Improving safety during medication administration has been a goal of today’s healthcare environment. The complexity of both medication use and the medication management process, especially in the in-patient setting, creates a significant risk for hospitalized clients. Medication administration errors have harmed millions of people and cost millions of dollars worldwide, including Malaysia. Patient safety is dependent on nurses (including student nurses), who must consistently demonstrate behaviour fundamental to the safe administration of medication. Therefore, nursing education must provide teaching and foster learning in students to prepare them to be a safe nurse. Literature has shown that deficiencies of knowledge and performance were the most common cause of medication errors apart from system errors. Literature has also shown that a simulation refresher course is an effective tool to increase and improve knowledge. This study describes the effectiveness of a simulation refresher course on nursing student knowledge and performance in medication administration using the SAM Scale. A pre-test using the SAM Scale was administered to 83 student participants who were divided randomly into two groups: an intervention group and a control group. Both groups underwent a pre-test with the SAM Scale. Then the intervention group underwent a simulation refresher course after a pre-test, whereas the control group followed their ‘program as usual’. It was hypothesized that the simulation refresher course would result in higher SAM Scale scores in the intervention group versus the control group on follow-up testing. One month after the pre-test, both groups underwent a post-test # 1 using the same SAM scale and one month later (after post-test #1) a second post-test was administered to all participants. The findings of the study were not what was hypothesized. Even though there were statistically significant differences in the scores before and after the simulation in the intervention group, the control group also shows the same statistically significant increase in scores. Therefore, the study concluded that in this instance the simulation refresher course did not show any benefit over use of the SAM Scale in improving medication administration scores. The study indicates that the use of SAM Scale itself can be an excellent tool to enhance knowledge and performance in medication administration among nursing students. Key words: nursing students, medication administration error, simulation, refresher course, barrier to safe MA.

LLU Discipline





School of Nursing

First Advisor

Pothier, Patricia

Second Advisor

D'Errico, Ellen D.

Third Advisor

Ramal, Edelweiss

Degree Name

Doctor of Philosophy (PhD)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Nursing - Study and Teaching; Simulation Training; Drugs - Administration - Safety Measures; Drugs - Administration & Dosage - Nurses' Instruction; Medication Errors; Patient Simulation; Malaysia

Subject - Local

Nursing Students; Medication Administration Error; Knowledge Deficiencies; SAM Scale



Page Count


Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives

Included in

Nursing Commons