Self-directed Learning Package Research Articles

Moving from Interest to Engagement-Understanding the Research Capacity Building Needs of Rehabilitation Doctors.

Doctors working in rehabilitation settings have specialized clinical skills and experience, but research activity may be constrained by time pressures and inadequate current skills. This means missed opportunities to contribute to the evidence-base for better clinical practice and outcomes for people living with disabling, chronic complex conditions. This research aimed to understand rehabilitation doctors' research needs, experience, and aspirations to enable future training initiatives that are tailored to their practice context. This exploratory sequential mixed-method study comprised a survey followed by focus groups. Rehabilitation doctors from three health services in south-east Queensland, Australia completed an online survey incorporating the Research Spider to explore their research experience, confidence, interest, opportunity, and intent. Focus groups explored the survey results and participants' views regarding strategies to build research capacity. The major findings were the gap between high research interest and low experience, confidence and opportunity; and fundamental research skills were identified as priority training topics. These findings support previous research. However, rehabilitation doctors may also have a self-expectation that, as competent clinicians, they should necessarily also be research-competent, and hold misperceptions regarding the shared nature of health services research. Protected time and funding may enhance engagement with research to generate specialty-relevant evidence for practice. To this end, a research capacity building initiative in the form of a series of self-directed learning packages has been developed and implemented. A tailored workshop to strengthen rehabilitation doctors' research skills and engagement has also been developed for implementation.

Improving Medical Student Comfort and Competence in Performing Gynecological Exams: A Systematic Review.

Performing a gynecological exam is an essential skill for physicians. While interventions have been implemented to optimize how this skill is taught in medical school, it remains an area of concern and anxiety for many medical students. To date, a comprehensive assessment of these interventions has not been done. The authors conducted a systematic review of the literature on interventions that aim to improve medical student education on gynecological exams. The authors searched 6 databases (Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL Plus, Scopus, Web of Science Core Collection, and ERIC [Proquest]) from inception to August 4, 2020. Studies were included if they met the following criteria: focus on medical students, intervention with the purpose of teaching students to better perform gynecological exams, and reported outcomes/evaluation. Extracted data included study location, study design, sample size, details of the intervention and evaluation, and context of the pelvic exam. All outcomes were summarized descriptively; key outcomes were coded as subjective or objective assessments. The search identified 5,792 studies; 50 met the inclusion criteria. The interventions described were diverse, with many controlled studies evaluating multiple methods of instruction. Gynecological teaching associates (GTAs), or professional patients, were the most common method of education. GTA-led teaching resulted in improvements in student confidence, competence, and communication skills. Physical adjuncts, or anatomic models and simulators, were the second most common category of intervention. Less resource-intensive interventions, such as self-directed learning packages, online training modules, and video clips, also demonstrated positive results in student comfort and competence. All studies highlighted the need for improved education on gynecological exams. The literature included evaluations of numerous interventions for improving medical student comfort and competence in performing gynecological exams. GTA-led teaching may be the most impactful educational tool described, though less resource-intensive interventions can also be effective.

Building competency in hematopoietic stem cell transplant coordination: Evaluating the effectiveness of a learning pathway for nurses new to this role.

For this pilot study, a learning pathway and educational tools were developed and evaluated to support a standardized and systematic approach to the staff education and to improve quality of care. Eight nurses new to HSCT coordination participated in this study and completed the follow-up evaluations. Nurses were assessed before the intervention to identify knowledge gaps for each sub-role of allogeneic and autologous stem cell coordination. Following the assessment, nurses received a tailored self-directed learning package mapped to a learning pathway and a competency evaluation tool. A competency-based "building-block" training approach was used in which a new skill was added only after a previous skill was mastered. Utilizing the Kirkpatrick (2006) model, nurses were evaluated pre- and postorientation to assess changes in both knowledge and in behaviour relating to transplant coordination. Participants reacted favourably to these tools and reported a significantly higher level of knowledge and competency in the transplant coordination role following orientation. Further research on the use of a learning pathway to guide the orientation of nurses to the HSCT coordination role would complement this pilot study.

