Colegio de Sta Lourdes of Leyte Foundation, Inc.

(CSLLFI) Student Nurses’

Perception of the Causes of Medication Administration Errors

A Research Study
Presented to the
Faculty of the College of Nursing
Colegio de Sta. Lourdes of Leyte Foundation, Inc
Tabontabon, Leyte

April 2012

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 Chapter I

Introduction

Problem and Its Background

With the growing reliance on medication therapy as the primary intervention for most

illnesses, patients receiving medication interventions are exposed to potential harm from

medication administration errors (MAE) which outweigh the benefits obtained such as effective

management of the illness, slowed progression of the disease, and improved patient outcomes

(Hughes and Blegen, 2011). The concept of medication administration (MA) within the

healthcare setting has long been the focus of scrutiny and research, in part because medication

administration errors contribute directly to patient morbidity and mortality (Tissot, et al., 2003).

According to Kohn, et al. (2009), medication errors are considered the eighth leading

cause of death in the world and occur at a rate greater than motor vehicle accidents, breast

cancer, or AIDS. Medication errors occur in nearly 1 of every 5 doses given to patients in the

typical hospital of 300 beds (Barker, et al., 2002). This translates to an average of 2 errors per

patient per day. Although not all these errors are dangerous, 7 percent can be fatal if not

potentially fatal. In the Philippines, there is a difficulty in obtaining the correct statistics on

medication errors because many of these errors are neither recognized nor reported (HERO,

2011). In addition, the problems, sources, and methods involving medication errors are

multifactorial and multidisciplinary.

Several definitions of what constitutes a MAE exist in published research and literature.

One definition of MAE cited by Headford, et al. (2001), which is frequently employed by

healthcare professionals, is any deviation from the physician’s medication order as written on the

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patient’s chart. Davydov, et al. (2004) finds this definition limited as it fails to consider

prescribing errors as a contributing factor. Wolf (1999) gives a more complete definition of MAE

and refers to it as mistakes associated with drugs and intravenous solutions that are made during

the prescription, transcription, dispensing, and administration phases of drug preparation and

distribution.

These errors can be classified as either acts of commission or omission, and may include

the following: wrong drug, wrong route, wrong dose, wrong patient, wrong timing of drug

administration, wrong site, wrong drug form, wrong infusion rate, expired medication date, or

prescription error. Such errors can occur in either an intentional or unintentional manner. Another

is the classification of Williams (2007), dividing errors into prescribing, dispensing, and

administration errors.

Medication administration is a complex and time-consuming task and occupies up to one-

third of nurses’ time (Pepper, 2005). Because of the complexity of the medication administration

process, there is much potential for error. Since nurses actually administer the medication to the

patient, they often assume or are assigned responsibility for these errors; however, the actions of

everyone involved in the system and the system design itself contribute to errors.

While the literature has focused on error-reporting systems and ways to prevent errors,

relatively little attention has been paid to why errors occur. Proposed reasons as to why

medication administration errors occur fall into the following categories: (a) inadequate

knowledge and skills, (b) failure to comply with policy and procedure or lack of procedures, (c)

failure in communication, and (d) individual and systems issues (Fuqua & Stevens, 1998).

Because of the lack of literature on causes of medication administration errors, this study

was directed toward documenting the reasons of such as perceived by nursing students.

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Furthermore, this study also aimed in gathering students’ insights as to whether or not ideal

medication administration practices have been followed by nurses and the bearing of such

practices on the quality of care being rendered.

Statement of the Problem

This research generally endeavored to evaluate student nurses’ perception of the causes of

medication administration errors. The specific research questions to answered were as follows:

1) What are the socio-demographic characteristics of nursing student respondents in

terms of the following:

a. Year level

b. Age

c. Sex

2) What are the perceived causes of medication administration errors of student nurses

of CSLLFI with consideration to the following:

3) To what extent are ideal medication administration practices being followed by

clinical nurses as perceived by students?

4) What is the relationship between the perceived extent of compliance of nurses to ideal

medication administration practices and students’ perceived causes of MAE?

5) Do respondents’ of varying socio-demographic characteristics differ in their

perception of MAE causes?

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Significance of the Study

Results gleaned from this research endeavor are important to the following entities:

Hospital Administrators. This study will serve as an input in devising policies that will

strengthen the medication administration process in various units, basing on the causes of

medication administration errors identified by students. Furthermore, results will be used in

determining the focus of efforts to avoid, if not reduce, medication errors. Specifically, students

can present an outline of the findings of this study to the administrators of Tacloban City

hospitals for increased awareness. In this manner, the type of care rendered in terms of giving of

medications will be elevated.

Clinical Nurses. Because this study will gather students’ observation whether or not

clinical nurses adhere to the ideals of medication administration as well as students’ perceived

reasons as to why medication administration errors occur, clinical nurses can then employ a

watchful and careful stance when administering medications basing on the presented findings.

Nursing Students. This study will provide helpful inputs as to the nature of medication

administration errors. This topic is not usually part of classroom discussions and deviates from

ideal standards of practice, and as such, can serve as an eye opener for them. Perhaps to aid in

increasing students’ awareness about MAEs and their prevention, clinical instructors can

synthesize the results of the findings of this study into a module (i.e. group discussion or role

playing) students can use and learn from. In addition, this study can also inspire students to

undertake similar researches to increase the quality of nursing care rendered.

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Theoretical Framework

This study borrows from the postulates of Albert Bandura’s Social Learning Theory.

According to him, “Learning would be exceedingly laborious, not to mention hazardous, if

people had to rely solely on the effects of their own actions to inform them what to do.

Fortunately, most human behavior is learned observationally through modeling: from observing

others one forms an idea of how new behaviors are performed, and on later occasions this coded

information serves as a guide for action.” (1977).

The Social Learning Theory proposed has become perhaps the most influential theory of

learning and development. While rooted in many of the basic concepts of traditional learning

theory, Bandura believed that direct reinforcement could not account for all types of learning.

His theory added a social element, arguing that people can learn new information and behaviors

by watching other people. Known as observational learning (or modeling), this type of learning

can be used to explain a wide variety of behaviors.

Basic Social Learning Concepts

1. People can learn through observation. In his famous “Bobo doll” studies, Bandura

demonstrated that children learn and imitate behaviors they have observed in other people. The

children in Bandura’s studies observed an adult acting violently toward a Bobo doll. When the

children were later allowed to play in a room with the Bobo doll, they began to imitate the

aggressive actions they had previously observed.

Bandura also identified three basic models of observational learning:

a. A live model, which involves an actual individual demonstrating or acting out a

behavior.

