An important piece of this competency is that examples be real life situations. When teaching math for pharmacy there can be no more real life scenario than dosage calculations. Students must be able to administer drugs safely in the "real world" setting. All tests and examples are based on real drugs and real dosages that students will find in their daily tasks as a nurse.
We invited student input with the formative evaluation. Students had many comments and I have provided a sampling of them in this hyperlink. Based on this feedback, I have added more in class math instruction to the Spring session of NUR 1141C. I added math homework for the first time based on the finding that the grades didn't really change from one semester to the other. My guess is that the students did not feel a need to work on math until the dosage test was looming. Since it is mandatory to pass the test for the course, most students began to panic at the end of the course when they realized that they were not prepared. The course has been changed in its order in the curriculum and that has changed student level of interest in math because they cannot pass medications until they have passed an elementary math quiz. Students are much more aware of their math deficits much earlier this term and have incentive to work on it.
Students must be able to Think when administering drugs. Is this dosage correct...Is it safe? These are questions that have to be answered by the nurse on a daily basis. Learning safe and reliable methods of drug calculation is imperative to this ability. They must Value dosage calculation. This competency has a built in incentive because it is necessary to pass the calculation exam in order to pass the course and medications. It is my hope that they will Value dosage calculation not only as a passing grade but also because safe drug calculation is valuable to the patients that are in their care. The must be able to Communicate their findings. In some cases, a drug may have been calculated wrong. If that is the case, it will be necessary to have evidence of how the dose was incorrectly calculated. The only way to do so is to be able to show the math. Finally, Act, in this scenario, it goes with communicate. Students have been taught not only to calculate effectively but also how to manage the situation in the event a mistake has been made. This concept is reinforced during the live math classes where students are instructed on safety measures such as leading zeros and appropriate rounding techniques.
Taking into consideration student comments and the formative feedback form. I added math homework in Spring 2004, so that students would have more input and a better idea of how they were progressing with their math skills. Again, I believe the water has been muddied by moving the course, but I do see a clear difference in most students assessment of their own math skills. In addition to NUR 1141C, I also teach in the accelerated program for practical nurses and paramedics. I implemented the math homework in this course as well. We do seem to have more people interested in honing their math skills earlier. To date with 100% of the final tests back for this group, only 3 students will need to take the retake exam.
All students do not arrive to NUR 1141C with the same skills. During my first semester here, we administered the assessment of basic math skills several weeks into the course. One of the interventions that I used in my action research project was to push that up to an earlier point. I moved it to the first math class, which was still several weeks into the term. Our original thinking was not to add stress to them, but we felt we needed to revisit that. As you can see from the table about 20 percent of each class had math deficits coming in. My thinking was that early identification would spur the student to get help earlier. As you can see however, the findings were equivocal.
I believe that the students did not have much incentive to work on math until the end of the term, when they actually had to pass the dosage exam. Nursing school is such a fast paced environment that students often put off work that is "nonessential" in that moment, until it becomes essential This Spring, I have moved the math to the first week. Of course, we have attached weight to the math questions that are on our tests. Now, a student cannot pass medications without being successful on the dosage questions on each exam. The dosage questions becomes progressively more difficult as the course progresses. This was always true. Now, however, if a student is unsuccessful on the dosage portion of the first unit test in NUR 1141C, that student cannot pass medications in the clinical setting. So we have drastically changed the stakes. It should not be surprising to note that I have had several group tutoring sessions and students requesting time for tutoring. To date I have seen about 25 students. This is a vast difference from prior terms when faculty had to go to the student to encourage the student to practice. There is only one student out of 100+ who is in danger of failing the math portion and she has many other issues including possibly a learning disability.
One of the problems that I see when trying to teach students about math, is that many are very "math phobic". They have for many reasons, been worried about the math or dosage part of the nursing program. As a person who was in fact "math phobic", I can relate to the fears and issues that students have when they come to the classroom and are faced with dosage calculation. Many are returning to school after several years, some have never had strong math skills, and some have been taught other methods of calculation when they were in their home countries. So, there are many things to consider.
During the session that the students were assigned the math diagnostic tool, a brief arithmetic review was taught (looking back on the thought process there, it does not seem to be prudent to review math and then give the diagnostic) Once a deficit has been identified, the student is asked to work on the arithmetic review section of the text. This chapter in the dosage text that we use provides a very nice arithmetic review including multiplication & division a fractions, decimals, and percentages. My thinking was that students who are lacking in basic arithmetic, have trouble with the concepts taught in the course for dosage calculation. This proved to be true. However, since we attached no weight to the tutoring and supplemental instruction, students were not inclined to complete the prescription for success. Two or three students worked on and turned in arithmetic assignment during Spring of 2003. Of note, all students who identified a math deficit completed the extra assignments and attended tutoring session. The Spring of 2003 students came to the faculty near the end of the term, usually, after failing the Dosage Practice Exam. At that point, they were very interested in attending tutoring sessions and doing additional work. What I noticed is that among all groups, they were equally paralyzed when the math deficit was identified.
It is very important to help them at whatever level they are at and then to advance them as their abilities dictate. I had several students this term from the Caribbean who came with severe math deficits. They told me that they learned a particular approach to math, it was not helping them to be successful. I worked with them to diagnose their weaknesses and created assignments to deal with them. For one student in particular, it was a series of 4 sessions, each one building on the last. The final session being only to boost her ego and show her that she could be successful. She went from a 68 to a 96.
The action research project that I attempted was not well thought out in its inception. It was a place to start, as action research often is. I learned several things about student motivation, none that surprised me but some that caused me to change the course in subtle ways. I was able to access the mind of my mentor at all times and used Mrs. Woodbery as a sounding board for all ideas and as counsel when I needed to evaluate observations. I still have that relationship. I made several changes this term and because of some problems with the publisher, I will be changing textbooks. I will be adding a WebCT component to the course and that is where the students will do the math homework. The diagnostic will be during the first session on the computer so that students have the opportunity to use this modality. Once the course is up, I will continue to "tweak" the math portion. I will survey this group sometime this semester and add their input to the rest. I anticipate that the course will eventually work the way that I had intended it to, students becoming proficient and successful with dosage calculation, not just for a test but actually developing stronger math skills.