{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:43:06Z","timestamp":1785544986586,"version":"3.56.0"},"reference-count":52,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Nursing"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Medical errors occur more frequently in health care than in other industries due to challenges in patient safety education for nurses and students. To address this, it is important to identify the factors and structures underlying clinical errors and apply these insights to educational programs. Medication-related errors are highly preventable with appropriate interventions, highlighting the importance of data-driven safety education. Previous research suggests that unit adaptation, rather than clinical experience alone, plays a critical role in error occurrence. Focusing on \u201cadaptive performance,\u201d an underexplored concept in nursing, can help identify new educational strategies and interventions.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This hypothesis-generating study used Bayesian network modeling to examine how unit experience\u2014and, secondarily, total nursing experience\u2014relates to the structure of medication-related errors, with implications for data-driven patient safety education and nursing student instruction.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This mixed methods study conducted a qualitative root cause analysis of medication error reports to identify causal factors. Bayesian network modeling, an artificial intelligence\u2013based approach, was used to visualize error-generation flows and compare models based on years of experience within the current unit. Data were obtained from 2023 medication-related error reports submitted by nurses to the Japan Council for Quality Health Care.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 119 medication-related incidents, the largest proportion occurred in internal medicine departments (n=47 cases, 39.5%), followed by surgical departments (n=27 cases, 22.7%), the intensive care unit (n=10 cases, 8.4%), and the emergency room (n=7 cases, 5.9%). Most incidents occurred in patient rooms or wards (n=97 cases, 81.5%). Root cause analysis identified 10 types of medication-related events and 23 contributing factors. Cases were categorized into low-, moderate-, and high-adaptation groups based on years of experience in the current unit. In the low-adaptation group (n=33), 69.7% of nurses had \u22655 years of total nursing experience, indicating that the group did not consist solely of novice nurses. The average entropy of incident events across the Bayesian network models ranged from 0.37 to 0.78, suggesting moderate to relatively high uncertainty in the inferred error structures. The moderate- and high-adaptation models exhibited fewer complex error networks, with weaker chains of unsafe conditions or actions than the low-adaptation model. The extensive clinical experience did not always prevent errors; rather, it was often linked to lapses in verification behavior.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Unit adaptation appears to play a critical role in shaping error pathways. Nurses with lower unit adaptation demonstrated more complex error structures, indicating higher vulnerability to incident chains. In contrast, total years of nursing experience did not uniformly reduce risk and may even relate to lapses in verification behaviors.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/87436","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T09:35:06Z","timestamp":1779701706000},"page":"e87436-e87436","source":"Crossref","is-referenced-by-count":0,"title":["Medication-Related Errors Among Nurses by Unit Adaptation Levels: Bayesian Network\u2013Based Exploratory Study"],"prefix":"10.2196","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3986-7536","authenticated-orcid":false,"given":"Naotaka","family":"Sugimura","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5474-7861","authenticated-orcid":false,"given":"Katsuhiko","family":"Ogasawara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,7,7]]},"reference":[{"issue":"2","key":"R1","doi-asserted-by":"publisher","DOI":"10.2196\/mededu.4789","article-title":"A conceptual analytics model for an outcome-driven quality management framework as part of professional healthcare education","volume":"1","author":"Hervatis","journal-title":"JMIR Med Educ"},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2021.110621","article-title":"The impact of data-driven learning on graduate medical education","volume":"78","author":"Mohamed","journal-title":"J Clin