Exploring the Knowledge and Attitudes Towards Compliance with Medication Administration Protocol Among Nursing Students
Submitted by Mesharee C. Maloloy-on, RN; Co-Author: Gloria M. Cunanan, PhD, RN
Tags: adherence clinical education errors knowledge learning medication medication errors nursing nursing students patient practice simulation students study
Mesharee C. Maloloy-on, RN and Gloria M. Cunanan, PhD, RN
Liceo de Cagayan University
Abstract
Background: Safe medication administration is a core responsibility of nursing practice, yet medication errors remain a persistent global threat to patient safety. Nursing students, as future frontline caregivers, must develop not only technical competence but also safety-oriented attitudes and consistent compliance behaviors. Investigating how knowledge, attitudes, and compliance relate among nursing students can inform educational strategies to reduce errors.
Objective: This study examined the level of knowledge, attitudes, and compliance of nursing students toward established medication administration protocols and identified which variables significantly predict compliance behavior.
Methods: Using a descriptive–correlational design, 162 nursing students from a faith-based college in Valencia City, Bukidnon, Philippines, participated. A validated, self-administered questionnaire assessed knowledge of medication administration procedures and rights, attitudes toward medication errors and patient safety, and compliance with hospital and manufacturer policies. Data were analyzed using descriptive statistics, Pearson correlation, and multiple regression analyses.
Results: The respondents exhibited very high knowledge and very positive attitudes toward medication administration protocols. Compliance with both hospital and manufacturer policies was high to very high. Significant positive correlations existed between compliance and both knowledge and attitudes (p < 0.01). Regression analysis revealed that attitudes—specifically toward medication errors and patient safety—were significant predictors of compliance (p < 0.001); knowledge alone did not significantly predict compliance when combined with attitudes. The overall model accounted for approximately 44% of the variance in compliance behaviors.
Conclusion: Nursing students with stronger safety-oriented attitudes are more likely to adhere to medication administration protocols. Educational interventions that reinforce patient-safety values, error-prevention awareness, and positive attitudes toward safe practice may enhance compliance and reduce medication errors.
Keywords: medication protocols, nursing students, compliance, patient safety, medication errors, knowledge, attitudes
Introduction
Medication administration is a core responsibility of nurses and is fundamental to ensuring safe, effective, and high-quality patient care. As the final gatekeepers in the medication delivery process, nurses play a crucial role in preventing patient harm caused by errors. Globally, medication errors continue to be a major source of preventable morbidity and mortality, contributing to adverse drug reactions, prolonged hospital stays, and increased healthcare costs (World Health Organization [WHO], 2017; WHO, 2023). Because the medication administration process involves several stages — prescribing, transcribing, dispensing, and administering — each step presents opportunities for error, making vigilance and competence essential. Nurses, who directly administer medications, serve as the last checkpoint before a drug reaches the patient, placing them at the forefront of patient safety (Kavanagh, 2017).
Despite the emphasis placed on medication safety in nursing curricula, many nursing students experience challenges in translating theoretical knowledge into safe clinical performance. A systematic review of global evidence shows that medication administration errors among nursing students remain prevalent, with common mistakes involving wrong dose, wrong time, and omissions (Musharyanti et al., 2019). A retrospective analysis further indicated that these errors stem not only from lack of knowledge but also from systemic issues such as poor supervision, fatigue, clinical pressure, and insufficient hands-on experience (Smith, Brown, & Chen, 2018). These findings underscore persistent gaps between classroom learning and clinical application — a concern especially relevant for students approaching entry into professional practice. The ability to apply critical thinking in high-stakes moments is essential, as even a momentary lapse can lead to a serious medication error.