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This study aims to study Thai non-formal education teachers’ perceptions of their opportunities to obtain knowledge about the learning society; identify the knowledge of non-formal education teachers need about the learning society which could be obtained through a distance learning package; and to develop and evaluate distance learning package on the learning society for the non-formal education teachers. The study sample was 264 non-formal education teachers in local areas from 24 district non-formal education and informal education centres in 12 provinces across the country. Research instruments were questionnaires and interviews. Data obtained were analysed by percentage, mean, standard deviation, and content analysis. Results of the study showed that the non-formal education teachers agreed that knowledge about the learning society was important for their work in promoting lifelong education for people. They strongly agreed that they needed knowledge and understanding about developing a learning society. The self-directed distance learning package on learning society was accepted by 10 experts in the field. Moreover, it was found that after the teachers had studied the distance learning package, their knowledge and understanding about the learning society was significantly higher. They were also highly satisfied with the printed media and the video cd (VCD) in the learning package. Key words: Lifelong education, learning society, non-formal education teachers.

Skill development of beginner sonography students using high-fidelity simulators: Initial experiences

Background The training of Australian sonographers is shared between accredited course providers and clinical training providers. Scanning skills are mostly developed in a real-life setting environment by the clinical training provider. Sonographer training is burdensome on clinical training providers due to increasing service delivery demands. Accredited course providers should therefore investigate innovative methods of skill training that can be undertaken outside of the clinical environment. Aims This report evaluates four sonographer skill development activities for novice students that used high fidelity ultrasound simulators. Results All students reported positive experiences and outcomes of simulator based learning activities and believed that simulated skills development sessions help them develop scanning skills. Students perceived their skills level after simulation sessions to be at levels where they could scan in a real clinical setting with supervision levels ranging from moderate to no assistance. Supervisor ratings ranged from students being able to scan with large amounts of assistance to being able to scan with minimal assistance. A self-directed learning package was introduced which was well received by students. Conclusions The results of the evaluations of the reported simulated learning activities are promising for a self-directed and student centered learning curriculum to be ‘wrapped’ around the use of high fidelity simulators to develop student skills in the early stages of training.

An evidence-based approach to the prevention and initial management of skin tears within the aged community setting: a best practice implementation project.

Maintaining skin integrity in a community setting is an ongoing issue, as research suggests that the prevalence of skin tears within the community is greater than that in an institutional setting. While skin tear prevention and management principles in these settings are similar to those in an acute care setting, consideration of the environmental and psychological factors of the client is pivotal to prevention in a community setting. Evidence suggests that home environment assessment, education for clients and care givers, and being proactive in improving activities of daily living in a community setting can significantly reduce the risk of sustaining skin tears. The aim of this implementation project was to assess and review current skin tear prevention and management practices within the community setting, and from this, to implement an evidence-based approach in the education of clients and staff on the prevention of skin tears. As well. the project aims to implement evidence-based principles to guide clinical practice in relation to the initial management of skin tears, and to determine strategies to overcome barriers and non-compliance. The project utilized the Joanna Brigg's Institute Practical Application of Clinical Evidence System audit tool for promoting changes in the community health setting. The implementation of this particular project is based in a region within Anglicare Southern Queensland. A small team was established and a baseline audit carried out. From this, multiple strategies were implemented to address non-compliance which included education resources for clients and caregivers, staff education sessions, and creating skin integrity kits to enable staff members to tend to skin tears, and from this a follow-up audit undertaken. Baseline audit results were slightly varied, from good to low compliance. From this, the need for staff and client education was highlighted. There were many improvements in the audit criteria following client and staff education sessions and staff self-directed learning packages. Future strategies required to sustain improvements in practice and make further progress are to introduce a readily available Anglicare Skin Integrity Assessment Tool to the nursing staff for undertaking new client admissions over 65 years, and to provide ongoing education to staff members, clients and care givers in order to reduce the prevalence of skin tears in the community setting. This implementation project demonstrated the importance of education of personal care workers, clients and their caregivers for prevention of skin tears in the community setting. This in turn created autonomy and empowered clients to take control of their health.

