Using technology to enhance physical therapy students’ problem-solving skills around safe patient handling

Abstract

Background: Physical therapy students are at risk of musculoskeletal injuries during patient handling. Current guidelines recommend a risk management approach to reduce the likelihood of injury associated with patient handling.

Objectives: To determine the benefits of online scenarios using scenario-based learning interactive (SBLi^®) to enhance students’ confidence in making decisions around patient handling techniques, including equipment, and in practical patient handling skills.

Methods: Third year undergraduate and first year graduate-entry masters (GEM) students from the 2011 cohort of the physical therapy program at The University of Queensland received comprehensive training in patient handling. Only GEM students completed two SBLi patient scenarios. Students’ confidence in selecting patient handling techniques and equipment was assessed pre- and post-training with three statements scored on a 10-cm visual analogue scale anchored from strongly disagree to strongly agree. Patient handling skills were assessed with a practical skill assessment. Student satisfaction with SBLi as a learning platform was determined with three items and a focus group with eight students.

Results: Students’ confidence in performing a patient risk assessment and selecting appropriate patient handling technique and equipment improved with training. However, the online scenarios provided no additional advantage to the GEM students’ confidence in these tasks or in the practical skill assessment. GEM students were moderately satisfied with SBLi as a learning platform, reporting that it assisted their clinical preparation for the clinical environment and increased their awareness for safety of themselves and others.

Conclusions: The online interactive scenarios provided no additional benefit but may assist student preparation for the clinical environment.     

Assessment of student competency in a simulated speech-language pathology clinical placement

Abstract

Clinical education programs in speech-language pathology enable the transition of students’ knowledge and skills from the classroom to the workplace. Simulated clinical learning experiences provide an opportunity to address the competency development of novice students. This study reports on the validation of an assessment tool designed to evaluate speech-language pathology students’ performance in a simulated clinical placement. The Assessment of Foundation Clinical Skills (AFCS) was designed to link to concepts and content of COMPASS^®: Competency Assessment in Speech Pathology, a validated assessment of performance in the workplace. It incorporates units and elements of competency relevant to the placement. The validity of the AFCS was statistically investigated using Rasch analysis. Participants were 18 clinical educators and 130 speech-language pathology students undertaking the placement. Preliminary results support the validity of the AFCS as an assessment of foundation clinical skills of students in this simulated clinical placement. All units of competency and the majority of elements were relevant and representative of these skills. The use of a visual analogue scale which included a pre-Novice level to rate students’ performance on units of competency was supported. This research provides guidance for development of quality assessments of performance in simulated placements.     

Applying Mezirow's Transformative Learning Theory into nursing and health professional education programs: A scoping review

IntroductionTransformative learning exposes students to situations where they can transform their perspective, question beliefs, and become effective learners.MethodsA scoping review was conducted guided by an established methodology. A search of six electronic databases was undertaken up to October 2021: 1) Academic Search Complete; 2) CINAHL; 3) Education Research Complete; 4) ERIC; 5) ProQuest Central; and 6) SCOPUS. Forward and backward searches of included studies were also performed.ResultsFive studies used Mezirow's theory to underpin educational program development or implementation, and seven used this theory to evaluate learning transformation following program completion. Although a range of learning and teaching strategies were used, group learning to promote student collaboration was used in seven studies. Nine studies reported learning transformation, however, the assessment of this outcome varied.DiscussionThe findings of this review highlight variability in the use of this theory across educational programs, underscoring the need to embed Mezirow's Transformative Learning Theory across all phases of educational program development, implementation, and evaluation. This review has also highlighted the need for the development of a tool to measure transformation due to variability in the way it was reported in the literature.     

Increasing Intent to Vaccinate for Seasonal Influenza

ABSTRACT

Background: The community college student is not currently armed with the resources or prevention information regarding influenza. Less than twenty percent of the college population receives influenza immunization annually.

Purpose: The purpose of the project was to evaluate if an evidenced-based influenza and vaccine education intervention will affect nursing students’ intent to vaccinate for influenza by increasing knowledge of the influenza vaccine using Zingg and Siegrist’s Knowledge Scale.

Methods: Participants were recruited voluntarily from their attendance at orientation for incoming nursing students on a specific date and time. Utilizing a computer survey, all seventy-seven participants completed an online pretest before an educational intervention, and then, the results were compared following the educational intervention with a posttest. Parametric tests such as a paired t-test, Pearson’s correlation coefficient, one-way analysis of variance (ANOVA), and percent change were utilized to determine whether an educational intervention was effective in improving influenza knowledge and whether there was a change in vaccination intention.

Outcomes and Results: The educational intervention in this project resulted in enhancement of influenza knowledge. The implications of this project demonstrated the value of providing an educational intervention to improve knowledge, intent, and willingness to vaccinate for influenza for nursing students at a community college.     

