Cath Lab Digest

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Methods

  Study design/sample/setting. A prospective, multiple-choice (options A through D) 20-question pre-/post test design was used. The test was given before and after the participant viewed the E-Learning Program Learning section. Use of the Living and Looking sections was optional due to concerns about program length.
  Patients were invited to participate between August 2008 and March 2009. Two study sites were selected for this study — Thomas Jefferson University Hospital, a level-one trauma center that specializes in SCI, and Thomas Jefferson University Hospital’s acute care rehabilitation center, a Delaware Valley Regional Spinal Cord Injury Center that received federal designation as a Model System Spinal Cord Injury Center in 1978. Access to the patient population was approved by Thomas Jefferson University Hospital’s administration as well as the SCI program director. This study was approved by the Institutional Review Boards (IRB) of the University of Virginia and Thomas Jefferson University Hospital and determined to be exempt from full IRB review.
  Inclusion criteria comprised all of the following: spinal cord-injured patients 1) with spinal cord injury at any level; 2) age 18 years and older; 3) men and women from all ethnic groups; 4) with or without a current pressure ulcer; 5) with or without a history of pressure ulcer; 6) medically stable on a medical or surgical unit; and 8) who had been transferred to an acute rehabilitation facility. Patients were excluded from consideration if they were: 1) non-English speaking (the E-Learning Program is in English) or 2) spinal cord-injured, but who were medically unstable in an intensive care unit.
  Demographic information was collected and included gender, race, age, highest level of education, level of injury, years since spinal cord injury, prior pressure ulcer, and current pressure ulcer status.
  Instrument.The investigator (JB) developed the paper and pencil pre-/post test because no existing test was associated with the E-Learning Program. Ten major concepts from the E-Learning Program were used to create the pre-/post test questions. These concepts included: 1) pressure ulcer definition (one question); 2) NPUAP staging definitions (six questions); 3) causes of pressure ulcers (one question); 4) seeking professional help (one question); 5) common risk factors (three questions); 6) nutrition (one question); 7) performing skin checks (two questions); 7) repositioning in a bed and weight shifts in a wheelchair (two questions); 9) equipment and support surfaces (two questions); and 10) taking charge of their own care (one question) (see Table 1). Each correct response was worth 5 points; the possible scores for the knowledge test ranged from 0 to 100, with 100 being a perfect score. The investigator used the publication Writing Multiple-Choice Items from the University of Minnesota – The Office of Measurement Services31 as a guideline to create the multiple-choice test questions. John Sanderson, PhD, Professor of Education Curry School of Education, University of Virginia, an expert in educational testing, reviewed the final instrument.
  Pre-/post test instrument validation. Nurses who worked on an acute rehabilitation unit were asked to assist with validation of the test questions. All of the rehabilitation nurses had prior education for the prevention and treatment of pressure ulcers. Nurse participation was voluntary and permission was received from the nurse manager, clinical nurse specialist, and charge nurse. During a 2-week time frame, a laptop with Internet access was available and nurses were invited to view the E-Learning Program Learning section and complete the 20 multiple-choice question test.
Twelve nurses participated in the test validation. Nurses test scores included four 100%, five 95%, two 90%, and one 85%.