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Educational Intervention (educational + intervention)
Selected AbstractsEvaluating the Impact of an Educational Intervention on Documentation of Decision-making Capacity in an Emergency Medical Services SystemACADEMIC EMERGENCY MEDICINE, Issue 7 2004Jennifer Riley MD Abstract Objectives: To compare the documentation of decision-making capacity by advanced life support (ALS) providers and signature acquisition before, one month after, and one year after an educational intervention. Methods:The intervention comprised a one-and-a-half-hour module on assessment and documentation of decision-making capacity. Ambulance call reports were reviewed for all ALS calls occurring during three two-month periods, and refusals of transport were recorded. Provider compliance with documentation of decision-making capacity and signature acquisition were determined from a convenience sample of 75 reports from each period. Reviewers were blinded to study period. Twenty-percent double data entry was undertaken to evaluate accuracy. Ninety-five percent confidence intervals were calculated to compare frequencies of cancelled calls and documentation. Results: From the emergency medical services database, 7,744 calls before the intervention, 7,444 immediately after, and 7,604 one year later were identified. Documentation rates in the second and third periods did not differ from that prior to the intervention (1.3% vs. 0.0% and 0.0% in subsequent periods), nor did the rates of signature acquisition differ (85.3% vs. 85.3% and 78.6%). The accuracy of data entry was 92.6%. However, the frequency of call refusals decreased significantly after the intervention (from 9.0% to 2.0% and 6.6% in the respective periods). Conclusions: An educational intervention resulted in no change in the rate of decision-making capacity documentation or signature acquisition by ALS providers for refusal of transport. There was a temporary increase in the number of transported patients. [source] Quality of Nursing Diagnoses: Evaluation of an Educational InterventionINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2 2005Jan Florin RN PURPOSE.,To investigate the effects on the quality of nursing diagnostic statements in patient records after education in the nursing process and implementation of new forms for recording. METHODS.,Quasi-experimental design. Randomly selected patient records reviewed before and after intervention from one experimental unit (n = 70) and three control units (n = 70). A scale with 14 characteristics pertaining to nursing diagnoses was developed and used together with the instrument (CAT-CH-ING) for record review. FINDINGS.,Quality of nursing diagnostic statements improved in the experimental unit, whereas no improvement was found in the control units. Serious flaws in the use of the etiology component were found. CONCLUSION.,Nurses must be more concerned with the accuracy and quality of the nursing diagnoses and the etiology component needs to be given special attention. PRACTICE IMPLICATIONS.,Education of RNs in nursing diagnostic statements and peer review using standardized evaluation instruments can be means to further enhance RNs' documentation practice. [source] A Cluster-Randomized Trial of an Educational Intervention to Reduce the Use of Physical Restraints with Psychogeriatric Nursing Home ResidentsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2009Anna R. Huizing PhD RN OBJECTIVES: To investigate the effects of an educational intervention on the use of physical restraints with psychogeriatric nursing home residents. DESIGN: Cluster-randomized trial. SETTING: Fifteen psychogeriatric nursing home wards in the Netherlands. PARTICIPANTS: In total, 432 psychogeriatric nursing home residents from 15 psychogeriatric nursing home wards in seven nursing homes were selected for participation; 404 consented, and 371 of these were available at baseline. Two hundred forty-one from 14 wards had complete data and were included in the data analyses. INTERVENTION: The nursing home wards were assigned at random to educational intervention or control status. The educational intervention consisted of an educational program for nursing staff combined with consultation with a nurse specialist (registered nurse (RN) level). MEASUREMENTS: Data were collected at baseline and 1, 4, and 8 months postintervention. At each measurement, the use of physical restraints was measured using observations of blinded, trained observers on four separate occasions over a 24-hour period. Other resident characteristics, such as cognitive status, were determined using the Minimum Data Set. RESULTS: Logistic and linear regression analyses showed no treatment effect on restraint status, restraint intensity, or multiple restraint use in any of the three postintervention measurements. Furthermore, only small changes occurred in the types of restraints used with residents in the experimental group. CONCLUSION: An educational program for nursing staff combined with consultation with a nurse specialist (RN level) had no effect on the use of physical restraints with psychogeriatric nursing home residents. In addition to restraint education and consultation, new measures to reduce the use of physical restraints with psychogeriatric nursing home residents should be developed. [source] Effect of an Educational Intervention on Optimizing Antibiotic Prescribing in Long-Term Care FacilitiesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2007(See Editorial Comments by Dr. Lona Mody on pp 130, 1302) OBJECTIVE: To assess the effect of an educational intervention aimed at optimizing antibiotic prescribing in long-term care (LTC) facilities. DESIGN: Cluster randomized, controlled trial. SETTING: Eight public LTC facilities in the Montreal area. PARTICIPANTS: Thirty-six physicians. INTERVENTION: The educational intervention consisted of mailing an antibiotic guide to physicians along with their antibiotic prescribing profile covering the previous 3 months. Targeted infections were urinary tract, lower respiratory tract, skin and soft tissues, and septicemia of unknown origin. In the prescribing profile, each antibiotic was classified as adherent or nonadherent to the guide. Physicians in the experimental group received the intervention twice, 4 months apart, whereas physicians in the control group provided usual care. MEASUREMENTS: Data on antibiotic prescriptions were collected over four 3-month periods: preintervention, postintervention I, postintervention II, and follow-up. A generalized estimating equation (GEE) model was used to compare the proportion of nonadherent antibiotic prescriptions of the experimental and control groups. RESULTS: By the end of the study, nonadherent antibiotic prescriptions decreased by 20.5% in the experimental group, compared with 5.1% in the control group. Based on the GEE model, during