Course: Numeracy for Nursing Practice | Open Essex

  • Exploring Numeracy for Nursing

    Student nurse administering an injectionWelcome to the Numeracy Moodle page for the School of Health and Human Sciences.

    The resources on this page have been designed to address the numeracy requirements for the BSc in Nursing (Adult & Mental Health).


    There is also a resources page containing a reading list and links to some websites that you might find useful in supporting your studies.


    Don't forget, you've also got access to SafeMedicate.com, where you can practise some of these calculations at your own pace and in your own time.

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    • Numeracy Forum
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      Please use this forum for:

      • Posting questions for response from peers or the Numeracy Tutor
      • Discussing numeracy strategies
      • Notifying typos, errors or broken links
      • Suggesting new resources

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  • 1

    Welcome to the Numeracy Moodle page! This site contains resources, tutorials, screencasts, exercises and other links that will help you to develop your skills and your confidence in your ability to use numeracy as a key nursing skill.

    You may already be very confident with your numeracy skills, and looking forward to applying them in the clinical context. 

    On the other hand, maths may be a subject that you've always struggled with and something that you're dreading having to face again at university. If this sounds more like you, don't panic! Here at the University of Essex, we have plenty of ways to support you throughout your studies.

    It may interest you to know that if you're worried about maths, you're definitely not alone! About 80% (four out of every five) of adults in the UK have some difficulties with practical numeracy skills; this includes plenty of people who already have a GCSE at grade C or above!

    The good news: As long as you're prepared to work at your skills and to engage with the resources and the opportunities provided to help you, we're certain that you'll be absolutely fine.

    This short video gives more information about adults who struggle with numeracy. It's a lot more common than you might think.

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      The following video dispels the myth that maths achievement is all about talent, and places it in the framework of values that we teach on the nursing degree. Your belief in your ability to improve and the effort that you are prepared to put in will take you much further than your 'talent'!

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  • 2

    The table below shows a very wide range of numeracy skills, mapped to specific nursing tasks. You will cover many of these, both in university and on placement, during your first year. Your numeracy assesssment for HS541, at the end of Year 1, will focus only on Medication Dosages and Unit Conversions, as detailed in the NMC's Essential Skills Cluster 33.

    You will see that the same skills - arithmetic, decimal place value and fractions occur repeatedly.

    Taxonomy of nursing tasks and associated numeracy skills

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  • 3

    Books

    Introductory


    Chinn S (2011) The Fear of Maths: How to Overcome It London: Souvenir Press Online Book - Albert Sloman Library

    Coben D & Atere Roberts E (2005) Calculations for Nursing and Healthcare (2nd edition) Basingstoke: Palgrave Macmillan

    Haylock W & Warburton P (2013) Mathematics Explained for Healthcare Practitioners London: Sage


    Intermediate

    Gatford JD & Phillips N (2002) Nursing Calculations London: Churchill Livingstone Online Book - Albert Sloman Library

    Hutton M (2008) Essential Calculation Skills for Nurses, Midwives and Healthcare Practitioners Maidenhead: Open University Press Online Book - Albert Sloman Library

    Lapham R & Agar H (2009) Drug Calculations for Nurses (3rd Edition) London: Hodder Arnold Online Book - Albert Sloman Library

    Scott WN & McGrath D (2009) Dosage Calculations Made Incredibly Easy London: Lippincott, Williams and Wilkins

    Starkings S & Krause L (2015) Passing Calculations Tests for Nursing Students (3rd edition) London: Learning Matters Companion Website - Student Resources

    Wright K (2011) Drug Calculations for Nurses – Context for Practice Basingstoke: Palgrave Companion Website


    Advanced

    Olsen JL, Giangrasso AP, Shrimpton DM, Dillon PM & Cunningham S (2010) Dosage Calculations for Nurses Harlow: Pearson


    Selected Online Resources - General Adult and Clinical Numeracy

    Baxter Healthcare - Good Practice for Drug Calculations

    BBC GCSE Bitesize Maths - Number

    BBC Skillswise Maths

    Citizen Maths

    Flinders University - Basic Drug Calculations

    Flinders University - Metric SI Units and Conversions

    Khan Academy

    National Numeracy Challenge

    Nursing Numeracy Info

    Queen's University Belfast - Numeracy Skills for Drug Calculations

    RMIT University - Online Learning Module for Drug Calculations

    RMIT University - Resources for Nursing Students

    SafeMedicate.com

    SN@P - NHS Standard Numeracy Assessment Process

    University of the West of England Bristol - Online Numeracy Course for Health & Social Care

    Essential Calculation Skills For Nurses, Midwives And Healthcare Practitioners
    by Hutton, Meriel
    Price to Student £5.99 *
    * VAT included
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  • 4

    There are many strategies for solving number problems. The method that you were taught at school may still work well for you. However, if maths just didn't 'click' at school and you still find mental and/or written arithmetic confusing, then this section is here to help. It contains:

    • quick guides to the essential strategies for basic arithmetic
    • short screencasts and supporting resources for brushing up your skills
    • topics presented in order of difficulty, starting with some quite basic revision materials, working through to more complex and challenging calculations. 

