- Email: [email protected]
Mobile community learning programme's effectiveness in case management for psychiatric nurses: A preliminary randomised controlled trial
Journal Pre-proof Mobile community learning PROGRAMME'S effectiveness in CASE management for psychiatric nurses: A preliminary randomised controlled trial
Wen-I Liu, Chien-Hung Liu, Chang-Ye Liao, Pei-Ru Chao, KuoChung Chu PII:
S0260-6917(19)30521-0
DOI:
https://doi.org/10.1016/j.nedt.2019.104259
Reference:
YNEDT 104259
To appear in:
Nurse Education Today
Received date:
2 May 2019
Revised date:
24 September 2019
Accepted date:
29 October 2019
Please cite this article as: W.-I. Liu, C.-H. Liu, C.-Y. Liao, et al., Mobile community learning PROGRAMME'S effectiveness in CASE management for psychiatric nurses: A preliminary randomised controlled trial, Nurse Education Today(2019), https://doi.org/ 10.1016/j.nedt.2019.104259
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© 2019 Published by Elsevier.
Journal Pre-proof MOBILE COMMUNITY LEARNING PROGRAMME’S EFFECTIVENESS IN CASE MANAGEMENT FOR PSYCHIATRIC NURSES: A PRELIMINARY RANDOMISED CONTROLLED TRIAL Word count: less 4994 words
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Wen-I Liu, RN, PhD Professor, School of Nursing, National Taipei University of Nursing and Health Sciences Mailing address: 365, Ming Te Road., Peitou 11219, Taipei, Taiwan, R.O.C. Telephone number: +886-2-28227101 ext. 3184 Fax number: +886-2- 28213233 E-mail: [email protected]
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Chien-Hung Liu Head Nurse, Department of Nursing, Tri-Service General Hospital Beitou Branch Mailing address: No. 60, Xinmin Road, Beitou District 11243, Taipei, Taiwan, R.O.C. Telephone number: +886-2-28959808 ext. 603908 E-mail: [email protected]
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Chang-Ye Liao, PhD Assistant professor, College of Nursing, National Taipei University of Nursing and Health Sciences Mailing address: 365, Ming Te Road., Peitou 11219, Taipei, Taiwan, R.O.C. Telephone number: +886-2-28227101 ext. 3006 E-mail: [email protected]
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Pei-Ru Chao Supervisor, Department of Nursing, Tri-Service General Hospital Beitou Branch Mailing address: Road., Peitou 11219, Taipei, Taiwan, R.O.C. Telephone number: +886-2-28959808 ext. 603905 E-mail: [email protected] Kuo-Chung Chu, PhD Professor, Department of Information Management, National Taipei University of Nursing and Health Sciences Mailing address: 365, Ming Te Road., Peitou 11219, Taipei, Taiwan, R.O.C. Telephone number: +886-910088278 Fax number: +886-2-28280219 Email: [email protected]; [email protected] Keywords: Mobile community learning, Case management, Continuing education, Psychiatric nurses, Randomised controlled trial
Journal Pre-proof Abstract
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Background The global health care system has applied case management (CM) as a care delivery service provided by nurses. Nurses require continuing education in CM to enhance their professional knowledge and competence. Mobile communities have been used to promote continuing education for medical professionals. However, limited studies have examined the effectiveness of such learning programmes in CM for psychiatric nurses. Objective To evaluate the effectiveness of a mobile community learning (MCL) programme in CM for psychiatric nurses. Design This study used an experimental two-group pre- and post-test design. Settings and Participants Psychiatric nurses employed in a psychiatric teaching hospital situated in northern Taiwan were recruited. Methods Nurses were randomly allocated to the experimental or comparison group. The former participated in the learning intervention in CM. The CM knowledge index and a competence scale were used to determine outcomes. Pre-tests and 2-month post-tests were conducted. The MCL programme comprised five simulated learning modules, self-assessment questions, learning cases, learning resources and experience sharing. A two-way repeated-measures analysis of variance was performed to evaluate the effect of the intervention on target outcomes. Results The questionnaires were completed by 48 participants. The two groups possessed high homogeneity with regard to characteristics and pre-test outcomes. Differences between the two groups regarding CM knowledge (F=22.99, p<0.01) and competence (F=6.33, p=0.015) were significant. The programme had a positive benefit on the learning experience in the experimental group; the mean satisfaction score for the programme reached 4.27 (range, 1–5). Conclusions MCL programmes for psychiatric nurses can effectively enhance CM knowledge and competence. However, these methods cannot completely replace the continuing education approach for achieving CM competence. Keywords: Mobile community learning, Case management, Continuing education, Psychiatric nurses, Randomised controlled trial Funding Source The Ministry of Science and Technology provided the funding required for this project (MOST 102-2511-S-227-006). The views and opinions expressed in this manuscript are the authors’ own. Conflict of Interest There are no conflicts of interest to declare. Ethical Approval This study was conducted after being reviewed by an institutional review board and obtaining their approval (approval number: 1-103-05-073). Acknowledgements The authors are grateful to the psychiatric centre that encouraged their nursing employees to contribute to the research, and also the Taiwanese psychiatric nurses who participated in this study.
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INTRODUCTION Continuing education in case management (CM) CM—an evidence-based community-care model for treating patients with severe mental illness—can effectively promote the continuity of care for patients with mental illness, reduce the number of hospitalisations and hospital stays and improve quality of life and client satisfaction (Dieterich et al., 2017). The processes of CM services are the primary tasks of nurse case managers (Case Management Society of America, 2016). The nursing staff plays a key role in CM, and educational preparation is critical to ensure CM success (Liu et al., 2009; 2014). However, in a study involving 424 psychiatric nurses, up to 87% of the nurses did not receive CM education, had limited knowledge and exhibited a lack of confidence in implementing CM practices. These findings support the need for continuing education in CM for psychiatric nurses (Liu et al., 2014). The introduction of empirical literature in nursing education promotes learning effectiveness (Liu et al., 2014). A review of programmes for continuing education in CM identified at least 16 hours of education and interactive lectures and discussions as the key features of effective teaching methods (Liu et al., 2009). Liu et al. (2014) developed a CM digital CD course that has proven to enhance professional knowledge regarding CM among psychiatric nurses. However, it did not improve confidence in implementing CM practices. Development of flexible educational programmes for interactive discussions to improve nurses’ competence in implementing CM practices was recommended (Liu et al., 2014a; Liu et al., 2014b). The mobile community learning (MCL) model represents a new technical education model that can overcome the deficiencies of some digital self-learning models with less interaction and discussion. Health care or nursing education is increasingly using MCL to promote the development of health professionals (Curran et al., 2017). Studies have explored the effectiveness of such MCL programmes on learner perception, motivation and knowledge (Alrasheedi and Capretz, 2018; Hsu, 2009; Strandell-Laine et al., 2015). However, none of these studies were designed for nurses to explore the impact on nurses’ professional competence. Therefore, using an experimental design, this study was constructed and evaluated considering the effectiveness of a MCL programme for continuing education in CM for psychiatric nurses.