postintervention II, physicians in the experimental group were 64% less likely to prescribe nonadherent antibiotics than those in the control group (odds ratio=0.36, 95% confidence interval=0.18,0.73). CONCLUSION: An educational intervention combining an antibiotic guide and a prescribing profile was effective in decreasing nonadherent antibiotic prescriptions. Repetition of the intervention at regular intervals may be necessary to maintain its effectiveness. [source] An Educational Intervention to Improve Antimicrobial Use in a Hospital-Based Long-Term Care FacilityJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2007(See Editorial Comments by Dr. Lona Mody on pp 130, 1302) OBJECTIVES: To improve antimicrobial use in patients receiving long-term care (LTC). DESIGN: Prospective, quasi-experimental before,after assessment of the effects of physician education and guideline implementation. SETTING: Public LTC and acute care hospital. PARTICIPANTS: Twenty salaried internists who provided most of the medical care to LTC patients. INTERVENTION: National guidelines, hospital resistance data, and physician feedback were incorporated into a series of four teaching sessions presented over 18 months and into booklets detailing institutional guidelines on the optimal management of common LTC infection syndromes. MEASUREMENTS: One hundred randomly selected LTC patients treated with antimicrobials were reviewed before these interventions were implemented and 100 after, and measures of the quality of care were compared. The effect of the interventions on antimicrobial days and starts were also assessed using interrupted time series analysis. RESULTS: Charted clinical abnormalities met guideline diagnostic criteria (62% vs 38%, P=.006), and initial therapy agreed with guideline recommendations (39% vs 11%, P<.001), more often in the post- than in the preintervention cohort. Mean census-adjusted monthly LTC antimicrobial days fell 29.7%, and antimicrobial starts fell 25.9% during the intervention period; both decreases were sustained during the 2-year postintervention period. CONCLUSION: The teaching and guideline intervention improved the quality and reduced the quantity of antimicrobial use in LTC patients. [source] CLINICAL SCHOLARSHIP: Systematic Review of Educational Interventions for Improving Advance Directive CompletionJOURNAL OF NURSING SCHOLARSHIP, Issue 3 2010Christine R. Durbin RN Abstract Purpose: To systematically analyze evidence about the outcome and percent of newly completed ADs, focusing on the effectiveness of (a) types of educational interventions versus controls and (b) one educational intervention over another. Design: Systematic review of literature based on Cochrane review criteria. Methods: Twelve randomized and four nonrandomized studies were selected from the nursing, medical, and social work literature that met the following criteria: described educational interventions, provided information to calculate the percent of newly completed ADs as an outcome, and published between 1991 and 2009. The review focused primarily on randomized studies. Reviewers calculated the percent of newly completed ADs by determining the number of subjects per group without an AD at baseline and the percentage of those who then completed one by the end of the studies. Findings: Findings were inconsistent regarding all types of educational interventions studied versus controls. Sufficient evidence exists to conclude that combined written and verbal educational interventions were more effective than single written interventions in increasing the percent of newly completed ADs in adult clinic outpatients and hospitalized elderly. Conclusions: Calculating the percent of newly completed ADs was successful in allowing for study result comparisons. Overall, the evidence base regarding the effectiveness of single or combined educational interventions in increasing AD completion is weak. Randomized studies with diverse samples should be conducted against controls before more studies comparing interventions are undertaken. Clinical Relevance: This article provides nurses with a summary of research related to educational interventions and AD completion and identifies where future study is needed. [source] Heart failure self-management education: a systematic review of the evidenceINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 3 2009Suzanne Austin Boren PhD MHA Abstract Objective, The objective of this systematic review is to identify educational content and techniques that lead to successful patient self-management and improved outcomes in congestive heart failure education programs. Methods, MEDLINE, CINAHL and the Cochrane Central Register of Controlled Trials, as well as reference lists of included studies and relevant reviews, were searched. Eligible studies were randomised controlled trials evaluating congestive heart failure self-management education programs with outcome measures. Two of the investigators independently abstracted descriptive information, education content topics and outcomes data. Results, A total of 7413 patients participated in the 35 eligible congestive heart failure self-management education studies. The congestive heart failure self-management programs incorporated 20 education topics in four categories: (i) knowledge and self-management (diagnosis and prognosis, pathophysiology of how congestive heart failure affects the body, aims of treatment, management and symptoms, medication review and discussion of side-effects, knowing when to access/call the general practitioner, communication with the physician, follow up for assessment or reinforcement); (ii) social interaction and support (social interaction and support, stress, depression); (iii) fluids management (sodium restriction, fluid balance, daily measurement of weight, ankle circumference, self-monitoring and compliance relative to fluids); and (iv) diet and activity (dietary assessment and instructions, physical activity and exercise, alcohol intake, smoking cessation). A total of 113 unique outcomes in nine categories (satisfaction, learning, behaviour, medications, clinical status, social functioning, mortality, medical resource utilisation and cost) were measured in the studies. Sixty (53%) of the outcomes showed significant improvement in at least one study. Conclusion, Educational interventions should be based on scientifically sound research evidence. The education topic list developed in this review can be used by patients and clinicians to prioritise and personalise education. [source] Correlates of knowledge and beliefs about depression among long-term care staffINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 4 2008Liat Ayalon Abstract Context Despite the high prevalence of depression in long-term care (LTC), it often is unrecognized and inadequately treated. Thus, the goals of the present study were to evaluate LTC