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Research in Nursing & Health
, 2012, 35, 178–186
Math Anxiety, Self-Efficacy, and
Ability in British Undergraduate
Nursing Students
Miriam McMullan,
1
*Ray Jones,
1
** Susan Lea
2y
1
Faculty of Health, Education and Society, University of Plymouth, Peninsula Allied Health Centre,
Derriford Road, Plymouth PL4 8AA, UK
2
Institute of Psychiatry, King’s College London, UK
Accepted 28 December 2011
Abstract: Nurses need to be able to make drug calculations competently.
In this study, involving 229 second year British nursing students, we
explored the influence of mathematics anxiety, self-efficacy, and numerical
ability on drug calculation ability and determined which factors would
best predict this skill. Strong significant relationships (p<.001) existed
between anxiety, self-efficacy, and ability. Students who failed the numerical
and/or drug calculation ability tests were more anxious (p<.001) and less
confident (p.002) in performing calculations than those who passed.
Numerical ability made the strongest unique contribution in predicting
drug calculation ability (beta ¼0.50, p<.001) followed by drug calculation
self-efficacy (beta ¼0.16, p¼.04). Early testing is recommended for basic
numerical skills. Faculty are advised to refresh students’ numerical skills
before introducing drug calculations. ß2012 Wiley Periodicals, Inc. Res Nurs
Health 35:178–186, 2012
Keywords: anxiety; drug-dosage calculations; numerical ability; nursing;
self-efficacy
Medication administration remains a traditional,
responsible task nurses perform, which can take
up 40% of their time at work (Armitage &
Knapman, 2003). Patients expect to receive the
right drug, in the right dose, at the right time,
by the right route, but serious failures, including
drug calculation errors do occur. Medication
errors not only adversely affect individual
patients, their families, and health care staff, but
also undermine general public confidence and
can be a significant source of morbidity and
mortality in hospitalized patients (Department
of Health, 2004). The purpose of this study was
to explore the influence of mathematics anxiety,
self-efficacy, and numerical ability in nursing
students on drug calculation ability and to
determine which factors would best predict this
skill.
Of the medication errors reported, between
65% and 87% occur during the prescription and
administration stages, with the wrong drug or
the wrong calculated dosage being the two most
common administration errors (Tang, Sheu, Yu,
Wei, & Chen, 2007). LaPointe & Jollis (2003)
found in their 54-month study on cardiology
hospital wards that the cause of 35% of
medication errors was a wrong dose. Kozer
et al. (2004) observed that during simulated
Correspondence to Miriam McMullan
*Lecturer.
**Professor of Health Informatics.
y
Vice-Dean.
Published online 19 January 2012 in Wiley Online Library
(wileyonlinelibrary.com). DOI: 10.1002/nur.21460
ß2012 Wiley Periodicals, Inc.
resuscitation tasks, 10-fold errors in dosing
occurred on 3% of occasions and that in 7% of
the cases the injected concentration differed
from the expected concentration by >50%.
Garnerin, Pellet-Meier, Chopard, Perneger, and
Bonnabry (2007) in a small study found that
when 30 nurses and 28 anesthetists were
observed preparing an injection, 24% of the
nurses made arithmetical calculation errors
compared to 9% of the anesthetists. In a larger
study, Parshuram et al. (2008) found that of the
464 intravenous infusions prepared for use in
neonates, 161 (35%) were made up in the wrong
concentration. As these types of drug calculation
errors can have serious consequences, it is
essential that this critical skill be accurately
developed and that personal factors that could
potentially influence this development, such as
having poor numerical skills, being anxious in
performing numerical tasks, or having low levels
of confidence (self-efficacy) in performing
numerical and drug calculations, be identified
as early as possible in order for them to be
addressed.
Many educators assume that students entering
higher education are numerically competent and
be able to carry out basic numerical calculations,
such as addition, subtraction, multiplication,
and division with whole numbers, fractions,
decimals, ratios, percentages, and conversions
(Jukes & Gilchrist, 2006). Anecdotally, an often
unstated assumption is that nurses should
achieve 100% marks in simple numeracy, but
the mean score of 868 undergraduate American
nursing students was 75% (Brown, 2002),
and 64% of 37 British nursing students were
unable to achieve 70% (Jukes & Gilchrist,
2006). A growing deficit among university
entrants in basic numerical dexterity, apprecia-
tion of number, and basic algebraic reasoning
has been reported for nursing students,
psychology students (Mulhern & Wylie, 2004),
bioscience undergraduates (Tariq, 2004),
and medical students (Conroy & Carroll,
2009).
