Does online learning click with rural nurses? A qualitative study

An Innovation in Cancer Nursing Education Across Europe: A Pilot Evaluation

The European Oncology Nursing Society (EONS) is a pan-European not for profit society involving approximately 28,000 cancer nurses from 32 countries in the region. The European College of Cancer Nursing (ECCN) exists under the umbrella of EONS and was established in 2020 with a strategic priority to develop, promote and deliver educational opportunities for nurses across Europe. ECCN introduced a pilot on-line education programme for 20 nurses in January 2023. This study evaluated participating nurses' views and experience of learning on the pilot programme. The study adopted a mixed method approach guided by the four levels of the Kirkpatrick theoretical framework. A dominant focus on qualitative data was used with supplementary quantitative data. The Standards for Reporting Qualitative Research (SRQR) was followed. Eleven nurses completed the pre-pilot online questionnaire (response rate 65%) and seven (n = 7) completed the post-pilot questionnaire (41% response rate). Five (n = 5) nurses participated in two focus group interviews. Data analysis resulted in the development of four overarching themes: A wider world of cancer nursing; Shapeless mentorship; Impact on Practice; Learning online and what now? On commencement of online education programmes, nurses value a structured timetable and support from nursing management to maximise engagement with the learning materials.

Nurses' perspectives, attitudes and experiences related to e-learning: A systematic review

OBJECTIVE

To summarize the current evidence on registered nurses (RNs) perspectives, attitudes and experiences related to e-learning.

DESIGN

A systematic review of the literature.

DATA SOURCES

The CINAHL, PubMed, Embase, the Cochrane Library, Scopus and Web of Science databases were searched for studies published in English from 2000 to 2021.

REVIEW METHODS

The study followed the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Inclusion criteria comprised studies with cross-sectional, quasi-experimental, qualitative, and randomised control designs on the attitudes toward, perspectives and experiences of registered nursing about e-learning. Quality appraisal for each study, based on their designs, was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. Data were synthesized using a narrative approach.

RESULTS

In the 15 included studies, 4 were high quality while 11 were moderate quality. Four themes were revealed in this review including e-learning approaches, facilitators of e-learning and barriers to e-learning barriers to e-learning among RNs and learning in practice barriers.

CONCLUSIONS

The systematic review uncovered that E-learning is an effective method for integrating knowledge with practice and promoting professional development among RNs in healthcare settings. However, RNs may lack motivation to engage with E-learning and face challenges associated with user-friendly platforms.

"It's given me confidence": a pragmatic qualitative evaluation exploring the perceived benefits of online end-of-life education on clinical care

BACKGROUND

Hospital admissions for end-of-life care are increasing exponentially across the world. Significant numbers of health professionals are now required to provide end-of-life care with minimal training. Many health professionals report they lack confidence to provide this care, particularly those in acute hospital settings. This study explored the perceived benefits of online education on health professionals' capacity to provide end-of-life care.

METHODS

This qualitative study adopted a pragmatic approach. Thirty semi-structured interviews were conducted with allied health professionals, nurses and doctors who had completed a minimum of three End-of-Life Essentials online education modules. Interviews were held on line and face-to-face, audio-recorded and transcribed verbatim. Demographic data were also collected. Three major themes and one minor theme were constructed from the data using inductive thematic analysis.

RESULTS

Themes were (1). Perceptions of preparedness to provide end-of-life care, (2). Shifts in approaching end-of-life discussions and (3). Motivation for engagement with online modules. Participants reported validation of knowledge and improved confidence to have end-of-life discussions with patients, carers and team members. They also noted improved ability to recognise the dying process and improved conversations with team members about patient and carer needs. Videos portraying a novice and then more able end-of-life discussions were particularly valued by participants. Modules provided practical guidance on how to engage in discussions about the end of life and care needs. Participants were self-motivated to improve their knowledge and skills to enhance end-of-life care provision. Continuing professional development requirements were also a motivator for module completion.

CONCLUSIONS

This study explored health professionals' perspectives about the perceived benefits of online education modules on their clinical practice. Module completion enhanced participant confidence and self-reported improved competence in end-of-life care provision. Findings build on existing research that supports the valuable role online education plays in supporting confidence and ability to actively engage with patients, carers and colleagues about provision of end-of-life care; however, self-report cannot be used as a proxy for improved clinical competence.

