Long-Term Math Skills Acquisition for Accurate Medication Calculations, a Qualitative Study

Long-Term Math Skills Acquisition for Accurate Medication Calculations, a Qualitative Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Long-Term Math Skills Acquisition for Accurate Medication Calculations, a Qualitative Study Amanda Park This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7614500/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract This qualitative research study was utilized to gain insight into the lived experiences of nursing students in regard to the learning, gaining mastery, and retaining mastery of nursing math throughout their nursing program and up to five-years post-graduation to further implement strategies for nurse educators. The study consisted of 10 participants with a mix of 2-year and 4-year nursing graduates, with five-years or less since graduation. The participants expressed challenges with nursing math skills acquisition, differences in learning opportunities and duration, and depending on positive/negative experiences with math in earlier education let to struggles. The participants all concluded that repetition is necessary to retain, increase confidence in their math skills and competence in nursing math. Nursing math drug calculations drug dosages medication administration nursing math curriculum Introduction The purpose of this qualitative study was to explore strategies for nursing math acquisition taught throughout the nursing curriculum. The previous research includes, yet is not limited to, literature by Hunter Revell and McCurry (2013), Røykenes (2016), and Stoic (2014) that suggests math instruction needs to be enhanced. Utilizing literature as a platform to launch how important nursing math is in drug calculation (Stoic, 2014). Using strategies set forth and building on the teaching methods elaborated the importance of having math problems incorporated throughout all nursing courses and recognizing any additional benefits for the students. The research explored the interests and safety of ensuring a robust additional check to prevent medication errors. What strategies can nurse educators implement for long-term math skills acquisition for accurate medication calculations? Nursing students exposed to nursing math throughout the nursing curriculum consistently are more confident in their math abilities, thereby reducing anxiety and outperforming those who have not, in situations requiring mathematics to administer medications in a hospital setting (Røykenes, 2016). The two-year nursing education platforms incorporated nursing math throughout the degree program, whereas, with many four-year schools, math instruction is lacking in their curriculum. Nursing math strategies are essential to have an ability to perform math to ensure that safe dosages, correct dosage amounts, and patient safety are paramount (Robabi, Mahmoudi, Arbabisarjou, & Movahed, 2019). This study used a qualitative approach with a case study design and was analyzed with a triangulation of nurses who are status post-licensure with five years or less of nursing experience, Benner’s novice to expert theory and an archival document. The researcher conducted semi-structured open-ended questions to nurses with the expertise to determine what methods were beneficial to long-term math skills acquisitions and what may be deemed ineffective. Benner's novice to expert's theoretical framework will be incorporated to assess the students' and educators' perceptions of nursing student's drug calculation competence throughout the four-year nursing program (Gatley, 1992). The researcher explored nursing math instruction strategies and nursing students' competency four-year nursing programs. Nursing math is essential to nursing education (Hunter et al., 2013). Anxiety due to previous math performances and poor math performance in earlier math courses can lead to difficulty mastering nursing math. Exploring nursing math inclusion throughout the program vs. intermittently may help determine if incorporated strategies can show decreased nursing math anxiety when nursing math is incorporated during day-to-day instruction. Medication errors in the healthcare setting are prevalent, and the healthcare field has been evolving to place safeguards, such as scanning the medication and patient bands and incorporating an additional check to decrease errors. Patient safety is the drive for accurate medication calculations. Even with the safety checks, there is still room for human error. A component of human error is incorrect drug dose calculations. Nursing math/drug dose calculations, according to Gunes, Baran, and Yilmaz (2016), account for 28.7% of all medication errors. Gunes et al. (2016) further extrapolate the rationale that calculation errors are from a students' lack of basic math skills. Roberts and Campbell (2017) suggest that the rationale for the lack of students' basic math skills may be rooted in math anxiety that originates during the students' elementary and secondary school experiences with math computation. Salami et al. (2018) describe that while there are several different types of medication errors, the error in calculating the medication to be given is avoidable. Robabi, Mahmoudi, Arbabisarjoy, and Movahed (2019) identify that drug dose calculation is not relegated to the United States. Drug dose calculation is seen all over the world. In addition to the medication rights taught to all nursing students, as Robabi et al. (2019) explain as the right patient, medication, time, dose, and route, many students and nurses are not competent in basic mathematical equations. Gregory et al. (2019) introduced workshops for first-semester nursing students to improve their numeracy skills. According to a study done by Shelton (2016), basic math skills should be tested before entering into the nursing programs. Testing students' math competency before admission into the nursing program may decrease drug calculation errors among nursing students. The research study topic chosen was "What strategies can nurse educators implement for long-term math skills acquisition for effective medication calculation?" The research design for this study topic is a case study, and the method is qualitative. The information was gathered through individual interviews from nurses in the field with five years or less of clinical experience. This information found similarities with Benner's novice to expert in skills the nurses have concerning their math skills and drug calculations. The qualitative case study approach has allowed for themes to emerge in the participants' answers. These themes may transform the way nurse educators teach nursing math and drug calculations to incorporate long-term skill acquisition. Allowing nursing faculty and nurses to synthesize their thoughts and experiences in their nursing math exposure may help shape future programs. Methods The researcher used a qualitative case study. The sample included nurses with five years' or less experience post-graduation and licensure. The researcher interviewed participants until data saturation was met. The researcher explored strategies and teaching methods to decrease medication errors in the clinical field. In accordance with the declaration of Helsinki, this study was reviewed by the IRB for A.T. Still University and found to be in the exempt category. IRB through A.T. Still University was approved. Human Ethics and Consent to participate was observed and maintained. Voluntary, written informed consent to participate in this study was given by all participants. There was no funding for this project. Results Table 1. (Appear under the Results Display heading) Analysis of Data Validity and Reliability Reporting Validity and reliability are implemented by asking the same questions the same way to all participants. Member checking is done after the interview process, and a summary given to the participants to confirm or deny that the researcher was able to gather the information accurately. Qualitative Theme Analysis The observed themes throughout this case study began with the number of participants that have attended a 2-year institution vs. a 4-year institution. The beginning of the interview process produced a majority of 2-year graduates. The purposeful sampling led to incorporate further nurses that had attended a 2-year institution. It was necessary to formulate a plan to garner participants that had attended a 4-year nursing program specifically. Theme One: Repetition in Nursing Math Education Ten participants (100%) used the word "Repetition." Repetition was used when asked, "what do you think might have helped with math mastery in your nursing program?" unsolicited. The participants expressed that the constant exposure to nursing math had (2-year) enabled them to become comfortable and confident in their nursing math abilities. P2, 3, 4, 6, 8, 9, and 10 stated "repetition" when asked what suggestions you have to strengthen the nursing program. P1 stated "repetition, confidence, consistency, and exposure," and P5 stated "taking sample ones and rewriting them, practicing and repetition," and P7 recommended "repetition with more examples and making sure everyone is on board." Three out of the 10 (30%) students were in the ADN programs expressed the need to have more than just an MCAT throughout the remaining semesters in their program, and P4 suggested: "it may decrease anxiety to have the repetition." P4 stated, "I was so anxious due to the high stakes of the MCAT. If you were unsuccessful three times, you are out of the program." P3 stated, "there needs to be more practice." The 4-year degree participants expressed that the contact exposure was lacking and that continued exposure would be beneficial. Participants had a range of medication calculations that they struggled with, and those who had had a negative experience with math before nursing did struggle with the more in-depth calculations, whereas those that had a positive experience with math before nursing did not find that nursing math was a struggle. However, the basic math structure with addition, subtraction, multiplication, and division was commonly referred to as medication calculations that the participants had excelled. Sixty percent (60%) of the participants suggested that nursing math was very easy, excelled with dimensional analysis and basic math. P2 stated, "math always came naturally to me," whereas P5 stated, "I was horrible with equations, but once they clicked, they clicked." When the nurses were asked what math calculations they excelled there was a variety of responses. P 1 stated "simple math," P2 stated "syringes," P3 stated "the easier, the basic ones," P4 stated "conversions and everything that was done on paper," P8 stated, "proportions and dimensional analysis were easy." Notwithstanding, when asked what math calculations were a struggle, all 10 (100%) of the participants were able to define an area that took a