Usability: An introduction to and literature review of usability testing for educational resources in radiation oncology.

Usability, or the ease with which something can be used, is a key aspect in ensuring end-users can achieve the best possible outcomes from a given educational resource. Ideally usability testing should take place iteratively throughout the design of the resource, and there are several approaches for undertaking usability testing described in the wider literature. Within radiation oncology education, the extent to which usability testing occurs remains unclear. This literature review aimed to assess current practice and provide a practical introduction to usability testing for educational resource design within radiation oncology. Two web databases were searched for articles describing planned or completed usability testing during the design of a radiation oncology educational resource. Fifteen studies were identified. Data was gathered describing the type of usability testing performed, the number of cycles of testing and the number of test subjects. Articles described design of educational resources for both patients and trainees, with the number of test subjects ranging from 8 to 18. Various testing methods were used, including questionnaires, think aloud studies and heuristic evaluation. Usability testing comprised a range of single cycle through to several rounds of testing. Through illustrative examples identified in the literature review, we demonstrate that usability testing is feasible and beneficial for educational resources varying in size and context. In doing so we hope to encourage radiation oncologists to incorporate usability testing into future educational resource design.

Supporting the provision of pharmacy medication reviews to marginalised (medically underserved) groups: a before/after questionnaire study investigating the impact of a patient-professional co-produced digital educational intervention.

OBJECTIVES: People who are marginalised (medically underserved) experience significant health disparities and their voices are often 'seldom heard'. Interventions to improve professional awareness and engagement with these groups are urgently needed. This study uses a co-production approach to develop an online digital educational intervention in order to improve pharmacy staffs' intention to offer a community pharmacy medication review service to medically underserved groups. DESIGN: Before/after (3 months) self-completion online questionnaire. SETTING: Community pharmacies in the Nottinghamshire (England) geographical area. PARTICIPANTS: Community pharmacy staff. INTERVENTION: Online digital educational intervention. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was 'behaviour change intention' using a validated 12-item survey measure. The secondary outcome measure was pharmacist self-reported recruitment of underserved groups to the medication review service. RESULTS: All pharmacies in the Nottinghamshire area (n=237) were approached in June 2017 and responses were received from 149 staff (from 122 pharmacies). At 3 months (after completing the baseline questionnaire), 96 participants (from 80 pharmacies) completed a follow-up questionnaire, of which two-thirds (n=62) reported completing the e-learning. A before/after comparison analysis found an improving trend in all the five constructs of behaviour change intention (intention, social influence, beliefs about capabilities, moral norms and beliefs about consequences), with a significant increase in mean score of participants' 'beliefs about capabilities' (0.44; 95% CI 0.11 to 0.76, p=0.009). In the short-term, no significant change was detected in the number of patients being offered and the patient completing a medication review. CONCLUSIONS: Although increases in the numbers of patients being offered a medication review was not detected, the intervention has the potential to significantly improve pharmacy professionals' 'beliefs about capabilities' in the short-term. Wider organisational and policy barriers to engagement with marginasied groups may need to be addressed. Future research should focus on the interplay between digital learning and practice to better identify and understand effective practice change pathways.

Improving developmental and educational support for children born preterm: evaluation of an e-learning resource for education professionals.

