E-Orientation

Evaluation of the Premature Infant Pain Profile-Revised (PIPP-R) e-Learning Module: Immediate and Sustained Competency

BACKGROUND

Electronic health (e-health) learning is a potential avenue to educate health professionals about accurately using infant pain assessment tools, although little is known about the impact of e-health interventions on clinical competence.

PURPOSE

To evaluate whether an e-health learning module for teaching the accurate use of the Premature Infant Pain Profile-Revised (PIPP-R) pain assessment tool results in immediate and sustained competency to assess infant pain.

METHODS

Neonatal intensive care unit (NICU) nurses who participated in a larger study across 2 tertiary NICUs in Canada examining the implementation and clinical utility of the PIPP-R e-learning module completed 2 follow-up evaluations at 1 week and 3 months. Participants were asked to view a video recording of an infant undergoing a painful procedure and to assess the infant's pain intensity response using the PIPP-R measure. Immediate and sustained competency was assessed via interrater consensus of participant-reported PIPP-R scores compared with those of an experienced trained coder.

RESULTS

Of the 25 eligible nurses, 22 completed 1-week and 3-month follow-up evaluations. At the 1-week follow-up, 84% of nurses scored the video accurately compared with 50% at 3 months. Behavioral pain indicators were more likely to be scored incorrectly than physiological indicators.

IMPLICATIONS FOR PRACTICE

Follow-up training after completion of the initial e-learning module training may improve competency related to the clinical use of the PIPP-R tool to assess infant pain over time.

IMPLICATIONS FOR RESEARCH

Additional study regarding the need and timing of e-health training to optimize sustained competency in infant pain assessment is warranted.

Nurses' perceptions about a web-based learning intervention concerning supportive family conversations in home health care

Aims and objectives

To describe the perceptions that municipal primary healthcare nurses and municipal registered nurses had about a web‐based learning intervention concerning supportive family health conversations in municipal home health care.

Background

Even though family health conversations are well grounded in theory with several reported benefits for patients and families, most working nurses have little or no training in practising family systems nursing including family health conversations. Continued learning is necessary for nurses, where web‐based learning may be one answer of updating the professional skills and knowledge of nurses regarding supporting families.

Design

The study used a descriptive design and followed the “Consolidated criteria for reporting qualitative research” (COREQ) checklist.

Methods

Twenty‐one nurses participated in an educational intervention that consisted of web‐based learning and two face‐to‐face seminars about family systems nursing including family health conversations. The nurses were interviewed after completion, and the audio‐recorded interviews were transcribed verbatim and analysed using qualitative content analysis.

Results

The findings consist of nurses’ perceptions regarding the disposition of instruction, the prerequisites for learning and a changed approach when working with families. The findings are further reflected on through Illeris’ theory concerning learning triangle.

Conclusions

The findings are encouraging for educating nurses in family health conversations at their workplace, with the purpose of supporting patients and families. However, it is important to be aware of the different dimensions of learning, in addition to the appraisal of social aspects and organisational circumstances when educating nurses as they influence the utilisation of the knowledge.

Relevance to clinical practice

This web‐based learning intervention seems to be suitable for educating nurses in family health conversations and could be an appropriate step towards implementing these conversations in home health care with the purpose of supporting families.

Impact of a multifaceted education program on implementing a pediatric palliative care guideline: a pilot study

BACKGROUND

A national clinical practice guideline for pediatric palliative care was published in 2013. So far there are only few reports available on whether an educational program fosters compliance with such a guideline implementation. We aimed to test the effect of the education program on actual compliance as well as documentation of compliance to the guideline.

METHODS

We performed a prospective study with pre- and post-intervention evaluation on compliance to the guideline of the nurse specialists of a pediatric palliative care team for case management at a children's university hospital. Eleven quality indicators were selected from 192 recommendations from the pediatric palliative care guideline, based on frequency, measurability and relevance. The multifaceted education program included e-learning and an interactive educational meeting. Four e-learning modules addressed 19 patient cases on symptoms, diagnostics and treatment, and a chart-documentation exercise. During the interactive educational meeting patient cases were discussed on how to use the guideline. Documentation of compliance to the guideline in the web-based patient-charts as well as actual compliance to the guideline through weekly web-based parent reports was measured before and after completion of the e-learning.

