Math anxiety, self-efficacy, and ability in British undergraduate nursing students

Nurse academics' self-reported insights into the teaching of undergraduate nursing numeracy: A national cross-sectional study

AIMS

The aim of this research was to explore the teaching of undergraduate nursing numeracy in tertiary education settings in Australia. Specifically, it explored and identified: (1) the most common basic numeracy concepts taught, (2) additional training and resources to support numeracy teaching, (3) who is best placed to teach numeracy and (4) the preferred methods of teaching medication calculations.

BACKGROUND

Nurse academics are required to teach nursing numeracy to undergraduate nursing students who enter university unprepared to accurately calculate medication dosages. It is important that students understand numeracy concepts as this is then applied to contextualised clinical applications. Nurse academics teach basic numeracy; however, the literature reveals that nurse academics do not consider themselves mathematics teachers and that experts in this area are better suited to teaching this skill. There are a dearth of studies about the nurse academics who conduct the teaching and this study seeks to fill that gap by exploring firsthand the nurse academics' self-reported insights into the teaching of undergraduate nursing numeracy.

DESIGN

Cross-sectional survey. The setting was Australian universities that deliver an accredited undergraduate nursing degree.

METHODS

Purposive sampling was used to recruit Australian nurse academics (n = 170), sessional or permanent who currently teach all aspects of nursing numeracy and medication calculations to undergraduate nursing students. Data were collected between Nov 2023 - Feb 2024 using an online survey platform and analysed using a descriptive content analysis.

RESULTS

Nurse academics taught basic arithmetic most commonly (92 %), yet most (90 %) had not received professional development or additional training in how to teach these concepts. To assist with numeracy teaching, resources were requested (47 %) as were the need for mathematics learning support staff (82 %). The formula method was most commonly taught (91 %), however, most participants (94 %) were willing to learn and to teach other methods of calculating medications.

CONCLUSIONS

This research suggests an evidenced-based education framework be created to support and guide nurse academics when teaching all aspects of nursing numeracy and medication calculations. Building the teaching capacity of nurse academics in this vital area will enhance student competence and contribute to patient safety.

Symbolic number ordering strategies and math anxiety

Math anxiety results in a drop in performance on various math-related tasks, including the symbolic number ordering task in which participants decide whether a triplet of digits is presented in order (e.g. 3-5-7) or not (e.g. 3-7-5). We investigated whether the strategy repertoire and reaction times during a symbolic ordering task were affected by math anxiety. In study 1, participants performed an untimed symbolic number ordering task and indicated the strategy they used on a trial-by-trial basis. The use of the memory retrieval strategy, based on the immediate recognition of the triplet, decreased with high math anxiety, but disappeared when controlling for general anxiety. In the study 2, participants completed a timed version of the number order task. High math-anxious participants used the decomposition strategy (e.g. 5 is larger than 3 and 7 is larger than 5 to decide whether 3-5-7 is in the correct order) more often, and were slower in responding when both memory- and other decomposition strategies were used. Altogether, both studies demonstrate that high-math anxious participants are not only slower to decide whether a number triplet is in the correct order, but also rely more on procedural strategies.

Evaluation of Urinary Catheterization Competency and Self-Efficacy in Nursing Students Using the Flipped Classroom Approach

Urinary catheterization is a complex procedure. Traditional teaching in classroom, such as using a simulator, is not enough to guarantee the necessary learning outcomes. It is therefore necessary to implement new active learning approaches such as the flipped classroom. The aim of this study was to examine the effect of the use of the flipped classroom on the level of self-efficacy and the assessment of clinical competencies in nursing students performing the urinary catheterization procedure. A quasi-experimental study of a single group with pre-/post-testing measures. A convenience sample of 139 nursing students. A flipped classroom approach was implemented. Measurements were taken pre and post intervention. This study followed the consolidated criteria for quality of nonrandomized evaluations studies (TREND) checklist. Regarding self-efficacy, statistically significant differences were found between the pre-test and post-test (Z = -14.453; p < 0.05). With respect to knowledge level, statistically significant differences were found when comparing pre-/post-test results (Z = -14,480; p < 0.05). Furthermore, statistically significant differences were found on the ability scale depending on pre-/post-test (Z = -10.277; p < 0.005); in all cases, obtaining a higher score in the post-test. The flipped classroom could be an effective educational tool for the development of clinical skills, specifically urinary catheterization. This method has been shown to improve the knowledge, skills, and self-efficacy in urinary catheterization of nursing students.

Where do nursing students make mistakes when calculating drug doses? A retrospective study

Background

Research internationally shows that nursing students find dosage calculation difficult. Identifying the specific aspects of dose calculation procedures that are most commonly associated with errors would enable teaching to be targeted where it is most needed, thus improving students’ calculation skills. The aim of this study was to analyze where specifically nursing students make mistakes when calculating drug doses.

Method

Retrospective analysis of written examination papers including dosage calculation exercises from years 1, 2, and 3 of a nursing degree program. Exercises were analyzed for errors in relation to 23 agreed categories reflecting different kinds of calculation or steps in the calculation process. We conducted a descriptive and bivariate analysis of results, examining the relationship between the presence of errors and the proportion of correct and incorrect final answers.

