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Student nurses' knowledge of palliative care: evaluating an education module.
There is evidence that education in palliative care in the UK is somewhat patchy and that this important area of health care should be given a greater emphasis in the nursing curriculum. This article describes an evaluation of a palliative care module taken by a group of third year student nurses. The effect of the module was evaluated using the palliative care quiz for nursing (PCQN), administered at the beginning and at the end of the module. The results demonstrate that the students significantly increased their understanding of aspects of pain and symptom control. In particular, they became knowledgeable about adjuvant therapies and opioid use. In contrast to previous studies, the students rejected the 'fear of addiction' associated with opioid use. Deficits in knowledge included side-effects of codeine, use of sedation and the use of placebos. The results support the need to develop a compulsory module in palliative care that is formally assessed and includes a palliative care placement. This would enable comprehensive and systematic coverage of palliative care in the undergraduate nursing curriculum.
Measurement in abstinence education. Critique and recommendations.
The purpose of this article is to identify, assess, and offer solutions to common measurement errors found in sexual abstinence education evaluation. A critical review of the methodology of adolescent sexuality research was performed. "Gold standards" of their measurement strategy were derived and applied against 14 selected studies. Many of the articles reviewed had substantial limitations in their measurement strategies. However, several articles demonstrated excellence and serve as models for future efforts. Sexual abstinence education evaluation is plagued by the inherent weaknesses of self-report and health outcome measures. However, with careful adherence to the gold standards proposed, it is possible to limit the threat from these weaknesses, maximizing the benefit of self-report surveys and county-level health indicators.
Impact of a national campaign on GP education: an evaluation of the Defeat Depression Campaign.
BACKGROUND: The Defeat Depression Campaign, which was run by the Royal College of Psychiatrists and the Royal College of General Practitioners (RCGP) from 1992 to 1996, aimed to educate general practitioners (GPs) to recognize and manage depression. AIM: To measure the educational impact on GPs of the Defeat Depression Campaign. METHOD: A postal survey using a structured questionnaire was distributed to 2046 GPs obtained by systematically sampling 1 in 14 GPs from alphabetical lists from family health services authorities (FHSAs) in England and Wales. The questionnaire covered awareness of the campaign, awareness and use of campaign materials, and ratings of the usefulness of the campaign in relation to other educational activities. RESULTS: Two-thirds of GPs were aware of the campaign and 40% had definitely or possibly made changes in practice as a result of it. Impact of materials was highest for a consensus statement on the recognition and management of depression in general practice and for guidelines derived from it, each of which had been read in detail by about one quarter of responders and was known of by an additional one third. Impact was low for the other materials. The campaign had the highest impact among younger GPs, members of the RCGP, and (less strongly) among those who had undertaken a six-month post in psychiatry, those who were working in larger practices and fundholding practices, and women; 56% of GPs had attended a teaching session on depression in the past three years. CONCLUSION: A national campaign of this kind can have a useful impact, but it needs to be supplemented by local and practice-based teaching activities.
An evaluation of educational preparation for cancer and palliative care nursing for children and adolescents: issues in the assessment of practice arising from this study.
This paper reports on findings from an externally funded research study designed to map and analyse the educational preparation for cancer and palliative care nursing for children and adolescents. The courses reviewed in the whole study, were the English National Board for Nursing, Midwifery and Health Visiting (ENB) courses ENB240 (care of children with cancer) and the ENB R62 (paediatric oncology for nurses). The specific findings reported here are those relating to the investigation into the assessment of the clinical practice of students on the ENB 240 course in the eight universities, which offered that course. Twenty-six nurses, comprising both students and assessors were interviewed in this part of the study. Key issues arising from the study were the variety in what was assessed, in particular the lack of emphasis on the of assessment of clinical skills, the problem of student selected content of assessment, the different starting points of students and the lack of reliability and validity of the assessment process. Low priority was given to the assessment of clinical skills in these programmes, particularly using direct observation. The study was funded by the ENB and was carried out between 2001 and 2003.
[Pediatrics: an integrated project for evaluating medical education].
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Reducing psychiatric stigma and discrimination--evaluating an educational intervention with the police force in England.
