Safety in numbers 2: Competency modelling and diagnostic error assessment in medication dosage calculation problem-solving

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.

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.].

Nurse education leaders' perspectives on the teaching of numeracy to undergraduate nursing students: A qualitative research study

AIM

The aim of this study was to explore the perspectives of nurse education leaders of Australian undergraduate nursing degrees on the teaching of nursing numeracy and how the Australian Nursing & Midwifery Accreditation Standards influence curriculum development.

BACKGROUND

Nurses' numeracy skills are reportedly deficient worldwide, posing a significant threat to patient safety. This is an issue for the education of undergraduate nurses and thus for the nursing profession. The international literature reveals a heterogeneous blend of learning approaches, but it is unclear which approaches are best suited to improve the numerical calculation ability of nurses. In the Australian context, there are no accreditation standards referring to numeracy, therefore, it is important to discover how nurse education leaders' design and implement the teaching of numeracy.

DESIGN

A qualitative approach using thematic analysis was employed. The setting was Australian universities that delivered an accredited undergraduate nursing degree leading to nursing registration.

METHODS

Purposive sampling was used to recruit 17 nurse education leaders of Australian undergraduate nursing degrees. Individual, semi-structured virtual interviews were conducted between November 2022 and January 2023. Interview data were analysed using Braun and Clarke's (2006) six phases of thematic analysis.

FINDINGS

Five themes emerged from the analysis: (i) indistinct accreditation standards, (ii) teaching basic maths for clinical applications, (iii) a range of bespoke teaching approaches (iv) we're nurses, not numeracy educators and (v) assumptions about an unprepared cohort.

CONCLUSION

The leaders of undergraduate nursing degrees assumed that nursing students would have proficiency in numeracy skills on entering university. However, this was not the case, hence numeracy was an essential skill that needed to be taught to the undergraduate nursing students. Lack of direction from the accreditation council led to the existence of various curricula and an array of approaches to teaching numeracy and medication calculations, which challenged nursing academics who did not consider themselves numeracy educators. This study makes a novel contribution to knowledge, teaching and practice in undergraduate nursing numeracy curricula.

Integration of Virtual Simulation Into a Web-Based Nursing Dosage Calculation Course

This article describes an innovative approach to student learning using virtual simulation in a web-based dosage calculation nursing course. This new technology was implemented in a baccalaureate generic nursing program. The project was designed to improve student test scores and increase self-confidence. Using this technology allowed students to practice their skills and receive feedback in real time. Feedback from students was mostly favorable. Higher performing students found it repetitive; lower performing students showed improvement in their scores.

Effects of Digital Learning Materials on nursing students' mathematics learning, self-efficacy, and task value in vocational education

The use of digital environments in nursing education offers new opportunities for nursing students' medical mathematics learning. The aim of this study was to investigate the effects of Digital Learning Materials (DLMs) on nursing students' mathematics learning, self-efficacy, and task value. A pre-test/post-test control group design was used. Students were assigned to the DLMs group (experimental condition) or the face-to-face group (control condition). Students in both conditions completed the same assignments and discussed these with their peers and the (online) teacher via the discussion board or in the classroom setting. The results showed that the mathematics learning of students undergoing DLMs training and of those undergoing face-to-face training improved from the pretest to the post-test, but no significant differences were found between the two conditions. A significant interaction effect between condition and self-efficacy was reported, producing a large reduction in the self-efficacy of students in the DLMs condition and a small reduction in the self-efficacy of students in the face-to-face condition. No significant differences were found for students' task value. The study offers new insights for the future design of mathematics training with DLMs, focusing on students' appreciation of DLMs features, considering students with low and high learning abilities separately.

Evaluation of Swedish nursing students' experience of a web-based platform for drug calculation

Safe drug calculation is important in nursing as insufficient skills pose a risk to patient safety. Therefor solid education in mathematics for undergraduate nursing students must be provided. To support nursing students' skills in drug calculation, a web-based learning platform for drug calculation was created. The aim of this study was to investigate nursing students' experiences of a web-based learning platform for drug calculation in terms of usability and learning support. The study was a cross-sectional comparative study. Ninety-five nursing students participated, out of which 46 students were in semester one and 49 students were in semester six. A questionnaire was used to evaluate the nursing students' experiences of a web-based learning platform for drug calculation in terms of usability and learning support. The findings were informed by statistical and thematic analyses. The majority of the participants evaluated the platform positively. The platform was deemed useful, and it was a support for the nursing students' learning. These findings provide that a web-based learning platform for drug calculation can be used as a complement to traditional lectures. Nevertheless, further research is required focusing teaching strategies facilitating different learning styles and level of computer skills.