Poor mathematics performance can be the
result of interplay among many factors, one
of them being mathematics (math) anxiety,
which is reputed to interfere with mathematics
cognition (Sheffield & Hunt, 2007). Richardson
and Suinn (1972, p. 551) defined mathematics
anxiety as: ‘‘feelings of tension and anxiety that
interfere with the manipulation of numbers
and the solving of mathematical problems in a
wide variety of ordinary life and academic
situations.’’ Glaister (2007), in her study of
97 second year nursing students, reported a
prevalence of math anxiety of 20%. More
recently, Bull (2009) in her study of 62 first
year nursing students, reported 45% math
anxiety prevalence. Pedagogic researchers have
demonstrated consistently that higher math
anxiety levels are associated with lower per-
formance levels (e.g., Sheffield & Hunt,
2007). In Australia, Glaister (2007) found that
students with greater negative attitudes towards
mathematics performed less well in drug
calculations tests than those reporting less
anxiety.
In addition to math anxiety, students’ drug
calculations ability might also be influenced by
their mathematics and drug calculations self-
efficacy levels. Self-efficacy, according to
Bandura (1977), is the belief that one is capable
of successfully performing a task. Bandura
eventually embedded self-efficacy in his more
general social cognitive theory (Bandura, 1986),
which became the overarching theoretical
framework of the self-efficacy construct. In his
revised framework, although anxiety and self-
efficacy are inversely related, a person’s self-
efficacy level is not as much influenced by
the presence of the anxiety response as by the
interpretation of the presence of this response
by the individual. For example, ‘‘having
butterflies in the stomach’’ will be interpreted
by persons with low self-efficacy as a sign of
their own inability, decreasing their self-efficacy
further, and a person with high self-efficacy will
interpret such a sign as normal and unrelated to
his or her ability.
Pedagogical researchers have demonstrated
the important role that math self-efficacy plays
in predicting math performance (Stevens,
Olivarez, Lan, & Tallent-Runnels, 2004) and
how performance prediction will be greatly
enhanced if efficacy assessments are tailored to
the performance task (Pajares, 1997). Maag
(2004) studied 96 undergraduate nursing students
to assess the effectiveness of an interactive
multimedia learning tool on the students’ math
self-efficacy and math performance scores.
No significant change in math performance
or math self-efficacy scores was found, but
post-intervention there was a moderate correla-
tion between the students’ mathematics test
scores and their self-efficacy results (r¼.28;
p¼.01).
In summary, although many nursing students
find it difficult to accurately perform drug
calculations, the reasons for this difficulty are
unclear. They may include poor basic numerical
MATH ANXIETY, SELF-EFFICACY, AND ABILITY/ MCMULLAN ET AL. 179
Research in Nursing & Health
skills, anxiety towards learning mathematics,
and/or a lack of confidence (Mayo & Duncan,
2004). Any factors that could potentially
influence the development of students’ drug
calculation ability need to be identified and
addressed as early as possible. For early
identification and support of those students who
might struggle with drug calculations, it is
particularly important to determine if, and how
strongly, participants’ drug calculation ability
scores could be predicted by individual factors
of anxiety, self-efficacy, and numerical ability.
The aim of this study was therefore to explore
personal factors that could potentially influence
the development of drug calculation ability,
including math anxiety, math and drug calcula-
tion self-efficacy, and numerical ability, and to
determine which, if any, of these factors would
be the best predictor(s) of drug calculation
ability. The research questions were the
following: What are the relationships between
math anxiety, math and drug calculation self-
efficacy, numerical ability, and drug calculation
ability? Are there differences in the anxiety
and self-efficacy levels between students who
pass and those who fail numerical and/or drug
calculation ability tests (DCAT)? Which factors
best predict drug calculation ability?
Methods
Participants
A cross-sectional research design was used with
a convenience sample of all the second year
undergraduate nursing students (n¼229)
attending a British University. A third of the
nursing students were 24 years or younger,
with 10% of the students aged over 45. Most
participants (93%) were female. Ethnicity
information was not obtained. The study was
approved by the university research ethics
committee. None of the participants were
known to the researchers. Participants were
given information regarding the study in a letter
a few weeks before the study started. The
letter provided contact details in case further
information was required and in case participants
wanted to obtain the results of the study.