staff characteristics that are associated with knowledge and beliefs about depression. Methods A cross sectional study of 371 LTC staff members completed a knowledge and beliefs about depression questionnaire, a short demographic questionnaire, a burden measure, and a questionnaire about attitudes associated with working with depressed residents. Results Relative to nurses, social workers, and activity staff, paraprofessional caregivers had a lower score on the depression measure and a higher score on the burden measure. Paraprofessional caregivers were more likely to view depression as a normal phenomenon, held less accurate beliefs about signs and symptoms of depression, and were less familiar with the effectiveness of specific treatments of depression. Conclusions Educational interventions about depression should be specifically geared to meet the needs of paraprofessional caregivers who provide the majority of care to LTC residents, yet possess less knowledge about depression and its treatments. Copyright © 2007 John Wiley & Sons, Ltd. [source] Management of childhood fever by parents: literature reviewJOURNAL OF ADVANCED NURSING, Issue 2 2006Anne Walsh MHSc RN Aim., This paper reports a review which draws together findings from studies targeting parents' temperature-taking, antipyretic administration, attitudes, practices and information-seeking behaviours. Background., Parents' concerns about the harmful effects of fever have been reported for more than two decades. These concerns remain despite successful educational interventions. Method., Medline, CINAHL, PsycINFO, PsycARTICLES and Web of Science databases were searched from 1980 to 2004 during November 2004. The search terms were fever, child, parent, education, knowledge, belief, concern, temperature, antipyretic and information, and combinations of these. Findings., In the 1980s, studies were mainly descriptive of small single site samples of parents with a febrile child seeking assistance from healthcare professionals. From 1990, sample sizes increased and multi-site studies were reported. Educational interventions were designed to increase knowledge and reduce unnecessary use of health services. One 2003 study targeted knowledge and attitudes. Parental knowledge about normal body temperature and the temperature that indicates fever is poor. Mild fever is misclassified by many as high, and they actively reduce mild fever with incorrect doses of antipyretics. Although some parents acknowledge the benefits of mild fever, concerns about brain damage, febrile convulsions and death from mild to moderate fever persist irrespective of parental education or socio-economic status. Many base their fever management practices on inaccurate temperature readings. Increased use of antipyretics to reduce fever and waking sleeping febrile children for antipyretics or sponging reflects heightened concern about harmful effects of fever. Educational interventions have reduced unnecessary use of healthcare services, improved knowledge about fever and when to implement management strategies, and reduced incorrect parental accuracy of antipyretic dosing. Information-seeking behaviours in fever management differ according to country of origin. Conclusion., Despite successful educational interventions, little has changed in parents' fever management knowledge, attitudes and practices. There is a need for interventions based on behaviour change theories to target the precursors of behaviour, namely knowledge, attitudes, normative influences and parents' perceptions of control. [source] Predictors of inappropriate utilization of intravenous proton pump inhibitorsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 5 2007W. AFIF Summary Background, Inappropriate use of intravenous proton pump inhibitors is prevalent. Aim, To assess appropriateness of intravenous proton pump inhibitor prescribing. Methods, Retrospective review of in-patient prescribing of intravenous pantoprazole over a 2-month period in 2004, in an academic centre. Prescribing was deemed appropriate before and after endoscopic haemostasis, and in fasting individuals requiring a proton pump inhibitor. Results, Amongst 107 patients, 49 (46%) had upper gastrointestinal bleeding. Overall, 33 (31%, 95% CI: 22,41%) received appropriate therapy (indication, dose and duration), 61 (57%, 95% CI: 47,67%) had an inappropriate indication, and 13 (12%, 95% CI: 7,20%) had an incorrect treatment dose or duration. Therapy was appropriate in 20 (41%, 95% CI: 27,55%) with upper gastrointestinal bleeding, and 13 (22%, 95% CI: 12,33%) in the non-upper gastrointestinal bleeding group. Appropriate prescribing rates decreased (from 41% to 16%, 95% on difference CI: 14,38%) when considering intravenous proton pump inhibitor use while awaiting endoscopy as inappropriate. Significant predictors of inappropriate use were increasing age and decreasing mean daily dose, with a trend for prescriptions written during evening shifts. Conclusion, Inappropriate intravenous proton pump inhibitor utilization was most frequent in the non-upper gastrointestinal bleeding group, mostly for unrecognized indications. Educational interventions to optimize utilization should target prescribing in older patients, those receiving lower mean daily doses, and, perhaps, prescribing outside regular hours. [source] Overcoming the barriers to disclosure and inquiry of partner abuse for women attending general practiceAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 5 2001Kelsey L. Hegarty Objectives: To determine the barriers to and rates of disclosure of partner abuse by women attending GPs. Methods: In a qualitative study, abused Melbourne women were interviewed about their experiences with GPs. Following this, adult women attending a random sample of Brisbane general practices were surveyed. Multivariate analyses were conducted on the data, using levels of disclosure and GP inquiry adjusting for cluster effect to obtain prevalence rate ratios. Results: Thirty-seven per cent of the survey participants (n=1836, response rate 78.5%) admitted to having ever experienced abuse in an adult intimate relationship. One-third (36.7%) of these abused women (n=674) had ever told a GP and 87.8% had never been asked by their GP about partner abuse. Women who disclosed were almost twice as likely than women who have not: to be middle aged, have experienced combined physical, emotional and sexual abuse and be afraid of their partner. They were more than twice as likely to have been asked about abuse. A GP's good communication skills facilitated disclosure. The main barriers to disclosure were that women saw the problem as their own i.e. internal barriers. The data from the qualitative study (n=20) are used to illustrate these findings. Conclusion: Educational interventions that improve GPs' communication skills might result in increased disclosure and early intervention