- Email: [email protected]
Drug calculations for nurses — a computer assisted learning application
02606917/90/0010-u27~/$10
NurreEducat~on Today (1990) 10,27&280 0 Longman Group L’K Ltd 1990
00
Drug calculations for nurses - a computer assisted learning application Thomas
Kwok-shing
Wong
A summative evaluation of the effectiveness of a computer assisted learning package, ‘Drug Calculations for Nurses’ was conducted. Two groups of students, the experimental and control were chosen from the schools of nursing where English was used as the medium of instruction. The experimental group was taught drug calculations in classrooms, but not the control group. Both groups used the software after they had attempted a drug calculation test. A posttreatment test of similar nature was undertaken to reflect the students’ mathematical achievement. An attitude semantic differential was used to measure subjects’ attitude. Findings of this investigation indicated that there was a significant difference in mathematical achievement of the students who experienced both teaching strategies as compared with the group taught by the computer software only. The experimental group scored significantly higher in their post-treatment test. Even though the control group did show some improvement, it was not statistically significant. Both groups demonstrated a positive attitude towards computer assisted learning, however, only the mean scores for the subscales comfort and function were significant. Implications of this study were then identified and areas for future research were recommended.
require
INTRODUCTION
competent
Administration of medicine is a common task but one which makes both the nurse and patient
different
very vulnerable.
Davis and Cohen (Thiele
1986)
found their study error rates to range from 5 20% of all medications administered in hospitals. Miscalculation
of drug
dosages
12% of these. Registration
accounted
authorities
for
normally
274
all nursing
students
in drug calculation
can be granted.
Nursing
backgrounds
should
before
students
come
and educational
some may have had nursing
experience
be
a licence from levels; before
they undertake nurse training. In these circumstances, teaching drug calculations to meet the need of students and the requirements of the registration
authorities
‘Drug Calculations practice
Thomas Kwok-shing Wong RN Dip Teach (NEd) BEd GD lnstr Comp Lecturer, Department of Health Sciences, Hong Kong Polytechnic, Hung Horn, Kowloon, Hong Kong. (Requests for offprints to TKW) Manuscript accepted 31 January 1990
that
game
may be difficult. for Nurses’
which
attempts
is a drill-andto address
the
above problem. It simulates the clinical situation where nurses dispense medications to patients. It is hoped that the game will help nurse educators function more proficiently withoutjeopardising their teaching
role. The software is divided
NURSE EDUCATION
Fig 1 Systems model for the design of computer-based
modules to facilitate modification and expansion. This has greatly increased its potential. Based on the Systems Model for the Design of Instructional Materials Computer Based (McCombs 1973), ‘Drug Calculations for Nurses’ was developed. Both the affective and cognitive student variables were observed in the process of development. Initially, the long-term educational goals were identified. The software objectives were specified in the light of the analysis of the instructional content and the entering student characteristics. Instructional sequence and strategies were worked out to facilitate accomplishment of these objectives. Then the materials were designed with particular attention to motivational factors such as creativity, usefulness and pleasantness. Criterion tests were organised in the order of difticulties. Before it was used by nursing students, a formative evaluation &riven 1967) or field testing of the design of the package was conducted. Thirty-one nursing students and five lecturers were invited to review the package. Generally, they felt that it was a worthwhile learning resource and enjoyed the challenge presented to them. However, there were two technical problems. Some students became confused by some inputs being single key entry into
instructional
TODAY
275
materials
while others requiring RETURN. This was then improved by adding the message ‘. . . and press RETURN’ to the latter. The second problem was the sound effect. Three mature age students claimed that they felt embarrassed by the sound when they gave the wrong answers to the questions. As this concern was not perceived by majority of the group, no attempt was made to alleviate such feeling. The last stage of the Systems Model is described in this paper. A summative evaluation (Striven 1967) of the effect of the software on student cognitive and affective attributes was carried out. It was envisaged that the findings would help the researcher further improve the quality of the package and explore its effect on student learning.
REVIEW OF THE LITERATURE Effects of instructional methods have been a long-standing topic of discussion among educators. Effects have always been viewed in the Authors have effectiveness. context of
276
NURSE EDUCATION
attempted
TODAY
to define effectiveness
as pointed
out
in various ways
by Chambers
and
Sprecher
found
(1980): ‘To some, effectiveness learning
means the amount
of retention
at the very least, whether
of learning,
Still others
are concerned
in attitude
instructional
medium
assisted
has been
studies.
or simply as a helpful (Chambers
of the controversy,
of computer Belfry
research
as an
& Sprecher
learning
reflected
and Winne
literature
computer
assisted
other
(1988)
learning
reviewed
before
and inferred
particularly
reported
when
the
that the mean
score
in computer
for
assisted
was higher than that for students who conventional instruction and 40% of significant.
were shown by Edwards
Similar
et al (cited by
1986). assisted learning
be very effective mathematics
and
stimulating
in primary
(Mevarech
8c Rich
has been found to in teaching
and secondary
1985,
Burns
schools
& Bozeman
1981). It would appear that it could be utilised effectively in teaching drug calculations. Reynolds and Pontious (1986) compared the relationship between students’ use of selected supplemental learning activities with their success on drug calculation that
the
computer
in contrast
able learning
tests. It was demondrill-and-practice
to any of the other
activities, were significantly
availrelated
which
conventional
supporters
teachers’
attitude
nology.
used with a
could
be
method
found
has
of
computers
for
the
assisted
shift in attitude learning
1986, Reynolds
1986, Cartwright
8c Pontious
1988).
in eight attitude
of
learning.
