参考文献六 文献案例（RCT）.pdf

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1、ORIGINAL ARTICLE Effectiveness of an educational video as an instrument to refresh and reinforce the learning of a nursing technique: a randomized controlled trial Loris Salina Carlo Ruffi nengoLorenza Garrino Patrizia MassarielloLorena CharrierBarbara Martin Maria Santina FavaleValerio Dimonte Publ

2、ished online: 28 April 2012 ? The Author(s) 2012. This article is published with open access at S Abstract The Undergraduate Nursing Course has been using videos for the past year or so. Videos are used for many different purposes such as during lessons, nurse refresher courses, reinforcement, and s

3、haring and comparison of knowledge with the professional and scientifi c community. The purpose of this study was to estimate the effi cacy of the video (moving an uncooperative patient from the supine to the lateral position) as an instrument to refresh and reinforce nursing techniques. A two- arm

4、randomized controlled trial (RCT) design was chosen: both groups attended lessons in the classroom as well as in the laboratory; a month later while one group received written information as a refresher, the other group watched the video. Both groups were evaluated in a blinded fashion. A total of 2

5、23 students agreed to take part in the study. The difference observed between those who had seen the video and those who had read up on the technique turned out to be an average of 6.19 points in favour of the fi rst (P0.05). The results of the RCT demonstrated that students who had seen the video w

6、ere better able to apply the technique, resulting in a better The research was conducted at the University of Turin Undergraduate Nursing Course, Turin, Italy. L. Salina ( moreover, they argue whether the use of technology will ever be able to replace the fundamental role of the teacher in student l

7、earning. Despite this, many studies suggest that the use of technology and internet is a useful instrument which favours education 1, 8, 9. In the literature, various observational studies have demonstrated that the use of video streaming contributes to learning as a powerful instrument for educatio

8、n and for the acquisition of clinical competencies, reducing the gap between theory and practice 1012. It has also been highlighted that knowledge is not only acquired through video observation, but as part of the students learning process. Moreover, some authors suggest how the use of the video can

9、 support students in learning different types of techniques 11, 12. There are also some observational studies which demonstrate that the introduction of video streaming in schools has been very positive in terms of effectiveness and facilitation of learning. 9, 1316. Some authors describe the simula

10、tionas a characteristic feature which may render the video particularly effective in stimulating learning and emphasizing the concepts. Watching videos is not a passive but an experiential process 17, 18. Video use should help students to learn new skills and enhance learning processes in much the s

11、ame way as experience is acquired during their practical training. The benefi ts of using videos are well documented and videos are considered a valid tool for student education 1922. Particular reference is given to the 68L. Salina et al. 123 pedagogical aspects and the impact of the image, the int

12、eraction and integration as key elements of video streaming 23. Currently, there are few experimental studies which demonstrate video effectiveness applied to traditional nursing techniques 2426. Studies carried out in critical care have demonstrated how teaching video use in the emergency situation

13、 can enhance performance quality. Einspruch 27 adopted this method with laypersons by estimating the effi cacy in a randomized controlled trial (RCT). In an RCT, conducted by medical students, it was demonstrated that a 3 min video play produced a comparable or better performance than that used in t

14、he American Heart Association (AHA) course 28. Cofi eld 29 carried out an experimental study measuring qualitative variables, suggesting the effectiveness of video streaming to reinforce and enhance learning. Indications of better video use have been analyzed by various experts,in particular by Race

15、 and Shephard 13. Two key elements should prevail: keeping to the content and guaranteeing maximum interactivity. Technological progress and the use of streaming videos has virtually erased problems. Interactivity is, therefore, guaranteed by enabling change in real time of any sequence of the video

16、 27. The advantage of using YouTube clearly emerges as an instrument for sharing videos and allowing students to participate actively in the discussion on fi lms. YouTube has grown during the last few years and is visited by almost 70 million persons a day. With their free access, the main search en