    Please do take the time to explore the resources on the Khan Academy and Maths Doctor websites. Each has a variety of online exercises and worksheets for practising your skills.

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  • 5

    A sound understanding of fractions and decimals will help you to master the basics of drug calculations quickly and efficiently.

    The following resources will help you to refresh your knowledge of fractions, decimals and percentages, including how to perform calculations with them and how they relate to each other in practice. 

    • Fractions, Decimal Fractions and Percentages: Explained with Infographics! Lightbox Gallery
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      The link above will take you to a gallery of 2 infographics, which explain fractions, decimal fractions and percentages in their simplest terms.

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      This Prezi resource covers the basics of fractions, from what they are, through to cancelling and multiplying for drug calculations. Work through at your own pace and in your time, and please feel free to contact me if you are still concerned.

      Click this link to open the resource in a new window.


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      The following resources will help you to tackle the various calculations relating to fractions, decimals and percentages:

      Introduction to Fractions - Open University

      Finding a Fraction of a Number - Maths Doctor

      Simplifying Fractions - Maths Doctor

      Learning to multiply fractions efficiently and confidently will help you to work out drug calculations confidently and efficiently. It is absolutely vital to many of the standard formulae used in drug calculations. Thankfully, it is much easier than you probably remember.  The screencast below will help you to understand the process. Please do follow the other links available on this site if you are having difficulties with understanding related concepts such as cancelling down. Alternatively, please feel free to book a tutorial or a small group workshop, where I will be able to consolidate your understanding of these calculations.

      Multiplying Fractions - Khan Academy


      You may need to revise your written division methods from Topic 1 before attempting this section.

      Alternatively, it is a very good idea to memorise the most common equivalencies between decimals and fractions so thoroughly that they become second nature to you. 

      Converting Fractions to Decimals - Khan Academy 

      Converting Decimals to Fractions - Khan Academy

      Fractions, Decimals and Percentages - Khan Academy

      Fractions, Decimals and Percentages - Maths Doctor

      Once you are confident with all of these, try the test below to check your skills!

    • Fractions, Decimals and Percentages - Test Yourself Level 2 Quiz
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  • 6

    In this section, we will cover how to calculate with units of measure within the same system. You will learn about the relationship between units of measure in the metric system - kilograms, grams, milligrams and micrograms, and how to convert between them quickly and easily.

    This skill is very important for avoiding drug errors. An incorrectly placed decimal point could potentially lead to a 10, 100 or even 1000 times overdose or underdose - with potentially fatal implications for the patient.


    The Rules


    unit conversions infographic
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      The Strategies

      1. Moving the Decimal Point


      The following link takes you to the website of Queen's University Belfast; one of the very best online resources for student nurses. A clearly explained screencast walks you through the 'moving the decimal point' method, and the interactive questions allow you to test your skills.

      Queen's University Belfast - Conversions for Drug Calculations.


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      2. Place Value Charts

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      Place Value Charts (cont.)

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      The Tools

      Further resources to help you develop your skills.

    • Test Yourself - Unit Conversions File
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      3.4 MB
    • Place Value Slide Rule Kit Folder
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      This folder contains all the documents and information you need to make your own effective slide rule for working out unit conversions.

      1. Print the document

      2. Laminate the document (recommended so you can wipe clean and use again)

      3.Score or cut along the dotted lines

      4. Insert the strip into the slot

      5. Job done!

    • Interactive Gattegno Chart File
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      You can use this chart to consolidate your understanding of positional notation (place value). Change the digits in the number, and watch the relevant chart sections light up.


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      The Quiz


      tick in a circleOnce you've decided which strategy works best for you, test your skills with this interactive quiz.

    • SI Unit Conversions - Test Yourself Quiz
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  • 7
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  • 8

    In this section, we will explore how to use an easy-to-remember formula for solving medication dosage calculations.

    • Tablets and Capsules Book
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      This short tutorial will take you through the basic formula and rules for setting up drug calculations. If solving the problems without a calculator is difficult, then you should work through the resources in Topic 2 - Fractions, Decimals and Percentages.