1986, Thiele
11 studies
towards
learning
preference
When
ation was conducted,
activities
an open-ended
tive of this mode of learning
indiwhich
for computer
many comments
’ “It really drummed
after
et al 1985,
Kulik et al (1980)
out
students demonstrated
have
towards
occurred (Ball
to
as a supple-
tool. Reviews of research
use was initiated
measured
and
and tech-
is important
usage especially
teaching
that
assisted
students’
and the latter’s receptivity
that a positive
assisted
been
attitude
learning
Hamby cated
of most computer
towards
Positive
computer
that
who
as compared
worksheets a
An area of concern
computer
learning received
Computer
as
learning
on
who participated
the results were statistically
used
in the mathe-
students
teaching.
the
1985
that it was more effective
methods,
the studies
problems,
who
categorised
mentary
edu-
students
strated
group
of
assisted learning
in nursing
computer was used as a supplement to other methods of instruction. It was found that 80% of
Hamby
computer
possible computer
numerous
difference
achievement
the effectiveness
through
published
most results suggested
findings
no significant
matical
former’s
1980) Regardless cation
experience.
with the learner’s
toward the computer
tool in the culture.’
or
or not an individual
stays in or drops out of a learning change
of
that takes place initially. To others it
means the degree
than
However, findings from a study conducted by Hamby (1986) contradicted these results. She
evalusuppor-
were received.
the information
into my
head.’ ‘It was fun and it went fast.’ ‘The
information
was spelled
out,
and
it
moved rapidly.’ ‘I liked being able to do it at my own pace.’ ‘There were problems.’
lots of examples
and
practice
‘It was fun and easy to do; it also tested me so I knew if I really learned
the material.’
‘I liked the sense of humour mer.” ’ These
positive outcomes
of the pogram-
attributed
(Thiele
1986)
to students
learning experience enhance their motivation and interest in future learning, thus improving their overall achievement
and performance.
to students’ success on the tests (p < 0.00009). They concluded by emphasising that computer assisted learning was effective as well as cost-andtime-efficient for students and teachers.
STATEMENT
OF THE PROBLEM
Findings
This study effectiveness
designed computer
Thiele
of similar nature were also reported
(1986).
by
was of
to determine the assisted learning
NURSE EDUCATION
Table 1 Subschs on attitude towards CAL semantic diierential (modified from L R Allen’s - 1986) Subscale
Adjective
Comfort
Pleasant Comfortable Nonthreatening Controllable Personal
- Unpleasant - Uncomfortable - Threatening - Overpowering - Impersonal
Creativity
Flexible Stimulating Creative
-
Function
Useful Valuable Efficient Time-saving Meaningful Appropriate Motivational
-
Rigid Boring Unimaginative
Useless - Worthless - Inefficient - Time consuming - Meaningless - Inappropriate - Distracting
TODAY
277
nursing where English was used as the medium of instruction. Their age range was from 18 - 23 years and they had not used computers before. Students of the experimental group had undertaken general nurse training for 12 months and had received 4 - 5 hours of didactic classroom instructions on drug calculations. The control group had only undertaken training for 6 weeks and had not received any theoretical instructions on drug calculations. All students were informed of the purpose of the investigation and their commitment. The procedure was explained before the study commenced.
Instruments
when used to supplement conventional teaching strategies. Specifically, the software ‘Drug Calculations for Nurses’, a drill-and-practice simuby the researcher was lation developed examined. Questions to be answered by this study included: 1. Is the achievement of nursing students on drug calculations after using ‘Drug Calculations for Nurses’ significantly greater than before? 2. Is there a significant difference in the achievement of nursing students taught drug calculations by lecture and computer assisted learning as compared with those taught by computer assisted learning only? Is there a significant difference in the 3. attitude of nursing students towards computer assisted learning when taught by lecture and computer assisted learning as compared with those taught by computer assisted learning only?
METHODS Subjects Two groups of students were chosen for this investigation. They all studied in the schools of
Two instruments were used to collect dependent variable data in this study. The first instrument was a drug calculation test formulated by the researcher to measure student’s level of mathematical competency. It was attempted before and after the use of the computer assisted learning software. The second instrument was modified from Allen’s Attitude Toward CAL Semantic Differential (1986). It consisted of 15 concepts which were grouped into three subscales. The instrument had a series of five-point bipolar adjectives such as pleasant/unpleasant or flexible/rigid and was filled in by students after they used the software.