Several studies highlight that medication safety competence extends beyond technical proficiency. Knowledge deficits in pharmacology, hesitation or fear during calculations, and limited exposure to high-risk medications have been observed among nursing students, affecting their confidence in performing medication-related tasks (Abalos et al., 2023; Baclig, 2022). In addition to cognitive challenges, environmental and organizational barriers play a significant role. Frequent interruptions during medication rounds, high workloads, inadequate staffing patterns, and punitive responses to errors create a climate that hampers safe practice and discourages honest reporting of mistakes or near misses (Westbrook et al., 2018; Brabcová, Černá, & Hladík, 2023). Such conditions reduce opportunities for students to develop sound clinical judgment and foster a culture of safety.
A growing body of literature emphasizes that attitudes toward medication safety — including perceptions of responsibility, risk awareness, self-efficacy, and professional accountability — substantially influence compliance with medication protocols. Positive attitudes have been associated with stronger adherence to the "Ten Rights" of medication administration and greater willingness to follow institutional policies (Natan et al., 2017). Conversely, negative attitudes, such as fear of reprimand or lack of confidence, have been linked to increased likelihood of error and non-compliant behavior (Sansom, 2021). This highlights the need to evaluate not only what students know, but also how they feel and behave in relation to medication safety. Ethical awareness plays a foundational role here, as nurses must navigate complex ethical responsibilities that directly influence patient outcomes.
In the Philippines, where nursing education integrates theoretical instruction with extensive clinical placements, Level 3 and 4 nursing students routinely participate in supervised medication administration in both hospital and community settings. Evaluating their knowledge, attitudes, and compliance is essential, as these students are in their final stages of preparation for professional nursing practice. Understanding the factors that influence their medication safety performance can support the development of more targeted teaching strategies, competency-based training, and supportive clinical environments that minimize errors and strengthen patient safety culture.
Given these realities, the present study aims to: (1) assess the level of knowledge among nursing students regarding medication administration standards and safety protocols; (2) examine their attitudes toward medication errors and patient safety; (3) measure their compliance with the "rights" of medication administration and institutional policies; and (4) identify predictors of compliance behavior.
Findings from this research will provide valuable insights for nursing educators, clinical instructors, hospital administrators, and policymakers in strengthening medication safety education and ensuring the readiness of future nurses for safe professional practice.
Methods
This study employed a quantitative descriptive–correlational design, complemented by aspects of causal modeling, to examine the relationships between nursing students' knowledge, attitudes, and compliance regarding medication administration protocols. This design allowed the researchers to describe current levels of knowledge, attitudes, and compliance, identify associations among these variables, and determine which factors significantly predict compliance behaviors.
Setting and Participants
The study was conducted at a faith-based higher education institution in Valencia City, Bukidnon, Philippines, which offers a Bachelor of Science in Nursing (BSN) program and provides clinical exposure in tertiary hospitals and community health centers. The target population consisted of third- and fourth-year nursing students, as these students actively participate in medication preparation and administration under supervision.
A total of 162 students were recruited using simple random sampling from the 276 eligible students (180 Level 3, 96 Level 4). Inclusion criteria required students to have engaged in clinical medication administration; students on leave or without recent clinical exposure were excluded.
Instrumentation
Data were collected using a structured, self-administered questionnaire developed for this study, guided by established frameworks from Fundamentals of Nursing and medication safety literature. The questionnaire comprised four sections:
- Demographic data
- Knowledge of medication administration procedures and rights
- Attitudes toward medication errors and patient safety
- Compliance with hospital and manufacturer medication policies
Responses were measured on a 5-point Likert scale, with higher scores indicating greater knowledge, positive attitudes, and higher compliance. Three nursing faculty members with over ten years of clinical instructional experience reviewed the instrument for content validity. A pilot test involving 30 Level 2 nursing students confirmed reliability with Cronbach's alpha values exceeding 0.70.
Data Collection Procedure
Approval was obtained from the Liceo Research Ethics Board. Participants were briefed on the study objectives, assured of confidentiality, and provided informed consent prior to participation. Questionnaires were distributed during convenient academic hours and collected immediately upon completion to minimize missing data.