An evidence-based approach to the prevention and initial management of skin tears within the aged community setting: a best practice implementation project

Background Maintaining skin integrity in a community setting is an ongoing issue, as research suggests that the prevalence of skin tears within the community is greater than that in an institutional setting. While skin tear prevention and management principles in these settings are similar to those in an acute care setting, consideration of the environmental and psychological factors of the client is pivotal to prevention in a community setting. Evidence suggests that home environment assessment, education for clients and care givers, and being proactive in improving activities of daily living in a community setting can significantly reduce the risk of sustaining skin tears. Objectives The aim of this implementation project was to assess and review current skin tear prevention and management practices within the community setting, and from this, to implement an evidence-based approach in the education of clients and staff on the prevention of skin tears. As well. the project aims to implement evidence-based principles to guide clinical practice in relation to the initial management of skin tears, and to determine strategies to overcome barriers and non-compliance. Methods The project utilized the Joanna Brigg's Institute Practical Application of Clinical Evidence System (PACES) audit tool for promoting changes in the community health setting. The implementation of this particular project is based in a region within Anglicare Southern Queensland. A small team was established and a baseline audit carried out. From this, multiple strategies were implemented to address non-compliance which included education resources for clients and caregivers, staff education sessions, and creating skin integrity kits to enable staff members to tend to skin tears, and from this a follow-up audit undertaken. Results Baseline audit results were slightly varied, from good to low compliance. From this, the need for staff and client education was highlighted. There were many improvements in the audit criteria following client and staff education sessions and staff self-directed learning packages (Appendix I, II and III). Future strategies required to sustain improvements in practice and make further progress are to introduce a readily available Anglicare Skin Integrity Assessment Tool to the nursing staff for undertaking new client admissions over 65 years, and to provide ongoing education to staff members, clients and care givers in order to reduce the prevalence of skin tears in the community setting. Conclusions This implementation project demonstrated the importance of education of personal care workers, clients and their caregivers for prevention of skin tears in the community setting. This in turn created autonomy and empowered clients to take control of their health.

Education of ICU nurses regarding invasive mechanical ventilation: Findings from a cross-sectional survey

BackgroundContinuing education for intensive care unit nurses on invasive mechanical ventilation is fundamental to the acquisition and maintenance of knowledge and skills to optimise patient outcomes. PurposeWe aimed to determine how intensive care unit nurses perceived current education provided on mechanical ventilation, including a self-directed learning package and a competency programme; identify other important topics and forms of education; and determine factors associated with the completion of educational programmes on invasive mechanical ventilation. MethodsA cross-sectional, 30-item, self-administered and semi-structured survey on invasive mechanical ventilation education was distributed to 160 intensive care nurses. Analysis included descriptive statistics and logistic regression was used to determine factors associated with current education completion, reported as adjusted odds ratios (AOR) and 95% confidence intervals (CIs). FindingsEighty three intensive care unit nurses responded and the majority (63%) reported not receiving education about mechanical ventilation prior to working in intensive care. Using a Likert rating scale the self-directed learning package and competency programme were perceived as valuable and beneficial. Hands-on-practice was perceived as the most important form of education and ventilator settings as the most important topic. Multivariate analysis determined that older age was independently associated with not completing the self-directed learning package (AOR 0.20, 95% CI 0.04, 0.93). For the competency programme, 4–6 years intensive care experience was independently associated with completion (AOR 17, 95% CI 1.7, 165) and part-time employment was associated with non-completion (AOR 0.23, 95% CI 0.08, 0.68). ConclusionRegistered nurses are commencing their ICU experience with limited knowledge of invasive MV therefore the education provided within the ICU workplace becomes fundamental to safe and effective practice. The perception of continuing education by ICU nurses from this research is positive regardless of level of ICU experience and may influence the type of continuing education on invasive MV provided to ICU nurses in the future, not only in the ICU involved in this study, but other units throughout Australia.

