Multimodal Education Research Articles

Assessing Barriers and Facilitators to Participation in a Nurse-Driven, Opt-Out HIV Screening Program in the Emergency Department

Emergency department (ED) HIV screening is a key component of the strategy to end the HIV epidemic, reaching populations with limited access to care for screening and early diagnosis. Many screening programs rely primarily on participation from ED nurses; however, little is known about the factors affecting nurse participation in screening. Guided by the Consolidated Framework for Implementation Research, 20 semi-structured interviews were conducted with ED nurses to explore perceptions of HIV screening, barriers and facilitators to participation, and implementation insights. Nurses were categorized as either high adopters or low adopters based on the number of HIV tests ordered 3 months prior to interviews. The Stanford Lightning Report Method, a rapid qualitative analysis approach, was used to analyze field notes. All participants generally agreed that the ED was an appropriate location for screening and that frequent, multimodal education about screening was needed. Integration of screening into standard workflows, education about the public health impact of screening, and the use of peer champions and mentors were identified as important strategies to increase participation. By incorporating these findings into implementation strategies, EDs may be able to increase nurse participation in screening, addressing important health equity issues in HIV diagnosis.

Lifestyle changes and patient-reported outcomes over five years in a sample of people with multiple sclerosis after a single multimodal intensive lifestyle education workshop.

Modifiable lifestyle risk factors for progression of multiple sclerosis (MS) have been increasingly studied. This study employed a single-group design involving a one-off intensive live-in educational workshop on lifestyle modification for people with MS. We aimed to examine changes in a range of clinical and lifestyle variables and quality of life, self-efficacy, physical impact of MS and disability from baseline to 3- and 5-years post-intervention. 95 participants completed the baseline survey. Data included lifestyle risk factors of diet quality, meat and dairy consumption, omega 3 and vitamin D supplementation, physical activity, stress reducing activities, and smoking status, and use of disease-modifying therapies (DMTs). Patient-reported outcomes included health-related quality of life, self-efficacy, physical impact of MS and disability. Generalised estimating equation models were used to account for within-participant correlation over time. Sixty participants (63.2%) provided data at 3- and 5-years. Significant improvements in diet quality, omega 3 supplementation, and non-smoking were seen at both timepoints. Use of DMTs and disability remained unchanged. Mental (8.8- and 6.9-point) and physical (10.5- and 7.3-point) quality of life, and self-efficacy (2.4- and 1.9-point) improved significantly at 3- and 5-years, respectively. Physical impact of MS reduced from baseline to 3-years (-3.7 points) with a trend towards reduction at 5-years (-2.9 points; p = 0.079). Education on lifestyle modification can lead to lifestyle modification and short and long-term improvements in mental and physical wellbeing outcomes. Results suggest potential value in lifestyle modification as an adjunctive component to standard therapy for MS.

"I'm worth saving"- A Qualitative Study of People with Alzheimer's Disease Considering Lecanemab Treatment.

People with Alzheimer's disease (AD) now have access to disease-modifying treatment with anti-amyloid monoclonal antibodies (mAbs). Their perception of risks and benefits and approach to treatment decisions remain unknown. To understand how people with early AD consider benefits and costs of anti-amyloid mAbs and make decisions about treatment. Qualitative semi-structured interviews. Memory care clinics at two academic medical centers. People with biomarker or imaging-confirmed early AD referred for evaluation for treatment with anti-amyloid mAbs. Themes identified through content analysis. Among 22 participants, mean age was 70 years, 8 (36%) were women, 22 (100%) were White, 8 (36%) had less than a college degree, 11 (50%) had annual income less than $100,000, and 6 (27%) lived in a rural area. The analysis revealed 3 major themes and associated subthemes: 1) People with AD sought and obtained information from different sources-advocacy organizations, the Internet, and clinicians; 2) hopes, expected benefits, and the existential threat of dementia drove willingness and readiness to start lecanemab-hopes included more time feeling like themselves and doing enjoyable activities; expected benefits included stalling progression, reversing cognitive decline or cure; 3) individual traits and preferences, family factors, and degree of trust in expertise influenced how people balanced risks and benefits- some would accept treatment at any cost; others carefully weighed risks and burdens carefully, but were motivated to pursue treatment by supportive families, insurance coverage, and trust in expertise; for a few, costs decidedly outweighed their personal benefits. People with AD desired more individualized information on risks and benefits and wanted to hear more from patients who took the medication. Results from this qualitative analysis inform clinician, health system and policy efforts to promote individualized treatment decisions for anti-amyloid mAb treatment through multimodal education and outreach, evidence-based communication skills, and adaptation of similar care models. Question: How do people with Alzheimer's disease (AD) decide on treatment with newly available anti-amyloid monoclonal antibodies?Findings: In this qualitative analysis, people with AD considering treatment relied on multiple information sources; were motivated by hope to delay cognitive decline and preserve independence; and worried side effects would impair quality of life. Personality traits, family support, and trust in expertise determined how they balanced these tradeoffs. People with AD wanted more personalized information and to hear from others who had taken the medications.Meaning: As access to treatment expands, these findings inform how clinicians can help people with AD make individualized treatment decisions.