in partner abuse. GPs need sensitive attitudes, greater skills, knowledge and support to manage the consequences of disclosure. [source] Evaluation of a multifaceted intervention to limit excessive antipsychotic co-prescribing in schizophrenia out-patientsACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2010L. Baandrup Baandrup L, Allerup P, Lublin H, Nordentoft M, Peacock L, Glenthoj B. Evaluation of a multifaceted intervention to limit excessive antipsychotic co-prescribing in schizophrenia out-patients. Objective:, To evaluate the effect of a multifaceted educational intervention on the frequency of antipsychotic co-prescribing in adult schizophrenia out-patients. Method:, Controlled quasi-experimental study performed in two Danish municipalities matched for baseline prevalence of antipsychotic polypharmacy, socioeconomic status and functional level of patients. The intervention was aimed at psychiatric healthcare providers and consisted of 1 day of didactic lectures, six 3-h educational outreach visits and an electronic reminder during drug prescribing. Results:, Between-group use of antipsychotic polypharmacy was compared at baseline (intervention group, N = 232/control group, N = 351) and after 1 year of intervention (intervention group, N = 216/control group, N = 386). The prevalence of antipsychotic polypharmacy at follow-up was not significantly different between treatment settings when adjusting for differences in case-mix (P = 0.07). Conclusion:, This multifaceted educational intervention failed to reduce the frequency of antipsychotic co-prescribing, but it suggested that future efforts to improve prescribing practice should address organizational barriers to implementation. [source] Evaluating the Impact of an Educational Intervention on Documentation of Decision-making Capacity in an Emergency Medical Services SystemACADEMIC EMERGENCY MEDICINE, Issue 7 2004Jennifer Riley MD Abstract Objectives: To compare the documentation of decision-making capacity by advanced life support (ALS) providers and signature acquisition before, one month after, and one year after an educational intervention. Methods:The intervention comprised a one-and-a-half-hour module on assessment and documentation of decision-making capacity. Ambulance call reports were reviewed for all ALS calls occurring during three two-month periods, and refusals of transport were recorded. Provider compliance with documentation of decision-making capacity and signature acquisition were determined from a convenience sample of 75 reports from each period. Reviewers were blinded to study period. Twenty-percent double data entry was undertaken to evaluate accuracy. Ninety-five percent confidence intervals were calculated to compare frequencies of cancelled calls and documentation. Results: From the emergency medical services database, 7,744 calls before the intervention, 7,444 immediately after, and 7,604 one year later were identified. Documentation rates in the second and third periods did not differ from that prior to the intervention (1.3% vs. 0.0% and 0.0% in subsequent periods), nor did the rates of signature acquisition differ (85.3% vs. 85.3% and 78.6%). The accuracy of data entry was 92.6%. However, the frequency of call refusals decreased significantly after the intervention (from 9.0% to 2.0% and 6.6% in the respective periods). Conclusions: An educational intervention resulted in no change in the rate of decision-making capacity documentation or signature acquisition by ALS providers for refusal of transport. There was a temporary increase in the number of transported patients. [source] Pain Scores Improve Analgesic Administration Patterns for Trauma Patients in the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 3 2004Paul A. Silka MD Abstract Objective: To determine the efficacy of pain scores in improving pain management practices for trauma patients in the emergency department (ED). Methods: A prospective, observational study of analgesic administration to trauma patients was conducted over a nine-week period following educational intervention and introduction of verbal pain scores (VPSs). All ED nursing and physician staff in an urban Level I trauma center were trained to use the 0,10 VPS. Patients younger than 12 years old, having a Glasgow Coma Scale score (GCS) <8, or requiring intubation were excluded from analysis. Demographics, mechanism of injury, vital signs, pain scores, and analgesic data were extracted from a computerized ED database and patients' records. The staff was blinded to the ongoing study. Results: There were 150 patients studied (183 consecutive trauma patients seen; 33 patients excluded per criteria). Pain scores were documented for 73% of the patients. Overall, 53% (95% confidence interval [CI] = 45% to 61%) of the patients received analgesics in the ED. Of the patients who had pain scores documented, 60% (95% CI = 51% to 69%) received analgesics, whereas 33% (95% CI = 18% to 47%) of the patients without pain scores received analgesics. No patient with a VPS < 4 received analgesics, whereas 72% of patients with a VPS > 4 and 82% with a VPS > 7 received analgesics. Mean time to analgesic administration was 68 minutes (95% CI = 49 to 87). Conclusions: Pain assessment using VPS increased the likelihood of analgesic administration to trauma patients with higher pain scores in the ED. [source] Educating Australian pharmacists about the use of online information in community pharmacy practiceINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 2 2005Margaret Bearman Lecturer Objectives Community pharmacists practice in an information technology-rich society, however many have not been educated in internet use for professional practice. The aims of this study were to investigate how community pharmacists use the internet in their practice; to develop an intervention to address their educational needs; and to examine the benefits and weakness of a flexible delivery programme. Method We conducted two focus groups investigating community pharmacists' internet use and education needs. We subsequently developed and provided a four-module educational course on CD ROM, ,Advanced web skills for pharmacists: finding quality on the internet'. In total, 147 pharmacists participated. A survey was conducted to evaluate the impact of the course. Key findings The focus group findings provided a clear rationale for an educational intervention. One-hundred and four pharmacists completed the course. Participating pharmacists were highly positive about the learning experience, in particular the provision of education by flexible delivery. Many reported specific changes to practice. They also described the time-consuming nature of the course as the biggest barrier to further education. Conclusions This project demonstrates the need for community pharmacists to have access to internet education. Flexible CD ROM-based