Evaluating a self-directed palliative care learning package for rural aged care workers: a pilot study

To evaluate the effectiveness of a self-directed learning package in increasing palliative care knowledge and confidence for aged care workers in Rural New South Wales, Australia. Participants piloted a palliative care self-directed learning package and completed pre- and post-package knowledge and confidence questionnaires with a 6-month follow-up. The data was then analysed via paired two-tailed T-tests. There was a statistically significant mean increase in knowledge and confidence after completion of the self-directed learning package. Knowledge but not confidence increases were retained after 6 months. Self-directed learning packages can play a part in increasing knowledge and confidence in palliative care for rural aged care workers. Questions remain regarding the role of ongoing support, education, and mentoring.

Registered nurses' medication management of the elderly in aged care facilities

Data on adverse drug reactions (ADRs) showed a rising trend in the elderly over 65 years using multiple medications. To identify registered nurses' (RNs) knowledge of medication management and ADRs in the elderly in aged care facilities; evaluate an education programme to increase pharmacology knowledge and prevent ADRs in the elderly; and develop a learning programme with a view to extending provision, if successful. This exploratory study used a non-randomized pre- and post-test one group quasi-experimental design without comparators. It comprised a 23-item knowledge-based test questionnaire, one-hour teaching session and a self-directed learning package. The volunteer sample was RNs from residential aged care facilities, involved in medication management. Participants sat a pre-test immediately before the education, and post-test 4 weeks later (same questionnaire). Participants' perceptions obtained. Pre-test sample n = 58, post-test n = 40, attrition rate of 31%. Using Microsoft Excel 2000, descriptive statistical data analysis of overall pre- and post-test incorrect responses showed: pre-test proportion of incorrect responses = 0.40; post-test proportion of incorrect responses = 0.27; Z-test comparing pre- and post-tests scores of incorrect responses = 6.55 and one-sided P-value = 2.8E-11 (P < 0.001). Pre-test showed knowledge deficits in medication management and ADRs in the elderly; post-test showed statistically significant improvement in RNs' knowledge. It highlighted a need for continuing professional education. Further studies are required on a larger sample of RNs in other aged care facilities, and on the clinical impact of education by investigating nursing practice and elderly residents' outcomes.