little more to grasp. The struggles the participants identified include proportions, fractions, drip rates, weight-based, step-based, label reconstitution, and five out of the 10 (50%) of the participants expressed difficulties with conversions. P1 stated "proportions and fractions" were a struggle; P2 stated, "weight-based conversions and drip rate was difficult at first." P3 stated "conversions and drip rates," P4 stated "IV push over a certain amount of time," P5 stated "I do not recall, equations and conversions," P6 stated "three-step medications," P7 stated "none, reading the labels with reconstitution," P8 stated "conversions were hard," P9 "conversions" and P10 "conversions and different measurements." Mackie and Bruce (2016) found in their qualitative review that, out of the eight students and eight nursing faculty, the high stakes nature of drug dose calculations can be a component of incorrect computation of medication dosages. Shelton (2016) found that more time spent practicing math skills increased nursing students' confidence and ability to perform the task. Shelton (2016) also surmises that students self-reported a higher level of confidence with math skills after positive reinforced and added practice. Gregory et al. (2019) supported that students' access to remediation and consistency with workshops and tutoring increased the math skills confidence in nursing students. Archival document analysis: The repetition noted in the archival document goes so far as allowing the students at least four changes to achieve the grade (dependent on the course and level of the curriculum) necessary to be considered passing. Eighty percent (80%) was the acceptable pass rate for students in their initial nursing math course, and by the final course, one hundred percent (100%) is necessary to be successful. While students are afforded multiple opportunities to be successful on the medication calculation and administration test (MCAT), repetition of nursing math content is not integrated throughout the courses in the curriculum. The MCAT is mandated for students to be able to pass medications in their clinical rotation. If they are unsuccessful after the fourth try, the student will be marked unsuccessful in their clinical and therefore be unsuccessful for the course. Theme Two: Differences in Nursing Math Instruction The majority of the participants who attended a 2-year degree program had expressed that nursing math was incorporated throughout the four semesters of schooling. Both the 4-year and 2-year graduates stated that nursing math instruction began with the first semester of nursing school. The 2-year graduates stated that they continued to have nursing math incorporated throughout their clinical and tests program. The Medication Calculation Administration Test (MCAT) is a ten-question math test that requires a 90-100% mastery before being allowed to pass medications given during the first clinical rotation. P2 stated, "nursing math was initially taught the first semester and continually tested on the remaining semesters in content exams." P4 stated, "nursing math was taught the first semester, except for the beginning of clinical, math was not seen again in the classroom for the program." The 4-year graduates ranged from those that had the nursing math the first and second semester of their degree plan from those that had nursing math taught in the first semester and no further nursing math exposure in courses until the final semester. Ten out of the 10 (100%) nursing students interviewed stated that they did have to prove nursing math competency at the start of clinical each semester with an MCAT-like test. In addition, a ten-question medication calculation administration test was given, requiring a score of 90-100% depending on the program and semester of nursing. If the score of 90-100% was not met, the student had two additional opportunities to prove mastery. All participants interviewed all stated having to prove nursing math mastery at least once in their nursing education. P1-10 all stated that they were required to take an MCAT at the beginning of each clinical rotation. Fifty percent (50%) of those interviewed stated that nursing math was tested throughout their nursing program. P3 stated that nursing math was taught in the first semester and was "reviewed and tested throughout the semesters." Whereas the remaining five (50%) interviewed stated that while nursing math was tested at the beginning of the semester in clinical, it was not seen in the course content. P10 stated, "the spring semester sophomore year was when nursing math was taught and tested on." P8 stated, "we were taught nursing math in the first semester, and other than clinical that first day, we did not see it again." P2 stated, "nursing math was taught throughout the first semester," and P4 stated, "nursing math was learned the first semester and continually tested throughout the remaining semesters." Robabi et al. (2019) found that nursing programs do not allow for enough time and consistency with nursing math to produce competent and confident students in their drug dose calculations. Salami et al. (2018) found that insufficient training and education for nurses contributed to medication administration errors. Chendake (2020) suggested that the nursing curriculum needs to be structured to improve basic math skills, and Shelton (2016) concluded that students increased their confidence in performing nursing math skills after attending a workshop. Finally, O'Reilly et al. (2020)conducted a study where wanting more and boosting confidence were key components to nursing students' success with nursing math. Archival document analysis: The nursing math instruction for the archival document includes a half-a-semester course worth one credit hour. The student must achieve an eighty percent (80%) or above continue in the nursing program. In addition, there is a specific date to which the students need to be successful to continue with the course. With the future nursing courses, the students need to be successful in the MCAT on predetermined dates within the semester or be considered unprepared for clinical and with a clinical failure. If the students do earn an unsuccessful grade and have to repeat a nursing course, the readmit to the nursing program is arduous with a requirement of a written math calculation test with a score of ninety percent (90%) for Nursing I and II and one hundred percent (100%) for Nursing III and IV. Theme Three: The Need to use Nursing Math Post-licensure The average length of time practicing as a licensed registered nurse for the participants is 2.7 years. All participants expressed that they have had to perform nursing math since becoming licensed and working. The most common nursing math conversion with eight of the ten (80%) participants identified that they have performed since licensure is converting milliliters to milligrams and drip rate calculations for intravenous fluid therapy. P6 indicated "not much use" of nursing math post-licensure but rescinded, stating, "now that I think about it, I have done drip rates and conversions." P7 used nursing math calculations post-licensure such as "fluid calculations, conversions from milligrams to milliliters and the ins and outs." P3 "I have done drip rates, wastes and converting," P4 stated "easy milligrams to milliliters conversions and IV rates," P5 "milligrams to milliliters," P8 "pounds to kilograms," P9 stated "fluid calculations, milligrams to milliliters and the ins and outs conversions" and P10 stated "drip rates and weight-based dosages." Ninety percent (90%) of the participants stated nursing math usage post-licensure. The majority of the participants had to think for a few seconds to identify the nursing math they used in practice since licensure. For example, P2 stated, "it has been a long time since nursing math" was differentiated for medication administration. P3,4,6,7, and nine all identified drip rates as a nursing math component that has been utilized in their practice. Several participants stated IV rate, wastes, conversations (milligrams-milliliters or pounds to kilograms), and reconstitution. P8 stated "wasting medications and pounds to kilograms," and P10 stated "drip rates and weight-based doses." Strategies suggested by the participants to increase confidence and competence in nursing math are repetition throughout the nursing program. While many of the 2-year participants expressed that they had been exposed to nursing math throughout their program, one participant stated that making math less scary would help. When the participant elaborated on the content, it was stated that the medication calculation administration test given at the beginning of the semester was extremely anxiety-producing. Participants of the 4-year degree program had the same consensus with the 2- year degree nurses, with repetition and exposure being the key to comfort, confidence, and recall later. P9 suggested, "there should be more repetition, examples, and make sure everyone is on board before moving on to ensure success." Archival document analysis: To complete the nursing program, the student must be proficient in nursing math. While the archival document does not specifically state that nursing math will be utilized in the future practice of the nurse graduates, it is assumed. The high stakes nature of the MCAT requirements ensures that nursing students are competent to perform nursing math after their education. Summary The academic justification that supports this study is Benner’s novice to expert. In Benner’s theory, it allows a student/professional to go through stages of learning in their new environment. Benner’s theory posits that there are several steps to which one will obtain expert level in their field of choice. All student’s starting in the nursing program will begin at the novice level and by the end of their education become an expert nursing student. This will restart when the nursing student enters into the healthcare setting, starting again at novice and to work towards expert. With nursing math, the students begin with novice and by the end of their nursing education will become experts in nursing math. Out of the ten nurses that participated in this study, the resounding theme was that repetition of nursing math assisted in their long-term memory in math skills acquisition. Out of 10 registered nurses, who have up to five years of practicing nurses, eight were 2-year nursing program graduates, and two were 4-year nursing program graduates. The reigning theme of nursing math mastery and long-term memory acquisition was ‘repetition’ within and throughout the nursing program. The continuation of nursing math in the field has encouraged this researcher to remain a relevant and important task. The incorporation of nursing math throughout the program was suggested by all who participated in the study. Data cleaning for the study allowed this researcher to understand and