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ABSTRACT Predicaments concerning drug dosage calculations have been an existing issue for nursing students exposed in clinical areas. Based on the researchers’ experience, nursing students have difficulty on the conversion of units of measurement, computation of pediatric and adult doses and IV flow rate. According to Johnson and Johnson (2002), the learning process for medication calculations has been problematic for years. The problem that occur were multifaceted and attributed to an array of factors that included students' limited basic mathematic skills and inconsistencies in terms of teaching strategies for medication calculations. This underlying thought has motivated the researchers to look into this problem in the assessment of the level of competency on drug dosage calculations among level IV nursing students of Far Eastern University. By knowing the competency of these students, the researchers will be able to identify their strengths and weaknesses on drug dosage calculations.

The focus of the study was to assess the level of competency of level IV Far Eastern University nursing students on drug dosage calculations. The researchers will utilize a nonexperimental research, specifically a descriptive design. Using the Slovin’s formula, the researchers have come up with a sample of 340 level IV Nursing Students of Far Eastern University. The respondent can either be male or female ranging from 18-23 years old. In the data collection there were 131 males and 209 females. Participants must at least finish and pass 3 units on the following subjects: College Algebra and Pharmacology. In addition to these, participants were asked to sign a consent form to serve as a basis of their willingness to participate in this research study. Researchers will use a drug calculation test as their medium or instrument in weighing the level of competency of the subjects in terms of drug dosage calculation. The drug calculation test will constitute the following elements: I. Basic Math Operations (25 items), II. Conversion of Units (25 items), III. Drug Dosage Calculations (25 items), IV. IV Flow Rate Calculations (25 items) with a total of 100 items. The study determined the Level of Competency of level IV Far Eastern University nursing students on drug dosage calculations. Among the 340 respondents which comprises of 131 male and 209 female, the computed mean score on the four areas are as follows. The male participant’s mean score on basic math operations, conversion of units of measurement, drug dosage calculations, and intravenous flow rate are 14.9, 15.39, 13.8, and 12.85 respectively

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with an overall mean score of 57.95 while the female participant’s mean score are 16.1, 16.02, 14, and 13.03 with an overall mean score of 59.16. With the value presented on the table, it shows that the females mean score on basic math operations, conversion of units of measurement, drug dosage calculations, and intravenous flow rate is higher than that of the male. On the other hand, independent t-test was used to determine the existence of significant difference on the participant’s level of competency on basic math operations, conversion of units of measurement, drug dosage calculations, and intravenous flow rate when grouped according to gender and the results are as follows. The computed value for basic math operations is -1.932 with a level of significance of 0.054; for conversion of units, the computed value is -1.007 with a level of significance of 0.314; for drug dosage calculations, the computed value is -0.280 with a level of significance of 0.780 and for IV flow rates, the computed value is -0.255 with a level of significance of 0.799. The overall computed value was -0.542 with a level of significance of 0.588. Since the absolute computed value, 0.542 was not greater than the critical value, 1.960 at alpha 0.05, then there is no significant difference on the participant’s overall level of competency when grouped according to gender. With the results and findings according to the test utilized, it reveals that the Level of Competency on Drug Calculations among Level IV Nursing Students of Far Eastern University based from their mean scores was categorized in Level II with a description of “Conditional Pass”. It also reveals that the level of competency of male and female participants does not differ significantly; making the study accepts the null hypothesis.

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Chapter 1 INTRODUCTION The Problem and its Background

Predicaments concerning drug dosage calculations have been an existing issue for nursing students exposed in clinical areas. Based on the researchers’ experience, nursing students have difficulty on the conversion of units of measurement, computation of pediatric and adult doses and IV flow rate. Despite the formulas and techniques integrated on the matter, some students still find it confusing and may end up committing a mistake, if not properly guided by the right principles on drug dosage computations.

According to Johnson and Johnson (2002), the learning process for medication calculations has been problematic for years. The problem that occur were multifaceted and attributed to an array of factors that included students' limited basic mathematic skills and inconsistencies in terms of teaching strategies for medication calculations.

Rice and Bell (2005) have cited problems in practice with substandard abilities for nurses to calculate medication dosages. Calculation of medications is an essential step in safe medication administration, and necessary to safeguard patients. The authors referenced the American Society of Health-Systems Pharmacist system which identified nine categories of medication errors. They have also discussed nursing students classified as poor performers in mathematics since anxiety attack takes place when dealing with calculations for the reason that they are concerned on arriving at a wrong answer and when exposed to inconsistent teaching strategies in medication calculations. Mathematical formulas have been identified as problematic due to misapplication of formulas or miscalculations.

Manno (2006) has stated that medication errors has been a problem for many years and has killed thousands of people and one of the causes of these errors is drug miscalculations that causes drug over dose. Across health care and home care, patients face the risk of medical error. According to his landmark study entitled: To Err is Human: Building a Safer Health care

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System (2006) at the Institute of Medicine, ,estimated that as many as 98,000 Americans die each year due to a variety of medical errors; 7,000 of these deaths are due to errors involving medications. Medication errors have become an increasing problem in the hospital setting. It is estimated that medication errors also known as "adverse drug events (ADE) increase the cost of hospitalization by $ 2,200 to $ 3,200 per stay and prolong stays by 2 days on average". Causes of medication errors are varied, ranging from inappropriate orders to failure of the nurse to follow the five rights of medication administration. Many people believe that medication errors are a direct result of poor nursing.

Dosage calculations should be double-checked by two nurses or another pharmacist, Verification of a dose, rate or amount does not mean to question the abilities or competencies of the dispensing or administering individual. It is simply a way to further verify and protect the patient and staff involved. Medication errors are the eighth leading cause of death in the US. (Banning, 2006). To help decrease the incidence of medication errors, nurses need to step up to the plate, and realize the importance of this issue. Following the five rights of medication administration is simply not enough.

In the Philippines, there are no statistics that can show the number of deaths due to medication dosage errors. This underlying thought has motivated the researchers to look into this problem in assessment of the level of competency on drug dosage calculations among level IV Nursing Students of Far Eastern University. By knowing the competency of these students, the researchers were able to identify the students’ strengths and weaknesses on drug dosage calculations. As a result, it served as a motivator for nursing students to improve their skills on medication calculation thereby reducing the number of untoward events that can range from mild discomfort and even possible death of patients. Along these lines, nurses could render a safe and quality nursing care for their patients thus improving nursing practice.

Statement of the problem The study was intended to determine the level of competency on drug dosage calculations among level IV nursing students of Far Eastern University.