Participants were assured their data would
remain confidential. The tests were only used
for the study and did not form part of any
formal assessment. Return of the tests implied
consent and was not compulsory.
Measurement
Mathematics Anxiety Scale (MAS). Mathe-
matics anxiety has been assessed with various
instruments. Most prominent is the 98-item
Mathematics Anxiety Rating Scale (MARS)
developed by Richardson and Suinn (1972).
However, the length of that instrument has been
a barrier to its use. Therefore, an adaptation by
Betz (1978) of the anxiety subscale of the
Fennema–Sherman Mathematics Attitudes Scales
(Fennema & Sherman, 1976), the MAS, was
used to assess math anxiety. This scale consists
of 10 items using a 5-point Likert-type scale
(1 ¼strongly disagree,5¼strongly agree),
with the first five items positively worded and
the last five negatively worded. For scoring the
positively worded items were reversed so that a
high score indicates high anxiety. Scores could
thus range from 10 (low level of math anxiety)
to 50 (high level of math anxiety). The scores
were converted into percentages for analysis
and could range from 0% to 100%. The
MAS had been found to have strong internal
consistency and stability. Correlations of 0.70
have been reported between the MAS and the
full scale 98-item MARS (Cooper & Robinson,
1991) indicating concurrent validity of the
scale. Hackett & Betz (1989) reported Cronbach
alpha values ranging from 0.86 to 0.90. Dew,
Galassi, and Galassi (1984) reported a Cronbach
alpha of 0.72 and a 2 week test–retest reliability
of 0.87 on a sample of 769 undergraduates,
providing some evidence that MAS scores are
stable over a short time. The Cronbach alpha
value for this study’s sample was 0.94 with 228
(99.6%) students completing the MAS.
Numerical ability test (NAT). This test was
developed from an Australian validated literacy
and numeracy test for Certificate 4 in nursing.
This test is a prerequisite entrance test for
Trainee Enrolled Nurses applying for jobs in
Australian New South Wales Health facilities.
Before use, the test had been validated by UK
nursing academics to be at the appropriate
difficulty level for British students. The test
contains 15 questions covering key calculation
skills (such as multiplication, addition, fractions,
subtraction, percentages, multiplication, decimals,
and conversions). The test’s final score can
range from 0 to 22. The scores were converted
into percentages for analysis, and a grade
of 60% was required to pass. All students
(n¼229) returned the test.
Mathematics Self-Efficacy Scale (MSES).
Two widely used scales that addressed the
180 RESEARCH IN NURSING & HEALTH
Research in Nursing & Health
concept of self-confidence in mathematics are
the confidence subscale of the Fennema–
Sherman Mathematics Attitudes Scales (MAS,
Fennema & Sherman, 1976) and the MSES
developed by Betz and Hackett in 1983. The
confidence subscale of the MAS, however,
tends to measure how confident students feel in
learning mathematics (generalized confidence);
the MSES assesses how confident individuals
are in doing mathematics. Therefore, to determine
how confident students felt in completing
mathematics related tasks used in everyday life,
the task subscale of the MSES was used. To
complete the 18 items scale, individuals are
asked for each item to indicate on a 10-point
scale ranging from ‘‘no confidence at all’’ (1)
to ‘‘complete confidence’’ (10) their confidence
in their ability to successfully perform the
item’s task. The final score for the MSES
task subscale can range from 18 to 180. The
scores were converted into percentages for
analysis. Betz and Hackett reported a Cronbach
reliability coefficient alpha of 0.92 for the task
subscale and a correlation of 0.66 between
the MSES and the confidence subscale of the
Fennema–Sherman MAS (Fennema & Sherman,
1976). In Nielsen and Moore’s (2003) study
with 302 Australian high school students,
significant correlations between MSES scores,
past mathematics grades, and Marsh’s Self-
Description Questionnaire III (Math) demonstrated
convergent validity of scores for the MSES.
Significant correlations between MSES scores
and students’ desired mathematics grades
indicated concurrent validity of the MSES
measures. Hackett and O’Halloran (1985, cited
in Hackett & Betz, 1989) reported that the
test–retest reliability of the MSES over a
2-week interval for the tasks subscale was 0.79.
For the sample in this study the Cronbach alpha
coefficient was 0.95 with 226 students (98.7%)
returning the test.