Procedure To account for as much uncontrolled variance as possible, both the experimental and control groups of students attempted a pre-test which examined their !evels of competency in drug calculations before they used the computer assisted learning software. Instructions on how to operate the computers and keyboards were given to the students by the researcher. Then the software, ‘Drug Calculations for Nurses’ which was menu driven was used by both groups. Student manuals were provided for the subjects to consult when necessary. A post-test identical to the pre-test was administered immediately after the use of the software. In addition, the
278
NURSE EDUCATION
TODAY
Table 2 Means. standard deviations and significance levels (t-tests) for achievement on drug calculations of each group
DISCUSSION The
analyses
indicated
Subjects Experimental N = 50
Control N = 47
Pre- x CAL SD
4.14 0.36
3.77 0.86
Post- x CAL SD
4.72* 0.24
3.98 NS 0.91
of the
that
p < 0.05 NS = No significance
any theoretical
orientation any
These
show
researches
(1988),
semantic
differential.
the attitude
with the findings
and
standard
analyse
the data. The
mathematical development
deviations
were
used
to
levels of significance for attitude and
achievement were
determined
tailed t-score distribution
by using
one-
with 90 d.f.
Table 2 revealed that the subjects who were taught drug calculations by lecture and participated in the computer
assisted learning
demonstrated
a significant
mathematical
competency,
pen in the control any classroom
mental
on drug calculations.
of the two groups after
was compared,
the experi-
group scored significantly calculation
test than
both groups displayed assisted
higher
the control
(Table 3). Analysis of the data in Table computer
in their
but this did not hap-
group who had not received
When the performance
drug
improvement
instructions
using the software
activity
assisted instruction
Indeed
should
be seen
computer
assisted
job
potential
threat
learning.
When
performance to
rather
their
job
in the subscales
comfort
ledge
of drug
calculation
than
the
assisted learning
group
Analyses
is
more
trol
believed
The
felt
difference
experimental
by computer
in Table
Both experimental quite
comfortable
4 indiand con-
with
It was more so in the former was statistically
could be attributed experience
assisted learning
that interaction with and threatening.
of the data displayed
groups
know-
in the group
taught
impersonal
cated the opposite. interaction.
assisted
the students’
activity only.
It is commonly computer
The
in Table 3 further
taught by lecture and computer activity
as a
security.
this claim. The computer
activity facilitated
nurse
than
significant
to an experiential
and
factor. The
group might have compared in the classrooms
the
group.
their
with that in the
that
towards
their
mean
scores were compared, it was found that there were significant differences between these two groups
learning
such as learning
as an asset to improve
educators’
was
rather
than to replace other forms of instruction lecture.
and
and Pontious
group
4 indicated
positive attitude
in the
by Belfry
when used to supplement
substantiated
Means
calculation
improvement.
conducted
analyses of the data illustrated
RESULTS
computer
to drug
significant
(1986) in that computer
to complete
by the
and by Reynolds
more effective were asked
their mathematical
results were consistent
Winne
2
under-
The students who did not have
did
not
in Table
with basic
was enhanced
of similar
students
shown
standing of drug calculation, competency
assisted learning.
l
data
the students
Table 3 Means, standard deviations and significance levels (t-tests) Post-CAL achievement
and function.
The experimental group was significantly more positive in these two subscales on attitude than the contro1 group. However, this was not the case
s”D
in the subscale creativity.
* p < 0.05
Subjects Experimental n = 50
Control n = 47
4.72 0.24
3.98* 0.91
NURSE EDUCATION
Comfort s”D Creativity
x SD
Function
x SD
scores of the groups were compared, mental
Subjects Experimental n = 50
Control n = 47
20.88 2.05
19.43’ 2.02
11.84 1.68
group
the control
activity.
At least in
the latter situation they could control
the pace of
their learning. considered
the computer
ware creative.
The
that both
groups
assisted learning
soft-
mean scores for the experi-
mental and control groups were 11.84 and 11.30 respectively
i.e. 2.84 and 2.30 above the neutral
score 9, or 3.16 and 3.70 below the most positive score
15.
However,
difference
between
there
was no significant
the groups.
As the students
came from the schools of nursing of the hospitals where
didactic
exposure
was predominant,
to an alternative
some effects the
teaching
three
on their responses.
bipolar
t-test, there
the control
adjectives
were significant
tives flexible/rigid. cantly higher
strategy
Its mean
When
findings score
The
each of
latter
to
on adjecwas signifi-
for the experimental group.
an
could have
was subjected
group
than
considered
the
software quite rigid. This could be explained by the fact that the software required decision making in two or more stages. For instance, students
had to inform
the computer
used
to the subscale
attitude of the students
the
in both groups was quite
positive. They generally felt that the computer assisted learning software was functional. It was
test difficult even after they
software.