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Specifically, it aims to answer the following questions:

1. What is the participant’s level of competency on the following area: A. Basic Math Operation B. Conversion of Units of Measurement C. Drug Dosage Calculation D. Intravenous Flow Rate Calculation

2. Is there a significant difference on The level of competency of participants when grouped according to gender? Significance of the Study The purpose of this study was to assess the level of competency on drug dosage calculations of level IV nursing students of Far Eastern University. This was important because accurate calculation of drugs is critical in nursing practice. Thus, nurses must be competent on drug dosage calculations and student nurses must be well developed on these skills to become efficient nurses. The research aimed to promote the enhancement of calculation skills in undergraduate nursing students by utilizing an assessment test that exhibited their level of competency on drug dosage calculations which will serve as basis for further improvement of their skills on medication calculation, thus preventing medication calculation errors. It is hoped that the findings of this study will enhance the knowledge of concerned individuals and parties. Particularly, this study will benefit the student nurses on the following: Nursing Practice Student nurses through this study will be able to practice and provide effective and safe care in the real clinical setting. Drug dosage calculation and administration, being an essential skill and knowledge in nursing care will be focused and enhanced to trigger the shaping of competent and efficient nursing students. When the undergraduates become members of the academe, they would be able to teach their students the importance and correct techniques of medication calculation and its administration. Nursing Education

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The academe will be able to look beyond the finite skill of medication calculation and acknowledge system issues that plague most medication errors. Through this study, they will be able to recognize the value of knowing the fundamentals of mathematics in relation to nursing. Nursing Administration As the students will become administrators in hospitals, they would be able to use medication proficiency exams for their staff members. This can be used in continuous screening and improvement of their personnel's knowledge and skill on drug calculations. Thus, they will be able to give safer and effective quality nursing care to their clients. Nursing Research With its direct relation to nursing practice, student nurses will be able to improve the patient care management they are delivering in the clinical area by means of the facts and evidences nursing research is going to provide. This field could also help in determining certain ways on how to enhance the level of competency of student nurses by means of other studies and researches that could be made in relation to this study.

Scope and Limitation The focus of the study was to assess the level of competency of level IV Far Eastern University nursing students on drug dosage calculations. The research was conducted at Far Eastern University, Manila. The researchers selected it as the setting primarily on the grounds that the study may advance Far Eastern University level IV nursing students into a paramount dexterity on medical dosage calculation which is a fundamental aspect of exceptional nursing care. The researchers desired to measure the effectiveness of the skill in drug dosage calculation of the level IV nursing students to further enhance and revamp their potentials to evade medication errors that may jeopardize patients’ lives, thus, producing globally competitive nurses. The respondents for this study were selected fourth year nursing students in Far Eastern University, within the age bracket of 18-23, either male or female, and had their willingness to participate in the research study. College Algebra and Nursing Pharmacology were prerequisites for all the respondents. The researchers preferred students under the Institute of Nursing due to

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their desire to straighten out the capabilities of these future nurses in encompassing quality nursing care through equipped drug dosage calculation. Participants came from different sections. The study is limited on assessing only their level of competency, specifically their knowledge, skills and abilities on basic math operations, conversion of units, drug dosage calculation, and IV flow rate calculation which are integral part of medication administration. The traits of the respondents were excluded from the study. The tools to be utilized were standardized, authorized, and approved by qualified and licensed experts. Researchers used a drug calculation test as their medium or instrument in weighing the level of competency of the subjects in terms of drug dosage calculation. The drug calculation test constituted the elements below in this blueprint: Drug Calculation Test: I. Basic Math Operations………………. (25 items) II. Conversion of Units………………… .(25 items) III. Drug Dosage Calculations…………. (25 items) IV. IV Flow Rate Calculations…………. (25 items) Total: 100 items

The limitations encountered during data collection were as follows: 1. The researchers were not able to consider the stress and anxiety level that the participants may experience can affect the results of the test. 2.

The Different IQ of the participants and their motivation to take and finish the exam.

3. The possibility of the participants to pick out any answer they like even without solving due to the number of items which is a 100 item test.

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Chapter 2 THEORETICAL FRAMEWORK Review of Related Literature and Studies Level of Competency Based on Commission on Higher Education Memorandum Order (CMO) No. Series of 2009 Policies and standards on Bachelor of Science in Nursing program, Article IV, Section 5 “Competency Standards”, under Safe and quality nursing care, a Bachelor of Science Nursing student must be able to administer medications and other health therapeutics which conform to the 10 golden rules in medication administration and health therapeutics. One of the rules is the right dose, that is why each nursing student who graduate in Bachelor of Science in Nursing course must be competent in knowing the right dose through correct drug dosage calculation. Burkhalter and Cooper (2001) had suggested in their study, the “Measurement of Competence of Health Care Providers,” that competence encompasses knowledge, skills, abilities, and traits. It is gained by the healthcare professions through pre-service education, inservice training, and work experience. Competence is a major determinant of provider performance as represented by conformance with various clinical, non-clinical, and interpersonal standards. Measuring competence is essential for determining the ability and readiness of health workers to provide quality services. Although competence is a precursor to doing the job right, measuring performance periodically is also crucial to determine whether providers are using their competence on the job. A provider can have the knowledge and skill, but use it poorly because of individual factors (abilities, traits, goals, values, inertia, etc.) or external factors (unavailability of drugs, equipment, organizational support, etc.). Competency can be assessed by using tests or inferred from performance that has been assessed using simulations or work samples. The major advantage of tests is that single competencies can be distinguished and targeted for improvement. The major advantage of simulated patients and job samples is that they are more predictive of job performance. Competency is not performance. Although it can predict performance, a competent healthcare provider may not necessarily use effective procedures on the job. Both internal factors (motivation, agreement with a standard, self-efficacy, inertia, etc.) and external factors