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LITERATURE Mobile community learning Developing professional learning communities can potentially promise competence building for sustainable cultivation to sustain learning over time (Stoll et al., 2006). A community of practice (CoP) is a group designed for knowledge sharing and interaction occurring over time (Wenger, 2011; Hsu, 2009). CoP is gradually applied to allow learners to brainstorm, communicate, coordinate and share as a team. CoP emphasizes the concept of Shared value (emphasising shared vision and letting everyone have a common goal to unite the community’s centripetal force); Collaboration (participants help each other grow and discuss using various methods such as discussion, sharing and collaboration); Sharing practice (helps participants practice teaching through discussion and sharing. Participants can also care, encourage and support each other and establish a relationship of trust (Wenger, 2011). Mobile technology is a model with various definitions. The common trait among all definitions is flexible learning in terms of time, place, speed and space (O’Connor and Andrews, 2015). The most important benefits of mobile technology are collaboration with others, overcoming time and space constraints and learner-friendly designs (Alrasheedi and Capretz, 2018; Hsu and Ching, 2013). It can be considered as a technology strategy for CoP (Kietzmann et al., 2013). Effectiveness of nursing MCL A comprehensive review has found that mobile learning is primarily applied to the teaching of fundamental nursing concepts and skills, long-term care and obstetrics and gynaecology, whereas it rarely explores other areas of nursing education (Chang et al., 2018). Some nursing-related learning communities have been established to link clinical nursing practice, share the latest experience from practice and participate in collaboration (Crawford, 2011; Egerton et al., 2010; Mathew, 2014). MCL can be used in clinical professional practice or care to discuss and collaboratively develop problem-solving strategies (Crawford, 2011). Learners’ perspectives regarding mobile learning platforms are critical factors affecting the success of mobile learning. Along with learners’ positive views regarding mobile learning as a key influencing factor, learning content and user context are significantly correlated (Alrasheedi and Capretz, 2018). Learning motivation and learning topics are consistent with learning needs, making them important factors influencing the participation of community members. Community members’ sense of community and diverse resources are crucial factors in sustaining the community’s continued operation. Therefore, when designing MCL models, it is necessary to consider the motivation to increase learning, meet the needs of learners and have diverse resources and community activities for the continued operation of the community. These will help promote the continuous development of the community and improve learning outcomes (Alrasheedi and Capretz, 2018; Chang and Wang, 2010). Hsu (2009) and Lai et al. (2008) have reported a positive learning experience for MCL; their collective academic achievement is enhanced by knowledge sharing and discussion among community members (Lu, 2000). Learners who perform more active learning behaviours display improved problem-solving and creative thinking skills (Gill et al., 2010; Wu, 2014). However, research is limited as none of these studies designed an MCL for psychiatric nurses to explore the impact on nurses’ knowledge and professional competence. Evaluating the learning effectiveness of nursing practitioners’ professional practice requires more rigorous experimental designs (Strandell-Laine et al., 2015), which were applied to only a few of these evaluations. As it is difficult to determine the effectiveness of MCL for nursing education, we used an online learning platform to construct and establish an MCL for psychiatric nurses. A preliminary randomised controlled trial was conducted to evaluate the effectiveness of continuing education in CM for psychiatric nurses.
Journal Pre-proof METHODS
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Design This study involved an experimental two-group parallel pre- and post-test design conducted in a hospital with a varied number of nurses ranging from 5 to 20. To control the motivation for attending the MCL, the participants were instructed to randomly select envelopes numbered 1–48; subjects with even and odd numbers were assigned to the experimental and comparison groups, respectively, rather than using block randomisation. The experimental group participated in an MCL programme, whereas the comparison group did not receive any specific intervention till the data were collected after intervention. Then, the comparison group could access the same learning programme. Structured self-administered questionnaires were used as measurements. The outcomes included CM knowledge, CM competence and participants’ perceptions of the learning experience.
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Sampling and participant recruitment A convenient sampling approach was applied. Psychiatric nurses in a psychiatric teaching hospital in northern Taiwan were recruited. The study sample was estimated using G*power3.1.2 software in
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advance; the statistical power was set to 0.8 and was 0.05. The effect size of CM knowledge as calculated in a prior CM e-learning interventional study was 0.23 (Liu, 2014). The required number of samples was 40. A 20% wastage rate was estimated. The participants were registered nurses, including home nurses, acute and chronic ward nurses, psychiatric outpatient nurses, drug addiction ward nurses and day ward nurses, who signed the consent form. The exclusion criteria were as follows: expected to leave within two months, internship nurses and ongoing CM-related training.
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The hospital included 119 psychiatric nurses in 13 wards. The purpose and process of the study was explained to the nurses during the ward staff meeting. We contacted 65 nurses for the screening. Of these, 6 nurses did not meet the research criteria, and 11 declined because of time restrictions; therefore, in total, 48 nurses agreed to participate and provided consent. Figure 1 presents the flow chart of recruitment and screening of participants. Ethical considerations This study was conducted after being reviewed by an institutional review board and obtaining their approval (approval number: 1-103-05-073). The consent form was signed by each participant, and the participants were permitted to withdraw from the study at any time without affecting their rights in future work. Programme development for MCL in CM The study was based on the mobile learning technology (Sharples et al., 2005; Traxler, 2009; Kearney et al., 2012). A digital CM course was built on the designed ‘MCL for Psychiatric Nurses Platform’. To increase the interaction between the facilitator and learners, the platform provides three facilitation principles—community information and synchronous and asynchronous communication tools based on mobile learning technology (Table 1). This platform can record the number of learner logins, postings and essays and the participants’ activities and discussion in the community. Figure 2 presents the community homepage.
Journal Pre-proof Five learning modules and five self-assessments developed by the authors’ previous studies were provided in the course area, covering the basic concepts of CM and CM processes, as follows: (1) Basic concepts for CM; (2) Case selection and assessment; (3) Planning; (4) Implementation and (5) Monitoring, evaluation and termination. To correspond to the unit course, there were five self-assessments, each comprising 10 questions and standard answers and explanations. These contents comprise the audio-visual learning module in the digital CD-ROM developed by Liu et al. (2014) which was demonstrated to improve CM knowledge among psychiatric nurses (Liu et al., 2014). The facilitator can ask questions regarding the discussion related to the case (Figure 3).
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MCL intervention Before the formal study commenced, five volunteer psychiatric nurses were invited to conduct a 2-week intervention trial as a pilot study. The pilot participants provided their experience of using the platform and reported the various issues they encountered. The research team handled the
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related issues until the participants were able to log in, post, discuss, conduct unit course online learning and complete unit self-assessments. After the research team revised and resolved all issues individually, the formal MCL intervention was completed. The five pilot participants were not included in the randomised portion of the study. We arranged separate meetings for the two groups for setting up user accounts and explained how to use the homepage of the platform. The participants were unaware of their groups and were told that they were assigned to the ‘learn first’ (experimental group) or ‘learn afterwards’ group (comparison group). We explained that the study time was at least 2 h a week for an 8-week community learning programme. To avoid between-group contamination of the intervention, the participants were instructed to refrain from lending their accounts to others or discussing any content learned or discussed on the platform in public.
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Data collection Two meetings were held in the research hospital to obtain the consent form and pre-test data. One research assistant provided the pre-test questionnaire in envelopes for the participants to complete, after which these envelopes were collected by the research assistant. The post-test data of the experimental group were collected directly by the learning platform and the post-test data for the comparison group were collected by the research assistant after two months of intervention. The questionnaires were returned via envelope by the participants. Reliability and validity of the measurements We used four tools to collect and evaluate data and designed a basic data collection tool, including sex, age, education level, years of nursing and psychiatric experience and the hours of CM courses attended. The effectiveness of intervention outcomes was measured using three tools: the Case Management Knowledge Scale, Case Management Competency Scale and Learner Perception Scale. The Case Management Knowledge Scale was developed by the research team with good reliability and validity and captured 20 questions related to the CM process and skills described in ‘A Case Manager’s Study Guide’. Each question had four options, each with a maximum score of five points (possible total score: 100 points). The content validity index (CVI) of this scale was 0.87,
Journal Pre-proof targeting 161 in-service psychiatric nurses with a Kuder–Richardson reliability of 0.80 (Liu et al., 2014) and Cronbach’s alpha of 0.88 in the present study.