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 b. A verbal instructional model, which involves descriptions and explanations of a

behavior.

c. A symbolic model, which involves real or fictional characters displaying behaviors in

books, films, television programs, or online media.

2. Mental states are important to learning. Bandura also noted that external, environmental

reinforcement was not the only factor to influence learning and behavior. He described intrinsic

reinforcement as a form of internal reward such as pride, satisfaction, and a sense of

accomplishment. This emphasis on internal thoughts and cognitions helps connect learning

theories to cognitive developmental theories. While many textbooks place social learning theory

with behavioral theories, Bandura himself describes his approach as a “social cognitive theory.”

3. Learning does not necessarily lead to a change in behavior. While behaviorists believed that

learning led to a permanent change in behavior, observational learning demonstrates that people

can learn new information without demonstrating new behaviors.

The Modeling Process

Not all observed behaviors are effectively learned. Factors involving both the model and the

learner can play a role in whether social learning is successful. Certain requirements and steps

must also be followed. The following steps are involved in the observational learning and

modeling process:

1. Attention. In order to learn, you need to be paying attention. Anything that detracts your

attention is going to have a negative effect on observational learning. If the model interesting or

there is a novel aspect to the situation, you are far more likely to dedicate your full attention to

learning.

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2. Retention. The ability to store information is also an important part of the learning process.

Retention can be affected by a number of factors, but the ability to pull up information later and

act on it is vital to observational learning.

3. Reproduction. Once you have paid attention to the model and retained the information, it is

time to actually perform the behavior you observed. Further practice of the learned behavior

leads to improvement and skill advancement.

4. Motivation. Finally, in order for observational learning to be successful, you have to be

motivated to imitate the behavior that has been modeled. Reinforcement and punishment play an

important role in motivation. While experiencing these motivators can be highly effective, so can

observing other experience some type of reinforcement or punishment. For example, if you see

another student rewarded with extra credit for being to class on time, you might start to show up

a few minutes early each day.

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Conceptual Framework

Figure 1 shows the relationship of the research variables. As depicted, the adherence of

healthcare professionals to the ideal medication administration practices serve as the independent

variable. This leads to formed perceptions of the causes of MAE by student nurse respondents,

the dependent variables of the study, as mediated by their respective socio-demographic

characteristics.

Figure 1. Conceptual relationship of research variables

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Hypothesis

This study postulates that there is no significant relationship between student nurses’

perception of whether or not clinical nurses adhere to the ideals of medication administration and

students’ perception of the causes of MAE. Furthermore, the respective socio-demographic

characteristics of study respondents also do not play an intervening role on the perceived causes

of MAE.

Scope and Limitation

Third year and fourth year students from CSLLFI, who have undergone clinical duty,

served as student respondents.

The perceived reasons by students as to why medication administration errors occur will

be measured in this study. However, reasons were already predetermined based on the existing

literature about MAE. Students were made to give their agreement or disagreement based on

their observation. Causes extended to involve other factors such as physician, system, and drug,

and did not just focus on nurses. In addition, the extent of how the ideals of medication

administration were being followed by clinical nurses as perceived by students was also

assessed. The attitude and practices of healthcare practitioners, however, were not evaluated in

this research endeavor.

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Definition of Terms

The following key terms are used in this study:

1. Medication administration errors. Refer to mistakes associated with drugs and

intravenous solutions that are made during the prescription, transcription, dispensing, and

administration phases of drug preparation and distribution, committed by nurses and

other healthcare professionals.

2. Socio-demographic characteristics. These are the personal characteristics that the study

respondents had during the time of the study and included the following:

a. Year level. Respondents either belonged to the 3rd year or 4th year levels.

b. Age group. Based on Eric Ericson’s classification, respondents can be grouped

either under the late adolescent (17 to 19 years old) or your adult (20 years old

and above) group.

c. Sex. Students can be categorized as male or female.

3. Perception of the causes of medication administration errors. This refers to respondents’

degree of agreement or disagreement to the enumerated statements about the causes of

MAE with respect to the following

a. Physician-related (6 statements). Causes associated with prescription errors of

medical doctors.

b. System-related (5 statements). Pertains to causes that fall under the hospital

climate, policies, and protocols.

c. Individual- (6 statements) and knowledge-related (5 statements). These are

causes usually committed by nurses and involve the performance of their duty

when it comes to medication administration.

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 d. Drug-manufacturing-related (3 statements). Refers to causes of MAEs which

might arise from the naming and retailing of drugs.

Because statements are structured negatively, scoring of responses were as follows:

Strongly agree - 1
Agree - 2
Somewhat agree - 3
Disagree - 4
Strongly disagree - 5

4. Extent to which ideal medication administration practices are followed. This measured

how much clinical nurses adhered to the standards of medication administration as

perceived by student respondents. Standards were based on the patients’ rights of drug

administration. Scoring was in a form of rating with the corresponding values:

Very Satisfactory - 5
Satisfactory - 4
Somewhat Satisfactory - 3
Unsatisfactory - 2
Very Unsatisfactory - 1

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 Chapter 2

Review of Literature

Medication administration is a complex and time-consuming task, occupying up to one-

third of nurses’ time (Pepper, 2005). Because of the complexity of the medication administration

process, there is much potential for error. Since nurses actually administer the medication to the

patient, they often assume or are assigned responsibility for these errors; however, the actions of

everyone involved in the system and the system design itself contribute to errors.

This chapter gives an account of the circumstances surrounding medications

administration errors especially as it applies to nurses as documented by various literatures.

Definition of Medication Administration Errors (MAE)

Multiple definitions of what constitutes a MAE exist in published research and literature.

One definition frequently employed by medical doctors of MAE is any deviation from the

physician’s medication order as written on the patient’s chart (Headford, et al., 2001), which fails

to consider that prescribing errors do contribute to MAE (Davydov, et al., 2004).

Specifically, medication error as defined by the Centers for Medicare and Medicaid

Services (2011) is the observed preparation or administration of drug or biologicals which is not

in accordance with: 1) physician’s orders, 2) manufacturer’s specifications regarding the

preparation and administration of the drug, and 3) accepted professional standards and principles

which apply to the professionals providing services including state regulations and accepted

standards of health established by national organizations, boards, and councils.

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 However, the definition typically cited in literature that is authored by nurses is that of

Wolf (1999), who defines MAE as mistakes associated with drugs and intravenous solutions that

are made during the prescription, transcription, dispensing, and administration phases of drug

preparation and distribution.

These errors can be classified as either acts of commission or omission, and may include

the following: wrong drug, wrong route, wrong dose, wrong patient, wrong timing of drug

administration, a contraindicated drug for that patient, wrong site, wrong drug form, wrong

infusion rate, expired medication date, or prescription error. Such errors can occur in either an

intentional or unintentional manner (Wolf, 1999).

