Nursing students’ mathematic calculation skills

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<ul><li><p>Nursing students mathematic calculation skills</p><p>Lynde Rainboth a,*, Chris DeMasi b,1</p><p>a BryanLGH College of Health Sciences, Nebraska Wesleyan University, USAb BryanLGH College of Health Sciences, USA</p><p>Accepted 20 July 2006</p><p>Summary This mixed method study used a pre-test/post-test design to evaluatethe efficacy of a teaching strategy in improving beginning nursing student learningoutcomes. During a 4-week student teaching period, a convenience sample of 54sophomore level nursing students were required to complete calculation assign-ments, taught one calculation method, and mandated to attend medication calcu-lation classes. These students completed pre- and post-math tests and a majormedication mathematic exam. Scores from the intervention student group werecompared to those achieved by the previous sophomore class. Results demonstrateda statistically significant improvement from pre- to post-test and the students whoreceived the intervention had statistically significantly higher scores on the majormedication calculation exam than did the students in the control group. The evalu-ation completed by the intervention group showed that the students were satisfiedwith the method and outcome.c 2006 Elsevier Ltd. All rights reserved.This article appears in a joint issue of the journals Nurse Education Today Vol. 26,No. 8, pp. 655661 and Nurse Education in Practice Vol. 6, No. 6, pp. 347353.</p><p>KEYWORDSMedication calculationskills;Nursing student;Calculation method;Mathematical skills</p><p>Introduction</p><p>From the very beginning of the nursing profession,the nurse has been the last line of defense againstmedication administration errors. The nurse mustnot only know the reasoning, incompatibilities,and the effects of the medication, but also be ableto perform medication calculations to assure thedosage is safe for the client. It has been discovered</p><p>that more than one in six medication errors entailerrors of calculation (Capriotti, 2004, p. 63). Medi-cation calculations in nursing can be a challengingskill to maintain, due to technological systems de-signed to facilitate medication administration, suchas, the intravenous pump that calculates drip ratesand as a result reduces mathematical practice inthe clinical setting (Cartwright, 1996). Recent andpast nursing research has consistently found thatpracticing nurses of various fields and studentnurses from various types of nursing schools,showed difficulties with basic mathematical skillsand medication calculation abilities (Bayne and Bin-</p><p>1471-5953/$ - see front matter c 2006 Elsevier Ltd. All rights reserved.</p><p>* Tel.: +1 605 688 4083; fax: +1 605 528 3958.E-mail addresses: melynda.rainboth@sdstate.edu (L. Rain-</p><p>both), chris.demasi@bryanlgh.org (C. DeMasi).1 Tel.: +1 402 481 8705.</p><p>Nurse Education in Practice (2006) 6, 347353</p><p>www.elsevierhealth.com/journals/nepr</p><p>NurseEducationin Practice</p></li><li><p>dler, 1988; Bindler and Bayne, 1991; Blais and Bath,1992; Craig and Sellers, 1995; Gillham and Chu,1995; Santamaria et al., 1997).</p><p>Literature</p><p>The reviews of various studies have found that ba-sic mathematic proficiency of college students can-not be assumed. As early as the mid 1960s, Mundayand Hoyt (1965) performed a study on beginningstudent nurses from seven schools of nursing, andfound that mathematics was the lowest of theirtest scores. To examine the discrepancy amongthe various colleges on entry requirements, Hilton(1999) and Hutton (1998) assessed if nursing col-leges have the ability to predict competence inmathematic calculations. The subjects in bothstudies completed the General Certificate of Sec-ondary Education (GCSE) diagnostic mathematictest. The results of both studies suggested that pa-per qualifications on mathematics, other thanthose above GCSE grade C or equivalent cannotbe relied upon to predict performance in a test ofmathematics required for nursing. However, itwas found that with the use of revision tutorialand self-help booklets in basic mathematics, testscores can be raised to acceptable levels in a shortperiod of time.</p><p>Today educators are continually confronted withstudents who lack basic mathematical skills. Gill-ham and Chu (1995) assessed the basic math skillsof pre-registered second year nursing students andfound that these students were deficit in the basicmath ability of division, formula use, and multipli-cation of fractions. A similar study done by Brown(2002), found that many of the nursing studentsare entering college with a lack of understandingof the very basic below seventh grade math skills,involving fractions, decimals, and percents. A studyby Blais and Bath (1992) was conducted to assessthe mathematical ability, conceptualization, andthe difficulty involved in measurements amongnursing students. The results found that 89% ofthe sample did not receive a passing score and mosthad difficulty with basic math skills and conceptual-izing the problem to set up the computation to pro-vide the correct dose.