ABSTRACT drug dosage calculations, and intravenous flow rate when

grouped according to gender and the results are as follows. The

Predicaments concerning drug dosage calculations
have been an existing issue for nursing students exposed in
clinical areas. Based on the researchers’ experience, nursing
students have difficulty on the conversion of units of
measurement, computation of pediatric and adult doses and IV
flow rate. According to Johnson and Johnson (2002), the
learning process for medication calculations has been
problematic for years. The problem that occur were
multifaceted and attributed to an array of factors that included
students' limited basic mathematic skills and inconsistencies in
terms of teaching strategies for medication calculations. This
underlying thought has motivated the researchers to look into
this problem in the assessment of the level of competency on
drug dosage calculations among level IV nursing students of Far
Eastern University. By knowing the competency of these
students, the researchers will be able to identify their strengths
and weaknesses on drug dosage calculations.
computed value for basic math operations is -1.932 with a level
of significance of 0.054; for conversion of units, the computed
value is -1.007 with a level of significance of 0.314; for drug
dosage calculations, the computed value is -0.280 with a level of
significance of 0.780 and for IV flow rates, the computed value is
-0.255 with a level of significance of 0.799. The overall
computed value was -0.542 with a level of significance of 0.588.
Since the absolute computed value, 0.542 was not greater than
the critical value, 1.960 at alpha 0.05, then there is no significant
difference on the participant’s overall level of competency when
grouped according to gender. With the results and findings
according to the test utilized, it reveals that the Level of
Competency on Drug Calculations among Level IV Nursing
Students of Far Eastern University based from their mean scores
was categorized in Level II with a description of “Conditional
Pass”. It also reveals that the level of competency of male and
female participants does not differ significantly; making the study
accepts the null hypothesis.

The focus of the study was to assess the level of

competency of level IV Far Eastern University nursing students
on drug dosage calculations. The researchers will utilize a non-
experimental research, specifically a descriptive design. Using
the Slovin’s formula, the researchers have come up with a
sample of 340 level IV Nursing Students of Far Eastern
University. The respondent can either be male or female ranging
from 18-23 years old. In the data collection there were 131
males and 209 females. Participants must at least finish and
pass 3 units on the following subjects: College Algebra and
Pharmacology. In addition to these, participants were asked to
sign a consent form to serve as a basis of their willingness to
participate in this research study. Researchers will use a drug
calculation test as their medium or instrument in weighing the Chapter 1
level of competency of the subjects in terms of drug dosage INTRODUCTION
calculation. The drug calculation test will constitute the
following elements: I. Basic Math Operations (25 items), II. The Problem and its Background
Conversion of Units (25 items), III. Drug Dosage Calculations
(25 items), IV. IV Flow Rate Calculations (25 items) with a total
Predicaments concerning drug dosage calculations have
of 100 items.
been an existing issue for nursing students exposed in clinical
areas. Based on the researchers’ experience, nursing students
The study determined the Level of Competency of
have difficulty on the conversion of units of measurement,
level IV Far Eastern University nursing students on drug dosage
computation of pediatric and adult doses and IV flow rate.
calculations. Among the 340 respondents which comprises of
Despite the formulas and techniques integrated on the matter,
131 male and 209 female, the computed mean score on the four
some students still find it confusing and may end up committing
areas are as follows. The male participant’s mean score on basic
a mistake, if not properly guided by the right principles on drug
math operations, conversion of units of measurement, drug
dosage computations.
dosage calculations, and intravenous flow rate are 14.9, 15.39,
13.8, and 12.85 respectively with an overall mean score of
57.95 while the female participant’s mean score are 16.1, 16.02,
According to Johnson and Johnson (2002), the learning
14, and 13.03 with an overall mean score of 59.16. With the
process for medication calculations has been problematic for
value presented on the table, it shows that the females mean
years. The problem that occur were multifaceted and attributed to
score on basic math operations, conversion of units of
an array of factors that included students' limited basic
measurement, drug dosage calculations, and intravenous flow
mathematic skills and inconsistencies in terms of teaching
rate is higher than that of the male. On the other hand,
strategies for medication calculations.
independent t-test was used to determine the existence of
significant difference on the participant’s level of competency
on basic math operations, conversion of units of measurement,
1
 Rice and Bell (2005) have cited problems in practice
with substandard abilities for nurses to calculate medication
dosages. Calculation of medications is an essential step in safe
medication administration, and necessary to safeguard patients.
The authors referenced the American Society of Health-Systems
Pharmacist system which identified nine categories of
medication errors. They have also discussed nursing students
classified as poor performers in mathematics since anxiety
attack takes place when dealing with calculations for the reason
that they are concerned on arriving at a wrong answer and when
exposed to inconsistent teaching strategies in medication
calculations. Mathematical formulas have been identified as
problematic due to misapplication of formulas or
miscalculations.
Manno (2006) has stated that medication errors has
been a problem for many years and has killed thousands of
people and one of the causes of these errors is drug
miscalculations that causes drug over dose. Across health care
and home care, patients face the risk of medical error.
According to his landmark study entitled: To Err is Human:
Building a Safer Health care System (2006) at the Institute of
Medicine, ,estimated that as many as 98,000 Americans die
each year due to a variety of medical errors; 7,000 of these
deaths are due to errors involving medications. Medication
errors have become an increasing problem in the hospital
setting. It is estimated that medication errors also known as
"adverse drug events (ADE) increase the cost of hospitalization
by $ 2,200 to $ 3,200 per stay and prolong stays by 2 days on
average". Causes of medication errors are varied, ranging from
inappropriate orders to failure of the nurse to follow the five
rights of medication administration. Many people believe that
medication errors are a direct result of poor nursing.
Dosage calculations should be double-checked by two
nurses or another pharmacist, Verification of a dose, rate or
amount does not mean to question the abilities or competencies
of the dispensing or administering individual. It is simply a way
to further verify and protect the patient and staff involved.
Medication errors are the eighth leading cause of death in the
US. (Banning, 2006). To help decrease the incidence of
medication errors, nurses need to step up to the plate, and
realize the importance of this issue. Following the five rights of
medication administration is simply not enough.