Results

A total of 285 exam papers including 1034 calculation exercises were reviewed. After excluding those that had been left blank, a total of 863 exercises were analyzed in detail. A correct answer was given in 455 exercises (52.7%), although this varied enormously depending on the type of exercise: 89.2% of basic dose calculations were correct, compared with just 2.9% of those involving consideration of maximum concentration. The most common errors were related to unit conversion, more complex concepts such as maximum concentration and minimum dilution, or failure to contextualize the answer to the clinical case. Other frequent errors involved not extracting the key information from the question, not including the units when giving their answer, and not understanding the question. In general, fewer errors in basic dose calculations were made by students at later stages of the degree program.

Conclusions

Students struggle with more complex dose calculations. The main errors detected were related to understanding the task and the key concepts involved, as well as not following the correct steps when solving the problem.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-01085-9.

The Impact of Parents' Intelligence Mindset on Math Anxiety of Boys and Girls and the Role of Parents' Failure Beliefs and Evaluation of Child's Math Performance as Mediators

This study aimed to examine the relationship between parents' intelligence mindset and children's math anxiety and the mediating role of parents' failure mindset and evaluations of their child's math performance. A total of 419 Chinese students (196 boys and 223 girls) and their parents were recruited to complete a series of questionnaires on topics such as math anxiety, parent's failure mindset, parent's intelligence mindset, and parents' evaluations of their child's mathematical performance. The results revealed that parents' intelligence mindset was not correlated with children's math anxiety. However, parents' intelligence mindset indirectly predicted children's math anxiety through the chain-mediated role of parents' failure beliefs and parents' evaluations of their child's math performance. Further, sex differences were found through a multigroup analysis, which showed a chain-mediated effect between parents' intelligence mindset and girls' math anxiety.

Self-efficacy matters: Influence of students' perceived self-efficacy on statistics anxiety

Statistical knowledge is a key competency for psychologists in order to correctly interpret assessment outcomes. Importantly, when learning statistics (and its mathematical foundations), self-efficacy (defined as an individual's belief to successfully accomplish specific performance attainments) is a central predictor of students' motivation to learn, learning engagement, and actual achievement. Therefore, it is crucial to gain a better understanding of students' self-efficacy for statistics and its interrelations with statistics anxiety and students' belief in the relevance of statistics. Here, we present results showing development and validation of a self-assessment questionnaire for examining self-efficacy for statistics in psychology students (Self-Efficacy for Learning Statistics for Psychologists, SES-Psy). Upon using different methodological approaches, we demonstrate that the SES-Psy questionnaire has (1) sound psychometric properties, and within our sample of university students, (2) a robust latent structure disclosing three clearly distinctive profiles that are characterized by a complex and nonlinear interplay between perceived self-efficacy (for basic and advanced statistics), statistics anxiety, and students' belief in the relevance of statistics. Implications for educational settings and future research are discussed.

Mathematics anxiety and associated interventions in nursing: A scoping review

BACKGROUND

Mathematics proficiency is a key element in accurate medication calculation and patient safety. Education providers play an important role in preparing students for safe medication administration. However, the presence of mathematics anxiety in students may impact on relevant mathematics mastery.

OBJECTIVES

To explore what is known and reported about mathematics anxiety in nursing and the nature of interventions developed.

DESIGN

A scoping review guided by the work of Arksey and O'Malley and Joanna Briggs Institute methodology.

DATA SOURCES

CINAHL, Medline, ERIC and Proquest Nursing and Allied Health.

REVIEW METHODS

Search included primary research published between 2000 and 2021 and in English language.

RESULTS

Ten studies were included in the final review, and numerous different tools used to measure mathematics anxiety. A number of factors were found to influence mathematics anxiety and various local interventions are reported. There is a lack of consistency in research reporting on mathematics anxiety, with most being single-site studies and small in scale.

CONCLUSIONS

Overall, despite its importance, there is scant research into mathematics anxiety in nursing. There is a need for a consistent, valid and reliable tool for its measurement, as well as validated interventions to address it. Furthermore, there is a deficit in research evaluating mathematics anxiety longitudinally across the duration of an education program. There is a need for nurse education providers to work to address these important gaps and establish entry-level benchmark requirements.

Adaptation Process of the Mathematic Self-Efficacy Survey (MSES) Scale to Mexican-Spanish Language

Trained professionals in science, technology, engineering, and mathematics (STEM) are needed for a robust, science-based economy that incorporates various technologies’ design, construction, and commercialization to address societal problems. However, keeping students interested in STEM subjects and achieving optimal performance is a challenging task. Math self-efficacy has shown to be one of the most important factors affecting students’ interest in STEM majors and assessing this factor has been a great challenge for education researchers around the world due to the lack of calibrated and culturally adapted instruments. Observing this need, this seminal study conducted psychometric validation tests and cultural adaptations to the Mathematic Self-Efficacy Survey (MSES) aiming to measure this instrument in Spanish-speaking students in different STEM areas in Mexico. Data collected from 877 students were tested for validity using sequential exploratory factor analyses, and contextual modifications were performed and analyzed aiming to achieve cultural equivalency. Suggestions for continuing the adaptation and validation process of the MSES to Spanish language and STEM students’ context are presented with the results of the exploratory factor analyses.