This
be
very
could affect
could
their
differential.
Implications for future studies There
are many rooms
for future
this area. The researcher while he was teaching its effectiveness used
for
effects software
in Australia
6 months.
This
were not familiar of
differential
drugs.
with the dosages Furthermore,
was designed
States and the connotations be verified
the
the clinical
hospitals. Therefore the subjects of this
and
the
has some
For instance,
investigation
tives should
and evaluated
to simulate
situation in the Australian it is not surprising that
semantic
in
the software
probably
study.
was developed
names
research
designed
in Hong Kong after it had been
on the present
the
in the United
of the bipolar adjec-
in order
to ensure
the
validity of this study. In the light of the findings of the investigation and
its limitations
mentioned
searcher recommended the future research:
another
group did not
group who did
input might have found
to the semantic
1. Modify
function,
be
explained
role of the nurse educa-
and subsequently
the
think this was tedious or rigid. They probably had experienced similar encounters in nursing. With reference
the
that they
were ready to input the answer before they could actually do so. The experimental
factor
of the control
the drug calculation frustrating
to note
than
this could
for Nurses’ was not meant
the teaching
tors. The students
had
It was interesting
higher
again,
to the experiential
not have any theoretical
26.68* 3.00
learning
Once
‘Drug Calculations to replace
responses
assisted
the experi-
significantly
above.
* p < 0.05 NS = No significance
computer
scored
group.
attributed
11.30 NS 1.69
29.36 4.96
279
useful, valuable, time-saving, meaningful, appropriate and motivational. When the mean
Table 4 Means, standard deviations and significance levels (t-tests) of the subscales on attitude towards CAI semantic differential
Subscales
TODAY
the
above,
the following
present
study
group of students,
to
the
re-
areas for
include
who are taught
drug calculations by lecture only. 2. Modify the computer assisted learning software
to
include
an
instructional
component and replicate this study. 3. Conduct comparative studies similar to the present investigation between a) Asian and European students, b) Students from English speaking
schools
,80
NURSE EDUCATION
TODAY
and students from Cantonese speaking schools. 4. Translate the semantic differential into Chinese and replicate the study.
CONCLUSION on the results of data analyses, and within .he limitations of the study, it was concluded that Drug Calculations for Nurses’ was related signiScantly to the nursing students’ mathematical achievement and the development of a positive attitude towards computer assisted learning. As Based
Far as the
summative
evaluation
is concerned,
:here is no indication for immediate modifi:ation of the software. However, continuous .tpdating of the contents is necessary in order to Iscertain its relevancy to current practice.
Fieferences illen L R 1986 Measuring attitude toward computer assisted instruction. Computers in Nursing 4,4: 144151 3all M J et al 1985 Nurses perceptions concerning computer uses before and after a computer literacy lecture. Computers in Nursing 3, 1: 23-32 3elfry M J, Winne P H 1988 A review of the effectiveness of computer assisted instruction in nursing education. Computers in Nursing 6,2: 77-85
Burns P, Bozeman W 1981 Computer-assistedinstruction 8c mathematics achievement: is there a relationship? Educational Technology 23, 10: 32-39 Cartwright M 1988 Computers and nursing education in one Australian tertiary institution. Nurse Education Today, 8: 23-29 Chambers J A, Sprecher J W 1980 Computer-assisted instruction: current trends and critical issues. CACM, 23,6: 332-342. In: Hamby C C 1986 A study of the effects of computer assisted instruction on the attitude and achievement of vocational nursing students. Computers in Nursing 4, 3: 109-l 13 Davis N M, Cohen M R 1981 Medication errors: Causes and prevention. In: Thiele J 1986 The development of computer assisted instruction for drug dosage calculations - a group endeavour. Computers in Nursing 4,8: 114-118 Edwards J et al 1975 How effective is CAI: a review of research. Educational Leadership 33,2: 147-153. In:
Hamby C C 1986 Kulik 1 et al 1980 Effectiveness of computer-based college teaching: a meta-analysis of findings. Review of Educational Research 50, 4: 525-554. In: Allen L R 1986 McCombs B L et al 1973 An adaptive model for utilising learner characteristics in computer based instructional system. Educational Technology, April: 47-5 1 Mevarech A R, Rich Y 1985 Effects of computerassisted mathematics instruction on disadvantaged pupils cognitive and affective development. Journal of Educational Research 79, 1: 5-l 1 Reynolds A, Pontious S 1986 CA1 Enhances the medication dosage calculation competency of nursing students. Computers in Nursing 4,4: 158-165 Schwirian P M 1987 Evaluation research in computerbased instruction. Computers in Nursing 5.4: 128 131 Striven M 1967 The Methodology of Evaluation In: Stenhouse L 1975 An Introduction to Curriculum Research and Development. Heinemann, London.
