Student nurses need more than maths to improve their drug calculating skills

Nurses need to be able to calculate accurate drug calculations in order to safely administer drugs to their patients (NMC, 2002). Studies have shown however that nurses do not always have the necessary skills to calculate accurate drug dosages and are potentially administering incorrect dosages of drugs to their patients (Hutton, M. 1998. Nursing Mathematics: the importance of application. Nursing Standard 13(11), 35–38; Kapborg, I. 1994. Calculation and administration of drug dosage by Swedish nurses, Student Nurses and Physicians. International Journal for Quality in Health Care 6(4), 389–395; O’Shea, E. 1999. Factors contributing to medication errors: a literature review. Journal of Advanced Nursing 8, 496–504; Wilson, A. 2003. Nurses maths: researching a practical approach. Nursing Standard 17(47), 33–36). The literature indicates that in order to improve drug calculations strategies need to focus on both the mathematical skills and conceptual skills of student nurses so they can interpret clinical data into drug calculations to be solved. A study was undertaken to investigate the effectiveness of implementing several strategies which focussed on developing the mathematical and conceptual skills of student nurses to improve their drug calculation skills. The study found that implementing a range of strategies which addressed these two developmental areas significantly improved the drug calculation skills of nurses. The study also indicates that a range of strategies has the potential ensuring that the skills taught are retained by the student nurses. Although the strategies significantly improved the drug calculation skills of student nurses, the fact that only 2 students were able to achieve 100% in their drug calculation test indicates a need for further research into this area.

The reporting behaviours of student nurses who have experienced verbal abuse

Background: There is evidence that student nurses are vulnerable to experiencing verbal abuse from a variety of sources and under-reporting of verbal abuse is prevalent throughout the nursing profession. The objective of the study is to explore the reporting behaviours of student nurses who have experienced verbal abuse. Method: For this study a definition of verbal abuse was adopted from current Department of Health (England) guidelines. Questionnaires were distributed in 2005 to a convenience sample of 156 third year nursing students from one pre-registration nursing programme in England. A total of 114 questionnaires were returned, giving an overall response rate of 73.0%. Results: Fifty one students (44.7% of responses) reported verbal abuse; all of these completed the section exploring reporting behaviours. The incidents involved patients in thirty three cases (64.7%); eight cases (15.7%) involved visitors or relatives and ten cases (19.6%) involved other healthcare workers. Thirty two students (62.7%) stated that they did report the incident of verbal abuse they experienced and nineteen (37.3%) of respondents reported that they did not. Only four incidents developed from an oral report to being formally documented. There was a statistically significant association (P = 0.003) between the focus of verbal abuse (patient/visitor or colleague) and the respondents reporting practices with respondents experiencing verbal abuse from colleagues less likely to report incidents. Most frequent feelings following experiences of verbal abuse from colleagues were feelings of embarrassment and hurt/shock. Most frequent consequences of experiencing verbal abuse from patients or relatives were feeling embarrassed and feeling sorry for the abuser. When comparing non reporters with reporters, the most frequent feelings of non reporters were embarrassment and hurt and reporters, embarrassment and feeling sorry for the abuser. When considering levels of support after the incident the mean rating score of respondents who reported the incident was 5.40 (standard deviation 2.89) and of those that did not, 4.36 (standard deviation 2.87) which was not statistically significant (p = 0.220). Conclusions: 1. Not documenting experiences of verbal abuse formally in writing is a prevalent phenomenon within the sample studied and reporting practices are inconsistent. 2. Both Higher Education Institutions and health care providers should consider emphasising formal reporting and documenting of incidents of verbal abuse during student nurse training and access to formal supportive services should be promoted. 3. Effective incident reporting processes and analysis of these reports can lead to an increased awareness of how to avoid negative interactions in the workplace and how to deal with incidents effectively.

