Developing Real World Simulations in Health Technology Math

by Donna Jo (D.J.) Pruitt

from Inquiry, Volume 2, Number 1, Spring 1998, 6-12

© Copyright 1998 Virginia Community College System

Return to Volume 2, Number 1

Abstract

Instructors at Southwest Virginia Community College believed that students in Math 126, Mathematics for Allied Health, needed more applied experiences in the classroom. Real-world simulations provided an avenue for active, contextual learning in what had been a traditional classroom.

Developing and implementing real-world simulations has been a very successful and comfortable teaching strategy for me. The motto of Dr. Charles King, President of Southwest Virginia Community College, has been a constant reminder to continue teaching "a real education for real people for the real world." When I began teaching nursing in 1992, many of our fundamental skills were taught in a fragmented manner. Skills were taught as "stand - alone" activities and were not demonstrated or applied to real-world situations. In 1993, I began developing nursing simulations for the majority of the skill content for which I was responsible. Consequently, when it came time to take these nursing students into a hospital setting, I noted less trauma and confusion among students when they applied their skills to real patients. They successfully adapted from a laboratory real-world simulation to the real world itself with less anxiety and less hesitation. Because the fear of how to apply their skills was removed and the ease in adapting to the real world was facilitated, a more relaxed environment ensued, and students were able to adjust more quickly to the hospital environment and therefore were enabled to learn more in the hospital setting.

Teresa Woodard, a math instructor teaching Math 126 - Mathematics for Allied Health at SVCC, approached me during the spring semester of 1996 requesting assistance in teaching students about medication dosage calculations using "real world" props. She suggested bringing various types of items such as syringes, medicine cups, and differing sizes and kinds of intravenous solutions to her classroom to pass around and to share with the class. The following semester another Math 126 instructor, Pansy Waycaster, requested assistance with a similar hands-on activity for her students. In discussing the previous semester’s activity, Dr. Waycaster and I decided to try a different approach for two reasons. During the previous semester’s activities, students were indeed interested in noting the various sized containers and syringes and in how contents that appeared equal could in fact be unequal in different packaging. But, during the "show and tell" activities, I genuinely felt that there was very little application of math concepts and dosage calculations learned during the course. My goal was to improve the pedagogy and make it more "real-world."

This time, I decided to have Dr. Waycaster take her students to the nursing laboratory for a "hands on" activity. Prior to student arrival in the nursing lab, I set up ten"work stations" or areas containing ten simulations. These simulations included very common dosage calculation problems that are frequently encountered in a hospital setting, i.e., tablet and liquid oral medications, and parenteral, intravenous, and topical medications. As with simulations that I have developed for nursing students, I took great care to ensure that these simulations appeared as much like the "real world" as possible. I used real world "props" such as empty manufacturer’s containers, manufacturer’s labels and packages, and different sizes of needle-less syringes. Each simulation contained a "story" or a situation describing what was occurring with the patient, what medication was available, and what the physician’s order required. For instance:

Station # 1

Situation: Mrs. Janice Kilroy is hospitalized for asthmatic bronchitis. She requests her "cough medicine" for a persistent, non-productive cough. In checking her medication administration record, you note that she has Tussend 15 ml q(every) 6h prn (as needed) cough.

Pour 15 ml into the plastic medication cup. How do you know you have an accurate dosage?

Station # 2

35 mg. IM q 3-4 h prn pain.

Calculate dosages (ml) for each of these medications by reading the labels. Since we only want to "stick" Mr. Deskins one time, we will mix both medications together in one syringe. Which syringe has the correct amount (ml) of the combined medications: A, B, or C?

Station # 3

Situation: Ms. Joy Underwood has developed angina (chest pain) with exertion. Her physician has placed her on long acting nitroglycerin in topical form (a patch). The physician has ordered Transderm-Nitro 15 cm qd.

Which of the displayed Nitro patches is the correct dose: #1, 2, 3, 4, 5, or 6?

Station # 4

Situation: Dr. Jones has written a new order for Mrs. Terri Jackson to receive an intravenous solution of 500 cc D5W 0.45 NaCl to infuse over 6 hrs. The IV equipment tubing has a drop factor of 10 gtt/ml.

How many drops/minute will the patient receive? Practice doing this on the IV set-up by holding your wristwatch with a second hand near the drip chamber. Slowly open and close the roller clamp on the tubing to adjust for the correct number of drops in one minute.

(Note: You can increase the fun and interest in the simulations by substituting names of familiar, well-known public figures, faculty, or college administrators.)

All of the students in this particular class were in the process of applying to one of the health technology programs. Therefore, I had to be careful that the simulations were not too complicated and certainly not as challenging and complex as I would make them for a freshman nursing student. Our goal was to enable the student to apply concepts and principles learned during the course to actual real-world dosage calculations. I also decided to include a few of the simpler medication preparation skills such as pouring liquid medications into a graduated medicine cup and regulating an intravenous fluid drip. I wanted as many "hands on" activities as I could incorporate into the simulations for this level of student. Such basic skills would allow the students to apply their math knowledge and enable them to get a real-world experience and perhaps learn something new in the process. Students were required to read medication labels and perform the dosage calculations from information on the label. Each simulation had all the needed supplies to calculate and determine the correct dosage, i.e., multiple tablets, bottles, unit-dose packaging, and needle-less syringes of various sizes. In those simulations requiring the student to differentiate the syringe with the correct dosage, I used food dye to tint tap water so the student could more easily see the solution in the syringe. I also prepared an instructor’s "key" for faculty that included correct answers and a discussion of the usual and alternate methods of solving the problems.

