Using e-learning to support clinical skills acquisition: exploring the experiences and perceptions of graduate first-year pre-registration nursing students - a mixed method study

Blended learning and simulation in nursing education: A quasi-experimental study on a nursing institute

BACKGROUND

The nursing module teaches basic nursing principles and procedures to undergraduate nursing students. This course is important for the acquisition of procedural and psychomotor skills. The aim of the present study is to evaluate the influence of blended training on the acquisition of practical skills related to gastric insertion tubes.

MATERIALS AND METHODS

A quasi-experimental study was undertaken, containing three groups: The blended group benefited from e-learning, followed by simulation), while the two groups benefited from theoretical teaching and procedural simulation. Then, the degrees of acquisition of declarative and procedural knowledge and the time of completion were measured.

RESULTS

The declarative knowledge grade was higher in the Simulation (16.07) and Blended (15.21) groups than in the Traditional Group (11.66), with a statistically significant difference (P < 0.001). The results also showed a statistically significant difference between the procedural knowledge grades of the three groups (P < 0.001). A statistically significant correlation was detected between declarative and procedural knowledge scores (r = 0.58, P < 0.001) and a negative correlation between procedural knowledge and the time of completion (r = -0.422, P < 0.001).

CONCLUSIONS

The results of this experimentation confirm the positive effect of the blended learning approach on the acquisition of declarative and procedural knowledge as well as the time management allocated to teaching.

How Should We Prepare Our Pharmacist Preceptors? Design, Development and Implementation of a Training Program in a Regional Australian University

Increased experiential learning within pharmacy education has highlighted the need for quality preceptors, leading to a recent focus on their development and training. This study describes the design, development and implementation of a pharmacist preceptor training program in a regional Australian University. The design of this program utilized the results of a previously conducted scoping review of preceptor training programs and a comprehensive preceptor training needs analysis. In addition, participation was sought from an expert advisory group, comprising preceptors and pharmacy professional organizations. Program materials were developed and transferred onto a suitable online learning platform for implementation. Post-training program evaluation will follow Kirkpatrick's model of training evaluation criteria, gaining feedback from both preceptors and students. The four flexible online modules that were designed are aligned with the main preceptor roles: role model, educator, mentor and assessor. The program also included a small-group online interactive networking session and an online discussion forum. Following implementation, 28 pharmacist preceptors completed the training. Preliminary feedback on the training program was extremely positive, particularly to the interactive networking activity. Future programs will continue to be adapted to reflect stakeholder feedback and optimize student placement experiences.

Factors That Enhance and Hinder the Retention and Transfer of Online Pre-Clinical Skills Training to Facilitate Blended Learning

Purpose

During the SARS-CoV-2 pandemic, various online instructional strategies in clinical skills training were piloted. The sudden transition to the remote platform circumvented the rigorous planning associated with curriculum reform. This study aimed to explore students' and tutors' perceptions of factors that promoted or hindered successful learning transfer and to propose a blended conceptual model to guide affective, cognitive, and psychomotor clinical skills training in the pre-clinical phase of medical education.

Methods

A mixed-method quasi-experimental study assessed third-year students' transfer of clinical skills and knowledge following online learning in 2021. Students and their tutors completed online surveys that included open and closed-ended questions regarding factors influencing their experience of the adapted teaching methods. Descriptive statistical analysis was used for the quantitative data. Qualitative responses were thematically analyzed.

Results

One hundred fourteen students (48%) and seven tutors (100%) responded to the surveys. The questionnaires' internal consistency and construct validity were determined using Cronbach's α-Coefficient. There was an overall positive response (86%) to the acceptability of the online platform in clinical skills training. Using online simulations with targeted onsite practice was reported as effective in clinical skills training. Tutors perceived students as well-prepared for the skills laboratory. Five emergent themes, qualified by a linear model of asynchronous and synchronous online and onsite teaching with the evaluation of the instructional design and institutional support, informed the proposed blended learning guide for clinical skills training in the pre-clinical phase.

Conclusion

Blended clinical skills learning that included the flipped classroom concept was well-accepted. Virtual patients proved a convenient cognitive preparation tool for skills training and potentially optimized teaching delivery. The study found that the adapted teaching frameworks incorporating an online clinical skills component into a modified onsite curriculum augmented learners' ability to transfer knowledge to the clinical skills laboratory. An integrated five-step blended model is proposed for future interventions.

Factors Influencing the Effectiveness of E-Learning in Healthcare: A Fuzzy ANP Study

E-learning has transformed the healthcare education system by providing healthcare professionals with training and development opportunities, regardless of their location. However, healthcare professionals in remote or rural areas face challenges such as limited access to educational resources, lack of reliable internet connectivity, geographical isolation, and limited availability of specialized training programs and instructors. These challenges hinder their access to e-learning opportunities and impede their professional development. To address this issue, a study was conducted to identify the factors that influence the effectiveness of e-learning in healthcare. A literature review was conducted, and two questionnaires were distributed to e-learning experts to assess primary variables and identify the most significant factor. The Fuzzy Analytic Network Process (Fuzzy ANP) was used to identify the importance of selected factors. The study found that success, satisfaction, availability, effectiveness, readability, and engagement are the main components ranked in order of importance. Success was identified as the most significant factor. The study results highlight the benefits of e-learning in healthcare, including increased accessibility, interactivity, flexibility, knowledge management, and cost efficiency. E-learning offers a solution to the challenges of professional development faced by healthcare professionals in remote or rural areas. The study provides insights into the factors that influence the effectiveness of e-learning in healthcare and can guide the development of future e-learning programs.

The development and implementation of a blended video watching and peer learning model for master's nursing students: a quasi-experimental study

BACKGROUND

With today's complex needs of the population and high demands in quality of care, there will be a continuing need for expanding role of nurses to assume more responsibilities in healthcare. Newly graduated nurses, who possess the competence to function as Registered Nurses, will soon recognize that lecture-based, passive delivery of content is not sufficient to deal with the complex healthcare environment.

AIM

This study aimed to compare the effects of a blended video watching and peer learning program and the usual lecture-based program on the levels of satisfaction and self-confidence in learning, perceptions of peer learning, and academic performance of students enrolled in a master's nursing program.

METHODS

A quasi-experimental study was conducted. The program was offered to Master of Science in Nursing students during Spring 2021 (intervention group, n = 46), while the usual face-to-face lectures and tutorial classes were provided to students enrolled during Fall 2020 (control group, n = 46).

RESULTS

There was a statistically significant increase in satisfaction, self-confidence in learning, and academic performance in the intervention group after learning in a blended video-watching and peer learning mode.

CONCLUSION

This study fills a knowledge gap to meet the learning needs of time-conscious, part-time students working full time in hospitals.

Improving procedural skills acquisition of students during medical device training: experiments on e-Learning vs. e-Learning with hands-on

In the context of medical device training, e-Learning can address problems like unstandardized content and different learning paces. However, staff and students value hands-on activities during medical device training. In a blended learning approach, we examined whether using a syringe pump while conducting an e-Learning program improves the procedural skills needed to operate the pump compared to using the e-Learning program only. In two experiments, the e-Learning only group learned using only the e-Learning program. The e-Learning + hands-on group was instructed to use a syringe pump during the e-Learning to repeat the presented content (section "Experiment 1") or to alternate between learning on the e-Learning program and applying the learned content using the pump (section "Experiment 2"). We conducted a skills test, a knowledge test, and assessed confidence in using the pump immediately after learning and two weeks later. Simply repeating the content (section "Experiment 1") did not improve performance of e-Learning + hands-on compared with e-Learning only. The instructed learning process (section "Experiment 1") resulted in significantly better skills test performance for e-Learning + hands-on compared to the e-Learning only. Only a structured learning process based on multi-media learning principles and memory research improved procedural skills in relation to operating a medical device.

