Effectiveness of a computer based medication calculation education and testing programme for nurses

Asynchronous e-learning with technology-enabled and enhanced training for continuing education of nurses: a scoping review

BACKGROUND

Asynchronous e-learning has become the mainstream choice since the transformation of learning formats by the coronavirus disease-19 pandemic. This scoping review aimed to examine the technologies used in asynchronous e-learning for the continuing education of clinical nurses and their modes of delivery and effectiveness.

METHODS

This scoping review covered the period between 2011 and 2023. Six databases were searched for relevant studies following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) protocol.

RESULTS

Sixty articles met the inclusion criteria. There was a noticeable trend toward using diverse technology-enabled and enhanced training (TEET) options after 2017. The enabling technological approaches, such as interactive online modules (25 articles) and video modules (25 articles), are described in the articles. The most commonly used enhancing technologies were scenario-based learning (nine articles), resource access (eight articles), computer simulation or virtual reality (three articles), and gamification (three articles). Among the outcomes, knowledge acquisition was the most commonly examined outcome (41 articles).

CONCLUSIONS

Notably, many interactive TEET modules were used in asynchronous e-learning. There were few studies on gamification, computer simulation or virtual reality, and scenario-based learning (techniques to enhance intrinsic motivation further). However, the adoption of asynchronous e-learning with advanced TEET options is anticipated to increase in the future. Therefore, objective outcome measures are required to determine the effects of such learning methods on knowledge acquisition and behavioral changes.

Numeracy Education for Health Care Providers: A Scoping Review

INTRODUCTION

Health numeracy (numerical literacy) refers to an individual's ability to use numerical information to make effective health decisions. Numeracy is fundamental in the role of a health care provider, forming the basis of evidence-based medicine and effective patient-provider communication. Despite a high level of education, many health care providers struggle with numeracy. Numeracy is often integrated into training curricula; however, teaching modality, competencies covered, learner satisfaction, and effectiveness of these educational interventions varies.

METHOD

A scoping review was conducted to explore and summarize what is known about numeracy skills education programs for health care providers. A comprehensive literature search was conducted from January 2010 to April 2021 in 10 databases. Controlled vocabulary terms and text words were used. The search was restricted to human studies, adults, and the English language. Articles were included if they were related to numeracy education for health care providers or trainees and provided details regarding methods, evaluation, and results.

RESULTS

The literature search retrieved 31,611 results and 71 met the inclusion criteria. Most interventions were conducted in a university setting, and targeted nursing students, medical students, resident physicians, and pharmacy students. Common numeracy concepts included statistics/biostatistics, medication calculations, evidence-based medicine, research methodology, and epidemiology. A variety of teaching modalities were used, which most often combined active approaches (eg, workshops, laboratories, small-group exercises, and discussion boards) with passive approaches (eg, traditional lectures and didactic teaching). Measured outcomes included knowledge and skills, self-efficacy, attitudes, and engagement.

DISCUSSION

Although efforts have been made to incorporate numeracy into training curricula, greater emphasis should be placed on developing strong numeracy skills in health care providers, particularly given the role numerical information plays in clinical decision making, evidence-based practices, and patient-provider communication.

Nurse Education and Mathematical Competency: Implementation of an Online, Self-Directed, Prerequisite Model

Mathematical competency in the profession of nursing has increasingly become a central focus as more nursing students appear to struggle with basic concepts of arithmetic, mental estimation, and critical reasoning. This paper highlights how one School of Nursing in Ontario, Canada implemented a Dosage Calculation Competency Test model which involved an online, self-directed, prerequisite approach to improve student mathematical competency and confidence. The purpose of this research case study was to document, through shared participant perceptions, the creation, implementation, and subsequent modifications to a Dosage Calculation Competency Test model in light of student needs and advances in online learning and assessment. The research design combined a quantitative survey of Year 1-4 nursing students, followed by a series of qualitative, semi-structured interviews with nursing students and program instructors. The study took place within a School of Nursing undergraduate program in Ontario, Canada. Forty-four participants, including students from all four years of the nursing program, completed the survey, followed by individual interviews with nine students and six faculty instructors. Survey (the open-response items) and interview data were analyzed thematically using ATLAS.ti (ATLAS.ti, Berlin, Germany). The authors recount the new DCCT model's development, implementation, and subsequent modifications and further discuss student/instructor perceptions of learning types, math confidence, and competency. The paper concludes with a series of seven key recommendations for nursing programs.

