error. This scenario was designed at the same level of
3
Nurse Education Today 84 (2020) 104250
difficulty as that used for the experimental group. Expert validity of this
traditional education approach was established by one nursing pro-
fessor and two nurses, each with more than ten years of clinical ex-
perience.
Prior to receiving the training, both groups were given a two-hour
lecture on medication principles and safety. The lecture presented
students with the ten medication safety practice guidelines developed
by the Institute for Safe Medication Practices (ISMP, 2011), the stan-
dards prescribed by the Korean Institute for Healthcare Accreditation
(KOIHA, 2014), and the medication-related safety requirements for
accreditation by Joint Commission International (JCI, 2014).
3.4. Measures
Confidence in medication safety performance was measured before
and after the intervention for both groups. Subjective confidence in the
medication safety procedure per the ISMP (2011), KOIHA (2014), and
JCI (2014) standards were measured using a tool we developed based
on the items suggested by the ISMP (2011; prescribing and transcribing,
confirming the appropriateness of the prescription, preparing, admin-
istering, recording, and monitoring); the medication administration
checklist endorsed by the KOIHA (2014) and JCI (2014); and the oral
medication administration principles endorsed by the KABONE (2014).
Expert validity of the items was established by three nursing experts
with more than 15 years of clinical experience each and one nursing
professor. The tool was tested in a pilot study on four nurses with two or
K. Kim and I. Lee Nurse Education Today 84 (2020) 104250

more years of clinical experience each. The final tool consisted of 36
items in eight subcategories, with five items for patient information
confirmation, six items for drug information confirmation, two items
for communication of prescription and drug information, eight items
for preparation, ten items for administration, one item for recording,
two items for patient monitoring, and two items for medication safety
management. Each item was scored on a 100-point scale (0 = I am not
confident at all to 100 = I am very confident). The reliability of the tool
was established with Cronbach's α of 0.81.
3.5. Ethical considerations
4.2. Pre- and post-treatment differences in medication safety confidence
between the intervention and control groups
Table 3 shows the pre- and post-treatment differences in medication
safety confidence between the experimental and control groups. After
the intervention, the experimental group showed a significant increase
in confidence in oral medication safety compared to the control group
(t = 3.52, p = .001). Among the domains of oral medication adminis-
tration, the experimental group showed significant improvement in
confidence regarding patient information confirmation, drug informa-
tion confirmation, and drug preparation.

The study received ethical clearance from the institutional review
board at H University (clearance number 15-05-01-0128). The re-
searchers provided participants with information on the purpose and
procedure of the study. Participants were informed that they would not
be disadvantaged in any way if they chose not to participate in the
study, and that their participation was irrelevant to the curriculum of
the nursing department. Students who provided informed consent were
enrolled in the study.
3.6. Data analysis
Data were analyzed using IBM SPSS Statistics (version 22).
Participants' general characteristics, learning-related characteristics,
and major study variables were analyzed using frequency, percentage,
mean, and standard deviation functions. The homogeneity of general
characteristics and learning-related characteristics between the two
groups were verified with the χ2 test, independent t-test, and Fisher's
exact test. Differences in performance confidence before and after the
intervention in both groups were analyzed with the independent t-test.
4. Results
4.1. Pre-treatment homogeneity of general characteristics and dependent
variables between the intervention and control groups
The mean age was 23.7 ± 1.38 years for the experimental group
and 22.78 ± 1.13 years for the control group. The majority of parti-
cipants were women in both the experimental group (83%) and control
group (92%). The mean GPA was 3.43 ± 0.34 and 3.54 ± 0.39 for the
experimental and control groups, respectively. There were no sig-
nificant differences in these general characteristics between the two
groups. There were also no significant differences in pre-treatment
medication safety confidence between the two groups, as shown in
Table 2.
5. Discussion
The MEET intervention was developed to enhance nursing under-
graduates' confidence in safe medication administration based on MEET
error encouragement training, which treats errors that may occur in
actual practice as learning components and allows students to focus on
both their actions and errors during training, facilitating reflective ex-
amination of the cause and process of their errors. Errors in the medical
field can have critical outcomes, so they need to be approached from
both an avoidance and a management perspective. Errors increase an-
xiety and fear of failure in graduate nurses, which in turn diminishes
their performance confidence and hinders a successful transition (Della
Ratta, 2016). A benefit of error encouragement training is that students
can advance their performance capacity and accurately understand
errors by actively experiencing errors in a safe environment (Gardner
et al., 2015). In addition, error management training is useful for novice
learners in that it enhances their performance as they safely experience
errors (Dyre et al., 2017).
Because of these benefits, error training has been actively used in
medical education (Gardner et al., 2015; Gully et al., 2002; Eva, 2009).
Dyre et al. (2017) applied error encouragement training in simulation-
based ultrasound training for medical students and reported that it
improved their diagnostic accuracy performance with real patients.
Gardner et al. (2015) reported that incorporating error encouragement
training into central venous catheterization simulation was effective in
terms of interns' skill retention, which the investigators attributed to
students' ability to acquire an in-depth understanding of the full pro-
cess. This understanding translates into long-term learning effects, as
the instructor actively encourages students to make errors and then
extensively discusses these errors. To apply these benefits to medication
safety, we designed our training program to allow students to experi-
ence making errors in a safe environment. We chose oral medication
administration as the scenario topic, since it is not greatly influenced by
individual skill differences and allowed us to control for individual skill
differences and exclusively assess the effects of the error

