Self-Directed Versus Traditional Clinical Learning Model on Nurses' Airway Management Competencies

NCT04244565 | Completed DMC

• 1 other identifier: FWA00019803
• Study Type: observational
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

Effect of Self-Directed Versus Traditional Clinical Learning Model on Nurses' Airway Management Competencies and Patients' Airway Related Incidents Introduction Airway crisis situations in ICUs (Intensive Care Units) are common, complex, dynamic and time-sensitive contexts, that pose a significant threat to patient safety, and are a major source of preventable errors. Airway management has the highest priority in patient care, it is the first step in the (ABCDE) approach. The concept of Airway management in nursing perspective includes any nursing procedures and techniques required to keep the airway open and prevent aspiration. Adult learning is a practice in which adults engage in systematic and sustained learning activities in order to gain new forms of knowledge, skills or values. Most adult education is voluntary; therefore, the participants are generally self-motivated. Continuing education (CE) of nurses is increasingly necessary to keep abreast of rapid changes in patient care due to advancements in knowledge and technology and improve their ability to serve the patients safely. Although nursing care has been changed significantly over the past 30 years, methods for clinical training nurses have not. A popular or traditional model for clinical teaching of nurses, including but not limited to; integrating lectures, skills laboratory training and supervised clinical experience. A benefit of this model is the opportunity to assist nurses to integrate the concept learned in class or skill lab in patient care. Also, the instructor can select clinical activities that best meet nurses' needs and are consistent with hospital goals. While, Self-directed learning (SDL) is one of modern approaches of clinical learning, the concept of SDL originates from the Adult Learning Theory, it is a process in which the instructors play a facilitating role while, learners actively participate in identifying their own learning needs, learning goals, allocating resources \& decide whether learning method can be used, and engaging in self-reflection \& evaluation. The positive outcomes of SDL including but not limited to, greater self-control, self-confidence, autonomy, and lifelong learning skills. In essence the aim of this study will be examining the effect of Self-directed clinical learning model as compared to the traditional models to improve nurses' Airway management competencies and minimize airway related incidents. Research Hypothesis H1: Critically care nurses who will approach self-directed clinical learning model (μ1) will have a higher level of Airway management skills (μ2), (H1: μ1 \> μ2). H1: Intensive care units who will approach self-directed clinical learning model to learn their working nurses (μ1) will have a lower frequency of patients' airway-related incidents (μ2), (H1: μ1 \< μ2). Subjects and Methods True experimental, prospective, and comparative research design will be utilized in the current study. This study will be conducted at selected two Adult Intensive Care Units, A convenience sample of 60 male and female Critically Care Nurses who are working in the selected Intensive Care Unit, will be recruited to the study. The sample size estimated by (G Power analysis) (independent t tests - One tail, Effect size = 0.65, α = 0.05, Power (1-β) = 0.80, balanced allocation ratio 1:1). The total sample size will be divided into two groups (study and control). All nurses should be corresponded to specific inclusion criteria. Five tools will be formulated to collect data pertinent to the study. Procedure The study will be conducted through three phases; preparation \& designation, implementation, and follow up \& evaluation phase. The 1st Part will be initiated by allocating the selected ICUs randomly into two paired settings, one for applying traditional learning (control ICU) and the other for self-directed learning experimentation (study ICU). the nurses who are working in selected ICUs and correspond to the inclusion criteria, will be randomly distributed into two equal groups (30 nurses in each group). The nurses who are working in study ICU will be asked to fill out the nurses' readiness assessment sheet to learn independently. The nurses who will demonstrate a high readiness score (\>80%) for independent learning will be included. Once implantation is complete, the follow-up and evaluation phase will be initiated by daily monitoring of the occurrence of patients' airway related incidents in both control and study ICUs for a continuous three months. Then, the nurses' knowledge and practices (in the control group) will be evaluated two times, 1st time will be 1 month after the implementation phase, and the second time will be after 3 months from the 1st evaluation (to measure the retention of given education and training). Upon completion of data collection, descriptive and inferential statistics will be utilized to test for differences among the study and control group subjects.

Conditions

Airway Morbidity; Nurse's Role; Airway Obstruction; Nurse's Scope of Practice

Keywords

Self-directed, Traditional Clinical Learning

Outcome Measures

Primary Outcomes (3)

• Structured questionnaire schedule to assess nurses' knowledge (Level) regarding Airway management related issues.

  Nurses' Airway management competencies need a wide theoretical background aimed to practice based on rational and evidence. Airway management has the highest priority in patient care. Nurses' knowledge regarding Airway management consists of different issues such as; (1) Causes of Airway obstructions (2) Ways to maintain Airway clear (3) Management of ETT cuff pressure. (4) Airway assessment items. This questionnaire will be self-administrated for the group who will be applied self-directed clinical learning model. While, it will be conducted by the clinical instructor by interview for the group who will be applying the traditional clinical learning model. The tool consists of 20 MCQ questions, each right answer will be given one score, total scores will be 20 grades. Those who obtained \> 80% will be considered as having a satisfactory knowledge level.