Though I was excited about applying my nursing simulations to a math class, Dr. Waycaster was concerned and admittedly somewhat anxious about how well she would be able to assist students’ progress through the simulations. In an effort to relieve her anxiety, I set aside a time where just the two of us could work through and discuss each of the simulations. I also demonstrated the basic medication skills previously discussed and encouraged Dr. Waycaster to demonstrate those activities.

Though we did not do a quantitative statistical evaluation of this activity, student evaluations of the experience were very good. Students made multiple positive comments about the experience and highly recommended it for future classes. As a result of the successful use of nursing simulations in the math realm, both the math instructor and the nursing instructor were very excited about the experience and enthusiastic about continuing the lab practicum in following semesters.

During the third semester, Teresa Woodard once again asked me to assist with a lab practicum for her class. She and Dr. Waycaster had discussed the previous semester’s lab practicum simulations, and Teresa wanted to continue with that format. I decided to finesse the simulations and slightly rework the problems to alleviate the occasional ambiguity noted in a couple of the scenarios. As noted with Dr. Waycaster, Ms. Woodard also had some anxieties about her ability to assist students through the simulations. As with Dr. Waycaster, I took time to let Ms. Woodard go through each of the simulations and discuss various problem-solving options with her. I also demonstrated how to pour a liquid medication into a medicine cup and how to calculate intravenous drips. Though it was Ms. Woodard’s class, I decided to take responsibility for the students and supervise the simulation experience. This time, students initially seemed anxious that they were "put on the spot" and perceived the experience as a test. I explained to them that it was not a test, but a means to apply that which they had learned during the semester. This class seemed an interesting mix of students having no experience in the health field and several students who were licensed practical nurses. Students were instructed to work through the simulations at their own pace but were told at what time the simulations were to be completed. Ms. Woodard and I roamed among the students, helping to clarify queries about the simulations. Students were observed working alone, in pairs, and in groups of three or four. During the activity, students appeared relaxed, interacted meaningfully with each other, and laughed among themselves and faculty in an easy camaraderie. Though a formal written evaluation was not obtained for the activity, both faculty and students were very pleased with the experience. Students frequently commented that "It makes sense, now!" and "That wasn’t as bad as I thought it was going to be!" After everyone had completed the simulations, Teresa and I spent time with the class as a whole to review the process of obtaining correct answers. After this, we asked students for feedback on the simulations and how they might be improved. Only one class member made a suggestion for improvement: that we include more pediatric problems/situations. All were quick to recommend that we continue the simulations for future Math 126 classes.

Though a practicing nurse for twenty-two years, I still consider myself a novice educator, knowing there is still much I need to learn about teaching. After much reflection about this interdisciplinary project, I wanted to know why this activity was so successful. Though it seemed right and felt right to teach this way, I wanted to know the reason it was successful. Truthfully, I was very surprised that nursing simulations would be so successful among allied health math students.

Many authors support and encourage the use of teaching strategies involving methods where the student applies classroom knowledge. Most learning is highly context bound, and students in higher education naturally search for real-world practical applications of new knowledge. Likewise, new information must make sense and be meaningful. Being exposed to knowledge in many different ways facilitates more comprehensive learning (Angelo, 1993; Hull & Souders, 1996; Knapper, 1995). Curriculum that is interdisciplinary in nature promotes more profound learning with a greater mastery of knowledge and a better connection between subject matter and ideas (Dickinson, 1997).

The student body in higher education is changing. Studies show that non-traditional students make up the larger portion of student populations, especially at community colleges (Henry & Smith, 1994; Schreiner & Goldsmith, 1996). Non-traditional students are 25 and older, have "stopped out" of education for at least two years, attend college part-time, and usually commute from home to college (Davis, 1993; Henry & Smith, 1994). Non-traditional students are more vocal about their learning needs and would rather be actively involved in learning than sitting in a traditional lecture format associated with passive learning (Meyers & Jones, 1993). Traditional students (ages 18 to 22) are more content to be passive consumers of knowledge, but Meyers & Jones (1993) write that "students no matter what their age, need opportunities to engage in activities that help them to create their own mental structures and test them" (p. 21).

Active learning is one method of providing contextual learning to both the traditional and the non-traditional learner. Active learning is any activity that facilitates student interaction and involvement with course content through the means of talking and listening, writing, reading, and reflection of knowledge (Meyers & Jones, 1993). An active learning environment is the classroom that excites students and encourages participation. Both the traditional, so-called "passive" learner, and the non-traditional, "Show me how this is meaningful to my life" student can benefit from active learning (Angelo, 1993; Billington, 1997; Davis, 1993; Hull & Souders, 1996; Knapper, 1995; Meyers & Jones, 1993). Teachers likewise thrive in an active learning environment and report being more creative, enthusiastic, and taking a more personal and professional pride in their teaching. As noted among students in an active learning environment, teachers share with and support each other more with less feeling of isolation (Dickinson, 1997). The math instructors and I wholeheartedly agree with this opinion.

