Using an Interactive Video Simulator to Improve Certified Nursing Assistants' Dressing Assistance and Nursing Home Residents' Dressing Performance: A Pilot Study

Simulation-based training for continuing professional development within a primary care context: a systematic review

BACKGROUND

Given the increasing complexity of tasks transferred to primary care, discipline-specific educational opportunities are required for those working within this context. Simulation-based training (SBT) is widely applied within a hospital setting, underpinned by extensive research. However, little is known about the transfer of simulations' utility to primary care. This systematic review sought to determine which SBT approaches are adopted for continuing professional development within primary care and appraise their impact.

METHODS

Medline, Embase, CINAHL and Web of Science databases were searched, with additional articles obtained through secondary searching. Eligible studies employed and evaluated a simulation-based educational intervention for fully qualified healthcare professionals, working within primary care. Included studies were quality assessed using the Mixed Methods Appraisal Tool (v18) and their findings narratively synthesised.

RESULTS

Forty-nine studies were included, sampling 4,601 primary care health professionals. Studies primarily adopted a quantitative design and demonstrated variable quality. Simulation approaches comprised standardised patients (n = 21), role-play (n = 14), virtual (n = 6), manikin (n = 5) and mixed manikin/standardised patients (n = 3). Efficacy was evaluated across Kirkpatrick levels and demonstrated a positive impact for knowledge-, skills- and attitude-based outcomes, though this was limited in select studies.

DISCUSSION

SBT has been adopted in the education of the spectrum of health professionals working within primary care, with the most common approach being standardised patients. Simulation delivers an acceptable and effective educational method, demonstrating a positive impact across various learning objectives. Further research assessing the impact at an organisational- and patient-level is required.

The characteristics of effective technology-enabled dementia education: a systematic review and mixed research synthesis

BACKGROUND

Dementia education is required to address gaps in dementia-specific knowledge among health and social care practitioners amidst increasing dementia prevalence. Harnessing technology for dementia education may remove obstacles to traditional education and empower large communities of learners. This systematic review aimed to establish the technological and pedagogical characteristics associated with effective technology-enabled dementia education for health and social care practitioners.

METHODS

MEDLINE, PubMed, Web of Science, CINAHL, Scopus, PsycINFO, ERIC and OVID Nursing Database were searched from January 2005 until February 2020. Quantitative, qualitative and mixed methods studies were eligible for inclusion. Study quality was assessed with the Mixed Methods Appraisal Tool. Quantitative evidence was categorised based on Kirkpatrick's Model. Qualitative data was synthesised thematically and integrated with quantitative findings before conclusions were drawn.

RESULTS

Twenty-one published papers were identified. Participants were acute, primary and long-term care practitioners, or were students in higher education. Most training was internet-based; CD-ROMs, simulations and tele-mentoring were also described. Technology-enabled dementia education was predominantly associated with positive effects on learning outcomes. Case-based instruction was the most frequently described instructional strategy and videos were common modes of information delivery. Qualitative themes emerged as existing strengths and experience; knowledge gaps and uncertainty; developing core competence and expertise; involving relevant others; and optimising feasibility.

DISCUSSION

Technology-enabled dementia education is likely to improve dementia knowledge, skills and attitudes among health and social care practitioners from multiple practice contexts. Confidence in the results from quantitative studies was undermined by multiple confounding factors that may be difficult to control in the educational research context. Convenience and flexibility are key benefits of technology-enabled instructive and simulated pedagogy that can support the application of theory into practice. More research is required to understand the role of online learning networks and provisions for equitable engagement. A future emphasis on organisational and environmental factors may elucidate the role of technology in ameliorating obstacles to traditional dementia education.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO ( CRD42018115378 ).

Establishing the effectiveness of technology-enabled dementia education for health and social care practitioners: a systematic review

BACKGROUND

Dementia prevalence is increasing globally and yet evidence suggest that gaps exist in dementia-specific knowledge among health and social care practitioners. Technological modes of educational delivery may be as effective as traditional education and can provide practitioners with increased accessibility to dementia training. Benefits of digitally based dementia education have been established including pedagogical strategies that influence dementia knowledge and care attitudes. This review aimed to appraise and synthesise contemporary experimental evidence that evaluated technology-enabled dementia education for health and social care practitioners. Outcomes based on Kirkpatrick's Model were learner satisfaction; knowledge, skills, and attitudes; behaviours; and results.

METHODS

MEDLINE, CINAHL, and Web of Science were among 8 bibliographic databases searched from January 2005 until February 2020. Keywords included dementia and education (and terms for technological modes of education, learning, or training). We included experimental and quasi-experimental studies. Medical Education Research Study Quality Instrument established the overall quality of included studies and pragmatic application of Mixed Methods Appraisal Tool established individual study quality and highlighted methodological features of educational research. Narrative synthesis was conducted as heterogeneous outcome data precluded meta-analysis.

RESULTS

We identified 21 relevant studies: 16 evaluated online dementia education and 5 evaluated computer-based approaches. Most studies used before-after designs and study quality was moderate overall. Most studies reported knowledge-based outcomes with statistically significant findings favouring the training interventions. Positive effects were also observed in studies measuring skills and attitudinal change. Fewer studies reported significant findings for behavioural change and results due to training. Case-based instruction was a frequently described instructional strategy in online dementia education and videos were common information delivery modes. CD-ROM training and simulation activities were described in computer-based dementia education.

