**Abstract**

Medication calculation skills are in great demand among registered nurses. However, miscalculations are a common medication error performed by registered nurses in the clinical setting. Medication calculation errors are common causes of unintended harm to patients of all ages. Mastery of medication calculation skills is one of the tasks nursing students should achieve during their education. Outcome measures, however, indicate that for many students, accurate medication calculations are challenging to both learn and master. This justifies the need for effective learning and teaching approaches in medication calculation skills for nursing students. In recent years, interactive and dynamic learning resources in the form of technological devices and interventions have been developed and implemented to improve nursing students' learning opportunities in medication calculation skills. Research suggests that web-based technologies can enhance learning opportunities in medication calculations. However, for students who have inadequate knowledge, opportunities, and abilities in learning, progression slows down, and more time must be spent on learning. Adaptive web-based learning technology is an emerging technology that have additional learning benefits than traditional interactive web-based learning technologies. This chapter describes the potential of adaptive web-based learning technologies to support learning of medication calculation skills.

**Keywords:** web-based learning, interactive learning, adaptive web-based learning, medication calculation skills, health care education, health care students, medication calculations, medication calculation skills

### **1. Introduction**

## **1.1 Learning and development of professional competence in medication calculation skills**

Professional competence is considered as an essential ingredient to provide effective nursing care and to ensure patient safety [1, 2]. Professional competence is defined as the ability to use a set of knowledge, skills, attitudes, clinical reasoning, and behaviors to successfully perform jobs, roles, or responsibilities [3]. Medication calculation skills are in great demand among registered nurses [4]. To provide highquality and safe care to patients, registered nurses need to be competent in medication calculations [5]. However, miscalculations are a common medication error performed by registered nurses in the clinical setting [5–7]. Medication calculation errors are common causes of unintended harm, such as injury and death, to patients of all ages [7, 8]. Miscalculations also affect patients' length of stay and the financial cost of healthcare services [9]. Miscalculations have to be avoided to protect patients against undesirable consequences such as injury and death [9, 10].

Nursing students go through extensive education, in both the academic and the clinical setting, to develop professional competence so that they are prepared to meet the patients' needs and to provide care with high quality [11, 12]. Mastery of medication calculation skills is one of the tasks nursing students should achieve during their education [12]. Outcome measures, however, indicate that for many students, accurate medication calculations are challenging to both learn and master [13–15]. For example, in a European study including six countries, the authors found that even simple calculation tasks were challenging to master correctly for nursing students [15]. Medication calculation skills should be acknowledged as a well-defined competency in nursing education curricula and continuing education programs [6, 12, 16].

Improving the medication calculation skills of nursing students has been an ongoing challenge for nursing educators [9, 15, 17]. The issue lies in designing pedagogical, monitoring, and tutoring scenarios to support students to learn medication calculation skills appropriately [13, 17]. Currently, there are several global educational initiatives to enhance learning and thereby prevent medication calculation errors. Most common are textbooks that aim to provide students with theoretical and practical knowledge in calculation skills [18]. Other resources that have been developed to facilitate student learning include audio files, pictures, animations, simulations, workshops, blended learning, and simple tests [19–22]. In an attempt to respond to the demands of patient safety, many web-based learning resources have also been developed over several years to assist students and professionals in the learning of medication calculations [23–30].

### *1.1.1 Web-based learning*

Web-based learning is increasing from the extensively available and easily accessible connection to the Web [31, 32]. In web-based learning, a computer, such as for example a laptop or mobile phone, is used for instructional processes and is a key component of the educational intervention [33]. Web-based learning allows students to acquire knowledge in risk-free environments without involving real patients, in addition to allowing the learning intervention to be used at a time and place convenient for the students [32, 34]. This means that students can access web-based learning in real time or according to their own schedules, meaning a synchronous and an asynchronous approach to learning. Such flexibility is reported to be a core benefit with web-based learning [34, 35].