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The Case Management Competence Scale was developed by the research team, along with a panel of experts, based on CM practice standards, literature review and the Delphi technique. CVI was 0.96. The scale was validated by 285 psychiatric nurses. The exploratory factor analysis consisted of two dimension factors (direct care competence with six questions and coordination facilitation competence with 12 questions). The variance for these 18 questions reached 78%, and Cronbach’s alpha was 0.94 (Chen et al., 2018). Using the literature, the research team designed a five-question learning perception assessment of the course covering the autonomous learning environment, time and flexibility, ability to improve learning motivation, ease of operation and ability to trigger self-reflection. The Cronbach’s alpha of the scale in this study was 0.85.
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Data analysis Statistical analyses were performed using IBM SPSS 20.0. The homogeneity test of the two groups was performed using the t-test and chi-squared test. A two-way repeated-measures analysis of variance was used to examine whether the two groups' CM knowledge and competence scores changed over time. The p value was pre-set to 0.05.
Journal Pre-proof RESULTS
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Demographic characteristics of participants and homogeneity of the two groups Among the participants, 42 (87%) were female. University level (65%) was the most common educational level, followed by college diploma level (27%). Mean participant age was 31.4 (SD=5.35) years. Average length of employment as a nurse was 8 (SD=5.00) years; mean length of time working in the department of psychiatry was 6.6 (SD=4.41) years. Overall, 77% of subjects had never participated in CM-related courses. Differences in the pre-test characteristics between both groups were insignificant. The mean CM knowledge pre-test score was 54.9% (range, 0–100, SD=16.77), with no significant difference noted between the two groups (p=0.53). The mean CM competence pre-test score was 2.0 points (range, 1–5, SD=0.78), difference between both groups were insignificant (p=0.89) (Table 2).
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Effects of the intervention on CM knowledge The interaction between group and time was used to analyse the effects of the community learning interventions on CM knowledge. The participants' score in the experimental group improved from 56.5 points in the pre-test to 80.8 points in the post-test, whereas those for participants in the comparison group reduced from 53.3 points to 52.3 points (Table 3).
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Group and time interaction were statistically significant [F(1,46)=22.99, p=000, partial 2 =33]. The experimental group exhibited significantly greater CM knowledge over time than the comparison group (Figure 4).
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Effects on CM competence The interaction between group and time was used to analyse the effectiveness of the community
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learning interventions regarding CM competence. The participants' score in the experimental group improved from 2.0 in the pre-test to 3.3 in the post-test, whereas those for participants in the comparison group improved from 2.1 to 2.6 (Table 3). Group and time interaction was statistically significant [F(1,46)=6.33, p=0.015, partial 2 =121]. The experimental group exhibited significantly better CM competence over time than the comparison group (Figure 5). Participants’ perceptions Overall, 96% of the participants agreed that the community learning is an autonomous learning environment, and 100% agreed that the learning is flexible (not limited by time and space); 81% agreed that this learning can enhance the motivation to learn, 100% agreed that the platform is easy to operate, and 87% agreed that it can lead to self-reflection. The overall recognition score averaged as 4.3 (range, 4.04–4.67), indicating that the participants were satisfied with MCL.
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DISCUSSION Changes in participants’ behaviours owing to shift from traditional learning to MCL The development process of this CM-MCL is rigorous; it was produced in four stages: conducting a systematic review; performing a needs assessment, developing learning materials and testing (Liu et al., 2014b). Participants experienced interactive and non-synchronous interactive communication with the community learning platform, computer operation and self-directed environment, which differed from the traditional learning model that was limited by time, place and space. The majority of the participants in the community believed that this type of self-learning can increase the motivation to learn. The overall satisfaction level was 4.3. Although this MCL course can significantly improve CM competence, the competence level
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was only 3.3 points, and proficiency was not yet reached (4 points). This may be due to CM competence requires the development of several new practical skills. It is challenging to learn only via peer cooperation through an MCL; 77% of these participants had not received CM training previously, and less experience in CM may affect the ability to improve competence.
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Effects of the accessibility of MCL on learning outcomes Our results support the use of MCL to effectively improve nurses’ CM knowledge and competence, consistent with previous reports (Lu, 2000; Lin, 2007). A meta-analysis (Lahti et al., 2013) revealed that digital learning improved the knowledge of nursing students and nurses without reaching significance, whereas the experimental group in this study exhibited significantly greater knowledge than that exhibited by the comparison group. This study further contributes to improving the
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professional competence of this new learning model. According to previous studies, the design of MCL needs to consider the motivation of learners, design of course content and need to meet learning needs. In the present study, the participants can conduct self-assessments at any time during the learning process, obtain assistance in understanding personal knowledge and competency gaps, use discussions to reflect on individual learning loopholes and re-arrange time-oriented self-determined learning. These curriculum design considerations could produce divergent outcomes. The MCL platform using new learning technology can offer a learning environment to share value, knowledge and practice. This study’s results showed its effectiveness on knowledge and competence. Moreover, it could act as an alternative method for professional development for nurses and meet the requirements of the nursing staff in their hectic work and continuing education schedules. Relationship between the autonomy of MCL and participants’ perception Learning autonomy plays a vital role in learning by adults (O’Shea, 2003; Knowles, 1975). The MCL developed in this study provides nurses with an environment wherein they can learn at any time, allowing them to learn according to their time schedules. All 24 experimental group participants believed that the MCL provides an independent learning environment that is flexible
Journal Pre-proof regarding time and space. Participants are free to choose different units for learning or self-assessments, as reported previously (Lu, 2000; Gill et al., 2010). All participants in the experimental group agreed that the course is easy to operate and stimulate learning motivation, which is consistent with the relevant factors mentioned previously (Chang and Wang, 2010). The MCL learning model, which is used less frequently, allows learners to interact with each other. Our study results support the use of MCL as a new effective continuing education model.
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Participants’ representation and research limitations The characteristics of the participants in this study were similar to those in a 400-subject study by Liu (2014), indicating that our study subjects were representative of the population. The finding that approximately 80% participants had not previously received CM education indicated lack of
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experience in continuing CM education. There were no significant differences between the experimental and comparison groups in terms of demographic variables, previous CM training, CM knowledge and competence. Despite a small sample size, the randomised allocation was appropriate, and homogeneity of the two groups was high. However, this study only included nurses in a psychiatric hospital in northern Taiwan; thus, generalising these findings may be limited. Although a double-blind method was considered, nurses with a master’s degree and research experience could have identified their group assignment. Therefore, neither we nor the participants were completely blinded to the intervention. This may have induced the Hawthorne effect, or the experimenter’s benefit, affecting the research results. The lack of procedural data analysis, despite the findings of significant differences, indicated that the
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results did not describe in detail the time and depth of actual participation of the research participants. Moreover, the learning autonomy concept was not really measured in this study. Further research may consider integrating all these issues in the future.