Table 2
Differences in the general characteristics and medication safety confidence (pre-treatment measurement) between the intervention and control group.
Variables M ± SD or N(%) t or χ2 p

Intervention group (47) Control group (50)

General characteristics Age 23.71 ± 1.38 22.78 ± 1.13 1.52 .131

Gender Female 39(83.0) 46(92.0) 1.81 .224
Male 8(17.0) 4(8.0)
GPA (max 4.5) 3.43 ± 0.34 3.54 ± 0.39 1.47 .144
Performance confidence of oral medication Patient information identification 70.32 ± 12.28 71.84 ± 15.04 0.54 .588
safety Medication information identification 62.76 ± 12.31 64.64 ± 11.42 0.78 .438
Communication about medication prescription and medication 66.53 ± 17.65 67.61 ± 19.12 0.29 .774
information
Medication preparation 87.95 ± 8.26 88.42 ± 9.73 0.25 .801
Medication administration 89.46 ± 8.36 89.71 ± 9.64 0.14 .890
Recording 87.14 ± 11.64 85.40 ± 16.18 0.61 .545
Monitoring of patient 76.40 ± 12.37 77.15 ± 14.64 0.27 .788
Medication safety management 66.69 ± 17.28 67.05 ± 18.65 0.99 .922
Total 78.60 ± 6.74 79.23 ± 8.75 0.39 .697

4
K. Kim and I. Lee Nurse Education Today 84 (2020) 104250

Table 3
Difference in pre-post medication safety confidence between intervention and control group.
Variables M ± SD △post-pre t
(p)
Intervention group Control group

Pre Post Pre Post

Patient information identification 70.32 ± 12.28 85.20 ± 9.43 71.84 ± 15.04 76.92 ± 12.51 Exp 13.17 ± 14.33 2.51
Con 6.60 ± 11.18 (.014)
Medication information identification 62.76 ± 12.31 83.79 ± 9.37 64.64 ± 11.42 77.00 ± 10.18 Exp 19.14 ± 9.66 2.36
Con 14.23 ± 10.85 (.021)
Communication about medication prescription and medication 66.53 ± 17.65 86.17 ± 11.75 67.61 ± 19.12 81.01 ± 13.04 Exp 18.56 ± 18.79 1.10
information Con 14.47 ± 17.54 (.272)
Medication preparation 87.95 ± 8.26 95.00 ± 6.76 88.42 ± 9.73 90.76 ± 8.92 Exp 6.58 ± 8.29 2.43
Con 2.80 ± 6.91 (.017)
Medication administration 89.46 ± 8.36 95.27 ± 7.74 89.71 ± 9.64 94.09 ± 7.25 Exp 5.56 ± 6.34 0.67
Con 4.63 ± 7.26 (.503)
Recording 87.14 ± 11.64 93.08 ± 10.73 85.40 ± 16.18 91.80 ± 9.85 Exp 7.68 ± 13.18 1.18
Con 4.65 ± 12.06 (.243)
Monitoring of patient 76.40 ± 12.37 87.80 ± 12.01 77.15 ± 14.64 82.29 ± 12.86 Exp 10.65 ± 14.94 1.68
Con 5.89 ± 12.80 (.097)
Medication safety management 66.69 ± 17.28 85.26 ± 15.90 67.05 ± 18.65 77.89 ± 13.75 Exp 18.21 ± 20.43 1.86
Con 11.20 ± 16.25 (.066)
Total 78.60 ± 6.74 90.35 ± 35 79.23 ± 8.75 85.73 ± 6.60 Exp 11.11 ± 5.73 3.52
Con 7.12 ± 5.41 (.001)

encouragement training. to better navigate these obstacles in practice. By experiencing errors

