Fear, silence, and moral injury following medication errors: insights from Jordanian pediatric nurses

Medication errors represent a major patient safety concern, with pediatric populations particularly vulnerable due to complex dosing requirements and developmental factors. Although the prevalence and causes of medication errors are widely documented, limited attention has been given to the emotional, ethical, and moral consequences for pediatric nurses, especially within non-Western healthcare contexts.

This study aimed to explore how Jordanian pediatric nurses experience, respond to, and learn from medication errors, with specific attention to emotional impact, moral distress, reporting behaviors, and institutional support.

A qualitative descriptive design with a phenomenological design was employed. Semi-structured interviews were conducted with 21 pediatric nurses working in a public pediatric hospital and a university-affiliated teaching hospital in Jordan. Interviews were audio-recorded, transcribed verbatim, and analyzed using Braun and Clarke's thematic analysis.

Five themes were identified: lingering emotional fallout marked by guilt and anxiety; blame-oriented cultures and lack of institutional support; growth through increased vigilance and peer solidarity; fear-driven silence related to reporting; and moral injury involving identity rupture, silent suffering, and moral repair.

Medication errors were experienced as enduring emotional and moral events rather than isolated technical incidents. Trauma-informed leadership, just culture implementation, structured emotional debriefing, and peer support are essential for promoting learning, reporting, and moral recovery.