In the Philippines, there are no statistics that can show
the number of deaths due to medication dosage errors. This
underlying thought has motivated the researchers to look into
this problem in assessment of the level of competency on drug
dosage calculations among level IV Nursing Students of Far
Eastern University. By knowing the competency of these
students, the researchers were able to identify the students’
strengths and weaknesses on drug dosage calculations. As a
result, it served as a motivator for nursing students to improve
their skills on medication calculation thereby reducing the
number of untoward events that can range from mild discomfort
and even possible death of patients. Along these lines, nurses
could render a safe and quality nursing care for their patients thus
improving nursing practice.
Statement of the problem
The study was intended to determine the level of
competency on drug dosage calculations among level IV nursing
students of Far Eastern University.
Specifically, it aims to answer the following questions:
1. What is the participant’s level of competency on the
following area:
A. Basic Math Operation
B. Conversion of Units of Measurement
C. Drug Dosage Calculation
D. Intravenous Flow Rate Calculation
2. Is there a significant difference on The level of
competency of participants when grouped according to
gender?
Significance of the Study
The purpose of this study was to assess the level of
competency on drug dosage calculations of level IV nursing
students of Far Eastern University. This was important because
accurate calculation of drugs is critical in nursing practice. Thus,
nurses must be competent on drug dosage calculations and
student nurses must be well developed on these skills to become
efficient nurses. The research aimed to promote the enhancement
of calculation skills in undergraduate nursing students by
utilizing an assessment test that exhibited their level of
competency on drug dosage calculations which will serve as
basis for further improvement of their skills on medication
calculation, thus preventing medication calculation errors.
It is hoped that the findings of this study will enhance
the knowledge of concerned individuals and parties. Particularly,
this study will benefit the student nurses on the following:
Nursing Practice
Student nurses through this study will be able to
practice and provide effective and safe care in the real clinical
setting. Drug dosage calculation and administration, being an
essential skill and knowledge in nursing care will be focused and
enhanced to trigger the shaping of competent and efficient
nursing students. When the undergraduates become members of
the academe, they would be able to teach their students the
importance and correct techniques of medication calculation and
its administration.
Nursing Education
The academe will be able to look beyond the finite skill
of medication calculation and acknowledge system issues that
plague most medication errors. Through this study, they will be
able to recognize the value of knowing the fundamentals of
mathematics in relation to nursing.
2

Nursing Administration
As the students will become administrators in
hospitals, they would be able to use medication proficiency
exams for their staff members. This can be used in continuous
screening and improvement of their personnel's knowledge and
skill on drug calculations. Thus, they will be able to give safer
and effective quality nursing care to their clients.
Nursing Research
With its direct relation to nursing practice, student
nurses will be able to improve the patient care management they
are delivering in the clinical area by means of the facts and
evidences nursing research is going to provide. This field could
also help in determining certain ways on how to enhance the
level of competency of student nurses by means of other studies
and researches that could be made in relation to this study.
Scope and Limitation
The focus of the study was to assess the level of
competency of level IV Far Eastern University nursing students
on drug dosage calculations.
The research was conducted at Far Eastern University,
Manila. The researchers selected it as the setting primarily on
the grounds that the study may advance Far Eastern University
level IV nursing students into a paramount dexterity on medical
dosage calculation which is a fundamental aspect of exceptional
nursing care. The researchers desired to measure the
effectiveness of the skill in drug dosage calculation of the level
IV nursing students to further enhance and revamp their
potentials to evade medication errors that may jeopardize
patients’ lives, thus, producing globally competitive nurses.
The respondents for this study were selected fourth
year nursing students in Far Eastern University, within the age
bracket of 18-23, either male or female, and had their
willingness to participate in the research study. College Algebra
and Nursing Pharmacology were prerequisites for all the
respondents. The researchers preferred students under the
Institute of Nursing due to their desire to straighten out the
capabilities of these future nurses in encompassing quality
nursing care through equipped drug dosage calculation.
Participants came from different sections. The study is limited
on assessing only their level of competency, specifically their
knowledge, skills and abilities on basic math operations,
conversion of units, drug dosage calculation, and IV flow rate
calculation which are integral part of medication administration.
The traits of the respondents were excluded from the study.
The tools to be utilized were standardized, authorized,
and approved by qualified and licensed experts. Researchers
used a drug calculation test as their medium or instrument in
weighing the level of competency of the subjects in terms of
drug dosage calculation. The drug calculation test constituted
the elements below in this blueprint:
Drug Calculation Test:
I. Basic Math Operations………………. (25 items)
II. Conversion of Units………………… .(25 items)
III. Drug Dosage Calculations…………. (25 items)
IV. IV Flow Rate Calculations…………. (25 items)
Total: 100 items
The limitations encountered during data collection were as
follows:
1. The researchers were not able to consider the stress and
anxiety level that the participants may experience can
affect the results of the test.
2. The Different IQ of the participants and their
motivation to take and finish the exam.
3. The possibility of the participants to pick out any answer
they like even without solving due to the number of
items which is a 100 item test.
Chapter 2
THEORETICAL FRAMEWORK
Review of Related Literature and Studies
Level of Competency
Based on Commission on Higher Education
Memorandum Order (CMO) No. Series of 2009 Policies and
standards on Bachelor of Science in Nursing program, Article IV,
Section 5 “Competency Standards”, under Safe and quality
nursing care, a Bachelor of Science Nursing student must be able
to administer medications and other health therapeutics which
conform to the 10 golden rules in medication administration and
health therapeutics. One of the rules is the right dose, that is why
each nursing student who graduate in Bachelor of Science in
Nursing course must be competent in knowing the right dose
through correct drug dosage calculation.
Burkhalter and Cooper (2001) had suggested in their
study, the “Measurement of Competence of Health Care
Providers,” that competence encompasses knowledge, skills,
abilities, and traits. It is gained by the healthcare professions
through pre-service education, in-service training, and work
experience. Competence is a major determinant of provider
performance as represented by conformance with various clinical,
non-clinical, and interpersonal standards. Measuring competence
is essential for determining the ability and readiness of health
workers to provide quality services. Although competence is a
precursor to doing the job right, measuring performance
periodically is also crucial to determine whether providers are
using their competence on the job. A provider can have the
knowledge and skill, but use it poorly because of individual
3
factors (abilities, traits, goals, values, inertia, etc.) or external
factors (unavailability of drugs, equipment, organizational
support, etc.).
Competency can be assessed by using tests or inferred
from performance that has been assessed using simulations or
work samples. The major advantage of tests is that single
competencies can be distinguished and targeted for
improvement. The major advantage of simulated patients and
job samples is that they are more predictive of job performance.