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(supervision, feedback, availability of resources, community, peer expectations, and incentives) affect whether a healthcare provider will apply his or her competency. Detailed and immediate feedback to the healthcare provider about his or her competence is useful for both learning and improving performance. The use of pre-testing of mathematics skills such as basic arithmetic and algebraic calculations, and the use of the results as a predictor of success in university based nursing courses, are not new. Van Lanen, Lockie and McGannon (2000) examined a university mathematics placement test and other variables that predicted performance in an organic and biochemistry course in an undergraduate nursing program. They sampled 308 undergraduate nursing students. The variables that showed significance in that study were the mathematics placement test score, the grade in the previous principles of chemistry course, the number of supplemental instruction sessions attended and the score on the Nelson–Denny test (which measures reading and comprehension skills and age). Although they acknowledged that these data were dependent on the individual student population, these authors concluded that using predictive values in this way provides a useful profile of students who are at risk. Similarly, Hutton (1998) pre-tested 231 nursing students with a 50 item test. Results showed 80% (n: 184) of students scored less than 75%. Pozehl (1996) examined the mathematics skills of 112 undergraduate students enrolled in an introductory statistics course; exactly half of these participants were students majoring in nursing. Pozehl’s findings indicated that the nursing students were deficient in mathematics skills, particularly algebra, compared to the non-nursing cohort. Pozehl made a number of recommendations, including selective admission requirements that valued pre-existing mathematics skills, early pre-testing of the mathematics skills of nursing students to identify students at risk, ensuring the availability of early and prompt educational opportunities to the students with a deficiency in these skills and finally the evaluation of mathematics skills throughout the course. Pozehl also tested the level of mathematics anxiety, finding that the nursing students reported higher levels than non-nursing students. Brown (2002) administered a computational mathematics test to 868 undergraduate associate degree nursing students from across the United States of America. The mean score was 75% and these students demonstrated that they were under-prepared in skills essential to medication calculation mathematics, such as fractions, decimals and percentages (Brown,

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2002). Brown’s (2002) conclusions echo the recommendations provided previously by Starkings (n.d) and Pozehl (1996): that pre-testing upon admission is critical; that remedial mathematics courses should be mandatory if the pre-test results indicate deficiencies; and finally that testing should be ongoing throughout the program.

Medication Calculation Medication calculation is a dosage calculation to determine what quantity of medication is to be administered to the patient. Medication administration is a critical skill of the professional nurse, who must understand and follow various steps in the drug administration process to assure patient safety. The nurse must be proficient in medication dosage calculation to safely administer drugs. However, many medical-surgical nurses experience difficulty when calculating drug dosages. One study revealed that 56% of nurses could not calculate medication dosages to a 90% proficiency rate. In addition, nurses made significantly more errors in calculating intravenous drug dosages as compared to oral, intramuscular, or subcutaneous drug dosages (Ashby, 1997). For the nurse to compute the correct dosage of a medication, first the prescriber must write out the order legibly. Poor handwriting has been cited as the primary cause in 15% of medication error incidents (Springhouse Corporation, 2001). It is advisable for prescribers to always clearly print medication orders in capital letters. Many clinical settings have established computerized prescription systems which have eliminated the problem of illegible handwriting. At times, verbal prescription orders are given to a nurse, by word of mouth or per telephone. Because these orders may be transcribed inaccurately, dosage errors can occur. In clinical settings, verbal orders should be discouraged due to this risk. If the prescriber has no choice but to give a verbal order, he or she should sign the order as soon as possible. A misinterpreted decimal point is also a common problem which can cause medication dosage errors. If a dosage of a drug is less than zero and documented as a decimal, a zero should precede the decimal point for clarity. Conversely, the prescriber should not place a decimal point and zero after a whole number. If the decimal point goes unnoticed by the

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transcriber or nurse, the zero then acts to mistakenly multiply the dose ten times (Karch & Karch, 2001). Abbreviations in medication orders can easily be misinterpreted. Abbreviations vary in different institutions and cause confusion. Whenever possible, the words in a medication order should be clearly written out. For example, words such as units, micrograms, milligrams, every day, or every other day are preferable to abbreviations for these words (Springhouse Corporation, 2001b). Abbreviation of terms within the metric system can be difficult to decipher if handwritten. Whenever possible, metric units should be written out as words. Medication Calculation Errors in Nursing Practice No one really knows how many the exact number of miscalculation errors since by some estimates as little as one in ten errors are reported (Pepper, 2002). Of reported errors, one Food and Drug Administration (FDA) study found that 7% were due to "miscalculation of dosage or infusion rate." Combining this estimate with the estimate for total deaths, as many as 3,000 to 6,800 deaths are caused annually by medication math errors (Thomas, et. al., 2001). This would mean that in the average hospital one patient dies every year or two because someone makes a miscalculation and one or two patients are sub-lethally harmed each month. As future nurses then, there is a distinct possibility that we will harm, or even cause the death of, a patient over the course of our career. In 2001, the academic pressure significantly increased in nursing, after the Institute of Medicine released a report documenting over seven thousand deaths/year from medication errors and reform efforts were flawed given the convoluted systems (Institute of Medicine, 2005). The public and professional outcry from this report pressured most nursing programs to revamp teaching strategies and revise standards for medication administration. Many nursing schools adopted strategies to assess medication calculation proficiency every semester. Increased assessments created the need for nursing programs to initiate or revamp existing policies. Studies by Johnson and Johnson (2002), suggest that the learning process for medication calculations has been problematic for nursing faculty and students for years. The

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problems that occur were multi-faceted and attributed to an array of factors that included students' limited basic mathematic skills, to disagreement among the faculty as to best teaching. Rice and Bell (2005) also discussed nursing students as classified poor performers in mathematics, expended high anxiety levels when dealing with calculations, and exposed to inconsistent teaching strategies in medication calculations. Mathematical formulas have been identified as problematic due to misapplication of formulas or miscalculations. Best teaching practices have been elusive and results for nursing students were dismal. They studied the application of dimensional analysis as an alternative learning strategy for medication calculations. Working from the assumption that students successfully completed science courses, the authors studied a total of 30 nursing students over two semesters. The authors concluded the learning strategy, dimensional analysis, was successful in improving conceptual skills, thereby reducing the number of incorrect responses to test items. Elliott and Joyce (2005) discussed the need to develop calculation skills over time, and not assume the mathematical skills have been previously taught to students. The development of these essential skills were not captured in one semester, instead these skills were built across all nursing courses. Elliott and Joyce suggested as content material became more complex over time, the pass rate for medication calculation tests should also become more difficult. Hence, the authors suggested building medication calculation mastery over a period of time to successfully reach medication calculation proficiency. The results of their research with 130 students not only supported the concept of on-going assessment of medication calculation skills, but additionally, the role of faculty to develop medication skills over a four-year curriculum. Nursing students would then advance from simple medication problems to highly technical and complex medication calculations. Elliott and Joyce recognized mathematical skills, may not necessarily be as simple as a review process, but suggested these skills be developed overtime in nursing curriculum. Burke (2005) described the nursing profession's need to broaden horizons for medication administration processes. Under education, barriers to successful and safe medication administration included lack of best practice to teach students the fundamentals of medication administration. More importantly, Burke identified nursing curriculum did not focus on the entire medication administration process. Instead, nursing schools primarily focus on administering, and often disregarded prescribing and dispensing processes. He also identified

