Nursing students’ satisfaction with the instructional design of a computer-based virtual learning environment for mathematical medication learning

Figures & data

Table 1. Overview of the design components of the task-centered instructional design of the CBVLE.

Design component	Design component specified in the CBVLE	References
Learning tasks: Meaningful, authentic and representative tasks that a student might encounter in future employment	In the CBVLE, learning tasks confront nursing students with the steps of the medication process and require mathematical medication knowledge and skills. The learning tasks reflect students’ future real-life tasks and the associated knowledge and attitudes, such as communication, hygiene measures, and correct administration of medication. A variety of domain-specific types of mathematical medication tasks permit the nursing students to grasp the learning procedures.	Dunlosky et al., 2013; Merchant et al., 2014; Rohrer et al., 2015; Van Merriënboer & Kirschner, 2018
Supportive information: Information in the CBVLE that explains how a learning domain is organised and how to approach problems in that domain	In the CBVLE, the relevant elements are highlighted to steer nursing students towards the goals of solving mathematical medication problems. Examples that illustrate task-specific procedures, such as domain-specific rules for underlying mathematical knowledge, are also embedded.	Frerejean et al., 2019; Van Merriënboer & Kirschner, 2018
Procedural information: Information that specifies how to perform the recurrent aspects of learning tasks, displayed “just in time”	Worked examples providing step-by-step instruction for mathematical medication learning are embedded as conditions in the CBVLE that students are assigned to. Detailed corrective feedback is provided for all students and is promptly displayed when wrong answers are given.	Chen et al., 2016; Maier et al., 2016; Tynjälä, 2013; Van Gog et al., 2011; Van Merriënboer & Kirschner, 2018; Yuang et al., 2020
Part-task practice: Exercises on recurrent aspects of learning tasks with the aim of developing a high level of automaticity	Students are trained on patients’ mathematical medication problems in response to orders by doctors. Furthermore, sets of short exercises involving the underlying mathematical knowledge and skills are displayed, which are necessary to develop the high level of automaticity of mathematical knowledge that students need to solve the problems.	Tynjälä, 2013; Van Merriënboer & Kirschner, 2018; Yuang et al., 2020
Cognitive feedback as reflection on learning: Stimulates students to identify strengths and weaknesses related to their learning	After a play round consisting of six mathematical medication problem and two sets of five short exercises, nursing students navigate through the CBVLE towards the doctor, who gives a feedback message as a reflection on learning. This message is related to the points awarded to nursing students during the play round for the right actions and right solutions to the mathematical medication problems.	Carless, 2019; Latifi et al., 2021; Mor et al., 2015; Nelson & Schunn, 2009

Table 2. Learning tasks involving domain-specific mathematical medication knowledge related to liquid medication, infusion of fluids and solid medication in a CBVLE.

Medication domains	Domain-specific knowledge	Domain-specific rules for feedback	Underlying domain-specific principles for all domains	Learning tasks	Basic computational skills (short exercises)
Liquid medication (incl. dilution)	Ratio of the dissolved substance and diluent	Mass/volume 1% = 1gram dissolved substance/100 ml 1‰ = 1gram dissolved substance/1000 ml (1 L) Volume/volume 1% = 1 ml liquid/100ml 1$\text{‰}$ = 1 ml dissolved liquid/1000 ml (1 L)	Quantities, units, conversions of ratios: a. fractions b. decimals c. numbers d. percentage relations between a, b, c, d, division, multiplication, hours, minutes, seconds, (time ratio), elements of the prescription dispensed, extraction of numerical information, applying calculations correctly and accurately	P. suffers severe pain. He is prescribed 15 mg morphine every four hours. Stocked: 1 ml morphine ampoules of 15 mg/ml. How many ml do you inject every four hours? How many ml is this per day?	16 × 8  =  12 × 9  =  ¼ + ¾ = ¼  =  3/3 + 5/3  =  3/4 - 2/8  =  14/5–9/5  =  3/4 × 4/5  =  5/10 × 4/8  =  4/5: 2/5  =  3/5: 1/3  =  ¼ = 0.25 1/20 = 0.05 5% of 1000 ml 4% of 250 ml 1 L = … ml 1 ml = … . cc
Infusion of fluids	Drip rating	20 drips per ml 1. Calculate the total number of drips 2. Calculate the drips per hour 3. Calculate the drips per minute		G. is administered a drip of 500 ml 0.9% NaCl in three hours. How many drips are administered to G. per minute?
Solid medication	Dosage calculation for tablets	Counting, division, multiplication, working with fractions, reference measurements: 24 h in a day, 60 min in an hour, 50% = 1/2, 1/4 = 25%, et cetera.		F. suffers from cystitis. She receives treatment with antibiotics for six days: 750 mg Amoxicillin every 12 h. Stocked: Flemoxin with 375 mg Amoxicillin per tablet. How many tablets should F. swallow during treatment?

Figure 1. Structure of mathematical medication learning in the CBVLE.

Figure 2. Screenshots of the CBVLE environment.

Table 3. Procedure used for the CBVLE study.

Procedure for mathematical medication training in the CBVLE				Duration
Week 1: Introduction and personal data (total)				70 min
	Introductory explanations of the procedure, materials, and the purpose of the research study			30 min
	Students were given avatars, logged in and played a round			30 min
	Personal data questionnaire			10 min
Individual pre-test measurements (total)				85 min
	Introductory remarks			5 min
	Assessment of self-efficacy (se) and intrinsic motivation (im) (questionnaire)			20 min
	Pre-test assessment of domain-specific mathematical knowledge			60 min
Weeks 2-5: Learning phase: CBVLE training (total)				90 min per week
Week 6: Post-tests and debriefing (total)				100 min
	Post-test assessment of domain-specific mathematical knowledge			60 min 30 min 10 min
	Assessment of se, im, and design components (questionnaires) Debriefing

Table 4. Summary of outcomes.

	Condition 1			Condition 2			Condition 3			Condition 4
	CBVLE with no support			Domain-specific support			Regular thinking strategies			Combination
	M	SD	n	M	SD	n	M	SD	n	M	SD	n
Test scores
Pre-test maths	23.41	7.00	27	24.45	7.88	33	20.33	6.71	27	21.26	5.08	31
Post-test maths	30.82	7.33	22	29.54	6.90	28	27.35	9.65	28	28.96	5.10	28
Pre-test self-efficacy	18.73	5.67	30	18.00	5.41	26	19.14	4.13	28	21.14	5.02	22
Post-test self-efficacy	20.07	5.45	28	20.21	4.62	24	21.88	4.53	26	22.18	4.37	22
Pre-test intrinsic motivation	15.58	3.26	31	16.31	3.62	26	16.50	3.12	28	16.83	3.32	24
Post-test intrinsic motivation	18.89	2.41	28	19.00	2.51	24	18.26	3.62	26	18.52	3.16	22

Table 5. Outcomes for nursing students’ satisfaction with the instructional design components.

	N	Min.	Max.	M	SD
Learning tasks	102	2.00	5.00	3.65	.64
Supportive information	103	1.50	5.00	3.67	.66
Procedural information	104	1.00	5.00	3.41	.80
Part-task practice	104	1.00	5.00	3.56	.82
Cognitive feedback	102	1.33	5.00	3.13	.71

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