practice what has occurred during the study's data collection and analysis. Consolidation of the data has given the researcher a representation of the study as a whole. Descriptive themes and attributes found in the data descriptive data analysis include interviews from nurses from licensure to five years' experience. Throughout the interviews, information gathered includes: the type of degree they have obtained for initial licensure, the duration of time in practice as a nurse, and their nursing math experiences in educational and professional environments. The nurses interviewed have offered their opinions to further the nursing math educational offerings for nurse educators to take into consideration in their academic offerings. Discussion, Limitations, and Recommendations The study results concerning strategies nurse educators can implement for long-term math skills acquisition for accurate medication calculations indicate that there is a need to facilitate nursing math instruction throughout the curriculum. Limitations include a small pool of participants of 2-year to 4-year graduate nurses, and a novice researcher. Recommendations include incorporating consistent nursing math teaching strategies throughout nursing courses and the nursing curriculum to implement long-term math skills acquisition. Discussion The research analyzed was done via a qualitative case study to determine what nursing educators can implement for long-term math skills acquisition for accurate medication calculation. The participants consisted of nurses from licensure to five years of experience working as a nurse. Out of 10 participants, eight were 2-year graduates (ADN), and two were 4-year graduates (BSN). Several themes emerged from the interview process, with repetition being the number one referenced phrase to bolster nursing math for students. Further mentioned in the themes were the lack of nursing math instruction and reinforcement throughout the nursing program and an overall struggle with basic math. Robabi, Mahmoudi, Arbabisarjoy, and Movahed (2019) found that there was not enough time and training for nursing students to become confident in their math skills and found an inadequacy of students performing nursing math dosage calculations. O'Reilly et al. (2020) found that roughly 10% of nursing students are competent in basic math skills. Math anxiety plays a role in confidence and competency in nursing math, as mentioned by Roberts and Campbell (2017), Røykenes (2016), and Shelton (2016). The nursing students' numeracy skills have come into the program, and the experiences they have had with math before nursing forms the personal perception of the student's ability to become proficient in math. Several participants suggested that they were not proficient and had always struggled in “math as a kid”, whereas some participants proclaimed proficiency in math before the nursing program. Chendake (2020) supports that 81% of students lack confidence and math competency. Limitations Limitations to this study included the time available to interview participants, which was conducted over the holiday season and during a pandemic. Another limitation included the lack of participants from a 4-year degree program, and the geographical location is specified to nurses educated and working in the east coast. The population interviews may not be an accurate depiction of all nursing programs. All of the 2-year graduate nurses were either finished with their BSN or were enrolled in a BSN program at the time of the interview. COVID-19 presented a limitation for participation, as originally this study was to be conducted with nurses in specific hospitals, but because of limitations from the hospitals and the school, another route was taken. COVID-19 also has undue strain on the healthcare force, making nurses less likely to participate in studies due to their increased workload and schedule. COVID-19 has opened many doors for interviewing without exposure, utilizing the Zoom platform, and a few interviews were rescheduled due to the nature and work schedule for some nurses that were interviewed. The Zoom platform was utilized to conduct interviews due to the pandemic. While the Zoom platform did allow the researcher and participant to meet with minimal travel time and exposure, there may have been a missing component being in person for an interview that will not be known for this study. Face-to-face interviews would have been this researcher's first preference, notwithstanding the Zoom platform allowing the researcher to schedule interviews closer together, not procure a room for interviews, and ease at recording the interviews. Recommendations Recommendations for nurse educators to implement for long-term math skills acquisition for accurate medication calculations is to incorporate (teach) nursing math early in the nursing curriculum and throughout all nursing courses and curriculum utilizing a consistent learning strategy. Implementing tutoring services for nursing students to include teaching nursing math strategies as well as nursing content to support student long-term skills acquisition. Røykenes (2016) supports that those students who are not confident or have math anxiety will benefit from the repetition of math over time. Shelton (2016) suggests assessing nursing student's basic math skills to help set them up for success in the nursing math programs. Early implementation of nursing math in the nursing program in lecture, clinical, and online will help the nursing student become proficient in nursing math skills. Márquez-Hernández et al. (2019) conducted a study where game-based software was used to add to the learning experience. Gallegos et al. (2017) also conducted a study where gaming helped bolster nursing students' confidence, comfort, and skill level with nursing math. With students able to access to nursing math software, this will allow them to practice on their own time with unlimited repetition to bolster confidence and competency in nursing math. Repetition, confidence, and competency are necessary for long-term math skills acquisition for nursing students. Basic math skills need to be evaluated and supported to improve the nursing students' rate for success in the nursing program. Nursing math is high stakes, where medication errors account for the number one preventable medical error. Building confidence in the nursing student through repetition of nursing math (basic math) taught will allow students to increase their confidence in their ability to competently perform nursing math, thereby decreasing their risk of medication error. Conclusion When premised on the notion that the math and drug dosing calculations performed by nurses contribute to the top preventable medical errors, this author set out to identify differences in nursing education and potential ways to support nurse educators’ in their teaching strategies to create long-term math skills acquisition for nursing students. Repetition and exposure have been long noted to be advantageous to learners in every field to ensure that long-term skills acquisition is met which supports a summative assessment throughout the course and curriculum for students. The results of this study suggest that the formative assessment of nursing math given to nursing students in the first semester of nursing content demonstrates inadequate math competencies. These competencies are necessary for a nursing student to retain the steps required to calculate nursing math correctly to decrease the likelihood of medication errors in the healthcare setting. In a summative approach, where the nursing students are taught nursing math at the beginning of their nursing program content and continually reviewed and are assessed in a formal (questions on the exams throughout the course) and informal (questioned during lecture as a group) setting, will allow for nursing students to have repetition in nursing math skills throughout their nursing courses and nursing curriculum. Repetition was a theme that all of the study participants referenced in their answers regarding what is necessary to have nursing math competency and confidence. Confidence and competence are an integral part of long-term skills acquisition in nursing math. The use of content repetition throughout the nursing courses and curriculum and by allowing the students access to a gaming-type program will assist with building confidence and competence in nursing math. The gaming-type program will allow the students unlimited access to nursing math questions with real-time answers and remediation as needed. Another component of assisting nursing students/nursing programs to produce competency in nursing math is by incorporating nursing math problems and teaching strategies into all nursing content tutoring sessions. This study concluded that there is a need for consistent nursing math instruction throughout the nursing courses and nursing curriculum. Repetition was the key component mentioned by the study participants concerning their success with nursing math or lack therein. Nursing math competency creates the basis to decrease preventable medication errors in the healthcare field. Abbreviations ADN- Associates degree in nursing, 2-year degree in nursing BSN- Bachelors degree in nursing, 4-year degree in nursing IV- Intravenous fluid MCAT- Medication calculation and administration test P-Participant Declarations IRB Approval from: A.T. Still University IRB. Human Ethics and Consent to participate declaration: Applicable. Written informed consent received by all participants in this study. Funding: No funding received. References Avari M, Feizollahzadeh H, Valizadeh S, Virani F. Development and evaluation of multimedia software of vital drug prescription and calculation principles. Res Dev Med Educ. 2018;7(1):32–7. https://doi.org/10.15171/rdme.2018.007 . Chendake MB. Self-efficacy in drug dosage calculation among undergraduate nursing students. Annals Med Health Sci Res. 2020;10(3):882. http://search.ebscohost.com/login.aspx?direct=true&AuthType=shib . &db=a9h&AN=1443 94467&site = eds-live. Gallegos C, Tesar AJ, Connor K, Martz K. The use of a game-based learning platform to engage nursing students: A descriptive, qualitative study. Nurse Educ Pract. 2017;27:101–6. https://doi.org/10.1016/j.nepr.2017.08.019 . Gatley EP. From novice to expert: the use of intuitive knowledge as a basis for district nurse education. Nurse Educ Today. 1992;12(2):81–7. https://doi.org/10.1016/0260- . 6917(92)90032-J. Gill M, Andersen E, Hilsmann N. Best practices for teaching pharmacology to undergraduate nursing students: A systematic review of the literature. Nurse Educ Today. 2019;74:15–24. https://doi.org/10.1016/j.nedt.2018.11.017 . Gregory L, Villarosa AR, Ramjan LM, Hughes M, O’Reilly R, Stunden A, Daly M, Raymond D, Fatayer M, Salamonson Y. The influence of mathematics self- efficacy on numeracy performance in first‐year nursing students: A quasi‐experimental study. J Clin Nurs. 2019;28(19–20):3651–9. https://doi.org/10.1111/jocn.14963 . Mackie JE, Bruce CD. Increasing nursing students' understanding and accuracy with medical dose calculations: A collaborative approach. Nurse Educ Today. 