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seven significant barriers to safe medication administration. Lack of interdisciplinary teamwork and efforts, fluctuation in staffing patterns, and use of abbreviations were identified within the seven barriers. Delays in responding to safety concerns and systems flaws within healthcare environments also influenced safe medication administration practice. Burke also identified recent research that has examined the negative impact of nursing staff working over 12 hour shifts or 40 hours per week and the increase risk of medication errors. Medication administration requires nurses to demonstrate successfully a range of mathematical concepts, including ratios, proportions, fractions, percentages and measurement conversion (Brown, 2002; Hoyles, Noss & Pozzi, 2001; Pozehl, 1996). Errors in medication mathematics may have serious consequences that include harm to the patient, potentially even death, not to mention disciplinary and possible legal consequences for the nurse and the organization in which he or she is employed (Brown, 2002; Grandell-Niemi, Hulpi, Leino-Kilpi & Puukka, 2003; Hoyles, Noss & Pozzi, 2001; Shore & Shore, 2003). A review of the literature shows that getting undergraduate nursing students to demonstrate a proficient level of medication calculation accuracy remains one of the strongest instructional challenges for nursing academics (Kelly & Colby, 2003). The findings of Hoyles, Noss and Pozzi’s (2001) ethnographic study into the practices of pediatric nurses strongly suggest that the mathematics utilized in undergraduate nurse education is not visible in practice. Instead, they found that the participant nurses, who had practiced longer than three years, employed a more holistic approach. Their success in medication calculation was related to “situated abstraction” (Hoyles, Noss & Pozzi, 2001). This notion is based upon the assumption that context is an inseparable component of medication mathematics, as nurses will choose actions that seem relevant to them in their situation (Hershkowitz, Schwarz & Dreyfus, 2001). The three factors that were situational were: the packaging of the drugs; the specific social routines (such as checking with two nurses); and the clinical effects of the drug itself. Kelly and Colby (2003) identified a similar phenomenon with their students and argued that a constructivist approach to teaching medication mathematics was the key. No formulas were provided to their students; instead the students were encouraged to answer the following questions: “What are the givens? What are you looking for? What information must be transformed in some way?” At the end of this process, one important step was performed and

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the students were asked to justify their answers. This process allowed the students to identify irregularities in dose rate, volume or concentration (Kelly & Colby, 2003). Although the constructivist approach may enhance students’ ability to learn medication calculations, we argue that students still require basic understanding of mathematical concepts. This review of related literature has shown that a large proportion of undergraduate nursing students are unable to demonstrate an appropriate level of mathematical knowledge on entry into the program. This study had sought to determine the level of mathematical knowledge of the Level IV nursing students of Far Eastern University. Cognitive Learning Theory The researchers had come up to employ the Cognitive Leaning Theory as the researchers’ guide in the study. This theory emphasizes unobservable mental processes that people use to learn and remember new information or skills. In other words, it stresses the importance of what goes on inside the learner. It is widely used in education and counseling. The key to learning and changing is the individual’s cognition (perception, thought, memory, and ways of processing and structuring information). Cognitive learning, a highly active process largely directed by the individual, involves perceiving information, interpreting it based on what is already known, and then recognizing the information into new insights or understanding (Bandura, 2001; Hunt, Ellis, & Ellis, 2004). Cognitive Learning Theory includes several well-known perspectives, such as gestalt, information processing, human development, social constructivism, and social cognition theory. With these perspectives, students or learners are encouraged to think of their potential applications in the healthcare setting, by keeping with cognitive principles of learning and being mentally active with information to encourage memory and retention. The researchers had seen many concepts of this theory that the researchers can apply to their study, primarily because it talks about the mind and processing of information that is relative in undertaking the study on assessment of the respondents’ level of competency on drug dosage calculation. That learning is merely unobservable and can be measured through an exam or aptitude test. Of the several perspectives or concepts of Cognitive Learning Theory, the researchers opted to apply the Information Processing Model which emphasizes thinking

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process: thought, reasoning, the way information is encountered and stored and memory functioning (Gagne, 1985; Stenberg, 2006). The researchers, as stated in the methodology of the study, did not include to seek the factors that affect the processing of information of the selected level IV Nursing Students in Far Eastern University but only to inquire about what happened with the information that was given to the students by their mentors, since then up to now, and that prior knowledge plays an important role in learning and in nursing practice. The researchers supposed that how the information was incorporated and retrieved was useful for health professionals as well as for nursing students to know, specifically on drug dosage calculation when it comes to hospital practice.

Applying this model to the researchers’ study, the first stage in the memory process involves paying attention to environmental stimuli; attention, then, is the key to learning. The drug calculation test that the researchers had conducted to the respondents of the study served as the stimulus. This test got the attention of the respondents. The researchers verbally explained the instructions aside from the written instructions on the test. It was also the researchers’ responsibility to know if the respondents are weary or distracted prior in taking the test, so that the explanation and test will be moved at another time when they are more receptive and attentive. In the second stage, the researchers prepared a visual drug calculation test that was processed by the senses of the respondents. Another responsibility of the researchers’ in this stage was to ascertain whether there are sensory deficits among respondents. In the third stage, the researchers did not take concern on short-term memory but

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more on long-term memory, because this served as aid in assessing the level of competency in drug dosage calculation of the respondents. In short term-memory, the researchers are concerned if the respondents are keeping their knowledge in drug dosage calculation activated every now and then, so that it will be then stored in their long-term memory, since short term memory is not limited in its capacity but in the duration with which it can actively retain information. This stage further assessed the long-term memory of the respondents since by experience and verity that also the researchers who were in the same level of the respondents, were done with their mathematics subjects, as well as pharmacology course last semester. So it is where, the knowledge of the respondents on basic math operations which is supposed to be taught since grade school and the formulas in drug dosage calculations last semester were applied and this was shown on their solutions upon answering the test as well as their score. It is also where the researchers as well as the respondents were able to assess if they remember or had forgotten their knowledge regarding these matters. The researchers also considered that while long-term memories are enduring, a central problem is retrieving the stored information at later time that affected the test results of the respondents in the study. In the last stage, it entails the action or response of the respondents upon answering the test. It is where the researchers assessed how the respondents attended to, processed and stored the information that was presented as well as finding ways on how to solve the problem. Piaget’s Theory of Cognitive Development The respondents are under the formal operational stage and had the ability to answer questions which included problem solving, analysis and rationalization. During this time, people develop the ability to think about abstract concepts. Skills such as logical thought, deductive reasoning, and systematic planning also emerge during this stage (Pilliteri, 2003). Ergo, the study was appropriate for these subjects because their cognitive aspect has reached this level based from Piaget’s theory of cognitive development.