Evaluation of the symptom-focused health assessment and empathy program for undergraduate nursing students: A randomized controlled trial

BackgroundHealth assessments are a vital competency required of nurses. The more traditional ways of teaching and learning this skill require practice and are often limited by time constraints. With the rise of technology-based platforms, students can supplement their learning health assessment skills through other means, such as videos, that not only teach the steps but also allow them to learn in context.ObjectivesThis study describes how a symptom-focused health assessment and empathy (SHAE) program, which primarily involves the use of a case-based health assessment video, was implemented and evaluated.DesignThe study involved a single-centre, single-blind, parallel randomized controlled trial.SettingsThe study was conducted at a university in Singapore.ParticipantsYear one undergraduate nursing students enrolled in the Comprehensive Health Assessment (CHA) module during semester two of the academic year 2018/2019 participated in the study.MethodsParticipants were randomized into one of the two parallel groups: the experimental group or the waitlisted control (WL) group. The experimental group received the SHAE program in addition to conventional learning methods (e-lectures, lab demonstration, and pair practice). The WL group received only the conventional learning methods. Pre- and post-test measures of the study variables such as knowledge, health assessment skills, confidence, empathy, and intention to learn were conducted. The WL group was given access to the SHAE program after the post-test. Analyses of covariance (ANCOVA) were used to compare the means of the study variables between the intervention and WL groups.ResultsParticipants in the intervention group had significantly higher scores on knowledge (p = 0.016), confidence (p = 0.03), and health assessment skills (p = 0.004). No significant differences in intention to learn and empathy between the two groups were found.ConclusionThe use of a case-based video has the potential to be a valuable method of teaching health assessments in context to nursing students. The SHAE program has shown beneficial effects on students' knowledge, health assessment skills, and confidence. However, there was no effect on students' intentions to learn and their empathy. Further refinements of the program will need to focus on improving these domains.     

Effects of a multifaceted neurological assessment educational program in nursing students: A randomized crossover study

AimThis study aimed to verify the effects of a multifaceted neurological assessment educational program on neurological assessment-related knowledge, skills, communication ability and self-efficacy in nursing students.BackgroundNurses should be equipped with optimal neurological assessment competency to ensure quality care for patients with neurological symptoms.DesignThis study involved a waitlist control group with a randomized crossover design.MethodsFourth-year nursing students were randomly assigned to an intervention group (n = 28) or a waitlist control group (n = 27). Pre- and post-intervention differences in neurological assessment knowledge, skills, communication ability and self-efficacy between the intervention and the waitlist control group were analyzed using generalized estimated equations.ResultsThe nursing students in the intervention group showed significantly improved knowledge, skills, communication ability and self-efficacy scores compared with those in the waitlist control group. Scores related to knowledge, skills and communication ability were maintained and self-efficacy scores had further increased at 2 weeks after the educational program in the intervention group.ConclusionsOur multifaceted neurological assessment educational program is useful for improving nursing students' knowledge, skills, communication ability and self-efficacy.     

A framework to facilitate self-directed learning,assessment and supervision in midwifery practice: A qualitative study of supervisors’ perceptions

BackgroundSelf-directed learning is an educational concept that has received increasing attention. The recent workplace literature, however, reports problems with the facilitation of self-directed learning in clinical practice. We developed the Midwifery Assessment and Feedback Instrument (MAFI) as a framework to facilitate self-directed learning. In the present study, we sought clinical supervisors’ perceptions of the usefulness of MAFI.MethodsInterviews with fifteen clinical supervisors were audio taped, transcribed verbatim and analysed thematically using Atlas-Ti software for qualitative data analysis.ResultsFour themes emerged from the analysis. (1) The competency-based educational structure promotes the setting of realistic learning outcomes and a focus on competency development, (2) instructing students to write reflections facilitates student-centred supervision, (3) creating a feedback culture is necessary to achieve continuity in supervision and (4) integrating feedback and assessment might facilitate competency development under the condition that evidence is discussed during assessment meetings. Supervisors stressed the need for direct observation, and instruction how to facilitate a self-directed learning process.ConclusionThe MAFI appears to be a useful framework to promote self-directed learning in clinical practice. The effect can be advanced by creating a feedback and assessment culture where learners and supervisors share the responsibility for developing self-directed learning.     

Making learning relevant by using e-portfolios as an assessment method in Radiography: Educator perspective

IntroductionAssessment in education is an expectation, however, traditional assessment methods of written tests and assignments are not the only approach to assess students and meet subject or module outcomes. There are numerous alternative assessment techniques that can be incorporated into a radiography program. The use of e-portfolios allow students to take learning beyond the classroom and gives them the chance to learn a new skill that they can use even after obtaining their qualifications. To my knowledge, currently there are no published resources available on using e-portfolios in radiography education within a South African context to assess a specific module outcome. This paper aims to address this gap in literature by providing insight into the application of e-portfolios in Radiography education.MethodKotter's 8 step change model was used to implement change to the assessment method for a final year Radiographic Management subject.ResultsThis is based on my personal perspective, and thus there is no primary data presented. This article outlines my rationale for and my personal experiences from using e-portfolios.Discussion and conclusionFrom my perspective this method has proven very useful for the teaching and learning of radiographic management with 4th year students.     