OBJECTIVES: Children born preterm are at higher risk for special educational needs and poor academic attainment compared with term-born peers, yet education professionals receive limited training and have poor knowledge of preterm birth. We have developed an interactive e-learning resource and evaluated its efficacy in improving teachers' knowledge of preterm birth and their confidence in supporting the learning of children born preterm. SETTING: Eight primary, infant or junior schools in England. PARTICIPANTS: 61 teachers of children aged 4-11 years, of which 55 (90%) were female. INTERVENTION: Interactive e-learning resource designed to improve education professionals' knowledge of long-term outcomes following preterm birth and strategies that can be used to support children's learning (www.pretermbirth.info). In a repeated measures design, participants were given up to 30 days access to the e-learning resource, before and after which they completed the Preterm Birth Knowledge Scale (PB-KS; scores 0-33; higher scores indicate greater knowledge) to assess knowledge of outcomes of prematurity. Four Likert scale items were used to assess confidence in supporting children's learning and 10 items were used to evaluate the utility of the resource. PB-KS scores and responses on confidence item were compared pre-resource and post-resource use. RESULTS: PB-KS scores significantly increased after accessing the e-learning resource (median (95% CI): pre-resource 13 (11 to 14); post-resource 29 (28 to 30)), equating to a 2.6 SD increase in PB-KS scores. Teachers' confidence in supporting children born preterm was also significantly improved after using the resource. The utility of the resource was evaluated positively by participants with 97% reporting that they would recommend its use to others. CONCLUSIONS: The e-learning resource substantially improved teachers' knowledge of preterm birth and their confidence in supporting preterm children in the classroom. Use of this resource may represent a key advance in improving educational outcomes for children born preterm.

Digital technology to facilitate Proactive Assessment of Obesity Risk during Infancy (ProAsk): a feasibility study.

OBJECTIVE: To assess the feasibility and acceptability of using digital technology for Proactive Assessment of Obesity Risk during Infancy (ProAsk) with the UK health visitors (HVs) and parents. DESIGN: Multicentre, pre- and post-intervention feasibility study with process evaluation. SETTING: Rural and urban deprived settings, UK community care. PARTICIPANTS: 66 parents of infants and 22 HVs. INTERVENTION: ProAsk was delivered on a tablet device. It comprises a validated risk prediction tool to quantify overweight risk status and a therapeutic wheel detailing motivational strategies for preventive parental behaviour. Parents were encouraged to agree goals for behaviour change with HVs who received motivational interviewing training. OUTCOME MEASURES: We assessed recruitment, response and attrition rates. Demographic details were collected, and overweight risk status. The proposed primary outcome measure was weight-for-age z-score. The proposed secondary outcomes were parenting self-efficacy, maternal feeding style, infant diet and exposure to physical activity/sedentary behaviour. Qualitative interviews ascertained the acceptability of study processes and intervention fidelity. RESULTS: HVs screened 324/589 infants for inclusion in the study and 66/226 (29%) eligible infants were recruited. Assessment of overweight risk was completed on 53 infants and 40% of these were identified as above population risk. Weight-for-age z-score (SD) between the infants at population risk and those above population risk differed significantly at baseline (-0.67 SD vs 0.32 SD). HVs were able to collect data and calculate overweight risk for the infants. Protocol adherence and intervention fidelity was a challenge. HVs and parents found the information provided in the therapeutic wheel appropriate and acceptable. CONCLUSION: Study recruitment and protocol adherence were problematic. ProAsk was acceptable to most parents and HVs, but intervention fidelity was low. There was limited evidence to support the feasibility of implementing ProAsk without significant additional resources. A future study could evaluate ProAsk as a HV-supported, parent-led intervention. TRIAL REGISTRATION NUMBER: NCT02314494 (Feasibility Study Results).

Using reusable learning objects (rlos) in injection skills teaching: Evaluations from multiple user types.

