Numeracy in Children's Nursing

Arija Parker, Arija Parker

• Publisher: Wiley-Blackwell
• Year: 2015
• ISBN:
  9781118488607
• Edition: 1
• Topic: Medicina
• Subtopic: Enfermería pedriática

Numeracy in Children's Nursing and Healthcare is a handy, practical book which highlights the importance of numbers, numeracy and calculations in children's nursing practice, instilling nursing students and qualified nurses with confidence and competence when working with numbers and calculating drug doses. This accessible guide covers all aspects of numeracy from basic skills through to complex drug administration, and provides case studies throughout enabling the reader to apply the theory to practice. Each chapter adopts the same accessible and easy-to-follow format, featuring learning outcomes, a case scenario, key numeracy information, hints and tips, activities and exercises, and a glossary of terms.

CHAPTER 1
THE ROLE OF NUMERACY IN NURSING AND HEALTHCARE PRACTICE

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LEARNING FOCUS

The Role of Numeracy in Nursing

The broad focus of this chapter is to define what numeracy is and where numeracy skills are needed in healthcare settings. There will be a particular focus on nursing practice and, more specifically, on numeracy skills to support children and young people’s nursing.

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LEARNING OUTCOMES

By the end of this chapter you should be able to:

• Identify why you need to read this book and why it is important to your practice
• Define what numeracy/mathematics are
• Have a conceptual understanding of the problems that adults, and so by default nurses have in relation to the use of number
• Use place value and the denary system
• Reflect on what you would like to achieve by working through this book and companion website having completed the diagnostic assessment which precedes this chapter

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CASE SCENARIO 1

Una Venn (Age 4) is visiting the hospital for a preoperative visit and assessment prior to admission for day case surgery in the following week for ENT surgery (tonsillectomy, adenoidectomy and insertion of grommets). She is accompanied by her mother, Mrs. Venn and little brother, Jack (1 year).

Una gets to visit ENT theatre 1 together with other children who will be coming into hospital for various day case surgical procedures over the coming week. Both Mrs. Venn and Una have the documentation explained to them, including a Pain Assessment Chart. The nurse, who will be caring for Una, carries out a set of baseline observations and weighs Una and then gives them both a chance to ask questions. Mrs. Venn is also advised about pain management in hospital, postoperatively and on discharge. The nursing staff on Gamma Ward use the Arch Mede Hospital Pain Assessment Tool for children. (The Arch Mede Pain assessment too is a fictitious tool just for use to illustrate numeracy issues in this book. It is adapted from Baker and Wong (1983; 1988) and numerous other numerical, visual and colour analogue scales and has a number focused theme.)

She had some blood tests, including a full blood count (FBC), performed in clinic the week before and the results are included in the table below. Mum is informed of the result and reassured that all is fine in preparation for admission to hospital and theatre next week.

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Una had a FBC performed because she has been unwell recently and looked pale and anaemic when seen by the ENT doctor in clinic. A FBC is not routinely performed as part of a preoperative assessment.

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Hospital number	AMH2014-01
Ward name/number	Gamma Ward 3 (children’s day case surgical unit)

Temperature	Pulse	Blood pressure	Respirations	CRT	Pain score	PEWS score
37°C	106 bpm	Not recorded	26 per minute	1–2 seconds	0	0

Full blood count	Una’s result	Normal range
Haemoglobin	13.3 g/dL	13.8 g/dL
White cell count	7 × 10^9/L	4–12 × 10^9/L
Platelets	255 × 10^9/L	100–300 × 10^9/L

INTRODUCTION

This chapter will explore the context of numeracy practice in nursing in general and children and young people’s nursing more specifically, define what is numeracy/mathematics and introduce the beginnings and basics of numeracy language including place value and the use of zero.

Why read this book?

The first question to ask is why are you reading this book and why do we need yet another book on numeracy for healthcare, nursing and children’s nursing in particular, especially when there are already many other very good numeracy text books available.

You only need to look at the unfortunately regular news headlines lambasting nurses for their poor numerical abilities, which lead to serious prescription and drug administration errors. As a result we need to sit up and take note of the fact that we need to be constantly updating and developing our numeracy skills however numeracy competent we may feel we are. Whilst competence is needed for all fields of nursing, with the nursing of children and young people – where we care for neonates to adolescent patients – being accurate, safe and competent in numeracy practice is of vital importance. In addition, the numeracy subset of skills for this particular group of patients also serves to offer more challenges to numerical ability.

So, to delve a bit more deeply beyond media headlines alone to more research-based evidence, the National Patient Safety Agency (2007a) found that the most serious errors were caused by errors in medicine administration (41%) and prescribing (32%). Medication errors with children were reported from all stages of the medication process though the majority were from the part involving administration of the medicine itself (56%). The main causes are listed below:

• Prescribing errors – where medicines prescribed as volume of liquid rather than actual dose and also calculation errors, that is, 5 mL instead of 250 mg
• Dispensing errors – due to labelling errors
• Administration – involving, most commonly, intravenous drug errors though also giving a drug like paracetamol when previous dose given was not recorded, a drug being given to the wrong patient or giving the wrong amount, that is, millilitre instead of milligram

Additionally, there is a whole list of errors including wrong dose, strength or frequency errors, weighing scale errors and weight in pounds not kilograms. This is why this book has a focus on all aspects of numeracy, not just that related to medication administration. The most common medicines involved are paracetamol, gentamicin and morphine, which are all medicines that are c...