Designing and delivering digital learning (e-Learning) interventions in nursing and midwifery education: A systematic review of theories

AIMS /OBJECTIVES

To identify and synthesise theories that support the design and delivery of digital learning interventions in nursing and midwifery education.

BACKGROUND

A range of educational and other theories are used to support nursing and midwifery education, including when e-learning interventions are being designed and delivered. However, there is a limited understanding of how theory is applied across the wide range of digital learning interventions to inform pedagogical research and practice.

DESIGN

A systematic review.

METHODS

CINAHL, ERIC, MEDLINE and PubMed were searched using key terms. Studies were screened by independent reviewers checking the title, abstract and full text against eligibility criteria. Due to the theoretical focus of the review, critical appraisal was not undertaken. Data were extracted and synthesised using a descriptive approach.

RESULTS

Thirty-four studies were included. Twenty theories were identified from a range of scientific disciplines, with the Technology Acceptance Model and Theory of Self-Efficacy employed most often. Theoretical frameworks were used to inform and explain how the digital learning interventions were designed or implemented in nursing and midwifery education. The sample were mainly undergraduate nursing students and the digital learning interventions encompassed animation, blended approaches, general technologies, mobile, online, virtual simulation and virtual reality applications which were used mainly in university settings.

CONCLUSIONS

This systematic review found a range of theories that support the design and delivery on digital learning interventions in nursing and midwifery education. While a single theory, the Technology Acceptance Model, tended to dominate the literature, the evidence base is peppered with numerous theoretical models that need to be examined more rigorously to ascertain their utility in improving the design or implementation of digital forms of learning to improve pedagogical research and practice in nursing and midwifery.

Evaluation of an infection control link nurse program: an analysis using the RE-AIM framework

BACKGROUND

Important elements of programs that train and support infection control link nurses (ICLN) are the engagement of stakeholders, support from hospital and ward management and a structure for iterative improvement. The effects of programs, that combine all these elements, are unknown. We evaluated such a comprehensive program to explore its impact on link nurses and infection prevention practices and routines.

METHODS

We used the RE-AIM framework, a robust, evidence-based framework within the field of Implementation Science, to evaluate the impact of our ICLN training and support program. We used a mixed methods approach and organized the outcomes along its five dimensions: Reach, Effectiveness, Adoption, Implementation and Maintenance.

RESULTS

Between 2014 and 2018, on average 91% of the inpatient wards and 58% of the outpatient clinics participated in the program (Reach) and impacted guideline adherence in inpatient wards. Link nurses felt engaged and empowered, and perceived their contribution to these results as pivotal. Ward managers confirmed the value of ICLN to help with implementing IPC practices (Effectiveness). The program was adopted both at the hospital and at the ward level (Adoption). Based on ongoing evaluations, the program was adapted by refining education, training and support strategies with emphasis on ward specific aspects (Implementation). The ICLN program was described as a key component of the infection prevention policy to sustain its effects (Maintenance).

CONCLUSIONS

Our infection control link nurse program helped ICLN to improve infection prevention practices, especially in inpatient wards. The key to these improvements lay within the adaptability of our link nurse program. The adjustments to the program led to a shift of focus from hospital goals to goals tailored to the ward level. It allowed us to tailor activities to align them with the needs specific to each ward.

Infection Prevention and Control Lead Link Practitioner: a new deployed role piloted on Exercise SAIF SAREEA 3

