GODOY, S.; MENDES, I.A.C.; HAYASHIDA, M., NOGUEIRA, M.S., ALVES, L.M.M. Inservice nursing education delivered by videoconference. Journal of Telemedicine and Telecare, v.10, n.5, p.303-305, 2004. IN-SERVICE NURSING EDUCATION DELIVERED BY VIDEOCONFERENCE Simone de Godoy, Isabel Amélia Costa Mendes, Miyeko Hayashida, Maria Suely Nogueira, Leila Maria Marchi Alves Ribeirão Preto College of Nursing, WHO Collaborating Centre for Nursing Research Development, University of São Paulo, Brazil. SUMMARY Thirty nursing auxiliaries at a Brazilian hospital were trained in intramuscular injection at the ventrogluteal site in a lecture delivered by videoconference (over an IP connection at up to 512 kbit/s). Participants were able thereafter to practise on the same manikins used for demonstration during the lecture, until they felt confident in carrying out the procedure. They then completed an evaluation questionnaire on the use of videoconferencing as a teaching method. Most of their responses were favourable. The principal reasons given for attending the videoconference lecture were the ability to combine work and education, the opportunity to participate in an innovative approach and an interest in the subject of the lecture. The present study demonstrates the potential of videoconferencing for distance education in nursing.
INTRODUCTION Difficulties in developing clinical research and teaching are common in Brazilian nursing, because of a lack of technical resources 1. In the international literature, videoconferencing has been used experimentally for nursing education, to deliver courses, for case discussion and as an integrated tool for e-learning in an undergraduate nursing course 2-5. These studies have demonstrated the efficacy of videoconferencing for professional training in rural areas. However, further research is required. We recently conducted a project in which videoconferencing was used to support collaborative research and education at a Brazilian nursing college and a teaching hospital. As one of the subprojects, we sought to train nursing auxiliaries in the intramuscular administration of medication in the ventrogluteal site, by means of videoconferencing. This topic was chosen since the ventrogluteal site is under-used by nursing auxiliaries, who, in most Brazilian institutions, prepare and administer medication under the supervision of a nurse 6,7. The aim of the present study was to examine the feasibility and acceptability of videoconferencing for the teaching of a nursing procedure. METHODS The study took place at the obstetrics and gynaecology clinic of a 600-bed hospital, since this was the only clinic at the hospital with a satisfactory network connection. The clinic had 54 beds and there were 42 nursing professionals 9 nurses and 33 nursing auxiliaries. All the nursing auxiliaries were invited to participate in the study and received explanations of the research. The research project was approved by the ethics committee of the hospital. The nursing department of the obstetrics and gynaecology clinic was connected to one of the college's teaching facilities, about 2 km away, via a videoconferencing link. The videoconferencing units (ViewStation 128, Polycom) were linked by an IP connection. Most of the time, the transmission speed was 512 kbit/s. A 30-minute lecture on the intramuscular administration of medication in the ventrogluteal site was transmitted by videoconference from the nursing college. It was delivered 11 times to groups of two or three students, during normal working hours. Each lecture demonstrated the intramuscular injection procedure in the ventrogluteal region on full-body adult manikins. The first five minutes of the lecture formed an introduction, in which participants were informed that they could ask questions at any time. There was then 15 minutes of instruction, which included an account of the relevant anatomy, delimitation of the ventrogluteal region, an explanation of the advantages of its use and the instructor's demonstration of the procedure on manikins. The remaining 10 minutes were used for questions and answers. During the lecture, the instructor encouraged the professionals to participate by means of directed questions. Further training was carried out during normal working hours, under the face-to-face supervision of one of the researchers. Participants practised on the same manikins used for
demonstration during the lecture, for as many times as necessary, with or without the help of the supervisor, until they felt confident in carrying out the procedure. An evaluation of the videoconference was then carried out. The instrument used to verify the participants' satisfaction with the technology consisted of 10 questions, eight of which required either a yes or a no response and two of which offered a list of options. Three nursing teaching researchers evaluated the instrument and considered it adequate for the proposed objectives. After the evaluation, participants received feedback about their performance. Data were compiled and processed by means of Epi Info, version 6.04d 2001, after which they were subjected to descriptive statistical analysis. RESULTS Thirty of the 33 nursing auxiliaries (91%) gave informed consent and participated. All of them completed the questionnaire about the use of videoconferencing. Most of the responses to the questions on the use of videoconferencing as an in-service education tool were favourable (Table l). With respect to interaction with the distant lecturer during a videoconference, 26 participants (87%) stated that it had been good, while four gave other answers: 'Different'; It's better', 'Excellent I did not imagine the technology was this good' and 'Good in a way, but bad because there is some time before our question reaches the lecturer'. The principal reasons given for attending the videoconference lecture were the ability to combine work and education, the opportunity to participate in an innovative approach and an interest in its content (Table 2). Only one person (3%) responded that the class content was not related to professional practice (this person said that 'the ventrogluteal site is not used in our daily practice'). The majority of the nursing auxiliaries said that they were motivated to discuss the class content; only one participant answered that she did not feel motivated (Table 3).
