The Value of E-Learning for the Prevention of Healthcare-Associated Infections

Medical Device-Related Pressure Injury Care and Prevention Training Program (DevICeU): Effects on intensive care nurses' knowledge, prevention performance and point prevalence

OBJECTIVE

To determine the effect of the training given to intensive care unit (ICU) nurses to prevent medical device-related pressure injuries (MDRPIs) on nurses' knowledge levels, their prevention performance, and the point prevalence (PP) of MDRPIs.

RESEARCH METHODOLOGY/DESIGN

A pre-post test intervention study without a control group.

SETTING

The study was conducted between May and July 2023 with ICU nurses in three phases: pre-training phase (E0) (104 nurses, 116 patients), training implementation phase (E) and post-training phase (E1) (89 nurses, 120 patients).

MAIN OUTCOME MEASURES

The data were collected by using the Patient (E0, E1) and Nurse (E0) Characteristic Forms, MDRPI Follow-up and Prevalence Form (E0, E1), D.E.V.I.C.E Performance Observation Checklist (E0, E1), MDRPI Knowledge Assessment Questionnaire (E0, E1), Braden Pressure Ulcer Risk Assessment Scale (E0, E1), Pressure Injury Grading Form (E0, E1), and Feedback Form about the Training Process (E).

RESULTS

The mean MDRPI knowledge score of the nurses increased significantly from E0 to E1 (13.23 ± 1.43 vs. 20.02 ± 1.30, p = 0.001), with the highest improvement in the staging and prevention themes. Nurses' MDRPI prevention performance increased significantly from E0 to E1 (2.15 ± 1.01 vs. 11.17 ± 1.65, p = 0.001). There was a significant difference between the PP rate at E0 (61.2 %) and E1 (27.5 %) (p = 0.001).

CONCLUSION

The study indicated that the training on MDRPIs given to ICU nurses increased their knowledge and prevention performance and decreased the prevalence of MDRPIs. However, further studies with a larger sample size are needed to confirm these findings.

IMPLICATIONS FOR CLINICAL PRACTICE

Since MDRPIs have more complex staging and prevention practices than conventional PIs, they require the adoption of a training approach that includes visual materials and practical methods in addition to theoretical knowledge. Accurate definitions of medical device dimensions and fixation, skin assessment, and prevention practices will lead to the desired outcome of reducing MDRPIs in ICUs.

Effect of e-learning program for improving nurse knowledge and practice towards managing pressure injuries: A systematic review and meta-analysis

AIM

The aim of this review was to determine the effectiveness of the e-learning programs for improving the knowledge and professional practices of nursing personnel in managing pressure injuries patients.

DESIGN

Systematic review and meta-analysis.

METHODS

Systematic search was done in EMBASE, SCOPUS, Cochrane library, MEDLINE, Google Scholar, ScienceDirect and Clinicaltrials.gov databases until August 2022. Meta-analysis was carried out using random-effects model, and the results were reported as pooled standardized mean differences (SMD), or odds ratios (OR) with 95% confidence intervals (CIs).

RESULTS

Eight studies were included in the analysis. Most of the studies had higher risk of bias. The pooled SMD for knowledge score and for the classification skill were 1.40 (95%CI: 0.45-2.35; I2  = 93.1%) and 1.75 (95%CI: 0.94-3.24; I2  = 78.3%) respectively. The pooled OR for the classification skills was 1.75 (95%CI: 0.94-3.24; I2  = 78.3%).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Effect of an educational intervention on compliance with care bundle items to prevent ventilator-associated pneumonia

OBJECTIVES

We aimed to evaluate the effectiveness of our ventilator-associated pneumonia prevention bundle implemented by education of the nursing staff, and to describe the tendency of knowledge retention.

RESEARCH METHODOLOGY

A prospective, before-and-after study was performed. The ventilator-associated pneumonia prevention bundle was implemented through a single educational intervention of the nursing staff. The risk of ventilator-associated pneumonia over time was estimated using a Cox proportional cause-specific hazard model. Compliance to preventive measures was assessed at three time-points: before education, at three months and 12 months after education.