Drug Calculations Self-Efficacy Scale
(DCSES). The DCSES, devised by the princi-
pal author, consists of six items covering the
principal areas of medication calculations,
(i.e., calculating dosages for liquid oral medica-
tions, solid medications, injections, percentage
solutions, and calculating infusion rates and
drip rates). To complete the scale individuals
are asked for each of the six items to indicate
on a 10-point continuum scale ranging
from ‘‘no confidence at all’’ (1) to ‘‘extremely
confident’’ (10) their confidence in their ability
to successfully perform the item’s task. The
final score can range from 0 to 60. The scores
were converted into percentages for analysis.
The scale was demonstrated to have good
reliability with a Cronbach alpha coefficient
larger than 0.90 in a pilot study with 22 first
year students. Significant correlations of 0.80
between the DCSES and the MSES indicated
the scale has concurrent validity. The Cronbach
alpha coefficient for this study’s sample was
0.93 with 225 students (98.2%) returning the
test.
Drug Calculation Ability Test (DCAT). The
DCAT, devised by the principal author, contains
20 questions covering the principal areas of
medication calculations, (i.e., calculating dosages
for liquid oral medications, solid medications,
injections, percentage solutions, and calculating
infusion rates and drip rates). Calculators may
not be used during the test. The scores were
converted into percentages for analysis. To
independently check for face validity, the test
was sent before use to three nursing academics
with expertise in medication calculations.
Feedback and corrections received (e.g., specific
drug dosages) were incorporated into the test.
All students (n¼229) returned the test.
Data Collection Procedure
The participants were recruited halfway through
their second year of undergraduate school
following a module on drug calculations.
Participation was voluntary. The tests were
administered to students in large classes by
the researchers. That the DCAT was at the
difficulty level appropriate for these students was
confirmed by the module faculty. Participants
were allowed to use pen and paper when
performing calculations but not calculators
as these could act as a substitute for the
participants’ arithmetical skills and knowledge
(Nursing and Midwifery Council, 2002).
Data Analysis
Descriptive and inferential statistical analyses
were applied to the quantitative data using
SPSS version 15.0 (SPSS Inc., Chicago, IL).
Pearson product-moment analysis was used to
explore inter-relationships between variables,
and standard multiple regression was applied to
determine statistically significant explanatory
variables. The independent samples t-test was
used to determine differences between groups.
MATH ANXIETY, SELF-EFFICACY, AND ABILITY/ MCMULLAN ET AL. 181
Research in Nursing & Health
Results
Thescoresonthefivekeyvariablesdemonstrated
considerable variation among participants
(Table 1). For example, scores for math anxiety
ranged from the minimum to the maximum
possible.
With 60% being the pass mark, 126 (55%) of
the participants failed the NAT, and 210 (92%)
of the participants failed the DCAT. As can be
seen in Table 2 low levels of math anxiety
(score 0–24%) were demonstrated by 10%
of the students, 70% demonstrated medium
levels of math anxiety (score 25–74%); 20%
demonstrated high levels of math anxiety
(score75%).
There were significant correlations between
all the variables (Table 3) with the strongest
being between math and drug calculation
self-efficacy, math anxiety and self-efficacy,
numerical and drug calculation abilities, and
math anxiety and drug calculation ability.
Cross-tabulations results indicated that 93%
of the students who failed the numeracy test
and 83% of the students who failed the drug
calculation test demonstrated signs of math
anxiety (score25%). In comparison, 63% of
the students who passed the numeracy test
and 32% of the students who passed the drug
calculation test demonstrated math anxiety
signs.
Independent samples t-tests (Table 4)
demonstrated that students who failed the
numeracy test were significantly more anxious
(t[216] ¼7.04, p<.001) and less confident
(t[214] ¼5.77, p<.001) in performing
numerical calculations and less confident in
performing drug calculations (t[213] ¼3.42,
p¼.001) than those who passed. In addition,
independent samples t-tests demonstrated that
students who failed the drug calculation test
were significantly more anxious (t[226] ¼4.43,
p<.001) and less confident (t[224] ¼3.18,
p¼.002) in performing numerical calculations
and less confident in performing drug
calculations (t[223] ¼2.48, p¼.014) than
those who passed the test.