The role of digital technology in providing education, training, continuing professional development and support to the rural health workforce

Purpose

Education, training and continuing professional development are amongst the evidence-based initiatives for attracting and retaining rural and remote health professionals. With rapidly increasing access to and use of digital technology worldwide, there are new opportunities to leverage training and support for those who are working in rural and remote areas. In this paper we determine the key elements associated with the utility of digital technologies to provide education, training, professional learning and support for rural health workforce outside the University and tertiary sector.

Design/methodology/approach

A scoping review of peer-reviewed literature from Australia, Canada, US and New Zealand was conducted in four bibliographic databases – Medline complete, CINAHL, Academic Search complete and Education Complete. Relevant studies published between January 2010 and September 2020 were identified. The Levac et al. (2010) enhanced methodology of the Arksey and O'Malley (2005) framework was used to analyse the literature.

Findings

The literature suggests there is mounting evidence demonstrating the potential for online platforms to address the challenges of rural health professional practice and the tyranny of distance. After analysing 22 publications, seven main themes were found – Knowledge and skills (n = 13), access (n = 10), information technology (n = 7), translation of knowledge into practice (n = 6), empowerment and confidence (n = 5), engagement (n = 5) and the need for support (n = 5). Ongoing evaluation will be critical to explore new opportunities for digital technology to demonstrate enhanced capability and retention of rural health professionals.

Originality/value

To date there has been limited examination of research that addresses the value of digital platforms on continuing professional development, education and support for rural health professionals outside the university and tertiary training sectors.

End-of-Life Care in Acute Hospitals: Practice Change Reported by Health Professionals Following Online Education

Providing quality care for those dying in hospital is challenging for health professionals who receive little training in this. “End of Life Essentials” (EOLE) was developed to address gaps in health professionals’ knowledge, skills and confidence in end-of-life care via the provision of online learning modules and practice resources. This study aimed to determine whether respondents could describe clinical practice change as a result of module completion. Deidentified data were collected between October and November 2018 from learners registered for the online learning modules. Both quantitative and qualitative data were extracted and analysed. The survey design and conduct were reviewed, and ethical approval was obtained. Although the response rate was very low, results from n = 122 learners show improvements in knowledge, skills, awareness and confidence as a result of the undertaking of the learning modules. Two thirds self-reported practice changes (71%, n = 59) following the education, with “communication” cited most commonly (n = 19). The findings suggest that the EOLE education modules can help to improve end-of-life care by increasing health professionals’ awareness of good practice as well as their knowledge, skills and confidence. Online learning has also been reinforced as an appropriate forum for end-of-life education. Following education, implementing what has been learned occurs more easily at a personal level rather than at a team and organisational level. Barriers to and enablers of clinical practice change in hospital are described, including the fact that the organisation may not be responsive to changes or have the relevant resources to support change.

E-learning: who uses it and what difference does it make?

BACKGROUND

CaseSearch 'My Learning' e-learning modules were designed to remind clinicians and practitioners about the role of evidence in practice and demonstrate how to find relevant evidence to make a difference in clinical care. This study aims to describe the role of the modules and their uptake, and determine whether the modules influenced the learners' palliative care practice and whether the modules were easy to use.

METHOD

Two sets of questions were designed to capture data to evaluate the modules.

FINDINGS

The modules supported the awareness and use of evidence by health professionals. The modules contribute to ongoing professional development for practitioners and can improve palliative care practice.

CONCLUSION

It is possible to collect meaningful data that contributes to understanding who uses e-learning resources and how useful healthcare professionals find them.

Translating facilitated multimodal online learning into effective person-centred practice for the person living with dementia among health care staff in Australia: an observational study

BACKGROUND

This paper aims to identify whether health care staff perceive a 12-week online facilitated, multimodal, person-centred care, dementia education program influences their knowledge, skills, behaviour and practice improvement activities in dementia care. In particular it will examine a dementia education program 'Positive Approach to Care of the Older Person with Dementia' (The Program).

METHODS

Three clusters of online questions were developed. Participants completed the first cluster at course completion (N = 1455;2013-2016). The second cluster was added into the 2015-2016 exit-surveys to measure clinical practice improvement (CPI) activities implementation (N = 520). Thirdly, all participants were invited to a 2018 follow-up survey (N = 343). The Program was also matched with key factors that are likely to result in effective online dementia education programs.

