Using CD-ROM Technology to Train Long-Term Care Staff
SBIR Grant, Phase 1 and 2 R44 NR04743
Funding Agency: National Institute of Nursing Research
As nursing facility populations escalate, administrators and in-service educators can benefit from the use of innovative approaches to staff training. The results of this study provide facility administrators and in-service educators with the evidence they need to feel comfortable with the effectiveness of computer-based training as an alternative instructional method.
Researchers demonstrated the short term effects of computer-based training in a small-scale pilot test and a large scale national field test. In the pilot test, 289 staff from a large North Carolina nursing facility were randomly assigned to a computer-based (CB) ( n = 152) or instructor-led (IL) group ( n = 137). Staff signed up for training times and completed the module offered at that time. They completed a preregistration form, pretest, posttest, and course evaluation. Both the CB and IL groups significantly improved their scores from pre- to posttest on the subtests (knowledge, attitudes, and practices) of each module. Results of the pilot test study were used to revise the materials for the national field test.
In the field test, the CB and IL versions of the fire safety training program were presented to staff of nine nursing facilities. Participants ( N = 1,294) were randomly assigned to the CB ( n = 670) or IL ( n = 624) groups. Both groups significantly increased their knowledge, attitude, and practice scores from pre- to posttest. Participants reported that they enjoyed the CB training and had no difficulty using the computers.
Researchers found that computer-based training was more effective than instructor-led training at increasing participants' knowledge. The findings from the national field test demonstrated that the computer-based (CB) group ( n = 670) significantly outperformed the instructor-led (IL) group ( n = 624) on the knowledge subtest at posttest ( F (1) = 6.138, p = .013). Differences between groups for the attitudes and practices subtests were not significant.
An important aspect of this research was the effect of computer-based training on participant's retention of knowledge, attitudes, and intended practices. Most nursing facilities are required by fire code to have fire drills quarterly on each shift to familiarize facility personnel with signals and emergency action required in a fire situation (National Fire Protection Association, 2000). In addition to these drills, many facilities have a yearly fire safety in-service training. How long do staff members remember the information from the in-services and fire drill training? Researchers found that after a three-month interval, participants in the field test performed significantly better on the follow-up test than they had on the pretest. Their losses from posttest to follow-up were also significant demonstrating the need for ongoing training in critical areas such as fire safety.
The data also suggest that the participants enjoyed the computer-based instruction and had no difficulty adapting to this method of training. In the field test study, nearly a quarter of the members of the CB group ( n = 163, 24%) had never used a computer prior to the training. Many of the first-time computer users were apprehensive when they entered the training room. After learning how to use the mouse, however, these participants responded positively to the training. A separate data analysis showed that these first-time computer users improved significantly from pre- to posttest for knowledge of fire safety ( t = 20.44; p < .001), attitude towards fire safety ( t = 7.68; p < .001) and practices related to fire safety ( t = 8.1; p < .001). Ninety-five percent of this group reported on the participant evaluation that the computer was easy-to-use for training and 86% said they wanted to use a computer for future training classes. Because staff are sometimes overwhelmed by the large volume of required training topics, using different methods to deliver information provides variety and may encourage staff enthusiasm.
Researchers found that staff with minimal education (high school or less than a high-school) improved significantly from pre-to posttest as a result of the computer-based training. Data for field test participants with a high school ( n =498) or less than high school ( n =94) education were included in a separate study. In this study, researchers performed a repeated measures analysis for each subtest with test scores measured at two points in time (pre- and posttest) as the dependent variables. The single within subjects variable was time. The two between subjects variables were group (CB or IL) and educational level (high school or less than high school). The main effect of time was significant for all subtests suggesting that across the modules participants significantly increased their knowledge, attitudes, and practices scores from pre- to posttest. The interaction of time and group was significant only on the knowledge subtest ( F (1) = 5.137, p = .024). Further analysis suggested that the participants in the CB training increased knowledge scores significantly more than those in the IL training, but that the IL and CB methods had similar effects on the participants' improvements on the attitudes and practices subtests.
The study also demonstrates the feasibility of using computers to present a training program to a large group of staff with a small number of computers and little supervision. Because all new staff need to be prepared to deal with fire emergencies from their first day on the job and group instruction is not always easily available, having the option of computer-based training gives administrators and nurse educators another instructional tool. While traditional instructor-led training will continue to be used, computer-based training offers advantages in the nursing facility environment. One of the difficulties in staff training is having large numbers of staff away from their duties at one time. To accommodate this problem, the instructors often present the training to small groups in several sessions. This approach is expensive and inefficient, requiring large facilities to hire several full time instructors. Using computer-based training offers a means of training staff on an individual basis that can supplement instructor-led training. Computer-based training can provide more time for nurse educators to manage staff development and provide the kinds of training that are best offered in a one on one environment. While this program used fire safety as the content, computers could be used to present other types of training as well.
The flexibility of computer-based training is perhaps its most important characteristic. In this program, staff from all departments and with all ranges of educational backgrounds participated. The results indicated that these participants significantly improved their knowledge of fire safety, recognized the importance of fire safety to a greater degree, and were more likely to recognize the most appropriate response to various fire safety-related situations.