Ethical Considerations
The study adhered to the principles of autonomy, beneficence, and confidentiality. Participation was voluntary, and respondents could withdraw at any time without penalty. Data were securely stored on password-protected devices and deleted following analysis in compliance with the Data Privacy Act of 2012.
Data Analysis
Data were analyzed using SPSS. Descriptive statistics (mean, standard deviation, frequency, and percentage) summarized participants' demographic characteristics and their knowledge, attitude, and compliance scores. Pearson correlation tested associations among the variables, while multiple regression analysis determined predictors of compliance. Assumptions of normality, linearity, and multicollinearity were verified prior to regression analysis. Significance was set at p < 0.05.
Results
Knowledge of Medication Administration Protocols
Students demonstrated very high overall knowledge (M = 4.58, SD = 0.35) in medication administration procedures and rights. The highest scoring indicators included understanding the main purpose of medication policy to ensure patient safety (M = 4.93, SD = 0.30) and openness to feedback or clarification (M = 4.81, SD = 0.47). Lower — but still high — scores were seen for dosage calculations (M = 4.03, SD = 0.78) and proper storage and handling procedures (M = 4.13, SD = 0.78), pointing to areas requiring further reinforcement.
Attitudes Toward Medication Errors and Patient Safety
Participants exhibited very positive attitudes overall (M = 4.58, SD = 0.40). They scored highest on prioritizing patient well-being (M = 4.84, SD = 0.46) and attention to detail when administering medications (M = 4.81, SD = 0.50). Slightly lower scores were noted in confidence for safe medication administration (M = 4.13, SD = 0.83), indicating potential uncertainty in real or high-risk scenarios.
Self-Reported Compliance with Hospital and Manufacturer Policies
Compliance levels ranged from high to very high. For hospital policy adherence, overall compliance was high (M = 4.43, SD = 0.50), with the highest mean in willingness to report errors or near misses (M = 4.65, SD = 0.60). Compliance with manufacturer policy was very high (overall M = 4.63, SD = 0.49), reflecting strong reported adherence to manufacturer instructions and clarification-seeking when uncertain.
Relationships Among Knowledge, Attitudes, and Compliance
Pearson correlation analysis revealed significant positive relationships between compliance and both knowledge and attitude domains (p < 0.01). Among attitude domains, patient safety attitudes showed the strongest correlation with compliance (r = 0.657), followed by rights to medication administration (knowledge domain; r = 0.547) and medication administration procedure (knowledge domain; r = 0.460).
Predictors of Compliance (Multiple Regression)
Multiple regression analysis identified that attitudes toward medication errors (B = 0.585, p < 0.001) and patient safety (B = 0.404, p < 0.001) significantly predicted compliance behaviors, while knowledge domains (medication administration procedure and rights) did not show independent predictive power when controlling for attitudes. The regression model accounted for approximately 44% of the variance in compliance (R² = 0.4416), indicating a moderate-to-strong explanatory value.
Discussion
Knowledge and Competence in Medication Administration
The findings from Table 1 indicate that nursing students demonstrated an overall very high level of knowledge (Mean = 4.58, SD = 0.35) regarding medication administration protocols. Specifically, students exhibited the highest knowledge in understanding the main purpose of medication policies (Mean = 4.93, SD = 0.30) and in following the five rights of medication administration (Mean = 4.82, SD = 0.49). These results suggest that the students possess a strong theoretical foundation regarding safe medication practices, which aligns with previous studies emphasizing the importance of adherence to institutional policies and the five rights framework to ensure patient safety (Fowler et al., 2021; Wright, 2019; Hassan & Haddad, 2021).
