This poster presentation aim is to disseminate the research protocol of an ongoing PhD. project in nursing education and practice:
Dual Diagnosis (DD) refers to the coexistence of a substance use disorder in individuals also diagnosis for one or more mental disorders. Studies from the USA and Canada suggest that DD patients receiving care from primary care providers’ (PCPs’) are less likely to achieve the required treatment threshold, as compared to specialist in DD. These findings are further supported by additional data showing PCPs’ lack of comfort and confidence in caring for DD patients. Moreover, qualitative research conducted specifically in first-line services showed that nurses frequently feel ill-equipped to manage more complex or severe cases.
Project Extension for Community Healthcare Outcomes (ECHO) is an educational program that uses videoconference technology to connect a specialist team at an academic center with PCPs’ across the province/state as an intent to share knowledge and best practices. Each ECHO session consists of didactics and a discussion of anonymized patient cases; with an emphasis on peer-to-peer interaction to consolidate learning. A recent systematic review showed that ECHO was effective to improve PCPs’ knowledge. Nonetheless, little is known about the learning processes through which these knowledge gains were achieved. Furthermore, there is a lack of long-term data to determine Project ECHO’s impacts on nurses’ knowledge mobilization and maintenance in practice.
This study aim is to measure and understand the extent to which an ECHO program on DD in Canada has an impact on primary care nurses’ competency development over a period of 12 months.
Methods:
This study builds on a constructivist conceptual framework of competence defined as a complex ability to act; supported by the mobilization and the efficient combination of a variety of resources within a specific situation. Competency development is view as an ongoing and dynamic process of learning based on the uniqueness of each person, their life experiences and their understandings of the situation itself.
A mixed-methods sequential design will be use. The first phase, quantitative, will consist of a prospective cohort study to measure participation, satisfaction, knowledge and self-efficacy of nurses engaged in a DD ECHO program over a period of 12 months. Then, a purposive sample strategy will be used to select a sub-group of nurses for the following phase. This second phase, qualitative, will employ a narrative design to understand how nurses developed their competencies over time and how they used them into their own practice. An interpretative analysis will be performed on nurses’ personal stories to gain rich description of learning processes, to identify pivotal moments of development and to explore the facilitators or barriers related to learning.
Results: The findings of this study might guide researchers, clinicians or trainers to develop innovative educational approach to effectively support nurses in acquiring high level of competence.
Conclusion: International experts have recently called for a transformation of nurses and other health professionals’ education to prepare them for complex healthcare environments. ECHO is a promising training program to improve clinical performance and patients' health status.