DISCUSSION

Future emphasis must be placed on teaching and learning methods within technology-enabled dementia education which should be role relevant and incorporate active and interactive learning strategies. Future evaluations will require contextually relevant research methodologies with capacity to address challenges presented by these complex educational programmes and multi-component characteristics.

SYSTEMATIC REVIEW REGISTRATION

This systematic review is based on a protocol registered with PROSPERO ( CRD42018115378 ).

eHBB: a randomised controlled trial of virtual reality or video for neonatal resuscitation refresher training in healthcare workers in resource-scarce settings

OBJECTIVE

To assess the impact of mobile virtual reality (VR) simulations using electronic Helping Babies Breathe (eHBB) or video for the maintenance of neonatal resuscitation skills in healthcare workers in resource-scarce settings.

DESIGN

Randomised controlled trial with 6-month follow-up (2018-2020).

SETTING

Secondary and tertiary healthcare facilities.

PARTICIPANTS

274 nurses and midwives assigned to labour and delivery, operating room and newborn care units were recruited from 20 healthcare facilities in Nigeria and Kenya and randomised to one of three groups: VR (eHBB+digital guide), video (video+digital guide) or control (digital guide only) groups before an in-person HBB course.

INTERVENTIONS

eHBB VR simulation or neonatal resuscitation video.

MAIN OUTCOMES

Healthcare worker neonatal resuscitation skills using standardised checklists in a simulated setting at 1 month, 3 months and 6 months.

RESULTS

Neonatal resuscitation skills pass rates were similar among the groups at 6-month follow-up for bag-and-mask ventilation (BMV) skills check (VR 28%, video 25%, control 22%, p=0.71), objective structured clinical examination (OSCE) A (VR 76%, video 76%, control 72%, p=0.78) and OSCE B (VR 62%, video 60%, control 49%, p=0.18). Relative to the immediate postcourse assessments, there was greater retention of BMV skills at 6 months in the VR group (-15% VR, p=0.10; -21% video, p<0.01, -27% control, p=0.001). OSCE B pass rates in the VR group were numerically higher at 3 months (+4%, p=0.64) and 6 months (+3%, p=0.74) and lower in the video (-21% at 3 months, p<0.001; -14% at 6 months, p=0.066) and control groups (-7% at 3 months, p=0.43; -14% at 6 months, p=0.10). On follow-up survey, 95% (n=65) of respondents in the VR group and 98% (n=82) in the video group would use their assigned intervention again.

CONCLUSION

eHBB VR training was highly acceptable to healthcare workers in low-income to middle-income countries and may provide additional support for neonatal resuscitation skills retention compared with other digital interventions.

Can Use of Digital Technologies by People with Dementia Improve Self-Management and Social Participation? A Systematic Review of Effect Studies

There is increasing interest in the use of technology to support social health in dementia. The primary objective of this systematic review was to synthesize evidence of effectiveness of digital technologies used by people with dementia to improve self-management and social participation. Records published from 1 January 2007 to 9 April 2020 were identified from Pubmed, PsycInfo, Web of Science, CINAHL, and the Cochrane Central Register of Controlled Trials. Controlled interventional studies evaluating interventions based on any digital technology were included if: primary users of the technology had dementia or mild cognitive impairment (MCI); and the study reported outcomes relevant to self-management or social participation. Studies were clustered by population, intervention, and outcomes, and narrative synthesis was undertaken. Of 1394 records identified, nine met the inclusion criteria: two were deemed to be of poor methodological quality, six of fair quality, and one of good quality. Three clusters of technologies were identified: virtual reality, wearables, and software applications. We identified weak evidence that digital technologies may provide less benefit to people with dementia than people with MCI. Future research should address the methodological limitations and narrow scope of existing work. In the absence of strong evidence, clinicians and caregivers must use their judgement to appraise available technologies on a case-by-case basis.

Simulation to educate healthcare providers working within residential age care settings: A scoping review

BACKGROUND

Simulation is used widely in health education to develop healthcare providers' knowledge and skills. The use of simulation however, as an educational strategy among aged care worker is not well understood.

OBJECTIVES

This review sought to describe studies where simulation is used to educate healthcare providers working within aged care settings; describe the method and structure used in simulations in residential aged care; the key learning outcomes for the participants in this setting; and identify any gaps in the current literature to illuminate future research opportunities.

DESIGN

The review follows the Joanna Briggs Institute Scoping Review methodology and utilises the PRISMA-ScR Checklist. Searches of CINAHL Complete, PubMed and Scopus databases were completed using the search terms "Simulation" AND "training" AND "Aged Care" OR "Elderly" OR "Older People". Inclusion criteria were peer-reviewed, English, full-text articles published from database inception to July 2018.

RESULTS

Twenty studies were included in this review. Studies differed in their methodology, sample size and participants and their findings varied significantly. Fourteen studies originated from the United States of America, five from Canada, and one from Taiwan. Studies were published between 1977 and July 2018. Clinical topics used in simulation were aggression and violence; dementia; aging; death and dying; range of motion exercises; person-centred care; sepsis; and dressing residents. Simulation types were role play, simulated patients, and mannequins. Debrief was described in less than a third of studies. Just over half of the studies evaluated participant outcomes.

DISCUSSION/CONCLUSION

This study demonstrated a large paucity of evidence utilising simulation for training within aged care settings. It highlights the need for future research in this area where simulation could be utilised to meet the unique learning needs of nurses working in aged care.