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

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.

The contributors to dosage calculation ability and its applicability to nursing education: An integrative review

Medication errors are a major patient safety issue and account for 1-2 million hospitalizations and between 100,000 and 200,000 deaths annually. Approximately 41 % of all medication errors are due to improper dose calculations. Studies have shown mean scores on the medication dosage calculation test for nursing students range from 35 to 71 %. Despite new technology created to aid in dosage calculations, the issue is still prevalent among nurses. It is critical that the elements contributing to the nurses' ability to complete dosage calculations be determined so that calculation curriculum in nursing schools can be updated to better prepare students for practice. An integrative review was completed using the databases of PubMed, CINAHL, and Embase to answer the research question: What contributors impact nurses' and nursing students' ability to complete dosage calculations? Four articles met the specified inclusion criteria and were used for this review. The three most common contributing themes among the review sample included mathematical medication calculation ability, medication calculation frequencies, and dosage calculation education. Results from this review can inform the issue of dosage calculations and highlight the need for further research regarding the medication administration competencies taught in undergraduate nursing studies.

The Effect of the Flipped Classroom Model on Teaching Clinical Practice Skills

INTRODUCTION

No evidence was found in the literature for the use of the flipped classroom model in teaching clinical practice skills in paramedics. The study aimed to determine the effect of the flipped classroom model in teaching clinical practice skills to paramedic program students.

METHODS

The study was a single-center, randomized controlled, single-blind parallel-group study. The research was carried out with a university's first-year paramedic program students in the 2021 to 2022 academic year. The students were divided into groups by stratified sampling (intervention group = 21, control group = 21). Five clinical skills practices at various times were explained to the intervention group with the flipped classroom model and to the control group with the traditional lecture method. The research data were collected with the Introductory Characteristics Information Form, Checklists, Time Tracking Form, and Students' Questionnaire for Evaluating the flipped classroom model.

RESULTS

Although the students in the intervention group received a higher total score from all 5 clinical practice skills than the students in the control group, this difference was not statistically significant (P > .05). However, although the time allocated for applications in the intervention group was 40 to 75 minutes longer than in the control group, most students stated that this model successfully taught skills and theory, increased their motivation during the application, and reduced application and exam anxiety.

DISCUSSION

The flipped classroom model can be used as an alternative method to the traditional system in teaching clinical practice skills. This innovative educational approach can be recommended as a student-centered method in clinical skills teaching.

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.

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.

Medication errors by nursing students on clinical practice: An integrative review

BACKGROUND

Medication errors are a serious concern and often due to multiple factors. The largest workforce in healthcare are nurses. Nurses play a major role in medication management especially in medication administration. To become proficient in safe medication administration undergraduate nurses, need to be provided with adequate training in clinical settings. Aim This integrative review aims to identify literature that reports medication errors including prevalence, types, causes and barriers of reporting whilst nursing students are on clinical placement.

METHODS

A review was conducted of five electronic databases to identify original empirical research published between 2007 and 2021. An integrative review method using Strengthening the Report of Observational Studies in Epidemiology guidelines was used to direct this review.

FINDINGS

The initial search yielded 1574 articles. A total of six full text articles met the eligibility criteria were reviewed. The prevalence of medication errors made by nursing students on clinical placement was 6-1.1%. Causes were due to student, education and environmental factors. Types of errors medication calculations, incorrect name of patient, wrong medication and omission of medication administration.

DISCUSSION

This review confirms previous studies with 10-5% of all errors by nurses are medication errors in hospitals. Strategies to improve medication administration are increasing staffing, communication, education and supervision of students.

CONCLUSION

Medication administration is a multifactorial process that involves medication skills. Closer supervision, improved education on technology and consistency is required in number of rights of medication administration.

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.

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.

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.

Characterization of adverse events occurring during nursing clinical rotations: A descriptive study

INTRODUCTION

Patient safety is a pillar of quality health care. Nursing students may commit errors during clinical practice, compromising patient safety.

OBJECTIVE

Analyze the adverse events, as well as the factors associated with the errors, reported by students from a private university in Santiago, Chile during nursing clinical rotations.

METHODS

Quantitative cross-sectional descriptive study. A total of 68 errors by first- through fifth-year nursing students were reported between 2012 and 2018. The data collection instrument was the Adverse Events Notification Form from the School of Nursing. This form documented information about the study as well as about the event.

RESULTS

After this reporting system was established in 2012, the number of events reported increased steadily each year. The greatest numbers of reported errors were committed by fifth-year students (73.5%), and the most common type of error was associated with medication administration (94.2%), including incorrect dose (27.9%) and incorrect medication (17.6%). The major factors contributing to errors were failure to review the "10 rights of medication administration" (85.3%) or lack of critical judgment (7.4%). Most of the errors occurred in public institutions (72.1%).

