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Kim, Park, and Park: Development and Effectiveness of a Drug Dosage Calculation Training Program using Cognitive Loading Theory based on Smartphone Application
Original Article

J Korean Acad Nurs 2012;42(5):689-698.

Published online: 12 October 2012

DOI: https://doi.org/10.4040/jkan.2012.42.5.689

Development and Effectiveness of a Drug Dosage Calculation Training Program using Cognitive Loading Theory based on Smartphone Application

Myoung Soo Kim1, Jung Ha Park1, Kyung-Yeon Park2

1Department of Nursing, Pukyong National University, Busan, Korea

2Department of Nursing, Silla University, Busan, Korea

Address reprint requests to : Kim, Myoung Soo Department of Nursing, Pukyong National University, 599-1 Daeyeon 3-dong, Nam-gu, Busan 608-737, Korea Tel: +82-51-629-5782 Fax: +82-51-629-7906 E-mail: kanosa@pknu.ac.kr

Received 1 February 2012       Revised 22 February 2012       Accepted 23 September 2012

Copyright © 2012 Korean Society of Nursing Science

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was done to develop and evaluate a drug dosage calculation training program using cognitive loading theory based on a smartphone application. Calculation ability, dosage calculation related self-efficacy and anxiety were measured.

Methods

A nonequivalent control group design was used. Smartphone application and a handout for self-study were developed and administered to the experimental group and only a handout was provided for control group. Intervention period was 4 weeks. Data were analyzed using descriptive analysis, χ2-test, t-test, and ANCOVA with the SPSS 18.0.

Results

The experimental group showed more ‘self-efficacy for drug dosage calculation’ than the control group (t= 3.82, p< .001). Experimental group students had higher ability to perform drug dosage calculations than control group students (t= 3.98, p< .001), with regard to ‘metric conversion’ (t= 2.25, p = .027), ‘table dosage calculation’ (t= 2.20, p = .031) and ‘drop rate calculation’ (t= 4.60, p< .001). There was no difference in improvement in ‘anxiety for drug dosage calculation’. Mean satisfaction score for the program was 86.1.

Conclusion

These results indicate that this drug dosage calculation training program using smart-phone application is effective in improving dosage calculation related self-efficacy and calculation ability. Further study should be done to develop additional interventions for reducing anxiety.

Keywords: Medication, Self-efficacy, Anxiety, Calculation ability, Effectiveness

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Figure 1.
Program development procedure.
jkan-42-689f1.tif
Figure 2.
Developed smartphone-based drug dosage calculation application.
jkan-42-689f2.tif
Table 1.
Principles of the Application Development and Examples of the Questionnaires
Principles of the application development
Teaching strategies for reducing cognitive loading Construction strategies for smartphone based application development
Goal-free effect Construct the learning area and the gaming area. Doesn't display the aim of the lesson in the learning area.
Worked example effect Insert the example tabs on the introduction page in the learning area, which provide solved examples.
Completion problem effect Provide the tips, but make participants write the answers themselves.
Split attention effect Arrange all contents in one page which prevents scrolling to see the cut screen.
Variability practice effect Construct gaming area in order to help participants solve the questionnaires repeatedly.
Modality effect Provide the screen changes and auditory stimulations at the period of scoring.
Redundancy effect Construct the standardized form of questionnaire to prevent cognitive loading resulting from the various information sources.
Multi-media effect Use visual stimuli and auditorial stimuli with graphs, illustrations and audio clips.
Examples of the questionnaires
Metric conversion Convert 1.17 g to mg.
Tablet calculation 62.5 mcg of digoxin is prescribed daily. On hand you have 250 mcg tablets. How many tablets will you give?
Fluid dosage calculation 0.75 g of lincomycin hydrochloride IV 8-12 hourly is prescribed. On hand you have 300 mg in 2 mL. How many mL will you administer?
Drop rate calculation 1 L of Lactated Ringer's solution is prescribed over 10 hours. The drop factor is 15. What is the drip rate (drops/minute) required?
Table 2.
Homogeneity Test of Study Variables at the Baseline (N=78)
Variables Categories (Numbers of items) Exp. (n=37) Cont. (n=41) t/χ2 (p)
n (%) or M±SD
Age (year) 20.30±1.51 20.15±1.28 0.48 (.633)
Gender* Female 36 (97.3) 37 (90.2) (.362)
Male 1 (0.7) 4 (9.8)
Self-efficacy for drug dosage calculation Confidence for mathematics (6) 3.30±0.66 3.09±0.79 1.23 (.211)
Confidence for drug dosage calculation (7) 2.98±0.72 2.71±0.75 1.64 (.106)
Total (13) 3.13±0.62 2.89±0.72 1.58 (.119)
Anxiety for drug dosage calculation Fear of asking help (4) 2.97±0.52 3.01±0.69 −0.24 (.812)
Self-concept (7) Total (11) 2.11±0.67 2.42 0.50 2.60±0.93 2.75 0.67 −2.66 (.010) 2.41 (.018)
Total (11) 2.42±0.50 2.75±0.67 −2.41 (.018)
Calculation ability Metric conversion (3) 2.27±0.87 1.98±0.69 1.67 (.100)
Tablet dosage calculation (3) 0.95±0.23 1.07±0.41 −1.66 (.101)
Fluid amount calculation (3) 2.76±0.72 2.63±0.80 0.71 (.481)
Drop rate calculation (3) 1.43±1.07 1.10±0.92 1.48 (.144)
Total (12) 7.40±2.18 6.78±1.59 1.43 (.156)

Exp.=Experimental group; Cont.=Control group. *Fisher's exact test.

Table 3.
Group Comparisons of Dependent Variables at the Posttest (N=78)
Variables Categories Exp. (n=37) Cont. (n=41) t or F (p)
M±SD M±SD
Self-efficacy for drug dosage Confidence for mathematics 3.48±0.60 3.15±0.75 2.15 (.035)
   calculation Confidence for drug dosage calculation 3.66±0.64 2.95±0.77 4.45 (<.001)
Total 3.58±0.57 3.04±0.67 3.82 (<.001)
Anxiety for drug dosage Fear of asking help 3.02±0.67 2.90±0.65 0.79 (.433)
   calculation Self-concept* 2.14±0.65 2.51±0.69 0.82 (.684)
Total* 2.46±0.49 2.65±0.43 0.66 (.862)
Calculation ability Metric conversion 2.19±0.91 1.78±0.69 2.25 (.027)
Tablet dosage calculation 2.54±0.77 2.12±0.90 2.20 (.031)
Fluid amount calculation 2.81±0.57 2.63±0.70 1.23 (.223)
Drop rate calculation 2.41±0.80 1.41±1.09 4.60 (<.001)
Total 9.95±2.31 7.95±2.12 3.98 (<.001)
Satisfaction for program Effective way to learn 4.38±0.72 − −
Generally appropriate 4.30±0.57 − −
Recommendable 4.24±0.55 − −
Frequency Visit to learning area (number/week) 5.45±7.10 − −
Visit to game area (number/week) 7.68±10.26 − −
Connect hours (min/week) 21.93±26.61 − −

Exp.=Experimental group; Cont.=Control group. *ANCOVAs were used to identify group differences at post-test.

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