During the MEET program, many students were flustered when they
made a mistake, feeling they had failed the training. As noted by
DaRosa and Pugh (2012), this type of response seemingly results from
medical education's traditional framing of errors as indicative of failure
and something to be avoided. When students fear and avoid errors, the
benefits of error encouragement training are thwarted. Fear and
avoidance may also hinder students' medication administration prac-
tice. Therefore, instructors must actively discuss this with students and
encourage them to make errors in an accepting environment when
administering error encouragement training.
The MEET program was effective in boosting medication safety
confidence among nursing graduates. The resultant decrease in anxiety
should facilitate safer and more effective medication administration
(Kim et al., 2012; McMullan et al., 2010; Vaismoradi et al., 2014). The
MEET program also lowered students' anxiety about errors by actually
encouraging them to make errors. In addition to its educational effect
pertaining to error itself, error management training also positively
influences the negative psychological consequences of students' errors
(Frese and Keith, 2015). King et al. (2013) reported that applying error
encouragement training in medical team training led to better emo-
tional control and increased foresight for managing the situation. Psy-
chological preparation for a task influences task performance; error
training enhances task performance by strengthening students' emo-
tional control and metacognition (Keith and Frese, 2005).
Another educational benefit of error management training involves
error detection training during an organizational task process. Frese
and Keith (2015) reported that error encouragement training was ef-
fective in detecting error related processes. This was confirmed in our
study as well, where confidence in patient information confirmation,
drug information confirmation, and drug preparation steps were sig-
nificantly improved. This is important because these three aspects of
medication administration are more easily influenced by systemic fac-
tors. The drug information confirmation stage, in particular, requires
that individuals have the professional knowledge needed to confirm
medication appropriateness in the context of the patient's medical
status, review its interactions with previously prescribed drugs, effec-
tively communicate their conclusions to physicians and pharmacists,
and engage in detailed communication with physicians (regarding
prescriptions) and pharmacists (regarding preparation). The MEET in-
tervention exposed students to the process in a way that revealed the
systemic contributors to medication errors, which should enable them
that frequently occur in this process, students learned that systemic
factors and individual factors both contribute to errors.
Medication administration is an appropriate topic for error en-
couragement training in that it is a common and frequent task per-
formed by nurses, requiring integrated thinking and continuity of
practice, and is also a task vulnerable to error. In this context, the
current study has important theoretical implications in that it verifies
the effects of error encouragement training on medication safety. The
study also has practical implications in proposing the MEET program as
a new training program that provides an opportunity for nursing
graduates to integrate segmented knowledge and use error as a learning
component. The MEET program has practical benefits; it is easy to
administer and can be adequately incorporated into the existing nursing
curricula.
However, the following study limitations should be considered.
First, the developed MEET program had limited content on medication
errors from a nursing perspective. There were not enough studies for us
to determine the type of errors that would be beneficial as learning
materials when we were developing the scenario and setting errors for
each medication step. In Korea, healthcare institutions are still reluctant
to disclose any medication errors in their institutions, so there is a
shortage of accurate statistics regarding medication errors. Therefore,
this study designed medication error scenarios based on a review of
international literature on medication errors and a survey of medication
errors in a large (over 1000 beds) tertiary hospital in Korea over a one-
year period. In the future, basic learning content should be more di-
versified by investigating medication errors that occur frequently in the
clinical setting.
Second, educators must consider the following when applying error
encouragement training. First, learners must be prepared with the pre-
requisites, such as basic knowledge about a task, to learn through error
management training (Eva, 2009; Dyre et al., 2017). Second, learners
must understand that errors during the training do not represent failure
(Metcalfe, 2017; Dyre et al., 2017). Third, educators must include well-
designed situations (Frese and Keith, 2015) and provide well-structured
debriefing such that students can reflect on their actions and errors
(Metcalfe, 2017; Dyre et al., 2017). During MEET implementation,
many participants were distressed when induced errors occurred,
feeling that their errors meant that they failed the training. These
prospective nursing graduates had been educated with a focus on error
avoidance over the previous four years, so they were disturbed and

