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.

Assessing numeracy and medication calculations within undergraduate nursing education: A qualitative study.

AIM: To explore how undergraduate nursing students are assessed on nursing numeracy and medication calculations from the perspective of Australian nurse education leaders. DESIGN: A qualitative study. METHODS: Semi-structured interviews were conducted with 17 nurse education leaders between November 2022 and January 2023. Braun and Clarke's six phases of thematic analysis were used to analyse the data. RESULTS: Five key themes were identified: (i) high expectations to keep the public safe, (ii) diverse assessment formats, (iii) different ways of managing assessment integrity, (iv) assessment conditions incongruent to the clinical setting and (v) supporting struggling students. CONCLUSION: Nurse education leaders set high standards requiring students to achieve 100% in numeracy and medication calculation assessments, thus maintaining the reputation of nursing and patient safety. However, students struggled to meet this expectation. Diverse assessment formats were implemented, with some examination conditions contrary to clinical practice. Currently, there is no benchmark or independent point of registration examination in Australia, hence the problem is each university had a different standard to judge students' competence. Gaining insight into how these assessments are conducted provides an opportunity to work towards an evidence-based model or benchmark for the assessment of numeracy. IMPLICATIONS FOR THE PROFESSION: Dosage errors in clinical practice threaten patient safety and the reputation of the nursing profession. The accuracy rate of calculations by undergraduate and registered nurses is deficient worldwide. This research highlights a major educational issue, that being the wide variation in how numeracy assessments are conducted with no clear pedagogical rationale for a standardised method. Such assessments would establish a national standard, contributing to quality assurance, the development of the nursing profession and improve patient safety.

Nurse education leaders' perspectives on the teaching of numeracy to undergraduate nursing students: A qualitative research study.

AIM: The aim of this study was to explore the perspectives of nurse education leaders of Australian undergraduate nursing degrees on the teaching of nursing numeracy and how the Australian Nursing & Midwifery Accreditation Standards influence curriculum development. BACKGROUND: Nurses' numeracy skills are reportedly deficient worldwide, posing a significant threat to patient safety. This is an issue for the education of undergraduate nurses and thus for the nursing profession. The international literature reveals a heterogeneous blend of learning approaches, but it is unclear which approaches are best suited to improve the numerical calculation ability of nurses. In the Australian context, there are no accreditation standards referring to numeracy, therefore, it is important to discover how nurse education leaders' design and implement the teaching of numeracy. DESIGN: A qualitative approach using thematic analysis was employed. The setting was Australian universities that delivered an accredited undergraduate nursing degree leading to nursing registration. METHODS: Purposive sampling was used to recruit 17 nurse education leaders of Australian undergraduate nursing degrees. Individual, semi-structured virtual interviews were conducted between November 2022 and January 2023. Interview data were analysed using Braun and Clarke's (2006) six phases of thematic analysis. FINDINGS: Five themes emerged from the analysis: (i) indistinct accreditation standards, (ii) teaching basic maths for clinical applications, (iii) a range of bespoke teaching approaches (iv) we're nurses, not numeracy educators and (v) assumptions about an unprepared cohort. CONCLUSION: The leaders of undergraduate nursing degrees assumed that nursing students would have proficiency in numeracy skills on entering university. However, this was not the case, hence numeracy was an essential skill that needed to be taught to the undergraduate nursing students. Lack of direction from the accreditation council led to the existence of various curricula and an array of approaches to teaching numeracy and medication calculations, which challenged nursing academics who did not consider themselves numeracy educators. This study makes a novel contribution to knowledge, teaching and practice in undergraduate nursing numeracy curricula.

Evaluation of a medication calculation mobile app using a cognitive load instructional design.

OBJECTIVE: For students attending healthcare courses, such as nursing and paramedicine, the ability to calculate medication dosages accurately is an essential but often a complex cognitive skill to be learned. This study aimed to determine whether a 'mastering medication calculation' mobile app, developed using an instructional design based on cognitive load theory, could improve students' medication calculation ability and self-efficacy. Additional objectives were: (1) To examine the correlations between students' medication calculation ability, self-efficacy and their numerical ability; (2) To explore how well medication calculation ability can be predicted by students' numerical ability and their medication calculation self-efficacy; (3) To obtain students' opinions regarding the mobile app's usefulness and usability. METHOD: A quasi-experimental study was carried out with a convenience sample of 60 second year UK university healthcare students who used the app for 8 weeks while in clinical practice. Students were given medication calculation ability and self-efficacy tests pre- and post-intervention. In addition, they were asked pre-intervention to complete a numeracy test and to complete a post-intervention survey to obtain their opinions on the usefulness of the app. RESULTS: Following the use of the app students were significantly more able (p = 0.004) and more confident (p < 0.001) in performing medication calculations. There were significant positive correlations found between students' numerical ability and medication calculation ability (p < 0.001) and between students' medication calculation ability and self-efficacy (p < 0.001). Hierarchical multiple regression analysis indicated numerical ability (ß = 0.46, p < 0.001) and medication calculation self-efficacy (ß = 0.46, p < 0.001) to be the strongest predictors of medication calculation ability, with age and gender being non-significant. All students indicated the app to be an excellent method to support them in learning how to perform medication calculations. CONCLUSION: This study indicated that the app's instructional design, based on cognitive load theory, significantly improved students' medication calculation ability and self-efficacy. Although the app's usability was highly rated by the students, further research is needed to determine if the app's instructional design can be used by learners of different levels of expertise and whether the design can be adopted for the learning of other complex cognitive skills. As numerical ability is essential for medication calculation ability, early identification and rectification of any numerical deficits is recommended.