learning provided a successful delivery medium. [source] Clinical significance of clinical interventions in community pharmacy: a randomised trial of the effect of education and a professional allowanceINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 2 2003Shalom I. Benrimoj professor of pharmacy practice Objectives To assess the clinical significance of clinical interventions undertaken by community pharmacists, and to explore the effect of providing education and/or remuneration on the clinical significance of interventions. Design Randomised trial involving four groups of community pharmacists; expert panel to assess the clinical significance of the interventions. Methods The "proactive" clinical interventions undertaken by community pharmacists during the trial were reviewed by an expert panel for assessment of avoided adverse health consequences and clinical significance. The panel used a validated assessment instrument developed from the existing research literature and a pilot study by the authors. Data analysis Agreement between experts was determined using the kappa statistic. In addition, the results of the expert panel were analysed for cases where the majority of experts provided the same assessment of clinical significance (ie, consensus). Results Overall, there was no statistically significant difference in the clinical significance of clinical interventions undertaken by the four study groups. However, there were significant differences (95% CI) in the types of proactive interventions undertaken, with the two groups that received an educational intervention being more likely to engage in more complex intervention areas, such as drug/drug interactions and adverse/side effects. Analysis of consensus revealed that 52% of proactive clinical interventions were deemed to be "clinically significant" and 2% were deemed to be either "clinically very significant" or "potentially life-saving". When extrapolated to national Australian prescribing figures, a mean of 3,752 potentially life-saving interventions by community pharmacists could be expected per year (95% CI 454 to 13,554). Conclusion The results of this study provide the first estimates of the potential clinical benefits associated with clinical interventions in Australian community pharmacies. The study contributes evidence on the value of pharmaceutical services to the health care system. As such, it is expected that the study findings will provide a platform for discussion and decision-making. [source] Case management educational intervention with public health nurses: cluster randomized controlled trialJOURNAL OF ADVANCED NURSING, Issue 10 2010Wen-I. liu w.-i., edwards h. & courtney m. (2010) Case management educational intervention with public health nurses: cluster randomized controlled trial. Journal of Advanced Nursing,66(10), 2234,2244. Abstract Aim., This paper is a report of a study conducted to determine the effectiveness of a community case management collaborative education intervention in terms of satisfaction, learning and performance among public health nurses. Background., Previous evaluation studies of case management continuing professional education often failed to demonstrate effectiveness across a range of outcomes and had methodological weaknesses such as small convenience samples and lack of control groups. Method., A cluster randomized controlled trial was conducted between September 2005 and February 2006. Ten health centre clusters (five control, five intervention) recruited 163 public health nurses in Taiwan to the trial. After pre-tests for baseline measurements, public health nurses in intervention centres received an educational intervention of four half-day workshops. Post-tests for both groups were conducted after the intervention. Two-way repeated measures analysis of variance was performed to evaluate the effect of the intervention on target outcomes. Results., A total of 161 participants completed the pre- and post-intervention measurements. This was almost a 99% response rate. Results revealed that 97% of those in the experimental group were satisfied with the programme. There were statistically significant differences between the two groups in knowledge (P = 0·001), confidence in case management skills (P = 0·001), preparedness for case manager role activities (P = 0·001), self-reported frequency in using skills (P = 0·001) and role activities (P = 0·004). Conclusion., Collaboration between academic and clinical nurses is an effective strategy to prepare nurses for rapidly changing roles. [source] A Cluster-Randomized Trial of an Educational Intervention to Reduce the Use of Physical Restraints with Psychogeriatric Nursing Home ResidentsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2009Anna R. Huizing PhD RN OBJECTIVES: To investigate the effects of an educational intervention on the use of physical restraints with psychogeriatric nursing home residents. DESIGN: Cluster-randomized trial. SETTING: Fifteen psychogeriatric nursing home wards in the Netherlands. PARTICIPANTS: In total, 432 psychogeriatric nursing home residents from 15 psychogeriatric nursing home wards in seven nursing homes were selected for participation; 404 consented, and 371 of these were available at baseline. Two hundred forty-one from 14 wards had complete data and were included in the data analyses. INTERVENTION: The nursing home wards were assigned at random to educational intervention or control status. The educational intervention consisted of an educational program for nursing staff combined with consultation with a nurse specialist (registered nurse (RN) level). MEASUREMENTS: Data were collected at baseline and 1, 4, and 8 months postintervention. At each measurement, the use of physical restraints was measured using observations of blinded, trained observers on four separate occasions over a 24-hour period. Other resident characteristics, such as cognitive status, were determined using the Minimum Data Set. RESULTS: Logistic and linear regression analyses showed no treatment effect on restraint status, restraint intensity, or multiple restraint use in any of the three postintervention measurements. Furthermore, only small changes occurred in the types of restraints used with residents in the experimental group. CONCLUSION: An educational program for nursing staff combined with consultation with a nurse specialist (RN level) had no effect on the use of physical restraints with psychogeriatric nursing home residents. In addition to restraint education and consultation, new measures to reduce the use of physical restraints with psychogeriatric nursing home residents should be developed. [source] Effect of an Educational Intervention on Optimizing Antibiotic Prescribing in Long-Term Care FacilitiesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2007(See Editorial Comments by Dr. Lona Mody on pp 130, 1302) OBJECTIVE: