Student nurses need more than maths to improve their drug calculating skills

Numeracy Teaching for Undergraduate Nursing Students: A Scoping Review

BACKGROUND

Education providers teach numeracy to undergraduate nursing students using a diverse range of approaches. Proficiency in numeracy skills is critical for patient safety; however, alarmingly, the accuracy rate of calculations by both undergraduate nurses and RNs is reported to be low.

METHOD

The literature search yielded 1,180 articles published between 1994 and 2022. The assessment of the studies was reported using the PRIMSA extension for Scoping Reviews.

RESULTS

Thirty-nine articles were included in the review. A diverse range of approaches were used to teach numeracy including learning theory, methods of calculation, learning environment, and examination aids.

CONCLUSION

This review highlights the plethora of approaches for teaching numeracy within undergraduate nursing education. Internationally, there were limited studies on the most effective teaching approaches; therefore, developing a robust evidence-based numeracy framework would be beneficial to guide non-nursing instructors in teaching undergraduate nurses. [J Nurs Educ. 2024;63(4):218-227.].

Drug Calculations in Veterinary Medical Education-Where Are We?

Veterinary studies tracking medical errors and their underlying causes are lacking. In human health care, the importance of drug calculation errors in patient safety is well documented. As much as 25% of all medical errors in people are reportedly drug errors, and as much as 14% of those can be attributed to poor drug calculation skills among doctors and nurses. Assessment of the math and analytical skills needed to perform drug calculations accurately is not standardized in veterinary medical education, and there is potential for significant deficit. The purposes of this "Challenges and Issues" article are to briefly discuss the potential impact of poor drug calculation skills on veterinary patients; share one instructor's experience incorporating drug calculations into a veterinary curriculum; and promote further discussion and research that might yield more insight into the assessment and delivery of drug calculation education in veterinary medicine.

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.

Timing of Insulin with Meals in the Hospital: a Systems Improvement Approach

PURPOSE OF REVIEW

Coordination of glucose monitoring, mealtimes, and insulin delivery in the hospital is complex, involving interactions between multiple key agents and overlapping workflows. The purpose of this review is to evaluate the scope of the problem as well as to assess evidence for interventions.

RECENT FINDINGS

In recent years, there has been an emphasis on systems-based approaches which address multiple contributing components of the problem at once in an effort to more seamlessly integrate workflows. Technological advances, such as decision support systems and advances in automated insulin delivery, and strategies that minimize the need for complex insulin regimens hold promise for future study. Evaluation of the coordination of insulin delivery is limited by a lack of standardized metrics and systematically collected mealtimes. Nevertheless, successful efforts include system-wide multicomponent interventions, though advances in therapeutic approaches may be of value.

Determination of Senior Nursing Students' Mathematical Perception Skills and Pediatric Medication Calculation Performance

Aim

Math skills in the health field are often used to calculate drug dosage and liquid quantity, body mass and cost analysis. The aim of this research is to determine the senior nursing students' mathematical perception skills and pediatric medication calculation performance.

Method

The population of this descriptive cross-sectional research is composed of 103 nursing students in attending a state university in Izmir, Turkey. Of the 103 nursing students, 97 who answered all the questions comprised the study sample. All the participants took one-month training in the pediatric clinics during the last year of their education. The data were collected using the "Personal Information Form and Mathematics Perception, Information and Pediatric Drug Calculator Skills Survey" developed by the researchers by reviewing the literature.

Results

The mean age of the study participants was 22.24±0.89. Of them, 76.3% were female, 23.7% completed their Pediatric Internship Training in the pediatric inpatient units or the Pediatric Intensive Care Unit (PICU), 68% thought that their basic mathematics knowledge was adequate, and %30 stated that their dosage calculation, solution preparation and drug preparation skills were insufficient. In addition, the rate of the correct answers they gave to the questions on percentages, fractions and conversions was low.

Conclusion

In the drug application process; not only practical skills, but also the theoretical knowledge should be considered. A nurse's responsibility does not end once he/she administers medication. Being careful throughout the entire process is one of the nurse's legal and ethical responsibilities. In this study, the students' drug calculation skills were inadequate.