17、gines worldwide (Google, Yahoo) allow comparisons among the entire professional and scientifi c community, thus offering the possibility to comment and make suggestions, and for free and constructive debate, therefore becoming a reliable and updated point of reference. It is a powerful instrument wh

18、ich makes sharing and exchanging ideas possible 30. Videos are surely among the most interesting technologies, adding value to learning content. Not only should the image be detailed, but it should offer students the possibility to use more channels, thus enhancing and facilitating learning processe

19、s. However, there is little evidence on the effi cacy of video streaming to support student learning. The aim of this study is to verify the effectiveness of video streaming as an instrument for refreshing and reinforcing nursing education. Methods Design of the study A two-arm RCT design was chosen

20、 and performed in December 2009 at the Undergraduate Nursing Course at Turin University. This is a two-group design: subjects were randomly assigned to the experimental and control groups. Both groups attended lessons in the classroom as well as in the laboratory; a month later the control group rec

21、eived written information to refresh the technique, while the experimental group saw the video. Both groups were given ten minutes to allow them to freshen up on the technique. Students were assessed individually by a blinded evaluator using observational rating scales. Effectiveness video, refresh

22、and learning: RCT69 123 Participants The population consisted of 250 undergraduate students attending the nursing course at Turin University. Students who consented to participate in the study were fully informed about their right to withdraw at any time and the fact that data were to undergo aggreg

23、ate processing and would be stored safely. Randomization Participants were randomized by a computer-generated randomization scheme and the identifi cation number from the randomized allocation schedule. Students were not told whether they would be seeing the video or reading up on the technique. To

24、guarantee the effective homogeneity between the two groups, data variables infl uencing student performance, such as age, sex, qualifi cations, laboratory participation, reading information concerning the technique and development of a working activity in the fi eld, were collected. The video The vi

25、deo chosen involves the technique dealing with moving an uncooperative patient from the supine to the lateral position. The health care professional uses a sliding sheet to move a mobility-impaired person. The written information was compared with the video, which turned out to be identical regardin

26、g both the words and the sequence. The duration of the video was 7.32 min. Instrument of appraisal The appraisal instrument was an observational grid developed to assess student performance. The instrument was a 33-item observational form with the possibility to mark whether a single action had been

27、 carried out or not. Each item expresses single actions which together make up the technique (e.g. inform the patient about what is going to happen/wrap the cloth around both shoulders/lift the edge of the bed). Less important items were given 1 point whereas core items were given 2 points. The asse

28、ssment forms were anonymous and were identifi ed through a code assigned at the time of enrolment. Performance was evaluated based on the weighted sum of all the actions making up the procedure. Pilot study and evaluation of the sample size A pilot study was carried out in May 2009 on 21 students wi

29、th the aim of identifying potential shortcomings, testing the appraisal instrument for the collection of information and assessing the sample size necessary to perform the RCT. 70L. Salina et al. 123 Considering the measuring instrument could supply a range of values between 0 and 53 and taking 5 as

30、 the minimum signifi cant value which we would observe, we needed to enrol 100 students for each arm of the study for an 80 % statistical power. Statistical analysis The items that made up the technique were treated as qualitative variables: actions not performed vs actions done correctly. In compar

31、ing the experimental and control groups for qualitative variables, the Pearsons Chi-square or the Fishers exact test were used: in particular, the latter was used if at least one cell showed less than fi ve expected values. The ShapiroWilk test was performed to assess the normal distribution of quan

32、titative variables: the Students t test was used for variables normally distributed, while the MannWhitney test was used if the variable showed a non-normal distribution (ShapiroWilk test statistically signifi cant). All tests were conducted at a signifi cance level of 5 %. The data collected were p

33、laced on Excel spreadsheets and analyzed with the Stata 9 statistical programme. Results Altogether, 223 students joined the study: 74 males and 129 females. They were randomized into the experimental group (watching video, n = 112) and the control group (written information, n = 111). Table 1 illus