The subject matters: relations among types of anxiety, ADHD symptoms, math performance, and literacy performance

In this study, we extended a model of the relations among ADHD symptoms, anxiety, and academic performance. Undergraduates (N = 515) completed self-report measures of anxiety (i.e. trait, test, math, and literacy) and ADHD symptoms. During the study, they completed math and literacy measures and reported their current (i.e. state) anxiety three times. There were significant correlations among ADHD symptoms and all measures of anxiety. However, neither ADHD symptoms nor trait anxiety were correlated with math or literacy performance. Test-anxious students reported increasing state anxiety as the study progressed. In contrast, math-anxious students reported increased state anxiety following the math tasks but not the literacy tasks and literacy-anxious students reported increased state anxiety following the literacy tasks but not the math tasks. With respect to performance, math-anxious students had worse math performance and literacy-anxious students had worse literacy performance whereas test anxiety was not directly related to performance on either math or literacy tasks. Patterns of relations did not differ for men and women, but, except for literacy anxiety, women reported higher levels of all types of anxiety. These results could help educators understand how affective responses are related to university students' academic performance.

Medication calculation skills of graduating nursing students within European context

AIM

The aim of this study is to evaluate the medication calculation skills of graduating nursing students in six European countries and analyse the associated factors.

BACKGROUND

Medication calculation skills are fundamental to medication safety, which is a substantial part of patient safety. Previous studies have raised concerns about the medication calculation skills of nurses and nursing students.

DESIGN

As part of a broader research project, this study applies a multinational cross-sectional survey design with three populations: graduating nursing students, nurse managers and patients.

METHODS

The students performed two calculations (tablet and fluid) testing medication calculation skills requiring different levels of conceptual understanding and arithmetic. The managers and patients answered one question about the students' medication kills. In total, 1,796 students, 538 managers and 1,327 patients participated the study. The data were analysed statistically. The STROBE guideline for cross-sectional studies was applied.

RESULTS

Almost all (99%) of the students performed the tablet calculation correctly, and the majority (71%) answered the fluid calculation correctly. Older age, a previous degree in health care and satisfaction with their current degree programme was positively associated with correct fluid calculations. The patients evaluated the students' medication skills higher than the nurse managers did and the evaluations were not systematically aligned with the calculation skills tested.

CONCLUSIONS

Nursing students have the skills to perform simple medication calculations, but a significant number of students have difficulties with calculations involving multiple operations and a higher level of conceptual understanding. Due to the variation in students' medication calculation skills and the unalignment between the managers' and patients' evaluations and the calculation tests, further research is needed.

RELEVANCE TO CLINICAL PRACTICE

Graduating nursing students enter clinical field as qualified professionals, but there is still room for improvement in their medication calculation skills. This calls for attention in the fields of clinical nursing, education and research.

Medication math dosage assessment anxiety in undergraduate nursing students: A systematic review

BACKGROUND

Medication calculation assessment is commonplace in undergraduate nursing programs. A test is routinely used to assist in the determination of safe medication administration practice in a clinical setting. Multiple factors negatively impact student performance.

AIM

The aim of this article is to analyze current literature related to medication calculation assessment and undergraduate nursing student anxiety.

METHOD

A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Articles included were peer-reviewed publications focused on undergraduate nursing student anxiety related to medication dosage calculation.

FINDINGS

Anxiety related to medication calculation assessments can stem from students' personal lives and previous math experiences. Interventions related to increasing self-efficacy can impact student performance on assessments.

CONCLUSION

A variety of interventions to assist undergraduate nursing students increase performance on assessments were indicated in the literature. Advances in educational technologies allow for more assessment options to facilitate safe medication practices.

What impact does maths anxiety have on university students?

BACKGROUND

Maths anxiety is defined as a feeling of tension and apprehension that interferes with maths performance ability, the manipulation of numbers and the solving of mathematical problems in a wide variety of ordinary life and academic situations. Our aim was to identify the facilitators and barriers of maths anxiety in university students.

METHOD

A scoping review methodology was used in this study. A search of databases including: Cumulative Index of Nursing and Allied Health Literature, Embase, Scopus, PsycInfo, Medline, Education Resources Information Centre, Google Scholar and grey literature. Articles were included if they addressed the maths anxiety concept, identified barriers and facilitators of maths anxiety, had a study population comprised of university students and were in Arabic or English languages.

RESULTS AND DISCUSSION

After duplicate removal and applying the inclusion criteria, 10 articles were included in this study. Maths anxiety is an issue that effects many disciplines across multiple countries and sectors. The following themes emerged from the included papers: gender, self-awareness, numerical ability, and learning difficulty. The pattern in which gender impacts maths anxiety differs across countries and disciplines. There was a significant positive relationship between students' maths self-efficacy and maths performance and between maths self-efficacy, drug calculation self-efficacy and drug calculation performance.

CONCLUSION

Maths anxiety is an issue that effects many disciplines across multiple countries and sectors. Developing anxiety toward maths might be affected by gender; females are more prone to maths anxiety than males. Maths confidence, maths values and self-efficacy are related to self-awareness. Improving these concepts could end up with overcoming maths anxiety and improving performance.

