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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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