Promoting behavioural change by educating anaesthetists about the environmental impact of inhalational anaesthetic agents: A systematic review.

Of the total carbon footprint of Australia, 7% is attributed to healthcare. In the UK, inhalational agents make up 5% of the healthcare carbon footprint. This systematic review aims to determine which methods of education about the environmental impact of inhalational anaesthetic agents can be utilised to promote behaviour change, reducing the anaesthetic-related carbon footprint. This systematic review sourced records from CINAHL, EMBASE, ERIC, JBI and MEDLINE from 1970 to March 2022. The search identified 589 records, 13 of which met eligibility criteria after the screening process, in which 10 of these records were conference abstracts. Education curricula focused on inhalational agent choice (69%), lowering the fresh gas flow during maintenance anaesthesia (69%), encouraging alternatives such as total intravenous anaesthesia (23%) and/or switching off the gas on transfer (8%). The most common teaching techniques utilised in education curricula were didactic lectures (85%), visual prompts (54%), emails (46%), and conversation forums (31%). All but one study reported a positive relationship between teaching sessions and behavioural change resulting in lower inhalational anaesthetic use by participants and their organisations, reducing healthcare-associated emissions. This systematic review has demonstrated that single education sessions as well as multi-focused, multimodal education curricula on the topic of greener anaesthesia can be beneficial in promoting behavioural change.

Enhancing graduate nursing and social work students’ collaboration through screening, brief intervention, and referral to treatment and simulated education

BackgroundNurses and social workers are frontline providers to at-risk patients of substance and alcohol abuse but have limited education. MethodsA one-semester program incorporated multimodal education and simulated patients teaching graduate nursing and social work students SBIRT and interprofessional skills. Students completed the Interprofessional Collaborative Competency Assessment Scale pre- and post-program measuring interprofessional competencies. ResultsOne hundred graduate students (58 social work, 42 nursing) participated across two cohorts. There was significant increase in total competency post-program, t(99) = 7.19, p < .001, and among all subscales. ConclusionMultimodal education with simulation increases graduate students’ interprofessional competency, preparing them for careers with at-risk patients.

Usefulness of low-cost simulation models to learning surgical techniques for placenta accreta spectrum: An observational educational study.

To evaluate the utility of low-cost simulation models to teach surgical techniques for placenta accreta spectrum (PAS), included in a multimodal education workshop for PAS. This was an observational, survey-based study. Participants were surveyed before and after the use of low-fidelity mannequins to simulate two surgical techniques for PAS (one-step conservative surgery [OSCS] and modified subtotal hysterectomy [MSTH]), within a multimodal educational workshop. The workshops included pre-course preparation, didactics, simulated practice of the techniques using low-cost models, and viewing live surgery. Six OSCS/MSTH training workshops occurred across six countries and a total of 270 participants were surveyed. The responses of 127 certified obstetricians and gynecologists (OB-GYNs) were analyzed. Participants expressed favorable impressions of all components of the simulated session. Perceived anatomical simulator fidelity, scenario realism, educational component effectiveness, and self-assessed performance improvement received ratings of 4-5 (positive end of the Likert scale) from over 90% of respondents. When asked about simulation's role in technique comprehension, comfort level in technique performance, and likelihood of recommending this workshop to others, more than 75% of participants rated these aspects with a score of 4-5 (positively) on the five-point scale. Low-cost simulation, within a multimodal education strategy, is a well-accepted intervention for teaching surgical techniques for PAS.