    • Liquid Medicines and Injections Book
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      This short tutorial will take you through the basic formula and rules for setting up drug calculations involving liquids medicines and injections. If you have understood the fundamental principles of the NHS1 formula, you should find this topic relatively straightforward.

      If solving the problems without a calculator is difficult, then you should work through the resources in Topic 2 - Fractions, Decimals and Percentages.

    • Calculations in Micrograms/Milligrams File
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      Some nurses find digoxin and certain mental health medication calculations difficult because the strength on the product labels is often given in micrograms, whereas the patient's dose is often written up in milligrams.

      Work through the following document to ensure that you are confident in performing the conversions and setting up and solving the formula.

      39.8 KB
    • Calculations by Body Weight from RMIT University URL
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      Short screencast detailing how to calculate by body weight, from RMIT University.

      This screecast shows how to calculate a daily dosage by body weight. Remember that calculations may require you to divide this dose (e.g. 50/mg/kg daily, in four divided doses).

    • Drug Calculations Screencast URL
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      The following screencast talks you through a couple of straightforward drug calculations involving tablets, including divided doses calculated by body weight.

      It was recorded before we changed the formula that we teach to NHS1, and will be updated in due course. However, it may help you to consolidate your understanding of the principles involved.

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  • 9
    MDC calculations infographicThese revision resources contain examples of the type of questions tht you can expect in the Numeracy and Medication Dosage Calculations exam for HS541. Accuracy is essential, and it's important to think about your exam technique and to be very aware of the areas that you find most challenging. Remember, these are practise questions only - you may need to go to the other sections to find tutorial resources to help you to develop your skills. Alternatively, get in touch with me if you would like some additional support, either 1:1 or in small groups.

    Click here to request a 1:1 tutorial.

    The questions will cover:

    • SI Unit Conversion
    • Tablets and Capsules
    • Liquid Medicines
    • Injections
    • Unit, Multiple Unit and Sub Unit Doses

    The resources are split into three sections:

    1. In-house resources, developed to help you prepare for University of Essex drug calculation exams.
    2. External e-learning resources
    3. Printable resources
    Good luck!
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      University of Essex Resources

    • Unit Conversions - Test Yourself! File
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      Interactive, self-marking question generator.

      3.4 MB
    • Practise Your Skills Quiz
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      External E-learning Resources

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      The drug calculations site at Queen's University Belfast is one of the best interactive random question generators available. However, it's drawback is that in order to generate such a wide range of numbers, they're not always clinically realistic. So - brilliant for developing your numeracy skills, but use with caution and don't become de-sensitised to odd looking doses and quantities.

      Their Year 1 curriculum is slightly different from ours; remember, our exam will only focus on SI unit conversions, tablets, liquid medicines and injections. It's a good idea to develop competence in the other areas though - numeracy skills all link together eventually!

    • Queen's University Belfast Conversions URL
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    • Queen's University Belfast Basic Drug Calculations URL
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    • Queen's University Belfast - Tablets URL
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    • Queen's University Belfast Intermediate Drug Calculations URL
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      These questions are more challenging than Year 1 questions.
    • NHS SN@P URL
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      SN@P stands for Standard Numeracy Assessment Process and is the NHS's own e-learning tool for numeracy skills. 

      User account needed - you'll need to set this up yourself; please do come to the office and see me if you want to do this, but are finding it difficult, I'd be happy to help!

    • Nursing Maths Quizzes - Flinders University, Australia URL
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      Quizzes 1 - 4 are relevant for the HS541 exam.

    • SafeMedicate.com URL
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      Printable Resources

    • Maths pack: Unit Conversions - University of Leeds File
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      Printable resource pack all about conversions, from the University of Leeds.

      265.6 KB
    • Maths Pack - University of Nottingham URL
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      Prefer to practise written questions? This paper, from the University of Nottingham, will be useful. You can download it and print it out.

      Don't worry about Section 4 - we don't do intravenous work until Year 2!

    • Maths Pack: Nursing Essentials - University of Leeds File
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      More printables, this time from the University of Leeds.

      312.1 KB
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  • 10

    IV dripCalculating a flow rate in ml/hr requires us to learn a second formula: Volume = Rate x Time.

    This can be reduced to the mnemonic VRT (Very Rarely Troubled!)

