**2. Description of emerging technology, an adaptive web-based learning resource**

A big challenge in developing an educational web-based learning resource is the intelligent and personalized resource recommendation for learners, how to implement personalized facilities by understanding the learner's personal characteristics such as learning needs and abilities in learning [42, 47]. The adaptive web-based learning resource designed by Andresen [39] provides a personalized approach to learning of medication calculation skills, implying the individual student's level of calculations to be considered.

A key point was the use of the Technological, Pedagogical, and Content Knowledge (TPACK) model [48] (**Figure 1**) to design and develop the adaptive technological learning resource for medication calculations. Such knowledge is important to possess in order to realize the potential benefits from the web-based learning technology [43, 48]. Using the TPACK model contributed to a learning resource, shifting the accent from simple information transmission to a constructivist way of learning [46].

**Figure 1** illustrates that the TPACK model consists of three types of knowledge (technological, pedagogical, and content knowledge) and further that the TPACK model's three types of knowledge are mutually dependent for innovative teaching and learning. By differentiating among these types of knowledge, the TPACK model outlines how content and pedagogy form the foundation of effective education, while the technology used should communicate the content and support the pedagogy to enhance students' learning experience. **Content knowledge** is domain-specific knowledge and, in this case, related to medication calculations, for example, what formulas (dose–quantity–strength) to be used when calculating medicines in different categories (tablets, injections, drops etc.).

*Adaptive Web-Based Technology Aiming at Improving Learning of Medication Calculation… DOI: http://dx.doi.org/10.5772/intechopen.109638*

**Pedagogical knowledge** describes theoretical learning approaches, lesson planning, and assessments. The adaptive web-based learning technology in medication calculations is proposed as a person-centered long-term strategy for learning and developing essential medication calculation skills. A cognitive perspective on learning is underpinned by the idea that individual learning is a result of a re-construction of knowledge, implying that new knowledge builds on previous knowledge [49]. The adaptive web-based learning resource was also developed based on the theoretical understanding of scaffolding, a process in which a more knowledgeable 'other' demonstrates how to perform a specific task, then allows the learner to work independently, offering support as needed [50]. Vygotsky [50] related this to the zone of proximal development (ZPD), which describes the difference between what a learner can do independently and what he/she can do with support or guidance from the more knowledgeable 'other.' The adaptive web-based learning technology is the more knowledgeable 'other,' supporting the learner to be in a flow zone, which is the balance between what is too challenging and what is too easy to be mastered independently. In such a way, learning is adapted to the individual student's learning needs and abilities in learning. Students will be kept continuously motivated for learning and development when a computer guides them into their personal flow zone [43]. Additionally, the learning and teaching principle 'constructive alignment' has been taken into consideration, as learning goals, learning activities, and assessment methods have been appropriately aligned [51]. The adaptive web-based learning resource was developed in line with these theoretical approaches, as it is based on how students learn and develop knowledge in order to achieve understanding and competence. Theoretical approaches are commonly applied to inform development of web-based learning resources [46].

**Technological knowledge** concerns understanding the function of a web-based learning resource and exploring its possibilities for assisting or impeding learning in a specific subject area [48]. Adaptivity is implemented into the web-based learning resource via content adaption and link adaption: the former is how the learning outcomes/tasks are presented, and the latter is how the student navigates between

the content adaption [40, 47]. In this way, the student is provided with feedback and assessments that are the most appropriate for the student's medication calculation level, learning needs, and abilities in learning [41].

In summary, the TPACK model is implemented into the adaptive web-based learning resource via content and link adaption. The student's medication calculation level anticipates the types of medication calculations and learning support (content knowledge) that best address the student's learning needs and thereby increase learning efficacy. The student's correct and incorrect medication calculations are stored in the adaptive web-based learning resource to build the individual student's profile (knowledge, learning needs, ability in learning) and thereby adapt the presentation of education material according to learners' profile. In this way, computer algorithms coordinate the interactions and learning support to address the content, knowledge, learning needs, and ability in learning of each individual student in medication calculations (technological knowledge). Students are given opportunities to engage in repetitive learning and further be engaged in less challenging medication calculations before being engaged in more challenging medication calculations, which highlights the learning of medication calculation skills as a developmental trajectory (pedagogical knowledge). The adaptive web-based learning resource is in line with a complex learning resource, providing meaningful and constructive feedback around learning and motivating and stimulating reflection within the learning situation [52].