NurreEducat~on Today (1990) 10,27&280 0 Longman Group L’K Ltd 1990
00
Drug calculations for nurses - a computer assisted learning application Thomas
Kwok-shing
Wong
A summative evaluation of the effectiveness of a computer assisted learning package, ‘Drug Calculations for Nurses’ was conducted. Two groups of students, the experimental and control were chosen from the schools of nursing where English was used as the medium of instruction. The experimental group was taught drug calculations in classrooms, but not the control group. Both groups used the software after they had attempted a drug calculation test. A posttreatment test of similar nature was undertaken to reflect the students’ mathematical achievement. An attitude semantic differential was used to measure subjects’ attitude. Findings of this investigation indicated that there was a significant difference in mathematical achievement of the students who experienced both teaching strategies as compared with the group taught by the computer software only. The experimental group scored significantly higher in their post-treatment test. Even though the control group did show some improvement, it was not statistically significant. Both groups demonstrated a positive attitude towards computer assisted learning, however, only the mean scores for the subscales comfort and function were significant. Implications of this study were then identified and areas for future research were recommended.
require
INTRODUCTION
competent
Administration of medicine is a common task but one which makes both the nurse and patient
different
very vulnerable.
Davis and Cohen (Thiele
1986)
found their study error rates to range from 5 20% of all medications administered in hospitals. Miscalculation
of drug
dosages
12% of these. Registration
accounted
authorities
for
normally
274
all nursing
students
in drug calculation
can be granted.
Nursing
backgrounds
should
before
students
come
and educational
some may have had nursing
experience
be
a licence from levels; before
they undertake nurse training. In these circumstances, teaching drug calculations to meet the need of students and the requirements of the registration
authorities
‘Drug Calculations practice
Thomas Kwok-shing Wong RN Dip Teach (NEd) BEd GD lnstr Comp Lecturer, Department of Health Sciences, Hong Kong Polytechnic, Hung Horn, Kowloon, Hong Kong. (Requests for offprints to TKW) Manuscript accepted 31 January 1990
that
game
may be difficult. for Nurses’
which
attempts
is a drill-andto address
the
above problem. It simulates the clinical situation where nurses dispense medications to patients. It is hoped that the game will help nurse educators function more proficiently withoutjeopardising their teaching
role. The software is divided
NURSE EDUCATION
Fig 1 Systems model for the design of computer-based
modules to facilitate modification and expansion. This has greatly increased its potential. Based on the Systems Model for the Design of Instructional Materials Computer Based (McCombs 1973), ‘Drug Calculations for Nurses’ was developed. Both the affective and cognitive student variables were observed in the process of development. Initially, the long-term educational goals were identified. The software objectives were specified in the light of the analysis of the instructional content and the entering student characteristics. Instructional sequence and strategies were worked out to facilitate accomplishment of these objectives. Then the materials were designed with particular attention to motivational factors such as creativity, usefulness and pleasantness. Criterion tests were organised in the order of difticulties. Before it was used by nursing students, a formative evaluation &riven 1967) or field testing of the design of the package was conducted. Thirty-one nursing students and five lecturers were invited to review the package. Generally, they felt that it was a worthwhile learning resource and enjoyed the challenge presented to them. However, there were two technical problems. Some students became confused by some inputs being single key entry into
instructional
TODAY
275
materials
while others requiring RETURN. This was then improved by adding the message ‘. . . and press RETURN’ to the latter. The second problem was the sound effect. Three mature age students claimed that they felt embarrassed by the sound when they gave the wrong answers to the questions. As this concern was not perceived by majority of the group, no attempt was made to alleviate such feeling. The last stage of the Systems Model is described in this paper. A summative evaluation (Striven 1967) of the effect of the software on student cognitive and affective attributes was carried out. It was envisaged that the findings would help the researcher further improve the quality of the package and explore its effect on student learning.
REVIEW OF THE LITERATURE Effects of instructional methods have been a long-standing topic of discussion among educators. Effects have always been viewed in the Authors have effectiveness. context of
276
NURSE EDUCATION
attempted
TODAY
to define effectiveness
as pointed
out
in various ways
by Chambers
and
Sprecher
found
(1980): ‘To some, effectiveness learning
means the amount
of retention
at the very least, whether
of learning,
Still others
are concerned
in attitude
instructional
medium
assisted
has been
studies.
or simply as a helpful (Chambers
of the controversy,
of computer Belfry
research
as an
& Sprecher
learning
reflected
and Winne
literature
computer
assisted
other
(1988)
learning
reviewed
before
and inferred
particularly
reported
when
the
that the mean
score
in computer
for
assisted
was higher than that for students who conventional instruction and 40% of significant.
were shown by Edwards
Similar
et al (cited by
1986). assisted learning
be very effective mathematics
and
stimulating
in primary
(Mevarech
8c Rich
has been found to in teaching
and secondary
1985,
Burns
schools
& Bozeman
1981). It would appear that it could be utilised effectively in teaching drug calculations. Reynolds and Pontious (1986) compared the relationship between students’ use of selected supplemental learning activities with their success on drug calculation that
the
computer
in contrast
able learning
tests. It was demondrill-and-practice
to any of the other
activities, were significantly
availrelated
which
conventional
supporters
teachers’
attitude
nology.
used with a
could
be
method
found
has
of
computers
for
the
assisted
shift in attitude learning
1986, Reynolds
1986, Cartwright
8c Pontious
1988).
in eight attitude
of
learning.
