'Dyscalculia, maths anxiety and numerophobia in nursing practice.'

**Liz:** Welcome to the next episode of our RAINE podcast. And today we're talking about a fascinating topic, which I know a lot of nurses quite often chat and that's about maths and drug calculations in nursing. And it's my pleasure to have with me Allison Smale, who's a numeracy tutor, maths lecturer and also a published author. So Allison, thank you so much for joining us.

**Allison:** You're very welcome. It's a pleasure to be here and speak about something that I know a lot of people find difficulty with. And it's something I've got a real heart for too. So thank you for giving me this opportunity.

**Liz:** Oh, you're welcome, Allison, because yes, I mean, I personally am not a huge mathematics fan. So I often feel my students’ pain when they say to me about having some problems with them doing their drug calculations. But obviously in the in the guise of RAINE, as we're looking at it, obviously, it can be more than just not liking maths, isn't it? It can be maybe a disability or an impairment or a couple of the other issues or topics that we're going to talk about. And these are things that, as we've spoken about before, that you find come up during your career. So one first comes to mind is the dyscalculia, which is, you know…

**Allison:** Yes. So dyscalculia is kind of an interesting one. It's not as widely researched and looked into as dyslexia. So if people suspect they have dyscalculia, then the best thing to do is to have it diagnosed by an educational psychologist, or if you are at university, you may find that there is a specialist there who's able to assess whether or not you have it. I must admit, I didn't really find, and I'm still finding that that is not a huge problem. The main problem is maths anxiety. And I guess perhaps it might be helpful for some people to feel, oh, I need to put a label on it. So dyscalculia is a great label to put on it. But actually, it's the anxiety itself that probably needs to be addressed, rather than putting a label on it as such. So by all means, you know, go and have yourself assessed, go means, you know, access all the help that's available. You know, that's a really great thing to do. But it's mostly the anxiety that I found students have had problems with.

**Liz**: That's interesting, isn't it? Because as you say, sometimes we're very quick to want to put a label on something. But actually, and I have had students myself saying to me, I think I have dyscalculia, but actually, when they've come to their maths tutor, they've realised that it's actually maths anxiety. You know, it's the anxiety of maths or in fact, numerophobia, rather than the dyscalculia. Have you found that yourself in your career?

**Allison:** Oh, indeed. Yes. In fact, I have found it so prevalent that the best thing to do when I start teaching a particular cohort of students or, you know, anybody, one to one or whatever, is to address that anxiety, because it gets in the way of learning. And it presents itself in different ways. So I suppose the most dramatic reaction I've ever had was I went into a particular workshop and said to the students, OK, we're going to do some maths today. The lass on the front row stood up screened and ran out the room. So that is probably the most dramatic reaction I've had.

But other people react in different ways. So some people try and avoid my gaze. So they'll put their head down and sort of think, well, if I can't see her, she can't see me. And so I can just quietly disappear in the background and perhaps she won't ask me any awkward questions like, what's the answer to this question? But I don't know. So I've seen a lot of people like that. I've seen some people just sit and visibly shake. I've seen some people who just go totally blank, you know, very able, very clever students, mentions some numbers, and my mind’s just gone completely blank. And so it does manifest itself in lots of different ways.

**Liz:** As a lecturer, it's interesting. When you walk into an exam room, you know if a maths exam or a drug calculations exam is taking place, because you could cut the air with a knife. You can just tell. So do we know why not just nurses, but why people have maths anxiety?

**Allison:** Well, one of the things I do get students to do that I found is quite useful for them, is to talk about their past experiences with maths. And then that gives me an insight into where they are. So I would generally start with an icebreaker. So this is just kind of a fun game that involves maths. And there are a couple of very, very sort of useful ones I found. And it just distracts from the actual maths for a little while. And so people can just get a little bit more relaxed.

And then once we've done a couple of these icebreakers and games, then I encourage people to talk to each other about their experience of maths. So was it a good experience? Was it a bad experience? And then if they're able, perhaps to share it within the group. And common problems are perhaps somebody in the past has told them that they're not very good at maths. It might be a parent, a teacher, or it might just be something they've just picked up themselves that they're no good at anything and maths in particular. Or it might be all, you know, Miss Smith in year three told me I'd never amount to anything in maths. And you know, she's absolutely right. And so they start to tell themselves this little story.

It may be that they've just had an illness in the past in their childhood. And so they've missed a chunk of maths. And maths is very much like building blocks like Lego or Duplo, that you kind of need a lot of the foundation for you can go on. It's not like that geography where you can do France. And then well, if you miss France, because you were poorly, it doesn't matter because we're doing Germany next week kind of thing. It's not that sort of thing. And so sometimes people have just missed out on a really key thing. And that seems to be key to everything. And they just kind of can't get the group of it.