</p><p>The various mathematical needs and learningstyles of each nursing student showed the necessityfor faculty to assess students prior to developinginstructional strategies to meet students needs(Conner and Tillman, 1990; Jeffries, 2001). Bathand Blais (1993) found that the consistent use ofone formula throughout the entire curriculum for</p><p>solving dosage calculation problems reduced con-fusion and prevented mathematical inaccuracies.Similarly, Worrell and Hodson (1989) discoveredthat variations found between teaching methodol-ogies of nursing faculty and the usage of differentformulas had a negative effect on nursing studentsmathematical calculation abilities, creating confu-sion among the students required to perform multi-ple step calculations. Craig and Sellers (1995) alsofound that teaching one medication calculationformula supported mastery of basic mathematicalskills.</p><p>Richardson and Suinn (as cited in Pozehl, 1996,p. 37) stated Deficiency in conceptual ability re-lated to mathematics may also be compoundedby anxiety, which has been shown to interfere withthe manipulation of numbers and solving of mathproblems. To follow through with those findings,Pozehl (1996) conducted a study to assess howmathematical anxiety affects nursing studentsand nonhealthcare students. The results of thestudy showed that nursing students had a highermathematic anxiety level, but no statistical signif-icance found in the difference of anxiety levelamongst the subjects. The researcher concludedthe need for early identification of mathematicalcalculation problems throughout nursing programsto explore ways to reduce mathematical anxiety.</p><p>Theoretical background</p><p>This study was based on the premise of informationprocessing theory. This theory states that if infor-mation and skills need to be retrieved to completecomplex problem-solving situations, they must bepracticed and learned thoroughly so that automa-ticity, mastery learning, and enhanced studentself-efficacy are attained (Ormrod, 2003). The ra-tio and proportion problem-solving method is aknown mathematical formula that is incorporatedin elementary and high school curriculum (Matos,2004). This problem-solving method follows thestep-by-step concept of the information processinganalysis, in which the student defines the problem,identifies appropriate method of setting up theproblem, retrieves the relevant numbers, and thenapplies the problem solving operations (see exam-ple in Appendix A).</p><p>Purpose</p><p>To determine whether mandatory medication cal-culation classes and required weekly mandatory</p><p>348 L. Rainboth, C. DeMasi</p></li><li><p>calculation assignments with the use of one calcu-lation method will improve the performance onpre- to post-tests and major medication calcula-tion exam completed by beginning nursing stu-dents. To verify whether other factors influencedstudents calculation knowledge and ability priorto the intervention and to determine whether thestudents are able to retain medication calculationknowledge and skills.</p><p>Methodology</p><p>Participants</p><p>A convenience sample of 99 sophomore level diplo-ma nursing students, who took a medication calcu-lation course at a Midwestern diploma college, wasused in the study. The intervention group consistedof 54 current sophomore level diploma nursing stu-dents and the control group consisted of 45 nursingstudents from the previous sophomore level diplo-ma class.</p><p>Instruments</p><p>Medication calculation skills performance wasmeasured with a 14-item multiple-choice com-pleted pre- and post-test intervention. The testcontained items that required the use of a problemsolving formula to resolve medication calculationproblems. The test also required an understandingof metric system conversions, and fractions anddecimals, all necessary skills for conducting medi-cation calculations. An equivalency table was pro-vided for the medication calculation skillsperformance pre- and post-test. Content validitywas established through a review by expert nurseeducators in mathematics. Internal consistencywas established by the Cronbachs Alpha reliabilityof 0.674 for this instrument.</p><p>The final medication calculation skills perfor-mance was measured by the sophomore level ma-jor medication calculation exam that consisted of10 fill-in-the-blank questions. The questions in-cluded single step and multiple step calculationsfor tablet dosages, liquid medication dosages,and intramuscular and subcutaneous dosages. Thesame major medication calculation exam was givento both the intervention and control group of thestudy. Content validity was established through re-view by a group of expert nurse educators in math-ematics and Cronbachs Alpha reliability was notedat 0.135. This low score could be due to the large</p><p>percentage of students who received 100% on theexam.