5
K. Kim and I. Lee
anxious when they made errors during the MEET program. It was ne-
cessary to explain the focus of error encouragement education during
the orientation and to reassure them through debriefing throughout the
training. Educators must offer minimal external guidance to support
learners during training. It is more effective for learners to experience
making errors than for educators to guide learners through errors
(Metcalfe, 2017). Further, educators need to adopt a permissive attitude
about learners' errors (Dyre et al., 2017)—one of the most important yet
most challenging aspects of implementing the MEET program. There-
fore, we recommend that instructors maintain positive and permissive
teaching strategies within the boundaries of safety, to help students
meet their educational goals by learning from errors.
Third, we assessed confidence in medication safety performance as a
short-term effect of the MEET program. However, the effects of error
encouragement training are known to last longer compared to the ef-
fects of error avoidance training (Dyre et al., 2017; Metcalfe, 2017).
Therefore, subsequent studies should examine the long-term persistence
of MEET program effects.
6. Conclusion
In this study we measured student nurses' confidence in their ability
to safely administer medication. Considering the frequency of the task,
and its vulnerability to error, the results of our study have important
implications for nursing education. We have shown that error en-
couragement training in the form of our MEET intervention improves
students' safe medication administration confidence, which should
serve as a protective factor against medication errors in clinical settings.
Given the paucity of research on medication errors from a nursing
perspective, we had limited evidence to inform the development of the
MEET program. If broader implementation of this training is to occur,
the research gap needs to be addressed. The lack of evidence in this
regard may be attributed to the healthcare sector's resistance to dis-
closing information on medication errors in its institutions.
While our study shows promising results, further research on error
encouragement training in nursing education is needed. The im-
plementation of MEET interventions in other university and clinical
settings would allow more generalizability. Because this approach aims
to facilitate long-term information retention, studies investigating the
long-term effects of a MEET program are also needed.
Funding source
This research was supported by Basic Science Research Program
through the National Research Foundation of Korea (NRF) funded by
the Ministry of Science, ICT and Future Planning (NRF-
2017R1C1B5016540).
Ethical approval
The study received ethical clearance from the institutional review
board at Hannam University (clearance number 15-05-01-0128).
Declaration of competing interest
None to declare.
References
Andrew, S., Salamonson, Y., Halcomb, E.J., 2009. Nursing students’ confidence in med-
ication calculations predicts math exam performance. Nurse Educ. Today 29 (2),
217–223. https://doi.org/10.1016/j.nedt.2008.08.005.
Becker, K.L., Rose, L.E., Berg, J.B., Park, H., Shatzer, J.H., 2006. The teaching effec-
tiveness of standardized patients. J. Nurs. Educ. 45, 103–111.
Cleary-Holdforth, J., Leufer, T., 2013. The strategic role of education in the prevention of
Nurse Education Today 84 (2020) 104250
medication errors in nursing: part 2. Nurse Educ. Pract. 13 (3), 217–220. https://doi.
org/10.1016/j.nepr.2013.01.012.
Consolidated Standards of Reporting Trials (CONSORT), 2010. The CONSORT Flow
Diagram. Retrieved February 27, 2019. In: from, . http://www.consort-statement.
org/consort-statement/flow-diagram.
D’Angelo, A.L.D., Law, K.E., Cohen, E.R., Greenberg, J.A., Kwan, C., Greenberg, C., et al.,
2015. The use of error analysis to assess resident performance. Surgery 158 (5),
1408–1414. https://doi.org/10.1016/j.surg.2015.04.010.
DaRosa, D.A., Pugh, C.M., 2012. Error training: missing link in surgical education.
Surgery 151 (2), 139–145. https://doi.org/10.1016/j.surg.2011.08.008.
Della Ratta, C., 2016. Challenging graduate nurses’ transition: care of the deteriorating
patient. J. Clin. Nurs. 25 (19–20), 3036–3048. https://doi.org/10.1111/jocn.13358.
Dyre, L., Tabor, A., Ringsted, C., Tolsgaard, M.G., 2017. Imperfect practice makes perfect:
error management training improves transfer of learning. Med. Educ. 51 (2),
196–206. https://doi.org/10.1111/medu.13208.
Eva, K.W., 2009. Diagnostic error in medical education: where wrongs can make rights.