Integrating Family-Centered Care to Child Health and Diseases Nursing Course via Distance Education

The aim of this study was to determine the impact of an online Child Health and Diseases Nursing course emphasizing family-centered care upon the perceptions of nursing students toward family-centered care. A one-group pretest-posttest model was used in this study. The research participants consisted of 88 students studying at X University, Faculty of Health Sciences, Department of Nursing. While 67.1% of the students stated that there were obstacles in implementing family-centered care, 73.9% stated that there were no facilitating elements in implementing of family-centered care. A statistically significant difference was found between the mean scores of the students' posttest family-centered care attitude and parents' attitude at the end of the training. This study provides insights into family-centered care, which could be used in crafting policies and interventions in nursing education in Turkey. Such insights could foster positive perceptions of family-centered care among student nurses.

A Literature Review of Barriers and Opportunities Presented by Digitally Enhanced Practical Skill Teaching and Learning in Health Science Education

INTRODUCTION

An evidence gap exists identifying the challenges and opportunities presented by digitally enhanced practical skill teaching and learning in health science education. A literature review was carried out to address this gap and to provide recommendations for overcoming identified challenges.

METHOD

A systematic search strategy was carried out using PRISMA guidelines. The research databases PubMed, ERIC, Medline and CINHL, were searched using MeSH terms. Barriers and opportunities were identified through deductive thematic analysis of the included articles.

RESULTS

Of the 602 articles identified through the database screening, 29 were included in the current review. Potential challenges posed by technologically supported practical skill teaching identified were i) Inaccessibility and Inequity of Online Learning (ii) Digital illiteracy Among Staff (iii) Technological Challenges (iv) Lack of Engagement with Preparatory Material Hinders Practical Learning (v) Lack of Staff-Student Interaction (vi) Negative Attitudes Towards Online Learning and (vii) Skill Suitability. The opportunities presented by digital technologies identified were (i) Facilitates Higher Order Learning (ii) Ability to Practice in a Safe Environment (iii) Efficacious Use of Class Time (iv) Access to Education (v) Learning Brought to Life (vi) Diverse Range of Learning Materials (vii) Promotes Autonomous Learning.

DISCUSSION

This literature review demonstrates the acceptability and usability of digitally enhanced practical teaching in health science education among students and educators.

CONCLUSION

To consolidate the positive disturbances in higher education from the Covid-19 pandemic, potential barriers to online delivery and student engagement must be acknowledged and addressed by relevant stakeholders. Recommendations detailed as part of this paper suggest means of overcoming barriers and leveraging opportunities.

Effects of a sudden change in curriculum delivery mode in postgraduate clinical studies, following the COVID-19 pandemic

OBJECTIVE

To examine the effect of a change in the delivery mode of clinical neurology, a postgraduate subject at Macquarie University, following COVID-19 restrictions on face-to-face teaching.

METHODS

Participants were master of chiropractic students (n = 212) who completed 2019 or 2020 clinical neurology. The main outcome measure was a comparison of objective structured clinical examination (OSCE) marks between the 2019 and 2020 cohorts. The 2019 group underwent traditional, face-to-face learning, whereas the 2020 group were taught and examined remotely in session 1 but returned to campus in session 2. Descriptive analyses, between-group differences, and generalized linear models were performed.

RESULTS

Means for OSCE marks between the 2 groups were higher in the 2020 group in session 1 (p < .001). However, when students returned to campus in session 2, the means were significantly lower in the 2020 group compared with the 2019 group (p < .001). Generalized linear regression indicated that the web-based mode of delivery in 2020 might have had a significant impact on OSCE marks compared with their 2019 counterparts (p < .001).

CONCLUSION

The sudden change in the mode of delivery from face-to-face to remote learning and the change in testing methods in response to the global COVID-19 pandemic had a significant effect on clinical neurology student performance scores. The OSCE marks in the 2020 cohort for session 1 were higher than those in 2019. However, when the 2020 cohort returned to on-campus tutorials in session 2, their marks were lower than those of their 2019 counterparts.

Effectiveness of an educational cartoon animation on the knowledge of children about traumatic dental injuries

BACKGROUND/AIM

Although children are frequently exposed to traumatic dental injuries (TDIs), their knowledge and attitude regarding the emergency management of TDIs are largely insufficient. The aim of this study was to determine the knowledge of children about TDIs utilizing a questionnaire before and after watching a custom animated instructional video.

MATERIAL AND METHODS

The study was conducted with 332 children aged 8 to 13 years. The children were asked to complete a 3-part questionnaire that included socio-demographic data, past experiences related to TDIs, and knowledge of the emergency management of TDIs. An educational video containing evidence-based information about the management of TDIs was shown to the children. They then completed the questionnaire again immediately after viewing the video and 1 week later. The data were analyzed using Friedman's two-way ANOVA by ranks test, McNemar's test, and the Mann-Whitney U-test.

RESULTS

The children's scores increased significantly following the viewing of the video (p = .0001). Prior to watching the animation, children who had previously received dental trauma education had considerably higher scores than their peers (p = .004). The animation was considered to be beneficial by 96.7% of the children. Prior to watching the animation, 49.1% of the children believed they could help their friends in the event of dental trauma, and after viewing the animation, this rate increased to 86.4%, but decreased to 77.1% after 1 week (p < .001).

CONCLUSIONS

After watching the video, the children's scores improved dramatically and their self-confidence in helping their friends in the event of dental trauma increased.

Saudi Arabian Students’ Beliefs about and Barriers to Online Education during the COVID-19 Pandemic

At a time when pandemics such as the novel coronavirus (COVID-19) spread rapidly, the deployment of online education is essential. However, to successfully leverage online education in such times, it is important to investigate learners’ motivations and beliefs about online education and associated barriers as well as the role of religious and social values. To investigate these motivations and beliefs, this study included semi-structured interviews with 10 female undergraduate students. These interviews explored the perceptions of students with regard to their engagement with online learning and assessment amid the COVID-19 pandemic in Saudi Arabia’s higher education system. The findings indicate that the challenges linked to the sudden shift in learning mode and changes in assessment techniques impacted students’ engagement with learning and assessment. The findings also indicate that personal challenges decreased the willingness of students to learn online, but that their beliefs about learning online were improved by the quality of online learning. The study identified that one of the most important elements of improving beliefs about online learning is open communication between students and instructors, as this contributes to shared understanding and acceptance. The results are presented and discussed in connection with current literature, research implications, and future directions.

Meta-Analysis of Flipped Learning Effects in Nursing Education

Background: This study is a meta-analysis confirming the effect size of clinical competence, critical thinking ability, self-directedness, and learning satisfaction, the outcome variables of flipped learning applied to nursing education. Methods: We selected 18 related studies that analyzed data using CMA (Comprehensive Meta-Analysis 2.2). Results: The effect size of the entire study was Hedges’ g = 0.68 (95% CI = 0.43~0.92). The heterogeneity of the overall effect size was I² = 90.7% (Q = 246.67, p < 0.001); critical thinking ability had an effect size of Hedges’ g = 0.87, learning satisfaction of Hedges’ g = 0.79, clinical competence of Hedges’ g = 0.53, and self-directedness of Hedges’ g = 0.37. The differences were statistically significant. Conclusion: Flipped learning can effectively improve nursing students’ clinical competence, critical thinking ability, self-direction, and learning satisfaction.