The effectiveness of web-based learning in supporting the development of nursing students' practical skills during clinical placements: A qualitative study

Web-based learning, on its own or in combination with traditional teaching methods, has become a consolidated practice in many countries, and has been described as a valid and effective method that supports practical learning in undergraduate nursing students. The aim of this study was to explore the perception and effectiveness of web-based learning in facilitating the development of clinical skills in undergraduate nursing students. A qualitative descriptive study was conducted including online videos in three nursing schools of a university in Northern Italy. The participants were 26 undergraduate nursing students. A dedicated website was built including four videos and the respective checklists of four nursing techniques: insertion of a urinary catheter; insertion of a nasogastric tube; taking a blood sample; and the insertion of a peripheral intravenous line. Three Focus Groups were conducted, one for each nursing school. Thanks to its ease of use and unlimited access, web-based learning effectively supported students' clinical learning process by offering additional virtual visual support. Web-based learning could be effectively used to reduce the gap between theory and practice, and even as an upgrade for already qualified nurses.

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.

Students who developed logical reasoning skills reported improved confidence in drug dose calculation: Feedback from remedial maths classes

BACKGROUND

The safe administration of drugs is a focus of attention in healthcare. It is regarded as acceptable that a formula card or mnemonic can be used to find the correct dose and fill a prescription even though this removes any requirement for performing the underlying computation. Feedback and discussion in class reveal that confidence in arithmetic skills can be low even when students are able to pass the end of semester drug calculation exam.

OBJECTIVE

To see if confidence in the understanding and performance of arithmetic for drug calculations can be increased by emphasising student's innate powers of logical reasoning after reflection.

DESIGN

Remedial classes offered for students who have declared a dislike or lack of confidence in arithmetic have been developed from student feedback adopting a reasoning by logical step methodology. Students who gave up two hours of their free learning time were observed to engage seriously with the learning methods, focussing on the innate ability to perform logical reasoning necessary for drug calculation problems. Working in small groups allowed some discussion of the route to the answer and this was followed by class discussion and reflection.

RESULTS

The results were recorded as weekly self-assessment scores for confidence in calculation. A self-selecting group who successfully completed the end of semester drug calculation exam reported low to moderate confidence in arithmetic. After four weeks focussing on logical skills a significant increase in self-belief was measured. This continued to rise in students who remained in the classes.

CONCLUSION

Many students hold a negative belief regarding their own mathematical abilities. This restricts the learning of arithmetic skills making alternate routes using mnemonics and memorised steps an attractive alternative. Practising stepwise logical reasoning skills consolidated by personal reflection has been effective in developing student's confidence and awareness of their innate powers of deduction supporting an increase in competence in drug administration.

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.

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.

Safety in numbers 7: Veni, vidi, duci: a grounded theory evaluation of nursing students' medication dosage calculation problem-solving schemata construction

This paper evaluates nursing students' transition through schemata construction and competence development in medication dosage calculation problem-solving (MDC-PS). We advance a grounded theory from interview data that reflects the experiences and perceptions of two groups of undergraduate pre-registration nursing students: eight students exposed to a prototype authentic MDC-PS environment and didactic transmission methods of education and 15 final year students exposed to the safeMedicate authentic MDC-PS environment. We advance a theory of how classroom-based 'chalk and talk' didactic transmission environments offered multiple barriers to accurate MDC-PS schemata construction among novice students. While conversely it was universally perceived by all students that authentic learning and assessment environments enabled MDC-PS schemata construction through facilitating: 'seeing' the authentic features of medication dosage problems; context-based and situational learning; learning within a scaffolded environment that supported construction of cognitive links between the concrete world of clinical MDC-PS and the abstract world of mathematics; and confidence-building in their cognitive and functional competence ability. Drawing on the principle of veni, vidi, duci (I came, I saw, I calculated), we combined the two sets of evaluations to offer a grounded theoretical basis for schemata construction and competence development within this critical domain of professional practice.