RESULTS

The Program had a 78% completion rate. At course completion (2013-2016, N = 1455), 62% felt that the online forums generated useful discussion and 92% thought their work would support implementing their new knowledge and skills. In 2015-16, participants (N = 520) reported that The Program had influenced their practice in terms of new knowledge (87%), understanding (87%), awareness (88%), and new ideas about delivering dementia care (80%). Almost all (95%) participants indicated they had changed 'an aspect of their own professional practice'. Sixty-three percent had planned to develop a CPI activity. Of those (N = 310), 40% developed a new or improved tool and 21% planned to deliver education or create new resources. The most common CPI activities reported in the 2018 follow-up survey (N = 343) included education (49%) and role modelling of new behaviour (47%). Additionally, 75% indicated their CPI influenced their practice and had influenced patients (53%) and colleagues (53%). Fifty-seven percent reported their projects were sustained for 12 months or more.

CONCLUSION

The Positive Approach to Care of the Older Person with Dementia education program can potentially improve training the dementia workforce. Participants perceived that a multimodal online platform facilitated by clinical champions influences knowledge transfer, skills and behaviour, encourages workplace CPI activities. Further effort could be directed towards empowering and supporting care staff on system, procedure and practice change and engaging management to translate training activities into practice.

A Web-Based Dementia Education Program and its Application to an Australian Web-Based Dementia Care Competency and Training Network: Integrative Systematic Review

Background

Dementia education that meets quality and safety standards is paramount to ensure a highly skilled dementia care workforce. Web-based education provides a flexible and cost-effective medium. To be successful, Web-based education must contain features that promote learning and support knowledge translation into practice. The Dementia Care Competency and Training Network (DCC&TN) has developed an innovative Web-based program that promotes improvement of the attitudes, knowledge, skills, behavior, and practice of clinicians, regardless of their work setting, in order to improve the quality of life for people living with dementia.

Objective

This review aims to (1) determine the key features that are associated with an effective and functional Web-based education program—an effective and functional Web-based program is defined as one that measures results, is accessible, is user friendly, and translates into clinical practice—and (2) determine how these features correlate with the DCC&TN.

Methods

Six electronic databases—Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), AusHealth, Nursing@Ovid, and Google Scholar—were searched for articles published between 2009 and 2018 using the following keywords: Education, Distance, Continuing, Learning, Online, Web-Based, Internet, Dementia, Program Evaluation, Validation Studies, Outcome and Process Assessment Healthcare, Nursing, Assisted Instruction, and Facilitated. The Critical Appraisal Skills Programme (CASP) and Kirkpatrick’s model for the evaluation of training were used to ensure quality and rigor of the analysis.

Results

A total of 46 studies met the inclusion criteria. In total, 14 key features were associated with an effective Web-based learning environment, which enabled the environment to be as follows: self-directed, individualized, interactive, multimodal, flexible, accessible, consistent, cost-effective, measurable with respect to participant satisfaction, equitable, facilitated, nurturing of critical thinking and reflection, supportive of creating a learning community, and translated into practice. These features were further categorized into five subgroups: applicability, attractiveness, functionality, learner interaction, and implementation into practice. Literature frequently cites Kirkpatrick’s four-level model of evaluation and application in the review of education and training; however, few studies appeared to integrate all four levels of Kirkpatrick’s model. Features were then correlated against the DCC&TN, with an encouraging connection found between these features and their inclusion within the content and structure of the DCC&TN.

Conclusions

A total of 14 key features were identified that support an effective and functional Web-based learning environment. Few studies incorporated Kirkpatrick’s salient elements of the model—reaction, learning, behavior, and results—in their evaluation and clinical application. It could, therefore, be considered prudent to include Kirkpatrick’s levels of training evaluation within studies of dementia training. There were few studies that evaluated Web-based dementia education programs, with even fewer reporting evidence that Web-based training could increase staff confidence, knowledge, skills, and attitudes toward people with dementia and be sustainable over time. The DCC&TN appeared to contain the majority of key features and is one of the few programs inclusive of hospital, community, and residential care settings. The 14 key features can potentially enhance and complement future development of online training programs for health sciences education and beyond. The DCC&TN model could potentially be used as a template for future developers and evaluators of Web-based dementia training.

Using digital and social media for health promotion: A social marketing approach for addressing co-morbid physical and mental health

OBJECTIVE

This study examines consumer engagement with a social marketing digital media strategy designed to support the implementation of Equally Well-a program to improve the physical health of people living with mental illness.