The Correlation between Mathematics Anxiety, Numerical Ability and Drug Calculation Ability of Paramedic Students: An Explanatory Mixed Method Study

INTRODUCTION

Numeracy is the ability to reason and to apply simple numerical concepts. Numerical and drug calculation skills are essential for patient safety. Health-care providers who perform drug calculation in their work required good math skills, especially numerical ability. The aims of this study were to explore the relationship between numerical ability, math anxiety and drug calculation performance and to explore the factors that contribute to drug calculation ability among paramedic students.

METHODS

A sequential explanatory mixed-method approach that included a paper-based questionnaire followed by face-to-face interviews was used in this study. The participants completed a 30-minute survey that is composed of demographics, the 10-item Mathematics Anxiety Rating Scale (MARS), a 12-question numerical ability test (NAT) and a 9-question drug calculation ability test (DCAT) and then were invited for a structured interview.

RESULTS

The mean MARS scores were higher for the second-year students than the third students. The NAT and DCAT scores for the third-year students were higher than the second-year students. There was a significant difference in the mean drug calculation ability test scores (DCAT) (t (106) = 2.13, p = 0.035 and Cohen's d = 0.43 between males (5.05 (2.32)) and females (4.03 (2.43))). Math education prior joining the university (beta = 0.862, p = 0.030) made the strongest unique contribution when controlling for the other variables followed by numerical ability (beta =0.25, p <0.001). The themes that emerged from the interviews included the impact of technology, classmates' impact, mathematics competence and the mental block.

CONCLUSION

Drug calculation is fundamental in paramedic practice. It is affected by the numerical ability of the students and is negatively and indirectly impacted by mathematics anxiety. Modifications of a paramedic program curriculum can improve student's ability to think critically and to overcome medication dosage problems.

A meta-analysis of the relation between math anxiety and math achievement

Meta-analyses from the 1990s previously have established a significant, small-to-moderate, and negative correlation between math achievement and math anxiety. Since these publications, research has continued to investigate this relation with more diverse samples and measures. Thus, the goal of the present meta-analysis was to provide an update of the math anxiety-math achievement relation and its moderators. Analyzing 747 effect sizes accumulated from research conducted between 1992 and 2018, we found a small-to-moderate, negative, and statistically significant correlation (r = -.28) between math anxiety and math achievement. The relation was significant for all moderator subgroups, with the exception of the relation between math anxiety and assessments measuring the approximate number system. Grade level, math ability level, adolescent/adult math anxiety scales, math topic of anxiety scale, and math assessments were significant moderators of this relation. There is also a tendency for published studies to report significantly stronger correlations than unpublished studies, but overall, large, negative effect sizes are underreported. Our results are consistent with previous findings of a significant relation between math anxiety and math achievement. This association starts in childhood, remains significant through adulthood, is smaller for students in Grades 3 through 5 and postsecondary school, is larger for math anxiety than for statistics anxiety and for certain math anxiety scales, and is smaller for math exam grades and samples selected for low math ability. This work supports future research efforts to determine effective math achievement and math anxiety interventions, which may be most helpful to implement during childhood. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Contextualising numeracy skill development and assessment in a first year undergraduate nursing subject: A mixed methods research study

BACKGROUND

Undergraduate nursing students continue to perform poorly on clinically-related numeracy tasks, making errors that betray fundamental misconceptions about the underlying mathematics. Graduate nurses are also prone to error in this area but they have the benefit of performing their calculations in a real-world setting with the assistance of colleague nurses if required. These conditions are difficult to simulate in a classroom environment, but when effort is made in this direction the effects can be rewarding for students and educators.

OBJECTIVES

To investigate the effect on undergraduate nursing students' learning experience and test performance of a practical, clinically contextualised numeracy workshop featuring individual and collaborative modes of assessment.

DESIGN

A mixed methods study using pre and post tests and a survey.

SETTINGS

Clinical practice classrooms at an Australian university.

PARTICIPANTS

First year undergraduate nursing students undertaking a subject whose curriculum features medication safety and clinically-related numeracy.

METHODS

Administration of individual and collaborative short-answer pre and post tests, a survey, and facilitation of team-based, clinically-related numeracy activities over a 1.5 h workshop. All test marking, data collection and analysis were performed by the authors.

RESULTS

Positive responses to survey questions probing students' judgement of the effect of contextualised learning on their confidence, engagement and proficiency in nursing numeracy, as well as the value of working in a clinical setting. Significant improvement in students' performance in pre/post tests.

CONCLUSIONS

Contextualised, practical and collaborative learning and assessment of nursing numeracy is valued by students and has a positive effect on their experience and performance in the content area.

First year undergraduate nursing students' perceptions of the effectiveness of blended learning approaches for nursing numeracy

The ability to safely calculate and administer medications are indispensable, core nursing skills in nursing education and practice. Therefore, it is imperative that nursing students are adequately prepared with the necessary numeracy skills during their undergraduate nursing studies. The focus of this study, conducted at a single multi-campus university in the western Sydney region of Australia, was to determine the effectiveness of a suite of blended learning approaches on numeracy self-efficacy from the students' perspective. Surveys were administered as part of the study and included open-ended questions. 525 students provided open-ended responses that were analysed by the research team. Four main themes were identified from the open-ended responses: (i) Self-realisation; (ii) Practice, practice, practice; (iii) Boosting confidence; and (iv) Wanting more. The themes captured students' perceptions of the benefits of having a rigorous learning design in blended learning approaches. The study showed that a structured pedagogical approach to nursing numeracy in undergraduate programs improved students' self-reported self-efficacy with mathematics and assisted students in realising the importance of learning and applying these skills as nursing clinicians.

