Helping Student Nurses Learn Mathematics – Responding to National Change in Nursing Carol Hall Senior Health Lecturer University of Nottingham Patric Devitt Senior Lecturer University of Salford

What is Maths in Nursing for? Drug administration Drug prescribing Fluid balance calculation Children’s nutritional needs Intravenous fluid requirements/rates Calculations related to weight/BMI Administration Plotting and recording data Understanding research

Potential outcomes of error in mathematical judgment……. At best an efficient organisation… with sub optimal care At worse death or long term sequelaeAt worse death or long term sequelae

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

What are the challenges for Nurse Educators? 1.Determining those that need help…… Nurses and nursing students may profess that they are‘no 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……..

Further – it is not actually possible to say that a technically ‘good’ mathematician will never make mistakes…..

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) How can Nursing Students be supported?

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!

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

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 (OSCE’s) 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.

How can Universities decide?

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

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

A Career or a Life?

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)

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)

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)

What are the Challenges ? 4Much has been said about the problems and what should be done 4Much has been done to provide resources 4Many entrepreneurs/developers 4Plenty of individual evaluation BUT….. 6Nursing schools and study support centres need to work together more 6Little national/international connected thinking about how best to move forward to determine and monitor standards, or what support is needed 6Little systematic review of interventions 6No research currently that evaluates the maths ability of those who make errors of judgement in practice

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 HEI’s 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

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.

References Dyslexia and Dyscalulia Interest Group/Higher Education Academy Report on ‘Understanding Maths Phobia’ the first DDIG event of 2004/5 http// Ernest Gillespie J (1998) How To: Teach Arts Students Numeracy.. THES October 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): Kapborg I (1995) An Evaluation of Swedish Nurse Students Calculation Ability in Relation to their Earlier Educational Background. Nurse Education Today 15: Nursing and Midwifery Council (2002) Requirements for Pre-registration Nursing Programmes London NMC. Sabin M (2003) Competence in Practice-Based Calculation: Issues for Nursing Education – A Critical Review of the Literature. Occasional Paper No 3, London. Learning and Teaching Support Network.