Disease non-battle injury has plagued British expeditionary forces through the ages. While in recent years significant mortality has reduced, it has had a large impact on operational effectiveness, at times leading to closure of major medical treatment facilities (MTFs).Infection Prevention and Control (IPC) benefits from a subject matter expert and champion to ensure it remains at the front of people's minds and to be on hand to manage acute and dynamic situations. To mitigate the lack of an IPC Nursing Officer, we piloted a deployed military IPC Lead Link Practitioner (IPC-LL) for the first time on a large-scale overseas exercise (SAIF SAREEA 3). An experienced generalist nurse deploying as the IPC-LL (after specific training) provided pre-deployment IPC education and preparation, deployed IPC advice, undertook mandatory audits and monitored IPC compliance throughout the MTFs on the exercise. Data from 22 IPC audits conducted on the exercise showed that the presence of the IPC-LL improved IPC compliance and standards overall in the MTF where based, compared with others. In addition, a gastroenteritis outbreak occurred and was successfully managed with significant input from the IPC-LL. The IPC-LL was also able to add value by pre-empting potential IPC problems from occurring.There is a small pool of deployable Infection Prevention and Control Nursing Officers, so this new IPC-LL role could help to fill the capability gap. The IPC-LL could be the dedicated person focusing on IPC elements, reducing the IPC risk within the deployed field hospital setting where deployed experts are not available.

Infection control link nurses in acute care hospitals: a scoping review

Background

Involving link nurses in infection prevention and control is a strategy to improve clinical practice that has been implemented in hospitals worldwide. However, little is known about the use, the range and benefits of this strategy. We aimed to identify key concepts of infection control link nurses (ICLN) and ICLN programs, to evaluate the effect of such programs, and to identify gaps in the evidence base.

Methods

In a scoping review, we searched PubMed, CINAHL, Google and Google Scholar for manuscripts on ICLN in acute care hospitals. We included research- and opinion-based papers, abstracts, reports and guidelines.

Results

We included 29 publications and identified three key concepts: the profile of ICLN, strategies to support ICLN, and the implementation of ICLN programs. The majority of included studies delineates the ICLN profile with accompanying roles, tasks and strategies to support ICLN, without a thorough evaluation of the implementation process or effects. Few studies report on the effect of ICLN programs in terms of patient outcomes or guideline adherence, with positive short term effects.

Conclusion

This scoping review reveals a lack of robust evidence on the effectiveness of ICLN programs. Current best practice for an ICLN program includes a clear description of the ICLN profile, education on infection prevention topics as well as training in implementation skills, and support from the management at the ward and hospital level. Future research is needed to evaluate the effects of ICLN on clinical practice and to further develop ICLN programs for maximal impact.

Electronic supplementary material

The online version of this article (10.1186/s13756-019-0476-8) contains supplementary material, which is available to authorized users.

An evaluation of an infection prevention link nurse programme in community hospitals and development of an implementation model

Background

Little evidence exists to show the exact impact of the link nurse role in promoting best practice in infection prevention. This paper is a report of the implementation and evaluation of a link nurse programme for community hospitals across one NHS organisation.

Aim/objectives

The main aim of the study was to implement and evaluate an infection prevention link programme. The study objectives were: 1) to develop materials for a bespoke infection prevention programme which incorporated education, behaviour change, reward and recognition and 2) to evaluate the implementation of the programme, and to learn about barriers and enablers to implementation.

Method

Data were collected using semi-structured telephone interviews, contact logs and online course evaluation. Data were analysed using thematic analysis.

Findings

We identified four overarching themes that, collectively, construct a model for the implementation of the link nurse role in infection prevention. The themes are labelled as: selection process, support networks, essential roots, and turning points for success.

Discussion

This study contributes to understanding the contribution of link nurses in infection prevention. We suggest our findings are transferable to different settings, and the model provides guidance to support future link nurse programmes and promote best practice in infection prevention practice.

Strategies to promote infection prevention and control in acute care hospitals with the help of infection control link nurses: A systematic literature review

BACKGROUND

Infection control link nurses (ICLNs) are important backup personnel for the prevention and control of infections in hospitals. To identify facilitators and barriers for the implementation of and long-term collaboration with ICLNs.

METHODS

We conducted a systematic literature review, following the preferred reporting items for systematic reviews and meta-analyses guidelines. Inclusion criteria were defined as description of de novo implementation of an ICLN system, strengthening of an existing ICLN system, or analysis of an ICLN system.