BACKGROUND: Across the world there are programmes challenging negative stereotypes of people with mental health problems and associated discriminatory behaviours, but the evidence base describing what works in practice is still underdeveloped. This paper evaluates the effectiveness of a mental health training intervention with the police force in England. METHOD: A total of 109 police officers attended training workshops and completed pre- and post-questionnaires detailing knowledge, attitudes and behavioural interventions. RESULTS: Mean attitude scores fell from 2.4 at baseline to 2.3 at follow-up (p < 0.0001) using a 5-point Likert scale. Five key message statements were assessed - 70 % of cases successfully reported more messages at follow-up as compared to baseline; however, the stereotype linking people with mental health problems with violent behaviour overall was not successfully challenged. Positive impacts on police work, particularly improvements in communication between officers and subjects, were reported by a third of cases. CONCLUSIONS: Short educational interventions can produce changes in participants' reported attitudes towards people with mental health problems, and can leave police officers feeling more informed and more confident to support people in mental distress.
[Evaluating health education programs for preventing malignant melanoma].
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Reducing psychiatric stigma and discrimination: evaluation of educational interventions in UK secondary schools.
BACKGROUND: The persistent and disabling nature of psychiatric stigma has led to the establishment of global programmes to challenge the negative stereotypes and discriminatory responses that generate social disability, but these initiatives are rarely evaluated. AIMS: To assess the effectiveness of an intervention with young people aimed at increasing mental health literacy and challenging negative stereotypes associated with severe mental illness. METHOD: A total of 472 secondary school students attended two mental health awareness workshops and completed pre- and post-questionnaires detailing knowledge, attitudes and behavioural intentions. RESULTS: Young people use an extensive vocabulary of 270 different words and phrases to describe people with mental health problems: most were derogatory terms. Mean positive attitude scores rose significantly from 1.2 at baseline to 2.8 at 1-week follow-up and 2.3 at a 6-month follow-up. Changes were most marked for female students and those reporting personal contact with people with mental illness. CONCLUSIONS: Short educational workshops can produce positive changes in participants' reported attitudes towards people with mental health problems.
Public school teachers in the U.S. evaluate the educational impact of student space experiments launched by expendable vehicles, aboard Skylab, and aboard Space Shuttle.
Space education is a discipline that has evolved at an unprecedented rate over the past 25 years. Although program proceedings, research literature, and historical documentation have captured fragmented pieces of information about student space experiments, the field lacks a valid comprehensive study that measures the educational impact of sounding rockets, Skylab, Ariane, AMSAT, and Space Shuttle. The lack of this information is a problem for space educators worldwide which led to a national study with classroom teachers. Student flown experiments continue to offer a unique experiential approach to teach students thinking and reasoning skills that are imperative in the current international competitive environment in which they live and will work. Understanding the history as well as the current status and educational spin-offs of these experimental programs strengthens the teaching capacity of educators throughout the world to develop problem solving skills and various higher mental processes in the schools. These skills and processes enable students to use their knowledge more effectively and efficiently long after they leave the classroom. This paper focuses on student space experiments as a means of motivating students to meet this educational goal successfully.
[A pilot study for evaluating patient education with regard to asthma, bronchitis and emphysema supported by the Bad Reichenhaller Research Institute for Diseases of the Respiratory Tract].
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Disability discrimination in nursing education: an evaluation of legislation and litigation.
The Americans With Disabilities Act of 1990, the Civil Rights Restoration Act of 1987, and Section 504 of the Rehabilitation Act of 1973 have created rights for students with disabilities who choose to pursue an education in the health care disciplines. These statutes have also created new concerns for nursing educators as they assess students' qualifications for admission, retention, or dismissal. This article explores legislation and the judicial interpretation of the laws that affect disabled students in health care professions. Specifically, the article reviews and analyzes the reported case law in which health care students have claimed discrimination against education programs because of their disabilities. The analysis considers the requirements of the institution to assess or recognize if the student has a disability; to determine if the student is otherwise qualified to perform the essential responsibilities of the student role; and to establish reasonable accommodations for the student's learning environment. Finally, current and future implications for nursing education programs are presented.