Implementation and Evaluation of the Premature Infant Pain Profile-revised (PIPP-R) e-Learning Module for Assessing Pain in Infants

OBJECTIVES

The Premature Infant Pain Profile-revised (PIPP-R) is a well-established measure for infant pain assessment. The aim of this study was to evaluate the implementation and clinical utility of the PIPP-R electronic learning (e-Learning) module to promote standardized health care training for nurses.

MATERIALS AND METHODS

A descriptive mixed-methods study was conducted in 2 tertiary Neonatal Intensive Care Units in Canada. Nurses were recruited and asked to complete the PIPP-R e-Learning Module and evaluate it. A 26-item questionnaire was used to describe nurse demographics and clinical experience and to evaluate implementation success (ie, acceptability, feasibility, usability) and clinical utility.

RESULTS

In all, 98 nurses from 2 settings in Central and Eastern Canada participated; most were registered nurses highly experienced in neonatal nursing care. The majority had received previous training on the PIPP-R (61.2%) and routinely used it in practice (67.4%). They considered the e-Learning module as acceptable and feasible as it was easy to access (94.9%) and to navigate (94.8%). Content was considered clear (98.9%) and met users' learning needs (99.0%). Nurses agreed that completing the module improved their understanding of neonatal pain (96.0%) and was clinically useful in improving their ability to assess pain in neonates (97.9%). The module was accessed primarily from work settings (77.8%) using desktop computers (49.0%) or tablets (28.0%) and was usually completed in a single session (75.7%).

DISCUSSION

Nurses' evaluation of the PIPP-R e-Learning module was overwhelmingly positive. The module was perceived as easy to implement, clinically useful, and was considered as a promising online educational tool. Further testing in clinical practice is needed to build on the results of this study and support the importance of dissemination of this module for standardized training purposes.

Analysis of Incident Reports of a Dental University Hospital

Incident reports are important for improving the quality and safety of medical care. Healthcare workers with less than one year of work experience have been reported to cause the most incidents, and the most common incident is “drug-related”. However, few studies have comprehensively analyzed incidents in dentistry, and the characteristics of dental incidents have not been understood. In this study, to understand the characteristics of dental incidents, we comprehensively analyzed 1291 incident reports submitted to the Tokyo Medical and Dental University Dental Hospital from April 2014 to March 2019. As a result, dental outpatient and dental wards had different types of incidents. In outpatient wards, incidents included many dentistry-specific incidents related to “procedures”. Among them, “poor physical condition of the patient during dental treatment” was the most common incident. In contrast, the most common incident from subjects with less than one year of work experience was “damage to soft tissues around the teeth”. Thus, to improve the quality and safety in dentistry, it is was considered necessary to analyze and understand the characteristics of dentistry-specific incidents and to take appropriate measures and educate dental professionals.

Lapnurse-A Blended Learning Course for Nursing Education in Minimally Invasive Surgery: Design and Experts' Preliminary Validation of Its Online Theoretical Module

Background: The implantation of Minimally Invasive Surgery (MIS) leads to the specialization of nurses in this surgical field. However, there is no standard curriculum of MIS Nursing in Europe. Spanish and Portuguese nurses are inexperienced and have poor training in MIS. For that, a blended learning course for nursing education in MIS (Lapnurse) has been developed. This work aims to detail the course design and to preliminary validate by experts its online theoretical module. Methods: Lapnurse consists of an online module with nine theoretical lessons and a face-to-face module with three practical lessons. The e-learning environment created to provide the online module, with didactic contents based on surgical videos and innovative 3D designs, has been validated by two technicians (functionality) and four nurses with teaching experience in MIS (usability and content). Results: The E-learning platform meets all technical requirements, provides whole and updated multimedia contents correctly applied for educational purposes, incorporates interactivity with 3D designs, and has an attractive, easy-to-use and intuitive design. Conclusions: The lack of knowledge in MIS of Spanish and Portuguese nurses could be addressed by the blended learning course created, Lapnurse, where the e-learning environment that provides theoretical training has obtained a positive validation.

Innovative approaches to teaching vascular access to nursing students in the COVID-19 era

PURPOSE

For the student nurse, peripheral venous cannulation is one of the most stressful skills to be learned. Although some healthcare employers/establishments offer courses on vascular access and infusion nursing as part of their onboarding programs, ultimately educational institutions should share the responsibility to ensure that graduating nurses can provide safe infusion therapies.

METHODS

An innovative vascular access and infusion nursing (VAIN) curriculum was created and mapped onto the entry to practice undergraduate nursing program at McGill University in Montréal, Québec, Canada. This presented an opportunity to implement new teaching approaches.

RESULTS

Students experienced multiple new teaching approaches including multimedia and experiential learning and live simulation to ensure acquisition of knowledge and psychomotor skills. The teaching approaches had to be rapidly modified with the advent of the COVID-19 pandemic.

CONCLUSIONS

The VAIN curriculum emphasizes simulation and directed practice, seeking to increase competence, confidence, and knowledge. The pandemic underscored the need for flexibility and creativity in content delivery.

Evaluation of an international medical E-learning course with natural language processing and machine learning

BACKGROUND

In the context of the ongoing pandemic, e-learning has become essential to maintain existing medical educational programmes. Evaluation of such courses has thus far been on a small scale at single institutions. Further, systematic appraisal of the large volume of qualitative feedback generated by massive online e-learning courses manually is time consuming. This study aimed to evaluate the impact of an e-learning course targeting medical students collaborating in an international cohort study, with semi-automated analysis of feedback using text mining and machine learning methods.

METHOD

This study was based on a multi-centre cohort study exploring gastrointestinal recovery following elective colorectal surgery. Collaborators were invited to complete a series of e-learning modules on key aspects of the study and complete a feedback questionnaire on the modules. Quantitative data were analysed using simple descriptive statistics. Qualitative data were analysed using text mining with most frequent words, sentiment analysis with the AFINN-111 and syuzhet lexicons and topic modelling using the Latent Dirichlet Allocation (LDA).

RESULTS

One thousand six hundred and eleventh collaborators from 24 countries completed the e-learning course; 1396 (86.7%) were medical students; 1067 (66.2%) entered feedback. 1031 (96.6%) rated the quality of the course a 4/5 or higher (mean 4.56; SD 0.58). The mean sentiment score using the AFINN was + 1.54/5 (5: most positive; SD 1.19) and + 0.287/1 (1: most positive; SD 0.390) using syuzhet. LDA generated topics consolidated into the themes: (1) ease of use, (2) conciseness and (3) interactivity.

CONCLUSIONS

E-learning can have high user satisfaction for training investigators of clinical studies and medical students. Natural language processing may be beneficial in analysis of large scale educational courses.

eLearning in Physical Therapy: Lessons Learned From Transitioning a Professional Education Program to Full eLearning During the COVID-19 Pandemic

OBJECTIVE

The objectives of this cross-sectional qualitative study were to explore the perspectives of students enrolled in one physical therapist undergraduate education program in Australia about their experience with transitioning to full eLearning and student recommendations to improve the learning experience during the COVID-19 pandemic.

METHODS

Seven focus groups with 28 undergraduate physical therapist students were conducted following the transitioning to full eLearning as a result of strict physical distancing measures. Focus group questions explored the students' experiences of the transition from face-to-face to full eLearning approach and the students' recommendations for improving future eLearning experiences. Data were analyzed using inductive thematic analysis.

RESULTS

The 3 themes identified were: (1) students presenting heightened negative feelings such as anxiety, stress, and reduced motivation to study; (2) students continuing to value the face-to-face learning, as it provided social support and facilitated feedback from peers and tutors; (3) student recommendations for eLearning included having online lectures and supplementary videos but face-to-face practical classes and developing healthy learning habits such as scheduled times for studying, exercise, and other activities that regulate stress.