2016;40:146–53. 10.1016/j.nedt.2016.02.018 . Márquez-Hernández VV, Garrido-Molina JM, Gutiérrez-Puertas L, García-Viola A, Aguilera-Manrique G, Granados-Gámez G. How to measure gamification experiences in nursing? Adaptation and validation of the Gameful Experience Scale [GAMEX]. Nurse Educ Today. 2019;81:34–8. https://doi.org/10.1016/j.nedt.2019.07.005 . Oyelana O, Martin D, Scanlan J, Temple B. Learner-centred teaching in a non- learner-centred world: An interpretive phenomenological study of the lived experience of clinical nursing faculty. Nurse Educ Today. 2018;67:118–23. https://doi.org/10.1016/j.nedt.2018.05.012 . Robabi H, Mahmoudi N, Arbabisarjou A, Movahed S. Drug calculation skills in nursing students of Zahedan University of medical sciences. Drug Invention Today. 2019;12(2):227–30. Roberts S, Campbell A. Striving for a good standard of maths for potential student nurses. Br J Nurs. 2017;26(1):32–6. https://doi.org/10.12968/bjon.2017.26.1.32 . Røykenes K. My math and me: Nursing students’ previous experiences in learning mathematics. Nurse Educ Pract. 2016;16(1):1–7. https://doi.org/10.1016/j.nepr.2015.05.009 . Shelton C. Students who developed logical reasoning skills reported improved confidence in drug dose calculation: Feedback from remedial maths classes. Nurse Educ Today. 2016;41:6–11. https://doi.org/10.1016/j.nedt.2016.03.007 . Tables Table 1 (Appear after the Results Display heading) Interview Questions Responses 1) Did you complete a 2-year or 4-year nursing program? 2-year- 8 4-year- 2 2) In what year(s)/semester(s) did your program teach nursing math? 2 year-1st semester, math competencies for clinical (10 question quiz with mastery mandated)at the beginning of every semester, usually 2 math questions on every exam 4 year- 1st semester, math competencies for clinical (10 question quiz with mastery mandated)at the beginning of every semester, depends on course if math was included on exams throughout the curriculum 3) What was your experience with drug calculations in your nursing program? Positive-6 Key words: easy, simple, no problems Negative- 4 Key words : hard, need more instruction, difficult 4) What do you think might have helped with math mastery in your nursing program? Repetition, better explanation, 1:1, tutoring 5) What type of medication calculations did you struggle with in nursing math? Weight based, drip rates, proportions 6) What type of medication calculations did you excel at in nursing math, and why? Weight based, basic math, drip rates 7) What were your experiences with math before nursing school? “Did great took calculus in college” “Took stats in college” “Didn’t do well in high school math” “Tanked in college math” “I was always good at math” “Math was never a problem for me.” 8) What type of nursing math conversions have you had to perform since becoming licensed? IV drip rates, none, weight-based calculations, simple conversions, basic math 9) What strategies can you recommend for nursing educators to strengthen students' confidence and competence in nursing math? Repetition, 1:1, tutoring, different learning strategies 10) What additional information would you like to add to this study? None Table 2 (Appear in the manuscript in Theme Two: Differences in Nursing Math Instruction Responses Semester Nursing Math Taught Percentage of responses 1st 90% 2nd 60% 3rd 0% 4th 0% 5th 0% 6th 10% 7th 0% 8th 0% Additional Declarations No competing interests reported. Supplementary Files AppendixandTablesforLongtermmathskillsaquistionforaccuratemedicationcalulations.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7614500","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":535935049,"identity":"1e0fa1fa-e3f0-46eb-85c5-b0f23c536353","order_by":0,"name":"Amanda Park","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIiWNgGAWjYBACNjB54H99P4hOKCBCCz9ECzPjzAaQFgMitEg2QLVsOABiEKPF4NrZg58rzrAxG59fnfjhgQGDPL/YAQJabuclS565wcNmduPtZgmgwwxnzk4gpCXHQLLhgwSP2Y2zG0BaEgxuE9BifzvH+GfDBwMJ4xlnN/8gSgvQFjPJhhsJBgb8vduIswXolzTLhjMHEiRu8G6zSDCQIMYvuYdvNhw7kMDff3bzzR8VNvL80gS0MDDwQGkJsEoJQsqRtfAfIEb1KBgFo2AUjEQAAKxcSt+9KPTDAAAAAElFTkSuQmCC","orcid":"","institution":"A.T. Still University","correspondingAuthor":true,"prefix":"","firstName":"Amanda","middleName":"","lastName":"Park","suffix":""}],"badges":[],"createdAt":"2025-09-14 20:08:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7614500/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7614500/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":94753554,"identity":"39c3ec3b-0550-4ba9-aab6-214d6bd1af06","added_by":"auto","created_at":"2025-10-30 10:39:26","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":34040,"visible":true,"origin":"","legend":"","description":"","filename":"Longtermmathskillsaquisition...forPublicationParkAmanda.docx","url":"https://assets-eu.researchsquare.com/files/rs-7614500/v1/f7bdba7781464c090ce213f1.docx"},{"id":94824086,"identity":"c0f9849a-7706-42c5-a3d5-e7e5f52cc768","added_by":"auto","created_at":"2025-10-31 06:48:27","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":15920,"visible":true,"origin":"","legend":"","description":"","filename":"TablesforLongtermmathskillsacquistionforaccuratemedicationcalculations.docx","url":"https://assets-eu.researchsquare.com/files/rs-7614500/v1/009a7830e4fe6a51eee88add.docx"},{"id":94823288,"identity":"47d82394-33cd-4c13-8c35-e9ea38e55534","added_by":"auto","created_at":"2025-10-31 06:47:00","extension":"json","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":2790,"visible":true,"origin":"","legend":"","description":"","filename":"a6158848dbc44367bbe8055733233a71.json","url":"https://assets-eu.researchsquare.com/files/rs-7614500/v1/fc518696c8149d5833850c1c.json"},{"id":94753558,"identity":"a29655d4-aa7a-48bb-a8a5-85fb2a048378","added_by":"auto","created_at":"2025-10-30 10:39:26","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":20085,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixandTablesforLongtermmathskillsaquistionforaccuratemedicationcalulations.docx","url":"https://assets-eu.researchsquare.com/files/rs-7614500/v1/23ee78723b2206bb3e39a711.docx"},{"id":94823334,"identity":"d399716d-237e-4390-997c-64f3f11a7dfa","added_by":"auto","created_at":"2025-10-31 06:47:05","extension":"xml","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":67175,"visible":true,"origin":"","legend":"","description":"","filename":"a6158848dbc44367bbe8055733233a711enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7614500/v1/7389c0c407d529f7c95d9380.xml"},{"id":94823637,"identity":"0427568d-e69c-4285-ab44-943cc6106b32","added_by":"auto","created_at":"2025-10-31 06:47:42","extension":"xml","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":64854,"visible":true,"origin":"","legend":"","description":"","filename":"a6158848dbc44367bbe8055733233a711structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7614500/v1/ed17ed2354d52da43e3f7c20.xml"},{"id":94753559,"identity":"faa5921a-b37d-4e63-abf3-6be45764277f","added_by":"auto","created_at":"2025-10-30 10:39:26","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":71717,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7614500/v1/0a988d31e8c4dba83704053d.html"},{"id":98622999,"identity":"4542d29a-ca40-4ac9-b51f-fa36d77c3820","added_by":"auto","created_at":"2025-12-19 17:03:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":510629,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7614500/v1/d03697f9-b57c-4344-b6c5-b99e62f77dad.pdf"},{"id":94753552,"identity":"7a729176-0d79-489d-9f3b-c178bd60574e","added_by":"auto","created_at":"2025-10-30 10:39:26","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20085,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixandTablesforLongtermmathskillsaquistionforaccuratemedicationcalulations.docx","url":"https://assets-eu.researchsquare.com/files/rs-7614500/v1/5a2dec26b32ad735428d500b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Long-Term Math Skills Acquisition for Accurate Medication Calculations, a Qualitative Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe purpose of this qualitative study was to explore strategies for nursing math acquisition taught throughout the nursing curriculum. The previous research includes, yet is not limited to, literature by Hunter Revell and McCurry (2013), Røykenes (2016), and Stoic (2014) that suggests math instruction needs to be enhanced. Utilizing literature as a platform to launch how important nursing math is in drug calculation (Stoic, 2014). Using strategies set forth and building on the teaching methods elaborated the importance of having math problems incorporated throughout all nursing courses and recognizing any additional benefits for the students. \u0026nbsp;The research explored the interests and safety of ensuring a robust additional check to prevent medication errors.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;What strategies can nurse educators implement for long-term math skills acquisition for accurate medication calculations? Nursing students exposed to nursing math throughout the nursing curriculum consistently are more confident in their math abilities, thereby reducing anxiety and outperforming those who have not, in situations requiring mathematics to administer medications in a hospital setting (Røykenes, 2016). The two-year nursing education platforms incorporated nursing math throughout the degree program, whereas, with many four-year schools, math instruction is lacking in their curriculum. Nursing math strategies are essential to have an ability to perform math to ensure that safe dosages, correct dosage amounts, and patient safety are paramount (Robabi, Mahmoudi, Arbabisarjou, \u0026amp; Movahed, 2019).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;This study used a qualitative approach with a case study design and was analyzed with a triangulation of nurses who are status post-licensure with five years or less of nursing experience, Benner’s novice to expert theory and an archival document. \u0026nbsp;The researcher conducted semi-structured open-ended questions to nurses with the expertise to determine what methods were beneficial to long-term math skills acquisitions and what may be deemed ineffective. Benner's novice to expert's theoretical framework will be incorporated to assess the students' and educators' perceptions of nursing student's drug calculation competence throughout the four-year nursing program (Gatley, 1992).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;The researcher explored nursing math instruction strategies and nursing students' competency four-year nursing programs. \u0026nbsp;Nursing math is essential to nursing education (Hunter et al., 2013). Anxiety due to previous math performances and poor math performance in earlier math courses can lead to difficulty mastering nursing math. Exploring nursing math inclusion throughout the program vs. intermittently may help determine if incorporated strategies can show decreased nursing math anxiety when nursing math is incorporated during day-to-day instruction.