‘It is the situation that makes it difficult’: Experiences of nursing students faced with a high-stakes drug calculation test

Nursing students' perceived anxiety and heart rate variability in mock skill competency assessment

BACKGROUND

Skill competency assessments induce stress and anxiety and may affect nursing student performance. Little is known about stress and perceived anxiety levels and their relationship in the mock skill competency assessment.

METHODS

A cross-sectional study was conducted to examine the stress levels (as assessed by heart rate variability, HRV) and perceived anxiety before, during and after the mock skill competency assessment, and to explore their relationships to performance in a total of ninety first-year undergraduate nursing students.

RESULTS

The HRV decreased significantly during the assessment and increased significantly 10 min after the assessment (p < 0.01). Higher performers showed significantly lower HRV during and after the assessment (p < 0.01). The assessment score was negatively correlated with HRV during and after the assessment (p < 0.05).

CONCLUSIONS

Considering assessment-related stress and anxiety through a mock assessment prior to the actual skill assessment provides implications for future nursing education.

A National Survey of Medication Dosage Calculation Teaching Methods and Competency Criteria on Nursing Student Success: Recommendations for Nurse Educators

AIM

The purpose of this study was to synthesize the current landscape of medication dosage calculation (MDC) education for prelicensure nursing students in the United States.

BACKGROUND

There is little consistency in the format of MDC education and evaluation in prelicensure nursing education, yet consequences of not passing MDC exams can affect the number of graduating nurses. Consequences can include withdrawal from the course, delayed progression of a semester or more, or dismissal from the nursing program.

METHOD

An electronic survey was emailed to prelicensure administrators of 1,620 associate, bachelor's, and master's entry programs in the United States.

RESULTS

Surveys were received from 210 programs. Results confirmed inconsistent methods used to teach and evaluate MDC competency.

CONCLUSION

Inconsistent teaching methods and competency criteria can affect retention and subsequent growth of the nursing workforce. Based on the characteristics associated with MDC success, recommendations are made for nurse educators.

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.

Instruction strategies for drug calculation skills: A systematic review of the literature

BACKGROUND

Medication errors and unsafe medication practices are a leading cause of injury and avoidable harm worldwide.

OBJECTIVES

The aim of this review was to (i) explore and identify evidence-based strategies to teach medication calculation skills by determining the most common errors and assess the quality, level, and role of the evidence, and (ii) describe instruction strategies for drug calculation skills development or improvement based on seven research-based principles for smart teaching.

DESIGN

Systematic review.

DATA SOURCES

CINAHL, PubMed, and PsycINFO.

REVIEW METHODS

The review followed Whittemore and Knafl's framework steps with an assessment of the studies reporting using PRISMA, STROBE, COREQ and categorizing their methods by evidence hierarchy and roles. Two authors independently assessed eligibility and extracted data.

RESULTS

From the total 1793 articles, 51 studies met the eligibility criteria. The studies included 9210 nursing students/nurses and mainly used a quantitative approach (67.5%), followed by qualitative (22.5%) and mixed methods (10.0%), with the students/nurses doing arithmetic and conceptual mistakes. The findings presented were low levels of evidence III (23.5%) and V (41.2%), quality Level B (82.4%), and 47.1% focused on choosing the appropriate teaching and intervention approaches (role of the evidence). The teaching strategies addressed multiple smart teaching principles, but mainly prior knowledge (principle 1, 39.2%). The least used strategies were those addressing the levers that influence motivation and behaviors such as value, expectations, and environment climate (principle 3, 13.7%). Two studies addressed five principles simultaneously.

CONCLUSIONS

Regarding teaching strategies, the most recurring strategies were early diagnostic assessments on knowledge, anxiety and/or self-confidence, considering knowledge organization with scaffolding complex tasks, being explicit about objectives and expectations, and usage of e-learning. However, e-learning was mainly used after 2018. Considering the low levels and quality of evidence, we recommend higher levels of research design for future research. Randomized Controlled Trials could be conducted when randomizing teaching methods per semester or questions embedded in software. Web-base software could be used to support teaching and research approaches.