Competency is not performance. Although it can predict
performance, a competent healthcare provider may not
necessarily use effective procedures on the job. Both internal
factors (motivation, agreement with a standard, self-efficacy,
inertia, etc.) and external factors (supervision, feedback,
availability of resources, community, peer expectations, and
incentives) affect whether a healthcare provider will apply his
or her competency. Detailed and immediate feedback to the
healthcare provider about his or her competence is useful for
both learning and improving performance.
The use of pre-testing of mathematics skills such as
basic arithmetic and algebraic calculations, and the use of the
results as a predictor of success in university based nursing
courses, are not new. Van Lanen, Lockie and McGannon (2000)
examined a university mathematics placement test and other
variables that predicted performance in an organic and
biochemistry course in an undergraduate nursing program. They
sampled 308 undergraduate nursing students. The variables that
showed significance in that study were the mathematics
placement test score, the grade in the previous principles of
chemistry course, the number of supplemental instruction
sessions attended and the score on the Nelson–Denny test
(which measures reading and comprehension skills and age).
Although they acknowledged that these data were dependent on
the individual student population, these authors concluded that
using predictive values in this way provides a useful profile of
students who are at risk.
Similarly, Hutton (1998) pre-tested 231 nursing
students with a 50 item test. Results showed 80% (n: 184) of
students scored less than 75%. Pozehl (1996) examined the
mathematics skills of 112 undergraduate students enrolled in an
introductory statistics course; exactly half of these participants
were students majoring in nursing. Pozehl’s findings indicated
that the nursing students were deficient in mathematics skills,
particularly algebra, compared to the non-nursing cohort.
Pozehl made a number of recommendations, including selective
admission requirements that valued pre-existing mathematics
skills, early pre-testing of the mathematics skills of nursing
students to identify students at risk, ensuring the availability of
early and prompt educational opportunities to the students with
a deficiency in these skills and finally the evaluation of
mathematics skills throughout the course. Pozehl also tested the
level of mathematics anxiety, finding that the nursing students
reported higher levels than non-nursing students.
Brown (2002) administered a computational
mathematics test to 868 undergraduate associate degree nursing
students from across the United States of America. The mean
score was 75% and these students demonstrated that they were
under-prepared in skills essential to medication calculation
mathematics, such as fractions, decimals and percentages
(Brown, 2002). Brown’s (2002) conclusions echo the
recommendations provided previously by Starkings (n.d) and
Pozehl (1996): that pre-testing upon admission is critical; that
remedial mathematics courses should be mandatory if the pre-test
results indicate deficiencies; and finally that testing should be
ongoing throughout the program.
Medication Calculation
Medication calculation is a dosage calculation to
determine what quantity of medication is to be administered to
the patient. Medication administration is a critical skill of the
professional nurse, who must understand and follow various steps
in the drug administration process to assure patient safety. The
nurse must be proficient in medication dosage calculation to
safely administer drugs. However, many medical-surgical nurses
experience difficulty when calculating drug dosages. One study
revealed that 56% of nurses could not calculate medication
dosages to a 90% proficiency rate. In addition, nurses made
significantly more errors in calculating intravenous drug dosages
as compared to oral, intramuscular, or subcutaneous drug dosages
(Ashby, 1997).
For the nurse to compute the correct dosage of a
medication, first the prescriber must write out the order legibly.
Poor handwriting has been cited as the primary cause in 15% of
medication error incidents (Springhouse Corporation, 2001). It is
advisable for prescribers to always clearly print medication
orders in capital letters. Many clinical settings have established
computerized prescription systems which have eliminated the
problem of illegible handwriting.
At times, verbal prescription orders are given to a nurse,
by word of mouth or per telephone. Because these orders may be
transcribed inaccurately, dosage errors can occur. In clinical
settings, verbal orders should be discouraged due to this risk. If
the prescriber has no choice but to give a verbal order, he or she
should sign the order as soon as possible.
A misinterpreted decimal point is also a common
problem which can cause medication dosage errors. If a dosage
of a drug is less than zero and documented as a decimal, a zero
should precede the decimal point for clarity. Conversely, the
prescriber should not place a decimal point and zero after a whole
number. If the decimal point goes unnoticed by the transcriber or
nurse, the zero then acts to mistakenly multiply the dose ten times
(Karch & Karch, 2001).
Abbreviations in medication orders can easily be
misinterpreted. Abbreviations vary in different institutions and
cause confusion. Whenever possible, the words in a medication
order should be clearly written out. For example, words such as
units, micrograms, milligrams, every day, or every other day are
preferable to abbreviations for these words (Springhouse
Corporation, 2001b). Abbreviation of terms within the metric
4
system can be difficult to decipher if handwritten. Whenever
possible, metric units should be written out as words.
Medication Calculation Errors in Nursing Practice
No one really knows how many the exact number of
miscalculation errors since by some estimates as little as one in
ten errors are reported (Pepper, 2002). Of reported errors, one
Food and Drug Administration (FDA) study found that 7% were
due to "miscalculation of dosage or infusion rate." Combining
this estimate with the estimate for total deaths, as many as 3,000
to 6,800 deaths are caused annually by medication math errors
(Thomas, et. al., 2001). This would mean that in the average
hospital one patient dies every year or two because someone
makes a miscalculation and one or two patients are sub-lethally
harmed each month. As future nurses then, there is a distinct
possibility that we will harm, or even cause the death of, a
patient over the course of our career.
In 2001, the academic pressure significantly increased
in nursing, after the Institute of Medicine released a report
documenting over seven thousand deaths/year from medication
errors and reform efforts were flawed given the convoluted
systems (Institute of Medicine, 2005). The public and
professional outcry from this report pressured most nursing
programs to revamp teaching strategies and revise standards for
medication administration. Many nursing schools adopted
strategies to assess medication calculation proficiency every
semester. Increased assessments created the need for nursing
programs to initiate or revamp existing policies.
Studies by Johnson and Johnson (2002), suggest that
the learning process for medication calculations has been
problematic for nursing faculty and students for years. The
problems that occur were multi-faceted and attributed to an
array of factors that included students' limited basic mathematic
skills, to disagreement among the faculty as to best teaching.
Rice and Bell (2005) also discussed nursing students as
classified poor performers in mathematics, expended high
anxiety levels when dealing with calculations, and exposed to
inconsistent teaching strategies in medication calculations.
