Reappraising lithium, triiodothyronine and second-generation antipsychotic augmentation treatment for major depression: a systematic review and meta-analysis with bias-adjustment analyses.

Pediatric medication administration is recognized as a complex, multidisciplinary, and multistage process that requires comprehensive professional knowledge, skill, clinical judgement and attitude across the medication process, including a thorough understanding of pharmacological properties []. In particular, pediatric patients are more vulnerable to medication errors than adults because of weight-based dose calculations, the need for dilution due to limited standardized pediatric formulations, and communication differences associated with developmental stages []. In addition, pediatric patients exhibit considerable pharmacokinetic variability []. Their renal and hepatic functions are immature, which makes drug metabolism and excretion different from those of adults, complicating dosage adjustment [,]. Due to these characteristics, the incidence of medication errors in pediatric patients has been reported to be approximately 3 times higher than in adults, highlighting medication safety as a particularly critical issue in pediatric care settings []. Medication safety competence in pediatric nursing extends beyond medication administration and requires clinical reasoning, critical thinking, and highly proficient technical skills []. In particular, weight-based dosage calculation is the area prone to error in pediatric drug administration, and as a single calculation error can lead to a serious adverse drug event, which should be treated as a fundamental core competency []. Nursing students develop medication competence through pediatric nursing theory and practice in the undergraduate curriculum. However, pediatric medication management is still perceived as a challenging task []. Even when nursing students possess substantial theoretical knowledge, they often find it difficult to directly perform medication management tasks—such as medication preparation and administration—during clinical practicum, and they have limited opportunities to observe how medication administration is handled or reported []. As clinical placements in pediatric wards are limited, students may have fewer opportunities to gain sufficient experience in administering medications to pediatric patients []. In addition, limited opportunities for active participation may make it difficult for students to translate theoretical learning into practical competence [,].