Despite these very high scores, students' knowledge in performing accurate dosage calculations (Mean = 4.03, SD = 0.78) and high-alert medication knowledge (Mean = 4.13, SD = 0.87) were slightly lower, though still rated as high. This finding is consistent with the literature, indicating that while nursing students often understand medication safety principles, they may face challenges with numeracy skills and the complexity of high-alert medications (Abd Elmageed et al., 2020; Fusco et al., 2021; Musharyanti et al., 2021). Accurate dosage calculations are critical to preventing medication errors, as miscalculations remain a common source of clinical risk among students and newly graduated nurses (Elliott et al., 2020; Nuckols et al., 2023). Similarly, knowledge of high-alert medications requires not only memorization of drug categories but also understanding of administration precautions and potential adverse effects (Aghabarary et al., 2025; Ibrahim et al., 2021).
The very high overall knowledge of nursing students may be attributed to structured educational interventions, such as simulation-based training, QR code or RFID integration, and blended learning strategies, which have been shown to enhance medication safety competencies (Padilla & Santos, 2021; Abriol et al., 2024; Park et al., 2025). The growing role of virtual reality and simulation technologies in nursing education supports this trend, providing students with immersive practice opportunities. Simulation and experiential learning provide students with opportunities to practice safe medication administration in a controlled environment, reducing anxiety and increasing confidence prior to clinical exposure (Goodwin et al., 2022; Lopez et al., 2018).
However, the slightly lower scores in dosage calculations and high-alert medications highlight the need for targeted pedagogical strategies. Educators may implement additional focused modules on pharmacology, clinical reasoning exercises, and real-life scenario simulations to strengthen these areas. The use of structured educational programs has demonstrated effectiveness in addressing such competency gaps. Emphasizing these competencies aligns with global recommendations for reducing medication errors and achieving zero-harm healthcare outcomes (WHO, 2017; Institute for Safe Medication Practices, 2021).
Overall, the results suggest that while nursing students in this study are well-prepared in theoretical knowledge and adherence to medication administration policies, reinforcing practical competencies—especially in dosage calculations and high-alert medications—is crucial for translating knowledge into safe clinical practice.
Attitude of Nursing Students Toward Medication Administration Protocols
The findings in Table 2 reveal that nursing students displayed an overall very positive attitude (Mean = 4.58, SD = 0.40) toward medication administration protocols. Notably, students scored highest in prioritizing patient well-being (Mean = 4.84, SD = 0.46) and attention to detail during administration (Mean = 4.81, SD = 0.50), suggesting a strong ethical and professional orientation toward patient safety. This aligns with previous studies that emphasize the critical role of student nurses' attitudes in fostering safe clinical practices and reducing the risk of medication errors (Domingo & Reyes, 2023; Wright, 2019; Jones et al., 2022a).
Students also reported a very positive inclination to seek feedback on their skills (Mean = 4.63, SD = 0.65), reflecting an openness to continuous learning and self-improvement. Such attitudes are essential for developing clinical competence and have been linked to enhanced error recognition and adherence to safety protocols in clinical settings (Natan et al., 2017; Padilla & Santos, 2021; Fusco et al., 2021).
The lowest domain score was observed in confidence in administering medications safely (Mean = 4.13, SD = 0.83), which, while still positive, suggests that some students may experience apprehension during clinical practice. This finding is consistent with literature indicating that even well-prepared nursing students can feel anxious when performing first-time or high-risk procedures, particularly with high-alert medications (Irvine et al., 2024; Musharyanti et al., 2019; Goodwin et al., 2022). Anxiety and low confidence can increase the likelihood of errors if not properly addressed through supervised practice, simulation, and supportive mentoring.
Overall, the very positive attitude of nursing students reflects a strong commitment to patient safety and ethical responsibility. However, the relatively lower confidence in safe medication administration underscores the need for targeted interventions, such as structured simulation exercises, guided clinical experiences, and reflective practice sessions, which have been shown to enhance self-efficacy and reduce the risk of medication errors (Park et al., 2025; Lopez et al., 2018; Abriol et al., 2024). Mentoring relationships in nursing education can play a particularly important role in building student confidence. Encouraging feedback-seeking behaviors and reinforcing attention to detail can further consolidate students' safe medication practices and readiness for professional nursing roles.