Higher math anxious people have a lower need for cognition and are less reflective in their thinking

There exists a large body of literature seeking to understand the relation between math anxiety and success in mathematics. While most of this literature focuses on domain specific relations (i.e., how math anxiety impacts thinking about mathematics), in the current work we examine important relations between math anxiety and domain general factors. Specifically, we test three hypotheses: (1) that higher-math-anxious individuals have a lower need for and enjoyment of exerting cognitive effort, (2) that math anxiety mediates a relation between ones' propensity for cognitive effort and their achievement in mathematics, and (3) that higher-math-anxious individuals are less reflective in their thinking, and that this is not limited to questions that are heavily reliant on mathematical reasoning. As predicted, we uncovered relations between math anxiety and the domain-general constructs of need for cognition and cognitive reflection. Importantly, these negative relations hold even after controlling for math ability, general anxiety, and gender of the participant. The results are discussed in terms of implications for our understanding of the construct of math anxiety. Proficiency in mathematics is a major advantage in industrialised nations. Unfortunately, many people experience math-anxiety (Richardson & Suinn, 1972), becoming nervous when engaging in math tasks and avoiding math and math-related professions. As a result, those with math anxiety tend to severely limit their future career and earning opportunities (Chipman, Krantz, & Silver, 1992; Hembree, 1990). The resulting shortage of adults prepared to work in the sciences, technology, engineering, and mathematics field (STEM) has negative consequences at the national level, particularity as societies become increasingly dependent upon technology (Beilock & Maloney, 2015; Chipman et al., 1992; Maloney & Beilock, 2012). Worldwide, increased math-anxiety is linked to decreased math achievement (Foley et al., 2017; Lee, 2009), and this is not limited to academic situations. Math-anxious nurses, for example, are more likely than non-math-anxious nurses to make poor drug calculations (Mcmullan, Jones, & Lea, 2012); math-anxious women are more likely than their peers to engage in poor financial planning (McKenna & Nickols, 1988), and math anxiety is negatively linked to the ability to interpret health statistics (Silk & Parrott, 2014). Given that math-anxiety is related to important and detrimental consequences in people's daily lives, it is vital that we work to understand the behavioural and cognitive differences between those who are high and low in math-anxiety.

Predicting maths anxiety from mathematical achievement across the transition from primary to secondary education

The primary- to secondary-education transition is a substantive life event for many children. The transition can be associated with changes in the developmental trajectories of both emotional health and academic achievement. The current study looked at whether the trajectory of mathematical attainment and emotional health (anxiety) across this transition predicted later maths anxiety. A secondary analysis of data from the Twin Early Development Study (TEDS) was performed. The statistical models were fit on the 753 participants (one from each twin pair) for which there were measures of mathematical performance across the primary- to secondary-education transition and maths anxiety at age 18. Two multi-level growth models were fit predicting mathematical attainment and anxiety over the primary- to secondary-education transition. The intercepts and slopes for each child were extracted from these models and used as predictors of subsequent maths anxiety at age 18. These effects were adjusted for biological sex, socio-economic status, verbal cognitive ability and general anxiety. Maths anxiety at age 18 was significantly predicted by both pre-transition levels of anxiety and mathematical attainment and their rate of change across the primary- to secondary-education transition. However, the effects were small, suggesting that theories of maths anxiety may have overplayed the role of prior mathematical attainment and general anxiety.

Applied Pediatric Math: Bridging the Gap Between Theory and Practice for a Diverse Group of Learners

A gap exists between didactic theory and clinical practice when nursing students learn clinical calculations. Educators can provide innovative classroom teaching methods using practical mathematics to decrease this gap. In the simulation lab, students complete weight-based calculations and then administer medications as part of medication skills stations. Math assessments in the psychomotor domain promote application of didactic math content. Implementing math assessments that include a hands-on component facilitates the students' abilities to take math out of the classroom and apply it in clinical practice, enabling the educator to minimize disparities found when students have different mathematics backgrounds.

Heterosis in COMT Val158Met Polymorphism Contributes to Sex-Differences in Children's Math Anxiety

