Blended learning versus face-to-face learning in an undergraduate nursing health assessment course: A quasi-experimental study.

BACKGROUND: Blended learning, which integrates face-to-face and online instruction, is increasingly being adopted. A gap remains in the literature related to blended learning, self-efficacy, knowledge and perceptions in undergraduate nursing. OBJECTIVES: To investigate outcomes of self-efficacy, knowledge and perceptions related to the implementation of a newly blended course. DESIGN: This was a quasi-experimental pre-post test design. SETTING: This study was conducted at an undergraduate university in Alberta, Canada. PARTICIPANTS: A total of 217 second-year undergraduate nursing students participated and 187 participants completed all study components. METHODS: A convenience sampling method was used. Data were collected at the start and end of the semesters. Data were analyzed using descriptive and inferential statistics using R(3.4.3) and R-Studio(1.1.423). RESULTS: There were no significant differences in self-efficacy scores between groups or in the pre-post surveys (p > 0.100) over time. There was no significant difference in knowledge between the blended online and face-to-face groups (p > 0.100). For students in the blended course, perceptions of the online learning environment were positive. CONCLUSION: Blended learning has the potential to foster innovative and flexible learning opportunities. This study supports continued use and evaluation of blended learning as a pedagogical approach.

Emergency department skull trephination for epidural hematoma in patients who are awake but deteriorate rapidly.

BACKGROUND: Blunt head trauma patients who have been alert but are deteriorating (talk and deteriorate [T&D]) due to a rapidly expanding epidural hematoma (EDH) usually have poor outcome if they must wait for hospital transfer for evacuation. We therefore have continued to teach skull trephination to emergency physicians (EPs). We are unaware of any literature on EP trephination for EDH in the age of computed tomography (CT) scanning. METHODS: Patients with EDH from blunt trauma, either in our institution or known to our graduate network, who were T&D with anisocoria despite intubation plus medical therapy, and who had pre-transfer EP trephination, were compared to those who were transferred without trephination. RESULTS: There were 5 patients with blunt trauma and CT-proven EDH who were T&D with anisocoria who underwent Emergency Department (ED) trephination at outlying hospitals before transfer. All 5 had improvement in condition and good outcomes. Three had complete recovery without disability and 2 others had mild disability with good cognitive function. None had complications. Two patients with T&D and anisocoria were transferred without trephination. Both had good neurologic outcomes. The mean time to pressure relief in the trephination group vs. transfer group was 55 vs. 207 min, respectively. CONCLUSION: In T&D patients with CT-proven EDH and anisocoria, ED skull trephination before transfer resulted in uniformly good outcomes without complications. Time to relief of intracranial pressure was significantly shorter with trephination. Neurologic outcomes were not different.