Purpose
This study evaluated the immediate and sustained effects of a clinical decision-making program based on Simon’s decision-making model on medication safety competency among advanced-beginner nurses in intensive care units.
Methods
This nonequivalent control group pretest-posttest study used a time-lagged design and included 18 intensive care unit nurses at a tertiary hospital, with 12 assigned to the intervention group and six to the control group. The intervention group participated in a 2-week clinical decision-making program that integrated case-based learning and high-fidelity simulation, whereas the control group received lecture-based education. Clinical decision-making ability, medication safety competency, and safety motivation were measured at baseline and at 2 and 4 weeks after baseline. Near-miss medication error experiences were assessed at baseline and at 4 and 10 weeks. Data were analyzed using the independent t-test, Mann-Whitney U test, and linear mixed models.
Results
Clinical decision-making ability (F=3.94, p=.026), medication safety competency (F=4.97, p=.011), safety motivation (F=5.20, p=.009), and near-miss medication error experiences (F=14.28, p<.001) showed significant group-by-time interaction effects, indicating that outcome trajectories differed between the intervention and control groups.
Conclusion
These findings suggest that the program may be an educational strategy for strengthening nurses’ clinical decision-making during medication administration and improving medication and patient safety in intensive care unit settings.

Purpose
This study aimed to identify the mediating effect of fatigue in the relationship between clinical nurses’ job stress and medication safety performance.
Methods
For this cross-sectional study, 122 registered nurses were recruited through convenience sampling. The results were collected from August to September 2020 using self-reported structured questionnaires, analyzed with IBM SPSS Statistics 25.0 and using descriptive statistics, independent t-tests, one-way analysis of variance and Pearson correlation coefficient, and hierarchical multiple regression analysis. The mediating effect was analyzed using PROCESS macro with a 95.0% bias-corrected bootstrap confidence interval (5,000 bootstraps re-sampling).
Results
Significant positive correlation was observed between job stress and fatigue (r=.57, p<.001). Significant negative correlations were observed between job stress and medication safety performance (r=-.27, p=.003), fatigue, and medication safety performance (r=-.55, p<.001). Fatigue has a mediating effect between job stress and medication safety performance in nurses (indirect effect=-0.11, 95% Boot confidence interval=-0.16~-0.07).
Conclusion
To improve the medication safety performance of clinical nurses who experience job stress and fatigue, early detection and periodic observation of nurses’ job stress and fatigue should be made. Moreover, job stress and fatigue should be considered together in devising relevant interventions.

Citations

• Fatigue Among ICU Nurses and Its Influencing Factors: A Cross‐Sectional Study
  Yichen He, Yirui Wang, Jiayan Gou, Wei Zhang, Yuying Zhang, Weiguang Ma
  Nursing in Critical Care.2026;[Epub]     CrossRef
• The Influences of New Graduate Nurses’ Fatigue, Critical Thinking, and Nursing Work Environment on Patient Safety Nursing Behaviors
  Myojeong Kim, Yujeong Kim
  Journal of Korean Academy of Nursing Administration.2026; 32(1): 49.     CrossRef
• Experiences of Surgical Ward Nurses During a Healthcare Service Disruption in Korea: A Qualitative Study
  Sehyeon Im, Haeng-Mi Son
  Asian Nursing Research.2026;[Epub]     CrossRef
• The Mediating Effect of Self-Transcendence on the Relationship between Job Stress and Wellness among Nurses
  Sung Mi Kim, Da Eun Kim
  Journal of Korean Academy of Nursing Administration.2025; 31(4): 394.     CrossRef
• Factors influencing job stress in pediatric nurses during the pandemic period: Focusing on fatigue, pediatric nurse−parent partnership
  Bo Yeong Jeon, Sun Jeong Yun, Hye Young Kim
  Journal for Specialists in Pediatric Nursing.2024;[Epub]     CrossRef
• Comparison of methods for testing mediation effects under structural equation modeling framework: Percentile bootstrap and bias-corrected bootstrap
  Mikyung Sim, Youngsuk Suh, Su-Young Kim
  The Korean Journal of Psychology: General.2022; 41(2): 103.     CrossRef