</p><p>Medication calculation skills retention was mea-sured by the junior level major medication calcula-tion exam that consisted of 10 fill-in-the-blankquestions. The questions included single step andmultiple step calculations for tablet dosages, liquidmedication dosages, and intramuscular and subcu-taneous dosages. The same major medication cal-culation exam was given to both the interventionand control group of the study. Content validitywas established by a group of expert nurse educa-tors in mathematics and Cronbachs Alpha reliabil-ity was noted at 0.544. This low score could be dueto the large percentage of students who received100% on the exam.</p><p>Student perceptions of the medication calcula-tion education strategies were measured by an11-item 4-point Likert item survey that also in-cluded opened exploratory questions. Internal con-sistency was established by the Cronbachs Alphareliability of 0.768 for this instrument.</p><p>Procedure</p><p>The study was approved by the Dean of the collegeand the students in the intervention group were in-formed of the complete schedule and goal of thecourse. The students were also notified prior tothe course that the test scores and surveys wouldbe confidential and used to evaluate the teachingstrategy. It was noted that all students partici-pated and no objections were verbalized.</p><p>The course took place in a well lit large class-room, which could seat up to 100 people. Duringthe first class session the expert nurse educator ori-ented the students to the course and provided theassignment plan with due dates. The assignmentplan included the completion of the basic mathe-matical calculation assignments, including ratioand proportion worksheets to be handed in everyweek for 3 weeks. Prior to the completion of thefirst class the students completed the 14-itemmedication calculation pre-test. During the testingthe students were allowed to use the equivalencytable and a calculator, but instructed to write-out their calculations on the exam. All gradingand instructions were given by one nurse educatorwho is an expert on medication calculations andthe current educator of the sophomore level med-ication calculation course. The students were in-structed to use the ratio and proportion methodwhen conducting medication calculations. At theend of every week the nurse educator correctedthe assignments and provided written feedback</p><p>Nursing students mathematic calculation skills 349</p></li><li><p>for the students. On the third week a mandatorymedication calculation review class was con-ducted, which focused on problem areas noted onthe weekly assignments. Following the class eachstudent completed the 14-item medication calcula-tion post-test which was identical to the pre-test.</p><p>The students who missed more then two ques-tions on the post-test were required to attend an-other medication calculation review class and doadditional remedial homework. The review classwas scheduled prior to the major medication calcu-lation exam and focused on the areas of concernnoted on the post-test. On the 10-item sophomorelevel major medication calculation exam the stu-dents were allowed to use a calculator, but wererequired to write out their calculations on theexam. The equivalents table was not provided dur-ing the exam and the students were allowed asmuch time as needed to complete the exam.Immediately after the exam each student com-pleted an 11-item 4-point Likert survey.</p><p>To assess student retention of medication calcu-lation skills, each student (n = 93) took the juniorlevel 10-item major medication calculation examat the beginning of their junior level course. Priorto the beginning of the study the instructors ofthe junior level nursing course were informed ofthe study and advised to provide the same instruc-tions to the intervention group as had been pro-vided to the control group. On the 10-item majormedication calculation exam the students were al-lowed to use a calculator, but were required towrite out their calculations on the exam. Theequivalents table was not provided during the ma-jor medication calculation exam and the studentswere allowed as much time as needed to completethe exam.</p><p>Results</p><p>Description of subjects</p><p>The Nurse Entrance Test (NET) is given to all stu-dents prior to the start of courses in the nursingprogram. The NET is a diagnostic tool to assessthe academic and social skills of students who areapplying to the school of nursing. The NET evalu-ates six content areas, such as, basic math skills,reading comprehension for science textbooks,test-taking ability, stress levels, social interaction,and learning style (BryanLGH College of Health Sci-ences, 2004). A t-test for equality of means showedthat both groups of students, control and interven-tion were similar on their comprehension of math</p><p>(t = 0.246, df = 96, p = 0.807), decimal operations(t = 0.156, df = 96, p = 0.876), fraction operations(t = 0.16, df = 96, p = 0.988), reading comprehen-sion (t = 0.924, df = 92, p = 0.358), and numberconversions (t = 0.550, df = 94, p = 0.584) with amean score of all students at 66% (SD = 16.23).The intervention group consisted of 49 womenand five men and the control group consisted of41 women and four men. The mean age of theintervention group was 25.17 years (SD = 7.02) ascompared to a mean age of 24....</p></li></ul>