DESIGN

A four-stage strategic analysis and intervention mix were used as the theoretical framework to assess stakeholder needs and to evaluate the effectiveness of the intervention.

SETTING

Online and digital media.

PARTICIPANTS

Mental health consumers, carers, clinicians and service managers.

INTERVENTIONS

A digital media, social marketing intervention to support those seeking to improve the physical health of people living with mental illness. The strategy was developed using a co-design methodology and provided links to self-care resources, access to service providers, clinical tools for health professionals and links to existing successful rural programs.

MAIN OUTCOME MEASURES

The main outcome measures were the number of people from each category accessing the media, making connections and downloading resources.

RESULTS

The program has resulted in more than 24 500 website hits per annum, 3500 tweets and 14.5 million Twitter impressions with good bounce and download rates. The analysis suggested the materials were mostly used by clinicians and service managers using desktop computers.

CONCLUSIONS

Using a co-design approach, the study demonstrated the potential of a social marketing digital media strategy as a health promotion methodology. The paper has provided a framework for implementing and evaluating the effectiveness of digital social media campaigns that can help consumers, carers, clinicians and service planners address the challenges of rural health service delivery and the tyranny of distance.

The influence of hospital location and 'level of care' on continuing professional development

Healthcare workers core skills are reinforced and knowledge of latest developments ensured by undertaking systematic continuing professional development. The current study explored the impact of health facility location and level of care provided on the continuing professional development offered to maternity services healthcare workers in Victoria, Australia. An online survey of middle to senior management staff of 71 public and private health services as well as 7 professional bodies was conducted, yielding 114 participants. Analysis was by location (metropolitan or regional/rural) and level of care provided. The findings revealed Australian Health Practitioner Regulation Agency registration is the predominant requirement to provide continuing professional development to staff. Dedicated education departments or educators are significantly underrepresented in Level 1&2 facilities, while Level 5&6 facilities are more likely to provide breastfeeding continuing professional development. Metropolitan locations provided more wide-ranging programmes compared with rural/regional locations. Key enablers are the capacity to share resources, have access to external courses and simulation equipment/centres, and the provision of relevant and timely continuing professional development programmes, indicating that 'Educational hubs' with credentialed staff working from better resourced regional facilities could deliver a complete array of CPD programmes to lower level facilities.

Competencies and skill development in maternity care services in Victoria - A qualitative study

In healthcare, continuing professional development is provided to ensure professional standards are maintained and for clinicians to remain fit to practice. The purpose of the study was to identify potential gaps or issues with continuing professional development in maternity services through consultations with key stakeholders and, in addition, to generate possible solutions or recommendations towards the development of a state wide continuing professional development program. The data was collected through semi-structured interviews of a purposive sample between June and August 2018. A thematic analysis was undertaken. Participants included a practicing midwife, allied health practitioner (physiotherapist), manager, healthcare educator, and an outlier service worker (maternal and child health nurse). Following the thematic analysis, four main themes (education, practitioner standards, programme monitoring and resources) were identified along with nine sub-themes. The results suggest organisations need to offer explicit support for staff to access to continuing professional development. In addition, the qualifications of facilitators of continuing professional development and/or consumer education are recommended to go beyond education levels required for registration. In this respect, some organisations credentialed their educators locally in a 'train the trainer' manner however, most participants supported professional preparation for the role of educator.

Increasing rural nurses' awareness of a statewide health information resource: an educational outreach initiative

BACKGROUND

HEALWA is an online library of evidence-based health information resources that are available to Washington state health practitioners. To increase awareness and use of HEALWA among health practitioners in rural areas, the National Network of Libraries of Medicine Pacific Northwest Region and Washington State University Spokane co-funded an outreach librarian position to provide instruction on using HEALWA.

CASE PRESENTATION

After attempts at frequent in-person workshops failed due to lack of attendance, a one-hour-long webinar targeted at rural nurses was developed to be delivered once a month. These webinars introduced participating health professionals to HEALWA, including how to set up their access and how to navigate the resource. To accommodate the busy schedules and different learning styles of the target audience, the workshops occurred both as monthly webinars and in-person, when available, in addition to an online self-guided tutorial. Continuing education credit was obtained through the Washington State Nurses Association, and a partnership with the Washington State Nursing Commission improved promotion of the webinars. Evaluations for both the webinars and workshops have been largely positive.