Best practices for teaching pharmacology to undergraduate nursing students: A systematic review of the literature

OBJECTIVE

In this systematic review we describe best practices for teaching pharmacology to undergraduate baccalaureate nursing students based on the available evidence. Numerous teaching strategies employed in undergraduate pharmacology courses for nursing students have been summarized and compared for their impact on pharmacology knowledge retention, application of pharmacology theory to practice, and student satisfaction. Future directions for research are discussed.

DESIGN

The review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews and meta-analyses.

DATA SOURCES

The Cumulative Index of Nursing and Allied Health Literature (CINAHL), Academic Search Complete, Education Resources Information Center (ERIC), and Education Source and Health Reference Centre Academic were searched using key search terms and phrases. Twenty studies, conducted between 2001 and 2017, met the inclusion criteria.

METHOD

Quality assessment was made in accordance with two appraisal tools: Kirkpatrick's framework and the Medical Education Research Quality Instrument (MERSQI) for quantitative studies.

RESULTS

Online, simulation, and integrated methods of teaching pharmacology were most beneficial for pharmacology knowledge acquisition and student satisfaction. Traditional lecture, problem-based learning, and a flipped classroom were least effective strategies for teaching pharmacology to undergraduate students.

CONCLUSIONS

This systematic review will contribute to the body of knowledge used by nurse educators who teach in undergraduate nursing programs, may be particularly useful for undergraduate nursing program directors/administrators who are considering undergoing curricular changes, and may be a conduit for future researchers who wish to design studies aimed at improving teaching and learning within undergraduate nursing education.

Evaluation of students' knowledge about paediatric dosage calculations

Medication errors are common and may jeopardize the patient safety. As paediatric dosages are calculated based on the child's age and weight, risk of error in dosage calculations is increasing. In paediatric patients, overdose drug prescribed regardless of the child's weight, age and clinical picture may lead to excessive toxicity and mortalities while low doses may delay the treatment. This study was carried out to evaluate the knowledge of nursing students about paediatric dosage calculations. This research, which is of retrospective type, covers a population consisting of all the 3rd grade students at the bachelor's degree in May, 2015 (148 students). Drug dose calculation questions in exam papers including 3 open ended questions on dosage calculation problems, addressing 5 variables were distributed to the students and their responses were evaluated by the researchers. In the evaluation of the data, figures and percentage distribution were calculated and Spearman correlation analysis was applied. Exam question on the dosage calculation based on child's age, which is the most common method in paediatrics, and which ensures right dosages and drug dilution was answered correctly by 87.1% of the students while 9.5% answered it wrong and 3.4% left it blank. 69.6% of the students was successful in finding the safe dose range, and 79.1% in finding the right ratio/proportion. 65.5% of the answers with regard to Ml/dzy calculation were correct. Moreover, student's four operation skills were assessed and 68.2% of the students were determined to have found the correct answer. When the relation among the questions on medication was examined, a significant relation (correlation) was determined between them. It is seen that in dosage calculations, the students failed mostly in calculating ml/dzy (decimal). This result means that as dosage calculations are based on decimal values, calculations may be ten times erroneous when the decimal point is placed wrongly. Moreover, it is also seen that students lack maths knowledge in respect of four operations and calculating safe dose range. Relations among the medications suggest that a student wrongly calculating a dosage may also make other errors. Additional courses, exercises or utilisation of different teaching techniques may be suggested to eliminate the deficiencies in terms of basic maths knowledge, problem solving skills and correct dosage calculation of the students.

Pediatric Nurse Performance on a Medication Dosage Calculation Assessment Tool

Nurses who care for children must be competent to perform medication dosage calculations because most pediatric doses are weight based and obtained from adult formulations.

PURPOSE

The purpose of the study was to describe and compare nurse performance on a medication dosage calculation assessment tool, considering work unit, years experience, and certification status.

DESIGN

A secondary analysis of data from 851 Registered Nurses (RN) was completed. Multiple regression was used to model the effect of work unit, certification, and experience on score.

FINDINGS

The mean assessment tool score was 92.4 (47-100). The work unit and the interaction between certification status and experience were significant in relation to score on the calculation assessment.

Effectiveness of the training material in drug-dose calculation skills

AIM

The aim of study was to evaluate the effectiveness of the training material based on low-level environmental fidelity simulation in drug-dose calculation skills in senior nursing students.