Anesth"},{"issue":"2","key":"R3","doi-asserted-by":"publisher","DOI":"10.1177\/21582440241242180","article-title":"A systematic review of big data driven education evaluation","volume":"14","author":"Lin","journal-title":"Sage Open"},{"key":"R4","unstructured":"Patient safety. World Health Organization. URL: https:\/\/www.who.int\/features\/factfiles\/patient_safety\/en\/ [Accessed 13-10-2025]"},{"issue":"1","key":"R5","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3928\/01484834-20131209-04","article-title":"What do nursing students learn about patient safety? An integrative literature review","volume":"53","author":"Tella","journal-title":"J Nurs Educ"},{"issue":"4","key":"R6","doi-asserted-by":"publisher","first-page":"1967","DOI":"10.1002\/nop2.955","article-title":"Patient safety educational interventions: a systematic review with recommendations for nurse educators","volume":"9","author":"Lee","journal-title":"Nurs Open"},{"key":"R7","unstructured":"The essentials: core competencies for professional nursing education. American Association of Colleges of Nursing; 2021. URL: https:\/\/www.aacnnursing.org\/Portals\/0\/PDFs\/Publications\/Essentials-2026.pdf [Accessed 13-10-2025]"},{"key":"R8","doi-asserted-by":"crossref","unstructured":"Wittmann-Price RA . Competency-based curriculum development. In: Wittmann RA Gittings KK , editors. Fast Facts About Competency-Based Education in Nursing How to Teach Competency Mastery. 1st ed. Springer; 2020:17-35. ISBN: 9780826136633","DOI":"10.1891\/9780826136633.0002"},{"key":"R9","unstructured":"Grigsby K . Curriculum models for graduate programs. In: Billings DM Halstead JA , editors. Teaching in Nursing: A Guide for Faculty. 6th ed. Elsevier; 2019:163-180. ISBN: 9780323570374"},{"issue":"2","key":"R10","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1111\/j.1365-2834.2007.00627.x","article-title":"Challenges in delivering safe patient care: a commentary on a quality improvement initiative","volume":"15","author":"Currie","journal-title":"J Nurs Manag"},{"issue":"1","key":"R11","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.apnr.2008.02.004","article-title":"Error identification and recovery by student nurses using human patient simulation: opportunity to improve patient safety","volume":"23","author":"Henneman","journal-title":"Appl Nurs Res"},{"key":"R12","doi-asserted-by":"publisher","DOI":"10.1016\/j.profnurs.2025.02.004","article-title":"Utilization of backward design in health professional education: a rapid review","volume":"58","author":"Rinaldi","journal-title":"J Prof Nurs"},{"issue":"1","key":"R13","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-020-01774-9","article-title":"Preventable medication harm across health care settings: a systematic review and meta-analysis","volume":"18","author":"Hodkinson","journal-title":"BMC Med"},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4185","article-title":"Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis","volume":"366","author":"Panagioti","journal-title":"BMJ"},{"key":"R15","doi-asserted-by":"publisher","DOI":"10.3352\/jeehp.2024.21.12","article-title":"Events related to medication errors and related factors involving nurses\u2019 behavior to reduce medication errors in Japan: a Bayesian network modeling-based factor analysis and scenario analysis","volume":"21","author":"Sugimura","journal-title":"J Educ Eval Health Prof"},{"issue":"2","key":"R16","doi-asserted-by":"publisher","first-page":"327","DOI":"10.5465\/amj.2007.24634438","article-title":"A new model of work role performance: positive behavior in uncertain and interdependent contexts","volume":"50","author":"Griffin","journal-title":"Acad Manage J"},{"issue":"2","key":"R17","doi-asserted-by":"publisher","DOI":"10.1111\/jjns.12518","article-title":"Validity and reliability of the Japanese version of the Nursing Performance Instrument","volume":"20","author":"Sugimura","journal-title":"Jpn J Nurs Sci"},{"issue":"2","key":"R18","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1016\/j.smrv.2011.05.004","article-title":"Fatigue-proofing: a new approach to reducing fatigue-related risk using the principles of error management","volume":"16","author":"Dawson","journal-title":"Sleep Med Rev"},{"issue":"2","key":"R19","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1016\/j.aap.2009.11.007","article-title":"Fatigue risk management: organizational factors at the regulatory and industry\/company level","volume":"43","author":"Gander","journal-title":"Accid Anal Prev"},{"key":"R20","unstructured":"Benner P Tanner C Chesla C . Expertise in Nursing Practice: Caring, Clinical Judgment, and Ethics. 