Three-month follow-up effects of a medication management program on nurses' knowledge

This quasi-experimental study examined the effects of a medication management program on nurses knowledge of medication management, three months after program completion. Fifty-seven nurses took a multiple-choice test both immediately after the program and three months later. Changes in test performance were assessed using McNemar's test and generalized estimating equations for binary outcomes. Test results were generally consistent from immediately post-program to three months later, though four items differed significantly. From immediately post-program to three months later, fewer nurses correctly answered the items: documenting no medication administration (98.2 vs 86.6, p = 0.04); documenting opioid administration (56.1 vs 33.3, p = 0.01); and observation after opioid administration (35.1 vs 19.3, p = 0.08. Significantly more nurses correctly answered the item concerning the pharmacology of medication administered with food (64.9 vs 77.2, p = 0.09). We recommend both continuous medication management training and focusing on the correspondence between theory-based knowledge and clinical practice routines.

The effects of neurologic assessment E-learning in nurses

BACKGROUND

A firm understanding of the preliminary assessment of a patient with neurological disorders is needed for ensuring optimal patient outcomes.

OBJECTIVES

The purpose of this study is to evaluate the effects of using e-learning on neurologic assessment knowledge, ability, and self-confidence among nurses.

DESIGN

This study used a non-equivalent control group pretest-posttest design.

SETTINGS

Nurses working in the neurology and neurosurgery wards, Republic of Korea PARTICIPANTS: A convenience sample of 50 nurses was assigned to either the experimental group (n=24) or the control group (n=26).

METHODS

The experimental group participated in the self-directed e-learning program related to neurologic assessment, and control group underwent self-directed learning with handout. Knowledge, ability, and self-confidence were measured at pretest and posttest.

RESULTS

There were no significant differences in knowledge (U=270, p=0.399) and self-confidence (U=241.5, p=0.171) between the two groups. Nurses in the experimental group showed higher neurologic assessment ability compared with those in the control group (U=199, p=0.028).

CONCLUSIONS

Self-directed neurologic assessment e-learning induced improvement in the neurologic assessment ability among nurses. Self-directed e-learning can be applied for improving competencies in neurologic assessment.

Systematic review and meta-analysis of educational interventions designed to improve medication administration skills and safety of registered nurses

OBJECTIVES

The aim of this study is to evaluate the nature, quality and effectiveness of educational interventions designed to increase the medication administration skills and safety of registered nurses working in hospitals.

DESIGN

A systematic review with meta-analysis.

DATA SOURCES

Intervention studies designed to increase the medication administration skills and safety of nurses, indexed in one or more databases (CINAHL, PubMed, Scopus, Cochrane, PsycInfo, or Medic), and published in peer-reviewed journals between January 2000 and April 2015.

REVIEW METHODS

The nature of the interventions was evaluated by narrative analysis, the quality of studies was assessed using the Effective Public Health Practise Project Quality Assessment Tool and the effectiveness of the interventions was ascertained by calculating effect sizes and conducting a meta-analysis.

RESULTS

A total of 755 studies were identified and 14 intervention studies were reviewed. Interventions differed by their nature, including traditional classroom training, simulation, e-learning, slide show presentations, interactive CD-ROM programme, and the use of posters and pamphlets. All interventions appeared to improve medication administration safety and skills based on original p-values. Only five studies reached strong (n=1) or moderate (n=4) quality ratings and one of them had to be omitted from the meta-analysis due unclear measures of dispersion. The meta-analysis favoured the interventions, the pooled effect size (Hedges' g) was large, 1.06. The most effective interventions were a blended learning programme including e-learning and a 60-min PowerPoint presentation. The least effective educational intervention, an interactive internet-based e-learning course, was reported in the study that achieved the only strong quality rating.

CONCLUSIONS

It is challenging to recommend any specific intervention, because all educational interventions seem to have a positive effect, although the size of the effect greatly varies. In the future, studies sharing similar contents and methods should be compared with each other.