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Medication errors in the healthcare setting are prevalent, and the healthcare field has been evolving to place safeguards, such as scanning the medication and patient bands and incorporating an additional check to decrease errors. Patient safety is the drive for accurate medication calculations. Even with the safety checks, there is still room for human error. \u0026nbsp;A component of human error is incorrect drug dose calculations. Nursing math/drug dose calculations, according to Gunes, Baran, and Yilmaz (2016), account for 28.7% of all medication errors. Gunes et al. (2016) further extrapolate the rationale that calculation errors are from a students' lack of basic math skills. Roberts and Campbell (2017) suggest that the rationale for the lack of students' basic math skills may be rooted in math anxiety that originates during the students' elementary and secondary school experiences with math computation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Salami et al. (2018) describe that while there are several different types of medication errors, the error in calculating the medication to be given is avoidable. Robabi, Mahmoudi, Arbabisarjoy, and Movahed (2019) identify that drug dose calculation is not relegated to the United States. \u0026nbsp;Drug dose calculation is seen all over the world. \u0026nbsp;In addition to the medication rights taught to all nursing students, as Robabi et al. (2019) explain as the right patient, medication, time, dose, and route, many students and nurses are not competent in basic mathematical equations. Gregory et al. (2019) introduced workshops for first-semester nursing students to improve their numeracy skills. \u0026nbsp;According to a study done by Shelton (2016), basic math skills should be tested before entering into the nursing programs. Testing students' math competency before admission into the nursing program may decrease drug calculation errors among nursing students.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;The research study topic chosen was \"What strategies can nurse educators implement for long-term math skills acquisition for effective medication calculation?\" The research design for this study topic is a case study, and the method is qualitative. \u0026nbsp;The information was gathered through individual interviews from nurses in the field with five years or less of clinical experience.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;This information found similarities with Benner's novice to expert in skills the nurses have concerning their math skills and drug calculations.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; The qualitative case study approach has allowed for themes to emerge in the participants' answers. These themes may transform the way nurse educators teach nursing math and drug calculations to incorporate long-term skill acquisition. \u0026nbsp;Allowing nursing faculty and nurses to synthesize their thoughts and experiences in their nursing math exposure may help shape future programs.\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe researcher used a qualitative case study. The sample included nurses with five years' or less experience post-graduation and licensure. The researcher interviewed participants until data saturation was met. The researcher explored strategies and teaching methods to decrease medication errors in the clinical field. In accordance with the declaration of Helsinki, this study was reviewed by the IRB for A.T. Still University and found to be in the exempt category. IRB through A.T. Still University was approved. Human Ethics and Consent to participate was observed and maintained. Voluntary, written informed consent to participate in this study was given by all participants. There was no funding for this project.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTable 1. (Appear under the Results Display heading)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAnalysis of Data\u003c/em\u003e\u003c/p\u003e\n\u003cp id=\"_Toc72431183\"\u003e\u003cstrong\u003eValidity and Reliability Reporting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eValidity and reliability are implemented by asking the same questions the same way to all participants. Member checking is done after the interview process, and a summary given to the participants to confirm or deny that the researcher was able to gather the information accurately.\u003cbr\u003e \u003cstrong\u003eQualitative Theme Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe observed themes throughout this case study began with the number of participants that have attended a 2-year institution vs. a 4-year institution. The beginning of the interview process produced a majority of 2-year graduates. The purposeful sampling led to incorporate further nurses that had attended a 2-year institution. It was necessary to formulate a plan to garner participants that had attended a 4-year nursing program specifically.\u003c/p\u003e\n\u003ch2 id=\"_Toc72431184\"\u003e\u003cstrong\u003eTheme One: Repetition in Nursing Math Education\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eTen participants (100%) used the word \u0026quot;Repetition.\u0026quot; Repetition was used when asked, \u0026quot;what do you think might have helped with math mastery in your nursing program?\u0026quot; unsolicited. The participants expressed that the constant exposure to nursing math had (2-year) enabled them to become comfortable and confident in their nursing math abilities. P2, 3, 4, 6, 8, 9, and 10 stated \u0026quot;repetition\u0026quot; when asked what suggestions you have to strengthen the nursing program. P1 stated \u0026quot;repetition, confidence, consistency, and exposure,\u0026quot; and P5 stated \u0026quot;taking sample ones and rewriting them, practicing and repetition,\u0026quot; and P7 recommended \u0026quot;repetition with more examples and making sure everyone is on board.\u0026quot; Three out of the 10 (30%) students were in the ADN programs expressed the need to have more than just an MCAT throughout the remaining semesters in their program, and P4 suggested: \u0026quot;it may decrease anxiety to have the repetition.\u0026quot; P4 stated, \u0026quot;I was so anxious due to the high stakes of the MCAT. If you were unsuccessful three times, you are out of the program.\u0026quot; P3 stated, \u0026quot;there needs to be more practice.\u0026quot; The 4-year degree participants expressed that the contact exposure was lacking and that continued exposure would be beneficial.\u003c/p\u003e\n\u003cp\u003eParticipants had a range of medication calculations that they struggled with, and those who had had a negative experience with math before nursing did struggle with the more in-depth calculations, whereas those that had a positive experience with math before nursing did not find that nursing math was a struggle. However, the basic math structure with addition, subtraction, multiplication, and division was commonly referred to as medication calculations that the participants had excelled.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSixty percent (60%) of the participants suggested that nursing math was very easy, excelled with dimensional analysis and basic math. P2 stated, \u0026quot;math always came naturally to me,\u0026quot; whereas P5 stated, \u0026quot;I was horrible with equations, but once they clicked, they clicked.\u0026quot; When the nurses were asked what math calculations they excelled there was a variety of responses. P 1 stated \u0026quot;simple math,\u0026quot; P2 stated \u0026quot;syringes,\u0026quot; P3 stated \u0026quot;the easier, the basic ones,\u0026quot; P4 stated \u0026quot;conversions and everything that was done on paper,\u0026quot; P8 stated, \u0026quot;proportions and dimensional analysis were easy.\u0026quot; Notwithstanding, when asked what math calculations were a struggle, all 10 (100%) of the participants were able to define an area that took a little more to grasp.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe struggles the participants identified include proportions, fractions, drip rates, weight-based, step-based, label reconstitution, and five out of the 10 (50%) of the participants expressed difficulties with conversions. P1 stated \u0026quot;proportions and fractions\u0026quot; were a struggle; P2 stated, \u0026quot;weight-based conversions and drip rate was difficult at first.\u0026quot; P3 stated \u0026quot;conversions and drip rates,\u0026quot; P4 stated \u0026quot;IV push over a certain amount of time,\u0026quot; P5 stated \u0026quot;I do not recall, equations and conversions,\u0026quot; P6 stated \u0026quot;three-step medications,\u0026quot; P7 stated \u0026quot;none, reading the labels with reconstitution,\u0026quot; P8 stated \u0026quot;conversions were hard,\u0026quot; P9 \u0026quot;conversions\u0026quot; and P10 \u0026quot;conversions and different measurements.\u0026quot;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMackie and Bruce (2016) found in their qualitative review that, out of the eight students and eight nursing faculty, the high stakes nature of drug dose calculations can be a component of incorrect computation of medication dosages. Shelton (2016) found that more time spent practicing math skills increased nursing students\u0026apos; confidence and ability to perform the task. Shelton (2016) also surmises that students self-reported a higher level of confidence with math skills after positive reinforced and added practice. Gregory et al. (2019) supported that students\u0026apos; access to remediation and consistency with workshops and tutoring increased the math skills confidence in nursing students.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eArchival document analysis:\u003c/strong\u003e The repetition noted in the archival document goes so far as allowing the students at least four changes to achieve the grade (dependent on the course and level of the curriculum) necessary to be considered passing. Eighty percent (80%) was the acceptable pass rate for students in their initial nursing math course, and by the final course, one hundred percent (100%) is necessary to be successful. While students are afforded multiple opportunities to be successful on the medication calculation and administration test (MCAT), repetition of nursing math content is not integrated throughout the courses in the curriculum. The MCAT is mandated for students to be able to pass medications in their clinical rotation. If they are unsuccessful after the fourth try, the student will be marked unsuccessful in their clinical and therefore be unsuccessful for the course.