Can effective teaching and learning strategies help student nurses to retain drug calculation skills?
Introduction
Student nurses need to develop and retain drug calculation skills in order to accurately calculate drug dosages in clinical practice. Inaccurate drug calculations can lead to drug errors and potential harm to patients (DoH, 2000, O’Shea, 1999). The drug calculation skills of nurses and their preparation for this skill has been highlighted as a result of the recent government report which identified the large number of drug errors being made in the NHS and their involvement in 25% of all litigation clams against the NHS (DoH, 2004). There have been numerous studies that have demonstrated the poor drug calculation skills of both student nurses and nurses (Kapborg, 1994, Hutton, 1998, Weeks et al., 2000, Wilson, 2003). Very few studies however have focussed on evaluating strategies designed to improve their skills. The complexity and regularity of drug calculations required in clinical practice today have arguably reduced over the last 10 years in part due to better prescribing, pharmacist interventions and improved drug manufacturing (Cartwright, 1996). As a result, the opportunity for nurses to practice and revise drug calculation skills has reduced. Nurses will therefore need to have learnt and retained calculation skills in order to perform them accurately over irregular periods. Thus it is vital that the preparation student nurses receive to develop their drug calculation skills ensures not only that student nurses have demonstrated competent drug calculations skills, but that these skills have been taught and learnt effectively to guarantee retention.
Section snippets
Arithmetic skills
The literature examining drug calculation skills of student nurses has identified three key areas of difficulty and potential development. The first is the arithmetic skills of student nurses (Bliss-Holtz, 1994, Weeks et al., 2000), the second is the ability of student nurses to conceptualise the problem into a drug calculation to be solved (Weeks et al., 2001, Arnold, 1998) and the third is the ability of student nurses to symbolise the drug measurements involved in the drug calculation (
Conceptualising
The most common difficulty in performing drug calculations highlighted in the literature is student nurses’ inability to conceptualise what the question is asking them to do (Arnold, 1998, Weeks et al., 2000, Wilson, 2003). Conceptualising involves the student nurse being able to extract the relevant information from the drug bottles or medication charts, set up the problem to solve, understand the answer and recognise errors in answers (Hutton, 1998, Weeks et al., 2000, Weeks et al., 2001,
Role of clinical practice
Written word problems do not reflect the reality of clinical practice where information needs to be extracted from medication charts and drug ampoules to set up drug calculation problems and where there are visual cues to help make sense of the calculation and answer (Weeks et al., 2000, Arnold, 1998, Wilson, 2003). Wilson (2003) carried out a study to test nurses’ ability to carry out a practical drug calculation test designed to simulate clinical practice. Fifty-five nurses took part in the
Opportunities to practise
One reason could be the lack of opportunity nurses and student nurses have to practise drug calculations in their clinical area (Cartwright, 1996). Advances in technology, medication dispensing and roles of pharmacists have all reduced the need for regular complex calculations in practice (Arnold, 1998). Cartwright (1996) examined the number and types of calculations required in hospitals and found that, except for paediatrics, most drug calculations were very simple with very few determined to
Teaching and learning strategies
Several studies have implemented teaching and learning strategies to test whether they were effective in improving the skills of student nurses (Wright, 2005b, Wright, 2007b). Wright (2005b) implemented a range of strategies including online maths tutorials, face-to-face tutorials, calculation workbooks and drug calculation taught sessions. The strategies were evaluated using a pre and post 32-item maths and drug calculation test. The t-test for the pre and post scores showed a marked
Methodology
A quasi-experimental approach was used to test the effectiveness of a range of strategies in improving retention of drug calculation skills. The results from an IV additive drug calculation test were used to compare the drug calculation skills of student nurses between two groups of students who had received different approaches to teaching drug calculation skills. The sample group received specific teaching and learning strategies in relation to drug calculation skills (see Wright, 2005b) and
Results
The results between two sets of scores were statistically analysed using the Mann Whitney U test to see if there was a difference between the two samples. The results showed that there is a highly significant difference between the two samples using a two-tailed test (U = 39.5, p < 0.001). The strategies implemented therefore did make a difference to the retention of drug calculation skills in the students in the intervention group.
The mean score for the intervention group is 9.61, only slightly
Discussion
The results show that there is a statistical difference between the test result scores between the intervention and control group. This indicates that the strategies used in the intervention group are effective at both improving the drug calculation skills of student nurses (Wright, 2005b, Wright, 2007b) and at ensuring these skills are retained over a 12-month period. The strategies used in the intervention group focussed on improving the skills within the two key areas identified in
Conclusion
The study demonstrates that strategies focussing on mathematical skills and conceptualising can improve the learning and retention of drug calculation skills of student nurses. Improvements in drug calculation tests administered 18 months after initial strategies cannot be solely attributed to the strategies alone. One potential variable, which could have assisted retention, was the administration of a drug calculation test half way through this period for the intervention group only. This is
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