### **2.1 Reflections and expectations of the adaptive web-based learning resource in medication calculations**

To ensure that nursing students are competent in medication calculation skills, nursing education must bear the responsibility for the development and implementation of pedagogical strategies for teaching, learning, and assessing medication calculations [15]. Including any web-based learning resources does not necessarily guarantee better learning outcomes in medication calculation skills [27]. Students may fail to effectively grasp important information and learning opportunities due to having total freedom in browsing the web-based learning objectives/tasks. Selfdirected learning (known as learning independently) can be challenging even in higher education, even for the brightest and most motivated students [53]. The fact that students can decide which tasks they want to learn and what tasks to solve by quizzes is not to be understood as being adaptive but only an interactive non-adaptive function that stimulates an active approach to learning [40, 41].

We suggest that an adaptive web-based learning resource will facilitate acquisition of medication calculation skills so that students become competent in medication calculations. An adaptive web-based learning resource will enable students to learn more comprehensively through independent learning with individual accountability and mastery of learning [40, 42]. The existing literature is limited to the development of web-based learning resources in medication calculations without taking into consideration the individual's learning needs and abilities in learning. The adaptive web-based learning resource developed by Andresen (2018), however, tailors learning to each individual student instead of providing the same traditional educational material to all students in a one-size-fits-all model. The adaptive element of the web-based learning resource is considered to be a person-centered approach to learning, by providing students with personalized learning even in a large group or clinical setting and thus avoiding cognitive overload [49] when learning medication calculations. Furthermore, students are enabled to be active and engaged learners, with

*Adaptive Web-Based Technology Aiming at Improving Learning of Medication Calculation… DOI: http://dx.doi.org/10.5772/intechopen.109638*

individualized feedback based on their ZPD [50], important for optimal learning and development of their medication calculation skills.

The adaptive web-based learning resource is expected to allow educators teaching medication calculation skills to monitor nursing students' learning processes, to determine which aspects of medication calculation skills students find easy or difficult to master, and, in such a lens, to identify common challenges suitable for whole-class teaching. In this way, the adaptive web-based learning resource will function as a formative assessment resource to guide teachers as to what they should focus on when teaching in a group. In such an approach to teaching and learning in medication calculations, students' learning will become more visible and useful, to both teachers and nursing students. Teachers need to be aware of students' learning and development of knowledge to provide appropriate learning experiences for students [54]. Moreover, the adaptive web-based learning resource is assumed to be transferable to other healthcare professionals, for example, students in social work, paramedics, and medicine, who also are reported to have challenges in learning and developing knowledge and competence in medication calculation skills [55–57].

### **3. Conclusion**

This chapter has proposed an adaptive recommendation approach of educational resources in learning medication calculation skills in nursing education. The aim of this recommendation was to provide better learning opportunities in medication calculations for students according to the individual student's learning needs and abilities in learning. We have shown how to combine pedagogical rules with an adaptive web-based learning resource in order to give students more personalized learning experiences. We believe that nursing students will appropriately learn and develop medication calculation skills that are necessary to practice proper and safe nursing when they engage in using the adaptive web-based learning resource. How web-based learning resources are shaping learning in higher education is, however, less explored [42]. Due to the promising benefits of adaptive web-based learning [39, 42], we argue that directions for future research should be guided by the voices of the learners who will use the adaptive web-based learning resource when learning and developing medication calculation skills.

This complex adaptive web-based learning resource needs to be evaluated and tested to obtain knowledge of the consequences of implementing the resource in terms of its benefits and drawbacks in areas such as learning outcomes, learning experiences, user friendliness, motivation for learning outside the classroom, lightening the burden on the teaching staff when instructing large numbers of students, improved patient safety due to less miscalculations, and cost effectiveness due to accurate calculations in the clinical setting. Kabudi et al. [42] have emphasized the importance of evaluating adaptive web-based learning resources, because they can offer significant benefit for the individual learner.

### **Funding**

This book chapter did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
