Overdose and Understudy: Pre-service Teachers Tutoring Nursing Students in Mathematics

Author(s):

Jude Ocean(presenting / submitting)Ian McGrath

Conference:

ECER 2017

Network:

24. Mathematics Education Research

Format:

Paper

Session Information

24 SES 08,

Paper Session

Time:

2017-08-24

09:00-10:30

Room:

K6.04

Chair:

Ken Brown

Contribution

There is considerable evidence of poor numeracy skills, evidenced by inaccurate drug calculations, amongst health care professionals: indeed, poor numeracy skills have been recognized as being a significant factor in medication errors in many parts of the world including Europe (Jukes & Gilchrist, 2006; Eastwood, Boyle, Williams &Fairhill, 2011; Dilles, Vander Stichele, Van Bortel & Elseviers, 2011). This paper describes an initiative that was aimed at redressing poor numeracy skills in final-year nursing students. It reports on an initial stage of an education initiative between primary/elementary pre-service teachers and nursing students in a university in Melbourne, Australia.

Many studies have identified numeracy skills of nurses as problematic and various teaching and learning strategies have been tried (Young, Weeks & Hutton, 2013; Foss, Mordt, Oftedal & Lokken, 2013) but the numeracy skills of nurses continue to be a problem. Typically in nursing programs, this lack of numeracy skills has been addressed through the presentation of standardised formulas and repetitive practice. However the underlying problem for nursing students is lack of comprehension or lack of insight into the mathematics of the problem (Eley, Sinnot, Steinle, Trenning, Boyd & Dimeski, 2014). Noting that the numeracy skills of nursing professionals had improved little over 20 years, Arkell and Rutter (2012) suggested that it was time for re-examination of core numeracy skills and how they are taught, assessed and translated into clinical practice.

The form of mathematics to which most nurses have been exposed, both at school and in their nursing programs, is the ‘traditional’ or ‘absolutist’ approach to mathematics instruction. Many texts and online sites serve as examples of this (see for example Lapham, 2015; Tyreman, 2010). Traditionalist educators believe that learning mathematics is a linear, predictable process that can be easily systematised and manipulated, and that anything worth teaching can be tested (Pogrow, 2006). Stemhagen (2009) uses the term ‘absolutist’ to refer to the traditionalist, emphasising the absolutists’ belief in mathematics as a bastion of certainty and rigor: mathematics is a set of formulae and procedures learned by rote and reproduced exactly.

In contrast, constructivism takes a student-centred approach to the construction of knowledge. Students solve tasks that are meaningful to them, investigate multiple strategies towards solution, and communicate their mathematical ideas through discussion and debate (NCTM, 2014; Ridlion, 2009; Boaler, Altendorff & Kent, 2010). Also important is the use of multiple representations in the solution of mathematical problems. Mathematically, “no kind of mathematical processing can be performed without using a semiotic system of representation, because mathematical processing always involves substituting some semiotic representation for another” (Duval, 2006 p.107). Multiple representations include symbols, but also diagrams, formulae, pictures, stories, physical models, graphs. Accessing multiple representations for the same mathematical sign or idea builds conceptual understanding. Mathematics learning takes an extended period of time to build connections between different topics to understand the coherence of mathematical (Sullivan & Davidson, 2014).

In the program reported in this paper, the approach used in teaching mathematics was quite different to the ‘traditional’ way nurses are taught (with repetitive practice of formulas). The traditional method had not produced success for a large cohort of nursing students over the previous two years of their nursing degree.

Method

Nursing students and pre-service teachers were predominantly (90%) female. The 165 nurses had not successfully completed initial maths tests on drug calculations, in which they are required to score 100% for a pass, and the 120 (primary/elementary) pre-service teachers were skilled in constructivist approaches to teaching mathematics. Nurses were required to do the program if they scored less than 100% on the first test, and pre-service teachers were required to teach on the program as part of a fourth-year teaching course. Two ten-item tests were administered to the nursing students, the first a week before the tutoring program, and the second 5 weeks after it ended. Questions used in the tests were constructed to reflect the type of calculation requirement nurses would see in clinical practice. An example: The patient is to commence a nor-adrenaline infusion to maintain their MAP at 70mmhg. To achieve this you need to titrate the dose to response. The normal starting dose is 5 micrograms/min. The infusion is made up according to the local protocol with 6 milligrams of nor-adrenaline in 100 mls of normal saline. Calculate the rate in mls per hour to infuse the starting dose of 5 micrograms /min. The test questions were written by the nurse educator then analysed and adjusted by the mathematics educator to ensure that they assessed a variety of mathematical understandings. In particular, understandings of proportion, partitioning, speed and rates, base systems and measurement conversion are important in drug calculations, so a range of questions was chosen to assess students’ skills in these. In both tests, correct answers were given full marks, whether students produced them from formulas or from more conceptual methods. In the tutoring program, nurses had 1-hour sessions with a pre-service teacher, usually undertaken between two nurses and one teacher, in which test questions were solved by pre-service teachers and nursing students working together. Students worked with conceptual ideas, exploring together mathematical ideas as they solved up to ten questions from the first test. Sample solutions with accompanying photographs of models, tables, diagrams and other representations were prepared by the mathematics educator and made available to the pre-service teachers before each tutoring session. These now form a ‘curriculum package’ for the program. Preservice teachers also explored misconceptions that nursing students might have, such as the accurate representation of decimal quantities.

