Courses For Health Care Professionals Research Articles

E-learning—an interventional element of the PRiVENT project to improve weaning expertise

BackgroundPRiVENT (PRevention of invasive VENTilation) is an evaluation of a bundle of interventions aimed at the prevention of long-term invasive mechanical ventilation. One of these elements is an e-learning course for healthcare professionals to improve weaning expertise. The aim of our analysis is to examine the implementation of the course in cooperating intensive care units.MethodsThe course has been developed through a peer review process by pulmonary and critical care physicians in collaboration with respiratory therapists, supported by health services researchers and a professional e-learning agency. The e-learning platform “weLearn” was made available online to participating healthcare professionals. Feedback on the e-learning programme was obtained and discussed in quality circles (QCs). We measured the acceptance and use of the programme through access statistics.ResultsThe e-learning course “Joint Prevention of Long-Term Ventilation” consists of 7 separate modules with practice-oriented training units as well as a cross-module area and corresponding interactive case studies. Users can receive 23 CME (continuing medical education) credits. The platform was released on July 1, 2021. By June 28, 2023, 214 users from 33 clinics had registered. Most users (77–98%) completed the modules, thus performing well in the test, where 90–100% passed. In the QCs, the users commended the structure and practical relevance of the programme, as well as the opportunity to earn CME credits.ConclusionEspecially for medical staff in intensive care units, where continuous training is often a challenge during shift work, e-learning is a useful supplement to existing medical training.Trial registrationThe PRiVENT study is registered at ClinicalTrials.gov (NCT05260853) on 02/03/2022.

Opinions and approaches of pediatric surgery specialists and residents about neonatal resuscitation program-nrp: survey study

Aims: The Neonatal Resuscitation Program (NRP) is a course for healthcare professionals who can be called "those who touch the baby at the time of birth". The knowledge and skills obtained through this training program can be used in infant resuscitation at the time of birth and neonatal period resuscitation, which includes the first 30 days of life. It is aimed to evaluate the approaches of pediatric surgeons and research assistants in terms of their opinions and practices regarding NRP, as there are publications in the literature about the NRP experiences of other healthcare professionals. Methods: After receiving the approval of the Ethics Committee,the survey was published as a descriptive and cross-sectional study via the Google Docs system, and the participation of pediatric surgeons and research assistants was requested. Our research was conducted between October 2023 and March 2024 by asking the participants survey form questions via communication tools such as e-mail, telephone, social media, Internet. Data were sent to participants in the form of electronically prepared survey forms via e-mail addresses and social media platforms. It was collected electronically within the date ranges determined for the research. Results: Thirty-seven participants were male, and 40 participants were female. The average age of 77 pediatric surgeons who participated in the survey was determined to be 43.8 years old. Seventeen of the participants are research assistants; 24 of them are specialist physicians; 10 of them are Dr. Lecturers; 12 of them are associate professors; 14 of them were professors. It was determined that 48 of 77 physicians took the NRP course. It has been determined that those who took the NRP course can contribute more to resuscitation practices. Conclusion: It has been stated that pediatric surgeons are familiar with NRP applications and that as clinical experience increases, even among those who have not taken the course, interventions by NRP can be performed. It is seen that pediatric surgeons can effectively participate in NRP courses.

A Long-Term Impact of the Courses for Healthcare Professionals on Patients’ Perspectives on Medicines Use – A Qualitative Study

A Long-Term Impact of the Courses for Healthcare Professionals on Patients’ Perspectives on Medicines Use – A Qualitative Study

Reducing epilepsy diagnostic and treatment gaps: Standardized paediatric epilepsy training courses for health care professionals.