Prediction of Drug Calculation Ability
Before carrying out multiple regression analysis,
the linearity between dependent and independent
variables, normality, homoscedasticity, and
multicollinearity were checked. In the multiple
regression analysis, any missing cases were
excluded pairwise. Results of the multiple
regression, which included as independent
variables numerical ability, math anxiety, and
math and drug calculation self-efficacy, indicated
a good fit (R
2
¼36.5%) and the overall
relationship was significant (F[4,217] ¼31.2,
p<.001). Numerical ability (beta ¼0.500,
p<.001) made the strongest unique contribu-
tion, when controlling for the other variables,
followed by drug calculation self-efficacy
(beta ¼0.162, p¼.036). Math anxiety and
math self-efficacy were non-significant. When
the non-significant variables of math anxiety
and self-efficacy were removed, the model
remained a good fit (R
2
¼36.3%) and the
overall relationship was significant (F[2,222] ¼
63.3, p<.001). Numerical ability (beta ¼.52,
p<.001) made the strongest unique contribu-
tion, when controlled for other variables,
followed by drug calculation self-efficacy
(beta ¼0.18, p<.001).
Discussion
The findings demonstrated a strongly significant
positive relationship between participants’
Table 1. Descriptive Statistics of the Study Variables
Variable nMin % Max % Mean (SD) %
Math anxiety 228 0.0 100.0 58.6 (22.9)
Math self-efficacy 226 2.8 94.4 54.4 (19.4)
Drug calculations self-efficacy 225 10.0 93.3 45.6 (18.8)
Numerical ability 229 2.3 100.0 54.8 (24.7)
Drug calculation ability 229 0.0 85.0 36.2 (15.1)
Table 2. Math Anxiety Scores (n¼228)
Math anxiety scores n%
10%–24% 23 10
25%–74% 160 70
75% 45 20
182 RESEARCH IN NURSING & HEALTH
Research in Nursing & Health
numerical and drug calculation ability levels.
This result, together with the regression analysis
result indicating numerical ability to be the
main predictor of drug calculation ability,
demonstrate empirically the importance of
basic numerical skills for performing drug
calculations. Both the numerical and drug
calculation abilities of the participants were
found to be poor. The reasons for this can
only be speculated upon, but could include
dependence on calculators and inadequate
previous mathematical education (McMullan,
Jones, & Lea, 2010). However, no matter the
reason, the results suggest that any mathematical
deficits need to be identified early on (ideally at
admission) and corrected as soon as possible.
There was not only a significant positive
relationship between students’ math self-efficacy
and math performance, but also significant
positive relationships between math self-efficacy,
drug calculation self-efficacy, and drug calcula-
tion performance. This confirmed recent results
of Andrew, Salamonson, and Halcomb (2009),
who in a study of 112 second year students
found that those who had high math self-efficacy
scores performed significantly better in a drug
calculation exam than those who had low
math self-efficacy scores (t¼2.65, p¼.009).
Together these findings empirically support
Bandura’s (1986) self-efficacy theory, which
suggests that self-efficacy beliefs influence
performance, mainly through their effect on
effort, persistence, and perseverance.
An important way to improve a person’s self-
efficacy is by providing positive encouragement
and constructive feedback. There is consistent
evidence demonstrating that evaluative feedback
(either ability or effort feedback) during
mathematics practice increases mathematics
self-efficacy and achievement (Schunk &
Hanson, 1989). However, how the feedback is
perceived depends very much on the credibility
and competence of the person who provides it
and whether the encouragement and feedback
given is realistic and sincere, otherwise it can
negatively affect self-efficacy beliefs (Bandura,
1986, 1997).
Regarding the effect of math anxiety, partici-
pants in this study who failed the numerical
and/or drug calculation tests were significantly
more anxious in performing calculations than
those who scored higher. In addition, significant
negative relationships were found between
participants’ levels of math anxiety and their
levels of self-efficacy and ability in perform-
ing numerical and drug calculations. Similar
results had been found by Bull (2009), who
demonstrated the existence of a significant
Table 3. Bivariate Correlations
Variable
Math
anxiety
Math
self-efficacy
Drug calculation
self-efficacy
Drug calculation
ability
Numerical
ability
Math anxiety –
Math self-efficacy .63
–
Drug calculation self-efficacy .49
.71
–
Drug calculation ability .52
.46
.30
–
Numerical ability .39
.38
.34
.58
–
p<.001 (2-tailed).
