1
|
Pan JD, Ho KY, Liu HL, Huang JY, Zhang XL, Zeng QM, Lam KKW, Liu Q, Lin KL, Xu WT, Mao T, Wang Y, Ling DL. Implementation and effectiveness of a nurse navigation programme based on noddings' care theory in first-year undergraduate nursing students for professional identity and career planning: A quasi-experimental study. Nurse Educ Pract 2024; 75:103900. [PMID: 38277802 DOI: 10.1016/j.nepr.2024.103900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/28/2024]
Abstract
AIMS Development and evaluation of the effectiveness of a Nurse Navigation programme based on Noddings' Care theory on two dependent variables which were professional identity and career planning among first-year undergraduate nursing students. BACKGROUND First-year undergraduate nursing students generally have a low sense of professional identity and career planning, resulting in a loss of nursing power after graduation. Implemention of a Nurse Navigation program based on Noddings' Care theory may be potentially useful in cultivating their professional identity and career planning. DESIGN A quasi-experimental study. METHODS A convenience sample of 122 first-year undergraduate nursing students from two medical universities was recruited between September 2021 and June 2022. Students in the experimental group (n = 63) participated in the Nurse Navigation programme based on Noddings' Care theory, which contained four core components, spreading over 50 lessons. Those in the control group (n = 59) underwent a traditional training programme with five components across 44 lessons. The two groups were compared in terms of their level of professional identity by Professional identity questionnaire for nurse students (PIQNS) and career planning by Career planning questionnaire (CPQ) after the training using the t-test. RESULTS The mean score of professional identity in the experimental group increased significantly from 51.02 ± 8.46 at baseline to 58.02 ± 8.81 after the intervention (p < 0.001), with a large effect size (Cohen's d=0.810). Also, this post-intervention score was statistically significantly higher than that (52.86 ± 9.27) in the control group (p = 0.002), with a medium effect size (Cohen's d=0.571). The mean score of career planning in the experimental group increased significantly from 81.76 ± 9.86 at baseline to 94.52 ± 10.81 after the intervention (p < 0.001), with a large effect size (Cohen's d = 1.233). Also, this post-intervention score was statistically significantly higher than that (88.25 ± 9.30) in the control group (p < 0.001), with a medium effect size (Cohen's d=0.623). CONCLUSIONS The Nurse Navigation programme based on Noddings' Care theory showed effectiveness in enhancing professional identity and career planning among first-year undergraduate nursing students in China. Further rigorous studies are needed to examine its effectiveness and long-term impacts on these students.
Collapse
Affiliation(s)
- Jing-Da Pan
- Nursing Administration Department, the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou, Guangdong Province, China; School of Nursing, The Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Ka Yan Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Hong-Li Liu
- Pulmonary and Critical Care Medicine Department, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou,Guangdong Province, China
| | - Jing-Yi Huang
- Nursing Administration Department, the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou, Guangdong Province, China; School of Nursing, The Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Xue-Ling Zhang
- Obstetrics department, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Qiao-Miao Zeng
- Department of Nursing Education and Research, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | | | - Qi Liu
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ke-Lan Lin
- Nursing Administration Department, the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou, Guangdong Province, China; School of Nursing, The Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Wen-Ting Xu
- Nursing Administration Department, the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou, Guangdong Province, China; School of Nursing, The Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Ting Mao
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yuan Wang
- School of Nursing, The Guangzhou Medical University, Guangzhou, Guangdong Province, China.
| | - Dong-Lan Ling
- Nursing Administration Department, the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou, Guangdong Province, China.
| |
Collapse
|
2
|
Simes T, Cutmore E, Le Lagadec D, Bell T, Bradshaw J, Wirihana L. Preparing nursing students for clinical placement using synchronous role-play telesimulation: A descriptive survey study. NURSE EDUCATION TODAY 2024; 132:106012. [PMID: 37956568 DOI: 10.1016/j.nedt.2023.106012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Contemporary teaching modalities in nurse education include teaching clinical skills via telesimulation. The effectiveness of this modality has not been evaluated. OBJECTIVE To evaluate undergraduate nursing students' and clinical facilitators' perceptions of student preparedness for placement when clinical skills are taught via role-play telesimulation using home equipment packs. DESIGN A descriptive survey study was employed to measure and explore perceptions using Likert scales and open-structured questions delivered via an anonymous online survey. SETTING Clinical placement after undertaking preparation via role-play telesimulation for students at an Australian university. PARTICIPANTS Data were collected from 180 undergraduate nursing students and 22 clinical facilitators. METHODS Quantitative data were analysed using statistical analysis software, SPPS. Open ended responses to survey questions were analysed through the application of Elo and Kyngas (2008) three phases of content analysis. RESULTS Seventy-eight percent of students felt prepared for placement, and 86 % of clinical facilitators believed that students were adequately prepared. Three major categories were identified from students' responses: sense of community, learning logistics, and sense of comfort. Three categories emerged from clinical facilitators' responses: nervous and anxious, confidence and preparedness. CONCLUSIONS Findings from this study suggest that role-play telesimulation with home equipment packs is a viable, achievable, sustainable and effective modality for teaching hands-on practical skills to prepare undergraduate nursing students for industry placement.
Collapse
Affiliation(s)
- Tracey Simes
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, 160 Ann Street, Brisbane, Queensland 4000, Australia.
| | - Ellie Cutmore
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, 160 Ann Street, Brisbane, Queensland 4000, Australia.
| | - Danielle Le Lagadec
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, 6 University Drive, Bundaberg, Queensland 4670, Australia.
| | - Tracey Bell
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, 160 Ann Street, Brisbane, Queensland 4000, Australia.
| | - Julie Bradshaw
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Building 18, Bruce Highway, North Rockhampton, Queensland 4702, Australia.
| | - Lisa Wirihana
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Building 18, Bruce Highway, North Rockhampton, Queensland 4702, Australia.
| |
Collapse
|
3
|
Henrich D, Glombiewski JA, Scholten S. Systematic review of training in cognitive-behavioral therapy: Summarizing effects, costs and techniques. Clin Psychol Rev 2023; 101:102266. [PMID: 36963208 DOI: 10.1016/j.cpr.2023.102266] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/09/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023]
Abstract
With the steadily growing importance of psychotherapeutic care, there is also an increasing need for high-quality training. We analyze the literature published between 2009 and 2022 on the effectiveness of training in cognitive behavioral therapy. The review addresses current gaps in the literature by focusing on the description of specific training components and their associated costs, as well as examining therapist-level predictors of training effectiveness. Our findings confirm the effect of additional supervision on both therapist competence and patient outcomes. Instructor-led training and self-guided web-based training seem to moderately increase competence, especially when targeting specific and highly structured treatments or skills. The level of prior training and experience of a therapist appears to predict the strength of training-related gains in competence. Few studies analyzed the differential effect of certain elements of training (e.g., the amount of active learning strategies) and training costs were generally not reported. Future studies should replicate or expand the existing evidence on active ingredients and therapist-level predictors of training effectiveness. Costs should be systematically reported to enhance the comparability of different training strategies.
Collapse
Affiliation(s)
- Dominik Henrich
- Department of Clinical Psychology and Psychotherapy, RPTU Kaiserslautern-Landau, Germany.
| | - Julia A Glombiewski
- Department of Clinical Psychology and Psychotherapy, RPTU Kaiserslautern-Landau, Germany
| | - Saskia Scholten
- Department of Clinical Psychology and Psychotherapy, RPTU Kaiserslautern-Landau, Germany
| |
Collapse
|
4
|
The effects of an exposure therapy training program for pre-professionals in an intensive exposure-based summer camp. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Although exposure therapy (ET) is an effective treatment for anxiety disorders and obsessive-compulsive disorder, many clinicians report not utilizing it. The present study targeted common utilization barriers by evaluating an intensive ET training experience in a relatively inexperienced sample of pre-professionals. Thirty-two individuals at the undergraduate or college graduate level without formal clinical experience participated as camp counsellors in a 5day exposure-based therapeutic summer camp for youth with anxiety disorders and/or obsessive-compulsive disorder. Participants were trained in ET through a progressive cascading model and answered questionnaires before and after camp. Repeated measure MANOVA revealed significantly increased feelings of self-efficacy conducting exposures, and significantly decreased feelings of disgust sensitivity and contamination-related disgust from pre-camp to post-camp. A subset of individuals providing data 1 month after the camp maintained a significant gain in ET self-efficacy. Regression analyses revealed that contamination-related disgust, but not disgust sensitivity, significantly predicted post-camp ET self-efficacy. These findings suggest that individuals early into their post-secondary education can learn ET, and the progressive cascading model holds promise in its utility across experience levels and warrants further investigation. Disgust may also play a role in feelings of competency conducting ET. Implications on dissemination and implementation efforts are also discussed.
Key learning aims
(1)
How can training of CBT techniques such as exposure occur prior to graduate education?
(2)
Can self-efficacy in conducting exposures meaningfully increase in an experiential training of pre-professionals?
(3)
How does an individual’s tolerance of disgust impact feelings of competence conducting exposures?