Mathematical formulas have been identified as problematic due
to misapplication of formulas or miscalculations. Best teaching
practices have been elusive and results for nursing students
were dismal. They studied the application of dimensional
analysis as an alternative learning strategy for medication
calculations. Working from the assumption that students
successfully completed science courses, the authors studied a
total of 30 nursing students over two semesters. The authors
concluded the learning strategy, dimensional analysis, was
successful in improving conceptual skills, thereby reducing the
number of incorrect responses to test items.
Elliott and Joyce (2005) discussed the need to develop
calculation skills over time, and not assume the mathematical
skills have been previously taught to students. The development
of these essential skills were not captured in one semester,
instead these skills were built across all nursing courses. Elliott
and Joyce suggested as content material became more complex
over time, the pass rate for medication calculation tests should
also become more difficult. Hence, the authors suggested
building medication calculation mastery over a period of time to
successfully reach medication calculation proficiency. The
results of their research with 130 students not only supported the
concept of on-going assessment of medication calculation skills,
but additionally, the role of faculty to develop medication skills
over a four-year curriculum. Nursing students would then
advance from simple medication problems to highly technical
and complex medication calculations. Elliott and Joyce
recognized mathematical skills, may not necessarily be as simple
as a review process, but suggested these skills be developed
overtime in nursing curriculum.
Burke (2005) described the nursing profession's need to
broaden horizons for medication administration processes. Under
education, barriers to successful and safe medication
administration included lack of best practice to teach students the
fundamentals of medication administration. More importantly,
Burke identified nursing curriculum did not focus on the entire
medication administration process. Instead, nursing schools
primarily focus on administering, and often disregarded
prescribing and dispensing processes. He also identified seven
significant barriers to safe medication administration. Lack of
interdisciplinary teamwork and efforts, fluctuation in staffing
patterns, and use of abbreviations were identified within the
seven barriers. Delays in responding to safety concerns and
systems flaws within healthcare environments also influenced
safe medication administration practice. Burke also identified
recent research that has examined the negative impact of nursing
staff working over 12 hour shifts or 40 hours per week and the
increase risk of medication errors.
Medication administration requires nurses to
demonstrate successfully a range of mathematical concepts,
including ratios, proportions, fractions, percentages and
measurement conversion (Brown, 2002; Hoyles, Noss & Pozzi,
2001; Pozehl, 1996). Errors in medication mathematics may have
serious consequences that include harm to the patient, potentially
even death, not to mention disciplinary and possible legal
consequences for the nurse and the organization in which he or
she is employed (Brown, 2002; Grandell-Niemi, Hulpi, Leino-
Kilpi & Puukka, 2003; Hoyles, Noss & Pozzi, 2001; Shore &
Shore, 2003). A review of the literature shows that getting
undergraduate nursing students to demonstrate a proficient level
of medication calculation accuracy remains one of the strongest
instructional challenges for nursing academics (Kelly & Colby,
2003).
The findings of Hoyles, Noss and Pozzi’s (2001)
ethnographic study into the practices of pediatric nurses strongly
suggest that the mathematics utilized in undergraduate nurse
education is not visible in practice. Instead, they found that the
participant nurses, who had practiced longer than three years,
employed a more holistic approach. Their success in medication
calculation was related to “situated abstraction” (Hoyles, Noss &
Pozzi, 2001). This notion is based upon the assumption that
context is an inseparable component of medication mathematics,
as nurses will choose actions that seem relevant to them in their
situation (Hershkowitz, Schwarz & Dreyfus, 2001). The three
5
factors that were situational were: the packaging of the drugs;
the specific social routines (such as checking with two nurses);
and the clinical effects of the drug itself.
Kelly and Colby (2003) identified a similar
phenomenon with their students and argued that a constructivist
approach to teaching medication mathematics was the key. No
formulas were provided to their students; instead the students
were encouraged to answer the following questions: “What are
the givens? What are you looking for? What information must
be transformed in some way?” At the end of this process, one
important step was performed and the students were asked to
justify their answers. This process allowed the students to
identify irregularities in dose rate, volume or concentration
(Kelly & Colby, 2003). Although the constructivist approach
may enhance students’ ability to learn medication calculations,
we argue that students still require basic understanding of
mathematical concepts.
This review of related literature has shown that a large
proportion of undergraduate nursing students are unable to
demonstrate an appropriate level of mathematical knowledge on
entry into the program. This study had sought to determine the
level of mathematical knowledge of the Level IV nursing
students of Far Eastern University.
Cognitive Learning Theory
The researchers had come up to employ the Cognitive
Leaning Theory as the researchers’ guide in the study. This
theory emphasizes unobservable mental processes that people
use to learn and remember new information or skills. In other
words, it stresses the importance of what goes on inside the
learner. It is widely used in education and counseling. The key
to learning and changing is the individual’s cognition
(perception, thought, memory, and ways of processing and
structuring information). Cognitive learning, a highly active
process largely directed by the individual, involves perceiving
information, interpreting it based on what is already known, and
then recognizing the information into new insights or
understanding (Bandura, 2001; Hunt, Ellis, & Ellis, 2004).
Cognitive Learning Theory includes several well-
known perspectives, such as gestalt, information processing,
human development, social constructivism, and social cognition
theory. With these perspectives, students or learners are
encouraged to think of their potential applications in the
healthcare setting, by keeping with cognitive principles of
learning and being mentally active with information to
encourage memory and retention.
The researchers had seen many concepts of this theory
that the researchers can apply to their study, primarily because it
talks about the mind and processing of information that is
relative in undertaking the study on assessment of the
respondents’ level of competency on drug dosage calculation.
That learning is merely unobservable and can be measured
through an exam or aptitude test. Of the several perspectives or
concepts of Cognitive Learning Theory, the researchers opted to
apply the Information Processing Model which emphasizes
thinking process: thought, reasoning, the way information is
encountered and stored and memory functioning (Gagne, 1985;
Stenberg, 2006). The researchers, as stated in the methodology of
the study, did not include to seek the factors that affect the
processing of information of the selected level IV Nursing
Students in Far Eastern University but only to inquire about what
happened with the information that was given to the students by
their mentors, since then up to now, and that prior knowledge
plays an important role in learning and in nursing practice. The
researchers supposed that how the information was incorporated
and retrieved was useful for health professionals as well as for
nursing students to know, specifically on drug dosage calculation
when it comes to hospital practice.