Other people might have had a series of teachers. I do know some students who said in their GCSE year due to no fault the schools their own just kind of the way things happened that they might have had say five or six teachers in that year. And so they're just getting used to Miss Smith and then Mrs. Abdul comes and then you know, Mr. Singh comes and then Miss Brown comes and you know, they never kind of get the hang of anything really.

So there seem to be a variety of reasons why students come with this fear of maths. And so we then talk about the maths journey and that maths is very much a journey. So if they feel that they're dreadful at maths, then my role as a teacher is to make them better. If they feel they're good at maths, well, I want to make them excellent. If they're excellent, I want to make them outstanding. It doesn't matter where they are on that journey. They are, you know, my role is to move them on wherever they are. And so looking at it as a journey, again, is a very helpful concept.

So you can say to the students, right, let's look at the story of telling yourself. You can't do fractions. Okay, why don't we add a word to that? You can't do fractions *yet*. And then the story starts to change. So I think it was Henry Ford who said, ‘whether you think you can or whether you think you can't, you're right’. So the story you tell yourself is really, really important. So we do a little bit on that and there's various other tools I have for enabling people to tell themselves a good story. And that seems to be, again, a very helpful way. So a combination of starting off with perhaps some games or ice breakers, and then moving on to the story.

And then we perhaps move on to a very kind of simple or basic topic but do it in a variety of ways. So if a student doesn't grasp a particular method, then that doesn't matter, because there are loads of other methods. And we just keep going until we find one that works for you, because everybody is unique. And if you found one that works for you, that I haven't mentioned, then share it with group, because, you know, we're all, we're all in into this together. And kind of what you, what you create is you kind of create a culture where it's, me and the students against some maths, and we're fighting it together, and we're over coming it together, and we're showing it who's boss.

**Liz:** It's just so interesting, isn't it? It's that the psychological aspects of this maths, isn't it? I think quite often, students will come to university for their nursing degree, and we've seen it, they will be diagnosed with dyslexia on the nursing programme. And it's almost a relief for some of the students that they realise why they struggle with maybe writing or spelling or organisation. But when it comes to maths, it's, I don't know, I hear a different story, you know, it's psychological, you know. I mean, obviously, some people genuinely have dyscalculia. But as you say, for some people, they might think they have dyscalculia, but in fact, it's this maths anxiety or numerophobia.

And that's, I think, from correct me if I'm wrong, but I almost feel that that's important to make that distinction, like for the students, for the nurses, for nurses, and, you know, in general, to make that distinction that you haven't necessarily got dyscalculia, where you would need reasonable adjustments, you might have maths anxiety or numerophobia, but you could say that there are reasonable adjustments for that. So do you do you agree that it's important for our listeners, if this is something that resonates with them to try and make that, make that clear within their own head, you know, is this dyscalculia? Or is this, in fact, maths anxiety? Would you agree with that?

**Allison:** Oh, absolutely. I think it's very clear. It's very important to realise what the problem actually is. And you mentioned dyslexia. So I found that quite a lot of students with dyslexia may have an additional problem with numeracy, but that is not necessarily dyscalculia. So that is perhaps an extra thing where they are learning to manage their dyscalculia in a mathematical context. And that might be, say, getting numbers back to front. Or it might be when they read a particular scenario and a lot of maths exam, drug calculation exams, are where we set them a little scenario. It might only be a sentence or so, you know, Mrs X needs whatever, you know, what you do kind of thing. But even those couple of sentences might be really difficult for some to say with dyslexia. So you might have to do things like where you're chopping down the sentence into bits and making sure that you've got the right amounts of information and you're tackling it step by step and in a way that you yourself can manage.

**Liz:** Because again, I think a lot of lecturers might find like myself that fascinating that the maths we're talking about nursing is predominantly drug calculations. And by the bedside or in the clinical practice with the drug trolley, nurses can very proficiently, you know, on the whole calculate drugs. And feel quite confident, you know, with the patient in front of them. But in the classroom/exam scenario, it changes.

**Allison:** It does. And what you've mentioned again is a very useful tool for overcoming maths anxiety in that I sometimes say to students, just picture yourself on the ward with the patient. And if it's a tablet question, then picture yourself actually working out the tablets, putting the tablets into little pots. Or if it's an infusion, you know, picture what you would do, picture yourself with the patient. And again, that takes the student out of the scenario of the classroom, which itself can be quite stressful and puts them into scenario where the drug calculations are in context. And a lot of maths as well makes sense to people only when they can see it in the context that they understand it. So, you know, this is why a lot of people say, Well, why are we doing algebra? Why are we doing this? Because they haven't understood the context that they need to apply it in.