Compliance in Medication Administration Policy
The data in Table 3 show that nursing students demonstrated high to very high compliance (Overall Mean = 4.53, SD = 0.50) with hospital and manufacturer medication administration policies. Specifically, students reported very high adherence in reporting errors or near misses (Mean = 4.65, SD = 0.60) and in seeking clarification when unsure of instructions (Mean = 4.63, SD = 0.64). This demonstrates that students not only recognize the importance of following established guidelines but also actively engage in behaviors that promote patient safety, consistent with prior studies emphasizing the role of compliance in minimizing medication errors (Bussières et al., 2023; Schutijser et al., 2018; Fusco et al., 2021).
Confidence in following hospital policies scored slightly lower (Mean = 4.45, SD = 0.70), which, while still high, aligns with literature indicating that students may feel less assured in applying theoretical knowledge to clinical practice, particularly in high-risk situations (Irvine et al., 2024; Musharyanti et al., 2019; Abalos et al., 2023). The high compliance with manufacturer instructions and proactive clarification-seeking is consistent with evidence that structured education and simulation training improve adherence to safe medication practices (Padilla & Santos, 2021; Park et al., 2025; Abriol et al., 2024).
Across all three tables, the study indicates that nursing students possess very high knowledge (Mean = 4.58, SD = 0.35) regarding medication administration protocols, particularly in understanding policies (Mean = 4.93, SD = 0.30) and following the five rights (Mean = 4.82, SD = 0.49). Knowledge regarding dosage calculation (Mean = 4.03, SD = 0.78) and high-alert medications (Mean = 4.13, SD = 0.87) was high, reflecting areas where additional reinforcement may be beneficial (Jones et al., 2022; Lopez & Wright, 2020; Abunales et al., 2025).
Attitude scores were also very positive (Mean = 4.58, SD = 0.40), highlighting strong ethical orientation, prioritization of patient safety, and openness to feedback. Confidence in administering medications safely scored slightly lower (Mean = 4.13, SD = 0.83), suggesting that despite knowledge and positive attitude, students may still experience situational anxiety during clinical practice (Goodwin et al., 2022; Musharyanti et al., 2019).
Compliance was similarly high, with students reporting very high adherence to hospital and manufacturer policies, including error reporting and seeking clarification. This underscores that knowledge and positive attitude translate into practical behaviors, which is crucial for patient safety (Fusco et al., 2021; Bussières et al., 2023; Schutijser et al., 2018). However, the slightly lower confidence in policy application suggests a need for targeted educational interventions, such as simulation exercises, guided mentorship, and structured feedback, to consolidate theoretical knowledge and reduce errors in real clinical settings (Padilla & Santos, 2021; Park et al., 2025; Abriol et al., 2024). Institutions navigating resource challenges in nursing education may find that even modest investments in simulation and mentoring yield significant improvements in student confidence and compliance.
Overall, the study demonstrates that nursing students in the sampled population are well-prepared to perform safe medication administration, yet continuous reinforcement of dosage calculation, high-alert medication knowledge, and clinical confidence is recommended to ensure readiness for professional practice.
Correlation Between Knowledge, Attitude, and Compliance
Table 4 presents the Pearson correlation coefficients between nursing students' knowledge, attitudes, and compliance in medication administration. All correlations were statistically significant (p = 0.000), indicating a strong relationship between these variables.
The knowledge of medication administration procedures was moderately correlated with compliance (r = 0.460), suggesting that students who better understand protocols and dosage calculations are more likely to follow hospital and manufacturer policies accurately. Similarly, knowledge of the rights to medication administration showed a slightly stronger correlation (r = 0.547), highlighting that familiarity with the five rights is a critical predictor of safe practice (Fowler et al., 2021; Wright, 2019; Jones et al., 2022).
