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Nelson Selvaraj loves maths. And his enthusiasm is infectious. If you quake at the thought of drug calculations and have a phobia of fractions, Nelson is the person to calm your anxiety.

A lecturer in adult nursing and the numeracy lead at the School of Healthcare Sciences at Cardiff University his success in coaching undergraduate nurses towards a better grasp of numeracy was recognised in last year’s RCN Wales Nurse of the Year awards, where he won the Nurse Education category. 

The judges were impressed by his “enthusiasm, motivation and passion” – qualities that were also evident when he won a student-nominated lecturer of the year award in 2019.


Above: Nelson Selvaraj was a winner at last year's RCN Wales Nurse of the Year awards

“I was always interested in maths, ever since school,” Nelson says. He studied maths and science during his higher secondary education and numeracy featured strongly in the nursing degree he completed in India.

“A nursing degree in India takes four years and there are numeracy exams from year two. You have to pass the exam before you move on to the next year.”

Degree completed, he began working in critical care where he was able to put his love of maths to good use. “In critical care, you have to have very strong numeracy and calculation skills so you’re able to administer the drugs safely and effectively. Every year we used to have a drug calculation test locally. If you didn’t pass at 100%, you couldn’t do drug rounds for your patients. You’d be automatically put under supervision and another nurse would come and administer your drugs. It was very strict.”

Everyone learns at a different pace and in different ways

When he took over the numeracy lead role at Cardiff in 2017, he was puzzled why the first-attempt pass rate for students sitting numeracy exams seemed low, at around 65%.

“I started looking at ways I could better support students – for example, who else can I involve to give them the best teaching or learning resources so they can perform their calculations well?”

Common mistakes

When he studied the data more closely, it was clear it wasn’t just calculations that students were getting wrong. “The errors were around their understanding of a formula, for example, or their understanding of units – milligrams, micrograms – or how to convert from one to the other.”

So as well as calculation errors, students were prone to conceptual misunderstandings and basic measurement mistakes.

In fact, he says, according to one study, mistakes in clinical practice that are due solely to miscalculation account for only 12% of drug errors, suggesting nurses’ commonly expressed lack of confidence in their numeracy skills may be misplaced. By far the most mistakes are made during drug administration.

Cardiff Uni

Above: Nelson at work at Cardiff University

Clearly any error involving patients’ medication can have catastrophic consequences. So, he asked the university’s School of Mathematics for help in pushing up the pass rate. “I gave them the details – this is what our students are struggling with – and they offered to come and run some revision sessions.”

Nelson’s students found the sessions, organised by PhD maths candidates, “very, very useful”. He also involved the assessment team who set the students’ numeracy exams: “I wanted to be certain we had the right processes in place, especially for students who have additional learning needs to make sure we address their specific needs properly.”

The interventions worked. The pass rate for the numeracy exam shot up to 84%.

5 tips for maths confidence 

1. Stay calm

You don’t need to panic, says Nelson. Everyone can get to grips with basic maths.

2. Seek out support

Make sure you complete online learning modules, and ask your university for additional support if you need it.

3. Don’t compare yourself to others

Everyone learns at a different pace and in different ways, Nelson says, so focus on your own studies.

4. Look at the wider picture

This is just one of many nursing skills you’re learning, and contributes to patient safety. If you can master others, you can master this.

5. Practice makes perfect

Test yourself as much as you can until you feel more confident.

His key advice for students fearful of messing up their maths is to stay calm.“The moment students hear about numeracy, calculation or maths they get really, really frightened,” he says. “I know maths is not everyone’s cup of tea but it’s nothing to panic about.”

There are many drug calculation e-learning packages available across the UK, Nelson says. The one used by Cardiff University students is safeMedicate whose learning and assessment modules cover a wide range of topics.

Maths is nothing to be scared of

Start going through the e-learning modules as early in your course as you can, he suggests. “There are a lot of useful modules there – what’s a milligram, a microgram, how to convert. Making sure you complete the modules will definitely give you a confidence boost.”

And then? “Practise. I can’t overemphasise the importance of repeatedly practising. That, too, will give you confidence.”

If you find you’re still struggling, contact the numeracy lead or the maths support team at your university. And don’t wait – the sooner you find appropriate support, the sooner you can start improving your skills.

Everyone learns differently 

Try not to compare yourself to your peers, who may be rushing through the e-learning modules and dazzling everyone with the speed and accuracy of their mental arithmetic. Everyone learns at a different pace and in different ways, Nelson says, and there’s always someone who can help with your particular challenges.

At Cardiff, as well as those revision sessions, the School of Mathematics runs bespoke online sessions for individual students. The support is there, but you have to be proactive if you want to access it, says Nelson.

Safe drug administration is about so much more than calculations
Try to see all of this in the context of patient care, Nelson advises: “Maths is actually a very interesting subject and once they have really understood the concept behind the drug calculation, the student will enjoy it.”  

Safe drug administration is about so much more than calculations. The maths involved is just one more skill to learn, like giving an injection or monitoring a patient for side effects. 

Seeing the wider picture can help you focus and nail even complex calculations. Nelson says: “Maths is nothing to be scared of.”

Words by Daniel Allen

Further information

  • The RCN resource Safety In Numbers focuses on giving you the chance to practise the type of maths and number problems you will encounter in everyday nursing care.
  • Check out our dyscalculia resource on adjustments and strategies that can assist health care professionals and students with dyscalculia.

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