SETTING

A 29-bed mixed medical-surgical intensive care unit.

MAIN OUTCOME MEASURES

Ventilator-associate pneumonia incidence densities, the risk of ventilator-associated pneumonia, and compliance to preventive measures in the pre-implementation and post-implementation periods.

RESULTS

We analyzed the data of 251 patients. The incidence density of pneumonia decreased from 29.3/1000 to 15.3/1000 ventilator-days after the implementation of the prevention program. Patients in the post-implementation period had significantly lower risk to develop pneumonia (hazard ratio 0.34, 95 % confidence interval 0.19-0.61, p = 0.001). At 3 months of implementation, a significant improvement was detected to all the individual bundle components. Complete compliance increased from 16.2 % to 62.2 % (p < 0.001). Compliance with bundle components decreased to baseline levels after 12 months of implementation apart from head-of-bed elevation.

CONCLUSION

This study supports existing evidence that educational interventions improve compliance. The gained knowledge was well translated into clinical practice reflected by the decreasing ventilator-associated pneumonia rate. It may be assumed that a refresher educational session within 12 months after implementation is needed.

Knowledge and Skill Needs in E-course Training of an Expanded Program for Immunization Staff in Thailand: A Mixed-method Design

Background:

This study was conducted to examine essential content needs in E-course training to improve the knowledge and skills of immunization staff members in Thailand.

Methods:

This study used a mixed-method research design. Quantitative methodology was used to study 449 staff members of government care facilities in the Expanded Program on Immunization (EPI). Surveys were conducted by using the perceived needs for immunization training questionnaire. Qualitative methodology employed in-depth interview guidelines on immunization content that were used to interview 14 staff members at EPI. The quantitative data were analyzed by using descriptive statistics and one-way analysis of variance (ANOVA). Interview data were analyzed in content analysis.

Results:

The participants were immunization staff members of three positions: registered nurses, pharmacists and public health technical officers. The participants had different E-course training content needs concerning vaccine-report registration, administering the vaccines and dealing with adverse events following immunization (AEFI) with a statistical significance of .05. This was consistent with the findings from in-depth interviews, which showed staff members had both varying and connected work responsibilities, giving members from all three groups a need for the same basic knowledge pertaining to immunization. In some aspects, staff members required different training content details depending on job descriptions. Public health technical officers were found to require details on vaccine-report registration. Nurses required knowledge dealing with AEFI and administering the vaccines. Pharmacists needed details on the cold-chain system the most.

Conclusion:

Executives at the policy level should specify essential content requiring development for each position in addition to designing training models to meet the needs of EPI staff, enabling access and promoting effective use.

How does innovative technology impact nursing in infectious diseases and infection control? A scoping review

Aim

Considering the increasing number of emerging infectious diseases, innovative approaches are strongly in demand. Additionally, research in this field has expanded exponentially. Thus, faced with this diverse information, we aim to clarify key concepts and knowledge gaps of technology in nursing and the field of infectious diseases.

Design

This scoping review followed the methodology of scoping review guidance from Arksey and O’Malley.

Methods

Six databases were searched systematically (PubMed, Web of Science, IEEE Explore, EBSCOhost, Cochrane Library and Summon). After the removal of duplicates, 532 citations were retrieved and 77 were included in the analysis.

Results

We identified five major trends in technology for nursing and infectious diseases: artificial intelligence, the Internet of things, information and communications technology, simulation technology and e‐learning. Our findings indicate that the most promising trend is the IoT because of the many positive effects validated in most of the reviewed studies.

Using technology-based educational interventions to improve knowledge about clinical practice guidelines

OBJECTIVE

To describe the best evidence on the effectiveness of technology-based learning tools designed to improve knowledge of health care providers about clinical practice guidelines (CPGs).