1st ed. Springer; 1996. ISBN: 9780826187000"},{"issue":"1","key":"R21","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1111\/wvn.12622","article-title":"A global examination of clinical ladder programs\u2014a synthesis of commonalities and opportunities for standardization","volume":"20","author":"Slagle","journal-title":"Worldviews Evid Based Nurs"},{"issue":"11","key":"R22","doi-asserted-by":"publisher","first-page":"7597","DOI":"10.1111\/jan.16723","article-title":"Challenge-hindrance stressors and novice nurses\u2019 safety behaviour: the mediating role of regulatory focus and the moderating role of workplace spirituality","volume":"81","author":"Hou","journal-title":"J Adv Nurs"},{"issue":"5","key":"R23","doi-asserted-by":"publisher","first-page":"1070","DOI":"10.1111\/jonm.13033","article-title":"Transition shock and newly graduated nurses\u2019 job outcomes and select patient outcomes: a cross-sectional study","volume":"28","author":"Labrague","journal-title":"J Nurs Manag"},{"issue":"7","key":"R24","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare10071157","article-title":"Stepwise interactive situated training program for young nurses\u2019 safety behavior and interrupted coping behavior","volume":"10","author":"Yan","journal-title":"Healthcare (Basel)"},{"issue":"11","key":"R25","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1097\/00005110-200411000-00010","article-title":"Themes surrounding novice nurse near-miss and adverse-event situations","volume":"34","author":"Ebright","journal-title":"J Nurs Adm"},{"issue":"2","key":"R26","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1097\/00001888-200102000-00008","article-title":"A system of analyzing medical errors to improve GME curricula and programs","volume":"76","author":"Battles","journal-title":"Acad Med"},{"key":"R27","unstructured":"Outline [Article in Japanese]. Japan Council for Quality Health Care. URL: https:\/\/www.med-safe.jp\/contents\/english\/index.html [Accessed 13-10-2025]"},{"issue":"1","key":"R28","doi-asserted-by":"publisher","first-page":"1","DOI":"10.33160\/yam.2018.03.001","article-title":"Nursing competency: definition, structure and development","volume":"61","author":"Fukada","journal-title":"Yonago Acta Med"},{"issue":"6","key":"R29","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-067352","article-title":"Competency in nursing practice: a concept analysis","volume":"13","author":"Mrayyan","journal-title":"BMJ Open"},{"key":"R30","doi-asserted-by":"publisher","DOI":"10.1016\/j.nepr.2023.103826","article-title":"Factors affecting the development of clinical nurses\u2019 competency: a systematic review","volume":"73","author":"Almarwani","journal-title":"Nurse Educ Pract"},{"issue":"3","key":"R31","doi-asserted-by":"publisher","DOI":"10.1097\/jnr.0000000000000617","article-title":"Effects of length of employment and head nurse leadership style on the clinical competency of staff nurses in Taiwan","volume":"32","author":"Lin","journal-title":"J Nurs Res"},{"issue":"1","key":"R32","doi-asserted-by":"publisher","first-page":"9","DOI":"10.33160\/yam.2024.02.002","article-title":"Relationship between clinical nursing competence and work environment by career stage for nurses with 1-10 years of clinical experience","volume":"67","author":"Saiga","journal-title":"Yonago Acta Med"},{"key":"R33","unstructured":"Career philosophy [Article in Japanese]. Hokkaido University Hospital Nursing Department. URL: https:\/\/www.kango-hokudai.jp\/career [Accessed 01-03-2026]"},{"key":"R34","unstructured":"Campbell JP . Modeling the performance prediction problem in industrial and organizational psychology. In: Dunnette MD Hough LM , editors. Handbook of Industrial and Organizational Psychology. Consulting Psychologists Press; 1990:687-732. ISBN: 978-0891060413"},{"issue":"4","key":"R35","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1111\/1468-2389.00151","article-title":"Perspectives on models of job performance","volume":"8","author":"Viswesvaran","journal-title":"Int J Sel Assess"},{"issue":"8","key":"R36","doi-asserted-by":"publisher","first-page":"856","DOI":"10.1097\/JOM.0b013e318226a763","article-title":"Conceptual frameworks of individual work performance: a systematic review","volume":"53","author":"Koopmans","journal-title":"J Occup Environ Med"},{"key":"R37","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssci.2015.06.002","article-title":"Use of a human factors classification framework to identify causal factors for medication and medical device-related adverse clinical incidents","volume":"79","author":"Mitchell","journal-title":"Saf Sci"},{"issue":"4","key":"R38","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.1016\/j.ssci.2011.12.003","article-title":"Analysis