Jacqueline Bloomfield

The effect of computer-assisted learning versus conventional teaching methods on the acquisition and retention of handwashing theory and skills in pre-qualification nursing students: A randomised controlled trial

BACKGROUND High quality health care demands a nursing workforce with sound clinical skills. However, the clinical competency of newly qualified nurses continues to stimulate debate about the adequacy of current methods of clinical skills education and emphasises the need for innovative teaching strategies. Despite the increasing use of e-learning within nurse education, evidence to support its use for clinical skills teaching is limited and inconclusive. OBJECTIVES This study tested whether nursing students could learn and retain the theory and skill of handwashing more effectively when taught using computer-assisted learning compared with conventional face-to-face methods. DESIGN The study employed a two group randomised controlled design. The intervention group used an interactive, multimedia, self-directed computer-assisted learning module. The control group was taught by an experienced lecturer in a clinical skills room. Data were collected over a 5-month period between October 2004 and February 2005. Knowledge was tested at four time points and handwashing skills were assessed twice. SETTING AND PARTICIPANTS Two-hundred and forty-two first year nursing students of mixed gender; age; educational background and first language studying at one British university were recruited to the study. Participant attrition increased during the study. RESULTS Knowledge scores increased significantly from baseline in both groups and no significant differences were detected between the scores of the two groups. Skill performance scores were similar in both groups at the 2-week follow-up with significant differences emerging at the 8-week follow-up in favour of the intervention group, however, this finding must be interpreted with caution in light of sample size and attrition rates. CONCLUSION The computer-assisted learning module was an effective strategy for teaching both the theory and practice of handwashing to nursing students and in this study was found to be at least as effective as conventional face-to-face teaching methods.

Using computer assisted learning for clinical skills education in nursing: integrative review

AIM This paper is a report of an integrative review of research investigating computer assisted learning for clinical skills education in nursing, the ways in which it has been studied and the general findings. BACKGROUND Clinical skills are an essential aspect of nursing practice and there is international debate about the most effective ways in which these can be taught. Computer assisted learning has been used as an alternative to conventional teaching methods, and robust research to evaluate its effectiveness is essential. DATA SOURCES The CINAHL, Medline, BNI, PsycInfo and ERIC electronic databases were searched for the period 1997-2006 for research-based papers published in English. Electronic citation tracking and hand searching of reference lists and relevant journals was also undertaken. FINDINGS Twelve studies met the inclusion criteria. An integrative review was conducted and each paper was explored in relation to: design, aims, sample, outcome measures and findings. Many of the study samples were small and there were weaknesses in designs. There is limited empirical evidence addressing the use of computer assisted learning for clinical skills education in nursing. Computer assisted learning has been used to teach a limited range of clinical skills in a variety of settings. CONCLUSION The paucity of evaluative studies indicates the need for more rigorous research to investigate the effect of computer assisted learning for this purpose. Areas that need to be addressed in future studies include: sample size, range of skills, longitudinal follow-up and control of confounding variables.

Clinical skills education for graduate-entry nursing students: Enhancing learning using a multimodal approach

This paper discusses the development of a new clinical skills course at a school of nursing and midwifery in London. The course, part of a two year pre-registration programme for graduates in other disciplines, adopted an innovative multimodal approach. This comprised a range of teaching, learning and assessment strategies designed to maximise comprehensiveness, complementarity and flexibility. The background to the development is discussed and each component is described in detail. A brief summary of relevant feedback generated from anonymous student evaluations is included. This provides important insights into the perceived strengths and weakness of the module from a learner perspective. The paper concludes by identifying proposed future developments and recommending wider applications of the multimodal approach within nursing and healthcare education on an international level.

The development and evaluation of a computer-based resource to assist pre-registration nursing students with their preparation for objective structured clinical examinations (OSCEs)

This paper presents a narrative discussion of an innovative, computer-based resource developed, implemented and evaluated by a small project team at a school of nursing and midwifery in London. The interactive resource was designed to assist first and second year pre-registration nursing students with both their clinical skills revision and formative preparation for Objective Structured Clinical Examinations and involved a small range of clinical skills. These included: skin assessment; hand hygiene; reading a drug prescription chart, weighing a baby and assessment of an intravenous cannulae site. The processes involved in the development of the tool are described and, the key drivers informing its development are identified. Although a formal research approach was not adopted a summary of feedback obtained from anonymous student evaluations is included. This provides important insights into the perceived usefulness of the tool and is discussed in light of the challenges and practicalities associated with the content development and technical issues. The paper concludes by identifying proposed future developments and wider applications of this innovative clinical skills education initiative within nursing and healthcare education.