To evaluate improvement in knowledge and clinical behaviour among healthcare professionals after attendance at paediatric epilepsy training (PET) courses. Since 2005, 1-day PET courses have taught evidence-based paediatric epilepsy management to doctors and nurses in low-, middle-, and high-income countries. A cohort study was performed of 7528 participants attending 252 1-day PET courses between 2005 and 2020 in 17 low-, middle-, and high-income countries, and which gathered data from participants immediately after the course and then 6 months later. Training outcomes were measured prospectively in three domains (reaction, learning, and behaviour) using a mixed-methods approach involving a feedback questionnaire, a knowledge quiz before and after the course, and a 6-month survey. Ninety-eight per cent (7217 of 7395) of participants rated the course as excellent or good. Participants demonstrated knowledge gain, answering a significantly higher proportion of questions correctly after the course compared to before the course (88% [47 883 of 54 196], correct answers/all quiz answers, vs 75% [40 424 of 54 196]; p < 0.001). Most survey responders reported that the course had improved their epilepsy diagnosis and management (73% [311 of 425]), clinical service (68% [290 of 427]), and local epilepsy training (68% [290 of 427]). This was the largest evaluation of a global epilepsy training course. Participants reported high course satisfaction, showed knowledge gain, and described improvements in clinical behaviour 6 months later. PET supports the global reduction in the epilepsy 'treatment gap' as promoted by the World Health Organization.

Dementia and Nutrition: A Multidisciplinary Massive Open Online Course for Health Care Professionals, Students and Non‐Professionals

AbstractBackgroundMore than 55 million people worldwide have dementia. This number will increase in the future, causing strains on healthcare systems. In‐depth knowledge about dementia and its negative effects, such as nutritional problems, is necessary to pursue targeted prevention strategies and to provide adequate treatment and care. Therefore, the aim of the project was to develop a Massive Open Online Course (MOOC) on dementia and nutrition for the healthcare sector. Such MOOCs can reach many users and have proven effective for self‐directed continuous professional development.MethodsThe MOOC was developed for students and professionals in health care as well as for non‐professionals, like relatives of people with dementia, in German‐speaking countries as a joint project from 2021‐2022. Different disciplines (dietetics, nutritional scientists, nursing scientists, occupational therapists, speech and language therapists, nutritional geragogists, medical doctors, technological disciplines, social scientists) and institutions, like universities, developed the content of the MOOC based on design principles, international literature and expert knowledge. The online course was made available free of charge on the iMooX platform of the Technical University of Graz, Austria (https://imoox.at/mooc/).ResultsThe MOOC consists of 6 lessons which can be completed in a period of 6 weeks. The lessons include the following topics: (1) background information on dementia, like prevalence of dementia and costs; (2) risk factors for dementia, prevention and nutrition concepts; (3) impact of dementia on eating behaviors; (4) practical aspects of nutrition in dementia, like appetite stimulation; (5) activities of daily living &amp; eating support; and (6) new technologies (e.g. robots, virtual reality) for prevention and support of eating problems. The content is delivered to the participants by means of videos and learning materials via various end devices. Each lesson ends with a quiz. Participants who answer at least 75% of the self‐assessment questions correctly receive a certificate.ConclusionThe MOOC was successfully launched on January 17, 2023 (https://imoox.at/course/demern) and has already had more than 200 participants in the first round. In the future, an English‐language version is planned in order to further increase the number of people that can profit from the MOOC.

Using AI to Evaluate a Competency-Based Online Writing Course in Nursing

Nursing education is transitioning from traditional teaching to competency-based education. Additionally, more nursing courses and programs are now offered online. Scholarly writing is a powerful strategy to teach effective communication and critical thinking, both core competencies for safe and effective nursing practice. However, teaching writing online to nursing students is challenging due to a lack of research evaluating best practices, faculty time constraints, and inconsistent writing assessment. Automated essay scoring systems using artificial intelligence (AI) provide new opportunities for efficient, reliable, and valid assessment of writing skills. We used a quasi-experimental design to investigate the impact of a 14-week fully online competency-based writing course on students’ self-efficacy, task value, and writing performance. The participants were master’s nursing students enrolled in an existing one-semester online competency-based writing course for healthcare professionals. An AI-powered writing assessment, IntelliMetric®, and the SAWSES self-efficacy survey were administered pre- and post-intervention. The results showed statistically significant gains in self-efficacy and writing performance with large effect sizes. This study addresses the gap in nursing education regarding the assessment of online, research-based writing interventions on students’ scholarly writing capacity. Recommendations include implementing a required scholarly writing course in all graduate-level nursing programs, scaffolding students’ competency development with the cognitive apprenticeship model, using best practices from composition research to inform online instruction, and employing AI-powered automated essay scoring to evaluate students’ writing progress and instructional efficacy.