METHODS

A quasi-experimental design with one group. The sample included senior nursing students attending a nursing school in Turkey in the period December 2012-January 2013. Eighty-two senior nursing students were included in the sample. Data were obtained using a data collection form which was developed by the researchers. A paired-sample t-test was used to compare the pretest and post-test scores.

RESULTS

The difference between the mean pretest score and the mean post-test score was statistically significant (P < 0.05).

CONCLUSION

This study revealed that the training material based on low-level environmental fidelity simulation positively impacted accurate drug-dose calculation skills in senior nursing students.

Medication competency of nurses according to theoretical and drug calculation online exams: A descriptive correlational study

BACKGROUND

Medication administration is an important task of registered nurses. According to previous studies, nurses lack theoretical knowledge and drug calculation skills and knowledge-based mistakes do occur in clinical practice. Finnish health care organizations started to develop a systematic verification processes for medication competence at the end of the last decade. No studies have yet been made of nurses' theoretical knowledge and drug calculation skills according to these online exams.

OBJECTIVES

The aim of this study was to describe the medication competence of Finnish nurses according to theoretical and drug calculation exams.

DESIGN

A descriptive correlation design was adopted. Participants and settings All nurses who participated in the online exam in three Finnish hospitals between 1.1.2009 and 31.05.2014 were selected to the study (n=2479).

METHODS

Quantitative methods like Pearson's chi-squared tests, analysis of variance (ANOVA) with post hoc Tukey tests and Pearson's correlation coefficient were used to test the existence of relationships between dependent and independent variables.

RESULTS

The majority of nurses mastered the theoretical knowledge needed in medication administration, but 5% of the nurses struggled with passing the drug calculation exam. Theoretical knowledge and drug calculation skills were better in acute care units than in the other units and younger nurses achieved better results in both exams than their older colleagues.

CONCLUSION

The differences found in this study were statistically significant, but not high. Nevertheless, even the tiniest deficiency in theoretical knowledge and drug calculation skills should be focused on. It is important to identify the nurses who struggle in the exams and to plan targeted educational interventions for supporting them. The next step is to study if verification of medication competence has an effect on patient safety.

Mathematical ability of first year undergraduate paramedic students-A before and after study

BACKGROUND

An ability to accurately perform drug calculations unassisted is an essential skill for all health professionals, with various occupational-specific stressors exacerbating mathematical deficiencies.

OBJECTIVES

The objective of this study was to determine the unaided mathematic ability of first year undergraduate paramedic students before and after mathematical and drug calculation tutorials.

METHODS

Students were administered a questionnaire containing demographic, drug calculation and arithmetic questions during week one of the semester before the tutorials. During the semester students participated in three 2-hour tutorials which included both mathematical and drug calculation questions without assistance of computational devices. At the end of semester was a summative drug calculation examination of which five key questions were compared to similar questions from the first questionnaire. Descriptive statistics describe the demographic data with a paired t-test comparing the questionnaire and exam results.

RESULTS

Drug calculation and mathematical ability was markedly improved following the tutorials, mean score of correct answers before 1.74 (SD 1.4) and after 4.14 (SD 0.93), p<0001. When comparing the correct results for the same question type, there were statistically significant differences in four of five different drug calculations: volume of drug drawn up 10 v 57 p<0.0001, infusion rate 29 v 31 p=0.717, drip rate 16 v 54 p<0.0001, volume from a syringe 30 v 59 p<0.0001, and drug dose 42 v 62 p<0.0001. Total errors reduced from 188 to 45.

CONCLUSIONS

First year undergraduate paramedic students initially demonstrated a poor ability to complete mathematical and drug calculations without the assistance of computational devices. This improved significantly following appropriate education and practice. Further research is required to determine the retention of this ability over time.

Renal unit practitioners' knowledge, attitudes and practice regarding the safety of unfractionated heparin for chronic haemodialysis

Background

Chronic haemodialysis for adult patients with end-stage kidney failure requires a patent extracorporeal circuit, maintained by anticoagulants such as unfractionated heparin (UFH). Incorrect administration of UFH has safety implications for patients.

Objectives

Firstly, to describe renal practitioners’ self-reported knowledge, attitudes and practice (KAP) regarding the safe use of UFH and its effects; secondly, to determine an association between KAP and selected independent variables.