Catheter-associated urinary tract infection prevention: Implementation of a multimodal and evidence-based education program.

Catheter-associated urinary tract infection prevention: Implementation of a multimodal and evidence-based education program.

Reducing Blood Culture Contamination Rates: Introduction of a Combined Education and Skin Antisepsis Intervention.

Background. Blood culture contamination (BCC) is an important quality concern in clinical microbiology as it can lead to unnecessary antimicrobial therapy in patients and increased workload for laboratory scientists. The Clinical Laboratory and Standards Institute recommend BCC rates to be <3 % and recently updated guidelines have set a new goal of 1 %. The aim of this project was to design and implement interventions to reduce BCC rates at our institution. Methods. We introduced a combined education and skin antisepsis intervention in a large Model 4 academic teaching hospital in the South of Ireland. BD ChloraPrep skin antisepsis applicators (2 % chlorhexidine gluconate/70 % isopropyl alcohol), licensed for use for blood culture specimen collection, were introduced, replacing Clinell (2 % chlorhexidine gluconate/70 % isopropyl alcohol) wipes. In addition, a multimodal education programme was designed and delivered. This consisted of a video demonstrating the recommended blood culture specimen collection technique using the new applicators as well as simulation training for all interns. The video was uploaded to the intranet as an educational resource available to all staff. Results. The interventions were implemented in July 2022 and BCC rates pre- and post-intervention were calculated. The average BCC rate for the 12 months preceding the intervention (July 2021 to July 2022) was 2.56 % with highest rates in the Emergency Department. This compared to an average rate of 2.2 % in the 12 months post-intervention (July 2022 to July 2023). In comparing the two rates the reduction in BCC rates between the two periods was not statistically significant (P=0.30). Conclusion. Overall BCC rates reduced but the difference between the two periods did not reach statistical significance. The resource-intensive nature of providing regular and timely feedback of contamination rates and the larger impact of in-person education and training over virtual modalities may explain the modest reduction. Further investments in these areas, particularly in the Emergency Department, will be necessary to further reduce rates in line with new recommendations.

Teaching and Learning About the Transgender Population: Student Reflections.

Decreasing the disparities in health care for transgender people requires nursing to expand its knowledge base about the population. There is limited research and information about curricula integration inclusive of this population, yet much is written about the gap in nursing knowledge and education. There may be insufficient opportunities to expose students to the population as patients; therefore, creative education strategies are necessary. An innovative multimodal education process was implemented in an urban university setting to expose undergraduate nursing students to the population. Lecture, video, live testimonial, and panel discussion were used. Class reflections and survey data revealed three qualitative narrative reflections. Students reported awareness of how to improve their interactions with this population, appreciation for the experience, and meaningfulness of the experience. The experience brought students closer to understanding the need in providing equitable and appropriate care. Multiple modes of teaching were successful in the affective learning domain. More research in ways to enhance nursing education is necessary. [J Nurs Educ. 2024;63(X):XXX-XXX.].

Enhancing Physical Activity Recommendations to Support Cognition in Homecare: A Quality Improvement Project

Background: Physical activity is a safe, evidence-based self-management strategy for older adults (aged 65+) with cognitive impairment. Although homecare occupational therapists (OTs) and physiotherapists (PTs) are well positioned to support the growing number of older adults living at home with cognitive impairment, physical activity is rarely recommended as a strategy to manage cognition. Objective: To increase OTs’ and PTs’ knowledge of physical activity recommendations, as well as increase the range of physical activity recommendations for older adults living at home with cognitive impairment. Methods: This quality improvement project used a pre-post intervention approach. Data was collected through a pre-post clinician survey and pre-post chart audit to evaluate the impact of a multimodal education intervention on OT and PT knowledge and practice. The intervention included educational sessions and the development of four client handouts. Results: Post-intervention, OT and PT survey results showed a non-significant improvement in knowledge, and a greater range of physical activity recommendations. The PT chart audit demonstrated a statistically significant increase in PTs providing education about the role of physical activity in relation to cognitive impairment. For OTs, there was a non-significant increase in physical activity recommendations. Conclusions: This multimodal education resulted in non-significant improvements in knowledge for OTs and PTs, however there were significant practice changes for PTs when providing education to patients about the impact of physical activity on cognition. Future research could refine the targeting of this intervention to better meet the needs of OTs and incorporate an evaluation of patient outcomes.