RESULTS

In 10 publications, facilitators and barriers were identified for mode of selection of ICLN candidates, characteristics and responsibilities of ICLNs, composition of a training curriculum, educational strategies, and external influencing factors. Experienced nurses with an interest in infection control seemed appropriate candidates. The importance of psychological skills in addition to technical knowledge was emphasized. A clear definition of responsibilities was important. Viable tasks for ICLNs included surveillance and teaching activities and the implementation of prevention measures. Ongoing teaching was superior to a single course. Management support was pivotal for success.

CONCLUSION

Research on ICLNs is scarce. The potential to decrease health care-associated infections with the help of ICLNs has been demonstrated. The training in psychological skills in addition to technical knowledge deserves more attention.

Delivering an infection control link nurse programme: implementation and evaluation of a flexible teaching approach

Infection control nurses work to ensure practice is evidence-based, thereby minimising infection risks. There is, however, a gap between theory and practice in infection control at clinical level. Link nurse groups have been used in an attempt to ensure practice is evidence-based.

This article describes a research study that examined the efficacy of an infection control link nurse programme, which had an educational programme based upon adult learning theory, delivered using an action-research approach. Results of the study are described in subsequent articles.

Effect of palliative care nurse champions on the quality of dying in the hospital according to bereaved relatives: A controlled before-and-after study

BACKGROUND

To improve the quality of end-of-life care, hospitals increasingly appoint palliative care nurse champions.

AIM

We investigated the effect of nurse champions on the quality of life during the last 3 days of life and the quality of dying as experienced by bereaved relatives.

DESIGN

A controlled before-and-after study (June 2009-July 2012). Halfway, in each of seven intervention wards, two nurse champions were appointed; 11 wards served as control wards. The quality of life during the last 3 days of life, quality of dying and multiple dimensions of quality of dying were compared before and after the introduction of nurse champions.

SETTING

In a university hospital, each death at non-intensive care units was followed up by an invitation to relatives (10-13 weeks later) to answer a questionnaire.

RESULTS

For the two periods, data were collected on 86 and 84 patients in intervention wards and on 108 and 118 patients in control wards (overall response: 52%). In the intervention wards, no differences were found in the quality of life during the last 3 days of life and the quality of dying scores: in both periods, median score for the quality of life during the last 3 days of life was 3.0 and for the quality of dying 7.0. No differences were found in multiple quality of dying dimensions. In control wards, the median quality of dying score was 7.0 pre-intervention and 6.0 post-intervention (p = 0.04). Other scores were comparable with those in intervention wards.

CONCLUSION

Performing a complex intervention study in palliative care proved to be feasible. This study showed no differences in the experiences of bereaved relatives after introduction of nurse champions. The complexity of palliative care in the hospital might require more intensive and longer training of nurse champions.

Qualitative evaluation and economic estimates of an infection control champions program

BACKGROUND

In many North American hospitals, conventional infection control operational models often struggle to provide sufficient support to frontline health care workers. The objective of this study was to describe a sustainable infection control champion (ICC) program based on findings from focus groups.

METHODS

A distributed model of infection control was established by placing infection prevention and control-trained ICCs in 3 Canadian hospitals for a period of 12 months. Subsequently, semistructured focus groups were conducted to describe overall feasibility and impeding and critical factors affecting sustainability. An economic estimate of the ICC program compared with the cost of hiring a new infection control practitioner was also calculated.

RESULTS

Focus group participants considered the program feasible. Barriers included lack of time and staff turnover. Themes critical for the successful implementation of an ICC program included defined ICC roles and goals, adequate support and resources for the ICC, engagement with all levels of staff, flexible structure, and program evaluation. The cost per bed of the ICC program was less than the cost per bed of hiring a new infection control practitioner.