Applying this model to the researchers’ study, the first
stage in the memory process involves paying attention to
environmental stimuli; attention, then, is the key to learning. The
drug calculation test that the researchers had conducted to the
respondents of the study served as the stimulus. This test got the
attention of the respondents. The researchers verbally explained
the instructions aside from the written instructions on the test. It
was also the researchers’ responsibility to know if the
respondents are weary or distracted prior in taking the test, so that
the explanation and test will be moved at another time when they
are more receptive and attentive. In the second stage, the
researchers prepared a visual drug calculation test that was
processed by the senses of the respondents. Another
responsibility of the researchers’ in this stage was to ascertain
whether there are sensory deficits among respondents. In the third
stage, the researchers did not take concern on short-term memory
but more on long-term memory, because this served as aid in
assessing the level of competency in drug dosage calculation of
the respondents. In short term-memory, the researchers are
concerned if the respondents are keeping their knowledge in drug
dosage calculation activated every now and then, so that it will
be then stored in their long-term memory, since short term
memory is not limited in its capacity but in the duration with
which it can actively retain information. This stage further
assessed the long-term memory of the respondents since by
6
experience and verity that also the researchers who were in the
same level of the respondents, were done with their The Main Variables of the Study
mathematics subjects, as well as pharmacology course last
semester. So it is where, the knowledge of the respondents on The two main variables of the study were the drug
basic math operations which is supposed to be taught since calculation and level of competency. The independent variable
grade school and the formulas in drug dosage calculations last was the drug calculation while the dependent variable was the
semester were applied and this was shown on their solutions level of competency which was measured by a validated
upon answering the test as well as their score. It is also where questionnaire on conversion of units, drug dosage and IV flow
the researchers as well as the respondents were able to assess if rate calculation.
they remember or had forgotten their knowledge regarding
these matters. The researchers also considered that while long-
term memories are enduring, a central problem is retrieving the Definition of Terms:
stored information at later time that affected the test results of Drug Calculation
the respondents in the study. In the last stage, it entails the
action or response of the respondents upon answering the test. It It is the determination of drug dosage and Intravenous
is where the researchers assessed how the respondents attended flow rate through computation, and usage of formulas, unit
to, processed and stored the information that was presented as conversion and basic mathematical operations. It is the act of
well as finding ways on how to solve the problem. properly calculating the exact amount of medication to be
administered in a particular client.
Piaget’s Theory of Cognitive Development
Level of Competency
The respondents are under the formal operational stage
and had the ability to answer questions which included problem It is the measure of the quality of being competent or
solving, analysis and rationalization. During this time, people having a possession of required skill, knowledge, qualification, or
develop the ability to think about abstract concepts. Skills such capacity. It is the knowledge of the respondent or ability to
as logical thought, deductive reasoning, and systematic planning perform correct calculations or conversion of units, drug dosage
also emerge during this stage (Pilliteri, 2003). Ergo, the study and Intravenous flow rate calculation. It is the extent of the
was appropriate for these subjects because their cognitive aspect ability of the client to properly calculate for the medications to be
has reached this level based from Piaget’s theory of cognitive administered based on his/her own knowledge.
development.
Based from a research in University of Malaya for
Conceptual Framework health workers (2004), the level of competency can be measured
using Competency Level Evaluation (PTK). The scores of the
Equipped with knowledge on drug dosage calculation, respondents from the drug calculation test will be classified using
the respondents were tested by the researchers to know their this tool. After all the scores are taken, the researchers will get the
level of competency. The researchers gave a test about the basic average (mean) of the entire sample and also be classified using
mathematical operations, conversion of units, drug dosage and PTK. The structure for grading PTK is as follows:
IV flow rate calculation. This determined the level of
competency of the Level IV Institute of Nursing students Level of Competency
regarding drug dosage calculation. Description
Level IV Pass/Achieved the
Research Paradigm Competency Level
with excellence
The research paradigm was divided into input, process (80% and above
and output. The research process was focused on assessing level percentage score
of competency on drug calculations of level IV nursing students from the test)
of Far Eastern University. The research had undergone a process Level III Pass/Achieved the
in which the following statements above had been their channel competency Level
in answering the problem statements. Definitely, if these steps (60% to 79%
were achieved, they will be aiming an output, that will percentage score
contribute on the improvement and development of the skill on from the test)
drug calculations of nursing students of Far Eastern University. Level II Conditional Pass
(50% to 59%
Hypothesis percentage score
from the test)
o The Level IV Nursing Students of Far Eastern Level I Failed to achieve the Competency
University has achieved the competency in drug (50% and bellow
calculation. percentage score
o The level of competency of male and female from the test)
participants does not differ significantly.
7

Chapter 3
RESEARCH METHODOLOGY
This chapter contains all the information on how the
study was conducted, the locale of the study and the target
population. This chapter would further discuss the specific
interventions and research design that the researchers’ used in
order to collect and obtain the needed information.
Research Design
The researchers utilized a non-experimental research,
specifically a descriptive design. The objective of this design
was the accurate depiction of the level of competency among
level IV nursing students of Far Eastern University. It involved
collection of numerical data to test the hypothesis and to answer
the questions concerning their status. They haved described the
phenomena on the subject’s level of competency on drug
calculation.Through this, the researchers can describe the
dimensions and importance of the inclined number of students
who experienced drug calculation errors.
It was the selected design because the objective this
research was to describe the level of competency of their
subjects and do not include correlations and other study groups.
Also, the researchers utilized a cross-sectional design in which
they collected data at one point in time.
Population and Sample
The subjects were selected using stratified random
sampling, in which the researchers make use of the fishbowl
technique in selecting the sections that took part in the study.
This sampling technique captured the characteristics of the
population that was proportional to the sample. Thus, the result
of assessing the level of competency on drug calculation among
selected level IV nursing students of Far Eastern University
attributed to the whole population. Using the Slovin’s formula,
the researchers came up with a sample of 340 level IV Nursing
Students of Far Eastern University. The respondent can either
be male or female ranging from 18-23 years old. Participants
had finished and passed 3 units on the subject: College Algebra
and Pharmacology. In the data collection there were 131 males
and 209 females. In addition to these, participants signed a
consent form to serve as a basis for their willingness to
participate in this research study.