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CONCLUSION AND RECOMMENDATION MCL can effectively enhance CM knowledge and competence in continuing education for psychiatric nurses. The learners have positive perceptions regarding this new learning model. Approximately 80% of psychiatric nurses had not received prior CM education. The limited CM knowledge and competence illustrate the need for continuing education focused on CM. This study supported the use of MCL as a new learning model for continuing education that is convenient, autonomous and effective. This study applied an experimental and randomised controlled trial design. There were no between-group differences in the pre-tests; the homogeneity was high. The findings supported the effectiveness of this new learning model for continuing education to enhance professional
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knowledge and competence among nurses. This study provided the elements of programme development for MCL. Considering participant, empirical and practical factors and the care system, MCL can permit flexible and effective technology education. This new continuing education strategy can enable nursing staff to have spaces for discussion, share experiences and queries and learn independently and flexibly. However, if professional skills are required, other learning strategies are required to ensure professional competence, such as situational or case-oriented learning strategies. Therefore, MCL may not be able to completely replace existing continuing education models.
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Journal Pre-proof Figure 1. Flow chart of the recruitment and screening of participants
Figure 2. Mobile community learning homepage for psychiatric nurses Figure 3. Case management course area of the mobile community learning Figure 4. Changes in case management knowledge in the two groups (N = 48)
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Figure 5. Changes in case management competence in the two groups (N = 48)
Journal Pre-proof Table 1. Mobile community learning tools and function
Community information tools
Community function key (Figure 1) Community home page Announcements Members Administrator areas Instant graffiti wall
An instant messaging tool for multiple individuals that provides an instant question and answer for learners
Resource linking
Provide other related online learning resources outside the platform
Digital course area
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Elite area
Community members’ asynchronous communication environment; teaching facilitators can provide different questions for students to discuss Synopsis of discussion
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Discussion forum
Provide digital teaching materials and self-tests
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Asynchronous communication tools
Community page, representing the core spirit of the entire community Community news updates by community managers List of students and facilitators belonging to the community Management areas that community managers can use to manage the essential functions within the community
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Synchronous communication tools
Learning community features
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Type of tools
Journal Pre-proof Table 3. Pre-test differences and group × time interaction results for outcome variables Total
Variables
(N = 48) Mean (SD) CM knowledge
Experimental group
Comparison group
(N = 24)
(N = 24)
Mean (SD)
Mean (SD)
t-test
t
p
1
Pre-test Post-test CM competence
54.9 (16.77)
56.5 (16.91)
53.3 (16.85)
0.64
0.53
66.6 (18.71)
80.8 ( 9.85)
52.3 (13.91)
8.2
0.000
2
Pre-test
2.0 (0.78)
2.0 (0.77)
2.1 (0.81)
−0.13
0.89
Post-test
2.9 (0.88)
3.3 (0.82)
2.6 (0.81)
2.91
.006
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CM, case management 1. Possible score, 0–100 2. Possible score, 1–5 *p < 0.05
Group × time interaction
F
p
22.99
0.000*
6.33
0.015*
Journal Pre-proof Table 2. Participant demographics and homogeneity of the two groups Group Total (N = 48) (SD or %)
Characteristics
Experimental (N = 24) (SD or %)
Comparison (N = 24) (SD or %)
t (χ2)
Sex Male Female
6 (13)
3 (13)
3 (13)
42 (87)
21 (87)
21 (87)
Educational level 13 (27)
4 (17)
9 (38)
Bachelor
31 (65)
17 (71)
14 (58)
Master’s
4 (8)
3 (12)
31.3 (5.7)
Max
48
44
48
Min
21
22
21
8 (5)
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Mean (SD)
-p
31.4 (5.1)
Years in nursing ‡
7.9 (4.6)
8.1 (5.4)
20
19
20
Min
0.9
0.9
0.9
Min Previous training (hours) Max (hours) Min (hours)
6.6 (4.4)
6.8 (4)
6.5 (4.9)
18
15.2
18
0.3
0.9
0.3
0.79 (1.97)
1.17 (2.2)
0.42 (1.67)
10
10
8
0
0
0
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Max
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Max
Years in psychiatric nursing Mean (SD)
<0.01
1.00
3.29a
0.08
0.02
0.98
0.15
0.88
−0.23
0.82
−1.33
0.19
1 (4)
31.4 (5.3)
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Mean (SD)
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Age (years)
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Diploma
p
P < 0.05 Note. “a” means a chi-square test was performed.χ2, Chi-square test; otherwise, t tests were performed.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Wen-I Liu, Chien-Hung Liu, Chang-Ye Liao, Pei-Ru Chao, KuoChung Chu PII:
S0260-6917(19)30521-0
DOI:
https://doi.org/10.1016/j.nedt.2019.104259
Reference:
YNEDT 104259
To appear in:
Nurse Education Today
Received date:
2 May 2019
Revised date:
24 September 2019
Accepted date:
29 October 2019
Please cite this article as: W.-I. Liu, C.-H. Liu, C.-Y. Liao, et al., Mobile community learning PROGRAMME'S effectiveness in CASE management for psychiatric nurses: A preliminary randomised controlled trial, Nurse Education Today(2019), https://doi.org/ 10.1016/j.nedt.2019.104259
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
© 2019 Published by Elsevier.
Journal Pre-proof MOBILE COMMUNITY LEARNING PROGRAMME’S EFFECTIVENESS IN CASE MANAGEMENT FOR PSYCHIATRIC NURSES: A PRELIMINARY RANDOMISED CONTROLLED TRIAL Word count: less 4994 words
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Wen-I Liu, RN, PhD Professor, School of Nursing, National Taipei University of Nursing and Health Sciences Mailing address: 365, Ming Te Road., Peitou 11219, Taipei, Taiwan, R.O.C. Telephone number: +886-2-28227101 ext. 3184 Fax number: +886-2- 28213233 E-mail: [email protected]
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Chien-Hung Liu Head Nurse, Department of Nursing, Tri-Service General Hospital Beitou Branch Mailing address: No. 60, Xinmin Road, Beitou District 11243, Taipei, Taiwan, R.O.C. Telephone number: +886-2-28959808 ext. 603908 E-mail: [email protected]
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Chang-Ye Liao, PhD Assistant professor, College of Nursing, National Taipei University of Nursing and Health Sciences Mailing address: 365, Ming Te Road., Peitou 11219, Taipei, Taiwan, R.O.C. Telephone number: +886-2-28227101 ext. 3006 E-mail: [email protected]
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Pei-Ru Chao Supervisor, Department of Nursing, Tri-Service General Hospital Beitou Branch Mailing address: Road., Peitou 11219, Taipei, Taiwan, R.O.C. Telephone number: +886-2-28959808 ext. 603905 E-mail: [email protected] Kuo-Chung Chu, PhD Professor, Department of Information Management, National Taipei University of Nursing and Health Sciences Mailing address: 365, Ming Te Road., Peitou 11219, Taipei, Taiwan, R.O.C. Telephone number: +886-910088278 Fax number: +886-2-28280219 Email: [email protected]; [email protected] Keywords: Mobile community learning, Case management, Continuing education, Psychiatric nurses, Randomised controlled trial
Journal Pre-proof Abstract
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Background The global health care system has applied case management (CM) as a care delivery service provided by nurses. Nurses require continuing education in CM to enhance their professional knowledge and competence. Mobile communities have been used to promote continuing education for medical professionals. However, limited studies have examined the effectiveness of such learning programmes in CM for psychiatric nurses. Objective To evaluate the effectiveness of a mobile community learning (MCL) programme in CM for psychiatric nurses. Design This study used an experimental two-group pre- and post-test design. Settings and Participants Psychiatric nurses employed in a psychiatric teaching hospital situated in northern Taiwan were recruited. Methods Nurses were randomly allocated to the experimental or comparison group. The former participated in the learning intervention in CM. The CM knowledge index and a competence scale were used to determine outcomes. Pre-tests and 2-month post-tests were conducted. The MCL programme comprised five simulated learning modules, self-assessment questions, learning cases, learning resources and experience sharing. A two-way repeated-measures analysis of variance was performed to evaluate the effect of the intervention on target outcomes. Results The questionnaires were completed by 48 participants. The two groups possessed high homogeneity with regard to characteristics and pre-test outcomes. Differences between the two groups regarding CM knowledge (F=22.99, p<0.01) and competence (F=6.33, p=0.015) were significant. The programme had a positive benefit on the learning experience in the experimental group; the mean satisfaction score for the programme reached 4.27 (range, 1–5). Conclusions MCL programmes for psychiatric nurses can effectively enhance CM knowledge and competence. However, these methods cannot completely replace the continuing education approach for achieving CM competence. Keywords: Mobile community learning, Case management, Continuing education, Psychiatric nurses, Randomised controlled trial Funding Source The Ministry of Science and Technology provided the funding required for this project (MOST 102-2511-S-227-006). The views and opinions expressed in this manuscript are the authors’ own. Conflict of Interest There are no conflicts of interest to declare. Ethical Approval This study was conducted after being reviewed by an institutional review board and obtaining their approval (approval number: 1-103-05-073). Acknowledgements The authors are grateful to the psychiatric centre that encouraged their nursing employees to contribute to the research, and also the Taiwanese psychiatric nurses who participated in this study.