**Liz:** I remember a student saying to me once in her their final maths exam on the nursing programme, there were 10 questions. And she said, and the student said, so how many do I need to get right? And I said, well, think of this as giving 10 drugs on a drug round. How many drug areas would you want to make? Oh, none. I said, well, then 10 out of 10! Like you say, think of it as giving 10 drugs to 10 patients. How many would you want to get wrong, then the answer is zero. But it's just, I think it remains a challenge for nurses, isn't it, this mathematical element. But a lot of it's practice makes perfect in the clinical area.

**Allison:** Yes. So a lot of it is practice. So if you're a bit dodgy with fractions, your fractions are not quite as proficient as you would like them to be, then practicing is a good way of doing it. Practicing with the method that suits you is a good way of doing it. Understanding yourself as a learner is also very useful for students. So a lot of nurses are kinaesthetic learners, they're doing people. So picturing themselves doing something or having a process where they're doing something in the calculation is very helpful. So it's actually knowing yourself as a learner as well. If you're a visual person drawing things out, so draw out all the tablets, draw out a patient, don't worry about the artwork, you know, it's not an art exam, just draw things out. So I found that very useful to do in lectures and in the book, I've written, then a lot of it is visual as well. So to encourage people just to actually draw things out, so they can understand them in the way that makes sense to them.

For people who love formulae, well yeah, we've got loads of formulae as well. If you're a formula person and you just like that, systematically do this, this, this, this, and the answer pops out at the end. If you're that sort of person, then we can do it that way as well. There's always lots of different ways of doing it.

**Liz**: Good. And that leads me on quite nicely. You just mentioned your book there? And I've seen a copy of your book and I'm really happy to talk about it because I think not only is it clever in terms of teaching nurses maths, the maths they need, but it's also very insightful in terms of, as you were saying, it's got different ways of working this maths out, because you have this understanding of the individualisation of maths for people. So is that correct? Is this the second edition coming out now?

**Allison:** It is. So what I did was I realised that there was a resource that was missing. So when I was teaching, I thought, you know, I'd really love a textbook that I could just say to the students, just go and get a copy and we'll either work through it or you can use that as an additional resource to what we're doing in the classroom. And there were some really good books about, there's some fantastic books about, but some of them were quite high level, assumed a good level of maths, had a lot of text on a page or went at a very cracking pace.

So some students, you know, they were very well suited to and that's absolutely great. But I thought, you know, there's a real gap in the market for students who find a book like that cluttered or difficult to read, or it just assumes they know things they don't know. And I thought, you know, I'm going to have a go at that. So I’ve actually produced a colour version. So that's on there and was live yesterday.

**Liz:** So on Amazon. Just remind us of the name of the book.

**Allison:** It's called ‘Taking the Stress Out of Drug Calculations’.

**Liz:** Which already makes me smile. Yeah, brilliant. And that's by yourself, isn't it?

**Allison:** Yes. So if you just search for ‘Taking the Stress Out of Drug Calculations’ on Amazon, it will take you to the two books, two versions. So the black and white one is cheaper. And so if you're looking perhaps a more affordable version, then that's the one you might like to go for. And the coloured one, I guess, is more accessible. So if you're looking for accessibility, if that is your priority, then I would go for that one.

**Liz:** And having had a look at the first version, myself, I would highly recommend it for anyone like myself who finds maths difficult or challenging or a little bit anxiety-provoking. I think it's a very good tool for breaking down the maths process and offering different ways of working out drug calcs. So I personally would highly recommend it.

**Allison:** Oh, thank you, Liz.

**Liz:** No, you're welcome. And we shall put a link next to this podcast of where to get the books on Amazon as well. And finally Allison, is there anything else, any other particular resources or websites that you're aware of that nurses could go to help with working out drug calculations and the nursing side of maths that you particularly think are very helpful?

**Allison:** I think the RCN’s got a few resources, and that's specific to nurses. The BBC Skill Wise is a very good website for getting things like fractions, decimals, percentages, ratios under your belt and gaining confidence in that.

**Liz:** Well Allison, thank you so much again for joining us on our podcast, which I think is a very useful and prevalent issue in nursing, and hopefully our conversation today and your book and these resources we've talked about can help with anyone who needs that extra support, so thank you.

**Allison:** You're welcome, thank you very much for having me, lovely speaking with you Liz.

**Liz:** You too. So thank you so much for listening to this RAINE podcast, so please remember to check out our resources on our webpage, which is at the www.raine.org.uk and also follow us on Twitter at RAINE underscore int capital I-N-T (@RAINE_INT). There are lots of other resources and podcast videos etc there to expand our knowledge and share within our Community of Practice.

So for now, thank you again for joining us and please join us for future episodes of the RAINE podcast.

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