CONCLUSION

A distributed model of providing infection prevention and control services may have benefit when hospital infection control teams are underresourced, as is often the case. Several key factors are needed for the successful implementation of an ICC program.

Improving the quality of palliative and terminal care in the hospital by a network of palliative care nurse champions: the study protocol of the PalTeC-H project

BACKGROUND

The quality of care of patients dying in the hospital is often judged as insufficient. This article describes the protocol of a study to assess the quality of care of the dying patient and the contribution of an intervention targeted on staff nurses of inpatient wards of a large university hospital in the Netherlands.

METHODS/DESIGN

We designed a controlled before and after study. The intervention is the establishment of a network for palliative care nurse champions, aiming to improve the quality of hospital end-of-life care. Assessments are performed among bereaved relatives, nurses and physicians on seven wards before and after introduction of the intervention and on 11 control wards where the intervention is not applied. We focus on care provided during the last three days of life, covered in global ratings of the quality of life in the last three days of life and the quality of dying, and various secondary endpoints of treatment and care affecting quality of life and dying.

DISCUSSION

With this study we aim to improve the understanding of and attention for patients' needs, and the quality of care in the dying phase in the hospital and measure the impact of a quality improvement intervention targeted at nurses.

The palliative care link nurse role in nursing homes: barriers and facilitators

AIM

This paper is a report of a study to explore link nurses' views and experiences regarding the development, barriers and facilitators to the implementation of the role in palliative care in the nursing home.

BACKGROUND

The delivery of palliative care in nursing homes is widely advocated; one approach is to develop the link nurse role to cascade good practice and training to nurses and other care staff to enhance patient care.

METHOD

A descriptive qualitative study was conducted with a purposive sample of 14 link nurses from 10 nursing homes in Northern Ireland during 2006. Three focus groups, composed of all Registered Nurses currently acting as link nurses in their nursing homes participated, and the data were audio recorded, fully transcribed and content analysed.

FINDINGS

The link nurse system shows potential to enhance palliative care within nursing homes. However, link nurses experienced a number of difficulties in implementing education programmes. Facilitators of the role included external support, monthly meetings, access to a resource file and peer support among link nurses themselves. Lack of management support, a transient workforce and lack of adequate preparation for link nurses were barriers to fulfilling this role.

CONCLUSION

Whilst palliative care link nurses can improve care for residents in nursing homes, consideration must be given to overcome the types of barriers identified in order to enable the link nurse system to function effectively.

Macmillan nurse facilitators: establishing a palliative resource nurse network in primary care

AIM

to describe how a link nurse system for palliative care was established in primary care and report on an evaluation of the system undertaken as part of a larger evaluation of newly established Macmillan nurse facilitator posts.

METHOD

a range of data collection techniques was used to collect information relating to the link nurse system including interview, questionnaire and observation. Various sampling strategies were adopted for the different data collection methods. This paper reports on the findings of semi structured interviews with groups of district nurses and link nurses, a questionnaire to district nurses, telephone interviews with a sample of questionnaire respondents and site observations.

FINDINGS

the Macmillan nurse facilitators have established, supported and maintained a robust palliative resource nurse (PRN) group within primary care. The majority of practising clinical district nursing staff have used this important resource for a variety of reasons over the past four years. The model developed provides an opportunity for professional development for the PRNs. This initiative has been viewed as a very positive development and has been utilised for disseminating information, research and audit purposes from clinicians both within and out-with primary care.

CONCLUSIONS

The establishment of a palliative resource network within primary care has been successful. It has provided an effective and efficient means of disseminating information across a large workforce and extensive geographical area. The development of a clear structured model benefits both the PRNs and the organisation by providing clear expectations of the role while offering a framework for professional development.

Spreading the word, not the infection: reaching hospitalists about the prevention of antimicrobial resistance

BACKGROUND

To reach and engage hospitalists in the prevention of antimicrobial resistance, the Society of Hospital Medicine and the Centers for Disease Control and Prevention developed and conducted a quality improvement workshop based on the Centers for Disease Control and Prevention's Campaign to Prevent Antimicrobial Resistance in Healthcare Settings.