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INTRODUCTION Continuing education in case management (CM) CM—an evidence-based community-care model for treating patients with severe mental illness—can effectively promote the continuity of care for patients with mental illness, reduce the number of hospitalisations and hospital stays and improve quality of life and client satisfaction (Dieterich et al., 2017). The processes of CM services are the primary tasks of nurse case managers (Case Management Society of America, 2016). The nursing staff plays a key role in CM, and educational preparation is critical to ensure CM success (Liu et al., 2009; 2014). However, in a study involving 424 psychiatric nurses, up to 87% of the nurses did not receive CM education, had limited knowledge and exhibited a lack of confidence in implementing CM practices. These findings support the need for continuing education in CM for psychiatric nurses (Liu et al., 2014). The introduction of empirical literature in nursing education promotes learning effectiveness (Liu et al., 2014). A review of programmes for continuing education in CM identified at least 16 hours of education and interactive lectures and discussions as the key features of effective teaching methods (Liu et al., 2009). Liu et al. (2014) developed a CM digital CD course that has proven to enhance professional knowledge regarding CM among psychiatric nurses. However, it did not improve confidence in implementing CM practices. Development of flexible educational programmes for interactive discussions to improve nurses’ competence in implementing CM practices was recommended (Liu et al., 2014a; Liu et al., 2014b). The mobile community learning (MCL) model represents a new technical education model that can overcome the deficiencies of some digital self-learning models with less interaction and discussion. Health care or nursing education is increasingly using MCL to promote the development of health professionals (Curran et al., 2017). Studies have explored the effectiveness of such MCL programmes on learner perception, motivation and knowledge (Alrasheedi and Capretz, 2018; Hsu, 2009; Strandell-Laine et al., 2015). However, none of these studies were designed for nurses to explore the impact on nurses’ professional competence. Therefore, using an experimental design, this study was constructed and evaluated considering the effectiveness of a MCL programme for continuing education in CM for psychiatric nurses.
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LITERATURE Mobile community learning Developing professional learning communities can potentially promise competence building for sustainable cultivation to sustain learning over time (Stoll et al., 2006). A community of practice (CoP) is a group designed for knowledge sharing and interaction occurring over time (Wenger, 2011; Hsu, 2009). CoP is gradually applied to allow learners to brainstorm, communicate, coordinate and share as a team. CoP emphasizes the concept of Shared value (emphasising shared vision and letting everyone have a common goal to unite the community’s centripetal force); Collaboration (participants help each other grow and discuss using various methods such as discussion, sharing and collaboration); Sharing practice (helps participants practice teaching through discussion and sharing. Participants can also care, encourage and support each other and establish a relationship of trust (Wenger, 2011). Mobile technology is a model with various definitions. The common trait among all definitions is flexible learning in terms of time, place, speed and space (O’Connor and Andrews, 2015). The most important benefits of mobile technology are collaboration with others, overcoming time and space constraints and learner-friendly designs (Alrasheedi and Capretz, 2018; Hsu and Ching, 2013). It can be considered as a technology strategy for CoP (Kietzmann et al., 2013). Effectiveness of nursing MCL A comprehensive review has found that mobile learning is primarily applied to the teaching of fundamental nursing concepts and skills, long-term care and obstetrics and gynaecology, whereas it rarely explores other areas of nursing education (Chang et al., 2018). Some nursing-related learning communities have been established to link clinical nursing practice, share the latest experience from practice and participate in collaboration (Crawford, 2011; Egerton et al., 2010; Mathew, 2014). MCL can be used in clinical professional practice or care to discuss and collaboratively develop problem-solving strategies (Crawford, 2011). Learners’ perspectives regarding mobile learning platforms are critical factors affecting the success of mobile learning. Along with learners’ positive views regarding mobile learning as a key influencing factor, learning content and user context are significantly correlated (Alrasheedi and Capretz, 2018). Learning motivation and learning topics are consistent with learning needs, making them important factors influencing the participation of community members. Community members’ sense of community and diverse resources are crucial factors in sustaining the community’s continued operation. Therefore, when designing MCL models, it is necessary to consider the motivation to increase learning, meet the needs of learners and have diverse resources and community activities for the continued operation of the community. These will help promote the continuous development of the community and improve learning outcomes (Alrasheedi and Capretz, 2018; Chang and Wang, 2010). Hsu (2009) and Lai et al. (2008) have reported a positive learning experience for MCL; their collective academic achievement is enhanced by knowledge sharing and discussion among community members (Lu, 2000). Learners who perform more active learning behaviours display improved problem-solving and creative thinking skills (Gill et al., 2010; Wu, 2014). However, research is limited as none of these studies designed an MCL for psychiatric nurses to explore the impact on nurses’ knowledge and professional competence. Evaluating the learning effectiveness of nursing practitioners’ professional practice requires more rigorous experimental designs (Strandell-Laine et al., 2015), which were applied to only a few of these evaluations. As it is difficult to determine the effectiveness of MCL for nursing education, we used an online learning platform to construct and establish an MCL for psychiatric nurses. A preliminary randomised controlled trial was conducted to evaluate the effectiveness of continuing education in CM for psychiatric nurses.
Journal Pre-proof METHODS
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Design This study involved an experimental two-group parallel pre- and post-test design conducted in a hospital with a varied number of nurses ranging from 5 to 20. To control the motivation for attending the MCL, the participants were instructed to randomly select envelopes numbered 1–48; subjects with even and odd numbers were assigned to the experimental and comparison groups, respectively, rather than using block randomisation. The experimental group participated in an MCL programme, whereas the comparison group did not receive any specific intervention till the data were collected after intervention. Then, the comparison group could access the same learning programme. Structured self-administered questionnaires were used as measurements. The outcomes included CM knowledge, CM competence and participants’ perceptions of the learning experience.
