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Nursing Mathematics: What Skills Do Nursing Students Bring to Drug Calculations? Roslyn Gillies

Nursing Mathematics: What Skills Do Nursing Students Bring to Drug Calculations? Roslyn Gillies Learning Skills Unit Student Support Services University of Western Sydney. A bit about where I come from …. what I do …. and where I do it …. UWS – Sydney, NSW, Australia. A bit about UWS ….

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Nursing Mathematics: What Skills Do Nursing Students Bring to Drug Calculations? Roslyn Gillies

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  1. Nursing Mathematics: What Skills Do Nursing Students Bring to Drug Calculations? Roslyn Gillies Learning Skills Unit Student Support Services University of Western Sydney LSU 2006

  2. A bit about where I come from … LSU 2006

  3. LSU 2006

  4. what I do … LSU 2006

  5. and where I do it … LSU 2006

  6. UWS – Sydney, NSW, Australia LSU 2006

  7. A bit about UWS … • Six campuses covering entire west of Sydney • 36 000 students – 32 000 undergrads • Larger campuses: Parramatta & Penrith • Smaller: Hawkesbury & Blacktown • Motto: ‘Bringing knowledge to life’ • Emphasis on practical courses, providing educational opportunities for students in the region LSU 2006

  8. How does Nursing Mathematicsfit with Ethnomathematics? Several definitions of ethnomathematics … • … the study of mathematics which takes into consideration the culture in which mathematics arises (University of Idaho website) • … the mathematical practices of identifiable cultural groups (Ubiratan D’Ambrosio – first used in late 1960s) LSU 2006

  9. Human activities which require some form of mathematics • Architecture - construction • Weaving – textiles and baskets • Sewing – turning cloth/skins into clothing or shoes that fit • Agriculture – calendars to mark seasons, planning for quantity and storage, layout of gardens and fields • Kinship relations • Ornamentation – tilings and beadwork • Spiritual and religious practices (uidaho.edu website) • … and Nursing – dosage calculations! LSU 2006

  10. Mathematical skills nurses require • Computational skills • fractions, decimals, percentages, ratio, measurement, conversion between units • Conceptual Skills- ability to: • set up the problem for calculation • apply an appropriate solution method LSU 2006

  11. The culture and tradition ofteaching drug calculation • Early 1980s – Florence Nightingale’s hospital-trained apprentice system was replaced by higher education training • Occurred in countries such as: • UK • Canada • USA • Australia • New Zealand LSU 2006

  12. Impacts of this change • ‘Big bang’ curriculum revolution rather than incremental change • Emphasis on intellectual and higher- level thinking skills, problem solving • Mastery of basic principles rather than facts • Less time in clinical practice situation LSU 2006

  13. Other factors affecting drugcalculation instruction • Increasing student diversity • Multidisciplinary nature of nursing maths (maths applied in a nursing context) • Medication calculation frequently a stressful task performed on the ward • No clear policy on whose responsibility it is to develop and maintain nurses’ drug calculation competence • Little agreement on teaching methods LSU 2006

  14. Other factors (cont.) • Assumption that maths skills taught in the abstract will be successfully transferred to nursing context • Some nursing educators admit to poor maths skills and difficulty in teaching drug calculations • Limited opportunities for students to practice drug calculation skills • Reliance on formula methods that do not always result in students retaining skills LSU 2006

  15. The tradition of using formulamethods for drug calculation • Widespread use of formula methods • Examples of formulae taught: • Volume required to deliver a given mass: (Gatford & Phillips, 2002, p. 44) LSU 2006

  16. Another formula taught … • Drip rate for Intravenous Infusion: (Hext & Mayner, 2003, p. 80) LSU 2006

  17. Why are formulae taught? “… to bypass the need to appropriate or understand any mathematical structure and to impose consistency on what were seen to be dangerous variations in strategy” (Hoyles et al., 2001, p. 13) LSU 2006

  18. The dilemma – Advantages offormula methods • Standardised methods: one-size-fits-all • Easy to apply • Plug in the numbers and turn the handle to get the answer • Don’t need to think too much LSU 2006

  19. Disadvantages of formulamethods • Little use of students’ existing problem-solving skills • Encourage belief that drug calculation is a separate branch of mathematics • Do little to encourage students to think through the problem and understand the calculation method • Do little to encourage estimation and checking strategies to ensure calculated dosage is reasonable LSU 2006

  20. What the literature says … • Some students find formulae difficult to use correctly • Formulae may be a cause of conceptual errors • Formula methods are frequently ineffective and result in: • poor skill development • poor retention of skills LSU 2006

  21. What the literature says … (cont.) • In workplace situations nurses make little use of formulae learnt • Instead, nurses use a variety of correct proportional reasoning methods that preserve the meaning of the problem situation (Hoyles et al., 2001) LSU 2006

  22. The study • Subjects: 35 recently enrolled first year B Nursing students at UTS • Instruments: • Test – 10 calculations (see OHT) • set in everyday contexts • designed to parallel typical drug calculation problems • Questionnaire – demographic data LSU 2006

  23. Problem types simulated in test Calculate: • Number of tablets to deliver a given mass • Volume required to administer a given mass, either: • orally • by injection • Intravenous medications: • drip rate (drops per minute) • time to run the infusion LSU 2006