Medication Error Rates

The manner in which MAE rates are determined varies greatly and is dependent on the

method of measurement employed to assess the error rates. However, observations of practice

are considered to be the most accurate way of measuring the occurrence of MAE (Thomas &

Peterson, 2003). Other methods of measurement include analysis of incident report, chart audit,

prospective cohort study among others.

Two such observational studies found that MAE rates in the acute-care setting varied

between 14.9% (Tissot, et al., 2003) and 32.4% (Schneider, et al., 2008). The medication error

rate for intravenous medications is significantly higher than other types of medications according

to Wirtz, et al. (2003), with researchers observing preparation error rates of 26% and

administration error rates of 34%. The researches that have documented the error rates during the

prescribing, preparation, and/or administration phases of medication handling cite different

statistics. Leape (2005) places the errors of drug prescription and administration in medical and

surgical units at 39:100 and 38:100, respectively. Ashcroft, et al. (2003) has found error rates of

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22% in prescribing, 15% in preparation, and 32% in administration. These errors have been

committed either by doctors, nurses, or pharmacists in tertiary care hospitals. In general, the total

of all observed medication errors indicates that errors occur in almost one out of every five doses

(Barker, et al., 2002).

When addressing the issue of MAE rates, researchers return to standard categories for

describing the various ways in which errors occur. These factors cover errors such as wrong

administration rates, calculation errors, and wrong dose. Research suggests that the number one

occurring error is inaccurate IV push rates with 88 in 100 doses being improperly administered

(Headford, et al., 2001). Other frequently observed errors included wrong administration rates,

which ranged between five to 21.6 in 100 doses (Hicks, el al., 2004), and the omission of

dosages, which ranged between 8.1 to 50 in 100 doses (Fortescue, et al., 2003). As pointed by the

same authors, the least frequently observed error was an allergy related error, which occurred

between 1.3 and 1.8 times in 100 doses.

Factors Contributing to Medication Errors

Factors that contribute to medication errors are typically divided into two sub-groups:

those caused by systems errors, and those caused by individual health care professional issues.

Another issue that is worthy of examination in the context of contributing factors is that of

incident reporting.

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Systems Issues

Hospitals are complex systems comprising both human and technological aspects (Clancy

2004). Such systems may be thought of as consisting of components that include design,

equipment, procedures, operators, supplies and environments, within any of which errors may

occur.

As detailed by Anderson & Webster (2001), the medication process is in itself a complex

subsystem of a hospital. Prescribing, preparing, and administering medications is therefore

reliant on a variety of processes intended to ensure that patients receive appropriate treatment.

However, if a problem arises in any phase of either an organizational system or the medication

process, it increases the likelihood that a patient will not receive the correct medication,

compromising their safety.

Experts and researchers alike have identified a number of systems issues that impact on

patient safety in relation to MA including patient acuity levels, available nursing staff, access to

medication, and policy documentation. As a result, acute-care organizations have put systems

strategies in place to reduce the number of systems errors (Freedman Cook, et al., 2004). These

include, for example, purchasing a single type of intravenous medication pump that requires

access to a specific computer program to alter the pump’s settings (Brush 2003). Unfortunately,

there is little research evaluating the impact of these systems strategies in reducing the numbers

of medication errors.

Within the past decade there has been a shift internationally in how adverse events

including MAE, are understood; and more attention is being paid to organizational systems

errors (Vincent, 2003). The Veterans Health Administration in the United States of America

(Bagian, 2004), and more recently the National Health System in Britain (National Patient Safety

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Agency, 2007), have completely changed their approach to adverse events. Instead of focusing

on individual culpability, attention is focused on systems issues that contribute to errors in an

attempt to address gaps and failings within a system itself. In essence, rather than assigning

blame, the intent is to prevent the event from occurring again. The focus on improving systems

to avoid errors has led to a marked decrease in the rate of error occurrence (Bagian, 2004).

Professional Issues

The issues that affect an individual professional’s practice are varied and multifaceted. As

summarized by Preston (2004), the literature that explores MAE frequently links errors to

specific professional traits, focusing on individual practitioner’s attributes, skill levels and

competencies.

For example, it is reported that an individual practitioner may contribute to a medication

error through a lack of general knowledge about medications (Tissot, et al., 2003). This lack of

knowledge may include the inability to accurately calculate medication dosages which,

according to research, significantly contributes to a nurse’s likelihood of making an error

(Oldridge, et al. 2004). This is of particular importance in pediatric settings and neonatal

intensive care where drug dosages are determined by body weight.

Incident Reporting

The issue of reporting medication errors has been widely debated in the literature of

Freedman Cook, et al. (2004), Vincent (2003), as well as Anderson & Webster (2001).

It is acknowledged in these authors’ citations that the vast majority of accidents are not

reported and that near-miss accidents are almost never reported. In part this has been attributed to

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the fact that, historically, most incident reporting forms require individuals to identify themselves

and, if directly involved, accept responsibility for the error, regardless of the circumstances.

Nurses and other health care professionals participating in research have discussed how

they fear the consequences of reporting a medication error because of the disciplinary and

professional ramifications (Vincent, 2003). Baker (2007) highlights that because of this, nurses

frequently embrace their own version of what constitutes a medication error. She reports that

nurses engage in a process that seeks to negotiate between institutional policy and the practical

constraints that govern everyday practice.

Another issue that affects incident reporting is the format of the forms, many of which are

structured in such a way that systems issues are not identified. For this reason researchers and

practitioners have suggested changing incident forms to incorporate the identification of systems

issues and have proposed anonymous reporting (Anderson & Webster, 2001).

These strategies have been documented to increase the likelihood of practitioners

reporting errors as well as near-misses (Vincent, 2003). Such approaches to the issue of incident

reporting also increase the opportunity to discover the factors that contribute to systems-related

errors (Lamb, 2004). Authors such as Baker (2007) and Lamb (2004) assert that unless reporting

mechanisms that focus on a single individual are changed, systems issues will not be addressed,

and will remain invisible.

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 Chapter 3

Study Methodology

Research Design

This study used the descriptive research design, which investigates the nature of a

particular phenomenon—in this study is the context of which medication administration errors

occur. Furthermore, this study also aimed to investigate how student nurses perceive the degree

of compliance of clinical nurses to medication administration protocols of the hospital using the

rights of medication administration as a gauge.

Research Locale and Respondents

This study was conducted in Colegio de Sta Lourdes of Leyte Foundation, Inc.,

Tabontabon. Third and fourth year students of CSLLFI were chosen because of their exposure to

hospital duty, thus, have witnessed real medication administration practices and even errors

committed by nurses.