Math anxiety (MA) is a phobic reaction to math activities, potentially impairing math achievement. Higher frequency of MA in females is explainable by the interaction between genetic and environmental factors. The molecular-genetic basis of MA has not been investigated. The COMT Val158Met polymorphism, which affects dopamine levels in the prefrontal cortex, has been associated with anxiety manifestations. The valine allele is associated with lower, and the methionine allele with higher, dopamine availability. In the present study, the effects of sex and COMT Val158Met genotypes on MA were investigated: 389 school children aged 7-12 years were assessed for intelligence, numerical estimation, arithmetic achievement and MA and genotyped for COMT Val158Met polymorphism. The Math Anxiety Questionnaire (MAQ) was used to assess the cognitive and affective components of MA. All genotype groups of boys and girls were comparable regarding genotype frequency, age, school grade, numerical estimation, and arithmetic abilities. We compared the results of all possible genetic models: codominance (Val/Val vs. Val/Met vs. Met/Met), heterosis (Val/Met vs. Val/Val plus Met/Met), valine dominance (Val/Val plus Val/Met vs. Met/Met), and methionine dominance (Met/Met plus Val/Met vs. Val/Val). Models were compared using AIC and AIC weights. No significant differences between girls and boys and no effects of the COMT Val158Met polymorphism on numerical estimation and arithmetic achievement were observed. Sex by genotype effects were significant for intelligence and MA. Intelligence scores were higher in Met/Met girls than in girls with at least one valine allele (valine dominance model). The best fitting model for MA was heterosis. In Anxiety Toward Mathematics, heterozygous individuals presented MA levels close to the grand average regardless of sex. Homozygous boys were significantly less and homozygous girls significantly more math anxious. Heterosis has been seldom explored, but in recent years has emerged as the best genetic model for some phenotypes associated with the COMT Val158Met polymorphism. This is the first study to investigate the genetic-molecular basis of MA.

Challenges in Implementing an E-Learning Education Program for Syringe Pump Use

To prevent the incidence of risks imputable to human error during the process of preparing the infusion pump, clarity in teaching and learning are required. Because traditional classroom training is difficult and time-consuming, the aim of the present study was to challenge the implementation of an e-learning education program for syringe pump use. The impact of the e-learning program was evaluated with 100 nurses between March and June 2016. The e-learning program significantly increased general baseline knowledge in syringe pump use; however, aspects of the program confused participants. The feedback from 98 % of nurses on the e-learning program was that it was effective in helping them with this skill. However, only 54 % opted for the e-learning program versus traditional training. The present study showed nurses preferred a blended learning format. Based on our hospital incident and error reports, this study shows local training requires a specific approach strategy for syringe pump education.

The Nature of Math Anxiety in Adults: Prevalence and Correlates

It is important to understand the nature of math anxiety in the general adult population, as the importance of math skills does not end when one leaves school. To this end, we present a well-powered, preregistered study of English-speaking U.S. adults describing the nature of math anxiety in this population. 1000 participants were recruited online. Math anxiety was approximately normally distributed, with the mean between "some" and "moderate". Math anxiety was significantly negatively correlated with probability knowledge and math fluency, and significantly positively correlated with general anxiety and test anxiety. Women reported higher math anxiety than did men. Participants who had completed graduate school or had a STEM career had significantly lower levels of math anxiety than did those with less education, or non-STEM careers. Thus, we see evidence for math anxiety in U.S. adults and that it correlates with factors also reported in previous studies using younger and student populations.

Evaluation of a medication calculation mobile app using a cognitive load instructional design

OBJECTIVE

For students attending healthcare courses, such as nursing and paramedicine, the ability to calculate medication dosages accurately is an essential but often a complex cognitive skill to be learned. This study aimed to determine whether a 'mastering medication calculation' mobile app, developed using an instructional design based on cognitive load theory, could improve students' medication calculation ability and self-efficacy. Additional objectives were: (1) To examine the correlations between students' medication calculation ability, self-efficacy and their numerical ability; (2) To explore how well medication calculation ability can be predicted by students' numerical ability and their medication calculation self-efficacy; (3) To obtain students' opinions regarding the mobile app's usefulness and usability.

METHOD

A quasi-experimental study was carried out with a convenience sample of 60 second year UK university healthcare students who used the app for 8 weeks while in clinical practice. Students were given medication calculation ability and self-efficacy tests pre- and post-intervention. In addition, they were asked pre-intervention to complete a numeracy test and to complete a post-intervention survey to obtain their opinions on the usefulness of the app.

RESULTS

Following the use of the app students were significantly more able (p = 0.004) and more confident (p < 0.001) in performing medication calculations. There were significant positive correlations found between students' numerical ability and medication calculation ability (p < 0.001) and between students' medication calculation ability and self-efficacy (p < 0.001). Hierarchical multiple regression analysis indicated numerical ability (β = 0.46, p < 0.001) and medication calculation self-efficacy (β = 0.46, p < 0.001) to be the strongest predictors of medication calculation ability, with age and gender being non-significant. All students indicated the app to be an excellent method to support them in learning how to perform medication calculations.

CONCLUSION

This study indicated that the app's instructional design, based on cognitive load theory, significantly improved students' medication calculation ability and self-efficacy. Although the app's usability was highly rated by the students, further research is needed to determine if the app's instructional design can be used by learners of different levels of expertise and whether the design can be adopted for the learning of other complex cognitive skills. As numerical ability is essential for medication calculation ability, early identification and rectification of any numerical deficits is recommended.

Striving for a good standard of maths for potential student nurses

This article explores some of the issues surrounding numerical competence for potential pre-registration children's nursing students, with examples of success and failure, at the University of Hertfordshire. With poor numerical ability causing concern in the UK, and the effect of low competence on patient safety when calculating drug dosages in healthcare, this article considers some of the literature surrounding numerical ability, confidence and anxiety, along with considering whether a 'C' grade at GCSE is a suitable marker for assessing numerical competence before starting a pre-registration nursing programme.

