Evaluation of a web-based educational model to improve nurse recognition of delirium: An RCT

1. Queensland University of Technology, Australia McCrow J1, Beattie E1, Sullivan K.A.1, Fick D2 &Park J.Y.1 1Queensland University of Technology, Brisbane, QLD. Australia; 2 Pennsylvania State University, US INTRODUCTION Delirium is a serious issue associated with high morbidity & mortality in older hospitalised people. Early recognition enables diagnosis & treatment of underlying cause/s, which can lead to improved patient outcomes. Research shows accurate nurse recognition of delirium is poor. This RCT evaluated the usability & effectiveness in terms of improving nurse recognition & knowledge of delirium of a web-based learning site. The website was designed using constructivist learning principles & addressed the different learning styles of nurses. METHODS Materials. Outcome measures: Delirium recognition (DR) was assessed pre/post RCT using vignettes that depicted delirium of different types. These vignettes were developed & validated using an international panel of experts. Delirium knowledge (DK) was assessed using a 35 item questionnaire. Interventional materials: A delirium education website was designed using the constructivist learning elements of: learner foundations, cognitive scaffolding, meaningfulness & engagement, all within a learner centered environment. A pilot test of the website suggested minor revisions that were undertaken, but in general provided preliminary indications of its effectiveness. Sample & Procedure: A convenience sample of consenting Registered Nurses (RNs) (n=175) from 3 acute care facilities in Brisbane, Australia participated in the RCT. At baseline (T1) participants (Ps) completed a DR and a DK test. Following baseline assessment Ps were randomised to a control (C) and intervention (IV) group via a cluster randomisation procedure. Intervention group Ps were provided with website access for a five-week period. At the end of this period the website was locked & DR & DKwere assessed together with a participant evaluation of the website (T2). Further assessments of DR & DK were assessed two months later (T3). An intention-to-treat analysis was undertaken using linear mixed modeling (LMM) to determine differences in DR & DK between the IV & the C groups at three different time-points. Evaluation of a web-based educational model to improve nurse recognition of delirium: An RCT RESULTS Data analysis of the final sample at randomisation (n=147) showed Ps in the IV group spent a median time of 60 minutes online. Participants reported high levels of satisfaction and site usability. There were no statistically significant effects of any baseline characteristics on final outcome scores, therefore the final LMMs for both DK and DR included fixed-effects associated with group (C or IV), time and the interaction between group and time with a AR(1) covariance structure. Both models identified statistically significant (p<0.05) effects of both TIME and GROUP and the TIME X GROUP interaction was an increase in knowledge over time for all study participants independent of group. However, the change in delirium knowledge scores was higher in the IV group than for controls. The statistically significant differences over time when comparing the mean DK scores between groups were: 1) T3 and T1 (p=<0.001) & 2) T2 and T1 baseline (p=0.001). Calculations using the coefficients from the estimates of fixed-effects identified that on average participants in the IV group scored an estimated 3.5 (10%) more questions correct at the T2 testing & 3.1 (9%) more questions correct at the T3 testing than participants in the control group. the change scores for the IV group when compared to the control group between T2 and T1; and a statistically significant difference between T3 and T1 (p=0.049) in change scores between the two groups was found, despite a decreased in scores for both groups. Calculations using the coefficients from the estimates of fixed-effects identified that on average participants in the IV group scored an estimated 0.7 (14%) more diagnoses (using delirium recognition vignettes) correct at the T2 testing & 0.6 (12%) more diagnoses correct at the T3 testing than participants in the control group. For knowledge: the overall positive coefficient values for time indicated that there Figure 1. Results from the delirium knowledge questionnaire at each time-point between groups (35 questions). For recognition: A statistically significant (p=0.019) improvement was identified in Figure 2. Results of recognition using vignettes at each time-point between groups (5 vignettes). DISCUSSION Findings from this study support the concept that online learning is an effective & satisfying method of information delivery. Embedded within a constructivist learning environment the site produced a high level of satisfaction & usability for the RN end-users. Additionally, the results showed that the website significantly improved delirium knowledge & recognition scores & this was retained at a two month follow-up. Given the strong effect of the intervention the online delirium intervention should be utilised as a way of providing information to RNs so that they may improve outcomes for people with delirium. Although there is room for improvement, this intervention has the potential to provide RNs with links to external communities, connect with people from other countries with the same interests in delirium & continue to build on prior knowledge.A critical next step is demonstrating the effect of the intervention in improving health outcomes for people with delirium. For more information contact Judy McCrow: J.McCrow@qut.edu.au