To assess the effect of an educational intervention aimed at optimizing antibiotic prescribing in long-term care (LTC) facilities. DESIGN: Cluster randomized, controlled trial. SETTING: Eight public LTC facilities in the Montreal area. PARTICIPANTS: Thirty-six physicians. INTERVENTION: The educational intervention consisted of mailing an antibiotic guide to physicians along with their antibiotic prescribing profile covering the previous 3 months. Targeted infections were urinary tract, lower respiratory tract, skin and soft tissues, and septicemia of unknown origin. In the prescribing profile, each antibiotic was classified as adherent or nonadherent to the guide. Physicians in the experimental group received the intervention twice, 4 months apart, whereas physicians in the control group provided usual care. MEASUREMENTS: Data on antibiotic prescriptions were collected over four 3-month periods: preintervention, postintervention I, postintervention II, and follow-up. A generalized estimating equation (GEE) model was used to compare the proportion of nonadherent antibiotic prescriptions of the experimental and control groups. RESULTS: By the end of the study, nonadherent antibiotic prescriptions decreased by 20.5% in the experimental group, compared with 5.1% in the control group. Based on the GEE model, during postintervention II, physicians in the experimental group were 64% less likely to prescribe nonadherent antibiotics than those in the control group (odds ratio=0.36, 95% confidence interval=0.18,0.73). CONCLUSION: An educational intervention combining an antibiotic guide and a prescribing profile was effective in decreasing nonadherent antibiotic prescriptions. Repetition of the intervention at regular intervals may be necessary to maintain its effectiveness. [source] A systematic review of peer teaching and learning in clinical educationJOURNAL OF CLINICAL NURSING, Issue 6 2008Jacinta Secomb Aims and objectives., The purpose of this review is to provide a framework for peer teaching and learning in the clinical education of undergraduate health science students in clinical practice settings and make clear the positive and negative aspects of this teaching and learning strategy. Background., The practice of using peers incidentally or purposefully in the clinical education of apprentice or undergraduate health science students is a well-established tradition and commonly practiced, but lacks definition in its implementation. Method., The author conducted a search of health science and educational electronic databases using the terms peer, clinical education and undergraduate. The set limitations were publications after 1980 (2005 inclusive), English language and research papers. Selection of studies occurred: based on participant, intervention, research method and learning outcomes, following a rigorous critical and quality appraisal with a purposefully developed tool. The results have been both tabled and collated in a narrative summary. Results., Twelve articles met the inclusion criteria, representing five countries and four health science disciplines. This review reported mostly positive outcomes on the effectiveness of peer teaching and learning; it can increase student's confidence in clinical practice and improve learning in the psychomotor and cognitive domains. Negative aspects were also identified; these include poor student learning if personalities or learning styles are not compatible and students spending less individualized time with the clinical instructor. Conclusions., Peer teaching and learning is an effective educational intervention for health science students on clinical placements. Preclinical education of students congruent with the academic timetable increases student educational outcomes from peer teaching and learning. Strategies are required prior to clinical placement to accommodate incompatible students or poor student learning. Relevance to clinical practice., The findings from this systematic review, although not statistically significant, do have pragmatic implications for clinical practice. It can increase clinical placement opportunities for undergraduate health students, assist clinical staff with workload pressures and increase clinician time with clients, while further developing students' knowledge, skills and attitudes. [source] Undertreatment of congestive heart failure in an Australian settingJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 1 2004P. J. Boyles BPharm (Hons) Summary Aim:, Guidelines for the management of patients with chronic heart failure have undergone change in recent years, with , -blockers and spironolactone shown to reduce mortality when added to angiotensin converting enzyme (ACE) inhibitors, diuretics and digoxin. The aim of this study was to examine the therapeutic management of heart failure in patients admitted to Tasmania's three major public hospitals, with an assessment of the appropriateness of the therapy according to contemporary published guidelines. Methods:, An extensive range of clinical and demographic data was retrospectively extracted from the medical records of consecutive adult patients admitted to the medical wards of the hospitals with heart failure, either as a primary diagnosis or as a comorbidity, during a 6-month period in late 1999,early 2001. Results:, The 450 patients (57% females) had a mean age of 77·8 ± 10·2 years, and were being treated with a median of seven drugs on hospital admission. The percentages of patients being treated with the major drugs of interest were: ACE inhibitors (50%), , -blockers (22%), spironolactone (15%), digoxin (24%), loop diuretics (65%) and angiotensin-II receptor antagonists (8%). Almost 10% were taking a non-steroidal anti-inflammatory agent. Less than one-half the patients who were receiving an ACE inhibitor were taking a target dose for heart failure. There were no significant differences in the pattern of drug use between the three hospitals. Underuse of heart failure medications was most pronounced in women and elderly patients. Conclusions:, The data suggest that current guidelines for the treatment of heart failure are still not being reflected in clinical practice. The relatively low use of drugs shown to improve survival in heart failure is of concern and warrants educational intervention. [source] Identifying and changing the normative beliefs about aggression which lead young Muslim adults to join extremist anti-Semitic groups in PakistanAGGRESSIVE BEHAVIOR, Issue 6 2009Naumana Amjad Abstract Two studies investigated the role of beliefs about the acceptability of aggression ("normative beliefs") against Jews in determining who would join an extremist group. In Study 1, students in a university in Pakistan (N=144) completed self-report attitude measures, and were subsequently approached by a confederate who asked whether they wanted to join an extremist anti-Semitic organization. Normative beliefs about aggression against Jews were very strong predictors of whether participants agreed to join. In Study 2, participants (N=92) were experimentally assigned to either a brief educational intervention, designed to improve inter-group relations, or to a control group. They also filled in self-report attitude measures pre and post intervention. Participants in the intervention group were much less likely to agree to join the extremist group, and this effect of the intervention on joining was mediated by changes in normative beliefs about aggression against Jews. The results have implications for theories of inter-group aggression and interventions to prevent people from being recruited into extremist groups. Aggr. Behav. 