Dissemination and Implementation of Function Focused Care for Assisted Living

Assisted living (AL) settings are residential settings that provide housing and supportive services for older and disabled adults. Although individuals in AL are less functionally impaired than those in nursing home settings, they engage in limited amounts of physical activity and experience more rapid functional decline than their peers in nursing homes. Function Focused Care for Assisted Living (FFC-AL) was developed to prevent decline, improve function, and increase physical activity among residents living in these settings. The purpose of this study was to disseminate and implement the previously established, effective FFC-AL approach to 100 AL settings. Evidence of our ability to successfully disseminate and implement FFC-AL across these settings was established using the Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance model. Settings were eligible to participate if they had more than eight beds and identified a nurse (i.e., registered nurse, licensed practical nurse, or direct care worker) champion to facilitate the implementation process. Setting recruitment was done via mailed invitations to 300 eligible ALs and e-mails to relevant AL organizations. Evidence of reach was based on our ability to recruit 99 ALs with adoption of the intervention in 78 (78%). There was a significant improvement in policies supporting function-focused care and in establishing environments that supported function-focused care, and there was evidence of enduring changes in settings indicative of maintenance. We were able to implement all aspects of the intervention although challenges were identified. Future work should focus on using more face-to-face interactions with champions along with identified stakeholders, evaluating characteristics of champions to establish those who are most successful, and recruiting residents to obtain resident-specific outcomes.

Online intravenous pump emulator: As effective as face-to-face simulation for training nursing students

BACKGROUND

The expansion of online education for nursing students has created the challenge of finding innovative ways to teach clinical skills. An online intravenous pump emulator (IVPE) modelled on actual IV pumps used in clinical healthcare settings was developed to facilitate online education delivery.

OBJECTIVES

The objectives of the study were to implement the online IVPE and evaluate student learning outcomes and perceptions of device use.

DESIGN

A mixed method, quasi-experimental design was used.

SETTING

The study was conducted in the School of Nursing and Midwifery at a regional university in Queensland, Australia.

PARTICIPANTS

Participants were 179 first year nursing students enrolled in a medications course, ranging in age from 18 to 44years, of whom 150 were female.

METHODS

Participants were assigned to one of three groups and trained in the use of IV infusion pumps. Group 1 (n=57) were trained online using the IVPE (ONL); Group 2 (n=73) were trained on-campus using an actual IV pump (ONC); Group 3 (n=49) were trained both on-campus using the actual IV pump and online using the IVPE (ONL+ONC). Competence in using the actual IV pump was assessed for all participants at the conclusion of the training period.

RESULTS

No significant differences in learning outcomes, measured by assessment scores out of 80 points, were found between the ONL (M=65.5±9.2) and ONC (M=62.0±14.8; p>.05) groups. Significantly better learning outcomes were evident for the ONL+ONC group (M=68.7±4.9) compared to the ONC group (p<.01).

CONCLUSIONS

This study highlights that the nursing students became more competent in the skill of preparing and administrating IV infusions when face-to-face and online learning were combined.

The effectiveness of an e-learning course on medication calculation in nursing students: a clustered quasi-experimental study

AIM

To evaluate the effectiveness of an e-learning course compared with a face-to-face lecture on medication calculation.

BACKGROUND

The current knowledge on medication calculation of nursing students and nurses is insufficient to provide safe care.

DESIGN

A stratified-clustered quasi-experimental study.

METHODS

A random selection of nursing schools were allocated to the e-learning course (intervention group) (seven schools; 189 students) or face-to-face lecture (control group) (six schools, 222 students). Students in both groups completed a validated medication calculation test (maximum score: 16) prior to the course (T0), immediately after the course (T1) and 3 months later (T2). A linear mixed model was used for data analysis.

RESULTS

Medication calculation skills improved significantly more by the face-to-face lecture than e-learning course. Students in both groups significantly improved in medication calculation skills immediately after the course (T1) and 3 months later. The results flattened at T2 with a significant decline in the intervention group between T1 and T2 and a non-significant decline in the control group. Based on a subgroup analysis, improvement in medication calculation skills at T2 could only be observed in vocational-level (sub degree) nursing students receiving a face-to-face course.

CONCLUSIONS

Both medication calculation courses had a positive effect on medication calculation skills. Students receiving traditional face-to-face lecture improved significantly more than the students receiving the e-learning course.

A prospective three-step intervention study to prevent medication errors in drug handling in paediatric care

AIMS AND OBJECTIVES

To prevent medication errors in drug handling in a paediatric ward.

BACKGROUND

One in five preventable adverse drug events in hospitalised children is caused by medication errors. Errors in drug prescription have been studied frequently, but data regarding drug handling, including drug preparation and administration, are scarce.