Nurse Education and Mathematical Competency: Implementation of an Online, Self-Directed, Prerequisite Model

Mathematical competency in the profession of nursing has increasingly become a central focus as more nursing students appear to struggle with basic concepts of arithmetic, mental estimation, and critical reasoning. This paper highlights how one School of Nursing in Ontario, Canada implemented a Dosage Calculation Competency Test model which involved an online, self-directed, prerequisite approach to improve student mathematical competency and confidence. The purpose of this research case study was to document, through shared participant perceptions, the creation, implementation, and subsequent modifications to a Dosage Calculation Competency Test model in light of student needs and advances in online learning and assessment. The research design combined a quantitative survey of Year 1-4 nursing students, followed by a series of qualitative, semi-structured interviews with nursing students and program instructors. The study took place within a School of Nursing undergraduate program in Ontario, Canada. Forty-four participants, including students from all four years of the nursing program, completed the survey, followed by individual interviews with nine students and six faculty instructors. Survey (the open-response items) and interview data were analyzed thematically using ATLAS.ti (ATLAS.ti, Berlin, Germany). The authors recount the new DCCT model's development, implementation, and subsequent modifications and further discuss student/instructor perceptions of learning types, math confidence, and competency. The paper concludes with a series of seven key recommendations for nursing programs.

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.

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.

High-Stakes Testing in Nursing Education: A Review of the Literature

In an aim to improve first-time NCLEX-RN pass rates, some nursing programs have instituted high-stakes testing. This literature review investigated nursing faculty understanding of and student experiences with high-stakes testing. High-stakes testing is an assessment used to make decisions about student progression or completion of a nursing program. The literature revealed both negative and positive consequences associated with high-stakes testing. Literature from state boards of nursing and professional nursing organizations was also reviewed for recommendations.

Student Experiences of High-stakes Testing for Progression in One Undergraduate Nursing Program

Each year, thousands of students throughout the world are required to complete one or more high-stakes tests as a measure of competency in undergraduate nursing education. Currently, the trend in nursing education is to use high-stakes tests to establish program progression policies. However, use of these tests to block student progression is of serious concern. This article describes findings of a pilot study that used a phenomenographic approach to understand senior nursing students' experiences of completing multiple high-stakes tests for successful progression within one undergraduate nursing program. Eighteen graduating senior nursing students participated in the study via individual interviews. Students described a multitude of experiences, organized into five main categories of descriptions: high-stakes tests as a value; high-stakes tests as a stressor; high-stakes tests as a high expectation; high-stakes tests as various inconsistencies; and high-stakes tests affecting the transfer of learning. Student perspectives with high-stakes testing contributed valuable insight lacking in the current nursing education literature. Findings suggested if high-stakes tests are to be used for program progression, it is imperative for nurse educators to convene and explore strategies to support student preparation and success with testing, and develop well-defined structures of teaching and learning for the delivery of course content.

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.

"My math and me": Nursing students' previous experiences in learning mathematics

In this paper, 11 narratives about former experiences in learning of mathematics written by nursing students are thematically analyzed. Most students had a positive relationship with the subject in primary school, when they found mathematics fun and were able to master the subject. For some, a change occurred in the transition to lower secondary school. The reasons for this change was found in the subject (increased difficulty), the teachers (movement of teachers, numerous substitute teachers), the class environment and size (many pupils, noise), and the student him- or herself (silent and anonymous pupil). This change was also found in the transition from lower to higher secondary school. By contrast, some students had experienced changes that were positive, and their mathematics teacher was a significant factor in this positive change. The paper emphasizes the importance of previous experiences in learning mathematics to nursing students when learning about drug calculation.

Implementation of Mock Competency Skill Assessments to Improve Student Outcomes

A primary responsibility for nurse educators is to provide students with theoretical knowledge and clinical skills for professional nursing. In this study, laboratory faculty developed a creative pedagogical strategy to reduce nursing student stress during assessment of skill performance. Mock competencies were structured so that students participated in peer-to-peer evaluations in simulated competency assessments. The purpose of this study was to determine whether this pedagogical strategy had an impact on first-round pass rates for skills competency assessments.