Method

A cross-sectional descriptive survey by self-administered questionnaire and non-probability convenience sampling was conducted in two tertiary hospital dialysis units and five private dialysis units in 2013.

Results

The mean age of 74/77 respondents (96.1%), was 41.1 years. Most (41/77, 53.2%) had 0–5 years of renal experience. The odds of enrolled nurses having poorer knowledge of UFH than registered nurses were 18.7 times higher at a 95% Confidence Interval (CI) (1.9–187.4) and statistically significant (P = 0.013). The odds of delivering poor practice having ≤ five years of experience and no in-service education were 4.6 times higher at a 95% CI (1.4–15.6), than for respondents who had ≥ six years of experience (P = 0.014) and 4.3 times higher (95% CI 1.1–16.5) than for respondents who received in-service education (P = 0.032), the difference reaching statistical significance in both cases.

Conclusion

Results suggest that the category of the professional influences knowledge and, thus, safe use of UFH, and that there is a direct relationship between years of experience and quality of haemodialysis practice and between having in-service education and quality of practice.

Relationship between High School Mathematics Grade and Number of Attempts Required to Pass the Medication Calculation Test in Nurse Education: An Explorative Study

In Norwegian nurse education, students are required to achieve a perfect score in a medication calculation test before undertaking their first practice period during the second semester. Passing the test is a challenge, and students often require several attempts. Adverse events in medication administration can be related to poor mathematical skills. The purpose of this study was to explore the relationship between high school mathematics grade and the number of attempts required to pass the medication calculation test in nurse education. The study used an exploratory design. The participants were 90 students enrolled in a bachelor’s nursing program. They completed a self-report questionnaire, and statistical analysis was performed. The results provided no basis for the conclusion that a statistical relationship existed between high school mathematics grade and number of attempts required to pass the medication calculation test. Regardless of their grades in mathematics, 43% of the students passed the medication calculation test on the first attempt. All of the students who had achieved grade 5 had passed by the third attempt. High grades in mathematics were not crucial to passing the medication calculation test. Nonetheless, the grade may be important in ensuring a pass within fewer attempts.

Differences in medication knowledge and risk of errors between graduating nursing students and working registered nurses: comparative study

BACKGROUND

Nurses experience insufficient medication knowledge; particularly in drug dose calculations, but also in drug management and pharmacology. The weak knowledge could be a result of deficiencies in the basic nursing education, or lack of continuing maintenance training during working years. The aim of this study was to compare the medication knowledge, certainty and risk of error between graduating bachelor students in nursing and experienced registered nurses.

METHODS

Bachelor students in closing term and registered nurses with at least one year job experience underwent a multiple choice test in pharmacology, drug management and drug dose calculations: 3x14 questions with 3-4 alternative answers (score 0-42). Certainty of each answer was recorded with score 0-3, 0-1 indicating need for assistance. Risk of error was scored 1-3, where 3 expressed high risk: being certain that a wrong answer was correct. The results are presented as mean and (SD).

RESULTS

Participants were 243 graduating students (including 29 men), aged 28.2 (7.6) years, and 203 registered nurses (including 16 men), aged 42.0 (9.3) years and with a working experience of 12.4 years (9.2). The knowledge among the nurses was found to be superior to that of the students: 68.9%(8.0) and 61.5%(7.8) correct answers, respectively, (p < 0.001). The difference was largest in drug management and dose calculations. The improvement occurred during the first working year. The nurses expressed higher degree of certainty and the risk of error was lower, both overall and for each topic (p < 0.01). Low risk of error was associated with high knowledge and high sense of coping (p < 0.001).

CONCLUSIONS

The medication knowledge among experienced nurses was superior to bachelor students in nursing, but nevertheless insufficient. As much as 25% of the answers to the drug management questions would lead to high risk of error. More emphasis should be put into the basic nursing education and in the introduction to medication procedures in clinical practice to improve the nurses' medication knowledge and reduce the risk of error.

Factors effective on medication errors: A nursing view

Objective:

Medication errors are the most common medical errors, which may result in some complications for patients. This study was carried out to investigate what influence medication errors by nurses from their viewpoint.