CONCLUSIONS

The webinar series, coupled with in-person workshops and an online tutorial, reached nurses in rural areas of Washington state to increase awareness of HEALWA. To further facilitate access to HEALWA instruction, a recorded version of the live webinar is in development.

Nurses' Attitudes toward, and Needs for Online Learning: Differences between Rural and Urban Hospitals in Shanghai, East China

Health professionals need continuing education to maintain their qualifications and competency. Online learning increases the accessibility and flexibility of continuing education. Assessment of nurses' attitudes toward, and needs for, online learning can provide suggestions regarding learning program design and delivery. This study aimed to evaluate Chinese nurses' attitudes toward, and needs for, online learning, and to explore the differences in attitudes and needs between nurses working in rural and urban hospitals. This work is a secondary analysis of a multicenter cross-sectional study conducted in Shanghai in 2015 (n = 550). Multiple regression techniques were used to determine the factors associated with nurses' attitudes toward, and needs for, online learning. Results showed that nurses in rural hospitals had more positive attitudes toward online learning (102.7 ± 14.2) than those in urban hospitals (98.3 ± 12.9) (p < 0.001). For rural hospitals, nurses who could use computers and access the internet in their workplace reported more positive attitudes than those who could not. For urban hospitals, nurse educators showed significantly more positive attitudes than others. Communication skills (86.5%) and patient education (86.3%) were the most commonly-reported learning needs for nurses regardless of their working settings. Chinese nurses were willing to adopt online learning as a continuing education method. Nurses working in rural hospitals displayed more positive attitudes toward, and needs for, online learning than those working in urban hospitals. Nursing educators and managers should develop online learning programs and provide appropriate support to fulfill nurses' learning needs, especially for those working in rural healthcare settings.

Evaluation of Online Learning Modules for Improving Physical Activity Counseling Skills, Practices, and Knowledge of Oncology Nurses

PURPOSE/OBJECTIVES

To examine the effectiveness of online learning modules for improving physical activity counseling practices among oncology nurses. 
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DESIGN

Randomized, controlled trial.
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SETTING

Online.
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SAMPLE

54 oncology nurses.
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METHODS

Oncology nurses were randomly assigned to the learning modules group or control group. The learning modules group completed six online learning modules and quizzes focused on physical activity for cancer survivors, general physical activity principles, and motivational interviewing.
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MAIN RESEARCH VARIABLES

Percentage of cancer survivors counseled, self-efficacy for physical activity counseling, knowledge of physical activity, and perceived barriers and benefits of physical activity counseling.
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FINDINGS

Analyses of covariance revealed no significant difference between the learning modules and control groups in the percentage of cancer survivors that oncology nurses counseled. Significant differences were found in self-efficacy for physical activity counseling and perceived barriers to physical activity counseling at postintervention. 
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CONCLUSIONS

The online learning intervention tested in this study improved some parameters of physical activity counseling but did not increase the percentage of cancer survivors that oncology nurses counseled. Additional pilot work is needed to refine the intervention.
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IMPLICATIONS FOR NURSING

This study suggests the potential utility of an evidence-based online learning strategy for oncology nurses that includes information on physical activity and its benefits in cancer survivorship. The findings offer a framework on how to implement physical activity counseling skills in oncology nursing practice.

Evaluating Evidence-Based Practice Knowledge and Beliefs Through the e-Learning EBP Academy

BACKGROUND

This research examined evidence-based practice (EBP) knowledge and beliefs before and after a 3-month e-learning program was implemented to build EBP capacity at a large children's hospital.

METHOD

Ten clinicians completed the development, implementation, and evaluation of the e-learning education, comprising phase one. Revision and participation by 41 clinicians followed in phase two. Participants in both phases completed the EBP Beliefs and Implementation Scales preintervention, postintervention, and 6 months after postintervention.

RESULTS

EBP beliefs and implementation increased immediately and 6 months after postintervention, with statistically significant increases in both phases. Participants in both phases applied knowledge by completing mentor-supported EBP projects.

CONCLUSION

Although EBP beliefs and implementation scores increased and e-learning provided flexibility for clinician participation, challenges arose, resulting in lower-than-expected completion. Subsequent revisions resulted in hybrid education, integrating classroom and e-learning with project mentoring. This funded e-learning research contributes knowledge to the growing specialty of professional development. J Contin Educ Nurs. 2017;48(7):304-311.