Improving pediatric atopic dermatitis care in the emergency department and primary care setting: a collaborative quality improvement pilot project.

Emergency department visits and healthcare expenditures for pediatric atopic dermatitis have been increasing over the last two decades. There is a paucity of replicable quality improvement initiatives addressed at educating primary care and emergency medicine clinicians on this condition. The goal of this initiative was to improve clinician knowledge and comfort in the diagnosis and management of pediatric atopic dermatitis and superinfection. Clinicians were recruited via email from academic and community settings in Travis County, Texas, in 2020. They were sent a pre-intervention survey, a series of three quizzes, and a post-intervention survey. After each quiz, participants received performance feedback and various forms of multimodal education. Differences between the first and final quiz scores and clinician confidence levels were analyzed for statistical significance. Fifty-six clinicians completed the intervention. The average overall and treatment-specific scores increased significantly by 10% and 37%, respectively. Further, confidence levels improved significantly in the majority of clinicians. Clinician qualitative feedback revealed high satisfaction. Results from this educational quality improvement project have demonstrated that this is an effective and replicable resource for educating clinicians who manage pediatric atopic dermatitis in the emergency department and outpatient setting.

A Multimodal Educational Bundle to Reduce Postoperative Dehydration and Related Emergency Department Visits After Bariatric Surgery

A Multimodal Educational Bundle to Reduce Postoperative Dehydration and Related Emergency Department Visits After Bariatric Surgery

Importance of multimodal resident education curriculum for general surgeons: perspectives of trainers and trainees

PurposeSatisfaction should be prioritized to maximize the value of education for trainees. This study was conducted with professors, fellows, and surgical residents in the Department of general surgery (GS) to evaluate the importance of various educational modules to surgical residents.MethodsA questionnaire was administered to professors (n = 28), fellows (n = 8), and surgical residents (n = 14), and the responses of the three groups were compared. Four different categories of educational curricula were considered: instructor-led training, clinical education, self-paced learning, and hands-on training.ResultsThe majority of surgeons regarded attending scrubs as the most important educational module in the training of surgical residents. However, while professors identified assisting operators by participating in surgery as the most important, residents assessed the laparoscopic training module with animal models as the most beneficial.ConclusionsThe best educational training course for surgical residents was hands-on training, which would provide them with several opportunities to operate and perform surgical procedures themselves.

“Multimodal” Fits All: Revisiting the Relevance of Perceptual Learning Styles in Higher Education Today

Teaching has been continuously evaluated in light of learning styles research. This highlights the significance of investigating learning styles that may be evolving in tandem with changes in the contemporary era. This study assumes that twenty-first-century students share characteristics not based on unimodal models of learning styles, particularly in higher education. It supports multimodality at both the learning and teaching levels since learners typically prefer and share various learning styles. It employs the field's most influential learning styles framework, Reid's (1987) perceptual learning styles instrument, to investigate the validity of that assumption. To add to and question the corpus of literature that exists in the field, we looked at Saudi university-level learning styles in relation to gender and academic major as independent variables. Participants were identified as English as a foreign language (EFL) student from various academic majors. The quantitative research design of this study revealed that neither academic major nor gender significantly affected the learners’ preferences. Participants demonstrated a diversity of preferences for perceptual learning styles, with minimal overall differences. Nonetheless, they favored auditory learning over group and kinaesthetic styles. It was observed that students with an English major preferred individual learning styles. Research in the field, including the current study, found some discrepancies in PLS tendencies across different contexts and factors. With such inconsistent patterns, multimodal education is a good opportunity for teachers and educationists.