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Drug Calculation Test

Conceptual Model

Level of Competency Level IV

Knowledge on Drug Calculation

Level IV Nursing Students

Basic Mathematic al operations Conversion of Units Dosage Calculation IV flow rate Calculation

Level III Level II Level I

Description Pass/Achieved the Competency Level with excellence (80% and above percentage score from the test) Pass/Achieved the competency level (60% to 79% percentage score from the test) Conditional Pass (50% to 59% percentage score from the test) Failed to achieve the Competency Level (50% and bellow percentage score from the test)

Conceptual Framework Equipped with knowledge on drug dosage calculation, the respondents were tested by the researchers to know their level of competency. The researchers gave a test about the basic mathematical operations, conversion of units, drug dosage and IV flow rate calculation. This determined the level of competency of the Level IV Institute of Nursing students regarding drug dosage calculation. Research Paradigm

INPUT

PROCESS

Level of Competency on Drug Calculation of level IV Nursing Students of Far Eastern University.

Assess their Level of Competency on basic math operations, conversion, determination of dosage and intravenous flow rate calculation.

OUTPUT The level IV Nursing students of Far Eastern University will gain proficiency on drug calculations as they improve their skills in giving safe and quality nursing care.

The research paradigm was divided into input, process and output. The research process was focused on assessing level of competency on drug calculations of level IV nursing students of Far Eastern University. The research had undergone a process in which the

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following statements above had been their channel in answering the problem statements. Definitely, if these steps were achieved, they will be aiming an output, that will contribute on the improvement and development of the skill on drug calculations of nursing students of Far Eastern University. Hypothesis o

The Level IV Nursing Students of Far Eastern University has achieved the competency in drug calculation.

o

The level of competency of male and female participants does not differ significantly.

The Main Variables of the Study The two main variables of the study were the drug calculation and level of competency. The independent variable was the drug calculation while the dependent variable was the level of competency which was measured by a validated questionnaire on conversion of units, drug dosage and IV flow rate calculation.

Definition of Terms: Drug Calculation It is the determination of drug dosage and Intravenous flow rate through computation, and usage of formulas, unit conversion and basic mathematical operations. It is the act of properly calculating the exact amount of medication to be administered in a particular client. Level of Competency It is the measure of the quality of being competent or having a possession of required skill, knowledge, qualification, or capacity. It is the knowledge of the respondent or ability to perform correct calculations or conversion of units, drug dosage and Intravenous flow rate calculation. It is the extent of the ability of the client to properly calculate for the medications to be administered based on his/her own knowledge.

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Based from a research in University of Malaya for health workers (2004), the level of competency can be measured using Competency Level Evaluation (PTK). The scores of the respondents from the drug calculation test will be classified using this tool. After all the scores are taken, the researchers will get the average (mean) of the entire sample and also be classified using PTK. The structure for grading PTK is as follows: Level of Competency Level IV

Description Pass/Achieved the Competency Level with excellence (80% and above percentage score from the test)

Level III

Pass/Achieved the competency Level (60% to 79% percentage score from the test)

Level II

Conditional Pass (50% to 59% percentage score from the test)

Level I Failed to achieve the Competency (50% and bellow percentage score from the test)

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Chapter 3 RESEARCH METHODOLOGY This chapter contains all the information on how the study was conducted, the locale of the study and the target population. This chapter would further discuss the specific interventions and research design that the researchers’ used in order to collect and obtain the needed information. Research Design The researchers utilized a non-experimental research, specifically a descriptive design. The objective of this design was the accurate depiction of the level of competency among level IV nursing students of Far Eastern University. It involved collection of numerical data to test the hypothesis and to answer the questions concerning their status. They haved described the phenomena on the subject’s

level of competency on drug calculation.Through this, the

researchers can describe the dimensions and importance of the inclined number of students who experienced drug calculation errors. It was the selected design because the objective this research was to describe the level of competency of their subjects and do not include correlations and other study groups. Also, the researchers utilized a cross-sectional design in which they collected data at one point in time.

Population and Sample The subjects were selected using stratified random sampling, in which the researchers make use of the fishbowl technique in selecting the sections that took part in the study. This sampling technique captured the characteristics of the population that was proportional to the sample. Thus, the result of assessing the level of competency on drug calculation among selected level IV nursing students of Far Eastern University attributed to the whole population. Using the Slovin’s formula, the researchers came up with a sample of 340 level IV Nursing Students of Far Eastern University. The respondent can either be male or female ranging from 18-23 years old. Participants had finished and passed 3 units on the subject: College Algebra and Pharmacology. In the data collection there were 131 males and 209 females. In addition to

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these, participants signed a consent form to serve as a basis for their willingness to participate in this research study.

Total Number o 250

200 Research locale The study was conducted at Far Eastern University, Manila. The researchers had chosen FEU as their locale because it will benefit their colleagues as they will able to know their level of competency on drug calculation. It was also selected because it was where the

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researchers had established their observation and motivation in undertaking this study. The

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setting is mainly based on FEU, Manila specifically at Law Building wherein potential respondents had their classes most of the time. Research Instrument The primary tool of the research was a drug calculation test which measured the

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respondent’s competency on basic mathematical operations such as addition, subtraction, multiplication and addition along with conversion of units that all came with critical thinking and analysis. The remaining part of the test included questions regarding drug dosage and IV flow rate calculation. The test consisted of a hundred items divided into four major parts 25 items each. The entire questions were constructed using words or sentences requiring the

50

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respondents to evaluate and analyze each item according to their mathematical skill and capabilities. The tool was lifted mainly from mathematics and pharmacology books. It was answered manually with the use of pen or pencil. Respondent’s profile came prior to the series of questions. A sheet for computations was provided by the researchers and the use of calculator was allowed. The instrument had undergone validations from two mathematicians and a pharmacology professor. A pilot study was done to 20 students to test its reliability. Data Collection Procedure The researchers’ had collected quantitative data on the level of competency on drug dosage calculation among level IV nursing students. The initial step of the researchers was to select potential respondents that participated in the study. After identifying respondents, the researchers had personally introduced themselves, established rapport and stated the objectives of their study. If the respondents agreed to participate in the study, they are given the consent form for them to sign prior to answering the questionnaire. The researchers used a drug calculation test for data collection to assess their competence on drug calculations. The respondents used a pen or pencil in answering the test and were given 90 minutes to answer the corresponding questions. Statistical Treatment of the Data