35:514,519, 2009. © 2009 Wiley-Liss, Inc. [source] CLINICAL SCHOLARSHIP: Systematic Review of Educational Interventions for Improving Advance Directive CompletionJOURNAL OF NURSING SCHOLARSHIP, Issue 3 2010Christine R. Durbin RN Abstract Purpose: To systematically analyze evidence about the outcome and percent of newly completed ADs, focusing on the effectiveness of (a) types of educational interventions versus controls and (b) one educational intervention over another. Design: Systematic review of literature based on Cochrane review criteria. Methods: Twelve randomized and four nonrandomized studies were selected from the nursing, medical, and social work literature that met the following criteria: described educational interventions, provided information to calculate the percent of newly completed ADs as an outcome, and published between 1991 and 2009. The review focused primarily on randomized studies. Reviewers calculated the percent of newly completed ADs by determining the number of subjects per group without an AD at baseline and the percentage of those who then completed one by the end of the studies. Findings: Findings were inconsistent regarding all types of educational interventions studied versus controls. Sufficient evidence exists to conclude that combined written and verbal educational interventions were more effective than single written interventions in increasing the percent of newly completed ADs in adult clinic outpatients and hospitalized elderly. Conclusions: Calculating the percent of newly completed ADs was successful in allowing for study result comparisons. Overall, the evidence base regarding the effectiveness of single or combined educational interventions in increasing AD completion is weak. Randomized studies with diverse samples should be conducted against controls before more studies comparing interventions are undertaken. Clinical Relevance: This article provides nurses with a summary of research related to educational interventions and AD completion and identifies where future study is needed. [source] Effective Strategies for Implementing a Multicenter International Clinical TrialJOURNAL OF NURSING SCHOLARSHIP, Issue 2 2008Leanne M. Aitken Purpose:International collaboration in research is essential in order to improve worldwide health. The purpose of this paper is to describe strategies used to administer an international multicenter trial to assess the effectiveness of a nursing educational intervention. Design:The study design was a two-group randomized multicenter international clinical trial conducted to determine whether a brief education and counselling intervention delivered by a nurse could reduce prehospital delay in the event of symptoms suggestive of acute coronary syndrome (ACS) in patients previously diagnosed with cardiovascular disease. Method:A flexible but well-defined project structure showed intervention consistency in five sites among three countries and included experienced project coordinators, multidimensional communication methods, strategies to optimize intervention fidelity, site-specific recruitment and retention techniques, centralized data management, and consideration of ethical and budgetary requirements. Findings:Staff at five sites enrolled 3,522 participants from three countries and achieved 80% follow-up obtained at both 12 and 24 months. Conclusion:Multidimensional approaches to maintain consistency across study sites, while allowing flexibility to meet local expectations and needs, contributed to the success of this trial. Clinical Relevance:In order to support appropriate development of an evidence base for practice, nursing interventions should be tested in multiple settings. A range of strategies is described in this paper that proved effective in conducting a multicenter international trial. [source] Health Promotion and Risk Reduction in Malawi, Africa, Village WomenJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 2 2001FAAN, Susan Gennaro RN Objective: A train-the-trainer intervention was evaluated in which village leaders in Malawi, Africa, taught other villagers how to improve their health. Design: Health knowledge and reported health practices were compared before and after the educational intervention in 15 villages in Chimutu, Malawi, Africa. Setting: Surveys were completed by trained data gatherers in the village setting. Patients/Participants: All men and women of childbearing age who were present in the village when data collection occurred were asked to participate. There were 187 participants in the preintervention survey and 175 participants in the postintervention survey. Intervention: Seveniy-six village women were trained, using low literacy techniques, to provide content on health promotion and risk reduction in pregnancy. Over 20,000 persons have received at least one health teaching session from the village trainers. Results: The intervention resulted in reported changes in prenatal and postpartum care and in more births occurring in the hospital or clinic. Some positive nutritional changes were reported, although few changes in beliefs about use of herbal medicines or about the use of witchcraft were reported. Conclusions: A train-the-trainer approach is a sustainable intervention that appears to have positive benefits on the health of village women living in Malawi, Africa. [source] Testing the effectiveness of an educational intervention aimed at changing attitudes to self-harmJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 1 2007P. PATTERSON phd ba (hons) rmn rgn cert ed Nurses' attitudes toward service users who repeatedly self-harm can be negative and may interfere with the user's willingness to engage with services. The effectiveness of an educational intervention aimed at improving nurses' attitudes in this area was tested in this study. The intervention consisted of attendance on an accredited course on self-harm over a period of 15 weeks and the outcome of interest was attitudes as measured by the Self Harm Antipathy Scale. When deployed in a before-and-after design with two non-randomly allocated groups, there was evidence of a 20% reduction in