Assessing Barriers and Facilitators for Implementing Clinical Practice Guidelines in Middle Eastern and North African Region: Delphi Study.

Clinical practice guidelines (CPGs) improve clinical decision making and patient outcomes, but CPG implementation is poor. The success of CPGs is influenced by several factors related to barriers and facilitators. For this reason, it can be extremely useful to explore key barriers and facilitators of CPG implementation in the Middle East and North Africa (MENA). A three-round Delphi study was performed using the input of 30 experts involved in the clinical practice guidelines. In the first two rounds, participants were asked to score each statement relevant to barriers or facilitators for CPG implementation on a five-point Likert scale. These statements were identified from existing systematic reviews and expert input. In round three, participants ranked the most important barriers and facilitators identified from rounds one and two. A descriptive analysis was conducted on the barrier and facilitators statements using frequencies, percentages, and medians to summarize the variables collected. We identified 10 unique barriers and 13 unique facilitators to CPG implementation within the MENA region. The two highest-ranked barriers related to communications and available research and skills. The most important facilitator was the availability of training courses for healthcare professionals. Key barriers and facilitators to the implementation of clinical practice guidelines seem to exist in professional, organizational, and external contexts, which should all be taken into account in order to increase implementation success within MENA region. The results of this study are useful in the design of future implementation strategies aimed at overcoming the barriers and leveraging the facilitators.

Continuing education with a holistic approach to the Brazilian LGBT+ population through use of the m-health App

AimThis article aims to discuss the development of a continuing education course for health care professionals to provide competent healthcare assistance to the Brazilian LGBT+ population and the implementation of this course using a m-Health solution. BackgroundThere is a scarcity of continuing education courses in the Brazilian context that update provides evidenced-informed education to ensure health care professional competence in the delivery of health care to LGBT+ individuals. MethodsBased on Bloom's taxonomy, with a main focus on the cognitive domain, the course "Ally: A Holistic Approach to the LGBT+ Individual'' was developed in five months. This was based on the Nurse's Health Education for LGBT Seniors (HEALE), the Curriculum Implementation and Institutional Climate manual, Changes to Improve Healthcare for LGBT People, Gender Nonconforming or Born with DSD" and the National Comprehensive Health Policy for LGBT+ People, among others. ResultsComprising six modules: i) human sexuality; ii) equitable care and appropriate terminology; iii) public health policy for the LGBT+ population; iv) cultural skills for health professionals; v) aging and health care for the LGBT+ population; and vi) mental health of LGBT+ people. Content validity indexing was established using an expert panel and was Ally was supported by a m-Health Solution called “Over the Rainbow'' and totals of 60 h of education. ConclusionsThis m-Health solution and continuing education course for health professionals can be an opportunity to change health professionals’ practice to offer more equitable health care for the LGBT+ population.

Health care professionals' perceptions of unprofessional behaviour in the clinical workplace.

Unprofessional behaviour undermines organizational trust and negatively affects patient safety, the clinical learning environment, and clinician well-being. Improving professionalism in healthcare organizations requires insight into the frequency, types, sources, and targets of unprofessional behaviour in order to refine organizational programs and strategies to prevent and address unprofessional behaviours. To investigate the types and frequency of perceived unprofessional behaviours among health care professionals and to identify the sources and targets of these behaviours. Data was collected from 2017-2019 based on a convenience sample survey administered to all participants at the start of a mandatory professionalism course for health care professionals including attending physicians, residents and advanced practice providers (APPs) working at one academic hospital in the United States. Out of the 388 participants in this study, 63% experienced unprofessional behaviour at least once a month, including failing to respond to calls/pages/requests (44.3%), exclusion from decision-making (43.0%) and blaming behaviour (39.9%). Other monthly experienced subtypes ranged from 31.7% for dismissive behaviour to 4.6% for sexual harassment. Residents were more than twice as likely (OR 2.25, p<0.001)) the targets of unprofessional behaviour compared to attending physicians. Female respondents experienced more discriminating behaviours (OR 2.52, p<0.01). Nurses were identified as the most common source of unprofessional behaviours (28.1%), followed by residents from other departments (21%). Unprofessional behaviour was experienced frequently by all groups, mostly inflicted on these groups by those outside of the own discipline or department. Residents were most frequently identified to be the target and nurses the source of the behaviours. This study highlights that unprofessional behaviour is varied, both regarding types of behaviours as well as targets and sources of such behaviours. This data is instrumental in developing training and remediation initiatives attuned to specific professional roles and specific types of professionalism lapses.