Data Gathering Procedures

At the start of the research endeavor, permission was obtained from Dean of the College

of Nursing of CSLLFI through a transmittal letter (Appendix 1).

To choose study respondents, the probability method of simple random sampling was

employed for both groups, each arriving at a total of fifty percent of the total population. Since

there were forty third year and forty fourth year students during the conduct of this study, twenty

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respondents from each level were included. Names of student nurses came from the school’s

registrar office.

Student respondents were then be made to answer the researcher-generated questionnaire

soliciting data on their perception of the reasons of medication administration errors and their

perception of how clinical nurses adhere to ideal drug administration practices. The questionnaire

used in this study is found in Appendix 2.

Data Analysis

After collection of the completed questionnaires, data encoding, summarizing, and

tabulating were done to facilitate statistical analysis and interpretation. Among the descriptive

statistical tools that were used were as follows:

1) Frequencies. Used to describe the number of respondents whose answers

belonged to a specific category.

2) Sums. To determine the total number of respondents with answers falling under a

specific category.

3) Percentages. Compare parts of the whole.

Advanced statistics were also utilized and included the following tests:

1) Mann-Whitney. Determine differences in the responses of respondents belonging

to different year levels, age groups, and sexes.

2) Pearson Product Moment Correlation. Find out if a relationship existed between

the specific causes and students’ total rating.

The spreadsheet program of Excel was used to hasten the data analysis and interpretation.

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 Chapter 4

Results and Discussion

Socio-demographic Profile

Data on the socio-demographic profile of respondents were gathered to assess intervening

factors that can affect the relationship between the independent and dependent study variables.

Summarized results are presented in Figure 2 below.

In terms of year level, both third and fourth year students were represented by 20

respondents each making up 50% of the sample size. Ages of the respondents fell in the late

adolescent and young adult groups based on Eric Ericson’s classification with 72% or 29

students aged 17 to 19 years old and 28% or 11 students falling in the 20 years old and above

bracket, respectively. In terms of sex, 67% or 27 students were females and 33% or 13 students

were males.

Perceived Causes of MAE

Instead of mentioning the usual ordering/prescribing, transcribing and verifying,

dispensing and delivering, administration, and monitoring and reporting errors mentioned in

most literature about MAE (Williams, 2007), this study focused on identifying errors committed

by specific key persons or entities in the delivery of care, as follows:

Physician-related Causes

Table 1 depicts the degree of agreement or disagreement of respondents to the statements

about the physician-related causes.

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Figure 2. Socio-demographic profile of CSLLFI nursing student respondents

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Table 1. Responses of CSLLFI nursing students on the statements about physician-related causes
of medication administration errors

Causes of MAE Strongly Agree Somewhat Disagree Strongly

Agree Agree Disagree
N % N % N % N % N %
1) Doctors’ written medication 15 38 9 22 12 30 3 8 1 2
orders are not legible.
2) Doctors’ verbal medication 1 2 7 18 22 55 10 25 0 0
orders are not clearly stated.
3) Doctors change orders 1 2 12 30 16 40 11 28 0 0
frequently.
4) Doctors cannot be contacted 4 10 5 12 19 48 10 25 2 5
for questions regarding
prescribed medications.
5) Doctors give incomplete 1 2 6 15 13 33 20 50 0 0
medication orders.
6) Doctors are fond of using 7 18 8 20 16 40 9 22 0 0
abbreviations.

Almost all of the respondents (19% or 15 students strongly agreed, 22% or 9 students

agreed, and 30% or 12 students somewhat agreed) assented that doctor’s written medication

orders are not legible which is why medication administration errors occur.

Exactly three-fourths (2% or 1 student strongly agreed, 18% or 7 students agreed, and

55% or 22 students somewhat agreed) gave their agreement that doctors’ verbal medication

orders are not clearly stated.

Almost three-fourths (2% or 1 student strongly agreed, 30% or 12 students agreed, and

40% or 16 students somewhat agreed) concurred that because doctors change orders frequently,

MAEs occur.

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 More than two-thirds (10% or 4 students strongly agreed, 12% or 5 students agreed, and

48% or 19 students somewhat agreed) had varying levels of concurrence that doctors cannot be

contacted for questions regarding prescribed medications.

Only half (2% or 1 student strongly agreed, 15% or 6 students agreed, and 33% or 13

students somewhat agreed) of students said that doctors give incomplete medication orders with

the other half (50% or 20 students) disagreeing.

Lastly, a little over three-fourths (18% or 7 students strongly agreed, 20% or 8 students

agreed, and 40% or 16 students somewhat agreed) concurred that doctors are fond of using

abbreviations.

All these fall under prescribing errors. The proportion of medication errors attributable to

the ordering or prescribing stage ranges from 70 to 79 percent (Kaushal and Bates, 2008).

According to Joanna Briggs Institute (2005), of the five stages, ordering or prescribing most

often initiates a series of errors resulting in a patient receiving the wrong dose or wrong

medication. In this stage, the wrong drug, dose, or route can be ordered, as can drugs to which

the patient has known allergies. Workload, knowledge about the prescribed drug, and attitude of

the prescriber—especially if there is a low perceived importance of prescribing compared with

other responsibilities—are significantly associated with MAEs.

System-related Causes

As shown in Table 2, more than two-thirds each gave their agreement to the statement

that nurses are interrupted while administering medications to perform other duties (10% or 4

students strongly agreed, 18% or 7 students agreed, and 40% or 16 students somewhat agreed)

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and get floated to other areas (2% or 1 student strongly agreed, 25% or 10 students agreed, and

40% or 16 students somewhat agreed) resulting in MAEs.

Table 2. Responses of CSLLFI nursing students on the statements about system-related causes of
medication administration errors

Causes of MAE Strongly Agree Somewhat Disagree Strongly

Agree Agree Disagree
N % N % N % N % N %
1) Nurses interrupted while 4 10 7 18 16 40 12 30 1 2
administering medications to
perform other duties.
2) Nurses get floated to other 1 2 10 25 16 40 12 30 1 3
areas.
3) Nurses get switched between 2 5 12 30 14 35 12 30 0 0
teams.
4) Unclear or there is no policy in 1 2 2 5 10 25 21 53 6 15
place in the hospital for
medication administration.
5) There are many patients 6 15 11 28 13 32 8 20 2 5
assigned to one nurse resulting in
mix up of patient medication.

Exactly seven-tenth (5% or 2 students strongly agreed, 30% or 12 students agreed, and

35% or 14 students somewhat agreed) concurred that MAEs happen because of nurses getting

switched between teams.

