An educational intervention for advance directives.

In spite of the passage of the Patient Self-Determination Act in 1991, research indicates that providing information alone has not brought about a significant increase in the completion rates of advance directive (AD) documents. The purpose of this pilot study was to design, implement, and evaluate an interactive multimedia CD-ROM educational program on AD. Study subjects consisted of 31 volunteer elderly men and women in a senior citizens center. An interactive multimedia CD-ROM program was developed in phase I of the study. Subjects were administered on-line pretests and posttests. The effectiveness of the CD-ROM intervention was measured by AD attitude and knowledge changes. A program satisfaction scale was used, and an observer rated the subjects' use of the computer program. Subjects had a statistically significant change in posttest knowledge scores and a high degree of satisfaction and ease in using the computer program. The use of an interactive multimedia CD-ROM program with a touch-sensitive monitor to operate a computer-based AD program for senior citizens shows future promise.     

Audiovisual facilitation of clinical knowledge: a paradigm for dispersed student education based on Paivio's Dual Coding Theory

This article explores the application of Paivio's Dual Coding Theory (DCT) as a scientifically sound rationale for the effects of multimedia learning in programs of nurse anesthesia. We explore and highlight this theory as a practical infrastructure for programs that work with dispersed students (ie, distance education models). Exploring the work of Paivio and others, we are engaged in an ongoing outcome study using audiovisual teaching interventions (SBVTIs) that we have applied to a range of healthcare providers in a quasiexperimental model. The early results of that study are reported in this article. In addition, we have observed powerful and sustained learning in a wide range of healthcare providers with our SBVTIs and suggest that this is likely explained by DCT.     

The impact of interprofessional simulation on readiness for interprofessional learning in health professions students

Healthcare does not occur in a silo and yet healthcare education remains fractured into individual disciplines. This isolated curricular methodology does not represent the intricate interprofessional environment that healthcare providers are required to thrive in post-graduation. Interprofessional Education (IPE) has been identified as a crucial stratagem for creating effective collaborative healthcare teams. The purpose of this research project was to create an interprofessional education (IPE) simulation that represents the current collaborative healthcare practice environment. Medical students, Physicians Assistant's students and Nursing students from different educational institutes participated in a patient simulation using the Situation Background Assessment and Recommendation communication framework (SBAR).The design of this study was a one-group comparative, quasi-experimental, quantitative pilot study. The study employed the Readiness for Interprofessional Learning Scale (RIPLS) in a pre-and-post questionnaire to measure readiness for IPE simulation and student attitudes. Attitude toward collaboration has been found to positively influence care team collaboration, which can positively affect patient outcomes. The sample population (n=45) included the second-year associate degree nursing students, first-year medical students, and first-year physician assistant students. The results of this study indicated that the implementation and participation in an interprofessional communication simulation had a positive effect on readiness and attitudes.     

French healthcare professionals' perceived barriers to and motivation for therapeutic patient education: A qualitative study

Therapeutic patient education is effective for various patient outcomes; however, healthcare professionals sometimes lack the motivation to carry out patient education. Surprisingly, this issue has rarely been addressed in research. Therefore, this study explores healthcare professionals' perceived barriers to and motivation for therapeutic patient education. Healthcare professionals, mainly nurses, working in different French hospitals were interviewed. Thematic content analysis was performed. Findings included a lack of skills, knowledge, and disillusionment of the effectiveness of therapeutic patient education were features of a demotivated attitude. In contrast, a positive attitude was observed when therapeutic patient education met a need to work differently and more effectively. A key factor motivating professionals was the integration of therapeutic patient education in routine care within a multidisciplinary team. To keep healthcare professionals motivated, managers should ensure that therapeutic patient education is implemented in accordance with its core principles: a patient‐centered approach within a trained multidisciplinary team. In the latter case, therapeutic patient education is viewed as an efficient and rewarding way to work with patients, which significantly motivates healthcare professionals.     