Feasibility and preliminary evaluation of internet-based compassion and cognitive–behavioral stress-management courses for health care professionals: A randomized controlled pilot trial

Health care professionals (HCPs) are exposed to excessive demands in their work environment. In Sweden, work-related stress is one of the most common reasons for sick leaves. Finding cost-effective and easily accessible interventions for HCPs is crucial to counteract stress-related problems and reduce the number of sick leaves. The study aimed to evaluate the feasibility of two internet-based stress management courses and their preliminary effectiveness to reduce HCPs' stress of conscience and work-related stress, and act as a pilot for a larger randomized controlled trial (RCT). Thirty-two HCPs registered for the courses and were randomized to either an internet-based compassion course, ICOP (n = 18), or an internet-based cognitive–behavioral course, ICB (n = 14). Participants completed measures pre- (i.e., baseline, n = 32), post-intervention (at five weeks, n = 21), and at follow-up at 10 weeks (n = 17), 15 weeks (n = 13), and six months (n = 12). The study used the following scales: Stress of Conscience Questionnaires, Copenhagen Psychosocial Questionnaire, Self-Compassion Scale, and Professional Quality of Life Scale. Adherence of HCPs (n = 21) was measured using the number of logins, messages between course leaders and HCPs, and completed modules. Twelve interviews were conducted to explore participants' perceptions of the accessibility of the courses. Participants reported overall satisfaction with both the ICOP and ICB courses, stating that the courses contributed to new knowledge, individual insight, and behavior change. Both courses showed similar patterns of adherence. Quantitative analyses on pre-and post-intervention data (n = 21) showed that stress of conscience and secondary traumatic stress decreased, and self-compassion increased following ICOP. Following ICB, HCPs reported decreased burnout symptoms (according to one of two questionnaires) and increased compassion satisfaction. Both courses seemed feasible, showed promising results, and could be further evaluated in a larger study with a similar design.

Online and Blended Learning Courses for Healthcare Professionals and Policymakers on Patients' Perspectives on Medicine: A Project Report.

In order for healthcare professionals to better engage with patients, they need to understand and integrate the perspectives of patients into their daily work. In this project, we developed two courses for healthcare professionals on patients’ perspectives on medicine. One course was an online course that introduced the patients’ perspectives on medicine and explained its importance for healthcare and health policy. The second course was a blended learning course, consisting of online modules and face-to-face webinars, which specified how to explore patients’ perspectives in qualitative interviews, and how to develop implementation plans. Patients participated in the development, execution, and evaluation of both courses. Overall, more than 2000 healthcare professionals enrolled in the first course and, in just over a year, 191 participants completed the online course; 57 healthcare professionals registered in the second blended learning course and six participants completed both components of the course. The relevance of knowledge gained was positively evaluated. Participants especially appreciated the participation of patients. Based on the feedback, the second blended learning course was adapted to run online and both courses continue to be freely available to all interested healthcare professionals on the Coursera platform.

A digital online platform for education and certification of diabetic retinopathy health care professionals in the Region of Southern Denmark.

PurposeThe incidence of diabetes continues to increase across the world. As the number of patients rises, so does the need for educated health care professionals. Diabetic retinopathy (DR) remains one of the primary complications in diabetes, and screening has proved to be a cost‐effective measure to avoid DR‐related blindness. Denmark has an established screening programme, but no formal training of the people responsible for analysing retinal images.MethodsWe here present an online learning platform that offers a diabetic eye screening course for health care professionals undertaking screening responsibility in the Region of Southern Denmark. The course is divided into lectures, each focussed on identifying different levels of DR or detecting related lesions. The course is free to use on‐demand, contains instructional videos, interactive tests and exercises, and it is concluded with a certification test. The tools on the platform can in addition be used to generate data for research purposes, such as comparing users or experts in detection of lesions or annotating data for the development of machine learning models.ResultsMore than 150 participants have so far completed the course, and the platform is being adopted for education in other regions of Denmark.