Collapse
|
5
|
Kabir H, Tonmon TT, Hasan MK, Biswas L, Chowdhury MAH, Islam MD, Rahman M, Mitra DK. Association between preference and e-learning readiness among the Bangladeshi female nursing students in the COVID-19 pandemic: a cross-sectional study. BULLETIN OF THE NATIONAL RESEARCH CENTRE 2022; 46:8. [PMID: 35039742 PMCID: PMC8755973 DOI: 10.1186/s42269-022-00697-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/31/2021] [Indexed: 05/14/2023]
Abstract
BACKGROUND The COVID-19 pandemic jeopardized the traditional academic learning calendars due to the closing of all educational institutions across the globe. To keep up with the flow of learning, most of the educational institutions shifted toward e-learning. However, the students' e-learning preference and e-learning readiness did not identify, particularly among the Bangladeshi female nursing students, where those can pose serious challenges. A cross-sectional study was carried out among the female nursing students between December 26, 2020, and January 11, 2021. A total of 237 students were recruited who have enrolled in e-learning at least the last 30 days of the participation. Multivariable linear regression models were fitted to find the association of students' preference, e-learning readiness domains, and other variables. RESULTS A cross-sectional study was conducted among the female nursing students to assess perceived e-learning readiness in the subdomains of readiness; availability, technology use, self-confidence, acceptance and training. The findings of the study revealed that the prevalence of preference for e-learning was 43.46%. The students did not prefer e-learning compared to 'prefer group' has significantly less availability of technology (β = - 3.01, 95% CI - 4.46, - 1.56), less use of technology (β = - 3.08, 95% CI - 5.11, - 1.06), less self-confidence (β = - 4.50, 95% CI - 7.02, - 1.98), less acceptance (β = - 5.96, 95% CI - 7.76, - 4.16) and less training need (β = - 1.86, 95% CI - 2.67, - 1.06). The age, degree, residence, parents' highest education, having a single room, and having any eye problems were significantly associated with the variation of availability of technology, use of technology, self-confidence, acceptance, and training need of e-learning. CONCLUSIONS The outcomes of the study could be helpful while developing an effective and productive e-learning infrastructure regarding the preparedness of nursing colleges for the continuation of academia in any adverse circumstances like the COVID-19 pandemic.
Collapse
Affiliation(s)
- Humayun Kabir
- Department of Public Health, North South University, Plot 15, Block B, Bashundhara, Dhaka, 1229 Bangladesh
| | - Tajrin Tahrin Tonmon
- Department of Public Health, North South University, Plot 15, Block B, Bashundhara, Dhaka, 1229 Bangladesh
| | - Md. Kamrul Hasan
- Department of Public Health, North South University, Plot 15, Block B, Bashundhara, Dhaka, 1229 Bangladesh
| | - Lila Biswas
- CRP Nursing College, Savar, Dhaka, 1343 Bangladesh
| | | | - Muhammad Didarul Islam
- Department of Gerontology and Geriatric Welfare, University of Dhaka, Dhaka, 1000 Bangladesh
| | - Mamunur Rahman
- Department of Pharmacy, East West University, Dhaka, 1212 Bangladesh
| | - Dipak Kumar Mitra
- Department of Public Health, North South University, Plot 15, Block B, Bashundhara, Dhaka, 1229 Bangladesh
| |
Collapse
|
6
|
Kabir H, Hasan MK, Mitra DK. E-learning readiness and perceived stress among the university students of Bangladesh during COVID-19: a countrywide cross-sectional study. Ann Med 2021; 53:2305-2314. [PMID: 34889699 PMCID: PMC8667940 DOI: 10.1080/07853890.2021.2009908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 11/18/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has compelled all educational institutions from the conventional campus-based education system to e-learning worldwide. However, adapting to this new platform, e-learning readiness may cause perceived stress among students. This study aimed to examine the association between e-learning readiness and perceived e-learning stress and the relationship between sociodemographic and e-learning related factors. RESULTS A cross-sectional study was employed, where 1145 e-learning enrolled university students were surveyed. The result indicated that nearly 91% of students reported moderate (76.07%) to the higher level (14.85%) of perceived e-learning stress, whereas more than half of them (58.17%) were at the sub-optimum level of readiness. Furthermore, it was found that students with the sub-optimum level of readiness compared to optimum had a significantly higher chance of reporting moderate and high level of perceived e-learning stress. Besides, parents' highest education, residence, students' preference in (e-learning or learning format), and having any eye problems were associated with perceived e-learning stress. CONCLUSIONS A sudden introduction of e-learning during the COVID-19 catastrophe has brought about challenges, including the students' readiness, that might exacerbate the perceived stress level in different ways. This study reported that most of the students were at sub-optimal levels of readiness and suffered from moderate to high levels of perceived e-learning stress. The findings should integrate into the education monitoring system to enhance students' coping strategies, incite readiness, straighten, and nourish existing policies.Key messagesThe moderate and higher level of e-learning stress was 76% and 15%, respectively.Here, 58% of students were at the sub-optimum level of e-learning readiness.Students' sub-optimum level of e-learning readiness was significantly associated with the perceived moderate and high level of e-learning stress.
Collapse
Affiliation(s)
- Humayun Kabir
- Department of Public Health, North South University, Dhaka, Bangladesh
- CRP Nursing College, Savar, Dhaka, Bangladesh
| | - Md. Kamrul Hasan
- Department of Public Health, North South University, Dhaka, Bangladesh
- Department of Biochemistry and Molecular Biology, Tejgaon College, National University, Gazipur, Bangladesh
| | - Dipak Kumar Mitra
- Department of Public Health, North South University, Dhaka, Bangladesh
| |
Collapse
|
7
|
Dorszynski A, Lee E, Ton MT, Mintz A, McLaughlin JE, Jarstfer M. Virtual Pharmacopedia: An online educational database housing student-developed, expert-reviewed modules for PharmD curricular expansion. CURRENTS IN PHARMACY TEACHING & LEARNING 2021; 13:1432-1437. [PMID: 34799055 DOI: 10.1016/j.cptl.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 07/06/2021] [Accepted: 09/14/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The purpose of this study was to evaluate the feasibility of Virtual Pharmacopedia, an online educational resource that houses student-developed, expert-reviewed modules designed to supplement the elective pharmacy curriculum. METHODS Student volunteers were randomly assigned to one of two groups: those who created module content (creators) and potential utilizers (consumers). Modules on necrotizing fasciitis and ventricular arrhythmias were piloted and evaluated by experts before releasing to consumers. Learning was evaluated pre- and post-module creation via multiple-choice quizzes, and perceptions were evaluated afterward via survey. Perceived need for and utility of the modules were also evaluated for consumers using survey items analyzed using a five-point Likert type scale. All data were analyzed descriptively. RESULTS Most participating students (n = 95, 32% response rate) agreed they would use Virtual Pharmacopedia (96%), that module content enhanced understanding (88%), and that it would be a helpful resource (94%). Consumer quiz scores significantly improved from pre- to post-module for consumers who completed the module (n = 31) compared to those who did not (n = 89). Creator survey data (n = 10, 100%) revealed increased knowledge and application from pre- to post-module. CONCLUSIONS As a platform for self-directed learning, Virtual Pharmacopedia provides abbreviated national licensing examination review, rotation preparation, and exposure to unfamiliar content. Virtual Pharmacopedia increased learning and application of knowledge for both module creators and consumers, suggesting that Virtual Pharmacopedia can be a useful resource with potential for practical utility in pharmacy education.
Collapse
Affiliation(s)
- Amy Dorszynski
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States.
| | - Edward Lee
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States.
| | - Minh-Thi Ton
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States.
| | - Amanda Mintz
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States.
| | - Jacqueline E McLaughlin
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States.
| | - Michael Jarstfer
- Associate Dean for Graduate Education, Associate Professor, 4102 Marsico Hall, CB#7363, Division of Chemical Biology and Medicinal Chemistry, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States.
| |
Collapse
|
8
|
Batterbee RA. The inclusion of cognitive behavioural therapeutic components in the undergraduate nursing curriculum. A systematic integrative review of the evidence. NURSE EDUCATION TODAY 2020; 94:104567. [PMID: 32916407 DOI: 10.1016/j.nedt.2020.104567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 06/03/2020] [Accepted: 08/03/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Despite the increasing evidence base for the use of cognitive behavioural interventions in nursing, the extent to which therapeutic interventions and their components are included in the undergraduate curriculum in Australia remains unclear. OBJECTIVES To explore if and how cognitive behavioural components are being taught to undergraduate nursing students to deliver outcome benefits to students and patients. DESIGN An integrative literature review reporting links between CBT components and methods taught in pre-registration nurse education. FINDINGS AND CONCLUSION Based on an analysis of current literature, it is suggested that evidence-based cognitive behavioural components are being taught to undergraduate nursing students. The study reports that teaching cognitive behavioural components can bring clinical benefits to positive patient outcome, to student wellbeing and study performance. However, the teaching of cognitive behavioural conceptual models as a therapeutic skill was found to be limited. Recommendations to incorporate a simple, evidence based cognitive behavioural conceptual tool, highlights how nurse educators can address the requirement to teach from the current evidence base.