Research locale
The study was conducted at Far Eastern University,
Manila. The researchers had chosen FEU as their locale because
it will benefit their colleagues as they will able to know their
level of competency on drug calculation. It was also selected
because it was where the researchers had established their
observation and motivation in undertaking this study. The
setting is mainly based on FEU, Manila specifically at Law
Building wherein potential respondents had their classes most
of the time.
Research Instrument
The primary tool of the research was a drug calculation
test which measured the respondent’s competency on basic
mathematical operations such as addition, subtraction,
multiplication and addition along with conversion of units that all
came with critical thinking and analysis. The remaining part of
the test included questions regarding drug dosage and IV flow
rate calculation. The test consisted of a hundred items divided
into four major parts 25 items each. The entire questions were
constructed using words or sentences requiring the respondents to
evaluate and analyze each item according to their mathematical
skill and capabilities. The tool was lifted mainly from
mathematics and pharmacology books. It was answered manually
with the use of pen or pencil. Respondent’s profile came prior to
the series of questions. A sheet for computations was provided by
the researchers and the use of calculator was allowed. The
instrument had undergone validations from two mathematicians
and a pharmacology professor. A pilot study was done to 20
students to test its reliability.
Data Collection Procedure
The researchers’ had collected quantitative data on the
level of competency on drug dosage calculation among level IV
nursing students. The initial step of the researchers was to select
potential respondents that participated in the study. After
identifying respondents, the researchers had personally
introduced themselves, established rapport and stated the
objectives of their study. If the respondents agreed to participate
in the study, they are given the consent form for them to sign
prior to answering the questionnaire.
The researchers used a drug calculation test for data
collection to assess their competence on drug calculations. The
respondents used a pen or pencil in answering the test and were
given 90 minutes to answer the corresponding questions.
Statistical Treatment of the Data
To answer the research question number 1 on what the
level of competency of the participants was, the following
formula was used:
Formula:
Where:
Xi= score
To answer the research question number 2, on the
8
significant difference on the level of competency of the
participants when grouped by gender, the independent t-test was
used.
Formula:
Where:
X1 = Male participants
X 2 = Female participants
n = number of respondents
CHAPTER 4
RESULTS AND ANALYSIS
This chapter has aimed to answer the research questions to
determine the level of competency on drug dosage calculations
among level IV nursing students of Far Eastern University.
1. What is the participants’ level of competency on the
following area:
a. Basic Mathematical Operations
Table IV.1 Participants’ Level of Competency on Basic
Mathematical Operations
The table above displays that 60.3 % of the male
population and 72.25% of the female population reached the
competency level III and IV in basic mathematical operation.
The overall mean percentage of both populations in basic
mathematical operations is 62%. It means that, on the average,
the nursing students of Far Eastern University have achieved
competency in basic mathematical operations.
Student nurses shall demonstrate the ability to solve
multiple step mathematical problems that require demonstration
of basic math operations including fractions, decimals and
percentages and the use of algebraic equations. Nursing
students as well as practicing nurses continue to struggle with
math competency as it relates to nursing. According to Blais
and Bath (1992), the most frequent type of mathematical errors
was conceptual errors (setting up the problem) and arithmetic
errors (incorrect addition, subtraction, multiplication, division,
decimals, and fractions). According to 21 Flynn and Moore
(1990), graduate nurses made errors at a rate of 1 in 12 when
performing written calculations.
These statistics should alert nurse educators and
practicing nurses of the need for ongoing evaluation of student
basic math skills and provide continuing education in math skills
for practicing nurses.
b. Conversion of Units of Measurement
Table IV.2 Participants’ Level of Competency on
Conversion of Units of Measurement
This table indicates that majority of both gender
achieved the desired level of competency in terms of conversion
of units of measurement obtaining a total of 63.36% of males and
71.29% of females who were able to arrive at levels III and IV. In
line with this, barely 30% of both groups have failed to reach the
passing score of the test.
The females, having a higher mean score of 16.02
compared to the 15.39 mean score of males may suggest that
females are more competent than males in this area.
c. Dosage Calculation
Table IV.3 Participants’ Level of Competency on
Dosage Calculation
The table above displays the corresponding number of
male and female participants in each particular level of
competency. 42.75% of the male’s population failed to achieve
competency level while 41. 63 % of the female’s population also
failed to achieve competency with a mean score of 13.8 for males
and 14 for females. It denotes that a greater number of the
participants failed to achieve competency compared to those who
achieved competency.
The result of the test proves that most of undergraduate
nurses have problems in terms of dosage calculation which could
contribute to the overall problem of nurses in drug
administration. This could be evidence that not all nurses’
especially undergraduate nurses have mastery in dosage
calculation. It would support the previous studies made by
different experts like Brown (2002), which concluded that
students majoring in nursing were under- prepared in skills in
calculation of medication which is a very critical part of the job.
d. Intravenous Flow Rate Calculation
Table IV.4 Participants’ Level of Competency on
Intravenous Flow Rate Calculation
This table shows that majority of both groups has failed
to achieve the competency in Intravenous Flow Rate Calculation.
Only 50.38% (n=66) of the males and 49.76% (n=104) of
females has reached the level 3 and 4. Half of the participants
have failed to reach the competency which signifies that this area
is a weakness of many level IV nursing students in Far Eastern
University.
9

The mean score of females (12.85) was higher than
males (13.03) which may indicate that females are much
competent than males in this area.
The result might have been affected by the number of
items given. It was in the last part of the test and some
respondents were complaining of a lengthy exam during the
examination. The fact that this was not graded, there is a
tendency that they did not seriously answer questions that has
affected their scores.
e. Competency in all Areas
Table IV.5 Participants’ Level of Competency on all
Areas
The table above presents the participant’s level of
competency when grouped according to sex. It shows that the
number of males who failed to achieve the competency level
was 40 or 30.53% while the number in females is greater with
54 or 25.84%. Male participants with conditional pass score are
16 or 12.21%, however, 34 are in females or 16.27%. There are
60 males or 45.80% who achieved the competency score while
there are 93 or 44.50% in females. The number of participants
who achieved the competency with excellence is 15 or 11.45%
in males and 28 or 13.40% in females. The mean or average
achieved by the females which is 59.16 shows greater percent
than that of the males who got 57.95.
It can be interpreted that females have greater
competency on overall drug calculation than males. Several
factors contributed to this examination result that was out of
control by the researchers. These factors were as follows:
environmental factors, physical factors of the respondent,
cognitive factors of the respondent, and psychological factors of
the respondent.