\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc72431185\"\u003e\u003cstrong\u003eTheme Two: Differences in Nursing Math Instruction\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe majority of the participants who attended a 2-year degree program had expressed that nursing math was incorporated throughout the four semesters of schooling. Both the 4-year and 2-year graduates stated that nursing math instruction began with the first semester of nursing school. The 2-year graduates stated that they continued to have nursing math incorporated throughout their clinical and tests program. The Medication Calculation Administration Test (MCAT) is a ten-question math test that requires a 90-100% mastery before being allowed to pass medications given during the first clinical rotation. P2 stated, \u0026quot;nursing math was initially taught the first semester and continually tested on the remaining semesters in content exams.\u0026quot; P4 stated, \u0026quot;nursing math was taught the first semester, except for the beginning of clinical, math was not seen again in the classroom for the program.\u0026quot;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe 4-year graduates ranged from those that had the nursing math the first and second semester of their degree plan from those that had nursing math taught in the first semester and no further nursing math exposure in courses until the final semester. Ten out of the 10 (100%) nursing students interviewed stated that they did have to prove nursing math competency at the start of clinical each semester with an MCAT-like test. In addition, a ten-question medication calculation administration test was given, requiring a score of 90-100% depending on the program and semester of nursing. If the score of 90-100% was not met, the student had two additional opportunities to prove mastery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll participants interviewed all stated having to prove nursing math mastery at least once in their nursing education. P1-10 all stated that they were required to take an MCAT at the beginning of each clinical rotation. Fifty percent (50%) of those interviewed stated that nursing math was tested throughout their nursing program. P3 stated that nursing math was taught in the first semester and was \u0026quot;reviewed and tested throughout the semesters.\u0026quot; Whereas the remaining five (50%) interviewed stated that while nursing math was tested at the beginning of the semester in clinical, it was not seen in the course content. P10 stated, \u0026quot;the spring semester sophomore year was when nursing math was taught and tested on.\u0026quot; P8 stated, \u0026quot;we were taught nursing math in the first semester, and other than clinical that first day, we did not see it again.\u0026quot; P2 stated, \u0026quot;nursing math was taught throughout the first semester,\u0026quot; and P4 stated, \u0026quot;nursing math was learned the first semester and continually tested throughout the remaining semesters.\u0026quot;\u003c/p\u003e\n\u003cp\u003eRobabi et al. (2019) found that nursing programs do not allow for enough time and consistency with nursing math to produce competent and confident students in their drug dose calculations. Salami et al. (2018) found that insufficient training and education for nurses contributed to medication administration errors. Chendake (2020) suggested that the nursing curriculum needs to be structured to improve basic math skills, and Shelton (2016) concluded that students increased their confidence in performing nursing math skills after attending a workshop. Finally, O\u0026apos;Reilly et al. (2020)conducted a study where wanting more and boosting confidence were key components to nursing students\u0026apos; success with nursing math.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eArchival document analysis:\u003c/strong\u003e The nursing math instruction for the archival document includes a half-a-semester course worth one credit hour. The student must achieve an eighty percent (80%) or above continue in the nursing program. In addition, there is a specific date to which the students need to be successful to continue with the course. With the future nursing courses, the students need to be successful in the MCAT on predetermined dates within the semester or be considered unprepared for clinical and with a clinical failure. If the students do earn an unsuccessful grade and have to repeat a nursing course, the readmit to the nursing program is arduous with a requirement of a written math calculation test with a score of ninety percent (90%) for Nursing I and II and one hundred percent (100%) for Nursing III and IV.\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc72431186\"\u003e\u003cstrong\u003eTheme Three: The Need to use Nursing Math Post-licensure\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe average length of time practicing as a licensed registered nurse for the participants is 2.7 years. All participants expressed that they have had to perform nursing math since becoming licensed and working. The most common nursing math conversion with eight of the ten (80%) participants identified that they have performed since licensure is converting milliliters to milligrams and drip rate calculations for intravenous fluid therapy. P6 indicated \u0026quot;not much use\u0026quot; of nursing math post-licensure but rescinded, stating, \u0026quot;now that I think about it, I have done drip rates and conversions.\u0026quot; P7 used nursing math calculations post-licensure such as \u0026quot;fluid calculations, conversions from milligrams to milliliters and the ins and outs.\u0026quot; P3 \u0026quot;I have done drip rates, wastes and converting,\u0026quot; P4 stated \u0026quot;easy milligrams to milliliters conversions and IV rates,\u0026quot; P5 \u0026quot;milligrams to milliliters,\u0026quot; P8 \u0026quot;pounds to kilograms,\u0026quot; P9 stated \u0026quot;fluid calculations, milligrams to milliliters and the ins and outs conversions\u0026quot; and P10 stated \u0026quot;drip rates and weight-based dosages.\u0026quot;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNinety percent (90%) of the participants stated nursing math usage post-licensure. The majority of the participants had to think for a few seconds to identify the nursing math they used in practice since licensure. For example, P2 stated, \u0026quot;it has been a long time since nursing math\u0026quot; was differentiated for medication administration. P3,4,6,7, and nine all identified drip rates as a nursing math component that has been utilized in their practice. Several participants stated IV rate, wastes, conversations (milligrams-milliliters or pounds to kilograms), and reconstitution. P8 stated \u0026quot;wasting medications and pounds to kilograms,\u0026quot; and P10 stated \u0026quot;drip rates and weight-based doses.\u0026quot;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStrategies suggested by the participants to increase confidence and competence in nursing math are repetition throughout the nursing program. While many of the 2-year participants expressed that they had been exposed to nursing math throughout their program, one participant stated that making math less scary would help. When the participant elaborated on the content, it was stated that the medication calculation administration test given at the beginning of the semester was extremely anxiety-producing. Participants of the 4-year degree program had the same consensus with the 2- year degree nurses, with repetition and exposure being the key to comfort, confidence, and recall later. P9 suggested, \u0026quot;there should be more repetition, examples, and make sure everyone is on board before moving on to ensure success.\u0026quot;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eArchival document analysis:\u003c/strong\u003e To complete the nursing program, the student must be proficient in nursing math. While the archival document does not specifically state that nursing math will be utilized in the future practice of the nurse graduates, it is assumed. The high stakes nature of the MCAT requirements ensures that nursing students are competent to perform nursing math after their education.\u0026nbsp;\u003c/p\u003e"},{"header":"Summary","content":"\u003cp\u003eThe academic justification that supports this study is Benner’s novice to expert. In Benner’s theory, it allows a student/professional to go through stages of learning in their new environment. Benner’s theory posits that there are several steps to which one will obtain expert level in their field of choice. \u0026nbsp;All student’s starting in the nursing program will begin at the novice level and by the end of their education become an expert nursing student.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis will restart when the nursing student enters into the healthcare setting, starting again at novice and to work towards expert. With nursing math, the students begin with novice and by the end of their nursing education will become experts in nursing math. Out of the ten nurses that participated in this study, the resounding theme was that repetition of nursing math assisted in their long-term memory in math skills acquisition.\u003c/p\u003e\n\u003cp\u003eOut of 10 registered nurses, who have up to five years of practicing nurses, eight were 2-year nursing program graduates, and two were 4-year nursing program graduates. The reigning theme of nursing math mastery and long-term memory acquisition was ‘repetition’ within and throughout the nursing program. The continuation of nursing math in the field has encouraged this researcher to remain a relevant and important task. The incorporation of nursing math throughout the program was suggested by all who participated in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData cleaning for the study allowed this researcher to understand and practice what has occurred during the study's data collection and analysis. Consolidation of the data has given the researcher a representation of the study as a whole.\u003c/p\u003e\n\u003cp\u003eDescriptive themes and attributes found in the data descriptive data analysis include interviews from nurses from licensure to five years' experience. Throughout the interviews, information gathered includes:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003ethe type of degree they have obtained for initial licensure,\u003c/li\u003e\n \u003cli\u003ethe duration of time in practice as a nurse, and\u003c/li\u003e\n \u003cli\u003etheir nursing math experiences in educational and professional environments.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe nurses interviewed have offered their opinions to further the nursing math educational offerings for nurse educators to take into consideration in their academic offerings.