antipathy toward self-harm among course attenders maintained over a period of at least 18 months (compared with a 9% reduction in a comparison group). Three of the six Self Harm Antipathy Scale attitude dimensions showed significant short-term change with some further long-term effects. This is preliminary evidence for the effectiveness of the chosen intervention in reducing overall antipathy toward self-harm clients and enhancing a sense of competence, a valuing of the care process and an awareness of the factors contributing to self-harm. [source] Evaluation of HIV/AIDS Education in Russia Using a Video ApproachJOURNAL OF SCHOOL HEALTH, Issue 6 2000Mohammad R. Torabi ABSTRACT: HIV/AIDS has intruded upon the geographic, political, ethnic, gender, and sexual orientation of communities all over the world. As of April 1999, Russia has recorded approximately 13,532 cases of HIV infection. Since the costs of treatment are expensive for many countries, and especially for Russia, educational intervention appears to offer the most effective and affordable solution. A quasi-experimental design, with pre/post tests and intervention (through video education)/control groups, was used to study 20 public schools in St. Petersburg, Russia. Results confirmed the lack of HIV/AIDS education in schools and insufficient information sources from parents, friends, and public health education. ANCOVA statistics demonstrated that use of video education significantly improved students' scores on knowledge and attitudes related to HIV/AIDS prevention. Thus, health educators should consider video education as an effective and efficient tool to present facts to a young audience when they face constraints of shortage of funds, lack of trained teachers, and scarcity of related information. [source] A qualitative study examining tensions in interdoctor telephone consultationsMEDICAL EDUCATION, Issue 8 2006Anupma Wadhwa Objective, Communication skills have gained increasing attention in medical education. Much of the existing literature and medical curricula addresses issues of doctor,patient communication. The critical importance of communication between health professionals, however, is now coming under the spotlight. The interdoctor telephone consultation is a common health care setting in which health professional communication skills are exercised. Breakdowns in this communication commonly occur and, surprisingly, this skill is not formally addressed in medical training. This study sought to clarify the communication issues that can occur during interdoctor telephone consultations in order to inform future educational initiatives in this domain. Methods, Data were collected and triangulated among 3 sources: documentation of 129 telephone consults received; 51 hours of field observations of consultants, and semi-structured interviews of 12 callers and 12 consultants. Analysis was performed using grounded theory methodology. Results, Overwhelmingly, participants described tensions with telephone consultation communication. Recurrent theme analysis revealed 5 key sources of tension: discursive features; context; fragmented clinical process; reason for call, and responsibility. Often, callers and consultants viewed similar instances in different and opposite manners, contributing to difficulties in the exchange. Further, a vicious cycle in which a participant's strategies to mitigate tension actually increased tension for the other participant was identified. Conclusions, Interdoctor telephone consultation has become an integral part of medical practice; however, tensions within this exchange can undermine its effectiveness. The results of this study provide a preliminary theory upon which an educational intervention to improve this communication skill can be based. [source] The transition from knowing to doing: teaching junior doctors how to use insulin in the management of diabetes mellitusMEDICAL EDUCATION, Issue 8 2003Jennifer J Conn Objective To develop and evaluate a short education programme to improve the skills and confidence of junior doctors in managing the glycaemic control of inpatients with diabetes mellitus. Methods A total of 15 junior doctors completed two 1-hour workshops on the practical skills required to manage the glycaemic control of insulin-treated patients. The workshops were based on simulated case scenarios presented in a workbook format. Pre-workshop performance and levels of confidence were tested, using a set of tasks matched to the learning objectives. Participants were re-tested immediately after the second workshop and again after 3 months. Results There was a significant overall effect for time of testing for performance and confidence considered together, F(4,11) = 12.67, P = 0.000, power = 1.00. The mean score for performance for the intermediate and 3-month post-tests combined was significantly higher than the mean performance score for the pre-test (11.00 < [17.53 + 15.80]), t(56) = ,6.50, P = 0.000 (95% CI ,6.15, ,3.10). The mean score for confidence for the intermediate and 3 month post-tests combined was higher than the mean for the pre-test (13.20 < [15.33 + 15.20]), t(56) = 2.95, P = 0.011 (95% CI 2.19, 0.46), although this result must be treated with caution. Conclusions A brief educational intervention can improve and maintain the performance and confidence of junior doctors in managing patients with insulin-treated diabetes in a simulated environment. [source] A needs-based study and examination skills course improves students' performanceMEDICAL EDUCATION, Issue 5 2003Lutz Beckert Background, Adult learning theory suggests that learning is most effective when related to need, when driven by the learner and when it is flexible. We describe the effect of an educational intervention that was driven by student need, and largely designed by students. Methods, We undertook a needs assessment of fifth year medical students' study needs. Based on this, we helped them design a course to meet these needs. This was predominantly related to study skills and a practice objective structured clinical examination (OSCE). We evaluated the course by asking for student opinion and by measuring the effect on student performance in a high stakes medical school examination (written examination and OSCE). Findings, Despite the course being run voluntarily and in after-hours sessions, 80,90% of the medical student class attended each session. Student performance on the end of year examinations was significantly enhanced in the year of the intervention, compared with previous years and with students from other schools sitting identical examinations in the same year. Interpretation, Learning activities that are directly based on student needs, that focus on study and examination techniques, and that are largely student-driven, result in effective and valuable outcomes. [source] | ||||||||||||||||||||||||||||||||||||||||