METHODS

We aimed to examine motivating factors, perceived barriers, and cues to action for hospitalists to learn about and engage in the prevention of antimicrobial resistance and to determine whether a workshop can facilitate the implementation of a quality improvement project. Using the Health Belief Model as a theoretical framework, we interviewed hospitalists who attended (attendees) and did not attend (nonattendees) the workshop. Data were qualitatively coded and analyzed.

RESULTS

Nine attendees and 10 nonattendees participated in interviews. Motivating factors for attending the workshop included an interest in the topic of quality improvement and antimicrobial resistance prevention, the promotion of the workshop by institutions and colleagues, the opportunity to network with colleagues, and the qualifications of the presenter. Barriers to involvement in quality improvement efforts and the prevention of antimicrobial resistance for both attendees and nonattendees included perceived lack of time, other institutional priorities, and lack of administrative and institutional support. Attendees and nonattendees also identified perceived effective and preferred methods for receiving information about antimicrobial resistance, such as workshops and presentations, e-mail, institutional involvement, and the Internet. Overall, attendees thought that the workshop could be effective in facilitating the implementation of a quality improvement project.

CONCLUSION

By considering factors that influence behavioral change, interventions, such as the Society of Hospital Medicine workshop, have the ability to reach and engage clinicians such as hospitalists in quality improvement efforts to prevent antimicrobial resistance and improve adherence to infection control strategies. Furthermore, this study demonstrated that the Health Belief Model can provide an applicable framework for examining factors that influence clinician behavior.

Impact of Society of Hospital Medicine workshops on hospitalists' knowledge and perceptions of health care-associated infections and antimicrobial resistance

BACKGROUND

Health care-associated infections and antimicrobial resistance threaten the safety of hospitalized patients. New prevention strategies are necessary to address these problems. In response, the Society of Hospital Medicine (SHM) in collaboration with the Centers for Disease Control and Prevention developed and conducted workshops to educate hospitalists about conducting quality improvement programs to address antimicrobial resistance and health care-associated infections in hospitalized patients.

METHODS

SHM collected and analyzed data from pretests and posttests administered to physicians who attended SHM workshops in 2005 in 1 of 3 major cities: Denver, Colorado; Boston, Massachusetts; or Portland, Oregon.

RESULTS

A total of 69 SHM members attended the workshops, and 50 completed both a pretest and a posttest. Scores on the knowledge-based questions increased significantly from pretest to posttest (x = 48% vs. 63%, P < .0001); however, perceptions of the problem of antimicrobial resistance did not change. Most participants (85%) rated the quality of the workshop as "very good" or "excellent" and rated the workshop sessions as "useful" (x = 3.9 on a 5.0 scale).

CONCLUSIONS

Hospitalists who attended the SHM workshop increased their knowledge of health care-associated infections, antimicrobial resistance, and quality improvement programs related to these issues. Similar workshops should be considered in efforts to prevent health care-associated infections and antimicrobial resistance.

Controlling methicillin-resistant Staphylococcus aureus by stepwise implementation of preventive strategies in a university hospital: impact of a link-nurse system on the basis of multidisciplinary approaches

BACKGROUND

Current approaches in the control of methicillin-resistant Staphylococcus aureus (MRSA) in the large tertiary referral hospital have not been universally successful.

METHODS

The trend of MRSA rates and their relationship with stepwise implementation of preventive strategies in Tokai University Hospital during a 76-month period from September 1998 to December 2004, was retrospectively analyzed with a quasi-experimental design.