A Prospective Multimodal Education Intervention for Providers Does Not Increase Hepatic Encephalopathy Treatment Rates.

Over 50% of hospitalizations from hepatic encephalopathy (HE) are preventable, but patients often do not receive medical treatment. To use a multimodal education intervention (MMEI) to increase HE treatment rates and to evaluate (1) trends in HE treatment, (2) predictors of receiving treatment, and (3) the impact of treatment on hospitalization outcomes. Prospective single-center cohort study of patients hospitalized with HE from April 1, 2020-September 30, 2022. The first 15months were a control ("pre-MMEI"), the subsequent 15months (MMEI) included three phases: (1) prior authorization resources, (2) electronic order set, and (3) in-person provider education. Treatment included receiving any drug (lactulose or rifaximin), or combination therapy. Treatment rates pre- vs. post-MMEI were compared using logistic regression. 471 patients were included. There were lower odds of receiving any drug post-MMEI (p = 0.03). There was no difference in receiving combination therapy pre- or post-MMEI (p = 0.32). Predictors of receiving any drug included alcohol-related or cryptogenic cirrhosis (p's < 0.001), and the presence of ascites (p = 0.005) and/or portal hypertension (p = 0.003). The only significant predictor of not receiving any drug treatment was having autoimmune cirrhosis (p < 0.001). Patients seen by internal medicine (p = 0.01) or who were intoxicated (p = 0.02) were less likely to receive rifaximin. Any treatment was associated with higher 30-day liver disease-specific readmission (p < 0.001). This MMEI did not increase HE treatment rates, suggesting that alternative strategies are needed to identify and address barriers to treatment.

Integrating Practical Skills Into Multimodal Transportation Education In Indonesia

This research explores the integration of practical skills into multimodal transportation education in Indonesia. Through qualitative analysis of 50 Indonesian cadets, the study examines the balance between theoretical knowledge and practical application, the effectiveness of current educational practices, and recommendations for improvement. The findings reveal a strong consensus among cadets on the importance of practical skills alongside theoretical knowledge. While some practical training is provided, there is a need for more hands-on experiences and industry exposure. Recommendations include revising curricula to include more practical exercises and case studies, strengthening industry partnerships, enhancing instructor skills, integrating soft skills development, and promoting lifelong learning. These recommendations aim to better prepare students for the demands of the transportation industry and enhance their employability. By implementing these recommendations, educational institutions can bridge the gap between theory and practice, ultimately improving the quality and relevance of transportation education in Indonesia.

Pedagogical memes: a creative and effective tool for teaching STEM subjects

The rise of memes has transformed the way people communicate and share information online, presenting a unique opportunity to leverage technology in the service of education. We explore the potential of memes as an educational tool for supporting STEM education and increasing student engagement. We aim to provide a theoretical framework for using pedagogical memes in education and showcase examples of educational activities and assignments using memes. Further, we discuss the use of memes as an instructional tool in education and propose a multimodal meme-based education framework. We specify the pedagogical memes using a metamodel based on the ‘Relate-Create-Donate’ framework and Engagement Theory, combining collaborative learning and multiliteracies with the taxonomic levels of engagement. We provide the learning scenarios which include the use of pedagogical memes in a classroom for teaching STEM subjects. To support the proposed models, we present a case study of a mathematics teacher using memes to teach calculus and a qualitative evaluation of the effectiveness of using memes in the classroom. We evaluated the potential of pedagogical memes using the six conditions outlined in the Conditions of Excellence, and Revised Bloom's Taxonomy, and discussed limitations of using memes in education.