Methods:

In this descriptive study, 150 nurses who were working in Qazvin Medical University teaching hospitals were selected by proportional random sampling, and data were collected by means of a researcher-made questionnaire including demographic attributes (age, gender, working experience,…), and contributing factors in medication errors (in three categories including nurse-related, management-related, and environment-related factors).

Findings:

The mean age of the participant nurses was 30.7 ± 6.5 years. Most of them (87.1%) were female with a Bachelor of Sciences degree (86.7%) in nursing. The mean of their overtime working was 64.8 ± 38 h/month. The results showed that the nurse-related factors are the most effective factors (55.44 ± 9.14) while the factors related to the management system (52.84 ± 11.24) and the ward environment (44.0 ± 10.89) are respectively less effective. The difference between these three groups was significant (P = 0.000). In each aforementioned category, the most effective factor on medication error (ranked from the most effective to the least effective) were as follow: The nurse's inadequate attention (98.7%), the errors occurring in the transfer of medication orders from the patient's file to kardex (96.6%) and the ward's heavy workload (86.7%).

Conclusion:

In this study nurse-related factors were the most effective factors on medication errors, but nurses are one of the members of health-care providing team, so their performance must be considered in the context of the health-care system like work force condition, rules and regulations, drug manufacturing that might impact nurses performance, so it could not be possible to prevent medication errors without paying attention to our health-care system in a holistic approach.

Educational strategies aimed at improving student nurse's medication calculation skills: a review of the research literature

Medication administration is an important and essential nursing function with the potential for dangerous consequences if errors occur. Not only must nurses understand the use and outcomes of administering medications they must be able to calculate correct dosages. Medication administration and dosage calculation education occurs across the undergraduate program for student nurses. Research highlights inconsistencies in the approaches used by academics to enhance the student nurse's medication calculation abilities. The aim of this integrative review was to examine the literature available on effective education strategies for undergraduate student nurses on medication dosage calculations. A literature search of five health care databases: Sciencedirect, Cinahl, Pubmed, Proquest, Medline to identify journal articles between 1990 and 2012 was conducted. Research articles on medication calculation educational strategies were considered for inclusion in this review. The search yielded 266 papers of which 20 meet the inclusion criteria. A total of 5206 student nurse were included in the final review. The review revealed educational strategies fell into four types of strategies; traditional pedagogy, technology, psychomotor skills and blended learning. The results suggested student nurses showed some benefit from the different strategies; however more improvements could be made. More rigorous research into this area is needed.

A whole-of-curriculum approach to improving nursing students' applied numeracy skills

BACKGROUND

Nursing students often perform poorly on numeracy tests. Whilst one-off interventions have been trialled with limited success, a whole-of-curriculum approach may provide a better means of improving applied numeracy skills.

OBJECTIVE

The objective of the study is to assess the efficacy of a whole-of-curriculum approach in improving nursing students' applied numeracy skills.

DESIGN

Two cycles of assessment, implementation and evaluation of strategies were conducted following a high fail rate in the final applied numeracy examination in a Bachelor of Nursing (BN) programme. Strategies included an early diagnostic assessment followed by referral to remediation, setting the pass mark at 100% for each of six applied numeracy examinations across the programme, and employing a specialist mathematics teacher to provide consistent numeracy teaching.

SETTING

The setting of the study is one Australian university.

PARTICIPANTS

1035 second and third year nursing students enrolled in four clinical nursing courses (CNC III, CNC IV, CNC V and CNC VI) were included.

METHODS

Data on the percentage of students who obtained 100% in their applied numeracy examination in up to two attempts were collected from CNCs III, IV, V and VI between 2008 and 2011. A four by two χ(2) contingency table was used to determine if the differences in the proportion of students achieving 100% across two examination attempts in each CNC were significantly different between 2008 and 2011.

RESULTS

The percentage of students who obtained 100% correct answers on the applied numeracy examinations was significantly higher in 2011 than in 2008 in CNC III (χ(2)=272, 3; p<0.001), IV (χ(2)=94.7, 3; p<0.001) and VI (χ(2)=76.3, 3; p<0.001).

CONCLUSIONS

A whole-of-curriculum approach to developing applied numeracy skills in BN students resulted in a substantial improvement in these skills over four years.