Collapse
|
9
|
Trivasse H, Webb TL, Waller G. A meta-analysis of the effects of training clinicians in exposure therapy on knowledge, attitudes, intentions, and behavior. Clin Psychol Rev 2020; 80:101887. [DOI: 10.1016/j.cpr.2020.101887] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/24/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
|
10
|
Valenstein-Mah H, Greer N, McKenzie L, Hansen L, Strom TQ, Wiltsey Stirman S, Wilt TJ, Kehle-Forbes SM. Effectiveness of training methods for delivery of evidence-based psychotherapies: a systematic review. Implement Sci 2020; 15:40. [PMID: 32460866 PMCID: PMC7251851 DOI: 10.1186/s13012-020-00998-w] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 05/07/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Extensive efforts have been made to train mental health providers in evidence-based psychotherapies (EBPs); there is increasing attention focused on the methods through which providers are trained to deliver EBPs. Evaluating EBP training methods is an important step in determining which methods are most effective in increasing provider skill and improving client outcomes. METHODS We searched MEDLINE (Ovid) and PsycINFO for randomized controlled trials published from 1990 through June 2019 that evaluated EBP training methods to determine the effectiveness of EBP training modalities on implementation (provider and cost) and client outcomes. Eligible studies (N = 28) were evaluated for risk of bias, and the overall strength of evidence was assessed for each outcome. Data was extracted by a single investigator and confirmed by a second; risk of bias and strength of evidence were independently rated by two investigators and determined by consensus. RESULTS Overall, EBP training improved short-term provider satisfaction, EBP knowledge, and adherence compared to no training or self-study of training materials (low to moderate strength of evidence). Training in an EBP did not increase treatment adoption compared to no training or self-study. No specific active EBP training modality was found to consistently increase provider EBP knowledge, skill acquisition/adherence, competence, adoption, or satisfaction compared to another active training modality. Findings were mixed regarding the additive benefit of post-training consultation on these outcomes. No studies evaluated changes in provider outcomes with regards to training costs and few studies reported on client outcomes. LIMITATIONS The majority of included studies had a moderate risk of bias and strength of evidence for the outcomes of interest was generally low or insufficient. Few studies reported effect sizes. The ability to identify the most effective EBP training methods was limited by low strength of evidence for the outcomes of interest and substantial heterogeneity among studies. CONCLUSIONS EBP training may have increased short-term provider satisfaction, EBP knowledge, and adherence though not adoption. Evidence was insufficient on training costs and client outcomes. Future research is needed on EBP training methods, implementation, sustainability, client outcomes, and costs to ensure efforts to train providers in EBPs are effective, efficient, and durable. TRIAL REGISTRATION The protocol for this review is registered in PROSPERO (CRD42018093381).
Collapse
Affiliation(s)
- Helen Valenstein-Mah
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, 2450 Riverside Avenue, F282/2A West, Minneapolis, MN, 55454, USA.
| | - Nancy Greer
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA.,Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Lauren McKenzie
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA.,Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Lucas Hansen
- Minneapolis VA Health Care System, Minneapolis, MN, USA.,University of St. Thomas, Minneapolis, MN, USA
| | - Thad Q Strom
- Oscar G. Johnson VA Medical Center, Iron Mountain, MI, USA
| | - Shannon Wiltsey Stirman
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Healthcare System, Palo Alto, CA, USA.,Stanford University, Palo Alto, CA, USA
| | - Timothy J Wilt
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA.,Minneapolis VA Health Care System, Minneapolis, MN, USA.,Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Shannon M Kehle-Forbes
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA.,Minneapolis VA Health Care System, Minneapolis, MN, USA.,Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.,National Center for PTSD Women's Health Sciences Division, VA Boston Healthcare System, Boston, MA, USA
| |
Collapse
|
11
|
Singh T, Reyes-Portillo JA. Using Technology to Train Clinicians in Evidence-Based Treatment: A Systematic Review. Psychiatr Serv 2020; 71:364-377. [PMID: 31960775 DOI: 10.1176/appi.ps.201900186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE There is a critical shortage of clinicians trained in evidence-based treatments (EBTs). New technologies, such as Internet-based training, video conferences, and mobile applications, can increase accessibility to specialized training and enhance traditional face-to-face training. A systematic review was conducted to identify and summarize research on the use of technology to train clinicians in EBTs. METHODS An electronic database search of PsycINFO, PubMed, Medline, Web of Science, CINAHL, and the Cochrane Library was conducted in June 2018. Articles were independently coded and assessed for risk of bias by two reviewers using the National Heart, Lung, and Blood Institute's Quality Assessment Tool for Controlled Intervention Studies. RESULTS Of the 7,767 citations initially identified, 24 articles met inclusion criteria. These articles described 21 training programs, including training for anxiety, depression, substance abuse, and eating disorder treatment. Most training programs were Internet based (N=19), and a majority of studies used a randomized controlled design (N=21). Most studies reported significant increases in clinician knowledge or skills, with small to large effect sizes. The methodological quality of studies ranged from good to poor. Many programs were limited by their use of completer analyses (i.e., only those who completed study included in analyses) and self-report measures. CONCLUSIONS Technology has great potential for increasing availability of training opportunities for clinicians and increasing the workforce trained in EBTs. Although technology-assisted training programs are not without limitations, overall they promise a new era of facilitative learning that promotes the adoption of new clinical practices in a dynamic and efficient manner.
Collapse
Affiliation(s)
- Tanya Singh
- Department of Psychology, Montclair State University, Montclair, New Jersey
| | | |
Collapse
|
12
|
Shin JY, Issenberg SB, Roh YS. The effects of neurologic assessment E-learning in nurses. NURSE EDUCATION TODAY 2017; 57:60-64. [PMID: 28734188 DOI: 10.1016/j.nedt.2017.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 02/06/2017] [Accepted: 07/10/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND A firm understanding of the preliminary assessment of a patient with neurological disorders is needed for ensuring optimal patient outcomes. OBJECTIVES The purpose of this study is to evaluate the effects of using e-learning on neurologic assessment knowledge, ability, and self-confidence among nurses. DESIGN This study used a non-equivalent control group pretest-posttest design. SETTINGS Nurses working in the neurology and neurosurgery wards, Republic of Korea PARTICIPANTS: A convenience sample of 50 nurses was assigned to either the experimental group (n=24) or the control group (n=26). METHODS The experimental group participated in the self-directed e-learning program related to neurologic assessment, and control group underwent self-directed learning with handout. Knowledge, ability, and self-confidence were measured at pretest and posttest. RESULTS There were no significant differences in knowledge (U=270, p=0.399) and self-confidence (U=241.5, p=0.171) between the two groups. Nurses in the experimental group showed higher neurologic assessment ability compared with those in the control group (U=199, p=0.028). CONCLUSIONS Self-directed neurologic assessment e-learning induced improvement in the neurologic assessment ability among nurses. Self-directed e-learning can be applied for improving competencies in neurologic assessment.
Collapse
Affiliation(s)
- Ji Yeon Shin
- Chung-Ang University Hospital, Seoul, Republic of Korea.
| | - S Barry Issenberg
- Gordon Center for Research in Medical Education, University of Miami Miller School of Medicine, USA.
| | - Young Sook Roh
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro Dongjak-gu, Seoul, 06974, Republic of Korea.
| |
Collapse
|
13
|
The Economic Benefits of Mobile Apps for Mental Health and Telepsychiatry Services When Used by Adolescents. Child Adolesc Psychiatr Clin N Am 2017; 26:125-133. [PMID: 27837938 DOI: 10.1016/j.chc.2016.07.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This article describes the benefits resulting from the use of mobile applications for mental health and telepsychiatry. Potential direct benefits include substitution for other forms of care, prevention of higher-acuity illness, higher rate of psychiatrist use, increased competition of services driving lower treatment costs, lower operating costs for psychiatrists, fewer missed appointments, and revenue for application developers. Potential indirect benefits include improved physical health, enhanced current and future productivity, and reduced demands on caregivers. A return on investment analysis framework is then presented as a generalized means for evaluating the return on investment of specific health care interventions.
Collapse
|
14
|
Evidence-based training in the era of evidence-based practice: Challenges and opportunities for training of PTSD providers. Behav Res Ther 2017; 88:37-48. [DOI: 10.1016/j.brat.2016.07.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/24/2016] [Accepted: 07/26/2016] [Indexed: 11/22/2022]
|
15
|
Cohen JA, Mannarino AP, Jankowski K, Rosenberg S, Kodya S, Wolford GL. A Randomized Implementation Study of Trauma-Focused Cognitive Behavioral Therapy for Adjudicated Teens in Residential Treatment Facilities. CHILD MALTREATMENT 2016; 21:156-67. [PMID: 26747845 PMCID: PMC5175405 DOI: 10.1177/1077559515624775] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Adjudicated youth in residential treatment facilities (RTFs) have high rates of trauma exposure and post-traumatic stress disorder (PTSD). This study evaluated strategies for implementing trauma-focused cognitive behavioral therapy (TF-CBT) in RTF. Therapists (N = 129) treating adjudicated youth were randomized by RTF program (N = 18) to receive one of the two TF-CBT implementation strategies: (1) web-based TF-CBT training + consultation (W) or (2) W + 2 day live TF-CBT workshop + twice monthly phone consultation (W + L). Youth trauma screening and PTSD symptoms were assessed via online dashboard data entry using the University of California at Los Angeles PTSD Reaction Index. Youth depressive symptoms were assessed with the Mood and Feelings Questionnaire-Short Version. Outcomes were therapist screening; TF-CBT engagement, completion, and fidelity; and youth improvement in PTSD and depressive symptoms. The W + L condition resulted in significantly more therapists conducting trauma screening (p = .0005), completing treatment (p = .03), and completing TF-CBT with fidelity (p = .001) than the W condition. Therapist licensure significantly impacted several outcomes. Adjudicated RTF youth receiving TF-CBT across conditions experienced statistically and clinically significant improvement in PTSD (p = .001) and depressive (p = .018) symptoms. W + L is generally superior to W for implementing TF-CBT in RTF. TF-CBT is effective for improving trauma-related symptoms in adjudicated RTF youth. Implementation barriers are discussed.