of factors that influence hazardous material transportation accidents based on Bayesian networks: a case study in China","volume":"50","author":"Zhao","journal-title":"Saf Sci"},{"issue":"1","key":"R39","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzaf009","article-title":"Applying the human factors analysis and classification system within root cause analysis to prevent medical errors and enhancing patient safety culture: insights from a medical center","volume":"37","author":"Lee","journal-title":"Int J Qual Health Care"},{"issue":"4","key":"R40","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0319483","article-title":"Educational needs for medication safety competence among nurses by clinical ladder stage","volume":"20","author":"Jung","journal-title":"PLoS One"},{"issue":"2","key":"R41","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1097\/PTS.0000000000000810","article-title":"Understanding the \u201cSwiss cheese model\u201d and its application to patient safety","volume":"18","author":"Wiegmann","journal-title":"J Patient Saf"},{"issue":"1","key":"R42","doi-asserted-by":"publisher","first-page":"e351","DOI":"10.1097\/PTS.0000000000000782","article-title":"Impact of teamwork and communication training interventions on safety culture and patient safety in emergency departments: a systematic review","volume":"18","author":"Alsabri","journal-title":"J Patient Saf"},{"issue":"5","key":"R43","doi-asserted-by":"publisher","first-page":"687","DOI":"10.7326\/ANNALS-24-02904","article-title":"Impacts of communication type and quality on patient safety incidents: a systematic review","volume":"178","author":"Keshtkar","journal-title":"Ann Intern Med"},{"issue":"1","key":"R44","doi-asserted-by":"publisher","DOI":"10.1186\/s12912-021-00684-2","article-title":"A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward","volume":"20","author":"Kwame","journal-title":"BMC Nurs"},{"key":"R45","doi-asserted-by":"publisher","DOI":"10.1016\/j.obhdp.2023.104255","article-title":"The limits of psychological safety: nonlinear relationships with performance","volume":"177","author":"Eldor","journal-title":"Organ Behav Hum Decis Process"},{"issue":"1","key":"R46","doi-asserted-by":"publisher","DOI":"10.2196\/23933","article-title":"Predicted influences of artificial intelligence on nursing education: scoping review","volume":"4","author":"Buchanan","journal-title":"JMIR Nurs"},{"key":"R47","doi-asserted-by":"publisher","DOI":"10.2196\/66186","article-title":"Effect of immersive virtual reality teamwork training on safety behaviors during surgical cases: nonrandomized intervention versus controlled pilot study","volume":"11","author":"Mazur","journal-title":"JMIR Med Educ"},{"issue":"1","key":"R48","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1037\/0021-9010.87.1.66","article-title":"The relative importance of task, citizenship, and counterproductive performance to global ratings of job performance: a policy-capturing approach","volume":"87","author":"Rotundo","journal-title":"J Appl Psychol"},{"key":"R49","doi-asserted-by":"publisher","DOI":"10.2196\/67873","article-title":"Technology acceptance model in medical education: systematic review","volume":"11","author":"Lee","journal-title":"JMIR Med Educ"},{"issue":"10","key":"R50","doi-asserted-by":"publisher","DOI":"10.3390\/jpm11100945","article-title":"The impact of the COVID-19 pandemic on nursing care: a cross-sectional survey-based study","volume":"11","author":"Clari","journal-title":"J Pers Med"},{"issue":"Suppl 13","key":"R51","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2105-13-S13-S10","article-title":"Model averaging strategies for structure learning in Bayesian networks with limited data","volume":"13 Suppl 13","author":"Broom","journal-title":"BMC Bioinformatics"},{"issue":"6","key":"R52","doi-asserted-by":"publisher","first-page":"455","DOI":"10.5271\/sjweh.3177","article-title":"Work strain in midlife and 28-year work ability trajectories","volume":"37","author":"von Bonsdorff","journal-title":"Scand J Work Environ Health"}],"container-title":["JMIR Nursing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/nursing.jmir.org\/2026\/1\/e87436","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:25:13Z","timestamp":1785536713000},"score":1,"resource":{"primary":{"URL":"https:\/\/nursing.jmir.org\/2026\/1\/e87436"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,7]]},"references-count":52,"URL":"https:\/\/doi.org\/10.2196\/87436","relation":{},"ISSN":["2562-7600"],"issn-type":[{"value":"2562-7600","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,7]]},"article-number":"v9i2e87436"}}