“All Stars” for at-risk middle school students in an afterschool setting: a pilot program

Abstract

Introduction: The evidenced-based program, All Stars, usually conducted in the in-school setting and taught by classroom teachers; was implemented in an afterschool setting for at-risk middle school students by local university student volunteers. The classroom-based program was moved to the after-school setting in this study in order to target the most at-risk students, and university student volunteers served as instructors to decrease program costs.

Methods: Middle school students enrolled in an afterschool program for the most academically and socially at-risk participated in an evidence-based substance abuse prevention program and study as a part of their overall afterschool curriculum. The Pre-Post Post All Stars Student Survey was used as the data collection instrument and included 45 demographic, behavior, and core mediator Likert-scale questions. A series of paired samples t-tests were used to assess pre-post differences in the following: Commitment to Avoid Risky Behaviors, Normative Beliefs, and Lifestyle Incongruence.

Results: At the conclusion of the program, participants’ lifestyle incongruence about substance abuse improved significantly, their commitment to avoid risky behaviors improved, but their normative beliefs decreased.

Discussion/conclusion: For those youth at high-risk, providing the program in the afterschool setting and using non-classroom teachers as instructors does seem to have potential for successful program delivery.     

Local Anesthetic Systemic Toxicity (LAST): Increasing Awareness Through Education

PurposeLocal anesthetics are used for procedures in various settings. Although complications related to local anesthetic use is rare, adverse events do occur. A significant knowledge deficit was identified regarding local anesthetic systemic toxicity (LAST) signs, symptoms, and treatment.DesignA learning needs assessment was performed at a local hospital to determine the nurses' baseline knowledge of LAST signs, symptoms, and treatment.MethodsA self-paced web-based learning module was developed and completed by clinical nurses with an immediate post survey and 6-month follow-up survey.FindingsThe repeat learning needs assessment immediately after education resulted in more than 50% improvement in nurses' knowledge of LAST. A 6-month follow-up survey indicated that the gain in knowledge, signs, symptoms, and treatment of LAST was maintained.ConclusionsAn educational gap was identified regarding clinical nurses' knowledge of LAST. An educational program was designed to improve baseline knowledge. The program goal was successfully met with more than half of nurses being able to identify signs, symptoms, and treatment of LAST.     

Problem-based learning in occupational therapy curriculum – implications and challenges

Purpose: Problem-based learning (PBL) is an educational method that fosters self-directed study in small groups. The purpose of this study was to describe the Tel Aviv University’s occupational therapy (OT) program and the challenges implementing such program. In addition, the study compared the PBL grades obtained by students who are native Hebrew speakers with those students who are native Arabic speakers; and, assessed the correlation between the grades in the PBL course and the grades in the clinical fieldwork studies.

Method: 166-second year OT undergraduate students participated. All completed three PBL courses and seven weeks of clinical fieldwork studies. Data collection included students’ grades in PBL course (based on PBL evaluation forms) and in clinical fieldwork studies (based on preceptor’s evaluation and a written assignment).

Results: Pearson correlations revealed significant correlations between PBL grades and clinical fieldwork studies grades. T-test analysis between students who are native Hebrew speakers and those who are native Arabic speakers revealed significant differences in PBL grades.

Conclusions: Findings imply partial congruence between students’ grades in the PBL course and their achievements in the fieldwork studies. Findings might suggest that adjustments should be made in order to assist students from minorities (challenged by language requirements) in gaining higher grades in the PBL program.

• Implications for Rehabilitation

• Problem-Based Learning (PBL) is an educational method, which fosters independent, self-directed study in small groups.

• PBL studies have the potential to prepare students for their clinical experience during studies.

• The PBL program should be adjusted for students from minorities (challenged by language requirements and different cultural backgrounds) in order to assist them in gaining more benefits from the program.