CONCLUSIONS

The transition to a full eLearning approach in an undergraduate physical therapist education program during the COVID-19 pandemic revealed that students had heightened negative emotions due to the pandemic. Students valued face-to-face practical classes to learn and receive social support from peers and tutors. Student recommendations to future eLearning suggested changes to curriculum development geared toward a greater blended approach to learning. Blended learning may include using online lectures instead of face-to-face lectures and online resources to supplement student learning of practical skills.

IMPACT

As higher education moves toward a more blended approach, lessons learned from this study can help educators design future physical therapist education programs. The findings can also assist programs in delivering a full eLearning approach as the COVID-19 pandemic continues.

Student nurses' knowledge acquisition on oral medication administration: comparison of lecture demonstration vs. video demonstration

Background

Oral Medication administration is one of the paramount nursing procedures, where nurses must pay their utmost commitment. The vital aims are to reduce medication errors and ensure patient safety. The objectives of this study were to evaluate whether the nursing students could learn and retain the basic guidelines for oral medication administration when they are taught using a video-assisted teaching method compared with the lecture-demonstration method and to assess the students’ attitudes towards the two types of teaching methods.

Methods

This study was conducted as a quasi-experimental study with a pre and post-test design. Forty-five students in the first year of the bachelor’s degree in nursing programme participated. All the participants completed a self- administered questionnaire, including socio demographic data and questions of oral medication administration. Subsequently, participants were randomly assigned to two groups. Oral medication administration procedure was taught using two different teaching methods. Finally, the post-test knowledge scores of both groups were assessed and analysed using the paired-sample t-test.

Results

The results revealed that there was no significant difference in terms of age, gender and type of residence of students in the two groups. When comparing the pre-test mean score and post-test mean score using paired sample t-test, there was a statistically significant difference in both video demonstration group (t = − 4.533, p < 0.001) and lecture-demonstration group (t = − 4.208, p < 0.001). Almost all the students obtained good knowledge scores regardless of the method used in teaching oral medication administration. However, when comparing post-test scores of both groups using an independent sample t-test, it was identified that there was no significant difference between the two groups. Therefore, it was difficult to identify which method was effective than the other. According to the student feedback obtained at the end of the study, 67% of them preferred to have more video demonstrations in their skills classes.

Conclusion

The results of this study suggested that oral medication administration can be effectively taught using lecture-demonstration and video-demonstration teaching methods.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-020-00527-6.

Effect of e-learning on nurses' continuing professional development

BACKGROUND

E-learning can provide nurses with the opportunity to undertake lifelong learning and continuing professional development (CPD) in a flexible, practical and engaging manner. However, much of the research focuses on pre-registration nursing students' experiences of e-learning, despite nursing students not always experiencing the same clinical demands as registered nurses.

AIM

To explore the concept of e-learning and nurses' perception of its value for engaging with lifelong learning and CPD, as well as to determine attitudes towards e-learning, what influencing factors exist and how they affect the perceived value of e-learning.

METHOD

This study used a mixed-methods sequential explanatory design, in which there were two phases of data collection and analysis. In the first phase, 39 children's nurses completed questionnaires about e-learning and its flexibility, accessibility, value and contribution to CPD. Their responses were analysed and used to inform questions for the second phase, which involved semi-structured interviews exploring the findings and emerging themes from the completed questionnaires. Of the 39 questionnaire respondents, 12 agreed to participate in the interviews.

FINDINGS

More than half of the questionnaire respondents ( n =22/39) agreed or strongly agreed that e-learning aids their CPD, while 29 respondents valued e-learning that is specific to their practice area. Three main factors were identified that may influence the effect of e-learning on nurses' CPD: motivation to engage with CPD and e-learning; the perceived value of e-learning as a method for CPD; and challenges to effective engagement with e-learning.

CONCLUSION

Engagement with e-learning is influenced by the content of its modules and, while mandatory training is often provided through e-learning, this should not be its sole purpose. Nurses should take the opportunity to develop and engage with e-learning that is specific to their area of practice, which may increase its value.

Exploring Adult Learners' Viewpoints and Motivation Regarding Distance Learning in Medical Education

INTRODUCTION

Literature in education and training supports the notion that distance learning (DL) is the most effective mode of learning for health care workers to improve the quality of patient care. However, implementing DL requires pre-assessing learners' perspectives and attitudes for providing better delivery, essential support, and facilities. This study aimed to identify the viewpoints and attitudes of dental graduates toward DL in medical education and their point views of the effectiveness and efficacy of DL tools.

METHODS

A structured, self-administered questionnaire was distributed to registered adult graduates working in government- or private hospitals in a permanent position or for a long term (3 months or more). Data were collected and analyzed.

RESULTS

Two-thirds (67.9%) of the participants had previously attended a DL course. The highest ranked items on the participants' views on DL were ease of access, ability to take the course from any location, and be taught from anywhere in the world. Their perception of DL was analyzed in relation to gender and previous exposure to DL.

CONCLUSION

This investigation revealed a positive attitude among graduates on the effectiveness of DL. Most respondents appreciated DL's convenience in terms of time flexibility and online attendance. Residents' attitudes toward DL and DL characteristics are major factors to consider when instituting or planning for DL. Continuous medical education through DL will continue to generate considerable interest as an international movement.

Undergraduate nursing students' use of video technology in developing confidence in clinical skills for practice: A systematic integrative literature review

AIMS AND OBJECTIVES

This review examines the current evidence of the effectiveness of the use of video or video podcast technology produced either commercially or in-house in developing nursing students' confidence in clinical skills for practice.

BACKGROUND

The ability of graduates to provide safe, quality, nursing care is the core of any nursing education curriculum. Developing teaching and learning strategies to enhance skills development and confidence is challenging for educators, particularly with contemporary and diverse student populations requiring student-centred, technology-enhanced learning.

DESIGN

An integrative review framework.

REVIEW METHODS

A systematic search was conducted using the following eight databases: CINAHL, MEDLINE, ProQuest, PubMed, ERIC, Scopus, EMBASE, and Google Scholar. Selection criteria included: published in English, involving undergraduate nursing students, measuring confidence in relation to skills development, and using video or video podcasts.

RESULTS

Four studies met the inclusion criteria, with six themes identified. Four themes emerged: Pedagogy; Skills performance and competency; Student satisfaction and confidence in relation to skills development; Technical constraints. Two additional themes related to the impetus for introducing video podcasts: first, time as an institutional, curricular, and academic/student challenge; and second, meeting the generational needs of students.

CONCLUSION

This review demonstrates that video technology teaching methods and traditional teaching methods used in conjunction with each other create the most positive learning environment. Although video technology methods provide a flexible teaching option for the contemporary student population, developing and delivering videos in a clinical skills program need to be conceptualised within an appropriate pedagogical approach to ensure a purposeful and meaningful learning experience. Whilst student confidence was embedded within other evaluations, it is not clearly reviewed or understood; therefore, further research is required in this area.

Applying interprofessional education to the practice setting

Interprofessional education is a key requirement identified in various professional and regulatory body education standards in the UK. However, recent high-profile investigatory reports into adverse incidents in NHS organisations have demonstrated failures of translating interprofessional education into practice. This paper explores how a university in the south of England uses service improvement projects to address this. Working with key senior clinicians, small groups of students from a variety of professional backgrounds collaborate to address an identified problem in practice to bring about better, safer practice to benefit patients. This style of learning enables students to acquire essential attributes in preparation for employment, such as critical thinking, teamworking, ethical practice and leadership.