BACKGROUND: Clinical skills are a critical component of pre-registration nurse education in the United Kingdom, yet there is widespread concern about the clinical skills displayed by newly-qualified nurses. Novel means of supporting clinical skills education are required to address this. METHODS: A package of Reusable Learning Objects (RLOs) was developed to supplement pre-registration teaching on the clinical skill of administering injection medication. RLOs are electronic resources addressing a single learning objective whose interactivity facilitates learning. This article evaluates a package of five injection RLOs across three studies: (1) questionnaires administered to pre-registration nursing students at University of Nottingham (UoN) (n=46) evaluating the RLO package as a whole; (2) individual RLOs evaluated in online questionnaires by educators and students from UoN; from other national and international institutions; and healthcare professionals (n=265); (3) qualitative evaluation of the RLO package by UoN injection skills tutors (n=6). RESULTS: Data from all studies were assessed for (1) access to, (2) usefulness, (3) impact and (4) integration of the RLOs. Study one found that pre-registration nursing students rate the RLO package highly across all categories, particularly underscoring the value of their self-test elements. Study two found high ratings in online assessments of individual RLOs by multiple users. The global reach is particularly encouraging here. Tutors reported insufficient levels of student-RLO access, which might be explained by the timing of their student exposure. Tutors integrate RLOs into teaching and agree on their use as teaching supplements, not substitutes for face-to-face education. CONCLUSION: This evaluation encompasses the first years postpackage release. Encouraging data on evaluative categories in this early review suggest that future evaluations are warranted to track progress as the package is adopted and evaluated more widely.

Implementation of an emergency department information system: a qualitative study of nurses' attitudes and experience.

This article explores the reactions of nurses toward the implementation of an emergency department information system. Semistructured interviews were conducted with 22 nurses, and data were analyzed using thematic analysis. The results suggest that despite some initial apprehensions nurses were positive in their attitudes and interactions with clinical information systems supportive of their practice, especially in respect of performance targets. Issues of digital work environment design, system availability, and peer support during preliminary interactions were also involved in the formation of their views. Implementation teams addressing these issues have greater chances of maintaining the attitudes that contribute to the successful use of these systems.

Using e-learning to enhance nursing students' pain management education.

CONTEXT: Absence of standardised pain curricula has led to wide diversity in the understanding and awareness of pain by healthcare students. Indeed pain management is frequently under-prioritised in nursing education, providing potential to negatively impact upon patient care. Yet the recent addition of Pain to the UK National Health Service's Essence of Care Benchmarks has highlighted the need to address this issue, and in response pain educators have called for the development of high quality, globally accessible e-learning resources in pain management. OBJECTIVES: This study will determine the effectiveness of an e-learning intervention on pain management developed for nursing students. METHODS: Two variants of an e-learning resource on pain management were developed, each containing the same core content but one with a section focusing on pain assessment and the other on pharmacological management. Nursing students (n=42) were randomly assigned to trial one resource, after which they undertook a questionnaire adapted (to ensure alignment with the content of the e-learning resources) from Ferrell and McCaffrey's Nurses Knowledge and Attitudes Towards Pain Survey. Scores were analysed for each resource and year of study, and compared with scores from a standard non-intervention group completing the questionnaire only (n=164). RESULTS: Scores averaged 19.2% higher for students undertaking the e-learning resources (p<0.005). Specifically, undertaking the assessment resource improved assessment knowledge more, whilst assignment to the treatment resource particularly enhanced pharmacological knowledge (p<0.005). Correlation was found between year of study and pain knowledge. CONCLUSION: Results support the effectiveness of the resources independent of voluntary-response bias. Conclusions recommend that introducing e-learning has substantial benefit to enhance pain education in nursing.

Using the iBook in medical education and healthcare settings--the iBook as a reusable learning object; a report of the author's experience using iBooks Author software.

The recently launched iBooks 2 from Apple has created a new genre of 'interactive multimedia eBook'. This article aims to dscribe the benefit of the iBook in a medical education and healthcare setting. We discuss the attributes of an iBook as compared with the requirements of the conventional web-based Reusable Learning Object. The structure and user interface within an iBook is highlighted, and the iBook-creating software iBooks Author is discussed in detail. A report of personal experience developing and distributing an iBook for junior trainees in oral and maxillofacial surgery is provided, with discussion of the limitations of this approach and the need for further evidence-based studies.

A clinical practice teaching and learning observatory: The use of videoconferencing to link theory to practice in nurse education.