Verbal abuse experienced by student nurses

Aim: This paper is a report of a study to describe the nature, severity, frequency and sources of verbal abuse experienced by nursing students while gaining clinical experience. Background: Verbal abuse of healthcare workers is currently receiving considerable attention and nursing students have been identified as a group vulnerable to experiencing workplace verbal abuse. Method: Questionnaires were distributed in 2005 to a convenience sample of 156 third year nursing students from one pre-registration nursing programme in England. A total of 114 questionnaires were returned, giving a response rate of 73.0%. Findings: Experience of verbal abuse was reported by 45.1% of respondents, 34.5% had witnessed other students experiencing this and 65.5% reported that they were aware of other students experiencing verbal abuse. The incidents involved patients in 64.7% of cases, 15.7% involved visitors or relatives and 19.6% involved other healthcare workers. Students reported experiencing threats to kill them, racial abuse and sexually oriented verbal abuse, with the majority of incidents occurring in general medical, mental health and general surgical clinical areas. Conclusion: Education and healthcare providers should prepare students to manage negative verbal exchanges during nursing education, and policies and support networks relating to managing verbal abuse in clinical practice should be available to nursing students.

Experts on e-learning: insights gained from listening to the student voice!

The Student Experience of e-Learning Laboratory (SEEL) project at the University of Greenwich was designed to explore and then implement a number of approaches to investigate learners’ experiences of using technology to support their learning. In this paper members of the SEEL team present initial findings from a University-wide survey of nearly a 1000 students. A selection of 90 ‘cameos’, drawn from the survey data, offer further insights into personal perceptions of e-learning and illustrate the diversity of students experiences. The cameos provide a more coherent picture of individual student experience based on the totality of each person’s responses to the questionnaire. Finally, extracts from follow-up case studies, based on interviews with a small number of students, allow us to ‘hear’ the student voice more clearly. Issues arising from an analysis of the data include student preferences for communication and social networking tools, views on the ‘smartness’ of their tutors’ uses of technology and perceptions of the value of e-learning. A primary finding and the focus of this paper, is that students effectively arrive at their own individualised selection, configuration and use of technologies and software that meets their perceived needs. This ‘personalisation’ does not imply that such configurations are the most efficient, nor does it automatically suggest that effective learning is occurring. SEEL reminds us that learners are individuals, who approach learning both with and without technology in their own distinctive ways. Hearing, understanding and responding to the student voice is fundamental in maximising learning effectiveness. Institutions should consider actively developing the capacity of academic staff to advise students on the usefulness of particular online tools and resources in support of learning and consider the potential benefits of building on what students already use in their everyday lives. Given the widespread perception that students tend to be ‘digital natives’ and academic staff ‘digital immigrants’ (Prensky, 2001), this could represent a considerable cultural challenge.

Exploring knowledge and skills on HIV in student nurses and midwives

A cross-sectional survey design using a self-administered questionnaire was sent to a sample of 62 final-year student nurses and midwives to describe their knowledge of, skills related to, and attitudes towards, human immunodeficiency virus/acquired immune deficiency syndrome. Out of the 47 respondents who return the questionnaire, only 53% stated that they had received class instruction on the topic and 63.8% claimed to have increased their knowledge mainly from reading professional journals. Although only 32% said that they had cared for a patient or knew of a family member or another person with the disease, 91% indicated that they were willing to care for such patients. Overall, the respondents demonstrated positive attitudes towards this group of patients and a good level of knowledge about the subject, although some gaps were evident. However, a large majority stated that their skills to cater for the physical and psychological needs of this group of patients were deficient and would like further training.

Can effective teaching and learning strategies help student nurses to retain drug calculation skills?

Student nurses need to develop and retain drug calculation skills in order accurately to calculate drug dosages in clinical practice. If student nurses are to qualify and be fit to practise accurate drug calculation skills, then educational strategies need to not only show that the skills of student nurses have improved but that these skills have been retained over a period of time. A quasi-experimental approach was used to test the effectiveness of a range of strategies in improving retention of drug calculation skills. The results from an IV additive drug calculation test were used to compare the drug calculation skills of student nurses between two groups of students who had received different approaches to teaching drug calculation skills. The sample group received specific teaching and learning strategies in relation to drug calculation skills and the second group received only lectures on drug calculation skills. All test results for students were anonymous. The results from the test for both groups were statistically analysed using the Mann Whitney test to ascertain whether the range of strategies improved the results for the IV additive test. The results were further analysed and compared to ascertain the types and numbers of errors made in each of the sample groups. The results showed that there is a highly significant difference between the two samples using a two-tailed test (U=39.5, p<0.001). The strategies implemented therefore did make a difference to the retention of drug calculation skills in the students in the intervention group. Further research is required into the retention of drug calculation skills by students and nurses, but there does appears to be evidence to suggest that sound teaching and learning strategies do result in better retention of drug calculation skills.