1986, Thiele
11 studies
towards
learning
preference
When
ation was conducted,
activities
an open-ended
tive of this mode of learning
indiwhich
for computer
many comments
’ “It really drummed
after
et al 1985,
Kulik et al (1980)
out
students demonstrated
have
towards
occurred (Ball
to
as a supple-
tool. Reviews of research
use was initiated
measured
and
and tech-
is important
usage especially
teaching
that
assisted
students’
and the latter’s receptivity
that a positive
assisted
been
attitude
learning
Hamby cated
of most computer
towards
Positive
computer
that
who
as compared
worksheets a
An area of concern
computer
learning received
Computer
as
learning
on
who participated
the results were statistically
used
in the mathe-
students
teaching.
the
1985
that it was more effective
methods,
the studies
problems,
who
categorised
mentary
edu-
students
strated
group
of
assisted learning
in nursing
computer was used as a supplement to other methods of instruction. It was found that 80% of
Hamby
computer
possible computer
numerous
difference
achievement
the effectiveness
through
published
most results suggested
findings
no significant
matical
former’s
1980) Regardless cation
experience.
with the learner’s
toward the computer
tool in the culture.’
or
or not an individual
stays in or drops out of a learning change
of
that takes place initially. To others it
means the degree
than
However, findings from a study conducted by Hamby (1986) contradicted these results. She
evalusuppor-
were received.
the information
into my
head.’ ‘It was fun and it went fast.’ ‘The
information
was spelled
out,
and
it
moved rapidly.’ ‘I liked being able to do it at my own pace.’ ‘There were problems.’
lots of examples
and
practice
‘It was fun and easy to do; it also tested me so I knew if I really learned
the material.’
‘I liked the sense of humour mer.” ’ These
positive outcomes
of the pogram-
attributed
(Thiele
1986)
to students
learning experience enhance their motivation and interest in future learning, thus improving their overall achievement
and performance.
to students’ success on the tests (p < 0.00009). They concluded by emphasising that computer assisted learning was effective as well as cost-andtime-efficient for students and teachers.
STATEMENT
OF THE PROBLEM
Findings
This study effectiveness
designed computer
Thiele
of similar nature were also reported
(1986).
by
was of
to determine the assisted learning
NURSE EDUCATION
Table 1 Subschs on attitude towards CAL semantic diierential (modified from L R Allen’s - 1986) Subscale
Adjective
Comfort
Pleasant Comfortable Nonthreatening Controllable Personal
- Unpleasant - Uncomfortable - Threatening - Overpowering - Impersonal
Creativity
Flexible Stimulating Creative
-
Function
Useful Valuable Efficient Time-saving Meaningful Appropriate Motivational
-
Rigid Boring Unimaginative
Useless - Worthless - Inefficient - Time consuming - Meaningless - Inappropriate - Distracting
TODAY
277
nursing where English was used as the medium of instruction. Their age range was from 18 - 23 years and they had not used computers before. Students of the experimental group had undertaken general nurse training for 12 months and had received 4 - 5 hours of didactic classroom instructions on drug calculations. The control group had only undertaken training for 6 weeks and had not received any theoretical instructions on drug calculations. All students were informed of the purpose of the investigation and their commitment. The procedure was explained before the study commenced.
Instruments
when used to supplement conventional teaching strategies. Specifically, the software ‘Drug Calculations for Nurses’, a drill-and-practice simuby the researcher was lation developed examined. Questions to be answered by this study included: 1. Is the achievement of nursing students on drug calculations after using ‘Drug Calculations for Nurses’ significantly greater than before? 2. Is there a significant difference in the achievement of nursing students taught drug calculations by lecture and computer assisted learning as compared with those taught by computer assisted learning only? Is there a significant difference in the 3. attitude of nursing students towards computer assisted learning when taught by lecture and computer assisted learning as compared with those taught by computer assisted learning only?
METHODS Subjects Two groups of students were chosen for this investigation. They all studied in the schools of
Two instruments were used to collect dependent variable data in this study. The first instrument was a drug calculation test formulated by the researcher to measure student’s level of mathematical competency. It was attempted before and after the use of the computer assisted learning software. The second instrument was modified from Allen’s Attitude Toward CAL Semantic Differential (1986). It consisted of 15 concepts which were grouped into three subscales. The instrument had a series of five-point bipolar adjectives such as pleasant/unpleasant or flexible/rigid and was filled in by students after they used the software.