METHODS

We conducted a systematic review, searching MEDLINE, Embase, and CINAHL from inception to July 2018. Included studies investigated the effectiveness of any technology-based learning tools developed to improve knowledge of health care providers about CPGs. We used a 2-phase screening process to determine eligibility. Pairs of reviewers critically appraised relevant studies using the Scottish Intercollegiate Guidelines Network checklist for randomized controlled trials or the National Institutes of Health checklist for pre- and postintervention trials. Evidence from internally valid studies was described using a best-evidence summary. We conducted a sensitivity analysis to determine whether results varied according to methodological quality.

RESULTS

Twenty-five of 8321 articles met our selection criteria. Six studies had a low risk of bias and were included in this review. Spaced education was associated with improvement in knowledge; however, its effectiveness relative to other interventions is unknown. Module-based online educational interventions were associated with improvement in knowledge of CPGs; however, they may not be more effective than paper-based self-learning or in-person workshops. The sensitivity analysis determined that the evidence was similar between the high and low risk of bias studies.

CONCLUSION

Module-based- and spaced-education interventions may be beneficial for improving health care providers' knowledge of CPGs; however, much of the evidence toward their use is preliminary.

The development and evaluation of an online educational tool for the evidence-based management of neck pain by chiropractic teaching faculty

OBJECTIVE

To develop an online, interactive educational tool to deliver an evidence-based clinical practice guideline to faculty members at a Canadian chiropractic college. Second, to evaluate the learning, design, and engagement constructs of the tool in a sample of chiropractic faculty members.

METHODS

Using an integrated knowledge translation methodology and the Knowledge to Action Framework, we developed an evidence-based online learning tool. The context of the tool focused on a clinical practice guideline on the management of neck pain. We evaluated the learning, design, and engagement constructs in a sample of faculty members and residents using the Learning Object Evaluation Scale for Students. Participants were also asked to provide suggestions for improvement of the tool.

RESULTS

Sixteen participants completed the evaluation. Most (68.8%) participants were chiropractors, 75% were male and 56% were between the ages of 25 and 44 years. At least 75% of participants agreed that the learning, design, and engagement constructs of the learning tool were adequate. The open-ended suggestions unveiled 3 pedagogical themes, relating to multimedia, thinking skills, and learner control, within the tool that could benefit from further development. These themes informed recommendations to improve the tool.

CONCLUSION

Our online, interactive, module-based learning tool has sound pedagogical properties. Further research is needed to determine if its use is associated with a change in knowledge.

Do Checklist-Induced Behavioral Changes Improve Self-Confidence in Fundoscopic Examination? A Mixed-Methods Study

Purpose

Fundoscopic exams are conducted during outpatient consultations to assess intracranial disease and complications from chronic diseases. Low level of confidence in these skills which physicians have is one of the causes that implementation frequency is low. Research has not yet identified specific measures through which the healthcare system may increase the implementation of fundoscopic exams nor a qualitative process that enables physicians to gain confidence in their fundoscopic exam skills. We introduced a checklist and conducted a mixed-methods study.

Methods

This study is a before-and-after study, within an embedded-experimental mixed-methods design. We sampled 15 physicians in the department of general medicine at a university hospital assigned to initial consultation. We introduced a checklist to verify whether the fundoscopic exam was implemented. Measures are implementation ratio of the fundoscopic exam to the total number of indication cases, and Visual Analog Scale (VAS) values for the confidence in procedure are measured before and after the intervention. We obtained qualitative data from interviews and used the Modified Grounded Theory Approach.

Results

We observed significant increases in the implementation ratio (19.2% (29/151 cases) vs 64.8% (105/162 cases), p<0.001) and in the VAS value for the confidence (1.89 mm vs 4.68 mm (p<0.001)). Analysis of the interviews revealed the following. To increase the implementation, it is necessary to reduce the <Lack of confidence> and <Forgetting>, which is prevented by the checklist. The <Lack of successful experiences in detecting abnormalities> leads to a <Lack of confidence>. Repeated executions result in <Successful experiences and confidence building>.