  5 months

• Structured observational checklist to monitor the nurses' practices (Level) regarding Airway management skills

  Nurses' Airway management skills include different nursing procedures or maneuvers aimed to maintain airway clear. Airway management has the highest priority in patient care. Nurses' airway management skills such as; (1) Suction to remove secretion (2) Airway maneuvers e.g. head-tilt and chin-lift (3) Proper fixation and care of ETT (4) Management of ETT cuff pressure (5) Oral care (6) Airway assessment skills. This tool will be self-administrated for the group who will be applied self-directed clinical learning model. While, it will be conducted by the clinical instructor by direct observation for the group who will be applying the traditional clinical learning model. The tool consists of 50 items, each item checked as; done complete and correct was given two scores, done incomplete was given one score, and not done or done incorrect was given zero, eventually, those who obtained \> 80% will be considered as having a satisfactory practical level.

  3 months

• Patients' Airway Related Incidents (Rate)

  Patients' airway related Incidents defined as any airway safety problems or events for either intubated or non-intubated patients, which led to partial or complete airway obstruction, injury or infection. Such as; accumulation of secretion, aspiration or edema. the researcher will be assessed the incidents by pre-structured Patients' airway related Incidents assessment checklist which collect and categorize the incidents (events) within the planned time frame.

  3 months

Other Outcomes (1)

• Nurses' Readiness to Learn Independently (Rate)

  1 month

Study Arms (1)

Self-directed clinical learning

examining the effect of Self-directed clinical learning model as compared to the traditional models to improve nurses' Airway management competencies and minimize airway related incidents.

Behavioral: Self-directed model of clinical learning for nurses

Interventions

Self-directed model of clinical learning for nurses BEHAVIORAL

the instructors play a facilitating role while, learners actively participate in identifying their own learning needs, learning goals, allocating resources \& decide whether learning method can be used, and engaging in self-reflection \& evaluation.

Also known as: compared to the traditional models

Self-directed clinical learning

Eligibility Criteria

• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

A convenience sample of 60 male and female Critically Care Nurses who are working in the selected Intensive Care Unit

You may qualify if:

• Willing to participate in this study.
• Working for at least one month in the current position.
• Maximum two years of experience in critical care.

You may not qualify if:

• Nurses who attended any educational courses in Airway management in last 6 months, will be excluded.
• Nurses planning to leave work 6 months later, will be excluded.

Sponsors & Collaborators

• Cairo University: lead

Study Sites (1)

Cairo University Hospital

Cairo, 11612, Egypt

Location

Related Publications (24)

• Nguyen LHP, Bank I, Fisher R, Mascarella M, Young M. Managing the airway catastrophe: longitudinal simulation-based curriculum to teach airway management. J Otolaryngol Head Neck Surg. 2019 Feb 19;48(1):10. doi: 10.1186/s40463-019-0332-0.

  PMID: 30782200 BACKGROUND

• Chatterjee, A., Islam, S., & Divatia, J. V. (2004). Airway accidents in an intensive care unit.

  BACKGROUND

• Higgs A, Cook TM, McGrath BA. Airway management in the critically ill: the same, but different. Br J Anaesth. 2016 Sep;117 Suppl 1:i5-i9. doi: 10.1093/bja/aew055. Epub 2016 May 4. No abstract available.

  PMID: 27147544 BACKGROUND

• da Silva LFM, Pascoal LM, Nunes SFL, de Sousa Freire VEC, de Araujo Almeida AG, Gontijo PVC, Neto MS. Ineffective Airway Clearance in Surgical Patients: Evaluation of Nursing Interventions and Outcomes. Int J Nurs Knowl. 2019 Oct;30(4):251-256. doi: 10.1111/2047-3095.12242. Epub 2019 Mar 27.

  PMID: 30916452 BACKGROUND

• Divatia, J. V., & Bhowmick, K. (2005). Complications of endotracheal intubation and other airway management procedures. Indian J Anaesth, 49(4), 308-18

  BACKGROUND

• Holbery, N., & Newcombe, P. (2016). Emergency nursing at a glance. John Wiley & Sons.

  BACKGROUND

• Huitink, J. M., & Bretschneider, J. H. (2015). Airway Management Academy: A global initiative to increase patient safety during airway management by medical education. Trends in Anaesthesia and Critical Care, 5(1), 42-47

  BACKGROUND

• Spaliaras, J., Streiff, A., Mann, G., & Straker, T. (2019). Teaching and training in airway management: Time to evaluate the current model?. Airway, 2(1), 28

  BACKGROUND

• Lindkaer Jensen NH, Cook TM, Kelly FE. A national survey of practical airway training in UK anaesthetic departments. Time for a national policy? Anaesthesia. 2016 Nov;71(11):1273-1279. doi: 10.1111/anae.13567. Epub 2016 Sep 28.

