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Sullivan, Katherine

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Many students in pre-licensure nursing programs struggle with calculating accurate medication dosages even though they meet the numeracy requirements for application to the nursing programs. Most pre-licensure programs require that nursing students pass dosage calculation exams at a specified level of accuracy before progressing to the next term. Students typically have three tries to pass at the specified level and should they not succeed, they must withdraw. If they wish to continue in the program, they must complete the requirements for re-entry which may include space availability restrictions. Factors influencing dosage calculation performance include fear of mathematics, low math self-efficacy, lack of practice, perception of unimportance, and decontextualization of dosage calculation problems which contributes to conceptual errors. High stakes testing environments described above exacerbate student anxiety which may hinder success. This exploratory field study sought to examine the effects of a contextualized learning intervention on dosage calculation accuracy and math self-efficacy. In addition, it examined the relationships between the students’ Test of Essential Academic Skills (TEAS; Assessment Technologies Institute, 2020) scores, their math self-efficacy, and their ability to pass a dosage calculation exam on the first attempt. The learning intervention incorporated activities to engage the affective domain with the intent of internalizing a value for accurate dosage calculation skills. Two unique features of this learning intervention were that it occurred before students began their nursing courses and used interactive video conferencing due to Covid-19 restrictions. Thirty-six of 47 newly accepted nursing students participated in the intervention and were given kits consisting of basic medication administration accoutrements such as syringes, graduated medicine cups, vials, and pills, which added context to drug dosages. Students collaborated with peers in small virtual groups to solve rudimentary dosage calculation problems using Polýa’s (as cited in Pyo, 2011) problem-solving framework. Student math self-efficacy surveys (Nursing Student’s Self-Efficacy for Mathematics [NSE-Math]; Andrew et al., 2009) were administered before the intervention and again five to seven days after the intervention. A Wilcoxon matched-pairs analysis revealed a statistically significant increase between the pre- and post-intervention NSE-Math survey means, n = 25, Z = 3.786, p < .001, with a moderate effect size, r = 0.54. All nursing students (N = 47) took the initial dosage calculation exam six weeks after the start of their first semester of nursing courses with 41 (87%) passing. A 2 x 2 cross-tabulation table was used to compute the probability of passing the exam if students attended the learning intervention and compared it to the probability of passing if the intervention was not attended. The difference was statistically significant, X2 (1, N = 47) = 4.68, p = .021 (OR = 9.71, 95% CI: 1.48, 63.81), using the continuity correction and Fisher’s exact test. The positive relationship between the learning intervention attendance and passing the exam was low (phi = .391). The predictive relationship of the TEAS and NSE-Math scores to passing the dosage calculation exam was not amenable to logistic regression analysis due to the small sample size. The relationships among the TEAS and NSE-Math scores were examined using the Spearman test of correlation. A statistically significant positive relationship was found between the NSE-Math scores and the TEAS Math scores, r s = .360, p = .047. Overall, the study suggested that a rudimentary contextualized learning intervention might help increase pre-nursing students’ math self-efficacy and enhance their chances of passing a dosage calculation exam on the first attempt.


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