Collapse
Affiliation(s)
| | | | - Kay Jankowski
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | | | | | | |
Collapse
|
16
|
Jagt-van Kampen CT, Kremer LCM, Verhagen AAE, Schouten-van Meeteren AYN. Impact of a multifaceted education program on implementing a pediatric palliative care guideline: a pilot study. BMC MEDICAL EDUCATION 2015; 15:194. [PMID: 26525299 PMCID: PMC4631052 DOI: 10.1186/s12909-015-0478-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 10/25/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND A national clinical practice guideline for pediatric palliative care was published in 2013. So far there are only few reports available on whether an educational program fosters compliance with such a guideline implementation. We aimed to test the effect of the education program on actual compliance as well as documentation of compliance to the guideline. METHODS We performed a prospective study with pre- and post-intervention evaluation on compliance to the guideline of the nurse specialists of a pediatric palliative care team for case management at a children's university hospital. Eleven quality indicators were selected from 192 recommendations from the pediatric palliative care guideline, based on frequency, measurability and relevance. The multifaceted education program included e-learning and an interactive educational meeting. Four e-learning modules addressed 19 patient cases on symptoms, diagnostics and treatment, and a chart-documentation exercise. During the interactive educational meeting patient cases were discussed on how to use the guideline. Documentation of compliance to the guideline in the web-based patient-charts as well as actual compliance to the guideline through weekly web-based parent reports was measured before and after completion of the e-learning. RESULTS Eleven quality indicators were selected. The educational program did not result in significant improvement in compliance for any of these indicators. The indicators "treatment of nausea", "pain medications two steps ahead" and "pain medication for 48 h present", measured through parent reports, scored a compliance beyond 80 % before and after e-learning. The remaining indicators measuring compliance, as well as six indicators measuring documentation by chart review, showed a compliance below 80 % before and after e-learning. CONCLUSIONS The multifaceted education program did not lead to improvement in documentation of compliance to the guideline. Parent reported outcome revealed better performance and might be the more adequate assessment tool for future studies.
Collapse
Affiliation(s)
- Charissa Thari Jagt-van Kampen
- Emma Children's Hospital, Academic Medical Centre, Pediatric Oncology F8 Zuid, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
| | - Leontien C M Kremer
- Emma Children's Hospital, Academic Medical Centre, Pediatric Oncology F8 Zuid, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - A A Eduard Verhagen
- Universitair Medisch Centrum Groningen, Beatrix Kinderziekenhuis (code CA 72), Postbus 30.001, 9700, RB, Groningen, The Netherlands
| | | |
Collapse
|
17
|
Tyrer H, Tyrer P, Lisseman-Stones Y, McAllister S, Cooper S, Salkovskis P, Crawford MJ, Dupont S, Green J, Murphy D, Wang D. Therapist differences in a randomised trial of the outcome of cognitive behaviour therapy for health anxiety in medical patients. Int J Nurs Stud 2014; 52:686-94. [PMID: 25542343 DOI: 10.1016/j.ijnurstu.2014.11.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 11/21/2014] [Accepted: 11/26/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Health anxiety is common in medical settings and can be treated successfully by cognitive behaviour therapy. However it is not clear who might be best placed to deliver this therapy. OBJECTIVES In a planned secondary analysis of data from a randomised trial of adapted cognitive behaviour therapy for health anxiety we compared outcomes of therapy delivered by nurses and other professional groups. DESIGN A randomised controlled trial with two treatment arms, 5-10 sessions of cognitive behaviour therapy adapted health anxiety or standard care. SETTING Cardiology, endocrine, gastroenterology, neurological and respiratory clinics in six general hospitals in the UK covering urban, suburban and rural areas. PARTICIPANTS Medical patients attending the clinics who had pathological health anxiety and also scored for a diagnosis of hypochondriasis. METHODS Patients were randomised to one of two treatment arms, 5-10 sessions of cognitive behaviour therapy adapted health anxiety or standard care delivered by naive therapists (not randomised) who were trained in advance before delivering the treatment. Independent assessment of outcomes by researchers masked to allocation status at 3m, 6m, 12m and 24m. RESULTS 444 patients were randomised in the trial, 219 to cognitive behaviour therapy adapted health anxiety and 225 to standard care. 373 (84%) completed assessments after two years. Those treated by nurses (n=66) had improvement in health anxiety, generalised anxiety and depression outcomes that were significantly better and twice as great as those of the professional groups of assistant psychologists (n=87) and graduate workers (n=66) (P<0.01 over all time points). The number needed to treat to show superiority of nurse-delivered treatment over other treatment delivery was 4 at 6 months and 6 at one year. CONCLUSION General nurses, after suitable training, are very effective therapists for patients with health anxiety in medical clinics and should be the therapists of choice for patients in these settings.
Collapse
Affiliation(s)
- Helen Tyrer
- Centre for Mental Health, Imperial College, Claybrook Road, London W6 8LN, UK
| | - Peter Tyrer
- Centre for Mental Health, Imperial College, Claybrook Road, London W6 8LN, UK.
| | - Yvonne Lisseman-Stones
- Department of Nursing, King's Mill Hospital, Sutton-in-Ashfield, Nottinghamshire NG17 4JL, UK
| | - Sharon McAllister
- Medical Services, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
| | - Sylvia Cooper
- Centre for Mental Health, Imperial College, Claybrook Road, London W6 8LN, UK
| | - Paul Salkovskis
- Department of Psychology, University of Bath, Bath BA2 7AY, UK
| | - Michael J Crawford
- Centre for Mental Health, Imperial College, Claybrook Road, London W6 8LN, UK
| | - Simon Dupont
- Greenacres Centre, Hillingdon Hospital, Pield Heath Road, Uxbridge UB8 3NN, UK
| | - John Green
- Central and North West London NHS Foundation Trust, Hampstead Road, London NW1 7QY, UK
| | - David Murphy
- Department of Clinical Psychology, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| |
Collapse
|
18
|
Ruzek JI, Rosen RC, Garvert DW, Smith LD, Sears KC, Marceau L, Harty B, Stoddard AM. Online self-administered training of PTSD treatment providers in cognitive-behavioral intervention skills: results of a randomized controlled trial. J Trauma Stress 2014; 27:703-11. [PMID: 25522731 DOI: 10.1002/jts.21977] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Despite potential advantages in scalability and efficiency of web-based training for trauma providers, few controlled trials of feasibility and effectiveness of web-based mental health training have been performed. Our study compared web-based training in 3 intervention skills (motivation enhancement [ME], goal setting [GS], behavioral task assignment [BTA]) with web-based training plus telephone consultation, and a no-training control. The primary outcome measures included objective measures of skills acquisition (standardized patient assessments). Results showed significant differences among the training conditions. The overall tests of differences among the groups were statistically significant for ME and BTA skills (p < .001 and p = .005, respectively), but not for GS (p = .245). The web training plus consultation group improved in ME skills by 0.35 units compared to 0.12 units in the web only group (p < .001) and no change in the control group (p = .001). For BTA skills, the web training plus consultation improved by 0.27 units compared to 0.17 units in the web only group (p = .175) and no change in the control group (p = .004). Overall, these findings support the use of web-based dissemination for large-scale training programs for trauma providers in health care delivery systems. Further studies are needed to clarify the specific role of consultation as an adjunct to web-based training.
Collapse
Affiliation(s)
- Josef I Ruzek
- National Center For PTSD, VA Palo Alto Health Care System, Menlo Park, California, USA
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Harned MS, Dimeff LA, Woodcock EA, Kelly T, Zavertnik J, Contreras I, Danner SM. Exposing clinicians to exposure: a randomized controlled dissemination trial of exposure therapy for anxiety disorders. Behav Ther 2014; 45:731-44. [PMID: 25311284 PMCID: PMC4219859 DOI: 10.1016/j.beth.2014.04.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 04/23/2014] [Accepted: 04/23/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The present study evaluated three technology-based methods of training mental health providers in exposure therapy (ET) for anxiety disorders. Training methods were designed to address common barriers to the dissemination of ET, including limited access to training, negative clinician attitudes toward ET, and lack of support during and following training. METHOD Clinicians naïve to ET (N=181, Mage=37.4, 71.3% female, 72.1% Caucasian) were randomly assigned to (a) an interactive, multimedia online training (OLT), (b) OLT plus a brief, computerized motivational enhancement intervention (OLT+ME), or (c) OLT+ME plus a Web-based learning community (OLT+ME+LC). Assessments were completed at baseline, posttraining, and 6 and 12weeks following training. Outcomes include satisfaction, knowledge, self-efficacy, attitudes, self-reported clinical use, and observer-rated clinical proficiency. RESULTS All three training methods led to large and comparable improvements in self-efficacy and clinical use of ET, indicating that OLT alone was sufficient for improving these outcomes. The addition of the ME intervention did not significantly improve outcomes in comparison to OLT alone. Supplementing the OLT with both the ME intervention and the LC significantly improved attitudes and clinical proficiency in comparison to OLT alone. The OLT+ME+LC condition was superior to both other conditions in increasing knowledge of ET. CONCLUSIONS Multicomponent trainings that address multiple potential barriers to dissemination appear to be most effective in improving clinician outcomes. Technology-based training methods offer a satisfactory, effective, and scalable way to train mental health providers in evidence-based treatments such as ET.
Collapse
|
20
|
McCutcheon K, Lohan M, Traynor M, Martin D. A systematic review evaluating the impact of online or blended learning vs. face-to-face learning of clinical skills in undergraduate nurse education. J Adv Nurs 2014; 71:255-70. [PMID: 25134985 DOI: 10.1111/jan.12509] [Citation(s) in RCA: 250] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2014] [Indexed: 11/26/2022]
Abstract
AIM To determine whether the use of an online or blended learning paradigm has the potential to enhance the teaching of clinical skills in undergraduate nursing. BACKGROUND The need to adequately support and develop students in clinical skills is now arguably more important than previously considered due to reductions in practice opportunities. Online and blended teaching methods are being developed to try and meet this requirement, but knowledge about their effectiveness in teaching clinical skills is limited. DESIGN Mixed methods systematic review, which follows the Joanna Briggs Institute User guide version 5. DATA SOURCES Computerized searches of five databases were undertaken for the period 1995-August 2013. REVIEW METHODS Critical appraisal and data extraction were undertaken using Joanna Briggs Institute tools for experimental/observational studies and interpretative and critical research. A narrative synthesis was used to report results. RESULTS Nineteen published papers were identified. Seventeen papers reported on online approaches and only two papers reported on a blended approach. The synthesis of findings focused on the following four areas: performance/clinical skill, knowledge, self-efficacy/clinical confidence and user experience/satisfaction. The e-learning interventions used varied throughout all the studies. CONCLUSION The available evidence suggests that online learning for teaching clinical skills is no less effective than traditional means. Highlighted by this review is the lack of available evidence on the implementation of a blended learning approach to teaching clinical skills in undergraduate nurse education. Further research is required to assess the effectiveness of this teaching methodology.