     

The paradox of an expected level: The assessment of nursing students during clinical practice – A qualitative study

AimThe aim of this study is to increase knowledge about the assessment of nursing students’ clinical practice, particularly concerning how teachers and clinical supervisors identify and assess the expected level of competence in mid-term evaluations and students, teachers and supervisors’ experiences of mid-term assessment. Assessment is important to assure the quality of students’ clinical competence and studies show that further research on this topic is required.DesignThis study has an explorative qualitative design.MethodsThirty semi-structured interviews were conducted with nursing students, teachers and clinical supervisors along with 16 observations of mid-term assessments during clinical practice, as part of a bachelor’s programme in nursing.ResultsTwo main challenges concerning establishing an expected level of competence were identified from the analysis of the interviews and observations: 1) a general formulation of learning outcomes and 2) vague expectations of what is the expected level of achievements at different points in time. Both challenges were at institutional level. Furthermore, at performance level, certain patterns were identified related to these challenges, such as teachers and supervisors needing to concretise the general formulation of learning outcomes and their discretion to set the expected level. Additionally, non-verbal language during mid-term assessment seemed to affect how the assessment situation was perceived.ConclusionWe suggest that the institutional guidelines need to be critically reviewed to include greater focus on clarifying what students are expected to achieve, as well as what constitutes the expected level. We have emphasised that discretion is a necessary premise to identify an expected level of clinical competence at mid-term assessment, in particular when there is lack of a clear standard and the assessment form is vague, but also when there is no clear definition of the expected level of competence at different points in time. The consequences are that the student feel insecure about how the assessment ought to be perceived, what level they are at in their learning process, and subsequently, their level in the process of developing necessary clinical competence.     

Factors in the clinical learning environment that influence caring behaviors of undergraduate nursing students: An integrative review

AimThe aim is to explore literature on the influence of the clinical learning environment on caring behaviors of undergraduate nursing students.BackgroundCaring is a fundamental aspect of nursing practice. However, factors of and in clinical learning environment that help shape the caring behaviors of nursing students as part of their education journey remain understudied.DesignA modified version of Cooper’s five-stage integrative review method was used.MethodsFour databases (Cumulative Index of Nursing and Allied Health, PubMed, Scopus and Embase) were searched for research studies published from 2011 to 2021 in peer reviewed journals, written in English and addressing caring behaviors among nursing students in the clinical learning environment. A combination of keywords with Boolean operators was used including: “nursing students OR nursing undergraduates OR student nurses” and “clinical learning environment” AND “caring behaviors”. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines.ResultsEmpirical evidence was drawn from 11 studies including seven qualitative designs, three quantitative designs and one mixed method design. The results of this review suggest that factors in the clinical learning environment influence nursing students’ ability to develop caring behaviors. Specifically, the five themes of: [1] role modeling of clinical faculty and professional nurses, [2] creating a conducive clinical learning environment, [3] effective communication skills, [4] positive effect of simulation and [5] alternative clinical placements may facilitate the development of caring behaviors among nursing students.ConclusionThe findings highlight the factors in the clinical learning environment that influence nursing students’ caring behaviors. Improving students’ clinical learning experiences and implementing more effective role modeling and teaching strategies may advance their caring abilities. The information generated from this review provides evidence on how to enhance the clinical learning environment to develop students’ caring behaviors, subsequently leading to more optimal patient outcomes.     

Erognomic education on housework for women with upper limb repetitive strain injury (RSI): a conceptual representation of therapists’ clinical reasoning

Abstract

Background: Ergonomic education in housework that aims to facilitate behavior change is important for women with upper limb repetitive strain injury. Therapists usually conduct such programs based on implicit reasoning. Making this reasoning explicit is important in contributing to the profession’s knowledge.

Aim: To construct a conceptual representation of how occupational therapists make clinical decisions for such program.

Method: Based on a constructivist-grounded theory methodology, data were collected through in-depth interviewing with 14 occupational therapists from a major hospital in Singapore. Interviews were audiotaped and transcribed. Data was analyzed with line by line, focused and axial coding with constant data comparison throughout data collection.

Results: Therapists made clinical decisions based on their perceptions of their clients’ behavior change in three stages: (i) listen; (ii) try; and (iii) persevere, bearing significant similarities to the transtheoretical theory of change. The study also showed that therapists may not have considered the full range of meanings that their clients attach to housework when interacting with them, a gap that needs to be addressed.

Conclusions: The present study indicates the importance of therapists’ understanding of the meanings that their clients attach to housework. Further research needs to address how to achieve this in a time-pressured clinical environment.

• Implications for Rehabilitation

• This study used qualitative research to demonstrate the process of translating therapists’ tacit knowledge into an explicit form. It elucidates the following major implications for practice when therapists conduct ergonomic education to facilitate behavior change in housework for female homemakers with upper limb RSI:The conceptual framework of clinical reasoning constructed from the results can be used to increase therapists’ awareness of how they make clinical decisions during an intervention. This framework can also be used for training new therapists.

• It is important for therapists to actively listen to their clients. Active listening will enable the therapists to understand and consider the personal meanings that these women attach to housework in order to facilitate a behavior change.

• Client–therapist interactions to facilitate clients’ willingness to change should become a major focus in such a program.

• Similar research should be conducted in other clinical areas to develop explicit clinical reasoning frameworks to facilitate learning of novice therapists and reflection of experienced therapists to address any gap in their clinical reasoning.