Developing an e-learning course on the use of PRO measures in oncological practice: health care professionals\u2019 preferences for learning content and methods

PurposeImplementation of patient-reported outcome measures (PROMs) in clinical routine requires knowledge and competences regarding their use. In order to facilitate implementation, an e-learning course for health care professionals (HCPs) on the utilisation of European Organisation for Research and Treatment of Cancer (EORTC) PROMs in oncological clinical practice is being developed. This study aimed to explore future users’ educational needs regarding content and learning methods.MethodsThe sequential mixed methods approach was applied. A scoping literature review informed the guideline for qualitative interviews with HCPs with diverse professional backgrounds in oncology and cancer advocates recruited using a purposive sampling strategy. An international online survey was conducted to validate the qualitative findings.ResultsBetween December 2019 and May 2020, 73 interviews were conducted in 9 countries resulting in 8 topic areas (Basic information on PROs in clinical routine, Benefits of PRO assessments in clinical practice, Implementation of PRO assessments in clinical routine, Setup of PRO assessments for clinical application, Interpretation of PRO data, Integration of PROs into the communication with patients, Use of PROs in clinical practice, Self-management recommendations for patients based on PROs) subsequently presented in the online survey. The online survey (open between 3 June and 19 July 2020) was completed by 233 HCPs from 33 countries. The highest preference was indicated for content on interpretation of PRO data (97%), clinical benefits of assessing PRO data (95.3%) and implementation of routine PRO data assessment (94.8%). Regarding learning methods, participants indicated a high preference for practical examples that use a mixed approach of presentation (written, audio, video and interactive).ConclusionEducational needs for an integration of PROs in communication in clinical care and coherent implementation strategies became evident. These results inform the development of an e-learning course to support HCPs in the clinical use of EORTC PRO measures.

End of Life Care and Advance Care Planning for People with Dementia: A Pilot Simulation Course for Healthcare Professionals

BackgroundDementia care is a serious public health concern. Many healthcare professionals lack education in providing quality end of life (EOL) care and advance care planning (ACP) for those affected. Simulation-based education (SBE) is suggested as an educational tool to practice human factor skills through simulated clinical settings. Sample21 healthcare professionals volunteered from an EOL pilot simulation education course. Methods: A one-day simulation course with The Human Factors Skills for Healthcare Instrument and a course-specific questionnaire completed at pre- and post-course for evaluation. ResultsParticipants’ human factor skills, confidence, and knowledge on EOL care and ACP significantly improved after the SBE course, p < .001. ConclusionThis study suggests SBE as a viable tool to improve healthcare professionals’ human factor skills and confidence in and knowledge of EOL care and ACP for dementia care. Further research should aim to investigate SBE's direct impact on clinical practice.

1314 Ad-Hoc Suturing Course Teaching: A Valuable Tool for A New Starter

Abstract Aim The study aims to assess effectiveness of a three-hour suturing skills course for healthcare professionals at a tertiary hospital in London. Intended outcomes were improvement in confidence and proficiency at simple interrupted sutures. Method Four suturing sessions were delivered over five months to healthcare workers new to the clinical setting. The session included lecture, video, and practical skills. Participants completed a pre- and post-course survey to measure confidence levels in suturing using Likert scale. Participants performed simple interrupted sutures for 10 minutes in a pre- and post-course assessment. Performance was assessed using a suturing proficiency proforma. Pre- and post-course data was compared to assess improvement. Results Fifty participants attended the course. 93% had previous suturing teaching. Pre-course confidence in simple interrupted suture was 3.1 (SD = 1.2) and post course was 4.8 (SD = 0.2). One tailed T score was 14.7, and the difference was significant (p &amp;lt; 0.05). Pre- and post-course assessment demonstrated improvement in the following parameters and participant proportions: handling of the needle driver (50%, n = 25), adequate placement of needle driver (68%, n = 34), appropriate needle angle entering skin (60%, n = 30), following needle curve (36%, n = 18), non-touch technique (64%, n = 32), surgical knot tying (56%, n = 28). Average number of sutures completed in 10 minutes increased by 1.9 times. Conclusions The majority of participants had previously been taught suturing in other settings; however, data demonstrated improvement in confidence and performance. Ad-hoc suturing skill teaching is a valuable tool to increase confidence of healthcare workers at early stages in their careers.