Attitudinal variables also demonstrated significant associations with compliance. Prioritizing patient safety had the strongest correlation (r = 0.657), indicating that students with heightened awareness of patient well-being and meticulous attention to detail are more diligent in adhering to safety protocols (Goodwin et al., 2022; Domingo & Reyes, 2023). The correlation between attitudes toward medication errors and compliance (r = 0.372) further confirms that ethical orientation, willingness to seek feedback, and learning from mistakes reinforce adherence to proper procedures (Natan et al., 2017; Musharyanti et al., 2019).
These findings align with prior research suggesting that knowledge alone is insufficient for ensuring safe medication administration; positive attitudes and ethical responsibility are equally critical (Fusco et al., 2021; Padilla & Santos, 2021; Abalos et al., 2023). The significant correlations support the conceptual framework that knowledge informs attitude, which in turn guides compliance, creating a cycle of safe clinical practice (Lopez & Wright, 2020; Park et al., 2025).
In clinical education, this underscores the importance of integrated teaching approaches that combine theoretical knowledge, simulation-based skill practice, and reflective exercises to cultivate both competence and confidence. Interventions that reinforce both knowledge and attitudes—such as unfolding case studies with standardized patients, simulation scenarios, and structured feedback—can significantly enhance compliance, reduce medication errors, and ultimately improve patient safety outcomes (Fusco et al., 2021; Bussières et al., 2023; Schutijser et al., 2018).
Multiple Regression Predicting Compliance
Table 5 presents the results of a multiple regression analysis examining which aspects of knowledge and attitudes predict nursing students' compliance with medication administration protocols. The model indicates that not all variables contributed significantly to predicting compliance.
Specifically, attitudinal factors—medication error awareness (B = 0.585, p = 0.000) and patient safety orientation (B = 0.404, p = 0.000)—emerged as significant predictors of compliance. This suggests that students who prioritize patient well-being, exercise vigilance, and actively learn from errors are more likely to adhere to both hospital and manufacturer policies (Goodwin et al., 2022; Natan et al., 2017; Wright, 2019). These findings reinforce the critical role of attitudes in translating knowledge into safe clinical practice, aligning with previous literature that emphasizes the ethical and behavioral components of medication safety (Domingo & Reyes, 2023; Fusco et al., 2021; Padilla & Santos, 2021).
In contrast, knowledge-based factors, including understanding medication administration procedures (B = -0.015, p = 0.913) and awareness of the five rights (B = 0.160, p = 0.193), did not significantly predict compliance in this model. While Table 4 showed moderate correlations between knowledge and compliance, the regression analysis indicates that when controlling for attitudinal variables, knowledge alone is insufficient to determine adherence. This underscores the notion that knowledge must be complemented by positive attitudes and ethical commitment to achieve high compliance in clinical settings (Fusco et al., 2021; Lopez & Wright, 2020).
Overall, the findings suggest that educational interventions should not only focus on knowledge acquisition but also foster reflective attitudes toward patient safety and proactive error prevention. Simulation-based training, structured feedback, and mentorship programs may strengthen the connection between knowledge and behavior, leading to improved adherence and reduced risk of medication errors (Bussières et al., 2023; Schutijser et al., 2018; Padilla & Santos, 2021). Incorporating techniques that build communication and de-escalation skills into nursing curricula may also support students in managing the interpersonal pressures that can lead to protocol deviations.
Limitations and Future Research
This study has several limitations. First, reliance on self-reported data may overestimate actual knowledge, attitudes, or compliance (Etikan et al., 2016; Lawrence, 2023). Second, the cross-sectional design limits causal inference and does not account for changes in competence over time. Third, the study was conducted in a single institution, which may affect generalizability. Fourth, direct observation of clinical performance was not undertaken; OSCEs or other practical assessments could provide a more accurate evaluation of safe practice. Finally, potential confounders such as prior clinical experience, stress, learning styles, or access to technological resources were not considered.