Learners’ continuance intention in multimodal language learning education: An innovative multiple linear regression model

Confronted with the unprecedented COVID-19 pandemic, millions of learners have received, are receiving, or will receive multimodal language learning education. This study aims to explore the relationships between various factors influencing learners’ continuance intention by proposing an innovative multiple linear regression model in multimodal language learning education. Participants were randomly recruited (N = 334) in China who had received multimodal language learning education by combining Massive Open Online Courses, Rain Classroom, and WeChat. The research instrument, a comprehensive questionnaire, was sent through the online system named Questionnaire Star developed by technical experts. A multiple linear regression analysis was adopted to test the proposed hypotheses and fit the research model. This study confirms the relationships between the Technology Acceptance Model-inclusive constructs such as perceived ease of use, perceived usefulness, attitudes toward multimodal language learning education, and continuance intention of participating in multimodal language learning education. The Technology Acceptance Model is also associated with other constructs, e.g. Task-technology fit, Individual-technology fit, Openness, and Reputation of multimodal language learning educational institutes, and personal investment in multimodal language learning education. However, personal investment neither directly nor indirectly predicts continuance intention. Educators and designers could make every effort to improve multimodal language learning education to enhance personal investment and foster its association with continuance intention of learners.

Multimodal Educational Intervention for Adherence to Standard Precautions in the COVID-19 Pandemic Among Nursing Professionals: A Quasi-Experimental Study

Background: Health education is the means by which professional knowledge is improved. In this context, the combination of multimodal educational strategies must be implemented and evaluated to verify their impacts on the adherence of professionals working in coronavirus disease 2019 (COVID-19) care sectors, especially in a pandemic scenario. Objectives: This study aimed to evaluate self-reported adherence to standard precautions (SP) among nursing professionals before and after a multimodal educational intervention. Methods: This quasi-experimental study was carried out before and after the multimodal educational intervention within February and June 2022. The intervention comprised three educational strategies, previously published separately: The use of a composite of five moments for educational construction, a validated educational video, and a problematizing discussion with the use of a quiz (true or false), focusing on questions with the lowest correct rate (cut-off &lt; 70%) in phase 1 of data collection. The study involved 99 nursing professionals from a large hospital in the Brazilian Midwest. This study used a sociodemographic characterization instrument and the Compliance with Standard Precautions Scale (CSPS) to assess adherence to SP. The scores before and after the intervention were represented with mean and standard deviation. The Wilcoxon test, Mann-Whitney test, Kruskal-Wallis test, and Kolmogorov-Smirnov normality test were performed using SPSS software (version 20.0). Results: The sample comprised 99 participants, predominantly female (85.9%), working in various departments, including inpatient units, hemodialysis, intensive care unit (ICU), emergency room, and others (not specified). There was a statistically significant difference between the scores before (15.29 ± 2.23) and after (16.48 ± 1.98) the educational intervention (W = -4.443; P &lt; 0.05). Additionally, there was a statistically significant increase in adherence after the intervention concerning the correct disposal of sharps boxes (P = 0.023) and changing out of uniforms in designated areas (P = 0.034). Conclusions: The obtained results demonstrated, in a pioneering manner, that the use of a multimodal educational strategy (combining different approaches such as the use of five moments, a validated video, and a question-and-answer quiz) had a positive impact on adherence by professionals who work in sectors caring for patients with COVID-19.

Deimplementation of Gastric Residual Volume Monitoring to Enhance Patient Nutrition.

Routine gastric residual volume monitoring remains common in nursing practice. However, current evidence supports using a focused nursing assessment to identify signs and symptoms of enteral feeding intolerance such as abdominal pain, abdominal distension, and vomiting. At the author's institution, nurses and other clinicians began reporting inconsistencies in gastric residual volume monitoring along with frequent interruptions in the delivery of enteral nutrition. The quality improvement project included patients in the medical intensive care unit receiving enteral nutrition. Gastric residual volume monitoring was eliminated. Instead, enteral nutrition was suspended on the basis of signs and symptoms of enteral feeding intolerance. Multimodal education was provided to nurses, nurse practitioners, and physicians caring for these patients. Formative evaluation occurred via staff rounds, summative evaluation occurred through a staff survey, and nutritional adequacy was evaluated by tracking patient weight. The 6-week project included 37 patients on the medical intensive care unit service. Of these patients, 28 gained weight; the mean change in weight was +6.2%. The practice change was well perceived by staff and is now an established part of care for any patient receiving enteral feedings at the study hospital. The deimplementation of routine gastric residual volume monitoring is supported by evidence. Use of a focused gastrointestinal nursing assessment to identify enteral feeding intolerance is safe, feasible, and effective and improves nutrition delivery and nurses' workflow.