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Sampling and participant recruitment A convenient sampling approach was applied. Psychiatric nurses in a psychiatric teaching hospital in northern Taiwan were recruited. The study sample was estimated using G*power3.1.2 software in
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advance; the statistical power was set to 0.8 and was 0.05. The effect size of CM knowledge as calculated in a prior CM e-learning interventional study was 0.23 (Liu, 2014). The required number of samples was 40. A 20% wastage rate was estimated. The participants were registered nurses, including home nurses, acute and chronic ward nurses, psychiatric outpatient nurses, drug addiction ward nurses and day ward nurses, who signed the consent form. The exclusion criteria were as follows: expected to leave within two months, internship nurses and ongoing CM-related training.
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The hospital included 119 psychiatric nurses in 13 wards. The purpose and process of the study was explained to the nurses during the ward staff meeting. We contacted 65 nurses for the screening. Of these, 6 nurses did not meet the research criteria, and 11 declined because of time restrictions; therefore, in total, 48 nurses agreed to participate and provided consent. Figure 1 presents the flow chart of recruitment and screening of participants. Ethical considerations This study was conducted after being reviewed by an institutional review board and obtaining their approval (approval number: 1-103-05-073). The consent form was signed by each participant, and the participants were permitted to withdraw from the study at any time without affecting their rights in future work. Programme development for MCL in CM The study was based on the mobile learning technology (Sharples et al., 2005; Traxler, 2009; Kearney et al., 2012). A digital CM course was built on the designed ‘MCL for Psychiatric Nurses Platform’. To increase the interaction between the facilitator and learners, the platform provides three facilitation principles—community information and synchronous and asynchronous communication tools based on mobile learning technology (Table 1). This platform can record the number of learner logins, postings and essays and the participants’ activities and discussion in the community. Figure 2 presents the community homepage.
Journal Pre-proof Five learning modules and five self-assessments developed by the authors’ previous studies were provided in the course area, covering the basic concepts of CM and CM processes, as follows: (1) Basic concepts for CM; (2) Case selection and assessment; (3) Planning; (4) Implementation and (5) Monitoring, evaluation and termination. To correspond to the unit course, there were five self-assessments, each comprising 10 questions and standard answers and explanations. These contents comprise the audio-visual learning module in the digital CD-ROM developed by Liu et al. (2014) which was demonstrated to improve CM knowledge among psychiatric nurses (Liu et al., 2014). The facilitator can ask questions regarding the discussion related to the case (Figure 3).
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MCL intervention Before the formal study commenced, five volunteer psychiatric nurses were invited to conduct a 2-week intervention trial as a pilot study. The pilot participants provided their experience of using the platform and reported the various issues they encountered. The research team handled the
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related issues until the participants were able to log in, post, discuss, conduct unit course online learning and complete unit self-assessments. After the research team revised and resolved all issues individually, the formal MCL intervention was completed. The five pilot participants were not included in the randomised portion of the study. We arranged separate meetings for the two groups for setting up user accounts and explained how to use the homepage of the platform. The participants were unaware of their groups and were told that they were assigned to the ‘learn first’ (experimental group) or ‘learn afterwards’ group (comparison group). We explained that the study time was at least 2 h a week for an 8-week community learning programme. To avoid between-group contamination of the intervention, the participants were instructed to refrain from lending their accounts to others or discussing any content learned or discussed on the platform in public.
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Data collection Two meetings were held in the research hospital to obtain the consent form and pre-test data. One research assistant provided the pre-test questionnaire in envelopes for the participants to complete, after which these envelopes were collected by the research assistant. The post-test data of the experimental group were collected directly by the learning platform and the post-test data for the comparison group were collected by the research assistant after two months of intervention. The questionnaires were returned via envelope by the participants. Reliability and validity of the measurements We used four tools to collect and evaluate data and designed a basic data collection tool, including sex, age, education level, years of nursing and psychiatric experience and the hours of CM courses attended. The effectiveness of intervention outcomes was measured using three tools: the Case Management Knowledge Scale, Case Management Competency Scale and Learner Perception Scale. The Case Management Knowledge Scale was developed by the research team with good reliability and validity and captured 20 questions related to the CM process and skills described in ‘A Case Manager’s Study Guide’. Each question had four options, each with a maximum score of five points (possible total score: 100 points). The content validity index (CVI) of this scale was 0.87,
Journal Pre-proof targeting 161 in-service psychiatric nurses with a Kuder–Richardson reliability of 0.80 (Liu et al., 2014) and Cronbach’s alpha of 0.88 in the present study.
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The Case Management Competence Scale was developed by the research team, along with a panel of experts, based on CM practice standards, literature review and the Delphi technique. CVI was 0.96. The scale was validated by 285 psychiatric nurses. The exploratory factor analysis consisted of two dimension factors (direct care competence with six questions and coordination facilitation competence with 12 questions). The variance for these 18 questions reached 78%, and Cronbach’s alpha was 0.94 (Chen et al., 2018). Using the literature, the research team designed a five-question learning perception assessment of the course covering the autonomous learning environment, time and flexibility, ability to improve learning motivation, ease of operation and ability to trigger self-reflection. The Cronbach’s alpha of the scale in this study was 0.85.
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Data analysis Statistical analyses were performed using IBM SPSS 20.0. The homogeneity test of the two groups was performed using the t-test and chi-squared test. A two-way repeated-measures analysis of variance was used to examine whether the two groups' CM knowledge and competence scores changed over time. The p value was pre-set to 0.05.
Journal Pre-proof RESULTS
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Demographic characteristics of participants and homogeneity of the two groups Among the participants, 42 (87%) were female. University level (65%) was the most common educational level, followed by college diploma level (27%). Mean participant age was 31.4 (SD=5.35) years. Average length of employment as a nurse was 8 (SD=5.00) years; mean length of time working in the department of psychiatry was 6.6 (SD=4.41) years. Overall, 77% of subjects had never participated in CM-related courses. Differences in the pre-test characteristics between both groups were insignificant. The mean CM knowledge pre-test score was 54.9% (range, 0–100, SD=16.77), with no significant difference noted between the two groups (p=0.53). The mean CM competence pre-test score was 2.0 points (range, 1–5, SD=0.78), difference between both groups were insignificant (p=0.89) (Table 2).
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Effects of the intervention on CM knowledge The interaction between group and time was used to analyse the effects of the community learning interventions on CM knowledge. The participants' score in the experimental group improved from 56.5 points in the pre-test to 80.8 points in the post-test, whereas those for participants in the comparison group reduced from 53.3 points to 52.3 points (Table 3).
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Group and time interaction were statistically significant [F(1,46)=22.99, p=000, partial 2 =33]. The experimental group exhibited significantly greater CM knowledge over time than the comparison group (Figure 4).
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Effects on CM competence The interaction between group and time was used to analyse the effectiveness of the community
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learning interventions regarding CM competence. The participants' score in the experimental group improved from 2.0 in the pre-test to 3.3 in the post-test, whereas those for participants in the comparison group improved from 2.1 to 2.6 (Table 3). Group and time interaction was statistically significant [F(1,46)=6.33, p=0.015, partial 2 =121]. The experimental group exhibited significantly better CM competence over time than the comparison group (Figure 5). Participants’ perceptions Overall, 96% of the participants agreed that the community learning is an autonomous learning environment, and 100% agreed that the learning is flexible (not limited by time and space); 81% agreed that this learning can enhance the motivation to learn, 100% agreed that the platform is easy to operate, and 87% agreed that it can lead to self-reflection. The overall recognition score averaged as 4.3 (range, 4.04–4.67), indicating that the participants were satisfied with MCL.