  PMID: 27679501 BACKGROUND

• Ni C, Hua Y, Shao P, Wallen GR, Xu S, Li L. Continuing education among Chinese nurses: a general hospital-based study. Nurse Educ Today. 2014 Apr;34(4):592-7. doi: 10.1016/j.nedt.2013.07.013. Epub 2013 Aug 7.

  PMID: 23931929 BACKGROUND

• Croxon L, Maginnis C. Evaluation of clinical teaching models for nursing practice. Nurse Educ Pract. 2009 Jul;9(4):236-43. doi: 10.1016/j.nepr.2008.06.004. Epub 2008 Aug 21.

  PMID: 18722161 BACKGROUND

• Niederhauser V, Schoessler M, Gubrud-Howe PM, Magnussen L, Codier E. Creating innovative models of clinical nursing education. J Nurs Educ. 2012 Nov;51(11):603-8. doi: 10.3928/01484834-20121011-02. Epub 2012 Oct 11.

  PMID: 23061436 BACKGROUND

• Shellenbarger, T., Gaberson, K., & Oermann, M. (2018). Clinical teaching strategies in nursing. Springer publishing company.5th ed

  BACKGROUND

• Luhanga, F. L. (2018). Learning in the traditional-faculty supervised teaching model: part 1-the nursing students' perspective. J Nurs Educ Pract, 8, 89-102

  BACKGROUND

• Hill, L., & Williams, E. P. (2017). Contemporary Models for Clinical Nursing Education

  BACKGROUND

• Ghiyasvandian S, Malekian M, Cheraghi MA. Iranian Clinical Nurses' Activities for Self-Directed Learning: A Qualitative Study. Glob J Health Sci. 2015 Sep 1;8(5):48-58. doi: 10.5539/gjhs.v8n5p48.

  PMID: 26652072 BACKGROUND

• Montin, L., & Koivisto, J. M. (2014). Effectiveness of self-directed learning methods compared with other learning methods in nursing education related to nursing students' or registered nurses' learning outcomes: a systematic review protocol. JBI Database of Systematic Reviews and Implementation Reports, 12(2), 1-8

  BACKGROUND

• Levett-Jones TL. Self-directed learning: implications and limitations for undergraduate nursing education. Nurse Educ Today. 2005 Jul;25(5):363-8. doi: 10.1016/j.nedt.2005.03.003.

  PMID: 15894411 BACKGROUND

• Kim, R., Olfman, L., Ryan, T., & Eryilmaz, E. (2014). Leveraging a personalized system to improve self-directed learning in online educational environments. Computers & Education, 70, 150-160

  BACKGROUND

• Murad MH, Varkey P. Self-directed learning in health professions education. Ann Acad Med Singap. 2008 Jul;37(7):580-90.

  PMID: 18695772 BACKGROUND

• Self-Directed Learning: A Four-Step Process. University of Waterloo. (2019, March 4). Retrieved April 12, 2019, from https://uwaterloo.ca/centre-for-teaching-excellence/teaching-resources/teaching-tips/tips-students/self-directed-learning/self-directed-learning-four-step-process

  BACKGROUND

• Manning, G. (2007). Self-directed learning: A key component of adult learning theory. Business and Public Administration Studies, 2(2), 104

  BACKGROUND

• Terry, A. (2017). Clinical research for the doctor of nursing practice. (3rd ed). Jones & Bartlett Publishers

  BACKGROUND

• Elhabashy S, Moawad A. Effect of self-directed versus traditional learning model on nurses' airway management competencies and patients' airway-related incidents. BMC Nurs. 2024 Aug 27;23(1):599. doi: 10.1186/s12912-024-02232-0.

  PMID: 39192309 DERIVED

MeSH Terms

Conditions

Airway Obstruction

Interventions

Nurses

Condition Hierarchy (Ancestors)

Respiratory Insufficiency; Respiration Disorders; Respiratory Tract Diseases

Intervention Hierarchy (Ancestors)

Health Personnel; Health Care Facilities Workforce and Services

Study Officials

• Gaber

  Cairo University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: CASE CONTROL
• Time Perspective: PROSPECTIVE
• Target Duration: 3 Months
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Lecturer

Study Record Dates

• First Submitted: January 7, 2020
• First Posted: January 28, 2020
• Study Start: February 1, 2020
• Primary Completion: July 31, 2021
• Study Completion: August 1, 2021
• Last Updated: March 3, 2023

Record last verified: 2023-03

Locations

EG (1)