CONCLUSION

The results suggest that it would be beneficial to re-evaluate how safety and quality of care are taught at the school of nursing, with an emphasis on understanding the learning styles of students and teaching strategies of instructors. It is crucial that the academic institution remain actively involved in teaching safety-related skills to future nursing professionals. Furthermore, we suggest modifications to the adverse events reporting system that would avoid the need for personal interpretations of the event by the student.

A comparison of inquiry-oriented teaching and lecture-based approach in nursing ethics education

BACKGROUND

With developing nursing ethics education, the traditional methods of teaching could not meet the learning needs of undergraduates. Improving ethical decision-making to undergraduates is necessary toward promoting nursing ethics.

OBJECTIVE

The aim of study is to compare the effect of inquiry-oriented teaching and lecture-based approach on nursing ethics education for undergraduates.

DESIGN

A quasi-experimental study was conducted for undergraduate nursing students.

SETTINGS

Two nursing schools participated in the study in mainland China.

PARTICIPANTS

A total of 97 undergraduate nursing students participated in the study.

METHODS

The study adopted a quasi-experimental design.

RESULTS

The inquiry-oriented teaching group was significantly higher on average scoring than the lecture-based group after intervention in 2 aspects including: professional relationship (P = 0.015) and ethical decision making (P = 0.021). Contrarily, this study also showed that in the lecture-based group the score of foundational theories of nursing ethics was higher than Inquiry-oriented group (P = 0.038). A statistically significant difference was not found between the two groups in 3 scenarios: ethics related to nursing practice, ethics related to nursing research and necessity of learning nursing ethics.

CONCLUSION

Combination of inquiry-oriented teaching and lecture-based approach is suggested as part of design for curriculum of nursing ethics education.

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.

Experiential Teaching Increases Medication Calculation Accuracy Among Baccalaureate Nursing Students

Safe medication administration is an international goal. Calculation errors cause patient harm despite education. The research purpose was to evaluate the effectiveness of an experiential teaching strategy to reduce errors in a sample of 78 baccalaureate nursing students at a Northeastern college. A pretest-posttest design with random assignment into equal-sized groups was used. The experiential strategy was more effective than the traditional method (t = -0.312, df = 37, p = .004, 95% CI) with a reduction in calculation errors. Evaluations of error type and teaching strategies are indicated to facilitate course and program changes.

Teaching Students to Administer Medications Safely

This article is one in a series on the roles of adjunct clinical faculty and preceptors, who teach nursing students and new graduates to apply knowledge in clinical settings. In this article, the authors discuss important methods in teaching nursing students to administer medications, and include best practices and strategies for student success, with a focus on safety.

Teaching and Learning Medication Calculations: A Grounded Theory of Conceptual Understanding

OBJECTIVE

The purpose of this study was to identify the process of nursing students' attainment of conceptual understanding when learning medication dosage calculations.

DESIGN

This study utilized a grounded theory research design with a blended theoretical framework of constructivism and symbolic interaction.

RESULTS

A process of conceptual understanding began with the teaching and learning experiences in the classroom and progressed to students' reengagement with the course content outside of the classroom. Confusion was the core category of the process. Students who were able to work through the confusion and solve problems were able to attain conceptual understanding and progress to more complex problem solving.

CONCLUSIONS

Nurse educators need to identify teaching and learning strategies that promote conceptual understanding. Helping students to get beyond memorization and move to understanding of medication calculations can help students' critical thinking and problem solving ability and lead to conceptual understanding.

Online intravenous pump emulator: As effective as face-to-face simulation for training nursing students

BACKGROUND

The expansion of online education for nursing students has created the challenge of finding innovative ways to teach clinical skills. An online intravenous pump emulator (IVPE) modelled on actual IV pumps used in clinical healthcare settings was developed to facilitate online education delivery.

OBJECTIVES

The objectives of the study were to implement the online IVPE and evaluate student learning outcomes and perceptions of device use.

DESIGN

A mixed method, quasi-experimental design was used.

SETTING

The study was conducted in the School of Nursing and Midwifery at a regional university in Queensland, Australia.

PARTICIPANTS

Participants were 179 first year nursing students enrolled in a medications course, ranging in age from 18 to 44years, of whom 150 were female.

METHODS

Participants were assigned to one of three groups and trained in the use of IV infusion pumps. Group 1 (n=57) were trained online using the IVPE (ONL); Group 2 (n=73) were trained on-campus using an actual IV pump (ONC); Group 3 (n=49) were trained both on-campus using the actual IV pump and online using the IVPE (ONL+ONC). Competence in using the actual IV pump was assessed for all participants at the conclusion of the training period.

RESULTS

No significant differences in learning outcomes, measured by assessment scores out of 80 points, were found between the ONL (M=65.5±9.2) and ONC (M=62.0±14.8; p>.05) groups. Significantly better learning outcomes were evident for the ONL+ONC group (M=68.7±4.9) compared to the ONC group (p<.01).

CONCLUSIONS

This study highlights that the nursing students became more competent in the skill of preparing and administrating IV infusions when face-to-face and online learning were combined.

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.