Only about one-third (2% or 1 student strongly agreed, 5% or 2 students agreed, and 25%

or 10 students somewhat agreed), however, were positive that MAEs happen because of having

no policy in place in the hospital for medication administration.

Exactly three-fourths (15% or 6 students strongly agreed, 28% or 11 students agreed, and

32% or 13 students somewhat agreed) gave varying levels of agreement that there are many

patients assigned to one nurse resulting in mix-up of patient medication.

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 As cited by Hughes and Blegen (2011), systems factors that can influence medication

administration include staffing levels and RN skill mix (proportion of care given by RNs), shift

length, patient acuity, and organizational climate. Except for the 4th statement above which falls

under organizational climate, the others are considered staffing levels and RN skills.

The effect of heavy workloads and inadequate numbers of nurses can be manifested as

long workdays, providing patient care beyond the point of effective performance. According to

Rogers et al. (2004), the likelihood of a medication error increases by three times once the nurse

worked more than 12.5 hours of providing direct patient care. Among nurses working more than

12.5 hours, 58 percent of actual errors and 56 percent of near misses were associated with

medication administration. In addition, a review of incident reports done by Wolf et al. (2006)

found that of the major contributing factors to errors, insufficient staffing ranked 2 nd,

agency/temporary staffing ranked 3rd, and floating staff, 9th.

Individual-related Causes

Nurses are primarily involved in the administration of medications across settings.

Specifically, nurses can be involved in both the dispensing and preparation of medications (in a

similar role to pharmacists) such as crushing pills and drawing up a measured amount for

injections. According to Hughes and Blegen (2011), of all the factors, approximately one out of

every three MAEs is attributable to nurses administering medications to patients, pointing to the

fact that nurses have a large role when it comes to patient medication safety and quality of care.

Both individual- and knowledge-related causes outline below fall under the responsibility of the

nurse.

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 Almost two-thirds (58% or 23 students disagreed and 5% or 2 students strongly

disagreed) negated the statement that nurses do not transcribe orders to the Kardex correctly

(Table 3).

Respondents were equally (50% or 20 students) divided in their opinion that nurses do

not communicate to other nurses about missed medications to be administered later with half

each agreeing and disagreeing.

Over three-fifths (8% or 3 students strongly agreed, 8% or 3 students agreed, and 9% or

students somewhat agreed) gave varying levels of affirmation to the statement that errors occur

when Kardex is copied.

Table 3. Responses of CSLLFI nursing students on the statements about individual-related

causes of medication administration errors

Causes of MAE Strongly Agree Somewhat Disagree Strongly

Agree Agree Disagree
N % N % N % N % N %
1) Nurses do not transcribe orders 2 5 4 10 9 22 23 58 2 5
to the Kardex correctly.
2) Nurses do not communicate to 3 8 8 20 9 22 19 48 1 2
other nurses about missed
medications to be administered
later.
3) Error when Kardex is recopied. 3 8 3 8 19 47 14 35 1 2
4) Medication Kardex is illegible. 3 8 5 12 13 32 17 43 2 5
5) Nurses do not adhere to the 1 2 5 12 7 18 24 60 3 8
approved medication
administration procedure.
6) Nurses lack the necessary 1 2 4 10 13 33 20 50 2 5
experience to administer
medications safely (i.e. use of
equipment such as infusion pump).

22
 A little over one-half (8% or 3 students strongly agreed, 13% or 5 students agreed, and

33% or 13 students somewhat agreed) concurred that the medication Kardex is illegible.

Approximately two-thirds (60% or 24 students disagreed and 8% or 3 students strongly

disagreed) gave their negation that nurses do not adhere to the approved medication

administration procedure.

More than half (50% or 20 students disagreed and 5% or 2 students strongly disagreed)

contradicted the statement that nurses lack the necessary experience to administer medications

safely.

Knowledge-related Causes

Table 4 on the knowledge-related causes continues the nurse factors (along with Table 3)

associated with medication administration errors.

Almost three-fourths (10% or 4 students strongly agreed, 23% or 9 students agreed, and

40% or 16 students somewhat agreed) had varying levels of agreement that names of many

medications are similar.

Majority (8% or 3 students strongly agreed, 30% or 12 students agreed, and 50% or 20

students somewhat agreed) concurred that many patients are on the same medications that is why

MAEs happen.

A little over half (5% or 2 students strongly agreed, 18% or 7 students agreed, and 32%

or 13 students somewhat agreed) gave their affirmation that nurses have limited knowledge about

the adverse effects of medications.

The same proportion assented that there is no easy was to look up medications (8% or 3

students agreed and 50% or 20 students somewhat agreed) and nurses come to duty unprepared

22
to tend to their assigned patients’ needs especially in giving of medications (18% or 7 students

agreed and 40% or 16 students somewhat agreed).

Table 4. Responses of CSLLFI nursing students on the statements about knowledge-related

causes of medication administration errors

Causes of MAE Strongly Agree Somewhat Disagree Strongly

Agree Agree Disagree
N % N % N % N % N %
1) Names of many medications 4 10 9 23 16 40 10 25 1 2
are similar.
2) Many patients are on same 3 8 12 30 20 50 5 12 0 0
medications.
3) Nurses have limited knowledge 2 5 7 18 13 32 17 43 1 2
about adverse effects of
medications.
4) No easy way to look up 0 0 3 8 20 50 15 37 2 5
medications.
5) Nurses come to duty 0 0 7 18 16 40 13 32 4 10
unprepared to tend to their
assigned patients’ needs especially
in giving of medications.

Drug-manufacturing-related Causes

Table 5 shows the summary of results of respondents’ degree of agreement or

disagreement to the statements on the drug-related causes of MAEs.

Almost three-fourths (8% or 3 students strongly agreed, 25% or 10 students agreed, and

40% or 16 students somewhat agreed) of respondents affirmed that many drugs look alike, which

can serve as a source of confusion when dispensed.

22
Table 5. Responses of CSLLFI nursing students on the statements about individual-related
causes of medication administration errors

Causes of MAE Strongly Agree Somewhat Disagree Strongly

Agree Agree Disagree
N % N % N % N % N %
1) Many drugs look alike and can 3 8 10 25 16 40 10 25 1 2
serve as a source of confusion
when dispensed.
2) Drugs sound alike and can 6 15 9 23 18 45 6 15 1 2
serve as source of mix-up
especially in verbal or telephone
orders.
3) Drug labels can be confusing 3 8 10 25 18 45 8 20 1 2
especially in terms of packaging
of doses (i.e. multidose vials).

Majority (15% or 6 students strongly agreed, 23% or 9 students agreed, and 45% or 6 students

somewhat agreed) had varying levels of agreement that many drug names sound alike, serving as

a source of mix-up especially in verbal or telephone orders.