Collapse
Affiliation(s)
- Karen McCutcheon
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, UK
| | | | | | | |
Collapse
|
21
|
Camargo LB, Raggio DP, Bonacina CF, Wen CL, Mendes FM, Bönecker MJS, Haddad AE. Proposal of e-learning strategy to teach Atraumatic Restorative Treatment (ART) to undergraduate and graduate students. BMC Res Notes 2014; 7:456. [PMID: 25034167 PMCID: PMC4118786 DOI: 10.1186/1756-0500-7-456] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 06/23/2014] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate e-learning strategy in teaching Atraumatic Restorative Treatment (ART) to undergraduate and graduate students. The sample comprised 76 participants-38 dental students and 38 pediatric dentistry students-in a specialization course. To evaluate knowledge improvement, participants were subjected to a test performed before and after the course. RESULTS A single researcher corrected the tests and intraexaminer reproducibility was calculated (CCI = 0.991; 95% IC = 0.975-0.996). All students improved their performances after the e-learning course (Paired t-tests p < 0.001). The means of undergraduate students were 4.7 (initial) and 6.4 (final) and those of graduate students were 6.8 (initial) and 8.2 (final). The comparison of the final evaluation means showed a statistically significant difference (t-tests p < 0.0001). CONCLUSIONS The e-learning strategy has the potential of improving students' knowledge in ART. Mature students perform better in this teaching modality when it is applied exclusively via distance learning.
Collapse
Affiliation(s)
- Lucila Basto Camargo
- Discipline of Pediatric Dentistry, Faculdade de Odontologia da Universidade Paulista, Av, Comendador Enzo Ferrari, 280 - Swift, Campinas, Brazil.
| | | | | | | | | | | | | |
Collapse
|
22
|
Masia Warner C, Brice C, Esseling PG, Stewart CE, Mufson L, Herzig K. Consultants' perceptions of school counselors' ability to implement an empirically-based intervention for adolescent social anxiety disorder. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2014; 40:541-54. [PMID: 23716144 DOI: 10.1007/s10488-013-0498-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Social anxiety is highly prevalent but goes untreated. Although school-based CBT programs are efficacious when delivered by specialized psychologists, it is unclear whether school counselors can implement these interventions effectively, which is essential to promote sustainable school programs. We present an initial consultation strategy to support school counselor implementation of group CBT for social anxiety and an evaluation of counselors' treatment fidelity. Counselors were highly adherent to the treatment, but competence varied based on measurement. Counselors and consultants demonstrated good agreement for adherence, but relatively modest correspondence in competence ratings. We discuss future directions for school-based implementation efforts informed by these initial findings.
Collapse
|
23
|
Latalova K, Prasko J, Kamaradova D, Jelenova D, Ociskova M, Sedlackova Z. Internet psychoeducation for bipolar affective disorder: basis for preparation and first experiences. Psychiatr Q 2014; 85:241-55. [PMID: 24307178 DOI: 10.1007/s11126-013-9286-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
There is growing evidence that patients with bipolar affective disorder (BAD), who use medication, respond well to further psychotherapeutic interventions. Internet-based psychoeducation is typically centered on the interaction between a client and therapist via the Internet. Multiple methods were required to investigate existing psychoeducational and psychotherapeutic strategies used on patients suffering from BAD. Systematic reviews and original reports of all trials of psychoeducation in BAD patients were retrieved. Patients with BAD, who were hospitalized in a psychiatric department or attended a day hospital program, were exposed to the first version of the program during the treatment, and then questioned about understandability, comprehensibility, and usefulness of each lecture. Twelve modules of the Internet E-Program for BAD were developed and the intervention was a pilot tested with twelve patients. Internet psychoeducation program for BAD is an intervention designed for universal implementation that addresses heightened learning needs of patients suffering from BAD. It is designed to promote confidence and reduce the number of episodes of the disorder by providing skills in monitoring warning signs, planning daily activities and practicing communication skills.
Collapse
Affiliation(s)
- Klara Latalova
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University Olomouc, Olomouc, Czech Republic,
| | | | | | | | | | | |
Collapse
|
24
|
Hedman E, Ljótsson B, Lindefors N. Cognitive behavior therapy via the Internet: a systematic review of applications, clinical efficacy and cost–effectiveness. Expert Rev Pharmacoecon Outcomes Res 2014; 12:745-64. [DOI: 10.1586/erp.12.67] [Citation(s) in RCA: 470] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
25
|
Lahti M, Hätönen H, Välimäki M. Impact of e-learning on nurses’ and student nurses knowledge, skills, and satisfaction: A systematic review and meta-analysis. Int J Nurs Stud 2014; 51:136-49. [DOI: 10.1016/j.ijnurstu.2012.12.017] [Citation(s) in RCA: 165] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 11/18/2012] [Accepted: 12/19/2012] [Indexed: 10/27/2022]
|
26
|
Harned MS, Dimeff LA, Woodcock EA, Contreras I. Predicting adoption of exposure therapy in a randomized controlled dissemination trial. J Anxiety Disord 2013; 27:754-62. [PMID: 23538148 PMCID: PMC3758433 DOI: 10.1016/j.janxdis.2013.02.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 01/29/2013] [Accepted: 02/15/2013] [Indexed: 10/27/2022]
Abstract
The present study examined organizational, client, and therapist characteristics as predictors of use of and proficiency in exposure therapy (ET) after training. Therapists naïve to ET (N=181) were randomized to: (1) online training (OLT), (2) OLT plus motivational enhancement (ME), or (3) OLT+ME plus a learning community. Twelve weeks after training, self-reported use of ET in clinical practice was high (87.5%) and therapists demonstrated moderate clinical proficiency. Use of ET was predicted by therapist degree, self-efficacy, and knowledge. Clinical proficiency was predicted by therapist anxiety sensitivity, attitudes, and knowledge, as well as organizational and client barriers. Several of these effects were moderated by training condition, indicating that therapists who received more comprehensive training were less impacted by barriers and showed enhanced adoption in the presence of facilitating factors. Overall, these results suggest that the primary barriers to the adoption of ET are therapist, not organizational or client, factors.
Collapse
|
27
|
Feng JY, Chang YT, Chang HY, Erdley WS, Lin CH, Chang YJ. Systematic review of effectiveness of situated e-learning on medical and nursing education. Worldviews Evid Based Nurs 2013; 10:174-83. [PMID: 23510119 DOI: 10.1111/wvn.12005] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2012] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Because of the complexity of clinical situations, traditional didactic education is limited in providing opportunity for student-patient interaction. Situated e-learning can enhance learners' knowledge and associated abilities through a variety of activities. Healthcare providers who interact with virtual patients in designed situations may avoid unnecessary risks and encounters with real patients. However, the effectiveness of situated e-learning is inconsistent. The purpose of this study is to determine the effectiveness of situated e-learning in prelicensure and postlicensure medical and nursing education. METHODS Literature databases of PubMed, Medline, CINAHL, ERIC, and Cochrane Library were searched. The study eligibility criteria included articles published in English, which examined the effectiveness of situated e-learning on the outcomes of knowledge and performance for clinicians or students in medicine and nursing. Effect sizes were calculated with 95% confidence intervals. RESULTS Fourteen articles were included for meta-analysis. Situated e-learning could effectively enhance learners' knowledge and performance when the control group received no training. Compared to traditional learning, the effectiveness of situated e-learning on performance diminished but still remained significant whereas the effect become insignificant on knowledge. The subgroup analyses indicate the situated e-learning program significantly improved students' clinical performance but not for clinicians. CONCLUSIONS Situated e-learning is an effective method to improve novice learners' performance. The effect of situated e-learning on the improvement of cognitive ability is limited when compared to traditional learning. Situated e-learning is a useful adjunct to traditional learning for medical and nursing students.
Collapse
Affiliation(s)
- Jui-Ying Feng
- Department of Nursing & Institute of Allied Health Sciences, National Cheng Kung University and Hospital, Taiwan
| | | | | | | | | | | |
Collapse
|
28
|
Clarke G, Jo Yarborough B. Evaluating the promise of health IT to enhance/expand the reach of mental health services. Gen Hosp Psychiatry 2013; 35:339-44. [PMID: 23701698 PMCID: PMC3716575 DOI: 10.1016/j.genhosppsych.2013.03.013] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 03/20/2013] [Indexed: 01/18/2023]
Abstract
OBJECTIVE A growing number of health information technologies (HIT) are being developed and tested to address mental health conditions. HIT includes Internet and smartphone programs or apps, text messaging protocols and telepsychiatry. We reviewed the promise and evidence that HIT can expand access to mental health care and reduce disparities in use of services across groups in need. CONCLUSIONS Limited reach of mental health services is a pervasive problem in the United States, and solving it will require innovations that enable us to extend our clinical reach into underserved populations without significantly expanding our workforce. In theory, HIT can extend access to mental health care in several ways: by enhancing the reach to priority populations, addressing system capacity issues, supporting training, improving clinical decision making, lowering the "consumer's threshold" for treatment, delivering preventive mental health services, speeding innovation and adoption and reducing cost barriers to treatment. At present, evidence is limited, and research is needed, focusing on consumer engagement strategies, the benefits and harms of HIT for the therapeutic relationship and the comparative effectiveness of various HIT alternatives.