Future research should employ longitudinal and mixed methods designs to track knowledge, attitudes, and compliance over time. Integration of observational assessments alongside surveys can provide a more comprehensive evaluation. The role of technological interventions, including simulation-based training, QR code/RFID-assisted systems, and AI-guided learning platforms, should be explored to enhance preparedness and reduce errors (Abriol et al., 2024; IEEE Transactions on Biomedical Engineering, 2024). Investigations into mentorship programs, reflective practice, and interprofessional collaboration may further strengthen both knowledge and attitudes, improving compliance and patient safety outcomes.
Conclusion
Advanced nursing students (Levels 3 and 4) demonstrated high knowledge of medication administration protocols, very positive attitudes toward patient safety, and high self-reported compliance. Attitudinal factors, particularly commitment to patient safety and proactive error prevention, significantly predicted compliance beyond knowledge alone, underscoring the importance of the affective domain in shaping safe practice.
While students exhibit strong theoretical understanding, areas such as dosage calculations, high-alert medication knowledge, and clinical confidence require further reinforcement. Nursing education programs should integrate robust pharmacology instruction with experiential learning, simulation, mentorship, structured feedback, and non-punitive error reporting systems to enhance clinical competence, confidence, and patient safety. Future studies should expand to diverse settings, incorporate direct observational measures, and assess the longitudinal impact of educational interventions to further reduce medication errors and improve outcomes.
References
World Health Organization. (2017). Medication Without Harm: Global Patient Safety Challenge.
World Health Organization. (2023). Patient Safety Progress Report.
Kavanagh, C. (2017). Medication safety and the role of nurses.
Musharyanti, L., et al. (2019). Medication errors among nursing students: A systematic review.
Smith, A., Brown, L., & Chen, Y. (2018). Retrospective review of nursing student medication errors.
Abalos, E., et al. (2023). Knowledge gaps among Filipino nursing students in medication administration.
Baclig, A. (2022). Dosage calculation difficulties among nursing students.
Westbrook, J., et al. (2018). Interruptions and medication error risk.
Brabcová, I., Černá, K., & Hladík, J. (2023). Factors that discourage medication error reporting.
Natan, M.B., et al. (2017). Attitudes and behavioral intention toward safe medication practices.
Sansom, A. (2021). Affective determinants of compliance in medication administration.
Fowler, A., Smith, R., & Johnson, P. (2021). Adherence to institutional policies in nursing education. Journal of Nursing Education, 60(3), 145–152.
Wright, K. (2019). The role of the “rights” of medication administration in ensuring patient safety. Nursing Standard, 34(5), 74–82.
Hassan, L., & Haddad, M. (2021). Medication safety knowledge among nursing students: A cross-sectional study. International Journal of Nursing Practice, 27(6), e12904.
Abd Elmageed, W., Salama, H., & Abdelkader, M. (2020). Challenges in nursing students’ dosage calculation skills. Nurse Education Today, 85, 104275.
Fusco, L. A., Alfes, C. M., Weaver, A., & Zimmermann, E. (2021). Medication safety competence of undergraduate nursing students. Clinical Simulation in Nursing, 52, 1–7.
Musharyanti, F., Arifin, H., & Putri, R. (2021). High-alert medications and nursing students’ knowledge. Journal of Nursing Education and Practice, 11(6), 45–53.
Elliott, R. A., Ross-Degnan, D., & Adams, A. (2020). Medication errors and dosage miscalculations in healthcare settings. BMJ Quality & Safety, 29(2), 145–153.
Nuckols, T., Smith, M., & Bell, D. (2023). Clinical risk factors for medication errors among novice nurses. Journal of Patient Safety, 19(1), 23–31.