Conclusion

The intervention increased the implementation ratio, thereby increasing successful experiences and confidence among physicians. The growth of confidence boosted motivations to implement fundoscopic exams.

Nurses' knowledge, experience and self-reported adherence to evidence-based guidelines for prevention of ventilator-associated events: A national online survey

OBJECTIVE

To explore Australian intensive care nurses' knowledge of ventilator-associated pneumonia and self-reported adherence to evidence-based guidelines for the prevention of ventilator-associated events.

DESIGN

A quantitative cross-sectional online survey was used.

SETTING

The study was conducted in two Australia intensive care units, in large health services in Victoria and an Australia-wide nurses' professional association (Australian College of Critical Care Nurses).

MAIN OUTCOME MEASURES

Participants' knowledge and self-reported adherence to evidence-based guidelines.

RESULTS

The median knowledge score was 6/10 (IQR: 5-7). There was a significant positive association between completion of post graduate qualification and their overall knowledge score p = 0.014). However, there was no association (p = 0.674) between participants' years of experience in intensive care nursing and their overall score. The median self-reported adherence was 8/10 (IQR: 6-8). The most adhered to procedures were performing oral care on mechanically ventilated patients (n = 259, 90.9%) and semi-fowlers positioning of the patient (n = 241, 84.6%). There was no relationship between participants' knowledge and adherence to evidence-based guidelines (p = 0.144).

CONCLUSION

Participants lack knowledge of evidence-based guidelines for the prevention of ventilator-associated pneumonia. Specific education on ventilator-associated events may improve awareness and guideline adherence.

Influence of national culture and context on healthcare workers' perceptions of infection prevention in Greek neonatal intensive care units

BACKGROUND

Healthcare-associated infections (HAIs) in neonatal intensive care units (NICUs) result in increased morbidity, mortality and healthcare costs. HAI rates in Greek NICUs are among the highest in Europe. There is a need to identify the factors that influence the transmission of HAIs and implementation of prevention interventions in this setting.

AIM

To understand healthcare workers' perceptions about HAI prevention in Greek NICUs.

METHODS

Qualitative interviews were conducted with NICU staff (physicians and nurses) and infection prevention stakeholders (infectious diseases physicians and infection control nurses) working in three hospitals in Athens. Interviews were conducted in Greek, transcribed and translated into English, and analysed using a modified grounded theory approach.

FINDINGS

Interviews were conducted with 37 respondents (20 physicians and 17 nurses). Four main barriers to HAI prevention were identified: (1) resource limitations leading to understaffing and cramped space; (2) poor knowledge about HAI prevention; (3) Greek-specific cultural norms, including hierarchy-driven decisions, a reluctance for public workers to do more than they are paid for, a belief that personal experience trumps evidence-based knowledge, and reactive rather than proactive approaches to societal challenges; and (4) lack of a national infection prevention infrastructure. Respondents believed that these barriers could be overcome through organized initiatives, high-quality HAI performance data, interpersonal interactions to build engagement around HAI prevention, and leveraging the hierarchy to promote change from the 'top down'.

CONCLUSION

Implementing HAI prevention interventions in Greek NICUs will require consideration of contextual features surrounding the delivery of care, with particular attention paid to national culture.

Development of an e-learning prototype for assessing occupational stress-related disorders: a qualitative study

BACKGROUND

Occupational stress-related disorders are complex to diagnose and prevent, due to their multifactorial origin. We developed an e-learning programme aimed at supporting occupational physicians when diagnosing and preventing occupational stress-related disorders. In order to explore the extent to which a developed e-learning prototype was perceived as useful and feasible by occupational physicians, we executed a qualitative study.

METHODS

We conducted semi-structured, face-to-face interviews with fifteen occupational physicians, who were recruited using a combination of convenience and purposive sampling. Participants were shown a hard copy prototype of the e-learning programme, on which they were invited to comment in terms of perceived usefulness and feasibility. The interview data was transcribed verbatim and coded by two researchers using a content analysis approach.