DESIGN

A three-step intervention study including monitoring procedure was used to detect and prevent medication errors in drug handling.

METHODS

After approval by the ethics committee, pharmacists monitored drug handling by nurses on an 18-bed paediatric ward in a university hospital prior to and following each intervention step. They also conducted a questionnaire survey aimed at identifying knowledge deficits. Each intervention step targeted different causes of errors. The handout mainly addressed knowledge deficits, the training course addressed errors caused by rule violations and slips, and the reference book addressed knowledge-, memory- and rule-based errors.

RESULTS

The number of patients who were subjected to at least one medication error in drug handling decreased from 38/43 (88%) to 25/51 (49%) following the third intervention, and the overall frequency of errors decreased from 527 errors in 581 processes (91%) to 116/441 (26%). The issue of the handout reduced medication errors caused by knowledge deficits regarding, for instance, the correct 'volume of solvent for IV drugs' from 49-25%.

CONCLUSION

Paediatric drug handling is prone to errors. A three-step intervention effectively decreased the high frequency of medication errors by addressing the diversity of their causes.

RELEVANCE TO CLINICAL PRACTICE

Worldwide, nurses are in charge of drug handling, which constitutes an error-prone but often-neglected step in drug therapy. Detection and prevention of errors in daily routine is necessary for a safe and effective drug therapy. Our three-step intervention reduced errors and is suitable to be tested in other wards and settings.

A whole-of-curriculum approach to improving nursing students' applied numeracy skills

BACKGROUND

Nursing students often perform poorly on numeracy tests. Whilst one-off interventions have been trialled with limited success, a whole-of-curriculum approach may provide a better means of improving applied numeracy skills.

OBJECTIVE

The objective of the study is to assess the efficacy of a whole-of-curriculum approach in improving nursing students' applied numeracy skills.

DESIGN

Two cycles of assessment, implementation and evaluation of strategies were conducted following a high fail rate in the final applied numeracy examination in a Bachelor of Nursing (BN) programme. Strategies included an early diagnostic assessment followed by referral to remediation, setting the pass mark at 100% for each of six applied numeracy examinations across the programme, and employing a specialist mathematics teacher to provide consistent numeracy teaching.

SETTING

The setting of the study is one Australian university.

PARTICIPANTS

1035 second and third year nursing students enrolled in four clinical nursing courses (CNC III, CNC IV, CNC V and CNC VI) were included.

METHODS

Data on the percentage of students who obtained 100% in their applied numeracy examination in up to two attempts were collected from CNCs III, IV, V and VI between 2008 and 2011. A four by two χ(2) contingency table was used to determine if the differences in the proportion of students achieving 100% across two examination attempts in each CNC were significantly different between 2008 and 2011.

RESULTS

The percentage of students who obtained 100% correct answers on the applied numeracy examinations was significantly higher in 2011 than in 2008 in CNC III (χ(2)=272, 3; p<0.001), IV (χ(2)=94.7, 3; p<0.001) and VI (χ(2)=76.3, 3; p<0.001).

CONCLUSIONS

A whole-of-curriculum approach to developing applied numeracy skills in BN students resulted in a substantial improvement in these skills over four years.

Safety in numbers 7: Veni, vidi, duci: a grounded theory evaluation of nursing students' medication dosage calculation problem-solving schemata construction

This paper evaluates nursing students' transition through schemata construction and competence development in medication dosage calculation problem-solving (MDC-PS). We advance a grounded theory from interview data that reflects the experiences and perceptions of two groups of undergraduate pre-registration nursing students: eight students exposed to a prototype authentic MDC-PS environment and didactic transmission methods of education and 15 final year students exposed to the safeMedicate authentic MDC-PS environment. We advance a theory of how classroom-based 'chalk and talk' didactic transmission environments offered multiple barriers to accurate MDC-PS schemata construction among novice students. While conversely it was universally perceived by all students that authentic learning and assessment environments enabled MDC-PS schemata construction through facilitating: 'seeing' the authentic features of medication dosage problems; context-based and situational learning; learning within a scaffolded environment that supported construction of cognitive links between the concrete world of clinical MDC-PS and the abstract world of mathematics; and confidence-building in their cognitive and functional competence ability. Drawing on the principle of veni, vidi, duci (I came, I saw, I calculated), we combined the two sets of evaluations to offer a grounded theoretical basis for schemata construction and competence development within this critical domain of professional practice.