Increasing nursing students' understanding and accuracy with medical dose calculations: A collaborative approach

BACKGROUND

Accurate calculation of medication dosages can be challenging for nursing students. Specific interventions related to types of errors made by nursing students may improve the learning of this important skill.

OBJECTIVE

The objective of this study was to determine areas of challenge for students in performing medication dosage calculations in order to design interventions to improve this skill.

DESIGN

Strengths and weaknesses in the teaching and learning of medication dosage calculations were assessed. These data were used to create online interventions which were then measured for the impact on student ability to perform medication dosage calculations.

SETTING

The setting of the study is one university in Canada.

PARTICIPANTS

The qualitative research participants were 8 nursing students from years 1-3 and 8 faculty members. Quantitative results are based on test data from the same second year clinical course during the academic years 2012 and 2013.

METHODS

Students and faculty participated in one-to-one interviews; responses were recorded and coded for themes. Tests were implemented and scored, then data were assessed to classify the types and number of errors.

RESULTS

Students identified conceptual understanding deficits, anxiety, low self-efficacy, and numeracy skills as primary challenges in medication dosage calculations. Faculty identified long division as a particular content challenge, and a lack of online resources for students to practice calculations. Lessons and online resources designed as an intervention to target mathematical and concepts and skills led to improved results and increases in overall pass rates for second year students for medication dosage calculation tests.

CONCLUSION

This study suggests that with concerted effort and a multi-modal approach to supporting nursing students, their abilities to calculate dosages can be improved. The positive results in this study also point to the promise of cross-discipline collaborations between nursing and education.

Affective and Motivational Factors Mediate the Relation between Math Skills and Use of Math in Everyday Life

This study focused on the use of math in everyday life (the propensity to recognize and solve quantitative issues in real life situations). Data from a Dutch nation-wide research on math among adults (N = 521) were used to investigate the question whether math anxiety and perceived math competence mediated the relationship between math skills and use of math in everyday life, taken gender differences into account. Results showed that women reported higher math anxiety, lower perceived math competence, and lower use of math in everyday life, compared to men. Women's skills were estimated at a lower level than men's. For both women and men, higher skills were associated with higher perceived math competence, which in turn was associated with more use of math in everyday life. Only for women, math anxiety also mediated the relation between math skills and use of math in everyday life.

Factors associated with nursing students' medication competence at the beginning and end of their education

BACKGROUND

In previous studies, deficiencies in nursing students' medication competence have been highlighted. However, the focus of research has been limited especially to medication calculation competence and factors associated with it. In order to develop undergraduate nursing education and research, an understanding of the individual and learning environmental factors associated with medication competence from a broader approach is warranted. Our aim was therefore to evaluate the theoretical, practical and decision-making competence of nursing students and to identify factors associated with their medication competence at the beginning and end of their education.

METHODS

We used a descriptive, correlational study design with a structured instrument including a set of potential associated factors, knowledge test, medication calculation test and patient vignettes. The participants were nursing students at the beginning (n = 328) and at the end of their education (n = 338). Data were analyzed statistically.

RESULTS

In the evaluation of theoretical medication competence, the students' mean score over the semesters was 72 % correct answers in a knowledge test. In the evaluation of practical medication competence, the mean score was 74 % correct answers in a medication calculation test. In the evaluation of decision-making competence, the mean score was 57 % correct answers on deciding the best action in the situation given in patient vignettes. At the end of their education, students were able to solve patient vignettes significantly better. Individual factors were most evidently associated with medication competence. At the beginning of their education, students' previous academic success had a stronger association with medication competence. However, at the end of the education students' abilities in self-regulated learning and study motivation were more significant factors.

CONCLUSION

The core elements of medication competence are significantly interrelated, highlighting the need to provide integrated and comprehensive medication education throughout the undergraduate education. Students' learning style is associated with medication competence. There is a need for methods to identify and support students having difficulties to self-regulate their learning. To increase the safety of medication care of patients, research focusing on the development of effective teaching methods is needed. This study produced information for future nursing education research in this field, especially for interventional studies.

Math Anxiety

The United States is currently not producing enough graduates in science, technology, engineering, and math (STEM) fields to meet the demands of a technology-dependent society. Although there are many efforts in place to improve STEM education in the United States, most notably, President Obama’s Educate to Innovate campaign, these efforts focus mostly on innovating the teaching of math content and less on the role of affective factors in math achievement. Here we discuss a phenomenon known as math anxiety (i.e., negative feelings of tension and fear that many people experience when engaging in math) and the implications math anxiety carries for math success and STEM engagement. We begin by highlighting the most recent findings from research in psychology, education, and neuroscience on math anxiety. We then discuss the consequences of math anxiety as well as likely causes and promising remediations. We suggest that the initiatives currently underway to improve STEM involvement and achievement would benefit from educating current and future teachers, parents, and even students about math anxiety, its causes, consequences, and possibilities for amelioration.

Can I Count on Getting Better? Association between Math Anxiety and Poorer Understanding of Medical Risk Reductions

BACKGROUND

Lower numerical ability is associated with poorer understanding of health statistics, such as risk reductions of medical treatment. For many people, despite good numeracy skills, math provokes anxiety that impedes an ability to evaluate numerical information. Math-anxious individuals also report less confidence in their ability to perform math tasks. We hypothesized that, independent of objective numeracy, math anxiety would be associated with poorer responding and lower confidence when calculating risk reductions of medical treatments.