A transition program to primary health care for new graduate nurses: a strategy towards building a sustainable primary health care nurse workforce?

BackgroundThis debate discusses the potential merits of a New Graduate Nurse Transition to Primary Health Care Program as an untested but potential nursing workforce development and sustainability strategy. Increasingly in Australia, health policy is focusing on the role of general practice and multidisciplinary teams in meeting the service needs of ageing populations in the community. Primary health care nurses who work in general practice are integral members of the multidisciplinary team – but this workforce is ageing and predicted to face increasing shortages in the future. At the same time, Australia is currently experiencing a surplus of and a corresponding lack of employment opportunities for new graduate nurses. This situation is likely to compound workforce shortages in the future. A national nursing workforce plan that addresses supply and demand issues of primary health care nurses is required. Innovative solutions are required to support and retain the current primary health care nursing workforce, whilst building a skilled and sustainable workforce for the future.DiscussionThis debate article discusses the primary health care nursing workforce dilemma currently facing policy makers in Australia and presents an argument for the potential value of a New Graduate Transition to Primary Health Care Program as a workforce development and sustainability strategy. An exploration of factors that may contribute or hinder transition program for new graduates in primary health care implementation is considered.SummaryA graduate transition program to primary health care may play an important role in addressing primary health care workforce shortages in the future. There are, however, a number of factors that need to be simultaneously addressed if a skilled and sustainable workforce for the future is to be realised. The development of a transition program to primary health care should be based on a number of core principles and be subjected to both a summative and cost-effectiveness evaluation involving all key stakeholders.

Care, compassion and communication.

Care, compassion and effective communication are essential elements of nursing, which must be demonstrated by all nurses and nursing students. These requirements form the basis of the first essential skills cluster, which stipulates key skills and behaviours that must be demonstrated to meet the standards for registration with the Nursing and Midwifery Council. This article discusses the core aspects of compassionate care and effective communication and, in doing so, uses examples to demonstrate their use within nursing.

Assisting pre-registration students in the acquisition of clinical skills utilising computer assisted learning

Abstract Practical nursing skills form the bedrock of nursing practice. In line with Government initiatives, practitioners also need to master skills in information technology. In an attempt to address these issues, funding has been awarded for a nursing led multi-professional development of a Clinical Skills Website at the Florence Nightingale School of Nursing & Midwifery at King’s College London. The aim is to provide students with a high quality resource to promote mastery of clinical skills and information technology. It also provides practitioners with easily accessible teaching resources to use in their role as mentors.The following discussion explores the development of this innovative resource as well as the pedagogical underpinning, benefits, challenges and plans for future developments.

Nutrition and fluid management.

Management of fluid intake and nutrition is an essential component of nursing care and should be practised skilfully by all nurses and nursing students. This requirement forms the basis of the fourth essential skills cluster, nutrition and fluid management. The essential skills clusters stipulate key skills and behaviours to be demonstrated to meet the standards for registration with the Nursing and Midwifery Council. This article, the fourth in a series on the essential skills clusters, discusses the core aspects of nutrition and fluid management and emphasises their importance in recovery from illness and in maintaining optimal health.

Infection prevention and control.

All newly registered graduate nurses are required to have the appropriate knowledge and understanding to perform the skills required for patient care, specifically the competencies identified in the Nursing and Midwifery Councils essential skills clusters. This article focuses on the third essential skills cluster - infection prevention and control. It provides an overview and discussion of the key skills and behaviours that must be demonstrated to meet the standards set by the Nursing and Midwifery Council. In doing so, it considers the key principles of infection prevention and control, including local and national policies, standard infection control precautions, risk assessment, standard isolation measures and asepsis.

Organisational aspects of care.

Organisational aspects of care, the second essential skills cluster, identifies the need for registered nurses to systematically assess, plan and provide holistic patient care in accordance with individual needs. Safeguarding, supporting and protecting adults and children in vulnerable situations; leading, co-ordinating and managing care; functioning as an effective and confident member of the multidisciplinary team; and managing risk while maintaining a safe environment for patients and colleagues, are vital aspects of this cluster. This article discusses the roles and responsibilities of the newly registered graduate nurse. Throughout their education, nursing students work towards attaining this knowledge and these skills in preparation for their future roles as nurses.