RESULTS

Implementation of strategies including a feedback process with case and epidemic reporting, an infection control team and office, and a preventive guideline for MRSA did not result in reduction in monthly MRSA rates in the hospital, as analyzed with Shewhart u charts. When infection control link nurses were organized and their activities became full-scale, there appeared significant reduction in arithmetic mean of the monthly rates of MRSA from 6.3% to 5.0% in June 2002. Meanwhile the mean values for monthly counts of new MRSA cases also dropped in 15 of 25 wards/units in June 2002, as analyzed with Exponentially Weighted Moving Average charts. Concurrently, there was a significant increase (17.3%) in the monthly consumption of handwashing liquid plain soap. Thereafter the MRSA rates remained low for 2 years within three standard deviations.

CONCLUSIONS

The sustained reduction of MRSA rates in the hospital can be related to introduction of the infection control link-nurse system on the basis of continuous enforcement of basic and multidisciplinary approaches such as hand-hygiene compliance.

The experiences of lecturer practitioners in clinical practice

AIM

The aim of the study was to describe and understand the lived experiences of teaching for lecturer practitioners in the clinical workplace.

BACKGROUND

Lecturer practitioners appear to have been introduced into practice to bridge the gap between academic and clinical learning although there appears to be little empirical evidence of how they work in clinical practice.

METHODS

A qualitative approach was used in interpreting the transcribed interviews of five lecturer practitioners from different practice backgrounds working from the same university in the south of England.

FINDING

Two synthesised interpretations of the lecturer practitioner experiences of teaching were described. One was of looking and seeing practice differently and challenging practitioners to do the same. The second was of working in the middle of the practice theory gap rather than trying to reduce it.

CONCLUSIONS

Although the findings are not generalisable to other lecturer practitioners the participants appeared to work in partnership with practitioners to bring a change in the clinical environment where learning was supported and encouraged. The partnership appeared to place the onus on the practitioner to develop their practice and the lecturer practitioners appeared to work as an educational enabler.

Education in practice: a colorectal link-nurse programme

This article illustrates the planning, implementation, evaluation and personal implications of a link-nurse programme for colorectal cancer nursing. The programme was designed to maintain a patient-centred support service and continue the provision of bowel cancer education and support to nurses in the clinical environment. Literature on previous link-nurse schemes, and the recent legislation on education and cancer nursing provides the background on which this programme is based. The use of educational theory supplies the theoretical underpinnings for this approach to learning, and evaluation findings are reported from both the group's and the individual's viewpoints. The programme increased the link nurses' awareness of the patient's pathway, support and information needs and the role of the multidisciplinary team in managing care. Sufficient time, support and encouragement from ward teams and clinical managers were seen as vital to the success of the programme, and specific benefits and challenges when establishing this type of practice based education for nurses are explored.

An infection control link nurse network in the care home setting

Link nurse groups or networks are used to enhance practice at clinical level (Cooper, 2001), improve the collaboration and education of nursing staff (MacArthur, 1998) and, therefore, have an effect on patient care. The use of link nurse networks is widespread and applied to a range of nursing specialties, particularly in acute settings. Reference in the literature to link nurse networks in nursing homes is very limited, despite their existence. This article examines the advantages and disadvantages of link nurse networks and the link nurse role as described in the literature. In addition, comparisons are made with an established infection control link nurse network in North Wales nursing homes. The article describes the assessment of the North Wales network using an audit cycle. The efficacy of link nurse networks is rarely considered; however, the process of audit can enable the evaluation of the link nurse network in relation to staff education, monitoring of infection control practice and dissemination of information.

The role of the infection control link nurse

Link nurses act as a link between their own clinical area and the infection control team. Their role is to increase awareness of infection control issues in their ward and motivate staff to improve practice. It is essential that they receive training from the infection control team to ensure their competence. They have been shown to be of value to Trusts by improving clinical ward audit scores, helping infection control nurses implement policies and collecting data on hospital-acquired infections. In some hospitals, however, there are operational difficulties for link nurse schemes including high turnover of staff and insufficient time for training and monitoring their effectiveness.