Building capacity in times of crisis: Increasing cultural competence of healthcare professionals in the context of the COVID-19.

Nurses are the frontline healthcare professionals fighting the medical and social effects of the current COVID-19 pandemic. Although they work with diverse populations, there is a lack of literature on culturally competent education during an emergency such as a pandemic. To examine the effectiveness of an online education programme aimed at increasing cultural competence among rescue teams and healthcare professionals facing the challenges of the COVID-19 pandemic. Pre-post-web-based intervention study. Pre-post-intervention surveys were administered to a matched sample of Israeli healthcare and rescue organisation professionals. The initial sample included 303 participants (52% women) who completed the pre-intervention survey. More than half of the sample (56%, n=170) were paid workers or volunteers in health organisations. Of the initial sample, 154 participants completed the post-intervention survey following the online cultural competence education programme. Descriptive statistics and multivariate analysis were used to evaluate participants' gains in culturally competent attitudes, knowledge, skills and encounters. This study followed the STROBE guidelines. Participants found the online programme useful in improving their cultural competence during the COVID-19 pandemic. The highest gains were found in the attitudes domains, whereas the lowest in the knowledge domain. Pre-intervention cultural competence scores and incorporating the programme in the educational curricula predicted increased gains in cultural competence. Online educational interventions showed potential for increasing professionals' awareness of cultural biases, differences and attitudes, leading to more open and accepting attitudes towards patients of different backgrounds. Recognising the need for real-time, low-cost and available training, the World Health Organization recommended using online courses for healthcare professionals struggling in the pandemic frontline. Online education programmes provide a useful platform for training health professionals in times of emergency.

Protransition – an online-course for professionals to optimize the health care service for young people with mental illness in transition from adolescence to adulthood

IntroductionAdolescent transitions to adulthood are a vulnerable phase for the development of mental illnesses. Additionally, there are often disruptions in psychiatric care delivery during the transition phase, potentially leading to a considerable treatment delay with a high risk of early chronification. Thus, the health care system and professionals in both child and adolescent psychiatry and adult psychiatry should be given greater consideration to the transition phase.ObjectivesThe aim of the project ProTransition is the development of an online course for health care professionals to give in-depth knowledge of “transition psychiatry”, practical guidance and to sensitize them for the special challenges and needs of young adults with mental illness.MethodsThe online-course is being developed at the Department of Child and Adolescent Psychiatry/ Psychotherapy, Ulm and is expected to start in May 2021. It comprises e.g. special psychopathology of emerging adulthood, clinical interventions for adolescents with mental illness or legal aspects. An innovative and multi-didactical approach with specialized texts, case-studies, online-chats and interviews with experts and young people is applied. Additionally, user satisfaction with the online course will be evaluated.ResultsOn the basis of the gained experiences, ideas for new transition-psychiatric treatment models will be derived. The accompanying research will point out the status quo and the course-related increasing knowledge of health care professionals regarding transition psychiatry. First results are expected in November 2021.ConclusionsAs transition psychiatry is facing great difficulties and challenges, professionals should be adequately educated. E-Learning offers a flexible and low-level approach to reach a broad target group.