Comparison of Instructional Methods for Screening, Brief Intervention, and Referral to Treatment for Substance Use in Nursing Education

Most nursing programs lack curriculum on substance use. This project evaluated 3 didactic instructional methods for teaching baccalaureate nursing students about screening, brief intervention, and referral to treatment for substance use. In-person, asynchronous narrated slides and interactive online instructional methods were all effective in developing students’ competency; however, active learning methods (in-person and interactive online course) were more effective in changing students’ attitudes about their role in screening and intervening for drug use.

Disruptive Technology: Saving Money and Inspiring Engagement in Professional Staff

Competent, efficient, and cost-effective delivery of professional development is a challenge in health care. Collaboration of teaching methodologies with academia and acute care offers fresh perspectives and delivery methods that can facilitate optimal outcomes. One multihospital system introduced the academic "flipped classroom" model to its acute care setting and integrated it into professional development requirements. The concept of the flipped classroom requires independent student engagement prior to classroom activities versus the traditional classroom lecture model. Results realized a cost savings in 2 years of $28,737 in addition to positive employee engagement.

The effectiveness of internet-based e-learning on clinician behavior and patient outcomes: a systematic review protocol

REVIEW QUESTION/OBJECTIVE

The objective of this systematic review is to identify, appraise and synthesize the best available evidence for the effectiveness of internet-based e-learning programs on health care professional behavior and patient outcomes.

BACKGROUND

Technological innovation has not only impacted social change in recent years but has been the prime driver of educational transformation.The newest consumers of post-secondary education, the so-called 'digital natives', have come to expect education to be delivered in a way that offers increased usability and convenience. Health care professionals (HCPs) in the clinical setting, particularly those in rural and remote communities, are no different. Today's health workforce has a professional responsibility to maintain competency in practice through achieving a minimum number of hours of continuing professional development. Consequently, HCPs seeking professional development opportunities are reliant on sourcing these independently according to individual learning needs. However, difficulties exist in some health professionals' access to ongoing professional development opportunities, particularly those with limited access face-to-face educationdue to geographical isolation or for those not enrolled in a formal program of study.These issues challenge traditional methods of teaching delivery; electronic learning (e-learning) is at the nexus of overcoming these challenges.The term e-learning originated in the mid-1990s as the internet began to gather momentum.Electronic learning can be broadly defined as any type of educational media that is delivered in an electronic form.Terms such as computer-assisted learning, online learning, web-based learning and e-learning are often used synonymously but all reflect knowledge transfer via an electronic device. This broad definition allows for a gamut of multimedia to be used for the purpose of constructing and assessing knowledge. Multimedia typically used in e-learning range from the now archaic Compact Disc Read-Only Memory (CD-ROMs), to the simple Microsoft PowerPoint, or the more advanced and complex virtual worlds such a second life. Electronic learning can be delivered in asynchronous or synchronous formats, with the latter (for example interactive online lectures via platforms such as BlackboardCollaborate or WebEx) more commonly used in formal educational settings according to set timetables of study.Person-to-person interactivity is an important enabler of knowledge generation and while functionalities such as web 1.0 (discussion board and email) and more recently web 2.0 (Wikis and blogs) allow for this to occur both synchronously and asynchronously, it is usually utilized in formal educational contexts only. However, the economy of formal education does not allow for free access to courses which proves challenging for HCPs seeking quality educational opportunities who choose not to undergo a formal program of study or are just looking to meet a specific learning need. Alternatively, asynchronous e-learning is a more learner-centred approach that affords the opportunity to engage in learning at a time and location that is convenient and enables the learner to balance professional development with personal and work commitments.These learning opportunities are self-directed and do not require a human to facilitate learning, rather, technology officiates/facilitates the learning process and, in the asynchronous e-learning context, the learner negotiates meaning independently.Health-related e-learning research has focused on several domains including media comparative designs, self-efficacy, user satisfaction, instructional design, knowledge outcomes, clinical skills development, and facilitators/barriers to its use.The benefits of e-learning are well documented in terms of increased accessibility to education, efficacy, cost effectiveness, learner flexibility and interactivity.However, some fundamental methodological and philosophical flaws exist in e-learning research, not least the use of comparative design studies. Comparison between e-learning and traditional teaching methods are illogical and methodologically flawed because comparison groups are heterogeneous, lack uniformity and have multiple confounders that cannot be adjusted for.As early as 1994, researchersin computer-assisted learning were citing these limitations and called for a fresh research agenda in this area. Cookrepeated this call in 2005 and again in 2009 and noted a paucity of research related to patient or clinical practice outcomes. Electronic learning is not an educational panacea and research needs to progress from pre- and post-interventional and comparative designs that evaluate knowledge increases and user satisfaction. It is time to move towards determining whether improved self-efficacy or knowledge gained through e-learning improves patient outcomes or influences clinical behavior change and whether these changes are sustained. In order to develop the empirical evidence base in e-learning, research needs to be guided by established theoretical frameworks and use validated instruments to move from assessing knowledge generation towards improving our understanding of whether e-learning improves HCP behavior and more importantly, patient outcomes.One suitable framework that is congruent with e-learning research is Kirkpatrick'sfour levels of evaluation. Kirkpatrick's model is hierarchically based with level one relating to student reaction and how well the learner is satisfied with the education program. Level two pertains to learning and the evaluation of knowledge, level three expands on this and considers whether the education has influenced behavior. In the context of this review, behavior change is any practice that is intrinsically linked with the outcomes of the e-learning program undertaken. Finally, level four evaluates the impact on outcomes such as cost benefit or quality improvements.The majority of e-learning research has focused on participant experience and knowledge acquisition, outcomes that correspond with the first two levels of Kirkpatrick's model.To date, few studies have examined the effectiveness of internet-based e-learning programs on HCP behavior, which aligns with Level 3 of Kirkpatrick's model.Studies exist that use self-reported measures of intention to change behavior, however self-reported intention to change does not necessarily translate into actual behavior change. Studies that have not used self-reported measures of behavior change have used objectively measured evaluation criteria including objective structured assessment of technical skills (OSATS) using various methods including simulation task trainers and clinical simulations using standardized patients scored by a panel of experts using standardized assessment tools. Carney et al. used a national reporting and data system to measure the impact of a single one hour e-learning program undertaken by radiologists (n=31) aimed at reducing unnecessary recall during mammography screening. Carney et al. reported a null effect and attributed this to the complexities of behavior change, suggesting that longer term reinforcement of principles relating to mammography recall was required to effect behavior change. These findings also suggest that a multi-modal intervention may be required in order to reduce excessive recall rates in this area, rather than a single intervention. Contrary to Carney et al., Pape-Koehler et al. and Smeekins et al. reported positive findings using randomized controlled designs to test the efficacy of e-learning interventions on individual's surgical performance and the detection of child abuse, respectively. Pape-Koehler et al. used a 2x2 factorial design to demonstrate that an e-learning intervention significantly improved novice surgeon (n=70) surgical performance of a laparoscopic cholecystectomy (change between pre-post test OSATS p 0.001) when used in isolation or in combination with a practical training session compared to practical training alone. Smeekins et al. demonstrated that a 2 hour e-learning program improved nurses' (n=25) ability to detect child abuse in an emergency department. The nurses in the intervention (n=13) group demonstrated significantly better (p=0.022) questioning techniques and consequently, higher quality history taking, to determine children at risk of child abuse when compared with the control group who received no training at all.These three exemplar studies demonstrate the broad range of applications e-learning has in HCP education, as each study used different designs, had different subject areas and target health care professionals. This reflects the conceptual and practical challenges of the area of research that addresses levels three of Kirkpatrick's model. For this reason, the e-learning research agenda in health should focus on whether knowledge generated through e-learning is able to be re-contextualized into clinical practice, and influence sustained clinical behavior change and patient outcomes.A preliminary search of PubMed, CINAHL, The Cochrane Library, The JBI Database of Systematic Reviews and Implementation Reports, ERIC and PROSPERO was conducted to determine if a systematic review on the topic of interest already existed. This search identified four systematic reviews that specifically reviewed outcome measures of knowledge and skill improvement in the domain of e-learning. Two examined research conducted in nursing, with the other two in orthodontics. Lahti et al. systematic review examined the impact of e-learning on nurses' and nursing students' knowledge, skills and satisfaction. Lahti et al. were unable to demonstrate a statistical difference between cohorts undertaking e-learning compared to conventional teaching methods, findings that were not replicated by Du et al. This may be due to the decision by Lahti et al. (ABSTRACT TRUNCATED)