RESULTS

Eleven quality indicators were selected. The educational program did not result in significant improvement in compliance for any of these indicators. The indicators "treatment of nausea", "pain medications two steps ahead" and "pain medication for 48 h present", measured through parent reports, scored a compliance beyond 80 % before and after e-learning. The remaining indicators measuring compliance, as well as six indicators measuring documentation by chart review, showed a compliance below 80 % before and after e-learning.

CONCLUSIONS

The multifaceted education program did not lead to improvement in documentation of compliance to the guideline. Parent reported outcome revealed better performance and might be the more adequate assessment tool for future studies.

Reframing the Australian nurse teacher competencies: do they reflect the 'REAL' world of nurse teacher practice?

The Australian nurse teacher competencies were introduced in 1996; however, the researchers perceived that changes to the health care system and a nursing workforce shortage may have affected nurse teacher roles over the past decade. This study aimed to explore perceptions of nurse teachers on the applicability of the current Australian nurse teacher competencies to practice, and modify the nurse teacher competencies to better reflect current practice. Methodology utilized mixed methods, and data collection was via focus groups, telephone interviews, and survey data. Results revealed that participants were mostly positive about the original competency statements, although there were some variations between items. Themes that emerged from the qualitative data were: changing trends in health care; preparation for teaching; understanding of the competencies, contextual influences on education role; nurse teachers as change agents, and resource management. Conclusions were that the Australian nurse teacher competencies (1996) were reflective of the current generic roles of nurse teachers however some of the competencies needed reframing to meet the current needs of nurse teachers. However, changes needed to be made in areas such as reducing complex language, inclusion of technology, and cultural competencies. Nurse teachers were supportive of the research because they valued the teacher competencies for reflection on their practice and the development of portfolios, job descriptions and performance appraisals.

Benefits, barriers, and intentions/desires of nurses related to distance learning in rural island communities

BACKGROUND

This study assessed distance learning needs among nurses on the Neighbor Islands in Hawaii.

METHODS

An exploratory study was conducted using a descriptive qualitative design. Of the 37 nurses who completed the study, 7 were nurse administrators and 30 were staff nurses. There were 18 focus groups of nurses recruited from six public hospitals on the Neighbor Islands.

RESULTS

Three major themes related to distance learning emerged in this study: benefits, barriers, and intentions/desires. Each major theme had several linkages to categories and subcategories.

CONCLUSION

Overall findings were as follows: (1) cost was mentioned more often in three major thematic areas (benefit, barriers, and intentions/desires); (2) the need to revisit and address current curriculum approaches and practices in distance learning programs was identified; and (3) strong recommendations were made for programs and organizational support for distance learning in hospital settings. These findings have implications for nursing research, education, and practice.

Modeling clinical applications in intensive care settings for nursing orientation

The nursing shortage continues to influence the health care industry, as hospitals and other agencies invest resources into hiring and training registered nurses to care for patients. Intensive care nurseries and other specialty units have utilized new graduate registered nurses to reach desired staffing ratios. However, traditional nursing school programs do not routinely prepare graduates for positions in such areas. Orientation programs, especially in intensive care settings, will need structured orientation plans to maximize the opportunities for novice nurses to acquire complex skills and develop critical thinking abilities specific to the patient population. This NICU is an 82-bed, regional level III unit that historically hires new graduate nurses. The purpose of this project was to provide a structured orientation program that utilized computer-based instruction, hands-on learning experiences, and adult learning principles to guide new nurses in the development of their professional practice.

The right mix to support electronic medical record training: classroom computer-based training and blended learning

Staff development plays a crucial role in supporting clinicians to adapt to the ever changing technological advances in the healthcare setting. The quest to support staff in the implementation and ongoing optimization of an electronic medical record (EMR) led these staff development educators to computer based training and a blended learning approach building upon the traditional anchor of classroom learning and the advantages of computer-based training.