Identifying strategies to assist final semester nursing students to develop numeracy skills: a mixed methods study

BACKGROUND

It remains a grave concern that many nursing students within tertiary institutions continue to experience difficulties with achieving medication calculation competency. In addition, universities have a moral responsibility to prepare proficient clinicians for graduate practice. This requires risk management strategies to reduce adverse medication errors post registration.

AIM

To identify strategies and potential predictors that may assist nurse academics to tailor their drug calculation teaching and assessment methods. This project builds on previous experience and explores students' perceptions of newly implemented interventions designed to increase confidence and competence in medication calculation.

METHODS

This mixed method study surveyed students (n=405) enrolled in their final semester of study at a large, metropolitan university in Sydney, Australia. Tailored, contextualised interventions included online practice quizzes, simulated medication calculation scenarios developed for clinical practice classes, contextualised 'pen and paper' tests, visually enhanced didactic remediation and 'hands-on' contextualised workshops. Surveys were administered to students to determine their perceptions of interventions and to identify whether these interventions assisted with calculation competence. Test scores were analysed using SPSS v. 20 for correlations between students' perceptions and actual performance. Qualitative open-ended survey questions were analysed manually and thematically.

RESULTS

The study reinforced that nursing students preferred a 'hands-on,' contextualised approach to learning that was 'authentic' and aligned with clinical practice. Our interventions assisted with supporting students' learning and improvement of calculation confidence. Qualitative data provided further insight into students' awareness of their calculation errors and preferred learning styles. Some of the strongest predictors for numeracy skill performance included (1) being an international student, (2) completion of an online practice quiz, scoring 59% or above and (3) students' self-reported confidence.

CONCLUSION

A paradigm shift from traditional testing methods to the implementation of intensive, contextualised numeracy teaching and assessment within tertiary institutions will enhance learning and promote best teaching practices.

Evaluation of nurses' knowledge and understanding of obstacles encountered when administering resuscitation medications

AIM

The aim of the study was to develop and validate an instrument to evaluate nurses' knowledge and to understand the obstacles that they encounter when administering resuscitation medications.

BACKGROUND

Insufficient knowledge is a major factor in nurses' drug administration errors. Resuscitation involves situations in which doctors issue oral orders, and is inherently highly stressful. Sufficient knowledge is vital for nurses if they are to respond quickly and accurately when administering resuscitation medications.

METHODS

A cross-sectional study was conducted. A questionnaire (20 true-false questions) developed from literature and expert input, and validated by subject experts and one pilot study, was used to evaluate nurses' knowledge of resuscitation medications. Stratified sampling and descriptive statistics were applied.

RESULTS

A total of 188 nurses participated. The overall correct answer rate was 70.5% and the greater the nurse's work experience the higher the score. Only 8% of nurses considered themselves to have sufficient knowledge and 73.9% hoped to gain more training about resuscitation medications. The leading obstacle reported was "interruption of the drug administration procedure on resuscitation" (62.8%). Seventeen out of 20 questions achieved a discriminatory power of over 0.36, indicating good to excellent questions. In the study, a total of 16 resuscitation medication errors were reported by the participants, in which the errors involved atropine (five cases), epinephrine (three cases) and others (eight cases). The errors mainly involved misinterpretation of orders, insufficient knowledge and confusing certain drugs for other look-alike drugs.

CONCLUSION

Evidence-based results strongly suggest that nurses have insufficient knowledge and could benefit from longer working experience and additional training about resuscitation medications. Further research to validate the instrument is needed and the education of nurses regarding resuscitation medications is recommended.

Using simulation to improve the medication administration skills of undergraduate nursing students

AIM

This quasi-experimental pilot study examined simulation methods to improve nursing students' medication calculation and administration abilities.

BACKGROUND

Approximately 25 percent of junior-level students in the nursing program who took a medication administration exam (MAE) failed in their first attempt. It was theorized that simulation could facilitate their success.

METHOD

Students in the control group (n = 79) attended a didactic medication administration review session; students in the intervention group (n = 79) participated in a medication administration simulation review session. All students took the MAE within a week of their review.

RESULTS

The intervention group scored significantly higher (M = 95 percent, SD = 6.8) on the MAE than the control group (M = 90 percent, SD = 12.9) at the p = .004 level.

CONCLUSION

The simulation facilitated student success by giving students a state-of-the-art contextual reference to apply when taking the MAE.