Developing digital educational materials for nursing and sustainability: The results of an observational study

BACKGROUND

There is limited European literature on nursing and sustainability; nursing students are poorly prepared on the connections between resources, climate change, sustainability, and health, so they must acquire knowledge and develop skills and competencies in this field. The use of digital technologies and teaching via E-learning has grown, and has been widely adopted as a learning method for nursing.

OBJECTIVES

The aim of the current study was to test and evaluate digital educational materials on environmental sustainability and health, in the context of university nursing education in different European countries.

DESIGN

An observational cross-sectional design.

SETTINGS

University of Plymouth, University of Jaén, and University of Esslingen for Nursing Degree Studies.

PARTICIPANTS

299 nursing students: 161 students from University of Jaén; 106 from Plymouth; and 32 from Esslingen. 22 professional evaluators with different profiles were recruited: Teachers, Clinical professionals, Delphi Experts, and Technical Experts.

METHODS

We conducted a piloting and validation process. The materials were designed and adapted to the NurSusTOOLKIT Sustainability Literacy and Competency framework. Evaluation was developed by professionals and students. We used the Spanish Standard for the assessment of Digital Educational Material Quality at University level questionnaire. All students provided informed consent prior to taking part in the learning and evaluation.

RESULTS

The overall evaluations of materials by students and professionals were 7.98±1.28 and 8.50±1.17, respectively. The Ability to generate learning was scored higher among students (mean difference: 0.84; 0.22-1.47; p=0.008). In the overall assessment by students, statistically significant differences were found between the three universities (Welch: 11.69, p<0.001).

CONCLUSIONS

Students, professionals, and technical experts considered the materials to be very good quality, especially regarding the quality of contents, format, and design. For students, these materials can generate reflection and learning regarding environmental and health issues during nursing training.

A Web-Based Module to Enhance BSN Students’ Knowledge and Confidence in Teaching Parents About Newborn Behavior

As an adjunct to traditional instructional strategies, students enrolled in a Bachelor of Science in Nursing maternity course completed a Web-based module called “HUG Your Baby” (HYB) about newborn behavior, interpreting and responding to an infant’s cues and body language, and teaching new parents. Students who completed the HYB program were compared with students enrolled in another semester of the same maternity course in which only traditional teaching strategies were used. Both groups were compared on knowledge and confidence about newborn behaviors and teaching new parents. Knowledge and confidence scores increased significantly in both groups from beginning to end of the semester. Students who completed the HYB program demonstrated a significantly greater increase in knowledge and confidence compared with students who did not complete the HYB program. Students highly rated the HYB program and recommended it for incorporation into the maternity course.

Improving Nursing Students' Learning Outcomes in Fundamentals of Nursing Course through Combination of Traditional and e-Learning Methods

Background:

Fundamentals of nursing course are prerequisite to providing comprehensive nursing care. Despite development of technology on nursing education, effectiveness of using e-learning methods in fundamentals of nursing course is unclear in clinical skills laboratory for nursing students. The aim of this study was to compare the effect of blended learning (combining e-learning with traditional learning methods) with traditional learning alone on nursing students' scores.

Materials and Methods:

A two-group post-test experimental study was administered from February 2014 to February 2015. Two groups of nursing students who were taking the fundamentals of nursing course in Iran were compared. Sixty nursing students were selected as control group (just traditional learning methods) and experimental group (combining e-learning with traditional learning methods) for two consecutive semesters. Both groups participated in Objective Structured Clinical Examination (OSCE) and were evaluated in the same way using a prepared checklist and questionnaire of satisfaction. Statistical analysis was conducted through SPSS software version 16.

Results:

Findings of this study reflected that mean of midterm (t = 2.00, p = 0.04) and final score (t = 2.50, p = 0.01) of the intervention group (combining e-learning with traditional learning methods) were significantly higher than the control group (traditional learning methods). The satisfaction of male students in intervention group was higher than in females (t = 2.60, p = 0.01).

Conclusions:

Based on the findings, this study suggests that the use of combining traditional learning methods with e-learning methods such as applying educational website and interactive online resources for fundamentals of nursing course instruction can be an effective supplement for improving nursing students' clinical skills.

The Effects of Smartphone-based Nebulizer Therapy Education on Parents' Knowledge and Confidence of Performance in Caring for Children with Respiratory Disease

PURPOSE

This study aimed to identify the effects of smartphone-based nebulizer therapy education on the knowledge and confidence of parents while performing care for their children with respiratory disease.

DESIGN AND METHODS

This quasi-experimental study employed a pretest-posttest design using a nonequivalent control group. Data were collected from children's parents who had not used nebulizer therapy for their children previously. Both the groups were given nebulizer therapy education using the same content but different learning methods. The experimental group (n=36) was taught using smartphones, while the control group (n=36) was taught using verbal and paper-based methods. The data were analyzed using the Chi Square test, repeated measures analysis of variance, and t-test.

RESULTS

The mean scores on knowledge improvement (F=100.949, p<0.001) and confidence in performing care (t=-6.959, p<0.001) were significantly higher for the experimental group as compared to the control group. Further, the scores on satisfaction with the learning method were significantly higher for the experimental group as compared to the control group (t=-5.819, p<0.001). Our results suggest that smartphone-based education on nebulizer therapy might be effective in improving parents' knowledge and confidence in performing care for their children.

CONCLUSION

This study suggests that smartphone-based education needs to be considered as an effective educational intervention in providing nursing support for parents of children with respiratory disease.

The contributions of digital technologies in the teaching of nursing skills: an integrative review

Objective

To analyze the contributions of digital educational technologies used in teaching nursing skills.

Method

Integrative literature review, search in five databases, from 2006 to 2015 combining the descriptors 'education, nursing', 'educational technology', 'computer-assisted instruction' or related terms in English.

Results

Sample of 30 articles grouped in the thematic categories 'technology in the simulation with manikin', 'incentive to learning' and 'teaching of nursing skills'. It was identified different formats of digital educational technologies used in teaching Nursing skills such as videos, learning management system, applications, hypertext, games, virtual reality simulators.

Conclusions

These digital materials collaborated in the acquisition of theoretical references that subsidize the practices, enhancing the teaching and enable the use of active learning methods, breaking with the traditional teaching of demonstrating and repeating procedures.

Students' experience of the use of an online learning channel in teaching and learning: A sports therapy perspective

Background/Aims:

The inclusion of blended e-learning approaches to teaching has become more prevalent in higher education. The purpose of this paper was to examine sports therapy students' experiences of using an online learning channel designed to assist practical skills. Moreover, creating an understanding of students' adoption of the learning channel to determine its efficacy.