This paper discusses the implementation and evaluation of an innovative approach using videoconferencing to help student nurses to link theory to practice. A Clinical Practice Teaching and Learning Observatory (CP-TLO) was established to provide a synchronous learning opportunity for students in a university classroom observing and interacting with a specialist nurse, patients and carers in a diabetes clinic. Thirty eight students on a BSc/Diploma in Nursing course in the United Kingdom participated in the project which involved partnership working between lecturers, clinical and management staff, IT personnel and patients and their relatives. Student evaluations described the CP-TLO as an enjoyable and valuable learning experience. It is concluded that whilst the project focussed on nurse education and a diabetes clinic, videoconferencing between clinical placements and a classroom has the potential to strengthen links between theory and practice in other areas of nursing and health and social care professions.

Pharmacology education for nurse prescribing students - a lesson in reusable learning objects.

BACKGROUND: The shift away from a biological science to a social science model of nursing care has resulted in a reduction in pharmacology knowledge and understanding in pre-registration nursing students. This has a significant impact on nurse prescribing training where pharmacology is a critical component of the course from a patient safety perspective. METHODS: Reusable learning objects (RLOs) are electronic resources based on a single learning objective which use high quality graphics and audio to help engagement with the material and to facilitate learning. This study used questionnaire data from three successive cohorts of nurse prescribing students (n = 84) to evaluate the use of RLOs focussed around pharmacology concepts to promote the understanding of these concepts in students. A small number of students (n = 10) were followed up by telephone interview one year after qualification to gain further insight into students' perceptions of the value of RLOs as an educational tool. RESULTS: Students' perceptions of their own understanding of pharmacology concepts increased substantially following the introduction of RLOs to supplement the pharmacology component of the course. Student evaluation of the RLOs themselves was extremely positive with a number of students continuing to access these tools post-qualification. CONCLUSION: The use of RLOs to support the pharmacology component of nurse prescribing courses successfully resulted in a perceived increase in pharmacology understanding, with some students directly implicating these educational tools in developing confidence in their own prescribing abilities.

Putting post-registration nursing students on-line: important lessons learned.

A web site and discussion forum to support a part time degree course for nurses was introduced not only to support student learning but also to encourage students to use and develop their IT skills. Previous cohorts had identified that health informatics skills needed to be addressed more explicitly throughout the programme. The aims of the project were to: (i) evaluate the use of the web site and discussion forum; (ii) determine the barriers to using the web site and discussion forum; (iii) identify ways of overcoming any barriers. The first aim was addressed by analysing web page hits and contributions to the discussion forum. Students' experiences of using the web site and the discussion forum were collected using a questionnaire and followed up by a focus group made up of high and low users of the discussion forum. Students who had accessed the web site most often felt they had been able to communicate with their peers (Spearman's rho, p < 0.01) and had gained peer support by accessing the web site (Spearman's rho, p > 0.05). None of the participants in this study had used a discussion forum before and whilst some students had the skills and confidence to contribute to the on-line discussions, others 'lurked' and some did not access the discussion facility at all. Strategies for improving the engagement and quality of on-line learning are proposed from the lessons learned during this study.

Predictors of academic success in a Bachelor of Nursing course.

A longitudinal study of one Bachelor of Nursing course (n=181) was carried out to determine the relationship between academic outcomes and pre-entry qualifications and to discuss the progress and success of students with conventional and non-conventional qualifications. A multi-linear regression analysis was used to determine which pre-entry qualification best explained the variation in the course marks. Results identified that the number of GCSE A grades obtained significantly predicted success on the BN course. On the basis of this finding it has been suggested that the new AS levels, introduced as part of the reformed 16-19 curriculum, may have greater predictive value than current A levels since they allow a broader range of study. Students entering the course with non-conventional qualifications were found to achieve slightly lower marks throughout the course and had a high rate of attrition. Further research is needed to replicate these findings and to determine whether high grades in any specific subject, for example Biology, improve the predictive value of pre-entry qualifications.