Elsevier

Nurse Education Today

Volume 28, Issue 7, October 2008, Pages 856-864
Nurse Education Today

Can effective teaching and learning strategies help student nurses to retain drug calculation skills?

https://doi.org/10.1016/j.nedt.2008.01.002Get rights and content

Summary

Student nurses need to develop and retain drug calculation skills in order accurately to calculate drug dosages in clinical practice. If student nurses are to qualify and be fit to practise accurate drug calculation skills, then educational strategies need to not only show that the skills of student nurses have improved but that these skills have been retained over a period of time. 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 and the second group received only lectures on drug calculation skills. All test results for students were anonymous. The results from the test for both groups were statistically analysed using the Mann Whitney test to ascertain whether the range of strategies improved the results for the IV additive test. The results were further analysed and compared to ascertain the types and numbers of errors made in each of the sample groups. 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. Further research is required into the retention of drug calculation skills by students and nurses, but there does appears to be evidence to suggest that sound teaching and learning strategies do result in better retention of 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

References (22)

  • Department of Health

    Building a Safer NHS for patients: Improving Medication Safety

    (2004)
  • Cited by (33)

    • A whole-of-curriculum approach to improving nursing students' applied numeracy skills

      2014, Nurse Education Today
      Citation Excerpt :

      Wright (2007) found that a range of teaching and learning strategies including online mathematical sessions, lectures that explained formulas and how to use them, a drug calculation workbook with answers, and practical sessions improved numeracy calculation skills for student nurses. Student nurse error rates for the group receiving these interventions were reduced in comparison to the group who received only lectures to teach numeracy calculations (Wright, 2008). Bloomfield et al. (2010) also suggest that the use of multiple revision strategies accommodates different learning styles.

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

      2014, Nurse Education in Practice
      Citation Excerpt :

      Three studies used randomised control design (RCT) (Glaister, 2007; Koohestani and Baghcheghi, 2010; McMullan et al., 2011) and seventeen used quasiexperimental design (Adams and Duffield, 1991; Costello, 2011; Coyne et al., 2013; Craig and Seller, 1995; Dilles et al., 2011; Greenfield, 2007; Greenfield et al., 2006; Harne-Britner et al., 2006; Jackson and De Carlo, 2011; Kohtz and Gowda, 2010; Pierce et al., 2008; Rainboth and DeMasi, 2006; Rice and Bell, 2005; Unver et al., 2013; Wright, 2007, 2008, 2012). Five studies used two group pre test post test design (Craig and Seller, 1995; Harne-Britner et al., 2006; Pierce et al., 2008; Rainboth and DeMasi, 2006; Rice and Bell, 2005), one study investigated 29 groups (nursing schools) post test (Dilles et al., 2011), one study used three groups post test only with randomisation by surname (Glaister, 2007), four studies used two group post test (Greenfield, 2007; Greenfield et al., 2006; Kohtz and Gowda, 2010; Wright, 2008), five studies used pre test post test without control group (Adams and Duffield, 1991; Costello, 2011; Coyne et al., 2013; Unver et al., 2013; Wright, 2007) and two used post test only without control group (Jackson and De Carlo, 2011; Wright, 2012). The major weakness of quasiexperimental design is that the cause and effect inferences are difficult to establish rigorously(Polit, 2010).

    View all citing articles on Scopus
    View full text