Expected Outcomes

Before the program started, only 13% of the nursing students accurately answered 10 out of 10 questions. After this program, 65% of the nursing cohort accurately answered 10 out of 10 questions in the final test, and 80% of the nurses accurately answered nine out of 10 of the questions. This was a considerable improvement. Nurses also reported greater levels of confidence and enjoyment. Interestingly, thirty nursing students who scored only 2 or 3 correct answers out of ten on the first test achieved 100% on the final test. This was quite a striking result particularly as in previous years, many such students were unable to pass the drug calculation tests at all. We did not interview these nurses but anecdotal reports indicated that the nurses attributed their success to the use of various representations for problem solution and also to the identification of their misconceptions. Other factors ,such as nurses studying after-hours and using textbooks and websites for practice may also have influenced these outcomes. However, the results of the program are a noticeable improvement on previous years when classes emphasising formulas for calculations and online self-paced learning packages were the focus. The reaction of the pre-service teachers to this program was generally positive. One student noted that working with adults increased her anxiety but also motivated her to engage with the mathematics more deeply. At the end of five weeks, most of the primary pre-service teachers were easily solving questions that simultaneously involved proportional thinking, decimals, measurement conversions and speed and rates. They reported spending a considerable amount of self-study time in preparation for their tutoring sessions with the nurses. We are keen to share our methodology and our curriculum package with any tertiary educators who are interested in developing a larger research program with us.

References

Arkell, S. & Rutter, P. (2012) Numeracy skills of undergraduate entry level nurse, midwife and pharmacy students. Nurse Education Practice. 12(4), 198–203. Boaler, J., Altendorff, L., & Kent, G. (2011). Mathematics and science inequalities in the United Kingdom: when elitism, sexism and culture collide. Oxford Review of Education, 37(4), 457-484. Dilles, T. Vander Stichele, R.R. Van Bortel, L. & Elseviers, M.M. (2011) Nursing students’ pharmacological knowledge and calculation skills Ready for practice? Nurse Education Today. 31 (5), 499-405. Duval, R. (2006). A cognitive analysis of problems of comprehension in a learning of mathematics. Educational studies in mathematics, 61(1-2), 103-131. Eastwood, K. Boyle, M. Williams, B. & Fairhall, R. (2011) Numeracy skills of nursing students. Nurse Education Today. 31 (8), 815–8. Eley, R., Sinnott, M., Steinle, V., Trenning, L., Boyde, M., & Dimeski, G. (2014). The need to address poor numeracy skills in the emergency department environment. Emergency Medicine Australasia,, 26(3), 300-302. Foss, B. Mordt, P. Oftedal, B.F. & Lokken, A. (2013). Medication calculation: The Potential Role of Digital Game-Based Learning in Nurse Education. Computers in Nursing. 31(12), 589-593. Jukes, L. & Gilchrist, M. (2006). Concerns about numeracy skills of nursing students. Nurse Education Practice 6 (4), 192–198. Lapham, R. (2015). Drug calculations for nurses: A step-by-step approach. CRC Press. National Council of Teachers of Mathematics. (2014). Principles to actions: Ensuring mathematical success for all. Reston, VA: NCTM. Pogrow, S. (2006). The Bermuda Triangle of American education: Pure traditionalism, pure progressivism, and good intentions. The Phi Delta Kappan, 88(2), 142-150. Ridlon, C. L. (2009). Learning mathematics via a problem-centered approach: A two-year study. Mathematical Thinking and Learning, 11(4), 188-225. Stemhagen, K (2009). Social justice and mathematics: Rethinking the nature and purposes of school mathematics, In: P. Ernest, B. Greer and B. Sriraman, B. (eds.), Critical Issues in Mathematics Education. Charlotte, NC: Information Age Publishing, 2009, pp.337-349. Tyreman, C. J. (2010). How to master nursing calculations: pass numeracy tests and make sense of drug dosage charts. Kogan Page Publishers. Sullivan, P., and Davidson, A. (2014). The role of challenging mathematical tasks in creating opportunities for student reasoning. In Curriculum in focus: Research guided practice (Proceedings of the 37th annual conference of the Mathematics Education Research Group of Australasia) Sydney: MERGA. pp. 605–612. Young, S. Weeks, K.W. & Hutton, B.M. (2013) Safety in numbers: Essential numerical and scientific principles underpinning medication dose calculation. Nurse Education Practice 13 (e11–e22).

Author Information

Jude Ocean (presenting / submitting)

RMIT University, Australia

Ian McGrath

RMIT University

Health and Biomedical Science

Montmorency

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