Adv. Health Sci. Educ. 14 (1), 71–81. https://doi.org/10.1007/s10459-009-9188-9.
Faul, F., Erdfelder, E., Lang, A.-G., Buchner, A., 2007. G*Power 3: a flexible statistical
power analysis program for the social, behavioral, and biomedical sciences. Behav.
Res. Methods 39, 175–191.
Frese, M., Keith, N., 2015. Action errors, error management, and learning in organiza-
tions. Annu. Rev. Psychol. 66, 661–687. https://doi.org/10.1146/annurev-psych-
010814-015205.
Gardner, A., Rich, M., 2014. Error management training and simulation education. Clin.
Teach. 11 (7), 537–540. https://doi.org/10.1111/tct.12217.
Gardner, A.K., Abdelfattah, K., Wiersch, J., Ahmed, R.A., Willis, R.E., 2015. Embracing
errors in simulation-based training: the effect of error training on retention and
transfer of central venous catheter skills. J. Surg. Educ. 72 (6), e158–e162. https://
doi.org/10.1016/j.jsurg.2015.08.002.
Gully, S.M., Payne, S.C., Koles, K., Whiteman, J.A.K., 2002. The impact of error training
and individual differences on training outcomes: an attribute-treatment interaction
perspective. J. Appl. Psychol. 87 (1), 143.
Hewitt, J., Tower, M., Latimer, S., 2015. An education intervention to improve nursing
students’ understanding of medication safety. Nurse Educ. Pract. 15 (1), 17–21.
https://doi.org/10.1016/j.nepr.2014.11.001.
Holter, L.D., 2008. Nursing education and transition to the work environment: a synthesis
of national reports. J. Nurs. Educ. 47 (1), 5–12.
Institute for Safe Medication Practices, 2011. Medication Safety Self Assessment® for
Hospitals. Retrieved March 10, 2015 from. https://www.ismp.org/assessments/
hospitals.
Joint Commission International, 2014. Joint Commission International Accreditation
Standards for Hospitals, 5th ed. JCI Press, Illinois.
Keers, R.N., Williams, S.D., Cooke, J., Ashcroft, D.M., 2013. Prevalence and nature of
medication administration errors in health care settings: a systematic review of direct
observational evidence. Ann. Pharmacother. 47 (2), 237–256. https://doi.org/10.
1345/aph.1R147.
Keith, N., Frese, M., 2005. Self-regulation in error management training: emotion control
and metacognition as mediators of performance effects. J. Appl. Psychol. 90 (4),
677–691.
Keith, N., Frese, M., 2008. Effectiveness of error management training: a meta-analysis. J.
Appl. Psychol. 93 (1), 59–69. https://doi.org/10.1037/0021-9010.93.1.59.
Kim, M.H., Park, J.H., Kim, M.S., 2012. Predictors of drug calculation competence of
nursing students. J. Korean Biol. Nurs. Sci. 14 (3), 174–182.
King, A., Holder, M.G., Ahmed, R.A., 2013. Errors as allies: error management training in
health professions education. BMJ Qual. Saf. 22 (6), 516–519. https://doi.org/10.
1136/bmjqs-2012-000945.
Korean Accreditation Board of Nursing, 2014. Core Basic Nursing Skill Performance
Protocol. Retrieved January 6, 2016, from http://www.kabone.or.kr/HyAdmin/
upload/goodFile/120140117153430.pdf
Korean Institution for Healthcare Accreditation, 2014. KOIHA Accreditation Standards for
Hospitals, 2nd ed. KOIHA Press, Seoul.
McMullan, M., Jones, R., Lea, S., 2010. Patient safety: numerical skills and drug calcu-
lation abilities of nursing students and registered nurses. J. Adv. Nurs. 66 (4),
891–899. https://doi.org/10.1111/j.1365-2648.2010.05258.x.
Metcalfe, J., 2017. Learning from errors. Annu. Rev. Psychol. 68, 465–489. https://doi.
org/10.1146/annurev-psych-010416-044022.
Natan, M.B., Sharon, I., Mahajna, M., Mahajna, S., 2017. Factors affecting nursing stu-
dents’ intention to report medication errors: an application of the theory of planned
behavior. Nurse Educ. Today 58, 38–42. https://doi.org/10.1016/j.nedt.2017.07.
017.
National Coordinating Council for Medication Error Reporting and Prevention, 2018.
About Medication Errors. Retrieved October 2, 2018, from https://www.nccmerp.
org/about-medication-errors
Page, K., McKinney, A.A., 2007. Addressing medication errors: the role of undergraduate
nurse education. Nurse Educ. Today 27 (3), 219–224.
Roughead, L., Semple, S., Rosenfeld, E., 2013. Literature Review: Medication Safety in
Australia. (Sydney. Australian Commission on Safety and Quality in Health Care).
Sulosaari, V., Suhonen, R., Leino-Kilpi, H., 2011. An integrative review of the literature
on registered nurses’ medication competence. J. Clin. Nurs. 20 (3–4), 464–478.
https://doi.org/10.1111/j.1365-2702.2010.03228.x.
Vaismoradi, M., Jordan, S., Turunen, H., Bondas, T., 2014. Nursing students’ perspectives
of the cause of medication errors. Nurse Educ. Today 34 (3), 434–440. https://doi.
org/10.1016/j.nedt.2013.04.015.