Environmental factors that affected the results are the
place where they took the examination (noise, temperature, and
other distractions).
Physical factors are factors coming directly from the
respondent such as the condition of the respondent before and
while taking the exam.
Cognitive factors that contributed to the result are
mainly the previous knowledge of the respondent with regards
to the subject matter.
Psychological factors are those factors coming from
the respondent examples are anxiety of the respondent with
regards to questions regarding the subject matter.
These observations can be associated on Johnson and
Johnson’s analysis that the learning process for medication
calculations has been problematic for nursing faculty and
students for years wherein the problems are attributed to an array
of factors that included students' limited basic mathematic skills.
Rice and Bell (2005) also discussed that nursing
students are classified as poor performers in mathematics,
expended high anxiety levels when dealing with calculations, and
exposed to inconsistent teaching strategies in medication
calculations. Mathematical formulas have been identified as
problematic due to misapplication of formulas or miscalculations.
The table above shows the summary of the Level of
Competency of the different sections of the test. At section I
(Basic Mathematical Operations), 25% of the students failed
while the remaining 75% passed. At section II (Conversion of
Units), 27.94% failed while the remaining 72.05% passed. At
section III (Drug Dosage Calculation), 42.06% failed and the
remaining 57.94% passed. At section IV (IV Flow rate
Calculation), 41.47% failed while the remaining 58.53% passed.
As we can see, majority of the students failed at sections III and
IV compared to sections I and II. Generally, 27.65% of the
students failed the exam and 72.36% passed. Overall, the students
that reached the level of competency are 57.65%.
The student nurses of the Far Eastern University has a
higher percentage rate who passed the in the Basic Mathematical
Operations and Conversion of Units than the Drug Dosage
Calculation and IV Flow rate Calculation. This shows that
although according to Blais and Bath (1992), the most frequent
type of mathematical errors was conceptual errors (setting up the
problem) and arithmetic errors (incorrect addition, subtraction,
multiplication, division, decimals, and fractions) the students was
skilled enough in answering the Basic Mathematical Operations
questions and Conversion of Units questions than answering the
Drug Dosage Calculation questions and IV Flow rate Calculation
questions. It also shows that the student nurses are more
competent and experienced in Basic Math and conversion
compared to the drug dosage and IV flow rate computation. This
result also demonstrate that most of the student nurses of the Far
Eastern University have problems in terms of dosage calculation
and IV flow rate calculation which is very essential in their
profession as a future nurses. Just like what Brown (2002)
concluded that students majoring in nursing were under- prepared
in skills in calculation of medication.
But this result could have happen due to the many
factors that have affected the students while answering the test.
These factors includes the number of items of the test, the
environment where they have taken the test, the fact that it is not
graded, the positioning of the section Iii and IV at the last part of
the exam and the anxiety the student feels knowing that the test
includes math and computations.
Based on the result of the test, the majority of the level
IV student nurse of the Far Eastern University can be classified
under the Level III of the Level of Competency.
2. Is there a significant difference on the level of
competency of participants when grouped according to
10
 gender?
Not Accept
-0.280 1.960 0.780
Table IV.7 Independent T-test for the Significant Difference Significant H0
of Participants’ Level of Competency on Basic Math
Operations when Grouped According to Gender
The table above shows the result of the Independent T-
Computed Critical Level of test used to determine the existence of significant difference on
Interpretation Decision the participant’s level of competency on dosage calculation when
Value Value Significance
grouped according to gender. The computed value was -0.280
with a level of significance of 0.780. Since the absolute
Not Accept computed value, 0.280, was not greater than the critical value,
-1.932 1.960 0.054
Significant H0 1.960, at alpha 0.05, then there is no significant difference on the
participant’s level of competency on dosage calculation when
grouped according to gender.
The table above shows the result of the Independent T-
test used to determine the existence of significant difference on The decision was to accept H0 that the level of
the participant’s level of competency on basic math operations competency of male and female participants on dosage
when grouped according to gender. The computed value was calculation does not differ significantly.
-1.932 with a level of significance of 0.054. Since the absolute
computed value, 1.932, was not greater than the critical value, Table IV.10 Independent T-test for the Significant
1.960, at alpha 0.05, then there is no significant difference on Difference of Participants’ Level of Competency on
the participant’s level of competency on basic math operations Intravenous Flow Rates Calculation when Grouped
when grouped according to gender. According to Gender
The decision was to accept H0 that the level of
competency of male and female participants on basic math Computed Critical Level of
operations does not differ significantly. Interpretation Decision
Value Value Significance

Table IV.8 Independent T-test for the Significant

Difference of Participants’ Level of Competency on Not Accept
-0.255 1.960 0.799
Conversion of Units of Measurement when Grouped Significant H0
According to Gender

Computed Critical Level of The table above shows the result of the Independent T-
Interpretation Decision test used to determine the existence of significant difference on
Value Value Significance
the participant’s level of competency on Intravenous Flow Rates
Calculation when grouped according to gender. The computed
Not Accept value was -0.255 with a level of significance of 0.799. Since the
-1.007 1.960 0.314
Significant H0 absolute computed value, 0.255, was not greater than the critical
value, 1.960, at alpha 0.05, then there is no significant difference
on the participant’s level of competency on Intravenous Flow
The table above shows the result of the Independent T- Rates Calculation when grouped according to gender.
test used to determine the existence of significant difference on
the participant’s level of competency on conversion of units of The decision was to accept H0 that the level of
measurement when grouped according to gender. The competency of male and female participants on Intravenous Flow
computed value was -1.007 with a level of significance of Rates Calculation does not differ significantly.
0.314. Since the absolute computed value, 1.007, was not
greater than the critical value, 1.960, at alpha 0.05, then there is Table IV.11 Independent T-test for the Significant
no significant difference on the participant’s level of Difference of Participants' Level of Competency when
competency on conversion of units of measurement when Grouped According to Gender
grouped according to gender.
The decision was to accept H0 that the level of Computed Critical Level of
competency of male and female participants on conversion of Interpretation Decision
Value Value Significance
units of measurement does not differ significantly.

