Four-Week Education Program Boosts Psychiatric Nurses’ Medication Error Knowledge

A structured four-week educational program delivered to psychiatric nurses in Assiut, Egypt, significantly improved their knowledge about medication errors and was associated with a moderate decline in self-reported medication errors, according to a quasi-experimental study published in BMC Nursing. The program did not, however, produce a statistically significant reduction in stress of conscience, the inner moral strain nurses experience when their professional actions conflict with their ethical values. The findings come from one of the few interventions to target medication safety and moral distress simultaneously in psychiatric care settings.

The study enrolled 89 psychiatric nurses drawn from the inpatient units of two facilities: Assiut University Psychiatric Hospital and Assiut Mental Health Hospital, which is run by the Ministry of Health. Participants were recruited as a convenience sample because the intervention was embedded in routine staff development, making randomization impractical. All participants were female, with a mean age of 29.8 years, and 83.1 percent worked at the university psychiatric hospital. An a priori power analysis indicated that 34 participants would suffice to detect a medium effect, so the final sample of 89 provided adequate statistical power.

The researchers used a one-group pre-test/post-test quasi-experimental design, assessing each nurse immediately before and immediately after the program with the same instruments. The team acknowledged that this design limits causal inference: maturation effects, history effects, Hawthorne effects, and testing bias cannot be fully excluded, and causal interpretations were made cautiously. Reporting followed the TREND Statement recommendations for non-randomized behavioral and public health interventions.

The intervention itself ran for four weeks, with nurses divided into small groups of no more than five. Each group received twelve sessions, three per week, lasting 30 to 45 minutes, held in the recreational hall of the hospital. Content covered the definition, causes, and types of medication errors in psychiatric departments; prevention strategies demonstrated through scenarios of correct medication administration; and reflective discussion of the conscience concept. Teaching methods included demonstration, lecture, audio, and video. Data collection spanned from the beginning of September 2023 to the end of August 2024.

Knowledge was measured with a Medication-Error Knowledge and Practice Questionnaire adapted from the Medication Administration Error Survey, covering factors contributing to errors, barriers to reporting, and safe administration practices. Content validity was reviewed by senior nursing educators and psychiatric nursing specialists, with a content validity index of 0.91. Internal consistency was acceptable, with Cronbach’s alpha of 0.87 at pre-test and 0.89 at post-test. Stress of conscience was assessed with the Stress of Conscience Questionnaire, a nine-item instrument in which exposure to stressful situations is multiplied by the degree to which each troubles the respondent’s conscience, yielding total scores from 0 to 225.

The primary knowledge result was clear. Mean knowledge scores rose from 63.20 before the program to 72.19 afterward, a change the authors report as statistically significant with a medium effect size of 0.71. Reported medication errors declined moderately after the program, with an effect size of 0.54. Sub-analyses showed significant improvement in knowledge of the classification and causes of medication errors, while knowledge about the causes of not reporting errors did not improve significantly.

Stress-of-conscience scores, by contrast, decreased only slightly, from 37.0 to 36.0 on average, a difference that was not statistically significant. The authors suggest this may reflect the short duration of the intervention and the persistence of organizational and emotional stressors in psychiatric settings, where ethical stress is often shaped by institutional constraints, staffing shortages, and prolonged emotional exposure. They note that addressing moral stress may require longer psychosocial and organizational interventions before measurable improvements appear.

The study also documented a weak but statistically significant negative correlation between stress of conscience and medication errors, meaning higher stress of conscience was associated with a greater frequency of reported errors. The authors emphasize that the magnitude of the correlation was small, that stress of conscience is likely only one of several factors linked to medication-error occurrence, and that no causal relationship can be inferred from the study design.

Baseline descriptive findings offered a portrait of error patterns in these units. Nearly half of participants, 48.3 percent, reported having committed a medication error once, 40.4 percent reported two to three errors, and 11.2 percent reported more than three. A large majority, 86.5 percent, were aware when an error occurred, and 80.9 percent reported the incident, though nearly one-fifth refrained from reporting, which the authors attribute to barriers such as fear of blame or punitive consequences. No statistically significant associations were found between knowledge or conscience scores and nurses’ socio-demographic characteristics.

The authors caution that the one-group design without a control group restricts causal inference, that medication errors were self-reported and may have been underreported due to social desirability bias, and that the sample of two psychiatric hospitals with predominantly female nurses limits generalizability. The short follow-up period also precluded assessment of whether any effects were sustained. They recommend future randomized controlled or longitudinal studies incorporating objective data such as incident reports, and interventions that combine medication-safety education with cognitive-behavioral and organizational-support components to address both patient safety and nurses’ moral well-being.

Subject of Research: A quasi-experimental study of a structured educational program on medication error knowledge and stress of conscience among psychiatric nurses in Egypt

Article Title: Effectiveness of a structured educational program on knowledge about medication errors and stress of conscience among psychiatric nurses

Article References: Saraya, O. A. A. E.-F. A., Hossny, E. E. K., Mohamed, H. M., Arafat, A. E. A., Abuzaid, A. M. A. E.-A., Sweelam, R. K. M., & zaher, A. S. M. A. (2026). Effectiveness of a structured educational program on knowledge about medication errors and stress of conscience among psychiatric nurses. BMC Nursing, 25(1), Article 1008. https://doi.org/10.1186/s12912-026-05444-8

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05444-8

Keywords: psychiatric nursing, medication errors, patient safety, stress of conscience, nursing education, quasi-experimental study, Egypt, moral distress, medication safety, continuing education, BMC Nursing, pre-post study