Procedure To account for as much uncontrolled variance as possible, both the experimental and control groups of students attempted a pre-test which examined their !evels of competency in drug calculations before they used the computer assisted learning software. Instructions on how to operate the computers and keyboards were given to the students by the researcher. Then the software, ‘Drug Calculations for Nurses’ which was menu driven was used by both groups. Student manuals were provided for the subjects to consult when necessary. A post-test identical to the pre-test was administered immediately after the use of the software. In addition, the
278
NURSE EDUCATION
TODAY
Table 2 Means. standard deviations and significance levels (t-tests) for achievement on drug calculations of each group
DISCUSSION The
analyses
indicated
Subjects Experimental N = 50
Control N = 47
Pre- x CAL SD
4.14 0.36
3.77 0.86
Post- x CAL SD
4.72* 0.24
3.98 NS 0.91
of the
that
p < 0.05 NS = No significance
any theoretical
orientation any
These
show
researches
(1988),
semantic
differential.
the attitude
with the findings
and
standard
analyse
the data. The
mathematical development
deviations
were
used
to
levels of significance for attitude and
achievement were
determined
tailed t-score distribution
by using
one-
with 90 d.f.
Table 2 revealed that the subjects who were taught drug calculations by lecture and participated in the computer
assisted learning
demonstrated
a significant
mathematical
competency,
pen in the control any classroom
mental
on drug calculations.
of the two groups after
was compared,
the experi-
group scored significantly calculation
test than
both groups displayed assisted
higher
the control
(Table 3). Analysis of the data in Table computer
in their
but this did not hap-
group who had not received
When the performance
drug
improvement
instructions
using the software
activity
assisted instruction
Indeed
should
be seen
computer
assisted
job
potential
threat
learning.
When
performance to
rather
their
job
in the subscales
comfort
ledge
of drug
calculation
than
the
assisted learning
group
Analyses
is
more
trol
believed
The
felt
difference
experimental
by computer
in Table
Both experimental quite
comfortable
4 indiand con-
with
It was more so in the former was statistically
could be attributed experience
assisted learning
that interaction with and threatening.
of the data displayed
groups
know-
in the group
taught
impersonal
cated the opposite. interaction.
assisted
the students’
activity only.
It is commonly computer
The
in Table 3 further
taught by lecture and computer activity
as a
security.
this claim. The computer
activity facilitated
nurse
than
significant
to an experiential
and
factor. The
group might have compared in the classrooms
the
group.
their
with that in the
that
towards
their
mean
scores were compared, it was found that there were significant differences between these two groups
learning
such as learning
as an asset to improve
educators’
was
rather
than to replace other forms of instruction lecture.
and
and Pontious
group
4 indicated
positive attitude
in the
by Belfry
when used to supplement
substantiated
Means
calculation
improvement.
conducted
analyses of the data illustrated
RESULTS
computer
to drug
significant
(1986) in that computer
to complete
by the
and by Reynolds
more effective were asked
their mathematical
results were consistent
Winne
2
under-
The students who did not have
did
not
in Table
with basic
was enhanced
of similar
students
shown
standing of drug calculation, competency
assisted learning.
l
data
the students
Table 3 Means, standard deviations and significance levels (t-tests) Post-CAL achievement
and function.
The experimental group was significantly more positive in these two subscales on attitude than the contro1 group. However, this was not the case
s”D
in the subscale creativity.
* p < 0.05
Subjects Experimental n = 50
Control n = 47
4.72 0.24
3.98* 0.91
NURSE EDUCATION
Comfort s”D Creativity
x SD
Function
x SD
scores of the groups were compared, mental
Subjects Experimental n = 50
Control n = 47
20.88 2.05
19.43’ 2.02
11.84 1.68
group
the control
activity.
At least in
the latter situation they could control
the pace of
their learning. considered
the computer
ware creative.
The
that both
groups
assisted learning
soft-
mean scores for the experi-
mental and control groups were 11.84 and 11.30 respectively
i.e. 2.84 and 2.30 above the neutral
score 9, or 3.16 and 3.70 below the most positive score
15.
However,
difference
between
there
was no significant
the groups.
As the students
came from the schools of nursing of the hospitals where
didactic
exposure
was predominant,
to an alternative
some effects the
teaching
three
on their responses.
bipolar
t-test, there
the control
adjectives
were significant
tives flexible/rigid. cantly higher
strategy
Its mean
When
findings score
The
each of
latter
to
on adjecwas signifi-
for the experimental group.
an
could have
was subjected
group
than
considered
the
software quite rigid. This could be explained by the fact that the software required decision making in two or more stages. For instance, students
had to inform
the computer
used
to the subscale
attitude of the students
the
in both groups was quite
positive. They generally felt that the computer assisted learning software was functional. It was
test difficult even after they
software.