Active learning strategies, such as simulations, encourage students to become active participants rather than passive observers. Research findings indicate that simulations should be used as an adjunct to other teaching methods (McKeachie, 1994) and are capable of having a favorable impact on student motivation and involvement in the learning process (Davis, 1993). Tinzmann, et al. (1990), in describing active learning in the math classroom, indicate that students are generally not satisfied with the process of finding a right or wrong answer, but rather want to discuss it, to share methods of solution, and discover whether others in the class thought as they did. Our Math 126 students responded in much this way during the lab practicum. If students did not share results and answers as they progressed through each of the ten simulations, they invariably did after completing the simulations and during the post-simulation review process.

As a team, the math instructors and I are not quite finished with this project. In upcoming semesters we plan to formally evaluate activities of the lab practicum and continue to ask students for suggestions on how to improve the practicum. Preliminary information and observations from nursing faculty who teach freshman nursing pharmacology indicate that nursing students who have participated in the simulations have less pharmacology test-taking anxiety and are successfully passing the mandatory Comprehensive Dosage Calculation Exam on their first attempt (students are allowed three attempts to successfully pass the exam). This is particularly useful information since freshman nursing students in our program do not have the opportunity for hands-on medication administration experiences until after taking the Comprehensive Drug Calculation Exam. In the future, we would like to track these Math 126 nursing students to determine if ease of testing and earlier success is prevalent and indeed related to the lab practicum.

For both the math and nursing faculty involved in this project, it has been an exciting and extremely useful teaching strategy. At the close of the 1997 fall semester, Ms. Woodard and I once again incorporated the lab practicum into her Math 126 class. We asked students for verbal and written feedback of the experience. As before, the responses were overwhelmingly favorable. Students remarked that the atmosphere was relaxed, the activities were interesting and helpful, that they enjoyed a wonderful opportunity to experience hands-on learning about nursing, and that they enjoyed moving around the stations. From the students’ perspective, being able to manipulate syringes filled with "medicine," doing something besides "book work," and working together in a group were noted to be the most helpful aspect of the activity.

Interestingly, as I was tidying up the nursing lab after the practicum, several freshman nursing students were in the lab studying or socializing between classes. A few students recalled previous lab practicums that I had initiated and commented on how very helpful that experience had been for them not only in nursing pharmacology, but also in the medication administration unit of nursing fundamentals by helping them be "less confused" as they progressed through their nursing courses. Comments such as these reaffirm my belief in the positive results of providing a "real education for real people for the real world."

References

Angelo, T. A. (1993, April). A teacher's dozen: Fourteen general, research-based, principles for improving higher learning in our classrooms. American Association of higher Education Bulletin, 3-13.

Billington, D.B. (1997). Seven characteristics of highly effective adult learning programs. New Horizons [On-line]. Available: http://www.newhorizons. org/article_billingtonl.html

Davis, B. G. (1993). Tools for teaching. San Francisco: Jossey-Bass Publishers.

Dickinson, D. (1997). Positive trends in learning: Meeting the needs of a rapidly changing world. New Horizons [On-line]. Available: http:// www.newhorizons.org/positivetrends.html#adultprograms

Henry, T.C., Smith, G. P. (1994). Planning student success and persistence: Implementing a state system strategy. Community College Review, 22(2), 26-36.

Hull, D., Souders, J.C. (1996). The coming challenge: Are community colleges ready for the new wave of contextual learners? Community College Journal, 67(2), 15-17.

Knapper, C. K. (1995). Understanding student learning: Implications for instructional practice. In W. A. Wright and associates (Eds.) Teaching improvement practices (pp 58-75). Bolton: Anker Publishing Co.

McKeachie, W.J. (1994). Teaching tips: Strategies, research and theory for college and university teachers. Lexington: D.C. Heath and Co.

Meyers, C., Jones, T.B. (1993). Promoting active learning: Strategiesfor the college classroom. San Francisco: Jossey-Bass Publishers.

Schreiner, L. & Goldsmith, D. (1996). What works to retain re-entry & adult women. [On-line]. Available: itis.coni/wihe/back/april96/Reentry.html

Tinzmann, M.B., Jones, B.F., Fennimore, T.F., Bakker, J., Fine, C., & Pierce, J. (1990). What is the collaborative classroom? The Collaborative Classroom [On-line]. Available: http://www.ncrel.org/sdrs/areas/rpl_esys/collab.htm

D.J. Pruitt MSN, RN, CS is Associate Professor of Nursing in the Virginia Appalachian Tricollege Nursing Program (SVCC campus). This is her sixth year as a nurse educator. D.J. received her BSN from Berea College and her MSN from the University of Virginia. She is currently enrolled as a doctoral student at East Tennessee State University. E-mail: dj_pruitt@sw.cc.va.us