  24. Some of the questions … PRT item 4. A 12.5 kilogram bag of flour lasts a cook 5 days. How many days will 45 kilograms of flour last the cook? Parallel DCT item 4. On hand is Benadryl 12.5 mg per 5 mL. How many millilitres will you give if Benadryl 45 mg is ordered? LSU 2006

  25. PRT item 5. An automatic drip feeder installed in an aviary is to deliver 600 millilitres of water to the birds every 10 hours. If the feeder delivers 60 drops per millilitre, how many drops are delivered each minute? Parallel DCT item 5. An intravenous drip is to deliver 600 mL of normal saline over 10 hours. If the giving set delivers 60 drops per mL, what is the drip rate in drops per minute? LSU 2006

  26. PRT item 7. A dripping kitchen tap loses 1 litre of water over 8 hours. It is established that 15 drops of water is equivalent to 1 millilitre. Calculate in drops per minute the rate at which the tap is losing water. Parallel DCT item 7. A patient is ordered 1 litre of normal saline over 8 hours. The intravenous giving set delivers 15 drops per mL. Calculate the drip rate in drops per minute? LSU 2006

  27. PRT item 10. A car travelling on a country road is losing water from the radiator at the rate of 25 drops per minute. The driver uses his last 600 millilitres of water to top up the radiator. How long will it take for this amount to leak out if 20 drops of water is equivalent to 1 millilitre? Parallel DCT item 10. An intravenous giving set is delivering an infusion at the rate of 25 drops per minute. The patient is to have 600 mL of Hartmann’s. How long will the infusion take if the giving set delivers 20 drops per mL?? LSU 2006

  28. Research questions Before being exposed to drug calculation instruction of special formulae: • How well do students perform on tasks similar to drug calculations? • How successful are students in applying appropriate problem-solving methods to set up the problem for calculation? • What are the ‘native’ methods used by students to solve such problems? LSU 2006

  29. Scoring – two methods • Method 1 – right/wrong – test mark out of 10 • Method 2 – score/3 for each item – test mark out of 30 • 1 mark: some progress • 2 marks: correct method used • 3 marks correct method and correct answer LSU 2006

  30. Student profile • Female: 94% • Ages: 17-48 mean 25.6 (sd 7.7) • Mathematics backgrounds: • NSW HSC-level mathematics: 78% • Year 10 (junior high) maths or less: 20% • Maths studied after leaving school: 9% • NESB Language background: 12% LSU 2006

  31. Mean score • Method 1 (score/10)Mean score: 3.65 (sd: 2.25) • Method 2 (score/30)Mean score: 15.17 (sd: 7.57) LSU 2006

  32. Pass requirement:80% correct • Method 1:(score ≥ 8/10) • Pass: 11% of students • Fail: 89% • Method 2:(score ≥ 24/30) • Pass: 17% • Fail: 83% LSU 2006

  33. Pass requirement:100% correct • Methods 1 & 2:(Score: 10/10 or 30/30) • Pass: 0% • Fail: 100% LSU 2006

  34. Deficits in students’ skills • Inability to set up problem for calculation(Blais & Bath, 1992; Rutherford, 1996) • Computational errors(Gillies, 1994; Gillham & Chu, 1995) • Errors in metric conversions(Rodger & Jones, 2000) LSU 2006

  35. Some of the problem-solvingmethods students used • Division operations • Unitary method and adaptations • Fraction of a quantity • Proportion (formal set up) • Ratio • Proportional reasoning • Rewrite rate in equivalent form LSU 2006

  36. No of items where correctmethod applied LSU 2006

  37. Ability to apply correctmethod • On average, another 1.4 Qs per student where correct method used • For 26% of students, a further 3-4 Qs where correct method used • For 40% of students, at least 2 additional Qs where correct method used LSU 2006

  38. Items of particular interest • Those with greatest difference between % of students obtaining correct answer and % using correct method–Items 4, 5, 7, 10 • ie many more students can apply a correct method than can get the correct answer • These include all three IV infusion problems – traditionally most difficult Qs • For these items, high incidence of causes, other than conceptual difficulties, that prevent success viz computational difficulties LSU 2006

  39. Item 5 – Melika’s working LSU 2006

  40. Item 5 – Nicola’s working LSU 2006

  41. Item 5 - Summary Key to success: • Being able to convert: • ml to drops • hours to minutes • Being able to express stated ‘drip rate’ in appropriate equivalent forms LSU 2006

  42. Item 7 – Cate’s working LSU 2006

  43. Item 7 – Alison’s working LSU 2006

  44. Item 7 – Melika’s working LSU 2006

  45. Item 7 – Karen’s working LSU 2006

  46. Item 7 - Summary Simplest process: • Change ml to drops early • Leave conversion of hours to mins until the end (otherwise large numbers result) • Also valuable was the ability to express division in fraction form and cancel down (avoids long division) LSU 2006

  47. Item 10 – Karen’s working LSU 2006

  48. Item 10 – Melika’s working LSU 2006

  49. Item 10 - Summary • Both students used same method • Both had difficulty in arithmetic processes: • Karen gained a zero is division (2-step process) • Melika lost a zero in same division (long division) LSU 2006

  50. What analysis of students’ working suggests • Difficulties with IV problems are not always because of conceptual difficulties • Many students able to set up problem and apply appropriate method • Having applied an appropriate method, poor conceptual skills may prevent progress to correct answer LSU 2006

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