The exposure to verbal abuse of student nurses gaining placement experience

Clinical placement experience has a key role to play in the socialisation and preparation of future members of the nursing profession. Aggression experienced by healthcare workers is currently receiving considerable attention and student nurses have been identified as a group vulnerable to experiencing workplace abuse (Little 1999). The primary aim of the study is to gain a greater understanding of the nature, severity, frequency and sources of verbal abuse experienced by student nurses in health care settings in the south east of England, using as a definition, “the use of inappropriate words… causing distress” (Department of Health 2003). A convenience sample of 156 third year student nurses of all four branches of one preregistration nursing programme in the south east of England was studied with questionnaires distributed retrospectively; 11 4 student nurses returned the questionnaires equating to a response rate of 73%. Results 46% of respondents reported experiencing verbal abuse, 39% had witnessed other students experiencing verbal abuse and 61% reported that they were aware of other students experiencing verbal abuse. Students reported experiencing threats to kill, racial abuse, sexually orientated verbal abuse and bullying while gaining placement experience. Student nurses are a high risk group for experiencing verbal abuse whilst gaining placement experience.In the literature, mental health and learningdisability settings are viewed as high risk areasfor experiencing aggression (Beech and Leather 2003); this study suggests that student nurses experience verbal abuse in a variety of settings and verbal abuse may be more prevalent on general medical and surgical wards than previously expected.

Are adolescents/young people and their families getting the best service when being cared for by young adolescent student nurses?

The purpose of this presentation is to highlight issues that exist for student nurses who embark on a career in children's nursing at a very young age and subsequently find themselves in a situation where they are expected to deliver high quality care to young people and their families. An introductory sentence indicating the purpose of the presentation: Currently in the UK under the Making a Différence Curriculum (DOH 1999) students can enrol on a single registration programme for Children's Nursing as young as 17.5 years. Children are admitted to hospital onto the children's wards between the ages of 0-16 years (occasionally older). Using Viner's (2003) définition of adolescence as being that period between the ages of ten and twenty-five years when biopsychosocial maturation leads to functional independence in adult iife demonstrates the possibility that both the patients and the nursing students could be undergoing very similar transitional experiences. Historically, in the 1940-50's children were admitted to childrens wards between the ages of 2-12 years. Nurse education at that time tended to be undertaken for first or second level registration in the first instance, followed by post-registration training for specialist areas. Subsequently, the phenomenon of adolescent paediatric nursing students being required to care for adolescents and their families on the children's wards did not exist some 60 years ago. A brief description of the highiights of the présentation: This présentation will focus on adolescent transitions with particular reference to issues that could arise when young students are required to care for young people and their families, particularly when there is a diagnosis of self harm or substance abuse. A summary of findings and/or other relevant information: Preliminary findings have indicated that very young student nurses find caring for adolescents to be particularly challenging. Health issues pertinent to young people appear to présent particular challenges for the students which raises questions in respect of the quality of care that the young people and their families may receive. A conclusion and implications: The following need to be further explored: i) Support within the clinical areas and adequate de-briefing strategies, ii) The efficacy of single registration to children's nursing, iii) Young people and their family's perception of the quality of care they receive from very young students.

The collection and analysis of pre-evacuation times derived from evacuation trials and their application to evacuation modelling

This paper presents data relating to occupant pre-evacuation times from university and hospital outpatient facilities. Although the two occupancies are entirely different, they do employ relatively similar procedures: members of staff sweep areas to encourage individuals to evacuate.However the manner in which the dependent population reacts to these procedures is quite different. In the hospital case, the patients only evacuated once a member of the nursing staff had instructed them to do so, while in the university evacuation, the students were less dependent upon the actions of the staff, with over 50% of them evacuating with no prior prompting. In addition, the student pre-evacuation time was found to be dependent on their level of engagement in various activities.