Finally, a little less than four-fifths (8% or 3 students strongly agreed, 25% or 10 students

agreed, and 45% or 18 students somewhat agreed) concurred that drug labels can be confusing

especially in terms of the packaging doses.

As cited by Hughes and Blegen (2011), the top four drug-related causes of MAEs

ranked accordingly are medications with similar names or similar packaging, medications that

are not commonly used or prescribed, commonly used medications to which many patients are

allergic (e.g. antibiotics, opiates, and nonsteroidal anti-inflammatory drugs), and medications that

require testing to ensure proper (i.e. nontoxic) therapeutic levels are maintained (e.g. lithium,

warfarin, theophylline, and digoxin).

22
Adherence to the Standards of Medication Administration

Table 6 shows the results of the ratings given by students to nurses’ adherence to the

ideals of MAs basing on the patients’ rights of drug administration. Originally, there were only

five rights; but as the role of nurses in MA expanded and became more complex, other rights

were added.

Almost half (45% or 18 students) of respondents rated nurses as satisfactory in terms of

their adherence to right patient when administering medication by calling patients’ names or

checking their wristbands.

A little less than three-fifths (58% or 23 students) gave nurses a satisfactory rating in

terms of their adherence to right drug by checking the doctors’ orders, Kardex, and medication

record before administration.

About half of students (48% or 19 students) afforded nurses with a satisfactory rating

when considering their adherence to right drug form by checking the doctors’ orders, Kardex,

and medication record before administration.

Exactly half (50% or 21 students) scored nurses as satisfactory in terms of their

adherence to right dose by checking the doctors’ orders, Kardex, and medication record as well

as rechecking computation before administration.

More than half (53% or 21 students) said that nurses were satisfactory when it comes to

their adherence to right route by checking the doctors’ orders, Kardex, and medication record

before administration.

22
Table 6. Rating given by CSLLFI nursing students to nurses on their adherence to the standards
of medication administration practice

Rights of Drug Administration Very Satisfactory Somewhat Unsatisfactory Very

Satisfactory Satisfactory Unsatisfactory

N % N % N % N % N %

1) Adherence to right patient when 15 38 18 45 6 15 1 2 0 0

administering medication by calling
patients’ names or checking their
wristbands.
2) Adherence to right drug by checking 12 30 23 58 4 10 1 2 0 0
the doctors’ orders, Kardex, and
medication record before administration.
3) Adherence to right drug form by 14 35 19 48 6 15 1 2 0 0
checking the doctors’ orders, Kardex, and
medication record before administration.
4) Adherence to right dose by checking 14 35 20 50 5 13 0 0 1 2
the doctors’ orders, Kardex, and
medication record as well as rechecking
computation before administration.
5) Adherence to right route by checking 14 35 21 53 4 10 1 2 0 0
the doctors’ orders, Kardex, and
medication record before administration.
6) Adherence to right timing by checking 12 30 18 45 9 23 0 0 1 2
the doctors’ orders, Kardex, and
medication record before administration.
7) Adherence to right expiration date by 15 38 18 45 4 10 3 7 0 0
checking drug labels before
administration.
8) Adherence to right assessment by 11 28 21 52 7 18 1 2 0 0
checking patient condition and the
intended use of the drug before
administration (i.e. checking of patient
temperature before giving of antipyretic).
9) Adherence to right health education by 7 18 12 30 17 42 4 10 0 0
reading all aspects about the drug and
instructing the patient about them.
10) Adherence to right evaluation by 8 20 18 45 11 28 2 5 1 2
comparing the intended effect of the drug
to the effect on the patient (i.e. seeing to it
that the medication for diabetes results in
the lowering of blood sugar as seen in the
glucometer).
11) Adherence to right medication 7 18 16 37 15 37 2 5 1 2
administration error reporting by
following hospital policy.

22
 The same proportion (45% or 18 students) rated nurses as satisfactory when it comes to the

adherence to right timing by checking the doctors’ orders, Kardex, and medication record before

administration as well as the adherence to right expiration date by checking drug labels before

administration.

A little over half (52% or 21) gave nurses a satisfactory rating for their adherence to right

assessment by checking patient condition and the intended use of the drug before administration

(i.e. checking of patient temperature before giving of antipyretic).

More than two-fifths (42% or 17 students) scored nurses somewhat satisfactory when it

comes to their adherence to right health education by reading all aspects about the drug and

instructing the patient about them.

A little over two-fifths (45% or 18 students) said that nurses were satisfactory in terms of

their adherence to right evaluation by comparing the intended effect of the drug to the effect on

the patient (i.e. seeing to it that the medication for diabetes results in the lowering of blood sugar

as seen in the glucometer).

Lastly, the same proportion (37% or 15 students) each gave nurses a satisfactory

and somewhat satisfactory rating in consideration of their ability to adhere to right medication

administration error reporting by following hospital policy.

22
 Results of the Mann-Whitney Test

To determine whether differences existed between respondents’ of different year levels,

ages, and sexes in terms of their agreement or disagreement scores of the causes of MAE, the

Mann-Whitney Test scores were computed. Instead of using the ANOVA, this nonparametric test

was chosen because of the data not following the normal distribution. Computations are found in

Appendix 3.

In terms of year levels, significant differences (U 4th=123, U3rd=333, Ucrit=127 [n4th=20 and

n3rd=20], p=0.05) were found in the scores given by respondents. Specifically, four year

respondents had higher ranked scores (487) compared to their third year (333) counterparts. This

means that the former were much lenient in terms of scoring the causes of MAE.

Considering differences in the scores of respondents of various age groups, no significant

differences existed between them (UYA=166.5, ULA=348.5, Ucrit=94 [nYA=29 and nLA=11], p=0.05)

despite late adolescents (405.5) having higher ranked scores than young adults (218.5).

Furthermore, there was no significant difference (U M=173, UF=504.5, Ucrit=107 [nM=13

and nF=27], p=0.05) between the ranked scores of males (269) and females (224.5).

22
Results of the Pearson Product Moment Correlation

To determine whether there was a relationship between the rating respondents have given

to nurses on their extent of adherence to the standards of MA and respondents’ agreement or

disagreement scores of the various causes of MAE, the Pearson Product Moment Correlation test

was run on the data.

From the computed values, a positive correlation was found to exist between the rating

and system-related causes (r=0.0445, p=0.05), individual-related causes (r=0.2479, p=0.05),

knowledge-related cause (r=0.1108, p=0.05), and drug-manufacturing-related causes (r=0.0080,

p=0.05) , but a negative correlation was found between the rating and physician-related causes

(r=–0.0708, p=0.05).

