Methods: This study used a multi-method quasi-experimental design with pre- and post-intervention and observation to evaluate clinicians’ skill, confidence and competence after education package and OSCEs. The effects of this initiative were evaluated using three surveys: pre-survey (T0), immediately after the OSCE (T1) and six weeks post-OSCE (T2). Pre- session 1 (T0) questionnaires consisted of four demographic questions, four questions related to self-perceived confidence and competence of delirium assessment and knowledge and after OSCEs Delirium Education on improving the competence and confidence to deliver delirium care and 16 multiple-choice questions (MCQ) about delirium knowledge and skills. In addition, qualitative data were collected from open ended items in the surveys. The OSCE scenarios were developed in collaboration with an expert panel of senior nursing staff (n=10), physiotherapists (n=1), senior occupational therapist (n=1) and Geriatric Medical Consultants (n=2), all of whom work in aged care wards. The scenarios were developed based on de-identified cases from their own clinical practice. A total of five OSCE scenarios were developed.
Sample and settings: A convenience sample of all registered nurses, enrolled nurses, medical interns, physiotherapists and occupational therapists working on the four aged care units in two hospitals in NSW, Australia (one regional and one urban). Approximately 150 clinical practitioners were invited to participate in the study.
Data analysis: All data will be entered into SurveyMonkey. Data will be downloaded into Excel for data cleaning and imported to SPSS for data analysis. Descriptive statistics (including Chi-Squared) will be undertaken to test the effects of implementing the education intervention. The transcripts of data from the open-end questions were analysed independently by two authors (R.C. & A.S.) using constant comparison method.
Results: There was a total two acute care hospitals and 128 partitioners (registered nurses, allied health, assistants in nursing and medical doctors) participated. A total of 113 attended a one-hour face-to face education session (88.2 % response rate) and completed a demographic survey, self-assessment survey and a short formative multiple-choice questionnaire (MCQ). A total of 97 completed Survey T1 (response rate of 75.7%) and a total of 84 staff completed Survey T2 (response rate of 65.6%). Throughout the study a total of 12 participants (n=12) withdrew due to sick leave, maternity leave and resignation. A total of 2 participants (n=2) identified themselves as being “too anxious” to complete the OSCE component (Session 2). The majority of participants were registered nurses and enrolled nurses (n=64, 56.6%), others were medical doctors (n=7, 6.1%), physiotherapists and occupational therapists (n=13, 11.5%), AIN (n=12, 10.6%) and clinical nurse specialist (n=3, 2.6%).
The most important findings were statistically significant improvements in the regional hospital perceived: (i) perceived knowledge about delirium (P≤ 0.000) and (ii) perceived confidence of practitioners in using the Confusion Assessment Method (P≤ 0.000). These improvements were sustained over six weeks after the implementation of the intervention. However, there was no increase in confidence and competence in the assessment and management of delirium and in the use of CAM in the urban hospital. Since the participants from the urban hospital are all working in the age specific wards and have more experience in caring for delirium patients, it is not surprising that participants have higher confidence and competence at the baseline but this slightly decreased 6 weeks after post intervention. We might presume that after attending the education program, participants feel themselves lacking knowledge in the assessment, management of delirium and in the use of CAM so on the contrary, they feel that they need further education and training.
Although there was no increase in confidence and competence in the assessment and management of delirium and in the use of CAM in the urban hospital, the participants from both regional and urban hospitals expressed overall satisfaction from the OSCE component of the education initiative as evident by their scores on the high level of satisfaction (87.50%) in both confidence and competence to deliver evidence-based delirium care.
From qualitative results we found that all participants were highly satisfied regarding their experience of OSCEs session and video viewing of interaction, assessment and management of a delirious patient. They felt that the sense of the stimulated OSCE and videos providing clarification of points that they were unclear about after the face to face teaching session and they would be able to implement the techniques learnt into practice. They found education material interactive and easy to learn, the scenarios were realistic to normal practice and recommended to be a regular continue education and new staff program in the hospitals.
The result form facilitators evaluation survey (n= 6, response rate 85.7%) showed all of the facilitators reported that the overall contribution of the ‘OSCE Delirium Education Project’ was high on improving the confidence and competence of practitioners to deliver evidence-based delirium care. They found the participants express higher level of competence in using CAM assessment tool and more confidence in caring delirium patients after the project completed.
Conclusion:
The results of this study showed a significant increase in the participants’ knowledge in recognising delirium and increased confidence and competence in the use of CAM. The study indicates the use of an OSCE in the clinical setting with post-registration nurses and allied health staff may improve the rate of recognition for people at risk of delirium. Therefore future research into this project will include a review of in-patient records on the inclusion of the completed CAM in admission documentation.
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