Computers in patient education

Nurses in practice have an increasing need to become aware of the computer-based resources available and the evidence regarding their use in the process of patient education. This synthesis of the literature examines research related to computer-based patient education. A particular focus is placed on the nurse clinician's perspective and the role of the nurse as a patient educator in the digital age. Two primary healthcare database resources, MEDLINE and CINAHL, were selected for review of the current literature. A listing of articles related to the use of computer technology in patient education was obtained from both of these databases. The search strategy included exploding the subject heading terms "computer" and "patient education," and included articles from 1971 to 2001. Computer-based patient education is an effective strategy for improving healthcare knowledge and clinical outcomes. Computer-based learning can be tailored to the individual's age and specific learning needs. Furthermore, although access to computer-based resources continues to be a barrier for some, socioeconomic disparities have no reported impact on patients' abilities to use computer-based technologies effectively.     

Computerized training in breast self-examination: a test in a community health center

Fifty-eight women recruited from a community health center completed either a brief interactive multimedia training program on breast self-examination using a breast model and computer guided feedback on accuracy of lump detection or read a National Cancer Institute pamphlet on breast self-examination and breast lumps. Women using the computer program as compared to the pamphlet group reported a higher sense of self-efficacy for being able to perform a breast self-examination immediately after their educational session and 1 month later. However, the increase in self-efficacy for the computer group diminished over 4 weeks, underscoring the importance of an environment that reminds and reinforces learning for women about the performance of regular breast self-examination. The increase in sense of self-efficacy to perform breast self-examination with roughly 20 minutes of computer-based training and the partial maintenance of that self-efficacy 30 days later suggests the utility of incorporating short, focused interventions in busy primary healthcare settings.     

Technology-based vs. traditional instruction. A comparison of two methods for teaching the skill of performing a 12-lead ECG

The purpose of this study was to compare the effectiveness of an interactive, multimedia CD-ROM with traditional methods of teaching the skill of performing a 12-lead ECG. A randomized pre/posttest experimental design was used. Seventy-seven baccalaureate nursing students in a required, senior-level critical-care course at a large midwestern university were recruited for the study. Two teaching methods were compared. The traditional method included a self-study module, a brief lecture and demonstration by an instructor, and hands-on experience using a plastic manikin and a real 12-lead ECG machine in the learning laboratory. The second method covered the same content using an interactive, multimedia CD-ROM embedded with virtual reality and supplemented with a self-study module. There were no significant (p < .05) baseline differences in pretest scores between the two groups and no significant differences by group in cognitive gains, student satisfaction with their learning method, or perception of self-efficacy in performing the skill. Overall results indicated that both groups were satisfied with their instructional method and were similar in their ability to demonstrate the skill correctly on a live, simulated patient. This evaluation study is a beginning step to assess new and potentially more cost-effective teaching methods and their effects on student learning outcomes and behaviors, including the transfer of skill acquisition via a computer simulation to a real patient.     

Videoconferencing and telehealth technologies can provide a reliable approach to remote assessment and teaching without compromising quality

Cardiovascular disease remains a significant chronic healthcare problem in this country, with considerable associated economic and quality-of-life challenges. Along with these challenges, there is high demand for healthcare provider time, particularly in the areas of management of complex healthcare needs and patient education. At the same time, a critical nursing shortage exists. Telehealth technologies provide opportunities to meet the rapidly growing needs of consumers and healthcare practitioners. Many in need of services have limited access to high-end technologies. An argument has been made that the lowest level of technology needed to carry out a task should be used, if it is capable of providing the necessary services. Videoconferencing capabilities allow healthcare practitioners to engage in virtual face-to-face encounters with patients or other healthcare providers. A variety of levels of sophistication in these videoconferencing systems are available. In an effort to evaluate the effectiveness and consumer satisfaction with videoconferencing, 3 pilot studies were conducted to compare face-to-face, low-bandwidth, and high-bandwidth approaches to performing common assessments and patient education activities. In one study, a variety of experienced healthcare practitioners performed functional assessments of stroke subjects using a collection of validated scales by varying approaches (face-to-face, low-bandwidth, and high-bandwidth videoconferencing) in a randomized order. In a second study, undergraduate nursing students performed similar performance measures and taught an unfamiliar individual how to program and use an intravenous pump device, take a tympanic temperature, or to draw up insulin in a syringe. In the third study, advanced practice nursing students assessed vital signs and performed cardiopulmonary assessments on community-dwelling subjects using low-bandwidth and face-to-face approaches. Healthcare practitioners and students generally preferred high-bandwidth approaches over low-bandwidth alternatives when videoconferencing was performed; however, most participants and practitioners were satisfied with the encounters, regardless of the level of technology used.     