Regional public health education: current situation and challenges

At the UN Millennium Summit in September 2000, the 191 Member States of the UN reaffirmed commitments to work towards a world in which elimination of poverty and sustainable development are the highest priorities. Governments, health development agencies, nongovernmental agencies and WHO are committed to an unprecedented global effort to work towards the health-related Millennium Development Goals (MDGs) as their corporate mandates. Although significant progress has been made for most of the goals, the most recent evaluation indicates uneven achievements within and across countries.1 It is apparent that some countries in south Asia and sub-Saharan Africa need to channel special efforts through multisectoral actions to achieve maternal and HIV/AIDS mortality, and underweight targets. Poor health taxes productivity and undermines poverty reduction efforts. Given the MDG stakes, international evidence indicates that low-cost, effective interventions do exist2 but countries in south Asia and sub-Saharan Africa have failed to scale up these interventions to address the significant burden of diseases. Failure to scale up cost-effective interventions is the result of fragile health system capacity, lack of political commitment and weak public health capacity. Public health education and competency at various levels are needed to translate evidence into policy, and to implement and evaluate programmes.3 In addition to the public health aspects of the MDGs, the emergence of new infectious diseases, and multidrug and extensive drug resistance pose serious demands for scaling up surveillance as a key public health competency,4,5 especially in the light of avian influenza threat and implementation of the International Health Regulations (2005). The countries around the Asia Pacific rim are perceived as the potential epicentre of future influenza pandemics. A review of public health education in the WHO South-East Asia Region6 in 2005 showed mixed results. Despite the existence of several postgraduate courses in India, Indonesia and Thailand, and undergraduate courses in other countries, there is a great variation in institutes and courses offered in the region. Challenges include quality assurance, teaching standards and faculty members’ competency in practical field experience, especially in public health management and outbreak control. The absence of policy-relevant research or publication of staff in public health faculties indicates the weakness of public health education and its dissociation with real-life public health policies and practices.7 At a political level, it is doubtful that those in senior policy-making positions are competent in public health. Yet these are leaders who will play a vital role in stewardship of health systems and in translating evidence into policy and programme implementation. However, there are some positive developments in this bleak situation. In Australia, public health competencies are fostered by on-the-job in-service training, context-specific continuing education programmes and short courses, distance and self-directed learning packages, and postgraduate university-level courses.8 Experience of Field Epidemiology Training Programmes (FETPs) is worth mentioning. By 2007, 34 countries had established FETP programmes. FETP in Thailand,9 established in 1980, has applied the concept of “linking education and practice” in its programme which has recently developed into a training course for other countries in the region. Trainees spend 25% of their time in the classroom and 75% in the field and “learning by doing”. For example, they conduct outbreak investigation and control. They have become the backbone of epidemiological surveillance and broader public health responses in Thailand. The programme was a key player in the Ministry of Public Health in response to both the outbreak of SARS in 2003 and to AIDS epidemics. More recently, FETP trainees and graduates were able to detect several new avian influenza cases through the review of clinical signs and symptoms, which were subsequently confirmed by reference laboratories. In response to avian influenza threats, the programme played a vital role in coordinating 1070 surveillance and rapid response teams nationwide, which was triple the number of national and international trainees. Public health education that is irrelevant to national health priorities and divorced from public health practice is useless and constitutes a lost opportunity. Given the MDG stakes, challenges of re-emerging infectious diseases and the increasing complexity of chronic non-communicable diseases, it is the right time to revisit public health education. A regional network such as the South-East Asia Public Health Initiative can serve as a platform for public health education reform.6 ■

Deciphering Statistics in Research: A Beginners Guide to Statistics for Radiation Science Professionals

Statistics is a branch of mathematics that is involved with collecting, analyzing, interpreting and presenting various types of data. It can also be overwhelming for novice researchers who have not had much exposure to formal research or statistical courses. This selfdirected learning package will provide an informal overview of the basics of descriptive and inferential statistics that will enable radiation science professionals to have more confidence when critically appraising published literature or developing research protocols. Learners will be able to assess their understanding by completing the multiplechoice questions that are provided after each section.

Enhancing Graduate Nurses’ Health Assessment Knowledge and Skills Using Low-fidelity Adult Human Simulation

Although simulation technology in nursing education is becoming increasingly commonplace, a review of the literature reveals a paucity of rigorous, high-level research comparing the effectiveness of simulation with other traditional education methods in the acquisition of clinical knowledge and skills. This research aimed to investigate the impact of three learning interventions on graduate nurse health assessment knowledge and skills. It was hypothesized that the patient assessment skills of graduate nurses who completed a simulation learning activity would be superior to those who completed traditional education activities. Graduate nurses (n = 74) were randomly allocated to three groups (1: self-directed learning package [SDLP] only; 2: SDLP plus two scenario-based PowerPoint workshops; and 3: SDLP plus two simulation education sessions using a manikin with low-fidelity capabilities. Following the education activities, graduates completed an individual test involving a systematic patient assessment upon a manikin. They were scored using a checklist of relevant responses. Analysis of variance results suggest that the mean test score for nurses in the simulation group (mean = 135.52, SD = 26.63) was significantly higher (P < 0.001) than those in the learning package group (mean = 107.42, SD = 29.82) and the PowerPoint group (mean = 102.77, SD = 31.68). Simulation appears to be an effective educational tool for teaching patient assessment knowledge and skills to graduate nurses. Incorporation of such technology into graduate nurse education may decrease the time required to become clinically proficient, resulting in more confident and work-ready practitioners.