Methods:

The design was a qualitative exploratory study in which a questionnaire was designed to investigate students' experience of using the learning channel across all undergraduate BSc Sports Therapy modules. One-hundred and sixty-four (level four: n=67; level five: n=51; level six: n=46) students completed the questionnaire relating to their experience of an online video-based learning channel.

Findings:

BSc Sports Therapy students across all levels found the learning channel useful, with the most common responses related to revision and consolidation of practical skills. Exam preparation was associated to this suggesting students' beliefs were driven by resources which could facilitate grade improvement in practical exams.

Conclusions:

The sports therapy learning channel was received very positively, with both the visual and practical nature of online instructional videos deemed important.

Best Practices for Use of Blended Learning

Objective. To determine instructional best practice recommendations for use of blended learning from the students' perspective. Methods. Three focus groups were created, one for each of the first three years at a school of pharmacy. The focus group discussions were audio recorded and transcribed for content analysis. Results. Ten instructional best practices were identified from the focus groups: setting the stage, consistency when team teaching, timeliness in posting materials, time on task, accountability for online activities, use of structured active learning, instructor use of feedback on student preparation, incorporation of student feedback into the course, short reviews of online material during class, and ensuring technologies are user friendly. Conclusion. Instructors using blended learning should consider incorporating these best practices into their course design and management. More evaluation is needed to see if implementation of these practices affects student performance.

Conventional vs. e-learning in nursing education: A systematic review and meta-analysis

BACKGROUND

By and large, in health professions training, the direction of the effect of e-learning, positive or negative, strongly depends on the learning outcome in question as well as on learning methods which e-learning is compared to. In nursing education, meta-analytically generated knowledge regarding the comparisons between conventional and e-learning is scarce.

OBJECTIVES

The aim of this review is to discover the size of the effect of e-learning on learning outcomes in nursing education and to assess the quality of studies in which e-learning has been compared to conventional learning.

METHODS

A systematic search of six electronic databases, PubMed, Ovid MEDLINE®, CINAHL (EBSCOhost), Cochrane Library, PsycINFO, and ERIC, was conducted in order to identify relevant peer-reviewed English language articles published between 2011 and 2015. The quality of the studies included as well as the risk of bias in each study was assessed. A random-effects meta-analysis was performed to generate a pooled mean difference in the learning outcome.

RESULTS

Altogether, 10 studies were eligible for the quality assessment and meta-analysis. Nine studies were evaluated as good quality studies, but not without a risk of bias. Performance bias caused a high risk in nearly all the studies. In the meta-analysis, an e-learning method resulted in test scores that were, on average, five points higher than a conventional method on a 0-100 scale. Heterogeneity between the studies was very large.

CONCLUSIONS

The size and direction of the effect of a learning method on learning outcomes appeared to be strongly situational. We suggest that meta-regressions should be performed instead of basic meta-analyses in order to reveal factors that cause variation in the learning outcomes of nursing education. It might be necessary to perform separate meta-analyses between e-learning interventions aimed at improving nursing knowledge and those aimed at improving nursing skills.

The utility and impact of information communication technology (ICT) for pre-registration nurse education: A narrative synthesis systematic review

OBJECTIVES

To evaluate and summarise the utility and impact of information communication technology (ICT) in enhancing student performance and the learning environment in pre-registration nursing.

DESIGN

A systematic review of empirical research across a range of themes in ICT health-related education.

DATA SOURCES

Science Direct, Cinahl, AMED, MEDLINE, PubMed, ASSIA, OVID and OVID SP (2008-2014). Further date parameters were imposed by theme.

REVIEW METHODS

Evidence was reviewed by narrative synthesis, adopting Caldwell's appraisal framework and CASP for qualitative methods. Selection and inclusion was grounded in the PICOS structure, with language requirements (English), and further parameters were guided by theme appropriateness.

RESULTS

Fifty studies were selected for review across six domains: reusable learning objects, media, audience response systems, e-portfolios, computer-based assessment and faculty adoption of e-learning. Educational ICT was found to be non-inferior to traditional teaching, while offering benefits to teaching and learning efficiency. Where support is in place, ICT improves the learning environment for staff and students, but human and environmental barriers need to be addressed.

CONCLUSION

This review illuminates more advantages for ICT in nurse training than previously. The key advantage of flexibility is supported, though with little evidence for effect on depth of learning.

Mobile-Based Video Learning Outcomes in Clinical Nursing Skill Education: A Randomized Controlled Trial

Mobile devices are a regular part of daily life among the younger generations. Thus, now is the time to apply mobile device use to nursing education. The purpose of this study was to identify the effects of a mobile-based video clip on learning motivation, competence, and class satisfaction in nursing students using a randomized controlled trial with a pretest and posttest design. A total of 71 nursing students participated in this study: 36 in the intervention group and 35 in the control group. A video clip of how to perform a urinary catheterization was developed, and the intervention group was able to download it to their own mobile devices for unlimited viewing throughout 1 week. All of the students participated in a practice laboratory to learn urinary catheterization and were blindly tested for their performance skills after participation in the laboratory. The intervention group showed significantly higher levels of learning motivation and class satisfaction than did the control. Of the fundamental nursing competencies, the intervention group was more confident in practicing catheterization than their counterparts. Our findings suggest that video clips using mobile devices are useful tools that educate student nurses on relevant clinical skills and improve learning outcomes.

Baccalaureate nursing students' application of social-cognitive sexual counseling for cardiovascular patients: A web-based educational intervention

BACKGROUND

A gap in knowledge and practice exists for sexual counseling of cardiovascular patients, and innovative approaches are needed to address patients' sexual quality of life.

AIM

To evaluate a web-based social-cognitive intervention for evidence-based sexual counseling by baccalaureate nursing students with cardiovascular patients.

METHODS

A pre- post-test survey design was used: pre-test (T1), immediate post-test after intervention (T2), and at 4 to 6weeks post-intervention (T3). Data were collected using the Survey of Sexuality Related Nursing Practices -Cardiac version (SSRNP-CV). Data were analyzed using descriptive statistics and t-tests.

RESULTS

From T1 to T2, students (N=95) significantly increased their responsibility and confidence in sexual counseling; from T1 to T3 (N=57), students significantly improved sexual counseling for confidence and practice subscales, total SSRNP score, and cardiac-specific subscales of sexual counseling, sexual activity, and gender.

CONCLUSION

This study clearly demonstrated that a web-based social-cognitive sexual counseling intervention was effective in improving students' ability to provide evidence-based sexual counseling of cardiovascular patients.

Evaluation of a Web-Based E-Learning Platform for Brief Motivational Interviewing by Nurses in Cardiovascular Care: A Pilot Study

BACKGROUND

Brief motivational interviewing (MI) can contribute to reductions in morbidity and mortality related to coronary artery disease, through health behavior change. Brief MI, unlike more intensive interventions, was proposed to meet the needs of clinicians with little spare time. While the provision of face-to-face brief MI training on a large scale is complicated, Web-based e-learning is promising because of the flexibility it offers.

OBJECTIVE

The primary objective of this pilot study was to examine the feasibility and acceptability of a Web-based e-learning platform for brief MI (MOTIV@CŒUR), which was evaluated by nurses in cardiovascular care. The secondary objective was to assess the preliminary effect of the training on nurses' perceived brief MI skills and self-reported clinical use of brief MI.