22
 Chapter 5

Conclusion and Recommendations

Conclusion

Basing on the data gathered, the following conclusions can be drawn:

1) Most of the respondents were found to agree on the listed causes of medication

administration errors of physician-, system-, individual-, knowledge-, and drug-related

causes. With medication errors considered as one of the most preventable causes of

patient injury, much can still and should be done to eliminate if not reduce such errors.

To do so, the problems, sources, and methods of avoiding medications errors should be

studied in depth to come up with workable and concrete solutions. This will alleviate the

quality of healthcare rendered by increasing patient safety.

2) Despite nurses given mostly a satisfactory rating when it comes to their adherence to the

standards of medication administration practices, with the results of this study in mind,

nurses should have the initiative, exert conscious effort, and take a proactive stance to

better the care they render when it comes to medication administration.

3) Respondents of different year levels were found to differ in their agreement or

disagreement scores of the causes of MAE. Fourth year respondents had higher scores

than their third year counterparts. This means that they strongly disagreed and disagreed

to the causes more than the latter. This was perhaps because they have been more

exposed to the clinical experience, adapting to evidence-based practice.

4) In general, the findings from this survey support the notion that medication

administration is more than a simple psychomotor task. It is a complex process involving

22
multiple interactions among professionals, patients, and the healthcare environment.

With the increasing use of unlicensed medication technicians, it is critical that this

complex process be analyzed and improved.

22
Recommendations

The following recommendations can be made from the results of this study:

1) To address the problem of high prevalence of MAE, the following measures can be done:

a. Nationwide voluntary efforts. Policy makers, hospital and school administrators,

as well as other concerned sectors should come together and have a dialogue on

how to strengthen the quality of care by passing rules and regulations as, devising

standards, and revising the existing system, all of which will make the system

foolproof for MAEs.

b. Nursing training and education. More formal, informal, and nonformal education

should be offered to make nurses and healthcare professionals more prepared for

medication administration. For instance, trainings on the use of high-

technological gadgets used to administer medications can be required and offered.

c. Incidence reporting. Nobody wants to commit MAEs, but because sometimes they

cannot be avoided, the best course of action is to make a complete and concise

report to remedy the situation as soon as possible. Because less reporting is done

on MAEs because of nurses’ fearing the consequences of their actions such as

losing their job, a nonpunitive approach can be taken in dealing with MAEs.

2) To add to the local literature about MAEs, a study involving other healthcare

professionals such as physicians and pharmacists can be considered and planned out.

Perhaps a large-scale and full-blown study can be done through concerted efforts with

other concerned sectors to make MAEs more understandable and to identify solutions to

such.

22
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error on the hospital. Journal of Advanced Nursing. 35(1):34-41.
Ashcroft, D., Brirtwistle, M., Cooke, J., Hingley, K., & Moore, P. 2003. When do
medication errors occur and who reports them? Analysis of a web-based incident reporting
scheme in secondary care. The International Journal of Pharmacy Practice 11:R86.
Baker, H. 2007. Rules outside the rules for administration of medication: a study in New
South Wales, Australia. Image: Journal of Nursing Scholarship. 29(2):155-159.
Bandura, A. 1977. Social learning theory. Retrieved from
http://psychology.about.com/od/developmentalpsychology/a/sociallearning.htm.
Barker K.N., Flynn E.A., Pepper, G.A., PhD, Bates, D.W., & Mikeal, R.L. 2002.
Medication errors observed in 36 health care facilities. Arch Intern Med 2002;162:1897-1903.
Brush, K. 2003. Upgrading systems design to reduce medication administration errors.
Clinical Nurse Specialist. 17(1):15-16.
Clancy, T. 2004. Navigating in a complex nursing world. JONA. 34(6): 274-282.
Davydov, I., Caliendo, G., Mehl, B., & Smith, L. 2004. Investigation of correlation
between house-staff work hours and prescribing errors. American Journal of Health-System
Pharmacy. 61(1):1130-1134.
Fortescue, E., Kaushal, R., Landrigan, C., McKenna, K., Clapp, M., Federico, F.,
Goldman, D., & Bates, D. 2003. Prioritizing strategies for preventing medication errors and
adverse drug events in pediatric inpatients. Pediatrics. 111(4):722-729.
Freedman Cook, A., Hoas, H., Guttmannova, K., & Joyner, J. 2004. An error by any other
name. American Journal of Nursing. 104(6):32-43.
Fuqua, R.A. & Stevens, K.R. 1998. What we know about medication errors: A literature
review. Journal of Nursing Quality Assurance, 3(1), 1-17.
Headford, C., McGowan, S., & Clifford, R. 2001. Analysis of medication incidents and
development of a medication incident rate clinical indicator. Collegian. 8(3):26-31.
Kohn, L.T., Corrigan, J.M., & Donaldson, M.S. 2009. To err is human: building a safer
health system. Washington, DC: National Academy Press.
Lamb, R. 2004. Open disclosure: The only approach to medical error: Open, honest, and
timely disclosure should be the only approach to medical error. Quality and Safety in Health
Care. 13(1):3.
Leape, L., Bates, D., Cullen., J., Cullen, J., Cooper, H., Demonaco, T., Gallivan, R.,
Hallisey, J., Ives, N., & Laird, G. 2005. Systems analysis of adverse drug events: ADE
prevention study group. JAMA 274(1):35-43.
National Patient Safety Agency. 2003. Seven steps to patient safety: A guide for NHS
staff. Retrieved from:
http://www.npsa.nhs.uk/admin/publications/docs/sevensteps_overview(2).pdf.
Oldridge, G., Gray, K., McDermott, L., & Kirkpatrick, C. 2004. Pilot study to determine
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Pepper, G. 2005. Errors in drug administration by nurses. American Journal of Health-
System Pharmacy, 52, 390-395.
Preston, R. 2004. Drug errors and patient safety: The need for a change in practice.
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 Schneider, M., Cotting, J., & Pannatier, A. 2008. Evaluation of nurses’ errors associated
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Lacquet, M., & Woronoff-Lemsi, M. 2003. Observational study of potential risk factors of
medication administration errors. Pharmacy World Science. 25(6):264-268.
Vincent, C. 2003. Understanding and responding to adverse events. New England Journal
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Appendix 1. Letter of request

Colegio de Sta. Lourdes of Leyte Foundation, Inc.

College of Nursing
Tabontabon, Leyte

June , 2011

Ms. LILIA C. TISTON, BSN, RN, MAN

OIC, DEAN
COLLEGE OF NURSING

Madame:

Greetings!

We, the BSN-IV students, will be conducting a research study on “Colegio de Sta Lourdes of Leyte
Foundation, Inc. (CSLLFI) Student Nurses’ Perceptions of the Causes of Medication
Administration Errors.” This is in connection with the fulfillment of our requirement in research this
semester.