Development and test of a model for designing interactive CD-ROMs for teaching nursing skills

The use of interactive multimedia is well documented in the education literature as a medium for learning. Many schools of nursing and healthcare agencies purchase commercially-made CD-ROM products, and, in other cases, educators develop their own. Since nurses are increasingly designing CD-ROMs, they must be aware of the instructional design needed to develop comprehensive and effective CD-ROMs that do not compromise the quality of education. This article describes a process for developing and testing an interactive, multimedia CD-ROM on oral medication administration, using an instructional design model based on Chickering and Gamson's Principles of Good Practices in Education. Results from testing the model are reported. The findings can be used to guide the work of nurse educators who are interested in developing educational software.     

Effectiveness of an educational intervention on vulvo‐vaginal discharge for family healthcare workers: A nonrandomized controlled trial

Women's delay in seeking medical advice for abnormal vaginal discharge can cause serious effects such as infertility, ectopic pregnancy, and advanced cervical cancer. Family healthcare workers are in a unique position to help in the promotion of vaginal health. A nonrandomized controlled trial was conducted among a sample of family healthcare workers in the intervention (n = 37) and a control (n = 37) group to assess the effectiveness of an educational intervention, which was a 2‐day intensive workshop combining reading materials. Data were analyzed using SPSS software (version 20), and the effectiveness of the intervention was determined using a mixed between‐within subjects analysis of variance. The total knowledge and attitude scores were significantly greater for family healthcare workers in the intervention group immediately and at 3 and 6 months after the educational intervention, compared to the control group. A substantial main effect was observed concerning the time, showing an increase in family healthcare workers' knowledge and attitude scores across the four time periods. A statistically significant difference in the median overall health education competency score across the two groups was also observed. The mean score differences in all sub‐competencies in health education were significantly higher among the intervention group, compared to the control group between second postintervention and the baseline. The educational intervention had revealed successful and sustainable improvements in family healthcare workers' knowledge, attitude on vaginal discharge, and health education competency. This can be implemented as an in‐service program for family healthcare workers to improve health education practices.     

A systematic review and meta-analysis of outcomes of interprofessional education for healthcare students from seven countries

AimThis study aimed to analyze the effectiveness of the learning outcomes of the interprofessional education (IPE) model for healthcare students.BackgroundInterprofessional education (IPE) is an important teaching and learning model that involves two or more professions engaging or working together to improve the knowledge of healthcare students. However, the specific outcomes of IPE for healthcare students are unclear as only a few studies have reported them.DesignA meta-analysis was conducted to draw broad conclusions on the impact of IPE on healthcare students’ learning outcomes.MethodsThe CINAHL, Cochrane Library, EMBASE, MEDLINE, PubMed, Web of Science, and Google Scholar databases were searched for relevant articles in the English language. To investigate the effectiveness of IPE, a pooled estimate of knowledge, readiness for and attitude toward interprofessional learning, and interprofessional competence were analyzed using a random effects model. The methodologies of the studies evaluated were assessed using the Cochrane risk-of-bias tool for randomized trials, version 2. Sensitivity analysis was performed to ensure the rigor of the findings. STATA 17 was used to perform the meta-analysis.ResultsEight studies were reviewed. IPE had a significant positive impact on healthcare students’ knowledge (Standardized Mean Difference [SMD]: 0.43; 95% Confidence Interval [CI]: 0.21–0.66). However, its impact on readiness for and attitude toward interprofessional learning and interprofessional competence was nonsignificant and needs further investigation.ConclusionIPE enables students to develop their knowledge of healthcare. This study provides evidence that IPE is a better strategy for enhancing healthcare students’ knowledge than traditional/discipline-specific teaching techniques.     