Collapse
Affiliation(s)
- Greg Clarke
- Kaiser Permanente Center for Health Research, Portland, OR, USA.
| | | |
Collapse
|
29
|
Cougle JR. What makes a quality therapy? A consideration of parsimony, ease, and efficiency. Behav Ther 2012; 43:468-81. [PMID: 22697437 DOI: 10.1016/j.beth.2010.12.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 12/06/2010] [Accepted: 12/14/2010] [Indexed: 10/18/2022]
Abstract
Evaluations of psychotherapy have traditionally focused on symptom reduction as the primary standard by which their value is determined. This has contributed to the appearance of equivalence between many therapies that may differ considerably in complexity, feasibility, amount of homework and therapist contact required, expected cost, speed of symptom decline, and transdiagnostic utility. In the current paper, I make the case that these are fundamental features related to quality that should be considered in psychotherapy development, randomized controlled trials, and dissemination efforts. Empirically supported treatments for different disorders are evaluated based on these criteria, and special consideration is given to cognitive-behavioral treatments for anxiety disorders. Specific recommendations for a quality-oriented clinical research agenda are also provided.
Collapse
Affiliation(s)
- Jesse R Cougle
- Department of Psychology, Florida State University, Tallahassee, FL 32306, USA.
| |
Collapse
|
30
|
A randomized controlled trial comparing computer-aided learning with versus without tuition/lecture in promoting English proficiency. Cogn Process 2012; 13:277-83. [DOI: 10.1007/s10339-012-0437-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 02/23/2012] [Indexed: 10/28/2022]
|
31
|
Using Self-Guided Treatment Software (ePST) to Teach Clinicians How to Deliver Problem-Solving Treatment for Depression. DEPRESSION RESEARCH AND TREATMENT 2012; 2012:309094. [PMID: 23213493 PMCID: PMC3505632 DOI: 10.1155/2012/309094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 08/19/2012] [Accepted: 08/26/2012] [Indexed: 11/17/2022]
Abstract
Problem-solving treatment (PST) offers a promising approach to the depression care; however, few PST training opportunities exist. A computer-guided, interactive media program has been developed to deliver PST electronically (ePST), directly to patients. The program is a six-session, weekly intervention modeled on an evidence-based PST protocol. Users are guided through each session by a clinician who is presented via hundreds of branching audio and video clips. Because expert clinician behaviors are modeled in the program, not only does the ePST program have the potential to deliver PST to patients but it may also serve as a training tool to teach clinicians how to deliver PST. Thirteen social workers and trainees used ePST self-instructionally and subsequently attended a day-long workshop on PST. Participants' PST knowledge level increased significantly from baseline to post-ePST (P = .001) and did not increase significantly further after attending the subsequent workshop. Additionally, attending the workshop did not significantly increase the participants' skill at performing PST beyond the use of the ePST program. Using the ePST program appears to train novices to a sufficient level of competence to begin practicing PST under supervision. This self-instructional training method could enable PST for depression to be widely disseminated, although follow-up supervision is still required.
Collapse
|
32
|
Therapist training in empirically supported treatments: a review of evaluation methods for short- and long-term outcomes. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2011; 38:254-86. [PMID: 21656256 DOI: 10.1007/s10488-011-0360-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Therapist training efforts have been assessed using several outcomes. A model for evaluating therapist training in empirically supported treatments is presented, adapted from Kirkpatrick's (in: Craig and Bittel (eds.) Training and development handbook, 1967) training evaluation model. The adapted framework includes short-term outcomes, such as reactions to training and changes in attitude, knowledge, or skills, and longer-term outcomes, such as changes in therapist behavior in practice or client outcomes. Evaluation methods for these outcomes are reviewed, with information on their validity, reliability, and feasibility. An agenda for further research to improve therapist training evaluation is presented, with discussion of how evaluation can inform other areas of the field.
Collapse
|
33
|
Craske MG, Stein MB, Sullivan G, Sherbourne C, Bystritsky A, Rose RD, Lang AJ, Welch S, Campbell-Sills L, Golinelli D, Roy-Byrne P. Disorder-specific impact of coordinated anxiety learning and management treatment for anxiety disorders in primary care. ARCHIVES OF GENERAL PSYCHIATRY 2011; 68:378-88. [PMID: 21464362 PMCID: PMC3074172 DOI: 10.1001/archgenpsychiatry.2011.25] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Anxiety disorders commonly present in primary care, where evidence-based mental health treatments often are unavailable or suboptimally delivered. OBJECTIVE To compare evidence-based treatment for anxiety disorders with usual care (UC) in primary care for principal and comorbid generalized anxiety disorder (GAD), panic disorder (PD), social anxiety disorder (SAD), and posttraumatic stress disorder (PTSD). DESIGN A randomized controlled trial comparing the Coordinated Anxiety Learning and Management (CALM) intervention with UC at baseline and at 6-, 12-, and 18-month follow-up assessments. SETTING Seventeen US primary care clinics. PATIENTS Referred primary care sample, 1004 patients, with principal DSM-IV diagnoses of GAD (n = 549), PD (n = 262), SAD (n = 132), or PTSD (n = 61) (mean [SD] age, 43.7 [13.7] years; 70.9% were female). Eighty percent of the participants completed 18-month follow-up. INTERVENTIONS CALM (cognitive behavior therapy and pharmacotherapy recommendations) and UC. MAIN OUTCOME MEASURES Generalized Anxiety Disorder Severity Scale, Panic Disorder Severity-Self-report Scale, Social Phobia Inventory, and PTSD Checklist-Civilian Version scores. RESULTS CALM was superior to UC for principal GAD at 6-month (-1.61; 95% confidence interval [CI], -2.42 to -0.79), 12-month (-2.34; -3.22 to -1.45), and 18-month (-2.37; -3.24 to -1.50), PD at 6-month (-2.00; -3.55 to -0.44) and 12-month (-2.71; -4.29 to -1.14), and SAD at 6-month (-7.05; -12.11 to -2.00) outcomes. CALM was superior to UC for comorbid SAD at 6-month (-4.26; 95% CI, -7.96 to -0.56), 12-month (-8.12, -11.84 to -4.40), and 18- month (-6.23, -9.90 to -2.55) outcomes. Effect sizes favored CALM but were not statistically significant for other comorbid disorders. CONCLUSIONS CALM (cognitive behavior therapy and pharmacotherapy medication recommendations) is more effective than is UC for principal anxiety disorders and, to a lesser extent, comorbid anxiety disorders that present in primary care.
Collapse
Affiliation(s)
- Michelle G Craske
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA 90095-1563, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Harned MS, Dimeff LA, Woodcock EA, Skutch JM. Overcoming barriers to disseminating exposure therapies for anxiety disorders: a pilot randomized controlled trial of training methods. J Anxiety Disord 2011; 25:155-63. [PMID: 20888186 PMCID: PMC3031769 DOI: 10.1016/j.janxdis.2010.08.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 08/25/2010] [Accepted: 08/25/2010] [Indexed: 11/16/2022]
Abstract
The present study evaluated methods for training mental health providers (N=46) in exposure therapies (ETs) for anxiety disorders. A pilot randomized controlled trial compared: (1) an interactive, multimedia online training (ET OLT), (2) the ET OLT plus a brief Motivational Interviewing-based intervention (ET OLT+MI), and (3) a placebo control OLT. Assessments were completed at baseline, post-training, and one-week following training. Both ET OLT and ET OLT+MI received high satisfaction ratings and were comparably effective at increasing knowledge of ETs as well as clinicians' overt efforts to learn and use the treatment. ET OLT+MI was the most effective method for improving clinicians' attitudes toward ETs. Results indicate that OLT is effective for disseminating knowledge about ETs to clinicians, and suggest that supplementing OLT with a brief MI-based intervention may be a promising direction to address potential attitudinal barriers to adopting these highly efficacious treatments.
Collapse
Affiliation(s)
- Melanie S. Harned
- 3935 University Way NE, Department of Psychology, University of Washington,, Seattle, WA 98105, Behavioral Tech Research, Inc., 2133 Third Ave., Suite 210, Seattle, WA 98121,Please address correspondence to Melanie S. Harned, Ph.D., 3935 University Way NE, Department of Psychology, University of Washington, Seattle, WA 98105. . Phone: 206-616-1542. Fax: 206-616-1513
| | - Linda A. Dimeff
- Behavioral Tech Research, Inc., 2133 Third Ave., Suite 210, Seattle, WA 98121
| | - Eric A. Woodcock
- Behavioral Tech Research, Inc., 2133 Third Ave., Suite 210, Seattle, WA 98121
| | - Julie M. Skutch
- Behavioral Tech Research, Inc., 2133 Third Ave., Suite 210, Seattle, WA 98121
| |
Collapse
|
35
|
Murad MH, Coto-Yglesias F, Varkey P, Prokop LJ, Murad AL. The effectiveness of self-directed learning in health professions education: a systematic review. MEDICAL EDUCATION 2010; 44:1057-68. [PMID: 20946476 DOI: 10.1111/j.1365-2923.2010.03750.x] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
OBJECTIVES Given the continuous advances in the biomedical sciences, health care professionals need to develop the skills necessary for life-long learning. Self-directed learning (SDL) is suggested as the methodology of choice in this context. The purpose of this systematic review is to determine the effectiveness of SDL in improving learning outcomes in health professionals. METHODS We searched MEDLINE, EMBASE, ERIC and PsycINFO through to August 2009. Eligible studies were comparative and evaluated the effect of SDL interventions on learning outcomes in the domains of knowledge, skills and attitudes. Two reviewers working independently selected studies and extracted data. Standardised mean difference (SMD) and 95% confidence intervals (95% CIs) were estimated from each study and pooled using random-effects meta-analysis. RESULTS The final analysis included 59 studies that enrolled 8011 learners. Twenty-five studies (42%) were randomised. The overall methodological quality of the studies was moderate. Compared with traditional teaching methods, SDL was associated with a moderate increase in the knowledge domain (SMD 0.45, 95% CI 0.23-0.67), a trivial and non-statistically significant increase in the skills domain (SMD 0.05, 95% CI-0.05 to 0.22), and a non-significant increase in the attitudes domain (SMD 0.39, 95% CI-0.03 to 0.81). Heterogeneity was significant in all analyses. When learners were involved in choosing learning resources, SDL was more effective. Advanced learners seemed to benefit more from SDL. CONCLUSIONS Moderate quality evidence suggests that SDL in health professions education is associated with moderate improvement in the knowledge domain compared with traditional teaching methods and may be as effective in the skills and attitudes domains.