Use of Web Logs (Blogs) in Learning Environments: Blogs for Student Support

Innovation in technology and communications and particularly the advent of the Web is changing the structure of teaching and learning today. While there is much debate about the use of technology in learning and how e-learning is creating new approaches to delivery of learning there is been very little if any work on the use of of the emerging technologies in providing student support through their learning process. This paper reports on research and development undertaken by the eCentre based at the University of Greenwich School Of Computing in designing and developing a "Project Blog System" in order to address some long standing issues related to supervision of final year degree student projects. The paper will report on the methodology used to design the system and will discuss some of the results from students and staff evaluation of the system developed.

Student section: University of Greenwich MathSoc

The article provides an overview of the activities undertaken over the last few years by MathSoc - the mathematics society at the University of Greenwich. In particular, it explores those that have been particularly successful in engaging students' interest and building participation.

Hypertension - a contemporary approach to nursing care

The incidence of hypertension is increasing as the number of patients with obesity and diabetes mellitus increases. Hypertension results when the peripheral vascular resistance is increased, the blood viscosity is elevated and/or the flow of blood through the main arteries is impeded. Chronic hypertension results in enlarged heart, myocardial damage and lung and renal abnormalities. While some causative factors such as obesity can be controlled, others for example genetics are more difficult to treat because often there is more than one factor involved. This paper explores how essential and secondary factors contribute to the incidence of hypertension and the physiological changes resulting from raised blood pressure. It proposes that although traditional treatment has some success, nurse-led clinics are having better success not only in controlling raised blood pressure but also in reducing cardiac, pulmonary and renal morbidity. It is more cost-effective, staff is more productive and clients are more compliant with treatment.

What students can tell about lecturers when they are teaching: manifestations of confident and under-confident lecturers

Delivering a lecture requires confidence, a sound knowledge and well developed teaching skills (Cooper and Simonds, 2007, Quinn and Hughes, 2007). However, practitioners who are new to lecturing large groups in higher education may initially lack the confidence to do so which can manifest itself in their verbal and non-verbal cues and the fluency of their teaching skills. This results in the perception that students can identify the confident and non-confident teacher during a lecture (Street, 2007) and so potentially contributing to a lecturer’s level of anxiety prior to, and during, a lecture. Therefore, in the current educational climate of consumerisation, with the increased evaluation of teaching by students, having the ability to deliver high-quality, informed, and interesting lectures assumes greater significance for both lecturers and universities (Carr, 2007; Higher Education Founding Council 2008, Glass et al., 2006). This paper will present both the quantitative and qualitative data from a two-phase mixed method study with 75 nurse lecturers and 62 nursing students in one university in the United Kingdom. The study investigated the notion that lecturing has similarities to acting (Street, 2007). The findings presented here are concerned with how students perceived lecturers’ level of confidence and how lecturers believed they demonstrated confidence. In phase one a specifically designed questionnaire was distributed to both lecturers and students and a response rate of 91% (n=125) was achieved, while in phase two 12 in-depth semi-structured interviews were conducted with lecturers. Results suggested that students in a lecture could identify if the lecturer was confident or not by the way they performed a lecture. Students identified 57 manifestations of non-confidence and lecturers identified 85, while 57 manifestations of confidence were identified by students and 88 by lecturers. Overall, these fell into 12 main converse categories, ranging from body language to the use of space within the room. Both students and lecturers ranked body language, vocal qualities, delivery skills, involving the students and the ability to share knowledge as the most evident manifestations of confidence. Elements like good eye contact, smiling, speaking clearly and being fluent in the use of media recourses where all seen as manifestations confidence, conversely if these were poorly executed then a presentation of under confidence was evident. Furthermore, if the lecturer appeared enthusiastic it was clearly underpinned by the manifestation of a highly confidence lecturer who was secure in their knowledge base and teaching abilities: Some lecturers do appear enthusiastic but others don’t. I think the ones that do know what they are talking about, you can see it in their voice and in their lively body language. I think they are also good at involving the students even. I think the good ones are able to turn boring subjects into lively and interesting ones. (Student 50) Significantly more lecturers than students felt the lecturer should appear confident when lecturing. The lecturers stated it was particularly important to do so when they did not feel confident, because they were concerned with appearing capable. It seems that these students and lecturers perceived that expressive and apparently confident lecturers can make a positive impact on student groups in terms of involvement in lectures; the data also suggested the reverse, for the under confident lecturer. Findings from phase two indicated that these lecturers assumed a persona when lecturing, particularly, but not exclusively, when they were nervous. These lecturers went through a process of assuming and maintaining this persona before and during a lecture as a way of promoting their internal perceptions of confidence but also their outward manifestation of confidence. Although assuming a convincing persona may have a degree of deception about it, providing the knowledge communicated is accurate, the deception may aid rather than hinder learning, because enhances the delivery of a lecture. Therefore, the deception of acting a little more confidently than one feels might be justified when the lecturer knows the knowledge they are communicating is correct, unlike the Dr Fox Effect where the person delivering a lecture is an actor and does not know the subject in any detail or depth and where the deception to be justified (Naftulin, et al., 1973). In conclusion, these students and lecturers perceive that confident and enthusiastic lecturers communicate their passion for the subject in an interesting and meaningful manner through the use of their voice, body, space and interactions in such a way that shows confidence in their knowledge as well as their teaching abilities. If lecturers, therefore, can take a step back to consider how they deliver lectures in apparently confident ways this may increase their ability to engage their students and not only help them being perceived as good lecturers, but also contribute to the genuine act of education.