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion, Limitations, and Recommendations","content":"\u003cp\u003eThe study results concerning strategies nurse educators can implement for long-term math skills acquisition for accurate medication calculations indicate that there is a need to facilitate nursing math instruction throughout the curriculum. Limitations include a small pool of participants of 2-year to 4-year graduate nurses, and a novice researcher. Recommendations include incorporating consistent nursing math teaching strategies throughout nursing courses and the nursing curriculum to implement long-term math skills acquisition.\u003c/p\u003e\n\u003ch2 id=\"_Toc72431189\"\u003e\u003cstrong\u003eDiscussion\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe research analyzed was done via a qualitative case study to determine what nursing educators can implement for long-term math skills acquisition for accurate medication calculation. The participants consisted of nurses from licensure to five years of experience working as a nurse. Out of 10 participants, eight were 2-year graduates (ADN), and two were 4-year graduates (BSN). Several themes emerged from the interview process, with repetition being the number one referenced phrase to bolster nursing math for students. Further mentioned in the themes were the lack of nursing math instruction and reinforcement throughout the nursing program and an overall struggle with basic math.\u003c/p\u003e\n\u003cp\u003eRobabi, Mahmoudi, Arbabisarjoy, and Movahed (2019) found that there was not enough time and training for nursing students to become confident in their math skills and found an inadequacy of students performing nursing math dosage calculations. O'Reilly et al. (2020) found that roughly 10% of nursing students are competent in basic math skills. Math anxiety plays a role in confidence and competency in nursing math, as mentioned by Roberts and Campbell (2017), Røykenes (2016), and Shelton (2016). The nursing students' numeracy skills have come into the program, and the experiences they have had with math before nursing forms the personal perception of the student's ability to become proficient in math. Several participants suggested that they were not proficient and had always struggled in “math as a kid”, whereas some participants proclaimed proficiency in math before the nursing program. Chendake (2020) supports that 81% of students lack confidence and math competency.\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc72431190\"\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eLimitations to this study included the time available to interview participants, which was conducted over the holiday season and during a pandemic. Another limitation included the lack of participants from a 4-year degree program, and the geographical location is specified to nurses educated and working in the east coast. The population interviews may not be an accurate depiction of all nursing programs. All of the 2-year graduate nurses were either finished with their BSN or were enrolled in a BSN program at the time of the interview.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCOVID-19 presented a limitation for participation, as originally this study was to be conducted with nurses in specific hospitals, but because of limitations from the hospitals and the school, another route was taken. COVID-19 also has undue strain on the healthcare force, making nurses less likely to participate in studies due to their increased workload and schedule. COVID-19 has opened many doors for interviewing without exposure, utilizing the Zoom platform, and a few interviews were rescheduled due to the nature and work schedule for some nurses that were interviewed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The Zoom platform was utilized to conduct interviews due to the pandemic. While the Zoom platform did allow the researcher and participant to meet with minimal travel time and exposure, there may have been a missing component being in person for an interview that will not be known for this study. Face-to-face interviews would have been this researcher's first preference, notwithstanding the Zoom platform allowing the researcher to schedule interviews closer together, not procure a room for interviews, and ease at recording the interviews.\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc72431191\"\u003e\u003cstrong\u003eRecommendations\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eRecommendations for nurse educators to implement for long-term math skills acquisition for accurate medication calculations is to incorporate (teach) nursing math early in the nursing curriculum and throughout all nursing courses and curriculum utilizing a consistent learning strategy. Implementing tutoring services for nursing students to include teaching nursing math strategies as well as nursing content to support student long-term skills acquisition. Røykenes (2016) supports that those students who are not confident or have math anxiety will benefit from the repetition of math over time. Shelton (2016) suggests assessing nursing student's basic math skills to help set them up for success in the nursing math programs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEarly implementation of nursing math in the nursing program in lecture, clinical, and online will help the nursing student become proficient in nursing math skills. Márquez-Hernández et al. (2019) conducted a study where game-based software was used to add to the learning experience. Gallegos et al. (2017) also conducted a study where gaming helped bolster nursing students' confidence, comfort, and skill level with nursing math. With students able to access to nursing math software, this will allow them to practice on their own time with unlimited repetition to bolster confidence and competency in nursing math.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRepetition, confidence, and competency are necessary for long-term math skills acquisition for nursing students. Basic math skills need to be evaluated and supported to improve the nursing students' rate for success in the nursing program. Nursing math is high stakes, where medication errors account for the number one preventable medical error. Building confidence in the nursing student through repetition of nursing math (basic math) taught will allow students to increase their confidence in their ability to competently perform nursing math, thereby decreasing their risk of medication error.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWhen premised on the notion that the math and drug dosing calculations performed by nurses contribute to the top preventable medical errors, this author set out to identify differences in nursing education and potential ways to support nurse educators\u0026rsquo; in their teaching strategies to create long-term math skills acquisition for nursing students. Repetition and exposure have been long noted to be advantageous to learners in every field to ensure that long-term skills acquisition is met which supports a summative assessment throughout the course and curriculum for students.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe results of this study suggest that the formative assessment of nursing math given to nursing students in the first semester of nursing content demonstrates inadequate math competencies. These competencies are necessary for a nursing student to retain the steps required to calculate nursing math correctly to decrease the likelihood of medication errors in the healthcare setting. In a summative approach, where the nursing students are taught nursing math at the beginning of their nursing program content and continually reviewed and are assessed in a formal (questions on the exams throughout the course) and informal (questioned during lecture as a group) setting, will allow for nursing students to have repetition in nursing math skills throughout their nursing courses and nursing curriculum.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Repetition was a theme that all of the study participants referenced in their answers regarding what is necessary to have nursing math competency and confidence. Confidence and competence are an integral part of long-term skills acquisition in nursing math. The use of content repetition throughout the nursing courses and curriculum and by allowing the students access to a gaming-type program will assist with building confidence and competence in nursing math. The gaming-type program will allow the students unlimited access to nursing math questions with real-time answers and remediation as needed. Another component of assisting nursing students/nursing programs to produce competency in nursing math is by incorporating nursing math problems and teaching strategies into all nursing content tutoring sessions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study concluded that there is a need for consistent nursing math instruction throughout the nursing courses and nursing curriculum. Repetition was the key component mentioned by the study participants concerning their success with nursing math or lack therein. Nursing math competency creates the basis to decrease preventable medication errors in the healthcare field.\u0026nbsp;\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eADN- Associates degree in nursing, 2-year degree in nursing\u003c/p\u003e\n\u003cp\u003eBSN- Bachelors degree in nursing, 4-year degree in nursing\u003c/p\u003e\n\u003cp\u003eIV- Intravenous fluid\u003c/p\u003e\n\u003cp\u003eMCAT- Medication calculation and administration test\u003c/p\u003e\n\u003cp\u003eP-Participant\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eIRB Approval from: A.T. Still University IRB.\u003c/p\u003e\n\u003cp\u003eHuman Ethics and Consent to participate declaration: Applicable.\u003c/p\u003e\n\u003cp\u003eWritten informed consent received by all participants in this study.\u003c/p\u003e\n\u003cp\u003eFunding: No funding received.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAvari M, Feizollahzadeh H, Valizadeh S, Virani F. Development and evaluation of multimedia software of vital drug prescription and calculation principles. Res Dev Med Educ. 2018;7(1):32\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.15171/rdme.2018.007\u003c/span\u003e\u003cspan address=\"10.15171/rdme.2018.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChendake MB. Self-efficacy in drug dosage calculation among undergraduate nursing students. Annals Med Health Sci Res. 2020;10(3):882. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://search.ebscohost.com/login.aspx?direct=true\u0026amp;AuthType=shib\u003c/span\u003e\u003cspan address=\"http://search.ebscohost.com/login.aspx?direct=true\u0026amp;AuthType=shib\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. \u0026amp;db=a9h\u0026amp;AN=1443 94467\u0026amp;site\u0026thinsp;=\u0026thinsp;eds-live.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGallegos C, Tesar AJ, Connor K, Martz K. The use of a game-based learning platform to engage nursing students: A descriptive, qualitative study. Nurse Educ Pract. 