To answer the research question number 1 on what the level of competency of the participants was, the following formula was used: Formula:

Where:

Xi= score 22

To answer the research question number 2, on the significant difference on the level of competency of the participants when grouped by gender, the independent t-test was used. Formula:

Where:

X1 = Male participants X 2 = Female participants n = number of respondents

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CHAPTER 4 RESULTS AND ANALYSIS This chapter has aimed to answer the research questions to determine the level of competency on drug dosage calculations among level IV nursing students of Far Eastern University. 1. What is the participants’ level of competency on the following area: a. Basic Mathematical Operations Table IV.1

Participants’ Level of Competency on Basic Mathematical Operations

Level of Competency I (Failed to achieve competency) II (Conditional Pass) III (Achieved the Competency) IV (Achieved the Competency with Excellence)

MALE n

%

39 13

29.77% 9.92%

45

34.35%

34

25.95%

FEMALE Mean Score

14.9

n

%

46 12

22.01% 5.74%

84

40.19%

67

32.06%

Mean Score

16.1

The table above displays that 60.3 % of the male population and 72.25% of the female population reached the competency level III and IV in basic mathematical operation. The overall mean percentage of both populations in basic mathematical operations is 62%. It means that, on the average, the nursing students of Far Eastern University have achieved competency in basic mathematical operations. Student nurses shall demonstrate the ability to solve multiple step mathematical problems that require demonstration of basic math operations including fractions, decimals and percentages and the use of algebraic equations. Nursing students as well as practicing nurses continue to struggle with math competency as it relates to nursing. According to Blais and Bath (1992), the most frequent type of mathematical errors was conceptual errors (setting up the problem) and arithmetic errors (incorrect addition, subtraction, multiplication, division, decimals,

24

and fractions). According to 21 Flynn and Moore (1990), graduate nurses made errors at a rate of 1 in 12 when performing written calculations. These statistics should alert nurse educators and practicing nurses of the need for ongoing evaluation of student basic math skills and provide continuing education in math skills for practicing nurses.

b. Conversion of Units of Measurement Table IV.2 Participants’ Level of Competency on Conversion of Units of Measurement Level of Competency MALE FEMALE Mean Mean n % Score n % Score I (Failed to achieve competency) 41 31.30% 54 25.84% II (Conditional Pass) 7 5.34% 6 2.87% III (Achieved the 15.39 16.02 Competency) 39 29.77% 83 39.71% IV (Achieved the Competency with Excellence) 44 33.59% 66 31.58% This table indicates that majority of

both gender achieved the desired level of

competency in terms of conversion of units of measurement obtaining a total of 63.36% of males and 71.29% of females who were able to arrive at levels III and IV. In line with this, barely 30% of both groups have failed to reach the passing score of the test. The females, having a higher mean score of 16.02 compared to the 15.39 mean score of males may suggest that females are more competent than males in this area. c. Dosage Calculation Table IV.3

Participants’ Level of Competency on Dosage Calculation

Level of Competency I (Failed to achieve competency) II (Conditional Pass) III (Achieved the

MALE n

%

56 4 36

42.75% 3.05% 27.48%

FEMALE Mean Score 13.8

n

%

87 5 59

41.63% 2.39% 28.23%

Mean Score 14

25

Competency) IV (Achieved the Competency with Excellence)

35

26.72%

58

27.75%

The table above displays the corresponding number of male and female participants in each particular level of competency. 42.75% of the male’s population failed to achieve competency level while 41. 63 % of the female’s population also failed to achieve competency with a mean score of 13.8 for males and 14 for females. It denotes that a greater number of the participants failed to achieve competency compared to those who achieved competency. The result of the test proves that most of undergraduate nurses have problems in terms of dosage calculation which could contribute to the overall problem of nurses in drug administration. This could be evidence that not all nurses’ especially undergraduate nurses have mastery in dosage calculation. It would support the previous studies made by different experts like Brown (2002), which concluded that students majoring in nursing were under- prepared in skills in calculation of medication which is a very critical part of the job.

d. Intravenous Flow Rate Calculation Table IV.4 Participants’ Level of Competency on Intravenous Flow Rate Calculation Level of Competency MALE FEMALE Mean Mean n % Score n % Score I (Failed to achieve competency) 52 39.69% 89 42.58% II (Conditional Pass) 13 9.92% 16 7.66% III (Achieved the 12.85 13.03 Competency) 51 38.93% 79 37.80% IV (Achieved the Competency with Excellence) 15 11.45% 25 11.96% This table shows that majority of both groups has failed to achieve the competency in Intravenous Flow Rate Calculation. Only 50.38% (n=66) of the males and 49.76% (n=104) of females has reached the level 3 and 4. Half of the participants have failed to reach the competency which signifies that this area is a weakness of many level IV nursing students in Far Eastern University.

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The mean score of females (12.85) was higher than males (13.03) which may indicate that females are much competent than males in this area.

The result might have been affected by the number of items given. It was in the last part of the test and some respondents were complaining of a lengthy exam during the examination. The fact that this was not graded, there is a tendency that they did not seriously answer questions that has affected their scores.

e. Competency in all Areas Table IV.5 Level of Competency I (Failed to achieve competency) II (Conditional Pass) III (Achieved the Competency) IV (Achieved the Competency with Excellence)

Participants’ Level of Competency on all Areas MALE FEMALE Mean Mean n % Score n % Score 40 16

30.53% 12.21%

60

45.80%

15

11.45%

57.95

54 34

25.84% 16.27%

93

44.50%

28

13.40%

59.16

The table above presents the participant’s level of competency when grouped according to sex. It shows that the number of males who failed to achieve the competency level was 40 or 30.53% while the number in females is greater with 54 or 25.84%. Male participants with conditional pass score are 16 or 12.21%, however, 34 are in females or 16.27%. There are 60 males or 45.80% who achieved the competency score while there are 93 or 44.50% in females. The number of participants who achieved the competency with excellence is 15 or 11.45% in males and 28 or 13.40% in females. The mean or average achieved by the females which is 59.16 shows greater percent than that of the males who got 57.95. It can be interpreted that females have greater competency on overall drug calculation

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than males. Several factors contributed to this examination result that was out of control by the researchers. These factors were as follows: environmental factors, physical factors of the respondent, cognitive factors of the respondent, and psychological factors of the respondent. Environmental factors that affected the results are the place where they took the examination (noise, temperature, and other distractions). Physical factors are factors coming directly from the respondent such as the condition of the respondent before and while taking the exam. Cognitive factors that contributed to the result are mainly the previous knowledge of the respondent with regards to the subject matter. Psychological factors are those factors coming from the respondent examples are anxiety of the respondent with regards to questions regarding the subject matter. These observations can be associated on Johnson and Johnson’s analysis that the learning process for medication calculations has been problematic for nursing faculty and students for years wherein the problems are attributed to an array of factors that included students' limited basic mathematic skills. Rice and Bell (2005) also discussed that nursing students are classified as poor performers in mathematics, expended high anxiety levels when dealing with calculations, and exposed to inconsistent teaching strategies in medication calculations. Mathematical formulas have been identified as problematic due to misapplication of formulas or miscalculations.