METHODS

Objective numeracy was assessed using an 11-item objective numeracy scale. A 13-item self-report scale was used to assess math anxiety. In experiment 1, participants were asked to interpret the baseline risk of disease and risk reductions associated with treatment options. Participants in experiment 2 were additionally provided a graphical display designed to facilitate the processing of math information and alleviate effects of math anxiety. Confidence ratings were provided on a 7-point scale.

RESULTS

Individuals of higher objective numeracy were more likely to respond correctly to baseline risks and risk reductions associated with treatment options and were more confident in their interpretations. Individuals who scored high in math anxiety were instead less likely to correctly interpret the baseline risks and risk reductions and were less confident in their risk calculations as well as in their assessments of the effectiveness of treatment options. Math anxiety predicted confidence levels but not correct responding when controlling for objective numeracy. The graphical display was most effective in increasing confidence among math-anxious individuals.

CONCLUSIONS

The findings suggest that math anxiety is associated with poorer medical risk interpretation but is more strongly related to confidence in interpretations.

Using medical incidents to teach: effects of vicarious experience on nursing students' self-efficacy in performing urinary catheterization

This study compared the effects of instruction on nursing students' self-efficacy in urinary catheterization, using positively and negatively worded examples after vicarious experience of a medical incident. Nursing students (n = 128) completed measures on urinary catheterization performance, general self-efficacy, and self-efficacy in urinary catheterization before being assigned to one of three groups: the instruction with negative examples (NE), the instruction with positive examples (PE), or the control group. Each group read the same medical incident. The instruction with NE and PE groups read negatively and positively worded examples, respectively, about urinary catheterization, and the control group read a summary of the incident. All students indicated their self-efficacy in urinary catheterization. A statistically significant increase in self-efficacy was noted in the PE and NE groups but was significantly higher in the NE group, compared with the control group. Implications for nurse educators using medical incidents to increase nursing students' self-efficacy are discussed.

Numeric and graphic risk information processing of high and low numerates in the intuitive and deliberative decision modes: An eye-tracker study

The influence of numeracy on information processing of two risk communication formats (percentage and pictograph) was examined using an eye tracker. A sample from the general population (N = 159) was used. In intuitive and deliberative decision conditions, the participants were presented with a hypothetical scenario presenting a test result. The participants indicated their feelings and their perceived risk, evoked by a 17% risk level. In the intuitive decision condition, a significant correlation (r = .30) between numeracy and the order of information processing was found: the higher the numeracy, the earlier the processing of the percentage, and the lower the numeracy, the earlier the processing of the pictograph. This intuitive, initial focus on a format prevailed over the first half of the intuitive decision-making process. In the deliberative decision condition, the correlation between numeracy and order of information processing was not significant. In both decision conditions, high and low numerates processed pictograph and percentage formats with similar depths and derived similar meanings from them in terms of feelings and perceived risk. In both conditions numeracy had no effects on the degree of attention on the percentage or the pictograph (number of fixations on formats and transitions between them). The results suggest that pictographs attract low numerates’ attention, and percentages attract high numerates’ attention in the first, intuitive, phase of numeric information processing. Pictographs thus ensure low numerates’ further elaboration on numeric risk information, which is an important precondition of risk understanding and decision making.

Development of a Questionnaire and Cross-Sectional Survey of Patient eHealth Readiness and eHealth Inequalities

BACKGROUND

Many speak of the digital divide, but variation in the opportunity of patients to use the Internet for health (patient eHealth readiness) is not a binary difference, rather a distribution influenced by personal capability, provision of services, support, and cost. Digital divisions in health have been addressed by various initiatives, but there was no comprehensive validated measure to know if they are effective that could be used in randomized controlled trials (RCTs) covering both non-Internet-users and the range of Internet-users.

OBJECTIVE

The aim of this study was to develop and validate a self-completed questionnaire and scoring system to assess patient eHealth readiness by examining the spread of scores and eHealth inequalities. The intended use of this questionnaire and scores is in RCTs of interventions aiming to improve patient eHealth readiness and reduce eHealth inequalities.

METHODS

Based on four factors identified from the literature, a self-completed questionnaire, using a pragmatic combination of factual and attitude questions, was drafted and piloted in three stages. This was followed by a final population-based, cross-sectional household survey of 344 people used to refine the scoring system.

RESULTS

the patient ehealth readiness questionnaire (perq) includes questions used to calculate four subscores: patients' perception of (1) provision, (2) their personal ability and confidence, (3) their interpersonal support, and (4) relative costs in using the Internet for health. These were combined into an overall PERQ score (0-9) which could be used in intervention studies. Reduction in standard deviation of the scores represents reduction in eHealth inequalities.

CONCLUSIONS

PERQ appears acceptable for participants in British studies. The scores produced appear valid and will enable assessment of the effectiveness of interventions to improve patient eHealth readiness and reduce eHealth inequalities. Such methods need continued evolution and redevelopment for other environments. Full documentation and data have been published to allow others to develop the tool further.