Effective pedagogies for teaching math to nursing students: a literature review

Improving mathematical competency and problem-solving skills in undergraduate nursing students has been an enduring challenge for nurse educators. A number of teaching strategies have been used to address this problem with varying degrees of success. This paper discusses a literature review which examined undergraduate nursing student challenges to learning math, methods used to teach math and problem-solving skills, and the use of innovative pedagogies for teaching. The literature was searched using the Cumulative Index of Nursing and Allied Health Literature and Education Resource Information Center databases. Key search terms included: math*, nurs*, nursing student, calculation, technology, medication administration, challenges, problem-solving, personal response system, clickers, computer and multi-media. Studies included in the review were published in English from 1990 to 2011. Results support four major themes which include: student challenges to learning, traditional pedagogies, curriculum strategies, and technology and integrative methods as pedagogy. The review concludes that there is a need for more innovative pedagogical strategies for teaching math to student nurses. Nurse educators in particular play a central role in helping students learn the conceptual basis, as well as practical hands-on methods, to problem solving and math competency. It is recommended that an integrated approach inclusive of technology will benefit students through better performance, increased understanding, and improved student satisfaction.

How do nurses solve drug calculation problems?

This article reports on a pilot study that examined the cognitive processes and strategies used by senior nurses to solve written drug calculation problems.

METHODOLOGY

Verbal protocol methodology was used to gain and analyse data from eight senior nurses now working in the education setting. The data was analysed using verbal protocol analysis.

RESULTS

Nurses used a range of strategies to solve the problems, not just the nursing formula. The cognitive processes of the nurses showed a larger number of steps devoted to problem representation and only a few steps devoted to actually solving the problem.

CONCLUSION

Nurse educators need to consider the importance of problem representation in solving drug calculations and in particular ensure that written questions are representative of clinical practice.

Implementing a competence framework for administering medication: reporting the experiences of mental health nurses and students in the UK

Medicine administration is a high risk activity that most nurses undertake frequently. In this paper, the views of registered mental health nurses and final year student nurses are evaluated about the usefulness of the Medicines with Respect Assessment of the Administration of Medicines Competency Framework. A questionnaire using 22 items with closed and open response questions was distributed to 827 practising mental health nurses and 44 final year mental health nursing students. This article presents a content analysis of written replies to the open response questions. Four overlapping themes were identified in response to the open questions posed in the survey: (1) reasons for undertaking the Medicines with Respect Framework; (2) positive aspects; (3) negative aspects; and (4) service user benefits.

Contextualism adds realism: nursing students' perceptions of and performance in numeracy skills tests

This project investigated nursing students' perceptions of and performance in a de-contextualised diagnostic maths paper (i.e. questions only) and a contextualised diagnostic maths paper (i.e. visual pictures along with questions). Sampling was purposive, the criteria being that participants would be from the population of student nurses (n=700) in their second year, of a three-year Bachelor of Nursing course, undertaking a Unit 'Medical-Surgical Nursing 1' (MSN1) at one of four campuses across the University of Western Sydney (UWS), NSW, Australia. The numerical test scores for both papers were analysed with the assistance of SPSS software and a Professional Development Officer. The survey data were analysed manually and thematically by the researcher. There was a substantive improvement in scores from Test 1 (de-contextualised) to Test 2 (contextualised). It is uncertain whether the change occurred because Test 2 is a genuinely better presentation than Test 1 or just a practice effect. Nevertheless, the contextualised paper was preferred by the majority of students (80%). Students preferred the visual images and revealed that it led to a "deeper learning" of numeracy skills, reduced stress and anxiety levels and simulated 'the real life' clinical setting, thus adding "an element of realism" to the situation.

The impact of an integrated pharmacology and medicines management curriculum for undergraduate adult nursing students on the acquisition of applied drug/pharmacology knowledge

AIMS

To investigate the efficacy of a 14-month integrated pharmacology and medicines management curriculum for undergraduate nursing students on the acquisition of applied drug/pharmacology knowledge.

BACKGROUND

Despite considerable debate regarding nurses' ability to be able to fulfill their medication management responsibilities, little is known about how nurses should be educated in medicines management.