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Table IV 6. Number of Participants Classified According to their Level of Competency in Different Areas LEVEL I

LEVEL II

LEVEL III

Failed

Conditional Pass (50%-59%)

Achieved the competency (60%-79%)

LEVEL IV Achieved the competency with excellence (80% and above) n %

Section of Test

n

%

n

%

n

%

I. Basic Mathematical Operations

85

25.00%

25

7.35%

129

37.94%

101

29.71%

II. Conversion of Units

95

27.94%

13

3.82%

122

35.88%

110

32.35%

III. Drug Dosage Calculation

143

42.06%

9

2.65%

95

27.94%

93

27.35%

141

41.47%

29

8.53%

130

38.24%

40

11.76%

94

27.65%

50

14.71%

153

45.00%

43

12.65%

IV. IV Flow rate Calculation In all items

The table above shows the summary of the Level of Competency of the different sections of the test. At section I (Basic Mathematical Operations), 25% of the students failed while the remaining 75% passed. At section II (Conversion of Units), 27.94% failed while the remaining 72.05% passed. At section III (Drug Dosage Calculation), 42.06% failed and the remaining 57.94% passed. At section IV (IV Flow rate Calculation), 41.47% failed while the remaining 58.53% passed. As we can see, majority of the students failed at sections III and IV compared to sections I and II. Generally, 27.65% of the students failed the exam and 72.36% passed. Overall, the students that reached the level of competency are 57.65%. The student nurses of the Far Eastern University has a higher percentage rate who passed the in the Basic Mathematical Operations and Conversion of Units than the Drug Dosage Calculation and IV Flow rate Calculation. This shows that although according to Blais and Bath (1992), the most frequent type of mathematical errors was conceptual errors (setting up the problem) and arithmetic errors (incorrect addition, subtraction, multiplication, division, decimals, and fractions) the students was skilled enough in answering the Basic Mathematical Operations questions and Conversion of Units questions than answering the Drug Dosage Calculation questions and IV Flow rate Calculation questions. It also shows that the student nurses are more competent and experienced in Basic Math and conversion compared to the drug dosage and IV flow rate computation. This result also demonstrate that most of the student nurses of the Far Eastern University have problems in terms of dosage calculation and IV flow

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rate calculation which is very essential in their profession as a future nurses. Just like what Brown (2002) concluded that students majoring in nursing were under- prepared in skills in calculation of medication. But this result could have happen due to the many factors that have affected the students while answering the test. These factors includes the number of items of the test, the environment where they have taken the test, the fact that it is not graded, the positioning of the section Iii and IV at the last part of the exam and the anxiety the student feels knowing that the test includes math and computations. Based on the result of the test, the majority of the level IV student nurse of the Far Eastern University can be classified under the Level III of the Level of Competency.

2. Is there a significant difference on the level of competency of participants when grouped according to gender? Table IV.7

Independent T-test for the Significant Difference of Participants’ Level of

Competency on Basic Math Operations when Grouped According to Gender Computed Value

Critical Value

Level of Significance

Interpretation

Decision

-1.932

1.960

0.054

Not Significant

Accept H0

The table above shows the result of the Independent T-test used to determine the existence of significant difference on the participant’s level of competency on basic math operations when grouped according to gender. The computed value was -1.932 with a level of significance of 0.054. Since the absolute computed value, 1.932, was not greater than the critical value, 1.960, at alpha 0.05, then there is no significant difference on the participant’s level of competency on basic math operations when grouped according to gender. The decision was to accept H0 that the level of competency of male and female participants on basic math operations does not differ significantly. Table IV.8

Independent T-test for the Significant Difference of Participants’ Level of

Competency on Conversion of Units of Measurement when Grouped According to Gender

30

Computed Value

Critical Value

Level of Significance

Interpretation

Decision

-1.007

1.960

0.314

Not Significant

Accept H0

The table above shows the result of the Independent T-test used to determine the existence of significant difference on the participant’s level of competency on conversion of units of measurement when grouped according to gender. The computed value was -1.007 with a level of significance of 0.314. Since the absolute computed value, 1.007, was not greater than the critical value, 1.960, at alpha 0.05, then there is no significant difference on the participant’s level of competency on conversion of units of measurement when grouped according to gender. The decision was to accept H0 that the level of competency of male and female participants on conversion of units of measurement does not differ significantly. Table IV.9

Independent T-test for the Significant Difference of Participants’ Level of

Competency on Dosage Calculation when Grouped According to Gender Computed Value

Critical Value

Level of Significance

Interpretation

Decision

-0.280

1.960

0.780

Not Significant

Accept H0

The table above shows the result of the Independent T-test used to determine the existence of significant difference on the participant’s level of competency on dosage calculation when grouped according to gender. The computed value was -0.280 with a level of significance of 0.780. Since the absolute computed value, 0.280, was not greater than the critical value, 1.960, at alpha 0.05, then there is no significant difference on the participant’s level of competency on dosage calculation when grouped according to gender. The decision was to accept H0 that the level of competency of male and female participants on dosage calculation does not differ significantly. Table IV.10

Independent T-test for the Significant Difference of Participants’ Level of

Competency on Intravenous Flow Rates Calculation when Grouped According to Gender

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Computed Value

Critical Value

Level of Significance

Interpretation

Decision

-0.255

1.960

0.799

Not Significant

Accept H0

The table above shows the result of the Independent T-test used to determine the existence of significant difference on the participant’s level of competency on Intravenous Flow Rates Calculation when grouped according to gender. The computed value was -0.255 with a level of significance of 0.799. Since the absolute computed value, 0.255, was not greater than the critical value, 1.960, at alpha 0.05, then there is no significant difference on the participant’s level of competency on Intravenous Flow Rates Calculation when grouped according to gender. The decision was to accept H0 that the level of competency of male and female participants on Intravenous Flow Rates Calculation does not differ significantly. Table IV.11