Table IV.9 Independent T-test for the Significant Not Accept

-0.542 1.960 0.588
Difference of Participants’ Level of Competency on Dosage Significant H0
Calculation when Grouped According to Gender

Computed Critical Level of The table above shows the result of the Independent T-
Interpretation Decision test used to determine the existence of significant difference on
Value Value Significance
the participant’s overall level of competency when grouped
according to gender. The computed value was -0.542 with a level
11
of significance of 0.588. Since the absolute computed value,
0.542, was not greater than the critical value, 1.960, at alpha
0.05, then there is no significant difference on the participant’s
overall level of competency when grouped according to gender.
The decision is to accept H0 that the level of
competency of male and female participants does not differ
significantly.
Discussion of Findings
This section reiterates how the data were put into
understandable form and substantialized into its existing
literatures. The implications of the findings for nursing practice
and research was also made.
When a medication order differs from the fixed amount
at which a drug is supplied, the dose needed must be calculated.
Calculation requires knowledge of the systems of dosage
measurements and the ability to solve arithmetic. Nursing
students invariably express anxiety that they will miscalculate a
dose and cause harm. Although everyone is capable of error, no
one has to cause one. The surest way to prevent a mistake was
to exercise care in performing basic arithmetic operations.
The participants
This is consistent with the study conducted by Pozehl
(1996), Pozehl findings indicated that the nursing students were
deficient in mathematics skills, particularly algebra, compared
to the non-nursing cohort.
Most of the students feel anxious when it comes to
mathematical operations. Researchers observed that most of the
students were shocked when they first saw the questionnaire
because it deals with mathematics.
The respondents’ were given a series of computational
mathematics test focusing on Basic Math Operations,
Conversion of Units of Measurement, Drug Dosage
Computation, and IV Flow Rate Calculation. Their mean score
on these tests are 58%, passing but yet has not reached the level
of competency, which shows that most of the students are not so
focused on mathematics which is one of the basic skills needed
for a career in nursing, these further affects their level of
competence and more importantly their performance of the job
they will pursue.
Some studies showed the same result. Among these
were the studies of Hutton, Brown, and Lanen, Lockie and
McGannon. 231 nursing students were pre-tested by Hutton
(1998) with a 50 item test with results of showing that 80% of
these students scored less than 75%.
This has also been in congruent with the study by Brown
(2002), who administered to 868 undergraduate associate degree
nursing students from across the United States of America a
mathematics test. The conclusion of Brown to their results is that
pre- testing upon admission is critical and remedial of
mathematics courses should be mandatory because the results of
the study he has conducted was that the students had a mean
score of 75%. The result of the mathematics test further
implicated that students majoring in nursing were under-
prepared in skills in calculation of medication which is a very
critical part of the job.
In a mathematics placement test made by Lanen, Lockie
and McGannon (2000) to 308 undergraduate nursing students,
they concluded that the students are at a risk and they still lack
skills needed in nursing competence. Although they
acknowledged that the data they gathered were dependent on an
individual’s skills, it is better that they have more focus on the
mathematical aspects of their course because it affects the overall
performance.
The implications of the study for future researchers
include opening the path for a bigger scope of application. This
also raises the idea that it can be done in any clinical area.
Discussion of Hypothesis
The researchers had used an independent T-test for the
significant difference of participant’s level of competency when
grouped according to gender. This method was designed to
examine the statistical difference of two means of the male and
female group. It was presented in table 9-11the result of the
independent T-test, and it has clearly showed that all areas have
lesser absolute computed value than the computed value with a
level of significance ranging from 0.054-0.799. Ergo, there was
no significance on the participant’s level of competency when
grouped according to gender. In addition, the null hypothesis was
accepted since the test has proven no significant relationship
between means.
CHAPTER 5
12
 SUMMARYOF FINDINGS, CONCLUSION AND
RECOMMENDATION
Summary
The purpose of the study was to assess the level of
competency on drug calculations of level IV nursing students of
Far Eastern University. By knowing the competency of these
students, the researchers were able to identify their strengths
and weaknesses on this skill. The researchers had looked into
the problems of mathematics in nursing that focuses on basic
mathematical operations, conversion of units, drug dosage and
IV flow rate calculation. They had also inferred the significance
of the participant’s level of competency when grouped
according to gender.
The researchers had used a descriptive design. The
samples of 340 participants were based from the Slovin’s
formula. They had used stratified random sampling and students
were selected from different section using fishbowl technique.
The primary tool of the research was a 100 item drug
calculation test which is composed of 4 areas: basic
mathematical operations, conversion of units, drug dosage and
IV flow rate calculation.
Findings
1. What is the participant’s level of competency on the
following area?
The participants had achieved a level 3
competency on basic mathematical operations and
conversion of units; and level 2 competency on drug
dosage and IV flow rate calculation. Their overall
competency on drug dosage calculation is level 2.
2. Is there a significant difference when participants are
group according to gender to compare their level of
competency?
There exists no significant difference on the
participant’s level of competency when grouped
according to gender. The level of competency of male
and female respondents does not significantly differ.
Conclusion
The level of competency on drug calculation among
the 340 level IV nursing students of Far Eastern University was
in level 2. The level of competency between male and female
participants’ does not differ significantly. The male and female
participants’ were equally competent based on the results of the
test given by the researchers to measure their competency level
on the four major areas in medication calculations.
Recommendation
The researchers recommend further enhancement of
drug dosage calculation skills of level IV nursing students in Far
Eastern University. Drug calculation concept in pharmacology
must be further discussed in lectures; and if possible, there must
be an increase in units in pharmacology so it will be given more
emphasis. As early as level I, Algebra Course must be integrated
with medication calculations. It is better if the institution will
implement an annual assessment exam on this area to test the
proficiency of their students.
Teaching and learning strategies must be implemented
effectively and must be given focus in practice. In every clinical
exposure, clinical instructors must ask their students manual
computations of drug dosage or flow rate before administering
medications or setting up an IV infusion. They may also give
regular exercises on medication calculation to master this skill.
The researchers would like to recommend the following
for the next researchers that would like to embark on a similar
research. :
1. They can use this research as additional evidence that
will further study and determine the level of competency
on drug dosage calculations of nursing students.
2. The researchers also recommend that they also include
the factors that affect the level of competency on drug
dosage calculations of nursing students. .
3. The researchers should also measure the anxiety level
of the nursing students when answering mathematical
tests.
4. The researchers are recommended to study the best
strategies in teaching Mathematics which should come
along with enough time to learn the subject, which
should not be in a comprehensive manner but in an
invasive manner. If these strategies be applied, the next
researchers should also check if there is an improvement
in the competency of the students.
13