This
be
very
could affect
could
their
differential.
Implications for future studies There
are many rooms
for future
this area. The researcher while he was teaching its effectiveness used
for
effects software
in Australia
6 months.
This
were not familiar of
differential
drugs.
with the dosages Furthermore,
was designed
States and the connotations be verified
the
the clinical
hospitals. Therefore the subjects of this
and
the
has some
For instance,
investigation
tives should
and evaluated
to simulate
situation in the Australian it is not surprising that
semantic
in
the software
probably
study.
was developed
names
research
designed
in Hong Kong after it had been
on the present
the
in the United
of the bipolar adjec-
in order
to ensure
the
validity of this study. In the light of the findings of the investigation and
its limitations
mentioned
searcher recommended the future research:
another
group did not
group who did
input might have found
to the semantic
1. Modify
function,
be
explained
role of the nurse educa-
and subsequently
the
think this was tedious or rigid. They probably had experienced similar encounters in nursing. With reference
the
that they
were ready to input the answer before they could actually do so. The experimental
factor
of the control
the drug calculation frustrating
to note
than
this could
for Nurses’ was not meant
the teaching
tors. The students
had
It was interesting
higher
again,
to the experiential
not have any theoretical
26.68* 3.00
learning
Once
‘Drug Calculations to replace
responses
assisted
the experi-
significantly
above.
* p < 0.05 NS = No significance
computer
scored
group.
attributed
11.30 NS 1.69
29.36 4.96
279
useful, valuable, time-saving, meaningful, appropriate and motivational. When the mean
Table 4 Means, standard deviations and significance levels (t-tests) of the subscales on attitude towards CAI semantic differential
Subscales
TODAY
the
above,
the following
present
study
group of students,
to
the
re-
areas for
include
who are taught
drug calculations by lecture only. 2. Modify the computer assisted learning software
to
include
an
instructional
component and replicate this study. 3. Conduct comparative studies similar to the present investigation between a) Asian and European students, b) Students from English speaking
schools
,80
NURSE EDUCATION
TODAY
and students from Cantonese speaking schools. 4. Translate the semantic differential into Chinese and replicate the study.
CONCLUSION on the results of data analyses, and within .he limitations of the study, it was concluded that Drug Calculations for Nurses’ was related signiScantly to the nursing students’ mathematical achievement and the development of a positive attitude towards computer assisted learning. As Based
Far as the
summative
evaluation
is concerned,
:here is no indication for immediate modifi:ation of the software. However, continuous .tpdating of the contents is necessary in order to Iscertain its relevancy to current practice.
Fieferences illen L R 1986 Measuring attitude toward computer assisted instruction. Computers in Nursing 4,4: 144151 3all M J et al 1985 Nurses perceptions concerning computer uses before and after a computer literacy lecture. Computers in Nursing 3, 1: 23-32 3elfry M J, Winne P H 1988 A review of the effectiveness of computer assisted instruction in nursing education. Computers in Nursing 6,2: 77-85
Burns P, Bozeman W 1981 Computer-assistedinstruction 8c mathematics achievement: is there a relationship? Educational Technology 23, 10: 32-39 Cartwright M 1988 Computers and nursing education in one Australian tertiary institution. Nurse Education Today, 8: 23-29 Chambers J A, Sprecher J W 1980 Computer-assisted instruction: current trends and critical issues. CACM, 23,6: 332-342. In: Hamby C C 1986 A study of the effects of computer assisted instruction on the attitude and achievement of vocational nursing students. Computers in Nursing 4, 3: 109-l 13 Davis N M, Cohen M R 1981 Medication errors: Causes and prevention. In: Thiele J 1986 The development of computer assisted instruction for drug dosage calculations - a group endeavour. Computers in Nursing 4,8: 114-118 Edwards J et al 1975 How effective is CAI: a review of research. Educational Leadership 33,2: 147-153. In:
Hamby C C 1986 Kulik 1 et al 1980 Effectiveness of computer-based college teaching: a meta-analysis of findings. Review of Educational Research 50, 4: 525-554. In: Allen L R 1986 McCombs B L et al 1973 An adaptive model for utilising learner characteristics in computer based instructional system. Educational Technology, April: 47-5 1 Mevarech A R, Rich Y 1985 Effects of computerassisted mathematics instruction on disadvantaged pupils cognitive and affective development. Journal of Educational Research 79, 1: 5-l 1 Reynolds A, Pontious S 1986 CA1 Enhances the medication dosage calculation competency of nursing students. Computers in Nursing 4,4: 158-165 Schwirian P M 1987 Evaluation research in computerbased instruction. Computers in Nursing 5.4: 128 131 Striven M 1967 The Methodology of Evaluation In: Stenhouse L 1975 An Introduction to Curriculum Research and Development. Heinemann, London.