    Nurses need to be able to calculate any one of the three elements of the formula from the other two:

    • Volume - for calculating how much fluid should be left in a bag after a given amount of time
    • Rate - for setting a flow rate im ml/hr
    • Time - for calculating how long an infusion will take

    You may already be happy with transposing the 3 elements of the VRT formula - in which case, stick with it! If not, then the 3 permutations are as follows:

    1.Volume = Time x Rate
    2.Rate = Volume ÷ Time
    3.Time = Volume ÷ Rate
    Some people find a more visual representation easier to remember. The presentation below introduces a useful triangle menmonic for remembering the formula. If you can remember that 'the bag goes up high', then you will easily be able to construct the rest of the triangle. Remember to cover up the element that you wish to calculate.
    • Using the VRT Formula File
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      This presentation originally formed part of a Skills Lab Scenario Workshop undertaken by the 2nd Year BSc Adult Nursing cohort in May/June 2013. The 2 mnemonics plus examples should help you to remember, understand and apply this formula to a variety of calculations.

      1.4 MB
    • VRT Mnemonic Page
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      VRT Visual

    • Test Yourself URL
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      Test your VRT skills with this page from Queen's University Belfast - clicking on this link will open the resource in a new window.

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  • 11

    Drip rates are just as straightforward to calculate as ml/hr flow rates. There is a slightly different formula to remember, but as long as you are comfortable with cancelling and multiplying fractions, plus one of the written division methods, you should have no difficulty - even without a calculator! Use the supporting resources in the Calculation Strategies and Fractions topics, or feel free to request a tutorial or workshop if you need a refresher on these.

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      Drip Rate Formula

    • Flow Rates (mls/hr) and Drip Rates (drops/min) Formulae File
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      This printable poster contains the entire family of related formulae that you might need for solving IV infusion calculations - volumes, rates and times.

      It is important to understand the difference between flow rates (mls/hr) and drip rates (drops/min) so that you can use the correct time unit. The clue is in the rate unit - for mls/hr work in hours and for drops/min, work in minutes. Remember to convert if necessary!

      161.3 KB
    • University of Essex - Drip Rates Workbook File
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      This workbook and presentation were used in the Skills Lab Workshop delivered to the Year 2 Adult Nursing Cohort on 4 June 2014. They contain revision resources, worked examples and practise questions for drip rates as well as time and volume calculations.

      749.1 KB
    • Drip Rates Powerpoint File
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      This Powerpoint presentation accompanies the drip rates revision workbook.

      1.0 MB
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      Confused by drop factors? This short video, produced by RMIT University in Australia, might help to explain what's going on.

      Drop Factors - RMIT University

    • Calculating a drip rate URL
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      This is a lovely resource from Flinders University - a School of Nursing in Australia - which will walk you through the formula that is taught here. There is also a pdf link provided below, in case your device does not allow Flash.

    • Drip Rates - Flinders University PDF URL
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    • Drip Rate Calculation Examples URL
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      You can work through these more complex examples from Queen's University Belfast to practise your drip rate calculation skills. Click 'Add Question' to work your way through the question bank. The screencast demonstrates a different formula, which is slightly longer and more complicated, but works just as well.

      Click on this link will open the resource in a new window.

    • Conversion Chart - Hours to Minutes File
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      This chart will help you convert hours to minutes easily. You may find it useful in drip rate calculations.

      73.0 KB
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      Drip Rate Calculations - Student Workbook 2013

      This workbook was provided for 2nd year BSc Nursing Students during a Skills Lab session on Drip Rate Calculations in August 2013. You may find it useful to help you to understand the strategies and formulae used. Click this link to view the book online.

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  • 12

    MDCs infographicThe revision resources below contain examples of the kind of questions you can expect in the Numeracy and Drug Calculations section of the HS563 exam.

    The questions will cover:

    • SI Unit Conversions
    • Tablets
    • Liquid Medicines
    • Injections
    • Unit, Multiple Unit and Sub Unit Doses
    • Complex Calculations
    • Adult Nursing only: Intravenous infusions - flow rates (mLs/hr) and drip rates (drop/min)

    The resources are split into three sections:

    1. In-house resources, developed to help you prepare for University of Essex drug calculation exams. Please note that these resources do not yet cover intravenous infusions or complex calculations
    2. External e-learning resources
    3. Printable resources
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      University of Essex Resources

    • Unit Conversions - Test Yourself! File
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      Adult/Mental Health: Interactive, self-marking question generator.

      3.4 MB
    • Basic Drug Calculations Quiz
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      Adult/Mental Health: This interactive quiz covers tablets, liquid medicines and injections. It's a good starting point for revising the work that we did in Year 1, but you'll also need to use the more advanced resources.


    • Mental Health: 24 November Workshop Resources Folder
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      Mental Health: Slides, booklet and answers from revision workshop on 24 November

    • Adult Nursing: 17 November Revision Workshop Folder
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      Adult: Resources from the revision workshop on 17 November.