Educational courses for healthcare professionals in research writing

Educational courses for healthcare professionals in research writing

O enfermeiro e a criança: a prática do brincar e do brinquedo terapêutico durante a hospitalização

Objetivou-se identificar o conhecimento dos enfermeiros quanto à prática do brincar e do Brinquedo Terapêutico na hospitalização da criança. Estudo descritivo com abordagem qualitativa, realizado com 10 enfermeiros que atuam em um hospital público infantil no Norte de Santa Catarina, por meio de uma entrevista semiestruturada, no ano de 2018. Os dados foram analisados conforme o método da análise temática. Emergiram quatro categorias temáticas: o brincar e o enfermeiro; o brincar como parte do tratamento; o brincar em um ambiente favorável; a abordagem do enfermeiro e o uso do brinquedo/Brinquedo Terapêutico. Os resultados mostram que os enfermeiros reconhecem a importância do brincar durante a hospitalização da criança, considerado uma forma de aproximação com o infante. Verifica-se também o desconhecimento dos enfermeiros em relação à tecnologia do uso do Brinquedo Terapêutico durante a hospitalização como uma ferramenta de cuidados da enfermagem. Ressalta-se a importância da abordagem deste conteúdo nos cursos de graduação em enfermagem, especialização e residência em enfermagem pediátrica e a realização de cursos de capacitação para os profissionais da prática assistencial.

A staff training intervention to improve communication between people living with dementia and health-care professionals in hospital: the VOICE mixed-methods development and evaluation study

BackgroundTwenty-five per cent of hospital beds are occupied by a person living with dementia. Dementia affects expressive communication and understanding. Health-care professionals report a lack of communication skills training.ObjectivesTo identify teachable, effective strategies for communication between health-care professionals and people living with dementia, and to develop and evaluate a communication skills training course.DesignWe undertook a systematic literature review, video-recorded 41 encounters between staff and people with dementia, and used conversation analysis to investigate communication problems and solutions. We designed a communication skills training course using coproduction and multiple pedagogic approaches. We ran a pilot, followed by six courses for health-care professionals. We measured knowledge, confidence and communication behaviours before, immediately after and 1 month after the course, and undertook interviews with participants and managers. Behaviours were measured using blind-rated videos of simulations.SettingGeneral hospital acute geriatric medical wards and two hospital clinical skills centres.ParticipantsWe video-recorded 26 people with dementia and 26 professionals. Ten experts in dementia care, education, simulation and communication contributed to intervention development. Six health-care professionals took part in a pilot course, and 45 took part in the training.ResultsThe literature review identified 26 studies describing 10 communication strategies, with modest evidence of effectiveness. Health-care professional-initiated encounters followed a predictable phase structure. Problems were apparent in requests (with frequent refusals) and in closings. Success was more likely when requests were made directly, with high entitlement (authority to ask) and with lowered contingencies (made to sound less difficult, by minimising the extent or duration of the task, asking patients ‘to try’, offering help or proposing collaborative action). Closings were more successful if the health-care professional announced the end of the task, made a specific arrangement, body language matched talk, and through use of ‘closing idioms’. The training course comprised 2 days, 1 month apart, using experiential learning, including lectures, video workshops, small group discussions, simulations (with specially trained actors) and reflections. We emphasised the incorporation of previous expertise and commitment to person-centred care. Forty-four participants returned for the second training day and 43 provided complete evaluation data. Knowledge and confidence both increased. Some behaviours, especially relating to closings, were more commonly used after training. The course was rated highly in interviews, especially the use of simulations, real-life video clips and interdisciplinary learning. Participants reported that they found the methods useful in practice and were using them 1 month after the course finished.LimitationsData were from people with moderate to severe dementia, in an acute hospital, during health-care professional-initiated interactions. Analysis was limited to problems and solutions that were likely to be ‘trainable’. Actors required careful preparation to simulate people with dementia. Communication skills training course participants were volunteers, unlikely to be representative of the general workforce, who displayed high levels of baseline knowledge, confidence and skills. Before-and-after evaluations, and qualitative interviews, are prone to bias.ConclusionsRequests and closings pose particular difficulties for professionals communicating with people with dementia. We identified solutions to these problems and incorporated them into communication skills training, which improved knowledge, confidence and some communication behaviours. Simulation was an effective training modality.Future workFurther research should investigate a wider range of health, social care and family carers. Conversation analysis should be used to investigate other aspects of health-care communication.Study registrationThe systematic literature review is registered as CRD42015023437.FundingThe National Institute for Health Research Health Services and Delivery Research programme.