METHODS

Two groups of nursing students were compared. The first group were exposed to the usual curriculum (control group), whilst a second group experienced a new integrated pharmacology and medicines management curriculum (intervention group) (N=120). The impact of the curriculum on applied drug knowledge was assessed using a 69 item short answer questionnaire relating to a vignette. Students also undertook a 42 item on-line test exploring principles of pharmacokinetics. Students were also asked to self-rate their knowledge using a four point likert scale which asked how confident they were in relation to the prescribed medication regime. The data were collected in July 2008. The intervention group was exposed to an integrated curriculum approach, whilst the control group undertook periods of supervised practice within a clinical environment supported with a workbook and practice assessment learning outcomes.

RESULTS/FINDINGS

Students exposed to an integrated approach to pharmacology and medicines management demonstrated superior pharmacokinetic knowledge and were more able to apply drug knowledge to the patient vignettes than the control group.

CONCLUSION

An early introduction of an integrated approach to the teaching and assessing of pharmacological processes improves students' drug knowledge prior to qualification. A sound preparation will help to ensure safe and effective medicines management care for patients and will prepare nurses for post graduate education and further training.

eDrugCalc: an online self-assessment package to enhance medical students' drug dose calculation skills

AIMS

Dose calculation errors can cause serious life-threatening clinical incidents. We designed eDrugCalc as an online self-assessment tool to develop and evaluate calculation skills among medical students.

METHODS

We undertook a prospective uncontrolled study involving 1727 medical students in years 1-5 at the University of Edinburgh. Students had continuous access to eDrugCalc and were encouraged to practise. Voluntary self-assessment was undertaken by answering the 20 questions on six occasions over 30 months. Questions remained fixed but numerical variables changed so each visit required a fresh calculation. Feedback was provided following each answer.

RESULTS

Final-year students had a significantly higher mean score in test 6 compared with test 1 [16.6, 95% confidence interval (CI) 16.2, 17.0 vs. 12.6, 95% CI 11.9, 13.4; n= 173, P < 0.0001 Wilcoxon matched pairs test] and made a median of three vs. seven errors. Performance was highly variable in all tests with 2.7% of final-year students scoring < 10/20 in test 6. Graduating students in 2009 (30 months' exposure) achieved significantly better scores than those in 2007 (only 6 months): mean 16.5, 95% CI 16.0, 17.0, n= 184 vs. 15.1, 95% CI 14.5, 15.6, n= 187; P < 0.0001, Mann-Whitney test. Calculations based on percentage concentrations and infusion rates were poorly performed. Feedback showed that eDrugCalc increased confidence in calculating doses and was highly rated as a learning tool.

CONCLUSIONS

Medical student performance of dose calculations improved significantly after repeated exposure to an online formative dose-calculation package and encouragement to develop their numeracy. Further research is required to establish whether eDrugCalc reduces calculation errors made in clinical practice.

A literature review of the individual and systems factors that contribute to medication errors in nursing practice

AIM

This paper reports a review of the empirical literature on factors that contribute to medication errors.

BACKGROUND

Medication errors are a significant cause of morbidity and mortality in hospitalized patients. This creates an imperative to reduce medication errors to deliver safe and ethical care to patients.

METHOD

The databases CINAHL, PubMed, Science Direct and Synergy were searched from 1988 to 2007 using the keywords medication errors, medication management, medication reconciliation, medication knowledge and mathematical skills, and reporting medication errors. RESULTS Contributory factors to nursing medication errors are manifold, and include both individual and systems issues. These include medication reconciliation, the types of drug distribution system, the quality of prescriptions, and deviation from procedures including distractions during administration, excessive workloads, and nurse's knowledge of medications.

IMPLICATIONS FOR NURSING MANAGEMENT

It is imperative that managers implement strategies to reduce medication errors including the establishment of reporting mechanisms at international and national levels to include the evaluation and audit of practice at a local level. Systematic approaches to medication reconciliation can also reduce medication error significantly. Promoting consistency between health care professionals as to what constitutes medication error will contribute to increased accuracy and compliance in reporting of medication errors, thereby informing health care policies aimed at reducing the occurrence of medication errors. Acquisition and maintenance of mathematical competency for nurses in practice is an important issue in the prevention of medication error. The health care industry can benefit from learning from other high-risk industries such as aviation in the prevention and management of systems errors.