2017;27:101\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.nepr.2017.08.019\u003c/span\u003e\u003cspan address=\"10.1016/j.nepr.2017.08.019\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGatley EP. From novice to expert: the use of intuitive knowledge as a basis for district nurse education. Nurse Educ Today. 1992;12(2):81\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/0260-\u003c/span\u003e\u003cspan address=\"10.1016/0260-\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 6917(92)90032-J.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGill M, Andersen E, Hilsmann N. Best practices for teaching pharmacology to undergraduate nursing students: A systematic review of the literature. Nurse Educ Today. 2019;74:15\u0026ndash;24. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.nedt.2018.11.017\u003c/span\u003e\u003cspan address=\"10.1016/j.nedt.2018.11.017\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGregory L, Villarosa AR, Ramjan LM, Hughes M, O\u0026rsquo;Reilly R, Stunden A, Daly M, Raymond D, Fatayer M, Salamonson Y. The influence of mathematics self- efficacy on numeracy performance in first‐year nursing students: A quasi‐experimental study. J Clin Nurs. 2019;28(19\u0026ndash;20):3651\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jocn.14963\u003c/span\u003e\u003cspan address=\"10.1111/jocn.14963\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMackie JE, Bruce CD. Increasing nursing students' understanding and accuracy with medical dose calculations: A collaborative approach. Nurse Educ Today. 2016;40:146\u0026ndash;53. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.nedt.2016.02.018\u003c/span\u003e\u003cspan address=\"10.1016/j.nedt.2016.02.018\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eM\u0026aacute;rquez-Hern\u0026aacute;ndez VV, Garrido-Molina JM, Guti\u0026eacute;rrez-Puertas L, Garc\u0026iacute;a-Viola A, Aguilera-Manrique G, Granados-G\u0026aacute;mez G. How to measure gamification experiences in nursing? Adaptation and validation of the Gameful Experience Scale [GAMEX]. Nurse Educ Today. 2019;81:34\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.nedt.2019.07.005\u003c/span\u003e\u003cspan address=\"10.1016/j.nedt.2019.07.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOyelana O, Martin D, Scanlan J, Temple B. Learner-centred teaching in a non- learner-centred world: An interpretive phenomenological study of the lived experience of clinical nursing faculty. Nurse Educ Today. 2018;67:118\u0026ndash;23. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.nedt.2018.05.012\u003c/span\u003e\u003cspan address=\"10.1016/j.nedt.2018.05.012\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRobabi H, Mahmoudi N, Arbabisarjou A, Movahed S. Drug calculation skills in nursing students of Zahedan University of medical sciences. Drug Invention Today. 2019;12(2):227\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRoberts S, Campbell A. Striving for a good standard of maths for potential student nurses. Br J Nurs. 2017;26(1):32\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.12968/bjon.2017.26.1.32\u003c/span\u003e\u003cspan address=\"10.12968/bjon.2017.26.1.32\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eR\u0026oslash;ykenes K. My math and me: Nursing students\u0026rsquo; previous experiences in learning mathematics. Nurse Educ Pract. 2016;16(1):1\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.nepr.2015.05.009\u003c/span\u003e\u003cspan address=\"10.1016/j.nepr.2015.05.009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShelton C. Students who developed logical reasoning skills reported improved confidence in drug dose calculation: Feedback from remedial maths classes. Nurse Educ Today. 2016;41:6\u0026ndash;11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.nedt.2016.03.007\u003c/span\u003e\u003cspan address=\"10.1016/j.nedt.2016.03.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cdiv class=\"SimplePara\"\u003e(Appear after the Results Display heading)\u003c/div\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eInterview Questions\u003c/div\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003eResponses\u003c/div\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e1) Did you complete a 2-year or 4-year nursing program?\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e2-year- 8\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003e4-year- 2\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e2) In what year(s)/semester(s) did your program teach nursing math?\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e2 year-1st semester, math competencies for clinical (10 question quiz with mastery mandated)at the beginning of every semester, usually 2 math questions on every exam\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003e4 year- 1st semester, math competencies for clinical (10 question quiz with mastery mandated)at the beginning of every semester, depends on course if math was included on exams throughout the curriculum\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e3) What was your experience with drug calculations in your nursing program?\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003ePositive-6\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003eKey words: easy, simple, no problems\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003eNegative- 4\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003eKey words : hard, need more instruction, difficult\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e4) What do you think might have helped with math mastery in your nursing program?\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003eRepetition, better explanation, 1:1, tutoring\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e5) What type of medication calculations did you struggle with in nursing math?\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003eWeight based, drip rates, proportions\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e6) What type of medication calculations did you excel at in nursing math, and why?\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003eWeight based, basic math, drip rates\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e7) What were your experiences with math before nursing school?\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u0026ldquo;Did great took calculus in college\u0026rdquo;\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003e\u0026ldquo;Took stats in college\u0026rdquo;\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003e\u0026ldquo;Didn\u0026rsquo;t do well in high school math\u0026rdquo;\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003e\u0026ldquo;Tanked in college math\u0026rdquo;\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003e\u0026ldquo;I was always good at math\u0026rdquo;\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003e\u0026ldquo;Math was never a problem for me.\u0026rdquo;\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e8) What type of nursing math conversions have you had to perform since becoming licensed?\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003eIV drip rates, none, weight-based calculations, simple conversions, basic math\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e9) What strategies can you recommend for nursing educators to strengthen students' confidence and competence in nursing math?\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003eRepetition, 1:1, tutoring, different learning strategies\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e10) What additional information would you like to add to this study?\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003eNone\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003cbr/\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cdiv class=\"SimplePara\"\u003e(Appear in the manuscript in Theme Two: Differences in Nursing Math Instruction Responses\u003c/div\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eSemester Nursing Math Taught\u003c/div\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003ePercentage of responses\u003c/div\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e1st\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e90%\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e2nd\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e60%\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e3rd\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e0%\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e4th\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e0%\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e5th\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e0%\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e6th\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e10%\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e7th\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e0%\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e8th\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e0%\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003cbr/\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Nursing math, drug calculations, drug dosages, medication administration, nursing math curriculum","lastPublishedDoi":"10.21203/rs.3.rs-7614500/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7614500/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis qualitative research study was utilized to gain insight into the lived experiences of nursing students in regard to the learning, gaining mastery, and retaining mastery of nursing math throughout their nursing program and up to five-years post-graduation to further implement strategies for nurse educators. The study consisted of 10 participants with a mix of 2-year and 4-year nursing graduates, with five-years or less since graduation. The participants expressed challenges with nursing math skills acquisition, differences in learning opportunities and duration, and depending on positive/negative experiences with math in earlier education let to struggles. The participants all concluded that repetition is necessary to retain, increase confidence in their math skills and competence in nursing math.\u003c/p\u003e","manuscriptTitle":"Long-Term Math Skills Acquisition for Accurate Medication Calculations, a Qualitative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-30 10:39:21","doi":"10.21203/rs.3.rs-7614500/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"09d0640e-f3e4-4603-8331-6db819eb84ef","owner":[],"postedDate":"October 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-17T09:39:53+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-30 10:39:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7614500","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7614500","identity":"rs-7614500","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}