Helping Student Nurses Learn Mathematics Responding to National Change in Nursing Carol Hall Senior

1
Helping Student Nurses Learn Mathematics
Responding to National Change in
NursingCarol Hall Senior Health Lecturer
University of NottinghamPatric Devitt Senior
Lecturer University of Salford
2
What is Maths in Nursing for?

• Drug administration
• Drug prescribing
• Fluid balance calculation
• Childrens nutritional needs
• Intravenous fluid requirements/rates
• Calculations related to weight/BMI
• Administration
• Plotting and recording data
• Understanding research

3
Potential outcomes of error in mathematical
judgment.

• At best an efficient organisationwith sub
  optimal care
• At worse death or long term sequelae

4
Responses

• Examples such as this one have led the nursing
  and midwifery regulatory body to identify
  proficiencies at entry to nurse education and at
  point of registration
• (NMC 2004)
• Employers are also charged with reducing error
  rates year on year (DoH 2002)
• New nurses can expect potential employers to
  include maths as part of the interview process

5
What are the challenges for Nurse Educators?

• 1.Determining those that need help
• Nurses and nursing students may profess that they
  areno good at maths, or may have maths anxiety.
• Some may have genuinely identifiable problems
• Some may be dyscalculic
• None of this means that they WILL make errors.
  This is too simplistic..

6
Further it is not actually possible to say that
a technically good mathematician will never
make mistakes..
7
How can Nursing Students be supported?

• Facilitate a positive cycle of maths learning
• (Ashcraft 2002, Ernest 2000)
• Ensure students receive appropriate diagnostic
  assessment and follow up support (Sabin 2003,
  Engineering Council 2000, NES 2004)
• Ensure nurse teachers are knowledgeable about the
  wide range of available literature, research and
  resources related to maths learning in HE (Sabin
  2003 Hall, Davies et al 2005)
• Offer a range of opportunities to develop
  confidence and competence in basic maths skills
  (Wright 2004)

8
What are the challenges for Nurse Educators?

• 2. Determining what help can help..
• Nurse Educators have an array of resource
  materials to guide students but they are not
  maths teachers and materials are not always
  specific to health care, let alone validated for
  nursing
• Students can attend University study support
  units but teachers are not nurses, AND small
  units can easily be overwhelmed!

Students are individuals...
9
Requirements..

• The NMC, and the QAA, require specific
  proficiency in numeracy commensurate with the
  nurses requirements to care for patients safely
  (Hutton 2005)
• Students who fail to meet requirements will be
  unable to register as practitioners or gain
  employment
• Every University, employer and regulator can
  decide how their view of such proficiency will be
  measured

10
What are the challenges for Nurse Educators?

• 3. Determining when help cannot help enough!!
• Paper tests have demonstrated variable validity
  in terms of determining practical competence
• Practical tests (OSCEs) have been criticised as
  artificial and stressful.
• Continuous practical assessment is one option,
  but places the burden of determining success on
  practitioners. This has its own difficulties.

11
How can Universities decide?
12
Contemporary Issues in UK Nursing

• The government requires increasing numbers of
  nursing students
• The pool of traditional recruits is shrinking
• The entry gates to nurse education are opening
  increasingly wide
• The exit demands are increasing

13
What are the challenges for Nurse Educators?

• 4. Squaring the circle of Paradoxical demands
• Schools of Nursing face penalties for high
  attrition or poor admission rates
• Failing students thus risks financial loss and a
  reduction in output of qualified nurses
• Less nurses in practice means less mentors and
  reduced support for students
• Teachers and practitioners are working with
  individuals with very varied experience making
  support more complex
• BUT INCOMPETENT NURSES ARE DANGEROUS

14
A Career or a Life?
15
The concern remains...

• Competency in mathematics is an essential key
  skill in offering proficient nursing care (ICN
  2002 NMC 2002 NMC 2004 NES 2004)
• HOWEVER..
• Lack of confidence in maths skill remains of
  concern within nursing, both nationally and
  internationally (Kapborg 2001 Grandell Neimi et
  al 2003 Sabin 2003 NES 2004)

16
Nursing is not alone..

• Researchers and Study Support Staff in
• both the Sciences and the Arts have
• identified issues related to Maths learning
• in HE.
• Strategies for development have included
• mandatory diagnostic testing for new
• recruits and approaches in offering
• remedial help
• (Gillespie 1998 Engineering Council 2000 DDIG
  2004)

17
What has already been done?

• Conceptual and theoretical analysis (eg Weeks et
  al 2000)
• Development of local support initiatives and
  materials
• (eg Starkings 2005, Weeks 2005)
• Evaluation of interventions
• (eg Hall Davies et al 2005 Wright 2004)
• Analysis of concept of competence (Hutton 2005)
• Testing of pre and post-registered nurses
• Literature review of broad issues (Sabin 2003)
• The development of a network conference for
  Scotland and an all Wales strategy (Sabin 2005)

18
What are the Challenges ?

• Much has been said about the problems and what
  should be done
• Much has been done to provide resources
• Many entrepreneurs/developers
• Plenty of individual evaluation
• BUT..
• Nursing schools and study support centres need to
  work together more
• Little national/international connected thinking
  about how best to move forward to determine and
  monitor standards, or what support is needed
• Little systematic review of interventions
• No research currently that evaluates the maths
  ability of those who make errors of judgement in
  practice

19
What could be done?

• The development of a national benchmark for
  excellence in maths learning and teaching in
  nursing.
• Further research and systematic review into the
  validity of testing and intervention when
  compared with error in practice
• The development of a Maths in Life Sciences
  network to
• Support HEIs and Trusts in nursing and the life
  sciences.
• Draw together internationally available resources
  into one easily accessible database
• Develop a team relationship between vocational
  mathematicians, study support centres and health
  care to research and resolve problems

20
Whose responsibility and how can the challenge be
managed?

• This is the million pound question!!
• What is needed is a joint approach from all
  stakeholders.
• A nationally agreed approach is essential.

21
References

• Dyslexia and Dyscalulia Interest Group/Higher
  Education Academy Report on Understanding Maths
  Phobia the first DDIG event of 2004/5
  http//www.ddig.lboro.ac.uk
• Ernest
• Gillespie J (1998) How To Teach Arts Students
  Numeracy.. THES October 2 34-35
• Hall C (2002) An Evaluation of Nurse Preparation
  for Practice in
• Administering Medicine To Children. PhD Thesis
  (Unpublished) School
• of Education Nottingham. University of
  Nottingham.
• Hilton D (1999) Considering Academic
  Qualification in Mathematics as an
• Entry Requirement for a Diploma in Nursing
  Programme. Nurse Education
• Today 19 (7) 543-547.
• Kapborg I (1995) An Evaluation of Swedish Nurse
  Students Calculation
• Ability in Relation to their Earlier Educational
  Background. Nurse Education Today
• 15 69-73.
• Nursing and Midwifery Council (2002) Requirements
  for Pre-registration Nursing
• Programmes London NMC.