DECODING THE DNA OF HEALTHCARE NUMERACY: Establishing a mathematics and healthcare numeracy benchmark for nursing

1 January 2023

Research & Development Briefing Paper: January 2023


AUTHORS: Keith W. Weeks PhD, RN; David Pontin PhD, RN; Diana Coben PhD; Alex Weeks BSc; John M. Clochesy PhD, MA, RN; David Rowe PhD.
ARTWORK: Matt Brown BA; Kirsty Weeks BA 

What's the issue?


There is wide agreement that nurses need to be skilled in healthcare numeracy but no consensus on what skills they should have. As a result, teaching and assessment vary from place to place, creating entry barriers to nursing, increasing attrition, restricting Registered Nurse global mobility, and increasing the risk to patients.


What's our solution?


Our world-leading research identifies the healthcare numeracy competence needed for safe and effective nursing practice and regulation [see Fig 1&2].

We have developed a comprehensive taxonomy of healthcare numeracy for nursing and translated it into an authentic virtual clinical environment. This supports in-context learning, competence assessment, and application.

We call this process ‘decoding the DNA of healthcare numeracy’ because, while some healthcare numeracy is self-evident, much of it is deeply embedded in nursing practice. What has become second nature to Registered Nurses appears opaque to new students.


Who is it for?


Our work has implications for nursing regulators, policy makers and educators. It is also relevant to other safety-critical vocations and disciplines.


What is it?


Our Healthcare Numeracy Taxonomy provides a benchmark for safe practice. Our programme includes:


  • Healthcare Numeracy Assessment
  • Healthcare Numeracy Performance Fingerprint and
  • Mathematics and Healthcare Numeracy Learning Support Environment


This provides a standard reference point to measure and support the development and maintenance of competence of students and Registered Nurses:


Students are supported as they move from point of programme entry to point of registration and beyond, while reducing attrition caused by inappropriate forms of assessment

Registered Nurses are supported as they refresh their skills for revalidation, while reducing practice error and increasing patient safety.

Nursing competence model (adapted from Weeks et al 2019)
Constructivist-based authentic virtual-to-situated clinical practice environment transition model
20 healthcare numeracy skills that form the fundamental mathematical building blocks of nursing science and safe nursing practice

How did we create our Healthcare Numeracy Programme?


Identification


We identified the 20 healthcare numeracy skills that form the fundamental mathematical building blocks of safe nursing (see Fig 3). These skills combine in specific sequences to inform 60 common clinical nursing procedures and processes. Click the link for an animated video [7 minute view].

https://drive.google.com/file/d/1tASjLA9XvQKl8A4MENb_2T0lyJNfXbqf/view


Analysis, Transcription and Mapping


We analysed the step-by-step processes of each clinical procedure or process. As each step unfolded, we ‘transcribed’ (identified, externalised, classified and copied) the combination of mathematics skills into a ‘transcription grid’. Each relevant skill is represented by ☑️ in the relevant skill box (see Fig 4):

‘Transcription’, i.e., identification, externalisation, classification and copying of the combination of mathematics skills underpinning and informing the nursing science and safe practice of the procedure/process into a ‘transcription grid’ (e.g., the eight healthcare numeracy skills underpinning and informing the measurement, calculation and recording of a radial artery pulse rate)

We confirmed the combinations and sequencing of 20 core cross-cutting healthcare numeracy knowledge and skills in each of the 60 core clinical nursing procedures and processes. 


These were mapped and classified into a framework of individual and combinatory Healthcare Numeracy Taxonomies (HNT; cHNT). The outcomes were translated into the:


  • Healthcare Numeracy Assessment (HNA)
  • combinatory Healthcare Numeracy Assessment (cHNA)
  • Healthcare Numeracy Performance Fingerprint (HNPF) and
  • Mathematics & Healthcare Numeracy Learning Support Environment (M&HNLSE) models. 


Relative distribution of mathematics and healthcare numeracy skills

After mapping the HNT, we analysed the distribution and incidence of the 20 skills across nursing practice (see Fig 5). Our analysis revealed that about 40% relate to pharmacology, prescribing, drug dosage calculation and measurement, and medicines management. The remaining 60% relate to wider nursing practice. 


This work has implications for nursing regulators, policy makers and educators. It is also relevant to other safety-critical vocations and disciplines. The full paper can be accessed here.

Distribution and incidence of use and application of 20 core mathematics and healthcare numeracy skills across nursing science and 60 nursing procedures and processes analysed

This work has implications for nursing regulators, policy makers and educators. It is also relevant to other safety-critical vocations and disciplines. The full paper can be accessed here.

Nurse education leaders’ perspectives on the teaching of numeracy to undergraduate nursing students: A qualitative research study.

by NG Team • 8 September 2023
Walker C, Pettigrew J, Hunt L, Rylands L & Wilson N (2023) Nurse education leaders’ perspectives on the teaching of numeracy to undergraduate nursing students: A qualitative research study. Nurse Education in Practice, Volume 72, 103754
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