Evaluation of a Hospital-Wide Infection Prevention &amp; Control Certification Program: Increasing the Quality Limits for Patient Safety and Staff Satisfaction

BACKGROUND/OBJECTIVES: To evaluate the effect of Infection Conrol (IC) certification on confidence and comfort level of the health care workers.METHODS: The Severe Acute Respiratory Syndrome (SARS) Outbreak highlighted the significance of formal training in IC practical aspects as well as the development and publication of standards. Minor errors in the use of personal protective equipment were identified as sources of contamination of Health Care Workers' to SARS CoV. Our hospital's policy mandated that all staff, be certified in IC practices through a competency based educational program. A multi-disciplinary educational module, derived from a SARS specific model used to educate the SARS designated care team; was developed. Essential components included basic IC principles, specimen collection, use of protective clothing, high risk procedures, modified protocols for ventilator management and oxygen/aerosol therapy, transportation and care of equipment and the environment. Competency checklists for each module were developed. Education was customized, depending on the potential risk of exposure. A train the trainer model with direct involvement of the Infection Control Practitioners (ICP)disseminated the program hospital-wide.• A self-directed learning package including a video demonstration of application and removal of the Personal Protective attire was developed for the physicians.RESULTS: Evaluation of staff satisfaction indicated an average staff satisfaction of 98.3% with the pace and content of the sessions and also increased staff confidence while caring for patients in isolation. The result of a survey demonstrated a significant association between the level of confidence and comfort in providing patient care and certification among the two groups of staff (certified versus non- certified, p < 0.001).∗There was no nosocomial spread of SARS in our hospital, despite the admission of 5 confirmed cases and 27 patients that met the SARS case definitions.CONCLUSIONS: The program was highly successful in preventing the spread of SARS within the institution and easing staff's anxiety.Evaluations of the program participant using a RxC statistical analysesReceived Competency based certificationDid not receive Competency based certificationVery confident48 (72.7%)29 (35.8%)Somewhat confident16 (24.2%)43 (53.1%)Not Confident2 (3.0%)9 (11.1%)Total6681∗IC Education must be a mandatory and frequent part of the training for medical and paramedical programs with commitment and support from internal and external stakeholders.∗Directives and policies must have an implementation and a role out plan.∗There is a need to evaluate the long-term effectiveness and retension level of the competency based program.∗Ratio/bed of ICPs must be re-evaluated based on the new demands of the field.

The effects of specific educational preparation on emergency nurses’ clinical decisions regarding supplemental oxygen administration

The use of supplemental oxygen by emergency nurses has important implications for patient outcomes, yet there is significant variability in oxygen administration practises. Specific education related to oxygen administration increases factual knowledge in this domain; however, the impact of knowledge acquisition on nurses' clinical decisions is poorly understood. This study aimed to examine the effect of educational preparation on 20 emergency nurses' decisions regarding the assessment of oxygenation and the use of supplemental oxygen. A pre-test/post-test, quasi-experimental design was used. The intervention was a written, self-directed learning package. The major effects of the completion of the learning package included no change in the number or types of parameters used by nurses to assess oxygenation, a significant decrease in the selection of simple masks, a significant increase in the selection of air entrainment masks, fewer hypothetical outcomes of unresolved respiratory distress and more hypothetical outcomes of decreased respiratory distress. As many nursing education programs are aimed at increasing factual knowledge, while experience remains relatively constant, a greater understanding of the relationship between factual knowledge and clinical decisions is needed if educational interventions are to improve patient outcomes.

Enhancing recently graduated nurse health assessment knowledge and skills using low fidelity adult human simulation.