RESULTS

Occupational physicians perceived e-learning as useful when it contributed to creating a full clinical picture and supported the diagnosis. Its structure had to support occupational physicians to work systematically. The programme had to be applicable to their daily practice and had to incorporate learning tools in order to increase the competences of occupational physicians. Feasibility was perceived to increase when the e-learning programme took less time to complete, when the quantity of written text was not too high, and when the user was guided and recertification points provided.

CONCLUSIONS

An e-learning programme can be an asset in continuing medical education for occupational physicians when assessing occupational stress-related disorders. Perceived usefulness depended on the clinical picture, structure, practicality and the increasing of competences. Feasibility depended on text, time, structure and reward.

Long-term effects of an e-learning course on patient safety: A controlled longitudinal study with medical students

Background

To improve patient safety, educational interventions on all system levels, including medical school are necessary. Sound theoretical knowledge on elements influencing patient safety (such as error management or team work) is the basis for behavioral changes of health care professionals.

Methods

A controlled, quasi-experimental study with repeated measures was deployed. The intervention group participated in a mandatory e-learning course on patient safety (ELPAS) between October 2016 and December 2016. The control group did not receive any didactic session on patient safety. In both groups we measured technical knowledge and attitudes towards patient safety before the intervention (T0), directly after the intervention (T1) and one year after the intervention (T2). Participants were 309 third-year medical students in the intervention group and 154 first- and second-year medical students in the control group.

Results

Technical knowledge in the intervention group (but not the control group) improved significantly after the intervention and remained high after one year (F(2, 84) = 13.506, p < .001, η² = .243). Students of the intervention group felt better prepared for safe patient practice, even one year after the intervention F(2, 85) = 6.743, p < .002, η² = .137). There was no sustainable significant effect on attitudes towards patient safety.

Conclusion

This study shows, that eLearning interventions can produce significant long-term effects on patient safety knowledge, however, the study did not show long-term effects on attitudes towards patient safety. Our study implies two potential developments for future research: e-learning might be used in combination with face-to-face sessions, or more intensive (in terms of frequency and duration) e-learning sessions may be needed to achieve lasting changes in attitude.

Gastric residual volume measurement in the intensive care unit: an international survey reporting nursing practice

BACKGROUND

Gastric residual volume measurement is routinely used to evaluate the feeding tolerance and gastro-oesophageal reflux in patients receiving enteral feeding therapy in the intensive care unit. However, little supportive evidence for this intervention is available as the usefulness of gastric residual volume measurements in patients receiving enteral feeding therapy in the intensive care is controversial.

AIM

The aim of this study was to assess the practice of intensive care unit nurses related to gastric residual volume measurement in patients receiving enteral nutrition.

METHODS

A survey was conducted among a sample of intensive care unit nurses (n = 832) from four hospitals in Turkey (n = 182) and attendees of the Annual Congress of the Flemish Society for Critical Care Nurses in Flanders, Belgium (n = 650). The survey instrument was developed by the researchers based on the related literature.

RESULTS

A total of 480 nurses completed the questionnaire (response rate = 73%). Gastric residual volume is measured by 98·0% of respondents, with wide variations in the frequency of measuring. A 50-200 mL gastric residual volume is considered problematic by 45·5% (n = 183) of the participants, and only 18·4% (n = 81) reported their practice to be based on a current guideline. Strikingly, more experienced intensive care unit nurses appear to perform gastric residual volume measurements more commonly than their less experienced colleagues (p = 0·004), while the practice is more often reported to be performed in Belgium than in Turkey (p < 0·001).

CONCLUSION

Gastric residual volume management could be improved by applying current evidence to daily nursing practice.

RELEVANCE TO CLINICAL PRACTICE

Our results show that increased awareness of these guidelines by nurses is needed to reduce inefficient use of working time and resources, streamline clinical practices and improve patient outcomes. Current gastric residual volume measurement guidelines and up-to-date, relevant training should be provided to nurses.