METHODS

We conducted a single-group, pre-post pilot study involving nurses working in a coronary care unit to evaluate MOTIV@CŒUR, which is a Web-based e-learning platform for brief MI, consisting of two sessions lasting 30 and 20 minutes. MOTIV@CŒUR covers 4 real-life clinical situations through role-modeling videos showing nurse-client interactions. A brief introduction to MI is followed by role playing, during which a nurse practitioner evaluates clients' motivation to change and intervenes according to the principles of brief MI. The clinical situations target smoking, medication adherence, physical activity, and diet. Nurses were asked to complete both Web-based training sessions asynchronously within 20 days, which allowed assessment of the feasibility of the intervention. Data regarding acceptability and preliminary effects (perceived skills in brief MI, and self-reported clinical use of conviction and confidence interventions) were self-assessed through Web-based questionnaires 30 days (±5 days) after the first session.

RESULTS

We enrolled 27 women and 4 men (mean age 37, SD 9 years) in March 2016. Of the 31 participants, 24 (77%, 95% CI 63%-91%) completed both sessions in ≤20 days. At 30 days, 28 of the 31 participants (90%) had completed at least one session. The training was rated as highly acceptable, with the highest scores observed for information quality (mean 6.26, SD 0.60; scale 0-7), perceived ease of use (mean 6.16, SD 0.78; scale 0-7), and system quality (mean 6.15, SD 0.58; scale 0-7). Posttraining scores for self-reported clinical use of confidence interventions were higher than pretraining scores (mean 34.72, SD 6.29 vs mean 31.48, SD 6.75, respectively; P=.03; scale 10-50). Other results were nonsignificant.

CONCLUSIONS

Brief MI training using a Web-based e-learning platform including role-modeling videos is both feasible and acceptable according to cardiovascular care nurses. Further research is required to evaluate the e-learning platform in a randomized controlled trial.

TRIAL REGISTRATION

International Standard Randomized Controlled Trial Number (ISRCTN): 16510888; http://www.isrctn.com/ISRCTN16510888 (Archived by WebCite at http://www.webcitation.org/6jf7dr7bx).

Doing the Right Thing at the Right Time: Assessing Responses to Patient Deterioration in Electronic Simulation Scenarios Using Course-of-Action Analysis

International studies indicate that the recognition and management of deteriorating patients in hospitals are poor and that patient assessment is often inadequate. Face-to-face simulation programs have been shown to have an impact on educational and clinical outcomes; however, little is known about performance in contemporary healthcare e-simulation approaches. Using data from an open-access Web-based patient deterioration program (FIRSTACTWeb), the performance of 367 Australian nursing students in identification of treatment priorities and clinical actions was analyzed using a military model of Course of Action Simulation Analysis. Participants' performance in the whole program demonstrated a significant improvement in knowledge and skills (P ≤ .001) with high levels of participant satisfaction. Course of Action Simulation Analysis modeling identified three key participant groupings within which only 18% took the "best course of action" (the right actions and timing), with most (70%) completing the right actions but in the wrong order. The remaining 12% produced incomplete assessments and actions in an incorrect sequence. Contemporary approaches such as e-simulation do enhance educational outcomes. Measurement of performance when combined with Course of Action Simulation Analysis becomes a useful tool in the description of outcomes, an understanding of decision making, and the prediction of future events.

The effectiveness of Internet-based e-learning on clinician behaviour and patient outcomes: A systematic review

BACKGROUND

The contemporary health workforce has a professional responsibility to maintain competency in practice. However, some difficulties exist with access to ongoing professional development opportunities, particularly for staff in rural and remote areas and those not enrolled in a formal programme of study. E-learning is at the nexus of overcoming these challenges. The benefits of e-learning have been reported in terms of increased accessibility to education, improved self-efficacy, knowledge generation, cost effectiveness, learner flexibility and interactivity. What is less clear, is whether improved self-efficacy or knowledge gained through e-learning influences healthcare professional behaviour or skill development, whether these changes are sustained, and whether these changes improve patient outcomes.

OBJECTIVE

To identify, appraise and synthesise the best available evidence for the effectiveness of e-learning programmes on health care professional behaviour and patient outcomes.

DESIGN

A systematic review of randomised controlled trials was conducted to assess the effectiveness of e-learning programmes on clinician behaviour and patient outcomes. Electronic databases including CINAHL, Embase, ERIC, MEDLINE, Mosby's Index, Scopus and Cochrane - CENTRAL were searched in July 2014 and again in July 2015.

QUALITY ASSESSMENT AND DATA EXTRACTION

Studies were reviewed and data extracted by two independent reviewers using the Joanna Briggs Institute standardised critical appraisal and data extraction instruments.

DATA SYNTHESIS

Seven trials met the inclusion criteria for the analysis. Due to substantial instructional design, subject matter, study population, and methodological variation between the identified studies, statistical pooling was not possible and a meta-analysis could not be performed. Consequently, the findings of this systematic review are presented as a narrative review.

RESULTS

The results suggest that e-learning was at least as effective as traditional learning approaches, and superior to no instruction at all in improving health care professional behaviour. There was variation in behavioural outcomes depending on the skill being taught, and the learning approach utilised. No papers were identified that reported the effectiveness of an e-learning programme on patient outcomes.

CONCLUSION

This review found insufficient evidence regarding the effectiveness of e-learning on healthcare professional behaviour or patient outcomes, consequently further research in this area is warranted. Future randomised controlled trials should adhere to the CONSORT reporting guidelines in order to improve the quality of reporting, to allow evaluation of the effectiveness of e-learning programmes on healthcare professional behaviour and patient outcomes.

Surveying the experiences and perceptions of undergraduate nursing students of a flipped classroom approach to increase understanding of drug science and its application to clinical practice

Patient harm from medication error is a significant issue. Individual failures by health professionals including knowledge deficits and poor communication have been identified as increasing the likelihood of medication administration errors. In Australia, the National Strategy for Quality Use of Medicines in 2002 compels health professionals to have the knowledge and skills to use medicines safely and effectively. This paper examines nursing students' perceptions of the effectiveness of a flipped classroom approach to increase understanding of pharmacology principles and the application of this knowledge to medication practice. An internet-based self-completion questionnaire was used in 2013 (n = 26) after the flipped classroom approach was implemented, and pre- (n = 6) and post-flipping (n = 25) in 2014. Students who engaged with digitally recorded lectures (eLectures) prior to face-to-face workshops stated that they had greater understanding of the subject and enhanced critical thinking skills. The replay function of the eLecture was perceived by some students as most beneficial to independent learning. However, for some students, time constraints meant that they relied on eLectures alone, while others preferred traditional teaching methods. Although limited by sample size and potential participant bias, the results provide insights about the flipped classroom experience from a student perspective.

Preparation by mandatory E-modules improves learning of practical skills: a quasi-experimental comparison of skill examination results

BACKGROUND

Until recently, students at UMC Utrecht Faculty of Medicine prepared for practical skills training sessions by studying recommended literature and making written assignments, which was considered unsatisfactory. Therefore, mandatory e-modules were gradually introduced as substitute for the text based preparation. This study aimed to investigate whether this innovation improved students' performance on the practical skills (OSCE) examination.

METHOD

In both the 2012 and 2013 OSCEs, e-modules were available for some skill stations whereas others still had text based preparation. We compared students' performance, both within and between cohorts, for skill stations which had e-module preparation versus skill stations with text based preparation.

RESULTS

We found that performance on skill stations for which students had prepared by e-modules was significantly higher than on stations with text based preparation, both within and between cohorts. This improvement cannot be explained by overall differences between the two cohorts.

CONCLUSION

Our results show that results of skills training can be improved, by the introduction of e-modules without increasing teacher time. Further research is needed to answer the question whether the improved performance is due to the content of the e-modules of to their obligatory character.