Collapse
Affiliation(s)
- Mohammad H Murad
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
| | | | | | | | | |
Collapse
|
36
|
Roh KH, Park HA. A meta-analysis on the effectiveness of computer-based education in nursing. Healthc Inform Res 2010; 16:149-57. [PMID: 21818434 PMCID: PMC3089855 DOI: 10.4258/hir.2010.16.3.149] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Accepted: 08/24/2010] [Indexed: 11/28/2022] Open
Abstract
Objectives The purpose of this study was to conduct a comparative analysis of education effectiveness between computer-based education and traditional education methods in nursing. Methods Medical and nursing literature databases were searched to identify studies regarding the effectiveness of computer-based education in nursing. Overall effect sizes for three outcome variables (knowledge, attitude, and practice level) were calculated. The effects of study characteristics on the outcome variables were analyzed. Results Twenty-seven studies published from 1990 to February 2009, which that met the inclusion criteria, were included in the analysis. The meta-analysis showed that computer-based education generally had positive effects on knowledge, attitude, and practice, with overall effect sizes of 0.43, 0.35, and 0.34, respectively. This study also showed that the type of learner and the total education period had different effects on knowledge. Conclusions This metaanalysis found that computer-based education in nursing had positive effects on knowledge, attitude, and practice.
Collapse
Affiliation(s)
- Kook Hee Roh
- Previous Assistant Professor, Kunsan College of Nursing, Gunsan, Korea
| | | |
Collapse
|
37
|
Street RL, Slee C, Kalauokalani DK, Dean DE, Tancredi DJ, Kravitz RL. Improving physician-patient communication about cancer pain with a tailored education-coaching intervention. PATIENT EDUCATION AND COUNSELING 2010; 80:42-7. [PMID: 19962845 PMCID: PMC2891619 DOI: 10.1016/j.pec.2009.10.009] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Revised: 10/16/2009] [Accepted: 10/26/2009] [Indexed: 05/02/2023]
Abstract
OBJECTIVE This study examined the effect of a theoretically grounded, tailored education-coaching intervention to help patients more effectively discuss their pain-related questions, concerns, and preferences with physicians. METHODS Grounded in social-cognitive and communication theory, a tailored education-coaching (TEC) intervention was developed to help patients learn pain management and communication skills. In a RCT, 148 cancer patients agreed to have their consultations audio-recorded and were assigned to the intervention or a control group. The recordings were used to code for patients' questions, acts of assertiveness, and expressed concerns and to rate the quality of physicians' communication. RESULTS Patients in the TEC group discussed their pain concerns more than did patients in the control group. More active patients also had more baseline pain and interacted with physicians using participatory decision-making. Ratings of physicians' information about pain were higher when patients talked more about their pain concerns. CONCLUSIONS The study demonstrates the efficacy of a theoretically grounded, coaching intervention to help cancer patients talk about pain control. PRACTICE IMPLICATIONS Coaching interventions can be effective resources for helping cancer patients communicate about their pain concerns if they are theoretically grounded, can be integrated within clinical routines, and lead to improve health outcomes.
Collapse
Affiliation(s)
- Richard L Street
- Department of Communication, Texas A&M University, College Station, TX 77843-4234, USA.
| | | | | | | | | | | |
Collapse
|
38
|
Cuijpers P, Marks IM, van Straten A, Cavanagh K, Gega L, Andersson G. Computer-aided psychotherapy for anxiety disorders: a meta-analytic review. Cogn Behav Ther 2010; 38:66-82. [PMID: 20183688 DOI: 10.1080/16506070802694776] [Citation(s) in RCA: 285] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Computer-aided psychotherapy (CP) is said to (1) be as effective as face-to-face psychotherapy, while requiring less therapist time, for anxiety disorder sufferers, (2) speed access to care, and (3) save traveling time. CP may be delivered on stand-alone or Internet-linked computers, palmtop computers, phone-interactive voice response, DVDs, and cell phones. The authors performed a meta-analysis of 23 randomised controlled studies (RCTs) that compared CP with non-CP in anxiety disorders: phobias, n = 10; panic disorder/agoraphobia, n = 9; PTSD, n = 3; obsessive-compulsive disorder, n = 1. Overall mean effect size of CP compared with non-CP was 1.08 (95% confidence interval: 0.84-1.32). CP and face-to-face psychotherapy did not differ significantly from each other (13 comparisons, d = -0.06). Much caution is needed when interpreting the findings indicating that outcome was unrelated to type of disorder, type of comparison group, mode of CP delivery (Internet, stand-alone PC, palmtop), and recency of the CP system and that effect size decreased when more therapist time was replaced by the computer. Because CP as a whole was as effective as face-to-face psychotherapy, certain forms of CP deserve to be integrated into routine practice.
Collapse
Affiliation(s)
- Pim Cuijpers
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, Amsterdam, The Netherlands.
| | | | | | | | | | | |
Collapse
|
39
|
Beidas RS, Kendall PC. Training Therapists in Evidence-Based Practice: A Critical Review of Studies From a Systems-Contextual Perspective. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2010; 17:1-30. [PMID: 20877441 PMCID: PMC2945375 DOI: 10.1111/j.1468-2850.2009.01187.x] [Citation(s) in RCA: 515] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Evidence-based practice (EBP), a preferred psychological treatment approach, requires training of community providers. The systems-contextual (SC) perspective, a model for dissemination and implementation efforts, underscores the importance of the therapist, client, and organizational variables that influence training and consequent therapist uptake and adoption of EBP. This review critiques the extant research on training in EBP from an SC perspective. Findings suggest that therapist knowledge improves and attitudinal change occurs following training. However, change in therapist behaviors (e.g., adherence, competence, and skill) and client outcomes only occurs when training interventions address each level of the SC model and include active learning. Limitations as well as areas for future research are discussed.
Collapse
|
40
|
Variety is the spice of life: Isn’t it? Int J Nurs Stud 2010; 47:265-7. [DOI: 10.1016/j.ijnurstu.2010.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
41
|
The art and science of mental health nursing: Reconciliation of two traditions in the cause of public health. Int J Nurs Stud 2009; 46:1537-40. [DOI: 10.1016/j.ijnurstu.2009.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
42
|
Abstract
AIM Research has shown computerised tutorial to be as effective as face-to-face teaching in promoting knowledge acquisition. Subsequently, the clinician must synthesise and interpret data (clinical reasoning). This study extends previous research and compares the effectiveness of interactive lecture and computerised tutorial in promoting observational skills and clinical reasoning in the evaluation of paroxysmal events. METHODS The modalities were compared through a randomised crossover trial teaching epilepsy to third and fourth year medical students. The content matter (history and video clip) and format were identical for each topic (Topic 1: altered awareness, Topic 2: movement and posturing) in both modalities (interactive lecture and computerised tutorial). Structured worksheets promoted and evaluated skills of observation and clinical reasoning. Responses in both domains were compared with gold standard qualitative scores. Participants rated modality preference and perceptions of teaching. RESULTS One-hundred and fifty-seven medical students participated. Interactive lecture and computerised tutorial were both effective in promoting observational skills and clinical reasoning with no differences between modalities. Participants preferred the interactive lecture and rated it more enjoyable and effective. Twenty-five participants randomised to the computerised tutorial for Topic 1, elected to withdraw participation. Both modalities promoted interest and willingness to further learn. CONCLUSION This is the first randomised crossover trial evaluating the teaching of clinical reasoning in comparative medical education research. Interactive lecturing and computerised tutorial were both effective in teaching observational skills and clinical reasoning. Interactive lecture is the preferred method, and may influence initial engagement in learning.
Collapse
|
43
|
Craske MG, Roy-Byrne PP, Stein MB, Sullivan G, Sherbourne C, Bystritsky A. Treatment for anxiety disorders: Efficacy to effectiveness to implementation. Behav Res Ther 2009; 47:931-7. [PMID: 19632667 PMCID: PMC2784096 DOI: 10.1016/j.brat.2009.07.012] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Anxiety disorders are common, costly and debilitating, and yet often unrecognized or inadequately treated in real world, primary care settings. Our group has been researching ways of delivering evidence-based treatment for anxiety in primary care settings, with special interest to preserving the fidelity of the treatment while at the same time promoting its sustainability once the research is over. In this paper, we describe the programs we have developed and our directions for future research. Our first study evaluated the efficacy of CBT and expert pharmacotherapy recommendations for panic disorder in primary care, using a collaborative care model of service delivery (CCAP). Symptom, disability and mental health functioning measures were superior for the intervention group compared to treatment as usual both in the short term and the long term, although also more costly. In our ongoing CALM study, we have extended our population to include panic disorder, social anxiety disorder, generalized anxiety disorder and posttraumatic disorder, while at the same time utilizing clinicians with limited mental health care experience. In addition to pharmacotherapy management, we developed a computer-assisted CBT that guides both novice clinician and patient, thereby contributing to sustainability once the research is over. We have also incorporated a measurement based approach to treatment planning, using a web-based tracking system of patient status. To date, the computer-assisted CBT program has been shown to be acceptable to clinicians and patients. Clinicians rated the program highly, and patients engaged in the program. Future directions for our research include dissemination and implementation of the CALM program, testing potential alternations to the CALM program, and distance delivery of CALM.