Patient education for preventing diabetic foot ulceration.
BACKGROUND: Ulceration of the feet, which can result in loss of limbs and even death, is one of the major health problems for people with diabetes mellitus. OBJECTIVES: To assess the effectiveness of patient education on the prevention of foot ulcers in patients with diabetes mellitus. SEARCH STRATEGY: Eligible studies were identified by searching the Wounds Group Specialised Trials Register, which is compiled from regular searches of the major health care databases including MEDLINE, Cinahl and EMBASE, hand searching of wound care journals and relevant conference proceedings. For this review the Register was searched up to March 2001. SELECTION CRITERIA: Prospective randomised controlled trials (RCTs) which evaluated educational programmes for the prevention of foot ulcers in people with diabetes mellitus. There was no restriction on language of the publications. DATA COLLECTION AND ANALYSIS: Data extraction and assessment of study quality were undertaken by two reviewers independently. MAIN RESULTS: The methodological quality of the 8 included RCTs was poor. The internal validity score (range 0 - 10) of individual RCTs ranged from 2 to 4. Four trials compared the effect of intensive with brief educational interventions; 2 of these reported clinical endpoints. One study involving high-risk patients reported a reduction in ulcer incidence (Peto OR: 0.28 (95% CI 0.13,0.59)) and amputation rate (Peto OR: 0.32 (0.14,0.71)) after 1 year. The other RCT did not find an effect at seven years follow-up. Participants' foot care knowledge significantly improved with education in 2 trials. In one trial, foot care knowledge was significantly worse at 6 months, although foot care behaviour improved significantly. Non-calcaneal callus was significantly reduced by education in one trial. One RCT did not find that patient foot care education, as part of a general diabetes education program reduced foot ulceration compared with usual care. Patient education as part of a complex intervention targeted at both people with diabetes and doctors reduced the number of serious foot lesions at one year, in one RCT (OR: 0.41(0.16-1.00)) and improved foot care behaviour. Evidence from 2 RCTs comparing the effect of patient-tailored education in addition to usual care was conflicting. REVIEWER'S CONCLUSIONS: RCTs evaluating education for people with diabetes, aimed at preventing diabetic foot ulceration, are mostly of poor methodological quality. Existing data suggests that patient education may reduce foot ulceration and amputations, especially in high-risk patients. Foot care knowledge and behaviour of patients seem positively influenced by patient education in the short term. Because of conflicting results and the methodological shortcomings more RCTs are needed.
New challenges facing interinstitutional social science and educational program evaluation research at academic health centers: a case study from the ELAM program.
Since the mid-1990s, the protection of human subjects through institutional review boards (IRBs) has progressively broadened in scope. In this case study, the authors describe their challenges in effectively handling IRB processes to conduct educational and social sciences research within academic health centers, particularly (1) complications in conducting longitudinal interinstitutional research that involves multiple IRBs, each with different procedures that changed over ten years; and (2) factors affecting consent form and survey response rates when applying the biomedical IRB process to obtain the consent of human subjects for participation in social and educational research. The authors had a unique opportunity to follow the effect of changes in consent forms (from no form to a one-page form to a three-page form requiring signature of a witness), ways of administration (in person or by mail), and time of administration (at the time of the program or years later) on consent form and survey response rates among medical and dental school faculty members. The authors explore the extended timelines required for data collection and increased costs in dealing with these issues, as well as the effects on response rates of consent form language and administration procedures. The authors recommend strategies to lessen adverse effects of dealing with multiple IRBs at different institutions for social science and educational research, and discuss policy implications for funders, institutions and investigators.
An educational experience evaluated: the Christchurch Clinical School of Medicine.
This study explored the response of recent graduates to their clinical training at the University of Otago, Christchurch Clinical School of Medicine. Graduates rated their competence at dealing with a number of clinical problems and the adequacy of teaching received in relation to their anticipated requirements as medical practitioners. They also recorded information concerning their personal response to training--role identity, stress and anxiety felt during the course, and their commitment to ongoing education and research following training. Overall the course was regarded positively. In the light of anticipated requirements as medical practitioners some curricular gaps were perceived and criticisms of the course identified. Graduates were critical of their teachers' abilities in demonstrating interviewing and interpersonal skills. Over 70% of graduates felt that they had little or no role during much of their undergraduate clinical training. Many graduates felt that they had little opportunity to carry out research during training, nor the motivation to undertake research subsequently, but they were committed to continuing education.