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DISCUSSION Changes in participants’ behaviours owing to shift from traditional learning to MCL The development process of this CM-MCL is rigorous; it was produced in four stages: conducting a systematic review; performing a needs assessment, developing learning materials and testing (Liu et al., 2014b). Participants experienced interactive and non-synchronous interactive communication with the community learning platform, computer operation and self-directed environment, which differed from the traditional learning model that was limited by time, place and space. The majority of the participants in the community believed that this type of self-learning can increase the motivation to learn. The overall satisfaction level was 4.3. Although this MCL course can significantly improve CM competence, the competence level
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was only 3.3 points, and proficiency was not yet reached (4 points). This may be due to CM competence requires the development of several new practical skills. It is challenging to learn only via peer cooperation through an MCL; 77% of these participants had not received CM training previously, and less experience in CM may affect the ability to improve competence.
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Effects of the accessibility of MCL on learning outcomes Our results support the use of MCL to effectively improve nurses’ CM knowledge and competence, consistent with previous reports (Lu, 2000; Lin, 2007). A meta-analysis (Lahti et al., 2013) revealed that digital learning improved the knowledge of nursing students and nurses without reaching significance, whereas the experimental group in this study exhibited significantly greater knowledge than that exhibited by the comparison group. This study further contributes to improving the
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professional competence of this new learning model. According to previous studies, the design of MCL needs to consider the motivation of learners, design of course content and need to meet learning needs. In the present study, the participants can conduct self-assessments at any time during the learning process, obtain assistance in understanding personal knowledge and competency gaps, use discussions to reflect on individual learning loopholes and re-arrange time-oriented self-determined learning. These curriculum design considerations could produce divergent outcomes. The MCL platform using new learning technology can offer a learning environment to share value, knowledge and practice. This study’s results showed its effectiveness on knowledge and competence. Moreover, it could act as an alternative method for professional development for nurses and meet the requirements of the nursing staff in their hectic work and continuing education schedules. Relationship between the autonomy of MCL and participants’ perception Learning autonomy plays a vital role in learning by adults (O’Shea, 2003; Knowles, 1975). The MCL developed in this study provides nurses with an environment wherein they can learn at any time, allowing them to learn according to their time schedules. All 24 experimental group participants believed that the MCL provides an independent learning environment that is flexible
Journal Pre-proof regarding time and space. Participants are free to choose different units for learning or self-assessments, as reported previously (Lu, 2000; Gill et al., 2010). All participants in the experimental group agreed that the course is easy to operate and stimulate learning motivation, which is consistent with the relevant factors mentioned previously (Chang and Wang, 2010). The MCL learning model, which is used less frequently, allows learners to interact with each other. Our study results support the use of MCL as a new effective continuing education model.
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Participants’ representation and research limitations The characteristics of the participants in this study were similar to those in a 400-subject study by Liu (2014), indicating that our study subjects were representative of the population. The finding that approximately 80% participants had not previously received CM education indicated lack of
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experience in continuing CM education. There were no significant differences between the experimental and comparison groups in terms of demographic variables, previous CM training, CM knowledge and competence. Despite a small sample size, the randomised allocation was appropriate, and homogeneity of the two groups was high. However, this study only included nurses in a psychiatric hospital in northern Taiwan; thus, generalising these findings may be limited. Although a double-blind method was considered, nurses with a master’s degree and research experience could have identified their group assignment. Therefore, neither we nor the participants were completely blinded to the intervention. This may have induced the Hawthorne effect, or the experimenter’s benefit, affecting the research results. The lack of procedural data analysis, despite the findings of significant differences, indicated that the
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results did not describe in detail the time and depth of actual participation of the research participants. Moreover, the learning autonomy concept was not really measured in this study. Further research may consider integrating all these issues in the future.
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CONCLUSION AND RECOMMENDATION MCL can effectively enhance CM knowledge and competence in continuing education for psychiatric nurses. The learners have positive perceptions regarding this new learning model. Approximately 80% of psychiatric nurses had not received prior CM education. The limited CM knowledge and competence illustrate the need for continuing education focused on CM. This study supported the use of MCL as a new learning model for continuing education that is convenient, autonomous and effective. This study applied an experimental and randomised controlled trial design. There were no between-group differences in the pre-tests; the homogeneity was high. The findings supported the effectiveness of this new learning model for continuing education to enhance professional
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knowledge and competence among nurses. This study provided the elements of programme development for MCL. Considering participant, empirical and practical factors and the care system, MCL can permit flexible and effective technology education. This new continuing education strategy can enable nursing staff to have spaces for discussion, share experiences and queries and learn independently and flexibly. However, if professional skills are required, other learning strategies are required to ensure professional competence, such as situational or case-oriented learning strategies. Therefore, MCL may not be able to completely replace existing continuing education models.
