Numeracy Skills for Undergraduate Nursing Students’ Clinical Skill Assessment: An Expository Analysis

Introduction

In the current sophisticated clinical setting, nursing and mathematics are synonymous. Nurses are often intimated by the skills such as arithmetic, mathematics and analysing of the situation of patients that occur in daily clinical practice. Those skills are known as numeracy skills “the ability to understand the numerical and graphical or visual data in daily clinical life” [1, 2]. Moreover, patient safety depends on the clinical practitioner’s ability to calculate the correct medication dosage, proper interpretation of the haemodynamic parameters and diagnostic investigation results, correct usage of equipment required for patient care and so on [1, 3].

Healthcare personnel including doctors and nurses often lack the numeracy skills needed to enable them to do their jobs safely and effectively. They cannot accurately perform drug calculations, drug percentages and infusion rates in the clinical setting [4, 5]. Whilst further research is needed to establish how improving numeracy could improve patient safety. Moreover, studies suggested that improving numeracy skills is integral to increasing patient safety and reducing the costs of preventable patient stays in the hospital [1, 3].

Among the numeracy skills that apply in the clinical setting, the ability to perform drug calculations accurately is an essential skill for practitioners including nurses worldwide. It is assumed that when administering medications to patients, it is required to be 100% accurate by the performance of nurses on drug calculation. Incorrect calculation of drugs can lead to medication errors including adverse complications in patients. Medication error is a global issue concerning patient safety and is an important cause of morbidity and mortality of patients [6, 7, 8].

Globally, the economic impact of medication error is estimated at USD 42 billion every year [9]. There has been a rise in global attention on safe medication practices. The World Health Organization (WHO) launched the “Medication without Harm”, which is a global patient safety initiative aiming to reduce severe, avoidable harm related to medications in all countries by 50% in the next 5 years [9]. In Malaysia, several studies have been conducted and it was found that the rates of medication error reported varied between 11.7 to 97.7% [10, 11, 12, 13].

Studies have categorised the medication errors as three distinct groups that have occurred by the nurses. Those groups are referred to as conceptual errors, arithmetical errors and computational errors. Conceptual errors are the most common type of errors found in the literature and involve the inability to formulate the mathematical question correctly from the information given. Arithmetical errors occur when a person is unable to operate an equation correctly. Computational errors involve the miscalculation of simple functions such as multiplication, division, subtraction or addition [14, 15, 16, 17, 18]. If we look at those three distinct groups, all of them are related to having poor numeracy skills applied by nurses.

On the other hand, although numeracy skills have been identified as one of the competency elements for outcome- based education in the undergraduate nursing programme. However, the competency assessment of those skills posed by the nursing students is still in the infancy stage [19]. Studies have shown that undergraduate nursing students continue to perform poorly on clinically-related numeracy tasks, making errors that betray fundamental misconceptions about the underlying mathematics. These conditions can be eliminated when an effort is made and the effects can be rewarding for nursing students, nursing academics and as well as improving patient care and safety. Thus, this study aimed to address the importance of numeracy skills for undergraduate nursing students’ clinical skill assessment.

Method

This study used an expository analysis approach to address the issues of the importance of numeracy skills competency in the clinical skill assessment of undergraduate nursing students. This approach is used since there is research on expository writing that is still limited. Furthermore, the addressed issues are extremely recommended to be discovered [20]. To achieve the purpose of this study, we have analysed the current undergraduate nursing curriculum and clinical skill assessment components. Moreover, we also review the available literature related to numeracy skills competency for nursing students and newly registered nurses. The detailed findings of the expository analysis are described in the following session.

Discussion

The curriculum is the heart of every educational institute and every nursing program. The curriculum sets the goals, outcomes, standards, philosophy, and content that each nursing student will learn and perform. A high-quality nursing curriculum plays an important role in preparing effective nurses or holistic nurses for the current and future health care delivery system. Student assessment is a critical aspect of the design of the undergraduate curriculum. A previous study suggested that when learning outcomes are externally mandated (or strongly encouraged), it is important that institutions have effective road maps for their implementation [23].

Assessment of clinical skills is an essential component of undergraduate nursing education because it provides information about potential knowledge deficits and attitudes that interfere with the successful performance of patient care skills. Many studies on nursing competency training methods have focused on basic nursing education and little has been studied on clinical skill competency assessment [24, 25, 26].

The OSCE is a new form of evaluation that first was designed and implemented by Dundee in the mid-1970s in Scotland. A core competency of nursing is “the ability to practice nursing that meets the needs of clients cared for using logical thinking and accurate nursing skills.” The nursing competency structure consists of four abilities: the ability to understand needs, the ability to provide care, the ability to collaborate and the ability to support decision- making. These four abilities are closely related and utilized in all types of nursing practice settings.

Nowadays, nurses’ responsibilities are not only serving the medication to patients, but also need to analyse the situation of patients’ clinical condition, analyse the investigation results of the patients, interpret the haemodynamic status of the patients, and many more numerical activities in daily life. Therefore, they should be competent with numeracy skills to deal with all the situations in the clinical setting. A recent study also showed that it is important to have a well-structured clinical skill assessment tool to assess the nursing student’s competency level in order to produce holistic graduate nurses who equip with clinical skills and soft skills for the current healthcare delivery system [27]. Thus, it is important to have holistic nursing competency assessment methods which not only focus on psychomotor skills assessment but should assess their thinking skill like assessing the numeracy skills which contributes to improving nursing quality.

Conclusion

Numeracy skills competency assessment is vital for undergraduate nursing students who have to make complex calculations and analyse the patient’s situation in their clinical setting. Improving numeracy skills for undergraduate nursing students can reduce medical errors, prevent further complications and ultimately improve efficiency in the quality nursing care towards their patients.

Conflict of Interests

There is no conflict of interest. The development of this manuscript is part of a PhD study.