title: Identifying strategies to assist final semester nursing students to develop numeracy skills: a mixed methods study.
abstract: BACKGROUND
  It remains a grave concern that many nursing students within tertiary institutions continue to experience difficulties with achieving medication calculation competency. In addition, universities have a moral responsibility to prepare proficient clinicians for graduate practice. This requires risk management strategies to reduce adverse medication errors post registration.
  
  
  OBJECTIVE
  To identify strategies and potential predictors that may assist nurse academics to tailor their drug calculation teaching and assessment methods. This project builds on previous experience and explores students' perceptions of newly implemented interventions designed to increase confidence and competence in medication calculation.
  
  
  METHODS
  This mixed method study surveyed students (n=405) enrolled in their final semester of study at a large, metropolitan university in Sydney, Australia. Tailored, contextualised interventions included online practice quizzes, simulated medication calculation scenarios developed for clinical practice classes, contextualised 'pen and paper' tests, visually enhanced didactic remediation and 'hands-on' contextualised workshops. Surveys were administered to students to determine their perceptions of interventions and to identify whether these interventions assisted with calculation competence. Test scores were analysed using SPSS v. 20 for correlations between students' perceptions and actual performance. Qualitative open-ended survey questions were analysed manually and thematically.
  
  
  RESULTS
  The study reinforced that nursing students preferred a 'hands-on,' contextualised approach to learning that was 'authentic' and aligned with clinical practice. Our interventions assisted with supporting students' learning and improvement of calculation confidence. Qualitative data provided further insight into students' awareness of their calculation errors and preferred learning styles. Some of the strongest predictors for numeracy skill performance included (1) being an international student, (2) completion of an online practice quiz, scoring 59% or above and (3) students' self-reported confidence.
  
  
  CONCLUSIONS
  A paradigm shift from traditional testing methods to the implementation of intensive, contextualised numeracy teaching and assessment within tertiary institutions will enhance learning and promote best teaching practices.
authors.affiliation: School of Nursing and Midwifery, University of Western Sydney, Locked Bag 1797, Penrith NSW 2751. Electronic address: l.ramjan@uws.edu.au.
authors.forename: Lucie M
authors.initials: LM
authors.lastname: Ramjan
authors.affiliation: School of Nursing and Midwifery, University of Western Sydney, Locked Bag 1797, Penrith NSW 2751. Electronic address: lyn.stewart@uws.edu.au.
authors.forename: Lyn
authors.initials: L
authors.lastname: Stewart
authors.affiliation: School of Nursing and Midwifery, University of Western Sydney, Locked Bag 1797, Penrith NSW 2751. Electronic address: y.salamonson@uws.edu.au.
authors.forename: Yenna
authors.initials: Y
authors.lastname: Salamonson
authors.affiliation: Student Learning Unit, University of Western Sydney, Locked Bag 1797, Penrith NSW 2751. Electronic address: m.morris@uws.edu.au.
authors.forename: Maureen M
authors.initials: MM
authors.lastname: Morris
authors.affiliation: Student Learning Unit, University of Western Sydney, Locked Bag 1797, Penrith NSW 2751. Electronic address: l.armstrong@uws.edu.au.
authors.forename: Lyn
authors.initials: L
authors.lastname: Armstrong
authors.affiliation: School of Nursing and Midwifery, University of Western Sydney, Locked Bag 1797, Penrith NSW 2751; Centre for Applied Nursing Research (CANR), South Western Sydney Local Health Network Services, Locked Bag 7103, Liverpool BC NSW 1871. Electronic address: paula.sanchez@sswahs.nsw.gov.au.
authors.forename: Paula
authors.initials: P
authors.lastname: Sanchez
authors.affiliation: School of Nursing and Midwifery, University of Western Sydney, Locked Bag 1797, Penrith NSW 2751. Electronic address: l.flannery@uws.edu.au.
authors.forename: Liz
authors.initials: L
authors.lastname: Flannery
mesh_terms: D001315:Australia; D002983:Clinical Competence / Q000706:statistics & numerical data; D054796:Drug Dosage Calculations; D004508:Education, Nursing, Baccalaureate; D004521:Educational Measurement / Q000379:methods*; D005260:Female; D006801:Humans; D007858:Learning; D008297:Male; D013338:Students, Nursing; D055815:Young Adult
keywords: mixed methods study; numeracy skills performance; nursing education; undergraduate nursing students