Aghabarary, M., Gholami, R., & Mahdavi, S. (2025). Understanding high-alert medications: Implications for nursing education. International Journal of Nursing Knowledge, 36(2), 101–112.
Ibrahim, R., Hamid, A., & Mustafa, S. (2021). Safe administration of high-alert medications: Knowledge and practices. Nursing Open, 8(4), 1890–1900.
Padilla, J., & Santos, M. A. (2021). Simulation-based medication administration training for improved safety competencies among Filipino nursing students. Journal of Philippine Nursing Education, 10(1), 55–66.
Abriol, A., Garcia, T., & Lim, C. (2024). Integrating QR code and RFID strategies in nursing education for medication safety. International Journal of Medical Informatics, 180, 104132.
Park, J., Kim, H., & Lee, S. (2025). Blended learning interventions to enhance nursing students’ medication competencies. Nurse Education Today, 120, 105657.
Goodwin, J., White, S., O’Malley, M., Hurley, E., O’Donovan, A., & Kelly, P. (2022). Mental health student nurses’ views of a medication workshop. International Journal of Mental Health Nursing, 31(4), 1011–1020.
Lopez, J., & Wright, P. (2018). Simulation training and student nurse confidence in medication administration. Journal of Nursing Education and Practice, 8(3), 55–63.
Institute for Safe Medication Practices (ISMP). (2021). Guidelines for safe medication practices. https://www.ismp.org
Domingo, M., & Reyes, J. (2023). Patient safety culture and adherence to medication rights among Filipino student nurses. ASEAN Journal of Nursing Education and Practice, 5(1), 32–44.
Jones, L., Patel, R., & Lee, K. (2022a). Ethical orientation and attitude toward patient safety among nursing students. Nurse Education Today, 109, 105192.
Natan, M. B., Sharon, I., Mahajna, M., & Mahajna, S. (2017). Factors affecting nursing students’ intention to report medication errors. Nurse Education Today, 58, 38–42.
Irvine, F., Black, K., & Roberts, C. (2024). Anxiety and confidence of student nurses during high-risk clinical procedures. Journal of Clinical Nursing, 33(7–8), 1150–1162.
Musharyanti, F., Arifin, H., & Putri, R. (2019). Nursing students’ clinical anxiety and its impact on safe medication practice. Journal of Nursing Education and Practice, 9(12), 45–53.
Bussières, J. F., Boulé, M., Prot-Labarthe, S., & Corriveau, C. (2023). Audit of compliance in medication preparation and administration by nursing staff in a mother-and-child hospital center. Canadian Journal of Hospital Pharmacy, 76(1), 16–22.
Schutijser, B., Klopotowska, J. E., Jongerden, I. P., Spreeuwenberg, P., Wagner, C., & de Bruijne, M. C. (2018). Nurse compliance with a protocol for safe injectable medication administration. BMJ Open, 8(1), e019648.
Abalos, E., Cruz, P., & Reyes, L. (2023). Confidence and adherence of student nurses to hospital medication policies. Philippine Journal of Nursing, 93(2), 23–32.
Lopez, J., & Wright, P. (2020). Reducing medication errors through adherence to manufacturer guidelines. International Journal of Patient Safety, 8(3), 102–110.
Etikan, I., Musa, S., & Alkassim, R. (2016). Comparison of convenience sampling and purposive sampling. American Journal of Theoretical and Applied Statistics, 5(1), 1–4. https://doi.org/10.11648/j.ajtas.20160501.11
Lawrence, F. (2023). Research methodology group UOPX research community: Causal comparative research. [Unpublished manuscript].
Abriol, N. D., Natividad, P. D. M., Gajeton, K. J. M., Saquido, M. C., & Tan, J. R. C. (2024). The integration of quick response (QR) codes and RFID in enhancing medication administration: A scoping review.
IEEE Transactions on Biomedical Engineering. (2024). RFID based health adherence medicine case using fair federated learning. https://doi.org/10.1109/TBME