The Cooperative Care model: an innovative approach to deliver blood and marrow stem cell transplant care

Competition among healthcare institutions, the need to improve outcomes, and the desire to decrease costs have motivated blood and marrow stem cell transplant centers to develop innovative care models. In an effort to meet these challenges, a major midwestern medical center adapted the transplant process to the outpatient setting. This transition created greater educational and care demands for patients and families. To address these demands and provide improved accommodations and amenities for patients and families, the center adopted an innovative model of care, Cooperative Care, for transplant recipients. Cooperative Care embraces patients and families as key members of the healthcare team. A family member serves as a primary caregiver for the patient during the acute inpatient phase of the transplant. Care becomes more personal and individualized, cost is reduced, the rate of rehospitalization potentially is decreased, and patients ultimately become more confident and competent in caring for themselves. The healthcare team shifted its care philosophy to incorporate a care partner, increase patient control and independence, and create greater emphasis on education. Outcomes, including patient satisfaction, have demonstrated success and motivated expansion of this model to other patient populations.     

Patient safety competence for final-year health professional students: Perceptions of effectiveness of an interprofessional education course

As final-year medical and nursing students will soon play key roles in frontline patient care, their preparedness for safe, reliable care provision is of special importance. We assessed patient safety competencies of final-year health profession students, and the effect of a 1-day patient safety education programme on these competencies. A cross-sectional survey was conducted with 233 students in three colleges of medicine, nursing, and traditional medicine in Seoul. A before-and-after study followed to evaluate the effectiveness of the curriculum. Patient safety competency was measured using the Health-Professional Education for Patients Safety Survey (H-PEPSS) and an objective patient safety knowledge test. The mean scores were 3.4 and 1.7 out of 5.0, respectively. The communication domain was rated the highest and the teamwork domain was rated the lowest. H-PEPSS scores significantly differed between the students from three colleges. The 1-day patient safety education curriculum significantly improved H-PEPSS and knowledge test scores. These results indicated that strengthening patient safety competencies, especially teamwork, of students is required in undergraduate healthcare curricula. A 1-day interprofessional patient safety education programme may be a promising strategy. The findings suggest that interprofessional patient safety education needs to be implemented as a core undergraduate course to improve students’ safety competence.     

High-fidelity simulation for continuing education in nurse anesthesia

Simulation represents a true paradigm shift in teaching and learning that has revolutionized healthcare education. However, few continuing education opportunities for anesthesia providers exist using simulation of any type. This article explores the usefulness of high-fidelity simulation (HFS) as a valuable tool for continuing education and reports the results of a needs assessment conducted among 22 practicing nurse anesthetists. The questions related to their exposure to HFS and asked them to rank their experience with 11 anesthesia events. Next, respondents were asked to rank a similar list of anesthesia events that would be useful for continuing education using simulation. Of participants, 71% ranked advanced cardiac life support scenarios, anesthesia machine mishaps, and malignant hyperthermia as highly effective choices for using HFS. Eighty-one percent of participants identified that they envision simulation as a valuable tool to assess competency, but respondents had mixed written responses when asked if simulation should be used for recertification. This needs assessment represents a beginning, grassroots attempt to establish nurse anesthetists' perceptions related to using HFS as a tool for continuing education.     

The effects of computer-assisted instruction on the self-efficacy of baccalaureate nursing students.

As computer-assisted instruction (CAI) use has increased during the past few years, nurse educators have expressed concern regarding its effectiveness. The purpose of this quasiexperimental study was to determine if completion of a computerized simulation about a surgical patient increased baccalaureate nursing students' self-efficacy about caring for surgical patients in the clinical environment. Such an association is desirable because increased levels of self-efficacy have been associated with increased motivation, goal-setting, and achievement. A nonprobability, convenience sample (N = 23) of second-year baccalaureate nursing students was assigned randomly to experimental and control groups. The self-efficacy of the experimental group was measured three times: on an initial pretest; following the intervention of a computer simulation; and after an 8-week clinical rotation. The self-efficacy of the control group was measured on an initial pretest and after the 8-week rotation. Higher preclinical self-efficacy scores (p<.01) of the experimental group support the use of CAI as an important aspect of clinical education. Implications for nursing education, practice, and research are addressed. Computer-assisted instruction (CAI) has been available for several decades; however, its use in nursing education has escalated during the past few years. This intensified interest is the result of a decrease in the cost of computer hardware and an increase in the availability of relevant educational software (Wright, 1995). Cutbacks to educational funding, along with the rising costs of clinical teaching, have motivated studies of this method of nursing education. The purpose of this pilot study was to determine if completion of a supplemental computerized simulation about a surgical patient increased baccalaureate nursing students' self-efficacy about caring for surgical patients in the clinical area. The exploration of a link between CAI and self-efficacy focused on the processes of learning, thereby extending the literature.     