Web-based learning that only is based on a network of static hypertext pages provides students with passive and inadequate learning experiences [33]. However, in the recent years of web-based development, several web-based learning developers have implemented different kinds of interactive web-based learning interventions, providing students with opportunities to make their own choices from the various

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

options available based on their understanding of a task or situation [17, 32]. In this lens, students are given a hands-on approach to web-based learning, working with questions or quizzes and assessment activities when learning a task. This active learning approach engages students with the learning material [34]. Students are required to participate in the learning process actively, rather than simply be passive receivers of information [35].

Since the advent of web-based learning, various web-based learning resources have been developed to improve learning in medication calculation skills [23, 24, 27, 36–38]. However, technological learning interventions do not necessarily provide benefits in medication calculation skills for all students. Kim and Park [27], for example, studied the effectiveness of an interactive smartphone-based dosage calculation training app in a Korean context and revealed that the app improved nursing students' calculation skills but only for students with higher prior knowledge. The smartphone-based training program had an inadequate effect on knowledge building in students with lower prior knowledge. In a Norwegian context, Foss et al. [24] developed the interactive web-based learning resource 'The Medication Game.' Nursing students experienced the web-based learning resource to be fun to use, but the authors concluded that the learning resource did not significantly improve the students' test results in medication calculations. Both students and professionals continue to struggle with the learning and mastering of medication calculation skills [5, 6, 13, 26, 27]. This brings to the fact that even interactive web-based learning resources do not ensure learning and competence development in medication calculations for all learners.

Students progress at different paces; while some individuals learn fast, others learn more slowly [27]. It is imperative to design and develop web-based learning resources that provide appropriate learning opportunities in medication calculation skills for meeting knowledge requirements of all learners [15, 27]. The learning of medication calculation skills should be based on the individual student's learning needs and abilities in learning, an *adaptive approach* to learning, and not in a system that 'fits all' [39]. By adaptive technology, we mean an algorithm that can determine what knowledge the individual student lacks, what kind of feedback the individual student needs, and what challenges the student should face [40–42].

### *1.1.2 Adaptive web-based learning*

Adaptive means adaptation, and adaptive learning is the same as adapted training. Adaptive learning is an educational method that uses web-based learning resources to specially adapt learning materials and assignments to the individual's prior knowledge and skill level [40–43]. In adaptive web-based learning, the software observes one or more aspects of learning, most often whether if the student has answered correctly or has errors in tasks, and then analyzes the observations in order to personalize the learning materials offered by the web-based learning resource [41, 42]. This means that the software does an analysis of what the student has mastered and not and the need the individual has for learning to achieve progression in their understanding and mastery. In such an approach to learning, the adaptive web-based learning resource will help a student obtain information in a form that fits the individual's characteristics and fulfills the student's real learning needs automatically, as well as help the student to avoid the challenges of information overload [40–42]. Many students do not understand themselves as learners in order to understand their learning needs and abilities in learning [44]. Consequently, students do not understand their strength and limitations, making it challenging for students to select what tasks they need

to learn and practice. Moreover, they make inappropriate choices in both learning objectives and approaches to studying, for example, surface and deep approaches to studying and learning [45].

Development of adaptive web-based learning resources in the field of healthcare education is in its infancy [39, 40, 43, 46]. Fontaine et al. [40] have conducted a systematic review including 21 articles, enrolling 3684 health professionals and students. Clinical topics were in particular related to diagnostic testing, and no studies were related to medication calculation skills. In a recent scoping literature review by Andersen et al. [43], aiming to explore characteristics with adaptive learning technologies blended into nursing education, none of the six studies included in the review concerned medication calculation skills. Andresen [39] has in a Norwegian context developed an adaptive web-based learning resource related to medication calculation skills, and the learning resource is revised and adjusted until June 2022. This emerging web-based learning resource could hold promise for enhanced learning and development of competence in medication calculation skills. It is challenging to develop a web-based learning resource combining pedagogical rules with adaptive web-based technology in order to give students more personalized learning experiences [42, 47]. First, we describe the emerging web-based learning resource, and then, we suggest how the web-based learning resource can contribute to learning. Following this, we define research to be conducted to evaluate and test the adaptive web-based learning resource.