In this regard, please allow all of the BSN-III as well as BSN-IV students with due exemption of the
undersigned researchers involved, to serve as respondents in this study. Rest assured that confidentiality
will remain throughout the course of this research.

Attached herein is a copy of the survey questionnaire for your suggestions for improvement. We are
hoping this request may merit your kind and favorable consideration of such matter.

Thank you and more power.

Sincerely yours,

Noted by:

MS. LILIA C. TISTON, BSN, RN, MAN

OIC – DEAN

Approved by:

DR. RUSTICO B. BALDERIAN

PRESIDENT

22
Appendix 2. Questionnaire

Colegio de Sta Lourdes of Leyte Foundation Inc.

College of Nursing
Tabontabon, Leyte

Dear respondent,

Greetings!
We the fourth year nursing students of Colegio de Sta Lourdes of Leyte Foundation Inc. (CSLLFI)
will be conducting a study to assess the common causes of medication administration errors in the
hospital setting. Your inputs will augment the present knowledge as to why medication
administration errors do occur.
Rest assured that the information gathered will be used only for research purposes, and your
identity will be kept confidential.

I. Socio-demographic status
Directions: Please fill up information of the blanks provided and check boxes that apply.

Name (Optional): _________________________________________________________ Res. No.:_____

1) Year level:
a. Third year 
b. Fourth year 
2) Age:_________________________________
3) Sex:
a. Male 
b. Female 

II. Observed causes of medication administration errors

Directions: Please give your degree of agreement or disagreement to the below-mentioned causes
of medication administration errors by checking the box that applies.

Possible Causes of MAE Strongly Agree Somewhat Disagree Strongly

Agree Agree Disagree
Physician-related Causes
1) Doctors' medication orders are
not legible.
2) Doctors' medication orders are
not clear.
3) Doctors change orders frequently.

System-related Causes
1) Nurses interrupted while
administering medications to
perform other duties.
2) Nurses get floated to other areas.
3) Nurses get switched between

22
teams.

Individual-related Causes
1) Orders are not transcribed to the
Kardex correctly.
2) Nurses do not communicate to
other nurses about missed
medications to be administered
later.
3) Error when Kardex is recopied.
4) Medication Kardex is illegible.
5) Nurses do not adhere to the
approved medications
administration procedure.

Knowledge-related Causes
1) Names of many medications are
similar.
2) Many patients are on same
medications.
3) Nurses have limited knowledge
about adverse effects of
medications.
4) No easy way to look up
medications.

22
III. Clinical nurses’ extent of adherence to the standards of medication administration
Directions: Based on your observation, please rate clinical nurses’ degree of adherence to the
standards of medication administration. Check the boxed that apply to your rating.

Categories Very Satisfactory Somewhat Unsatisfactory Very

Satisfactory Satisfactory Unsatisfactory
1) Adherence to
right patient
2) Adherence to
right drug
3) Adherence to
right drug form
4) Adherence to
right dose
5) Adherence to
right route
6) Adherence to
right timing
7) Adherence to
right expiration
date
8) Adherence to
right assessment
9) Adherence to
right health
education
10) Adherence to
right evaluation
11) Adherence to
right medication
administration
error reporting

Thank you for your time.

22
Appendix 3. Computations of the Mann-Whitney test

For differences in year levels:

SDC Code Respondent No. Total Score Ranked Score Total Ranked Score Computed U Value
1 1 84 26.5
1 2 87 30
1 3 81 23.5
1 4 80 21
1 5 63 6
1 6 70 13.5
1 7 54 3
1 8 78 19
1 9 81 23.5
1 10 72 15.5
1 11 85 28
1 12 70 13.5
1 13 88 32.5
1 14 49 1.5
1 15 49 1.5
1 16 72 15.5
1 17 61 5
1 18 57 4
1 19 86 29
1 20 80 21 333 277
2 21 82 25
2 22 77 18
2 23 88 32.5
2 24 74 17
2 25 89 36
2 26 67 9.5
2 27 88 32.5
2 28 69 11.5
2 29 67 9.5
2 30 88 32.5
2 31 66 7.5
2 32 89 36
2 33 92 38
2 34 96 40
2 35 89 36
2 36 93 39
2 37 84 26.5
2 38 66 7.5
2 39 69 11.5
2 40 80 21 487 123
1=3rd year (n=20), 2=4th year (n=20)

22
For differences in age groups:
SDC Code Respondent No. Total Score Ranked Score Total Ranked Score Computed U Value
1 1 84 26.5
1 3 81 23.5
1 4 80 21
1 5 63 6
1 6 70 13.5
1 8 78 19
1 9 81 23.5
1 10 72 15.5
1 12 70 13.5
1 13 88 32.5
1 15 49 1.5
1 16 72 15.5
1 17 61 5
1 18 57 4
1 20 80 21
1 21 82 25
1 23 88 32.5
1 25 89 36
1 26 67 9.5
1 27 88 32.5
1 28 69 11.5
1 30 88 32.5
1 31 66 7.5
1 33 92 38
1 34 96 40
1 35 89 36
1 37 84 26.5
1 39 69 11.5
1 40 80 21 405.5 348.5
2 2 87 30
2 7 54 3
2 11 85 28
2 14 49 1.5
2 19 86 29
2 22 77 18
2 24 74 17
2 29 67 9.5
2 32 89 36
2 36 93 39
2 38 66 7.5 218.5 166.5
1=late adolescent (n=29), 2=young adult (n=11)

22
For differences in sexes:
SDC Code Respondent No. Total Score Ranked Score Total Ranked Score Computed U Value
1 6 70 13.5
1 7 93 39
1 8 78 19
1 9 81 23.5
1 11 85 28
1 13 88 32.5
1 16 72 15.5
1 20 80 21
1 22 77 18
1 24 74 17
1 28 69 11.5
1 30 88 32.5
1 39 69 11.5 269 173
2 1 84 26.5
2 2 87 30
2 3 81 23.5
2 4 80 21
2 5 63 6
2 10 72 15.5
2 12 70 13.5
2 14 49 1.5
2 15 49 1.5
2 17 92 38
2 18 57 4
2 19 86 29
2 21 82 25
2 23 88 32.5
2 25 89 36
2 26 67 9.5
2 27 88 32.5
2 29 67 9.5
2 31 66 7.5
2 32 89 36
2 33 61 5
2 34 96 40
2 35 89 36
2 36 54 3
2 37 84 26.5
2 38 66 7.5
2 40 80 21 224.5 504.5
1=male (n=13), 2=female (n=27)

22