Factors affecting nurses' attitudes toward computers in healthcare

The purpose of the study was to determine factors affecting nurses' attitudes toward computers in healthcare. This cross-sectional study was carried out with nurses employed at one state and one university hospital. The sample of the study included 890 nurses who were selected via a purposive sampling method. Data were collected by using a questionnaire for demographic information and Pretest for Attitudes Toward Computers in Healthcare Assessment Scale v.2. The nurses, in general, had positive attitudes toward computers. Findings of the present study showed a significant difference in attitudes for different categories of age (P < .001), marital status (P < .05), education (P < .001), type of facility (P < .01), job title (P < .001), computer science education (P < .01), computer experience (P < .001), duration of computer use (P < .001), and place of use of computer (P < .001). The results of the present study could be used during planning and implementation of computer training programs for nurses in Turkey and could be utilized in improving the participation of Turkish nurses in initiatives to develop hospital information systems and, above all, in developing computerized patient care planning.     

Understanding healthcare professionals’ self-efficacy to resolve interprofessional conflict

Conflict within interprofessional healthcare teams, when not effectively resolved, has been linked to detrimental consequences; however, effective conflict resolution has been shown to enhance team performance, increase patient safety, and improve patient outcomes. Alarmingly, knowledge of healthcare professionals’ ability to resolve conflict has been limited, largely due to the challenges that arise when researchers attempt to observe a conflict occurring in real time. Research literature has identified three central components that seem to influence healthcare professional’s perceived ability to resolve conflict: communication competence, problem-solving ability, and conflict resolution education and training. The purpose of this study was to investigate the impact of communication competence, problem-solving ability, and conflict resolution education and training on healthcare professionals’ perceived ability to resolve conflicts. This study employed a cross-sectional survey design. Multiple regression analyses demonstrated that two of the three central components—conflict resolution education and training and communication competence—were found to be statistically significant predictors of healthcare professionals’ perceived ability to resolve conflict. Implications include a call to action for clinicians and academicians to recognize the importance of communication competence and conflict resolution education and training as a vital area in interprofessional pre- and post-licensure education and collaborative practice.     

Outcomes of videotape instruction in clinic waiting area

PURPOSE: The purpose of our study was to examine the effectiveness of general health-promotion teaching for patients in the waiting room of a clinic, using focused videotape instruction. DESIGN: An experimental design was used. SAMPLE: Subjects were patients (N = 215) in the waiting rooms of clinics in a university medical center in the Midwest. METHOD: Patients were randomly assigned to two groups: focused videotape instruction in the clinic (n = 106) and control (no instruction in the clinic waiting area) (n = 109). The outcome measures included patient learning about a health education topic and patient satisfaction with overall care, explanations by the provider, and education received during the clinic visit. FINDINGS: There was a significant gain in knowledge for patients who viewed the videotape in the waiting room (t = 5.43, df = 213, p < .0001), and they were more satisfied with their education compared with the control group (t = 4.73, df = 213, p < .0001). IMPLICATIONS: This study supports focused video instruction as an effective and efficient teaching intervention for disseminating health information in the waiting area.     

A concept for a visual computer interface to make error taxonomies useful at the point of primary care

Evidence suggests that the quality of care delivered by the healthcare industry currently falls far short of its capabilities. Whilst most patient safety and quality improvement work to date has focused on inpatient settings, some estimates suggest that outpatient settings are equally important, with up to 200,000 avoidable deaths annually in the United States of America (USA) alone. There is currently a need for improved error reporting and taxonomy systems that are useful at the point of care. This provides an opportunity to harness the benefits of computer visualisation to help structure and illustrate the 'stories' behind errors. In this paper we present a concept for a visual taxonomy of errors, based on visual models of the healthcare system at both macrosystem and microsystem levels (previously published in this journal), and describe how this could be used to create a visual database of errors. In an alphatest in a US context, we were able to code a sample of 20 errors from an existing error database using the visual taxonomy. The approach is designed to capture and disseminate patient safety information in an unambiguous format that is useful to all members of the healthcare team (including the patient) at the point of care as well as at the policy-making level.