Independent T-test for the Significant Difference of Participants' Level of Competency when Grouped According to Gender

Computed Value

Critical Value

Level of Significance

Interpretation

Decision

-0.542

1.960

0.588

Not Significant

Accept H0

The table above shows the result of the Independent T-test used to determine the existence of significant difference on the participant’s overall level of competency when grouped according to gender. The computed value was -0.542 with a level of significance of 0.588. Since the absolute computed value, 0.542, was not greater than the critical value, 1.960, at alpha 0.05, then there is no significant difference on the participant’s overall level of competency when grouped according to gender. The decision is to accept H0 that the level of competency of male and female participants does not differ significantly. Discussion of Findings

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This section reiterates how the data were put into understandable form and substantialized into its existing literatures. The implications of the findings for nursing practice and research was also made.

When a medication order differs from the fixed amount at which a drug is supplied, the dose needed must be calculated. Calculation requires knowledge of the systems of dosage measurements and the ability to solve arithmetic. Nursing students invariably express anxiety that they will miscalculate a dose and cause harm. Although everyone is capable of error, no one has to cause one. The surest way to prevent a mistake was to exercise care in performing basic arithmetic operations.

The participants This is consistent with the study conducted by Pozehl (1996), Pozehl findings indicated that the nursing students were deficient in mathematics skills, particularly algebra, compared to the non-nursing cohort.

Most of the students feel anxious when it comes to mathematical operations. Researchers observed that most of the students were shocked when they first saw the questionnaire because it deals with mathematics.

The respondents’ were given a series of computational mathematics test focusing on Basic Math Operations, Conversion of Units of Measurement, Drug Dosage Computation, and IV Flow Rate Calculation. Their mean score on these tests are 58%, 33

passing but yet has not reached the level of competency, which shows that most of the students are not so focused on mathematics which is one of the basic skills needed for a career in nursing, these further affects their level of competence and more importantly their performance of the job they will pursue.

Some studies showed the same result. Among these were the studies of Hutton, Brown, and Lanen, Lockie and McGannon. 231 nursing students were pre-tested by Hutton (1998) with a 50 item test with results of showing that 80% of these students scored less than 75%.

This has also been in congruent with the study by Brown (2002), who administered to 868 undergraduate associate degree nursing students from across the United States of America a mathematics test. The conclusion of Brown to their results is that pre- testing upon admission is critical and remedial of mathematics courses should be mandatory because the results of the study he has conducted was that the students had a mean score of 75%. The result of the mathematics test further implicated that students majoring in nursing were under- prepared in skills in calculation of medication which is a very critical part of the job.

In a mathematics placement test made by Lanen, Lockie and McGannon (2000) to 308 undergraduate nursing students, they concluded that the students are at a risk and they still lack skills needed in nursing competence. Although they acknowledged that the data they gathered were dependent on an individual’s skills, it is better that they have more focus on the mathematical aspects of their course because it affects the overall performance.

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The implications of the study for future researchers include opening the path for a bigger scope of application. This also raises the idea that it can be done in any clinical area.

Discussion of Hypothesis The researchers had used an independent T-test for the significant difference of participant’s level of competency when grouped according to gender. This method was designed to examine the statistical difference of two means of the male and female group. It was presented in table 9-11the result of the independent T-test, and it has clearly showed that all areas have lesser absolute computed value than the computed value with a level of significance ranging from 0.054-0.799. Ergo, there was no significance on the participant’s level of competency when grouped according to gender. In addition, the null hypothesis was accepted since the test has proven no significant relationship between means.

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CHAPTER 5 SUMMARYOF FINDINGS, CONCLUSION AND RECOMMENDATION Summary The purpose of the study was to assess the level of competency on drug calculations of level IV nursing students of Far Eastern University. By knowing the competency of these students, the researchers were able to identify their strengths and weaknesses on this skill. The researchers had looked into the problems of mathematics in nursing that focuses on basic mathematical operations, conversion of units, drug dosage and IV flow rate calculation. They had also inferred the significance of the participant’s level of competency when grouped according to gender.

The researchers had used a descriptive design. The samples of 340 participants were based from the Slovin’s formula. They had used stratified random sampling and students were selected from different section using fishbowl technique. The primary tool of the research was a 100 item drug calculation test which is composed of 4 areas: basic mathematical operations, conversion of units, drug dosage and IV flow rate calculation.

Findings 1. What is the participant’s level of competency on the following area? The participants had achieved a level 3 competency on basic mathematical operations and conversion of units; and level 2 competency on drug dosage and IV flow rate calculation. Their overall competency on drug dosage calculation is level 2. 2. Is there a significant difference when participants are group according to gender to compare their level of competency? There exists no significant difference on the participant’s level of competency when grouped according to gender. The level of competency of male and female respondents does not significantly differ. Conclusion

36

The level of competency on drug calculation among the 340 level IV nursing students of Far Eastern University was in level 2. The level of competency between male and female participants’ does not differ significantly.

The male and female participants’ were equally

competent based on the results of the test given by the researchers to measure their competency level on the four major areas in medication calculations. Recommendation The researchers recommend further enhancement of drug dosage calculation skills of level IV nursing students in Far Eastern University. Drug calculation concept in pharmacology must be further discussed in lectures; and if possible, there must be an increase in units in pharmacology so it will be given more emphasis. As early as level I, Algebra Course must be integrated with medication calculations. It is better if the institution will implement an annual assessment exam on this area to test the proficiency of their students. Teaching and learning strategies must be implemented effectively and must be given focus in practice. In every clinical exposure, clinical instructors must ask their students manual computations of drug dosage or flow rate before administering medications or setting up an IV infusion. They may also give regular exercises on medication calculation to master this skill. The researchers would like to recommend the following for the next researchers that would like to embark on a similar research. :

1. They can use this research as additional evidence that will further study and determine the level of competency on drug dosage calculations of nursing students.

2. The researchers also recommend that they also include the factors that affect the level of competency on drug dosage calculations of nursing students. . 3.

The researchers should also measure the anxiety level of the nursing students when answering mathematical tests.

4. The researchers are recommended to study the best strategies in teaching Mathematics which should come along with enough time to learn the subject, which should not be in a comprehensive manner but in an invasive manner. If these strategies be applied, the

37

next researchers should also check if there is an improvement in the competency of the students.

38