Working Together to Develop Mathematical Skills for Practice in One UK School of Nursing

1. Working Together to Develop Mathematical Skills for Practice in One UK School of Nursing Dr Carol Hall, Sian Davies, Christopher Jones, Iain MacDiarmid

2. Project Team Dr Carol Hall, Senior Health Lecturer, School of Nursing, The University of Nottingham Sian Davies, ICT Trainer/elearning lead Nottingham City Health Informatics Training Department Christopher Jones, Health Lecturer, School of Nursing, The University of Nottingham Ian McDiarmid, QMC Learning Centre Lead, South Nottingham College

3. The Issues Competency in mathematics is a key skill in offering competent nursing care (ICN 2002; NMC 2002; NMC 2004) HOWEVER….. Lack of confidence in maths skills remains of concern within nursing, both nationally and internationally (Kapborg 2001; Grandell Neimi et al 2003; Sabin 2003)

4. Locally.... • New students entering the Diploma in Nursing are tested using a mathematics quiz • Approximately one-third of the cohort are unsuccessful on first attempt • This equals approximately 50 students every 6 months at one School of Nursing Centre

5. Questions What about our entry qualifications? Are we unique? Is our test valid? Does it matter in practice? Is the test environment a problem? How can we best support our students?

6. How can we best support nursing students? • Offer a wide range of opportunities to develop confidence and competence in basic maths skills. • View learning maths skills in a positive way. • Ensure students receive follow up support. • Ensure nurse teachers are knowledgeable about available support.

7. A Partnership with South Nottingham College • We approached the local Skills Centre run by South Nottingham College at the Queen’s Medical Centre. • Through a partnership, we facilitated a means by which student nurses could opt to enrol to use adult numeracy materials as within self directed study time. The materials used were predominantly produced by ‘learndirect’.

8. Running the maths programme Week 1 Week 3 Week 5 Week 7 -13 LD Diagnostic Review QUIZ/ENROL Enter Course Introduction ALL Quiz Feedback Tutorial Personal Tutorials and QUIZ Week 14 – to end of Semester One Continue/complete course work Optional Support Sessions

9. The Evaluation Project - Objectives • To determine whether student nurses who access learndirect materials in the first year of their nursing programme score significantly differently in the school maths assessment quiz from those who do not • To evaluate student perceptions of effectiveness of participating in the scheme in relation to developing skills for nursing practice • To disseminate findings locally and to a wider national and international audience

10. Methodology A mixed methodology approach included quantitative analysis of student test scores and content analysis of qualitative questionnaire data

11. Sample • 156 students have participated in the project from three cohorts. • Inclusion criteria was an attainment of less than 14 out of 20 in the school assessment • Cohort 1 self selected to LD or traditional path, Cohorts 2 and 3 have been randomised using a random number table (Polgar and Thomas 1991) • The work is ongoing and interim findings from Cohort 1 are being presented today

12. 56 Students met inclusion criteria 35 enrolled to LD, 21 to traditional tutorial path 28 completed LD diagnostic 18 progressed to courses All students completed a second test after six months on the course Cohort 1

13. Key Findings • At the baseline assessment, no significant difference was found between those electing to complete LD or traditional paths (Mann Whitney U, p=0.875) • At the second test 47 students had improved their test score, 2 remained the same and 7 scored lower. This improvement was significant (Mann Whitney U and Wilcoxon Signed Ranks p=<0.001) • At the post score, there was no significant difference between those receiving LD intervention and those who did not (Mann Whitney U p=0.285)

14. Evaluation Questionnaires 43 Students completed evaluation questionnaires 27 Students participated in learndirect 16 Followed traditional support methods including group and individual tutorial support from nurse teachers with experience of mathematics applied to nursing

15. Main Themes • Sources of Support Generally • Views on the “learndirect” adult numeracy programme • Satisfaction with support offered/identified

16. Sources of Support

17. Views on “learndirect” diagnostic “The diagnostic was enjoyable and helped me overcome my fear of facing and addressing my maths skills needs”. “It…(the diagnostic) highlighted the areas I needed to improve…” “…couldn’t see what relevance fences and rolls of wallpaper had to do with drug calculations…!”

18. Views on “learndirect” resource “…after moving onto a relevant course I have since re-assessed my skills and I have improved.” “I have gained confidence by practice (of maths skills) which has helped me immensely when on placement.”

19. Views on “learndirect” resource “I felt there was a lack of personal support. I also found that I did not have time to fit it in especially whilst on placement” “It helped me on some maths but not really on drug calculations. I’m a bit quicker on adding up but still not very confident with doing maths especially on the ward” “Still waiting for my disc and after telling them my concerns it has still not arrived”

20. Summary Discussion Points • Using “learndirect” as one example of an adult learning resource has not been found to differ from other teaching methods in relation to nursing student outcomes • “learndirect” was perceived positively by many students who identify benefits including increasing confidence and understanding • “learndirect” is a generic learning aid

21. Dissemination -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) • Ensure nurse teachers are knowledgeable about the wide range of available literature, research and resources related to maths learning in HE • Offer a range of opportunities to develop confidence and competence in basic maths skills