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      External E-learning Resources

    • Nottingham University Hospital Drug Calculations Pack URL
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      Adult/Mental Health: Pay careful attention to the format of this paper - virtual medication cupboard plus separate question paper.


      Mental Health only:  You do not need to learn how to do IV infusion calculations.

    • Nottingham University Hospital Answers - CALCULATIONS ONLY File
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      Worked answers to the drug calculations.

      Please note that I am not able to provide answers for aything other than the calculations in this instance. Also, please let me know if you disagree with any of my answers!

      989.7 KB
    • Safe Medicate URL
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      Adult/Mental Health: Our standard e-learning package for medication dosage calculations.

    • Queen's University Belfast - Drug Calculations URL
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      Adult/Mental Health: Extensive random question generator. Excellent resource for making sure that you know what you're doing!

    • NHS SN@P URL
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      Adult/Mental Health: SN@P stands for Standard Numeracy Assessment Process and is the NHS's own e-learning tool for numeracy skills. 

      User account needed - you'll need to set this up yourself; please do come to the office and see me if you want to do this, but are finding it difficult, I'd be happy to help!

    • Nursing Maths Quizzes (interactive) - Flinders University, Australia URL
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      Adult: All sections are relevant.

      Mental Health: Sections 1 - 4 are relevant.

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      Printable Resources

    • Maths Pack - University of Nottingham URL
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      Prefer to practise written questions? This paper, from the University of Nottingham, will be useful. You can download it and print it out.

      Adult: ALL sections are relevant

      Mental Health: All sections except the intravenous drip calculations are relevant.


    • University of Dundee Medciation Administration Workbook File
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      Lots more examples, practice questions and scenarios in this booklet, which goes way beyond calculations.

      Adult: ALL sections are relevant

      Mental Health: Section 1, A - C are relevant for calculations - lots of mental health examples in here.

      Sections 2 & 3 deal with the preparation for professional registration side of medications management. You may also find this useful for general revision.

      279.8 KB
    • Maths Pack: Nursing Essentials - University of Leeds File
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      More printables, this time from the University of Leeds.

      Adult/Mental Health: All sections are relevant

      312.1 KB
    • Maths pack: Unit Conversions - University of Leeds File
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      Adult/Mental Health: Printable resource pack all about conversions, from the University of Leeds.

      265.6 KB
    • Advanced and Complex Calculations File
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      Adult only: I have yet to find any evidence of NHS trusts setting questions quite this complex. 

      However, if you really want to stretch and challenge your calculation skills, this paper is the one for you!

      Answers are supplied; if you really can't work out how to solve one, drop me an email or book a tutorial session. I would also be interested to know your methods if you are able to solve questions 7 and 15 through to 19!

      71.0 KB
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  • 14
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      Whilst most hospitals ususally use the metric system for recording measurements, you also need to know how to calculate with units of measure between systems (metric and imperial), possibly with the use of conversion tables and scales, and using approximate conversion factors. 

      The following screencast was developed specifically for nurses and show a complex calculation involving a divided dosage by body weight, and mixed units of measurement. 

      Unit Conversion Example: Drug Dosage - Khan Academy

    • Advanced and Complex Calculations File
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      I have yet to find any evidence of NHS trusts setting questions quite this complex. 

      However, if you really want to stretch and challenge your calculation skills, this paper is the one for you!

      Answers are supplied; if you really can't work out how to solve one, drop me an email or book a tutorial session. I would also be interested to know your methods if you are able to solve questions 7 and 15 through to 19!

      71.0 KB
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  • 15

    The resources in this section contain examples NHS drug calculations test questions. When preparing for your recruitment exams, be sure to check whether or not you will be allowed to use a calculator.

    Some NHS trusts will provide some of the standard formulae for you on the day, and will state that you do not need to have memorised them. However, there are many different versions of the formulae, and there is no guarantee that the one they provide will be the one that works well for you. If you can memorise these, it would be wise to do so! A handy printable poster containing the formulae taught at Essex is also included here.

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  • 16
    Games can be a useful way to develop your maths skills. The following apps are recommended:

    Apps

    Elevate (Literacy and Numeracy)

    Mr Thorne's Maths Universe - this is a paid app, designed for school student use, but it is one of the best I've seen for multiplication and division.

    MultiFlow - for practising multiplication. More 'grown up' than Mr Thorne, but higher pressure games - good for consolidating more advanced skills.

    DivisionFlow - as above, for division.

    FlowPlus - same series, for addition



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      Websites

    • Multiplication Trainer URL
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      Very simple site that generates random multiplication questions and answers. You don't type the answer in; this is just for mental calculations.

      NB: Works better on mobile and touchscreen devices.


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