34、trates the characteristics of the study sample (experimental group vs. control group) for some variables: gender, age, whether the participant already had a degree, or was already a certifi ed nursing assistant (CNA). The two groups were homogenous for all these variables so that we can presume that

35、 possible differences in their performance are attributable to the use of the video. The results of the study are shown in Table 2. Table 2 illustrates, relatively to the two groups (experimental and control), the results of the performance. The mean difference observed between those participants Ta

36、ble 1 Characteristics of the study sample: experimental group vs. control group Experimental group (n = 112) Control group (n = 111) P Sex (M/F)40/7234/77N.s. Age (mean SD)22.25 5.921.92 4.55N.s. Other degree (yes/no)9/10312/99N.s. CNA (yes/no)3/1092/109N.s.? N.s. (P0.05) CNA certifi ed nursing assi

37、stant Pearsons Chi-square test ? Fishers exact test Students t test Effectiveness video, refresh and learning: RCT71 123 who had seen the video and those who had read about the technique was 6.19 points (1.08 standard error (SE). The difference between the two groups was statistically signifi cant (

38、P0.05), so viewing the video led to a better performance in comparison with simply reading up on the technique. Discussion What emerges according to the data we obtained is that videos are beginning to draw serious attention to their learning potential. The result of this study is in conformity with

39、 the other experimental studies present in the literature 2426. We also demonstrated that those who saw the video were better able to apply the technique. The video lasts 7.32 min. The technical aspect of video duration conforms with what emerged from the literature, which recommends that videos sho

40、uld last no longer than 15 min 22. The possibility of interrupting the fi lm and seeing some sections again offers the advantage of maintaining a high attention level. However, this means that the user should be able to easily access and view the contents. Therefore, it is necessary for users to sim

41、ply surf the Net, review, observe and retrieve the material of their choice. As described in the literature, and in particular by Bennet 21, students reported that the use of the video seemed a more effective learning tool since they could easily remember what they saw on the fi lm; moreover, they h

42、ad the possibility to stop, start and rewind the video to address their specifi c needs. Various descriptive studies and opinions of experts assert that the video represents an important opportunity for the student to increase and support learning, thus contributing to a better performance of the te

43、chnique. But the video cannot completely replace face-to-face lessons, although it widely contributes to and complements education 13. The video library will be available in additional languages, to allow comparison among the scientifi c and professional community all over the world. Moreover, it wo

44、uld be of support to those students who are not Italian. The educational use of the video surely offers remarkable advantages for online learning even if it clashes with the limits imposed by the web (the possibility Table 2 Overall performance: experimental comparison group vs. control group Experi

45、mental group (n = 112) Control group (n = 111) Mean difference SE (CI 95 %) P* All itemsa42.95 6.736.76 9.26.19 1.08 (4.068.32)0.00001 Minimum score 229 Maximum score 5353 CI confi dence interval, SE standard error * MannWhitney test a Data are presented as mean SD unless otherwise stated 72L. Salin

46、a et al. 123 of quickly linking to the web). Furthermore, even if effective, the video has to be part of an educational plan correlated with precise objectives which are refl ection, verifi cation, understanding and clarifi cation. Conclusions During the last few years, university education has unde

47、rgone profound changes in the organisation and methodologies used. Video use and video streaming represent one of these instruments. What emerges from the results of this study is that videos are useful tools for refreshing and reinforcing concepts learnt during nursing courses. The use of education

48、al videos couldbecome a routine instrument for student training. A limitation of the research is the possibility that respondents in the intervention group sought more information on their own. A second limitation is that the difference between the two groups could be a short-term effect, because th

49、e refresher training was immediately followed up by the assessment. Follow-up research could explore the permanence of the effect of using video as a tool for refresher training. Essentials The aim of the study is to verify the effectiveness of the video as an instrument for refreshing and reinforcing nursing education. The Universitys need to provide a useful tool for students. The use of the video contributes to refresher training as a powerful instrument for the education and the acquisition of clinical competencies, The use of educational videos could become a routine instru