Education and evaluation in emergency cardiac care programs (CPR and advanced cardiac life support): state of the art.
To increase the survival rate for out-of-hospital cardiac arrest, improvements in training must be made so that lay rescuers are motivated and have the ability to get involved. To overcome some of the fear and lack of involvement, better education strategies are needed. Adults learn didactic information through understanding and skills through repetition and reinforcement. Due to the fact that there is limited time that adults will commit to learning CPR, methods of simplification of the techniques need to be used so that there can be sufficient repetition and reinforcement. Teaching two-rescuer CPR to lay rescuers should not routinely be done. Most adults, particularly those around high-risk individuals, should learn one-rescuer CPR. Infant resuscitation should be taught predominantly to those around small children. Methods of reinforcement through the mass media should be attempted on a routine basis. Whenever possible the courses should be spread over a period of time to allow for repetition and reinforcement, thereby maximizing learning. Advanced cardiac life support (ACLS) should be widely taught to health professionals. ACLS instruction needs to be spread over time, whenever logistically possible, to enhance learning and retention. Good, validated examinations are needed and should be routinely rotated. Better methods of evaluation are needed to look at the benefit of these types of programs and to improve the cost-benefit ratio.
Training future pharmacists at a minority educational institution: evaluation of the Rx for change tobacco cessation training program.
OBJECTIVES: To estimate the impact of Rx for Change, an 8-h tobacco cessation training program on pharmacy students' perceived counseling skills, confidence for counseling, and future counseling of patients for tobacco cessation. METHODS: Unlinked, pre- and post-training surveys were administered to 142 pharmacy students enrolled at Texas Southern University, a primarily minority and historically black educational institution. RESULTS: Post-training counseling abilities were significantly improved over pretraining values for each of the five key components of tobacco cessation counseling (Ask, Advise, Assess, Assist, and Arrange), overall counseling abilities, and confidence for counseling (P < 0.001). Racial/ethnic differences in self-reported overall counseling was observed (P = 0.01). Ninety-one percent of participants believed that the training would increase the number of patients whom they counsel for cessation, and 95% believed that it would improve the quality of counseling that they provide. At least 95% of participants believed that the pharmacy profession should be more active in preventing patients from starting smoking and helping patients to stop smoking. CONCLUSIONS: The Rx for Change program had a positive impact on perceived abilities and confidence for providing tobacco cessation counseling to patients. While it is important that all current and future health care providers receive specialized tobacco cessation training, it is particularly important for clinicians of racial/ethnic minority backgrounds, who are more likely to practice in geographic areas with a high density of population subgroups at an elevated risk for tobacco-related mortality. In particular, pharmacists, who are uniquely positioned within the community to provide care to all patients, including the medically underserved, must be equipped with the necessary skills to assist patients with quitting.
Evaluating patient education materials about radiation therapy.
Targeted treatment education for cancer patients has the potential to promote adjustment through assisting patients to participate in treatment decision making, comply with treatment regimens and cope more effectively with treatment side effects. A quasi-experimental longitudinal pre-test post-test and follow-up design was used to assess the effect of a patient education video about radiation therapy on patients' psychological distress, knowledge about radiation therapy, self-efficacy about coping with treatment and physical symptoms. Patients with head and neck (n=26) and breast cancer (n=66) were recruited into the study and allocated into control and intervention groups. No significant differences were found between the control and intervention groups on any of the outcome variables. However, patients in the intervention group reported high levels of satisfaction with the video and all reported that they would recommend the video to other patients preparing for radiation therapy. As well, 90% of patients in the intervention group reported that some or all of the information in the video was new to them. Education materials that have excellent face validity and that are well received by patients may fail to produce significant change using standard controlled study designs. Future research in this area may need to consider alternative paradigms for evaluating the helpfulness of such materials.