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.
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).
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