Table 4. Math Anxiety, Math, and Drug Calculations Self-Efficacy Mean (SD) Scores for Students Who
Failed (Scores of <60%) and Passed (Scores 60%) the Numerical and DCATs
Variable
Numerical ability test scores Drug calculation ability test scores
<60% 60% t-test 60% 60% t-test
Mean (SD) Mean (SD) pMean (SD) Mean (SD) p
Math anxiety % 68.0 (17.2) 48.2 (24.0) <.001 60.6 (21.6) 37.2 (26.4) <.001
Math self-efficacy % 47.9 (19.0) 62.2 (17.3) <.001 53.5 (18.9) 68.0 (20.6) .002
Drug calculations
self-efficacy %
41.2 (18.5) 49.7 (17.8) <.001 44.6 (18.4) 55.6 (20.3) .014
MATH ANXIETY, SELF-EFFICACY, AND ABILITY/ MCMULLAN ET AL. 183
Research in Nursing & Health
negative correlation between students’ math
anxiety levels and their math test scores
(r¼.34, p¼.01). This finding of an inverse
relationship between anxiety and self-efficacy
supports Bandura’s (1986) social cognitive
theory in which he argued that increased
anxiety would lead to reduced self-efficacy and
vice versa. This study’s results, however, not
only demonstrated the presence of a negative
association between math anxiety and math
performance, but also between math anxiety
and drug calculation ability. This negative
association is probably indirect, in that math
anxiety affects numerical ability and vice versa,
which in turn will have an effect on drug
calculation ability.
The mechanism through which the students’
high math anxiety potentially influences their
math and drug calculation performances could
be indirectly through avoidance. This indirect
effect has been described by Preis & Biggs
(2001) as the Math Anxiety Cycle. The cycle
starts with the student having developed math
anxiety, possibly due to negative experiences
with math in the past. As a result of this anxiety
the student will avoid math situations or put in
little effort. This will subsequently lead to poor
math performance causing further increased
anxiety, reduced confidence, and avoidance. The
cycle can repeat itself so often that the math
anxious person will become convinced of his
or her inability to do math and, if the cycle is
not broken, this can eventually turn into a
permanent block.
Why certain students suffer from math
anxiety is not always clear, but the beginnings
of math anxiety can often be traced back to
negative classroom experiences and the manner
in which mathematics was taught at school,
such as the presence of gender bias, insensitive/
uncaring teachers, and embarrassment and
humiliation in front of peers (Jackson &
Leffingwell, 1999). According to Arem (1993),
these negative experiences with math in the
formative years can haunt students even into
their adulthood and can become a block to
their subsequent learning. These students have
lost confidence in their ability to perform
calculations resulting in increased anxiety
when they are asked to do so. It is therefore
important that, for students who suffer from
math anxiety, this anxiety is identified and
addressed as soon as possible, as the anxiety
can prevent them from reaching their true
potential in obtaining mathematical and drug
calculation proficiency.
To lessen math anxiety, a positive and
supportive learning environment is needed
(Uusimaki & Nason, 2004). Teaching, instead
of being didactic should be more student
directed (Farrell, 2006). According to Brewer
& Daane (2002), cooperative groups enable
students to exchange and clarify ideas, to ask
questions, and to provide explanations. They
found that these cooperating students had
greater understanding of mathematics and
experienced more success than those in
traditional classrooms. Murray, Ma, and Mazur
(2009) argued that as students have different
learning styles, instruction must be caring and
flexible enough to meet the needs of all the
students, and be able to address the frustration
that often leads to math anxiety.
Limitations
While the results highlight some important
and interesting issues for nurse education, the
study was carried out in only one UK higher
education institute and therefore caution should
be taken in generalizing the findings. Although
valuable information was obtained from the
scales, these data were self-reported.
Conclusion
The results of this study demonstrate numerical
ability, closely followed by math anxiety, to be
the main personal factors potentially influencing
students’ drug calculation ability development.
To improve drug calculation ability, early
identification of individuals who have problems
with numeracy is essential. This identification
testing can be done either at the time of the
admission interview or at the beginning of
the program. Subsequently, to improve their
numerical skills, these students can be targeted
by a range of remedial approaches such as
lectures, study groups, workbooks, and computer
assisted instruction (Jukes & Gilchrist, 2006). In
the end, to reduce math anxiety and improve
numerical ability, the best remedy is a caring
teacher in a supportive environment using
multiple teaching strategies that address the
needs of all students.
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