Nursing resources and patient outcomes in intensive care: a systematic review of the literature

Objectives: To evaluate the empirical evidence linking nursing resources to patient outcomes in intensive care settings as a framework for future research in this area. Background: Concerns about patient safely and the quality of care are driving research on the clinical and cost-effectiveness of health care interventions, including the deployment of human resources. This is particularly important in intensive care where a large proportion of the health care budget is consumed and where nursing staff is the main item of expenditure. Recommendations about staffing levels have been trade but may not be evidence based and may not always be achieved in practice. Methods: We searched systematically for studies of the impact of nursing resources (e.g. nurse-patient ratios, nurses' level of education, training and experience) on patient Outcomes, including mortality and adverse events, in adult intensive care. Abstracts of articles were reviewed and retrieved if they investigated the relationship between nursing resources and patient Outcomes. Characteristics of the studies were tabulated and the quality of the Studies assessed. Results: Of the 15 studies included in this review, two reported it statistical relationship between nursing resources and both mortality and adverse events, one reported ail association to mortality only, seven studies reported that they Could not reject the null hypothesis of no relationship to mortality and 10 studies (out of 10 that tested the hypothesis) reported a relationship to adverse events. The main explanatory mechanisms were the lack of time for nurses to perform preventative measures, or for patient surveillance. The nurses' role in pain control was noted by One author. Studies were mainly observational and retrospective and varied in scope from 1 to 52 units. Recommendations for future research include developing the mechanisms linking nursing resources to patient Outcomes, and designing large multi-centre prospective Studies that link patient's exposure to nursing care oil a shift-by-shift basis over time. (C) 2007 Elsevier Ltd. All rights reserved.

The feedback we give: university student perceptions and preferences

This paper reports the results of a study on higher education student perceptions of and preferences for feedback on their performance. The issue of feedback to students is becoming increasingly important in higher education, not only because it is an important element of learning, but also as a significant component of the student experience and its evaluation. Within a mass education context, written feedback on coursework may be an important opportunity available to students for individualised attention. The current research explored perceptions of feedback by participants who were studying in undergraduate business degrees in a UK university (N=175). The survey instrument asked participants to evaluate the feedback they receive at university in terms of its impact and influence, as well as their understanding of feedback received and preferences. Analysis of the data indicates that students generally find feedback provided to them helpful and encouraging in improving their work but they also indicate that they would prefer to discuss their work directly with their tutor instead of receiving written feedback. They comment on the illegibility of some hand written feedback received. They also report that, generally, they act on the feedback received in order to improve their work and say that it helps them to reflect on their learning. Students comment that negative feedback received does not make them angry or demotivate them. The survey found considerable variability in the students' understanding of 'typical' feedback comments. The majority of students (79%) also reported that they prefer a structured feedback matrix to general comments because they consider it more specific and easier to understand. The implications of these findings for feedback and assessment practices are discussed and suggestions for improvements developed.