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References Alrasheedi, M., Capretz, L. F., 2018. Determination of critical success factors affecting mobile learning: a meta-analysis approach. arXiv preprint arXiv:1801.04288. Chang, C.-Y., Lai, C.-L., Hwang, G.-J., 2018. Trends and research issues of mobile learning studies in nursing education: A review of academic publications from 1971 to 2016. Computers & Education 116, 28-48. Chang, D. R., Wang, S. C., 2010. The Development and Practice of Teacher Professional Learning Community in the Mentor Teacher Program. Journal of University of Taipei: Education 41 (1), 61-90. http://dx.doi.org/10.6336/JUTe/2010.41(1)3 Case Management Society of America. 2016. Standards of Practice for Case Management Practice. Little Rock, AR. Crawford, T. R., 2011. Using problem-based learning in web-based components of nurse education. Nurse Education Practice 11 (2), 124-130. http://dx.doi.org/10.1016/j.nepr.2010.10.010 Curran, V., Matthews, L., Fleet, L., Simmons, K., Gustafson, D. L., Wetsch, L., 2017. A review of digital, social, and mobile technologies in health professional education. Journal of Continuing Education in the Health Professions 37 (3), 195-206. Dieterich, M., Irving, C. B., Bergman, H., Khokhar, M. A., Park, B., Marshall, M., 2017. Intensive case management for severe mental illness. The Cochrane Library (1). 10.1002/14651858.CD007906.pub3 Egerton, E. O., McConnell, E. S., Corazzini, K., Kitzmiller, R. R., Crook, J. O., 2010. Birds of a feather: introducing a virtual learning community for geriatric nurse educators. Journal of Continuing Education in Nursing 41 (5), 203-208; quiz 209-210. http://dx.doi.org/10.3928/00220124-20100423-02 Gill, P., Kitney, L., Kozan, D., Lewis, M., 2010. Online learning in pediatrics’: a student-led web-based learning modality. Clinical Teacher 7 (1), 53-57. http://dx.doi.org/10.1111/j.1743-498X.2009.00337.x Hsu, C. T., 2009. Study on constructing mechanism of a web-based learning community (Unpublished master’s thesis). Ming-Dao University, Chang-Hua County, Taiwan, ROC. Hsu, Y.-C., Ching, Y.-H., 2013. Mobile Computer-Supported Collaborative Learning: A Review of Experimental Research. British Journal of Educational Technology 44 (5):E111-4. Kearney, M., Schuck, S., Burden, K., Aubusson, P., 2012. Viewing mobile learning from a pedagogical perspective. Research in Learning Technology 20 (1), n1. Kietzmann, J., Plangger, K., Eaton, B., Heilgenberg, K., Pitt, L., Berthon, P., 2013. Mobility at work: A typology of mobile communities of practice and contextual ambidexterity. The Journal of Strategic Information Systems, 22(4), 282-297. Knowles, M. S., 1975. Self-directed learning: A guide for learners and teachers. Lahti, M., Hätönen, H., Välimäki, M. (2013). Impact of e-learning on nurses' and student nurses knowledge, skills, and satisfaction: a systematic review and meta-analysis. International Journal of Nursing Studies 51 (1), 136-149. http://dx.doi.org/10.1016/j.ijnurstu.2012.12.017 Lai, Y. S., Chang, Y. H., Liu, M. T., Yu, P. T., 2008. Customize-Based Portal System for Supporting Knowledge Building. Curriculum & Instruction Quarterly 11 (1), 1-19. http://dx.doi.org/10.6384/CIQ.200801.0001 Lin, W. C., 2007. The Application of Asynchronous Network Collaborative Learning Model for Technology University Level. Journal of Tainan University of Technology 26 (1), 201-222. Liu, W. I., 2014. Examining Taiwanese psychiatric nurses' knowledge and confidence in case management. Journal of Continuing Education in Nursing 45 (1), 43-48. http://dx.doi.org/10.3928/00220124 -20131015-07 Liu, W. I., Chu, K. C., Chen, S. C., 2014a. The development and preliminary effectiveness of a nursing case management e-learning program. Computers Informatics Nursing 32 (7), 343-352. http://dx.doi.org/10.1097/cin.0000000000000050 Liu, W. I., Edwards, H., Courtney, M., 2009. Review of continuing professional education in case
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management for nurses. Nurse Education Today 29 (5), 488-492. http://dx.doi.org/10.1016/j.nedt.2008.11.004 Liu, W. I., Edwards, H., Courtney, M., 2010. Case management educational intervention with public health nurses: cluster randomised controlled trial. Journal of Advanced Nursing 66 (10), 2234-2244. http://dx.doi.org/10.1111/j.1365-2648.2010.05392.x Liu, W. I., Rong, J. R., Liu, C.Y., 2014b. Using evidence-integrated e-learning to enhance case management continuing education for psychiatric nurses: A randomised controlled trial with follow-up. Nurse Education Today 34, 1361-1367. http://dx.doi.org/10.1016/j.nedt.2014.03.004 Lu, Y. J., 2000. An empirical study on the implementation of Web-Based Community at university: usages of the learning community, factors and influences on learning performance (Unpublished master’s thesis). Tamkang University. New Taipei City, Taiwan, ROC. Mathew, B., 2014. Using a social networking tool for blended learning in staff training: Sharing experience from practice. Journal of Neonatal Nursing 20 (3), 90-94. doi: http://dx.doi.org/10.1016/j. jnn.2014.03.005 O'Connor, S., Andrews, T., 2015. Mobile Technology and Its Use in Clinical Nursing Education: A Literature Review. The Journal of nursing education, 54, 1-8. doi: 10.3928/01484834-20150218-01 O’shea, E., 2003. Self‐directed learning in nurse education: a review of the literature. Journal of Advanced Nursing 43 (1), 62-70. Sharples, M., Taylor, J., Vavoula, G., 2005. Towards a theory of mobile learning. In Proceedings of mLearn (Vol. 1, No. 1, pp. 1-9). Stoll, L., Bolam, R., McMahon, A., Wallace, M., & Thomas, S., 2006. Professional learning communities: A review of the literature. Journal of Educational Change 7 (4), 221-258. Strandell-Laine, C., Stolt, M., Leino-Kilpi, H., Saarikoski, M., 2015. Use of mobile devices in nursing student–nurse teacher cooperation during the clinical practicum: An integrative review. Nurse Education Today 35 (3), 493-499. Traxler, J., 2009. Learning in a mobile age. International Journal of Mobile and Blended Learning (IJMBL) 1 (1), 1-12. Wu, T.-T., 2014. Using smart mobile devices in social-network-based health education practice: a learning behaviour analysis. Nurse Education Today 34 (6), 958-963. Wenger, E., 2011. Communities of practice: A brief introduction.
Journal Pre-proof Figure 1. Flow chart of the recruitment and screening of participants
Figure 2. Mobile community learning homepage for psychiatric nurses Figure 3. Case management course area of the mobile community learning Figure 4. Changes in case management knowledge in the two groups (N = 48)
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Figure 5. Changes in case management competence in the two groups (N = 48)
Journal Pre-proof Table 1. Mobile community learning tools and function
Community information tools
Community function key (Figure 1) Community home page Announcements Members Administrator areas Instant graffiti wall
An instant messaging tool for multiple individuals that provides an instant question and answer for learners
Resource linking
Provide other related online learning resources outside the platform
Digital course area
lP
re
-p
Elite area
Community members’ asynchronous communication environment; teaching facilitators can provide different questions for students to discuss Synopsis of discussion
ro
Discussion forum
Provide digital teaching materials and self-tests
na
Asynchronous communication tools
Community page, representing the core spirit of the entire community Community news updates by community managers List of students and facilitators belonging to the community Management areas that community managers can use to manage the essential functions within the community
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Synchronous communication tools
Learning community features
of
Type of tools
Journal Pre-proof Table 3. Pre-test differences and group × time interaction results for outcome variables Total
Variables
(N = 48) Mean (SD) CM knowledge
Experimental group
Comparison group
(N = 24)
(N = 24)
Mean (SD)
Mean (SD)
t-test
t
p
1
Pre-test Post-test CM competence
54.9 (16.77)
56.5 (16.91)
53.3 (16.85)
0.64
0.53
66.6 (18.71)
80.8 ( 9.85)
52.3 (13.91)
8.2
0.000
2
Pre-test
2.0 (0.78)
2.0 (0.77)
2.1 (0.81)
−0.13
0.89
Post-test
2.9 (0.88)
3.3 (0.82)
2.6 (0.81)
2.91
.006
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CM, case management 1. Possible score, 0–100 2. Possible score, 1–5 *p < 0.05
Group × time interaction
F
p
22.99
0.000*
6.33
0.015*
Journal Pre-proof Table 2. Participant demographics and homogeneity of the two groups Group Total (N = 48) (SD or %)
Characteristics
Experimental (N = 24) (SD or %)
Comparison (N = 24) (SD or %)
t (χ2)
Sex Male Female
6 (13)
3 (13)
3 (13)
42 (87)
21 (87)
21 (87)
Educational level 13 (27)
4 (17)
9 (38)
Bachelor
31 (65)
17 (71)
14 (58)
Master’s
4 (8)
3 (12)
31.3 (5.7)
Max
48
44
48
Min
21
22
21
8 (5)
lP
Mean (SD)
-p
31.4 (5.1)
Years in nursing ‡
7.9 (4.6)
8.1 (5.4)
20
19
20
Min
0.9
0.9
0.9
Min Previous training (hours) Max (hours) Min (hours)
6.6 (4.4)
6.8 (4)
6.5 (4.9)
18
15.2
18
0.3
0.9
0.3
0.79 (1.97)
1.17 (2.2)
0.42 (1.67)
10
10
8
0
0
0
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Max
na
Max
Years in psychiatric nursing Mean (SD)
<0.01
1.00
3.29a
0.08
0.02
0.98
0.15
0.88
−0.23
0.82
−1.33
0.19
1 (4)
31.4 (5.3)
re
Mean (SD)
ro
Age (years)
of
Diploma
p
P < 0.05 Note. “a” means a chi-square test was performed.χ2, Chi-square test; otherwise, t tests were performed.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5