BACKGROUND: While the use of simulation technology in nursing education is becoming increasingly commonplace, few researchers have examined the effect of simulation on the acquisition of clinical knowledge and skills. It was hypothesized that the patient assessment skills of graduate nurses who complete a simulation learning activity will be superior to those who complete traditional education activities. METHOD: Graduate Nurses (n = 76) were randomly allocated to three groups (1: self-directed learning package [SDLP] only; 2: SDLP plus two scenario-based PowerPoint workshops; and 3: SDLP, plus two simulated patient assessment teaching sessions (replicating the PowerPoint scenarios) using a low-fidelity manikin. Following the education activities, all nurses completed an individual test scenario where they performed a systematic patient assessment upon the manikin, scored using a checklist of relevant observations and actions. RESULTS: Analysis of Variance results suggest that the mean test score for nurses in the simulation group (M = 135.52, SD = 26.63) was significantly higher (p < 0.001) than those in the self-directed learning group (M = 107.42, SD = 29.82) and the PowerPoint group (M = 102.77, SD = 31.68). CONCLUSIONS: Simulation appears to be an effective method of teaching patient assessment knowledge and skills to graduate nurses. The incorporation of such technology into both undergraduate and graduate nurse education may increase confidence and decrease the time taken to become clinically proficient, concomitant with improved patient outcomes and health care services.

1636 ORAL Implementation and evaluation of a self-directed learning package for nurses caring for patients with colorectal cancer

1636 ORAL Implementation and evaluation of a self-directed learning package for nurses caring for patients with colorectal cancer

Nursing knowledge and assessment skills in the management of patients receiving analgesia via epidural infusion.

In Australian hospitals, epidural infusions are commonly used for the management of post-operative pain in maternity and surgical patients, with little research evidence to indicate the efficacy of the educational preparation of nurses undertaking pain management. To describe nurses' assessment skills and knowledge related to the management of a patient with an epidural infusion and to explore relationships between these variables and the levels of education/clinical experience of the nurses. This descriptive correlational study used a convenience sample of surgical and obstetric unit registered nurses to explore relationships between the knowledge and skill in epidural management and the educational preparation of the nurse. Data were collected via survey and observation, using instruments developed by the research team. The nurses had a good knowledge base for the performance of sensory blockade assessment but scored less well in motor blockade assessment and clinical decision-making. Nurses who had clinical experience, had completed a self- directed learning package and who worked in surgical areas scored higher on the survey than other nurses. Observation scores revealed a range of performance outcomes. There was only a weak correlation between knowledge and skill performance. There were no differences in scores for the observation exercise for different groups of nurses. The results of this study indicated that the nurses' theoretical knowledge outweighed their clinical skill performance and clinical decision-making. Education for nurses regarding the management of epidural infusions needs to be comprehensive, context specific and have the capacity to develop the nurse's autonomous critical thinking and clinical decision-making skills. Strategies for this include self-directed learning packages best supplemented by a demonstration of clinical skills and supervised practice.

Training for the role of triage in Australasia

To characterize the prerequisite experience and training undertaken by nurses for the role of triage in emergency departments in Australasia. Postal survey of charge nurses/unit nurse managers of all Australasian emergency departments accredited for specialist emergency physician training by the Australasian College for Emergency Medicine. The response rate was 89%. The most common duration of prerequisite experience was 12-18 months. Most programmes use a combination of educational activities, with self-directed learning packages, lectures and mentored experience being the most common. Three hospitals reported no preparation for triage. In Australasia, there is wide variability in required training and experience before triage duties are performed. Strategies to set suggested minimum standards in these areas and to make training activities more accessible are recommended.

Contraception: a new practical learning package.

A new self-directed learning package was developed to assist medical students learn the counselling and practical skills to enable them to communicate with men and women about contraception and related matters. This paper describes the package and the way it was facilitated, the students' ratings of the package and their feedback about the session on the first time it was presented at four teaching hospitals. The students rated the contraception package as average. The reasons given were: no introduction to the contraception session, lack of a trained person to conduct and facilitate the contraception learning session, poor organization at one of the hospitals and too little emphasis on self-assessment. The assumption that the students had a basic hormonal knowledge prior to the contraception sessions was incorrect. The results suggest the contraception learning package needs a person with contraceptive knowledge, patient-doctor skills and experience with self-directed learning to be present throughout the 3-hour session and for tools to be available that emphasize self-assessment during the session. The modifications to be made to the learning package include pairing male and female students, a reduction in duration of the learning stations, an additional learning station relating to hormonal contraception, and inclusion of pregnancy and ovulation testing. These modifications were suggested by the participating students.