Collapse
Affiliation(s)
- Michelle G Craske
- University of California, Los Angeles, Department of Psychology, Franz Hall, 405 Hilgard Avenue, Los Angeles, CA 90095, USA.
| | | | | | | | | | | |
Collapse
|
44
|
Stuhlmiller C, Tolchard B. Computer-assisted CBT for depression & anxiety: increasing accessibility to evidence-based mental health treatment. J Psychosoc Nurs Ment Health Serv 2009; 47:32-9. [PMID: 19678477 DOI: 10.3928/02793695-20090527-01] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cognitive-behavioral therapy (CBT) is the most effective nonpharmacological treatment for almost all mental disorders, especially anxiety and depression. The treatment is time limited, encourages self-help skills, is problem focused, is inductive, and requires that individuals develop and practice skills in their own environment through homework. However, most of those with mental health issues are unable to seek help because of factors related to treatment availability, accessibility, and cost. CBT is well suited to computerization and is easy to teach to nurses. In this article we describe outcome studies of computer-assisted CBT (cCBT), outline the current technologies available, discuss concerns and resistance associated with computerized therapy, and consider the role of nurses in using cCBT.
Collapse
Affiliation(s)
- Cynthia Stuhlmiller
- School of Social Work, Office of Public Health Studies, University of Hawaii Manoa, Honolulu, HI 96822, USA.
| | | |
Collapse
|
45
|
Muroff J, Steketee G, Himle J, Frost R. Delivery of internet treatment for compulsive hoarding (D.I.T.C.H.). Behav Res Ther 2009; 48:79-85. [PMID: 19800051 DOI: 10.1016/j.brat.2009.09.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 09/07/2009] [Accepted: 09/10/2009] [Indexed: 11/25/2022]
Abstract
This study tested the effectiveness of an existing private online CBT-based group intervention designed to help people with hoarding. Web-group participants were hypothesized to show more improvement in hoarding symptoms over time compared to those placed on a naturalistic waitlist. This web-based self-help group (N = 106 members, N = 155 waitlisted) includes a formal application process and requires that participants post action steps and progress at least once monthly. Members have access to educational resources on hoarding, cognitive strategies, and a chat-group. Potential research participants were invited to complete an anonymous web-based survey about their hoarding behaviors and clinical improvement on five occasions (3 months apart). The sample was mainly middle-aged, female and White. Regression analyses show that Recent members reported greater improvement and less clutter at 6 months (than Waitlist). Long-term members reported milder hoarding symptoms than Recent ones, suggesting benefits from group participation over time. All members showed reductions in clutter and hoarding symptoms over 15 months. Less posting activity was associated with greater hoarding severity. Online CBT-based self-help for hoarding appears to be a promising intervention strategy that may extend access to treatment. Evaluating the benefits of internet self-help groups is critical given growing popularity of and demand for web-based interventions.
Collapse
Affiliation(s)
- Jordana Muroff
- Boston University, School of Social Work, Boston, MA 02215, USA.
| | | | | | | |
Collapse
|
46
|
Arch JJ, Craske MG. First-line treatment: a critical appraisal of cognitive behavioral therapy developments and alternatives. Psychiatr Clin North Am 2009; 32:525-47. [PMID: 19716989 DOI: 10.1016/j.psc.2009.05.001] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In this article, the authors assess the successes, remaining challenges, and new developments in cognitive behavioral therapy (CBT) for anxiety disorders. They define CBT, examine treatment components, review treatment efficacy, and discuss the challenges of attrition, long-term follow-up, co-occurring/comorbid disorders, limited treatment comparisons, treatment mediators, and broader implementation. In addition, they present recent developments in cognitive behavioral therapy for anxiety disorders, including linking exposure therapy to basic science, mindfulness and acceptance-based treatments, and unified or transdiagnostic treatment protocols.
Collapse
Affiliation(s)
- Joanna J Arch
- Department of Psychology, University of California Los Angeles, 1285 Franz Hall, Los Angeles, CA 90095-1563, USA.
| | | |
Collapse
|
47
|
Nance ET, Lanning SK, Gunsolley JC. Dental Anatomy Carving Computer-Assisted Instruction Program: An Assessment of Student Performance and Perceptions. J Dent Educ 2009. [DOI: 10.1002/j.0022-0337.2009.73.8.tb04786.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Elizabeth T. Nance
- Department of General Practice; Virginia Commonwealth University School of Dentistry
| | - Sharon K. Lanning
- Department of Periodontics; Virginia Commonwealth University School of Dentistry
| | - John C. Gunsolley
- Department of Periodontics; Virginia Commonwealth University School of Dentistry
| |
Collapse
|
48
|
Abstract
Evidence is growing that several computer-aided psychotherapy (CP) systems can effectively improve a range of common mental health problems. Most clients find CP acceptable because of its convenience, confidentiality, and reduction of stigma. CP can be accessed in a clinic, but recently clients have used CP especially on the Internet at home, with brief support on a telephone helpline and/or by email. Brief and efficient screening and support greatly reduce attrition. CP's efficacy, and encouragement of its dissemination and implementation by some national funding bodies and governmental agencies, has led to its spread as a regular care option and is increasing access to psychological therapies in some countries. Transfer of this new approach from use in tight research studies to use as an integrated part of everyday care under widely varying conditions generates teething problems that are being managed in diverse ways across different centers. Anonymized Internet audit of CP outcomes facilitates effective care and clinical governance. This review examines the current state of the art as well as the science and broad applications of CP.
Collapse
Affiliation(s)
- Isaac Marks
- Institute of Psychiatry, King's College London, London, United Kingdom.
| | | |
Collapse
|
49
|
Peroz I, Beuche A, Peroz N. Randomized controlled trial comparing lecture versus self studying by an online tool. MEDICAL TEACHER 2009; 31:508-512. [PMID: 19811166 DOI: 10.1080/01421590802203504] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Since 2001, an e-learning tool has been developed for dentistry. To compare online self study with traditional lectures, a module about instrumental occlusal analysis was offered by oral lecture and by a unit in the virtual library of the e-learning tool. METHODS 85 pre-clinical dental students were randomly divided into two groups: the computer assisted learning (CAL) group (n = 48) and the lecture group (n = 37). A pre-test was made to assess the students' basic knowledge. The first post-test and the scoring of the teaching methods were performed immediately after the lecture or the self studying by the online tool and a second post-test six weeks later. RESULTS The oral lecture got better educational and enjoyment values. The students prefer CAL in addition to traditional lectures. The results of the pre-tests were not different between the two groups (p = 0.706). The lecture group significantly improved their scores in the first post-test (p = 0.011), but the scores of the second post-test did not differ significantly (p = 0.157). CONCLUSIONS In the short term, knowledge acquisition seems to be better in oral lectures but in the long term there is no difference in knowledge retention between the two learning scenarios.
Collapse
|
50
|
Craske MG, Rose RD, Lang A, Welch SS, Campbell-Sills L, Sullivan G, Sherbourne C, Bystritsky A, Stein MB, Roy-Byrne PP. Computer-assisted delivery of cognitive behavioral therapy for anxiety disorders in primary-care settings. Depress Anxiety 2009; 26:235-42. [PMID: 19212970 PMCID: PMC2906395 DOI: 10.1002/da.20542] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This article describes a computer-assisted cognitive behavioral therapy (CBT) program designed to support the delivery of evidenced-based CBT for the four most commonly occurring anxiety disorders (panic disorder, posttraumatic stress disorder, generalized anxiety disorder, and social anxiety disorder) in primary-care settings. The purpose of the current report is to (1) present the structure and format of the computer-assisted CBT program, and (2) to present evidence for acceptance of the program by clinicians and the effectiveness of the program for patients. METHODS Thirteen clinicians using the computer-assisted CBT program with patients in our ongoing Coordinated Anxiety Learning and Management study provided Likert-scale ratings and open-ended responses about the program. Rating scale data from 261 patients who completed at least one CBT session were also collected. RESULTS Overall, the program was highly rated and modally described as very helpful. Results indicate that the patients fully participated (i.e., attendance and homework compliance), understood the program material, and acquired CBT skills. In addition, significant and substantial improvements occurred to the same degree in randomly audited subsets of each of the four primary anxiety disorders (N=74), in terms of self ratings of anxiety, depression, and expectations for improvement. CONCLUSIONS Computer-assisted CBT programs provide a practice-based system for disseminating evidence-based mental health treatment in primary-care settings while maintaining treatment fidelity, even in the hands of novice clinicians.
Collapse
Affiliation(s)
| | - Raphael D. Rose
- University of California, Los Angeles, Department of Psychology
| | - Ariel Lang
- University of California, San Diego, Department of Psychiatry, and VA San Diego Heath Care System, Center of Excellence for Stress and Mental Health
| | - Stacy Shaw Welch
- University of Washington at Harborview Medical Center, CHAMMP and the Anxiety and Stress Reduction Center of Seattle
| | - Laura Campbell-Sills
- University of California, San Diego, Department of Psychiatry, and VA San Diego Heath Care System, Center of Excellence for Stress and Mental Health
| | | | | | - Alexander Bystritsky
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences
| | - Murray B. Stein
- University of California, San Diego, Department of Psychiatry and Department of Family & Preventive Medicine
| | - Peter P. Roy-Byrne
- University of Washington at Harborview Medical Center, CHAMMP and the Anxiety and Stress Reduction Center of Seattle
| |
Collapse
|