Table 1 Opinions of the 30 nursing auxiliaries on the use of videoconferencing as an in-service educational tool Question Number of answers Were you able to concentrate during the entire class? Yes 28 93 No 2 7 What was the quality of your interaction with the distant instructor? Good 26 87 Other 4 13 Did the videoconferencing tool contribute to your learning? Yes 28 93 No 2 7 Is videoconferencing useful as an in-service education tool? Yes 30 100 No 0 0 Are you interested in other teaching using this modality? Yes 30 100 No 0 0 Was the class content related to your professional practice? Yes 29 97 No 1 3 Proportion (%)
Table 2 Reasons for taking the videoconference lecture Reasons Number of respondents Proportion (%) Ability to combine work and education and opportunity to participate 12 40 in an innovative approach and interest in the contents offered Ability to combine work and education and an opportunity to 6 30 participate in an innovative approach Ability to combine work and education 5 17 Ability to combine work and education and interest in the contents 2 7 offered Opportunity to participate in an innovative approach and interest in 2 7 the contents offered Interest in the contents offered 2 7 Opportunity to participate in an innovative approach 1 3 Total 30 100 Table 3 Responses to the question Were you motivated to discuss the content of the lecture? Reasons Number of respondents Proportion (%) Yes, during the lecture 11 37 Yes, at the end of the lecture 10 33 Yes, during and at the end of the lecture 8 27 No 1 3 Total 30 100
DISCUSSION The experiment showed that videoconferencing was a good means of facilitating distance learning. It was clear that not being obliged to leave the workplace or to attend outside normal working hours was an important factor for the nursing auxiliaries in their professional education. This may have increased their motivation to learn and also their satisfaction with the technology. It is important to note that most of the participants could concentrate for the duration of the 30-minute videoconference lecture. It has been said that most students lose their attention within 15 minutes during an educational videoconference, which suggests that teachers need to find other forms of interaction 8. In the present study, the aim of contributing to the adoption of intramuscular administration of medication in the ventrogluteal site was combined with an evaluation of videoconferencing as an inservice educational tool. We are not aware of any reports in the national literature about courses or training in this form. The present study demonstrates the potential of videoconferencing for distance education in nursing. Acknowledgements: This research received financial support from CNPq (Brazilian National Scientific and Technological Development Council). REFERENCES 1 Mendes IAC, Costa AL, Godoy S, et al. Grupo de pesquisa, difusão de conhecimento e EAD: um caso da enfermagem. [Research group, knowledge dissemination and distance education: a nursing case] In: Terra JCC, ed. Gestão do conhecimento e e-learning na prática. [Knowledge Management and e-learning in Practice] Rio de Janeiro: Elsevier, 2003: 285-93 2 Fukue Y, Ando N, Mitani M. The potential of a nursing education support system using videoconferencing. Journal of Telemedicine and Telecare 2000; 6 (suppl. 2):18-19 3 Harkins LT, Harkins CJ 3rd. Respiratory care education goes the distance. Journal of AIlied Health 1997; 26:163-8 4 Geibert RC. Integrating Web-based instruction into a graduate nursing program taught via videoconferencing. Challenges and solutions. Computers in Nursing 2000; 18:26-34 5 Tachakra S, Creagh-Brown B. Using telemedicine for distance education. Journal of Telemedicine and Telecare 2001; 7 (suppl. l):43-4 6 Castellanos BEP. Estudo sobre as regiões para aplicação de injeção por via intramuscular. [Study on Intramuscular Injection Regions.] Dissertation. São Paulo: University of São Paulo College of Nursing, 1977
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