E-learning: An alternative delivery method for clinical risk training in addictions services.
In 2010 East London NHS Foundation Trust commissionedCityUniversityto deliver a project focussing upon assessing risk assessment within Addiction services. The addictions directorate felt there was an identified need within the service to build upon the already significant training offered by the Trust as this was primarily focussed around risk assessment within mainstream mental health services. Initial meetings revealed that traditional classroom based methods were impractical in terms of the release of staff from the service. It was proposed by the project lead at City to consider the development of an e-learning resource.
The budget for the project was quite limited which resulted in a limited number of options in terms of developing the E-resource. It was felt that the resource needed to incorporate more than just a web-based PowerPoint presentation in order to engage staff and encourage retention of information. It was decided to utilise Adobe Presenter as this was a readily accessible resource that enabled an audio stream to be recorded, interactive quizzes to be used and video role plays to be incorporated. This combination of mediums avoids the learner simply being presented with a resource which requires little more of them than to read from the screen. Ross and Tuovinen (2001) highlighted that by adding questions or using tasks which require synthesis or analysis deeper learning can be achieved. Adobe presenter easily enables this with its facility to input questions and quizzes related to the material. A key aim of the project was also to produce videos of staff undertaking role play to demonstrate the skills required and the type of questioning needed to assess the varied risk presented by substance using service users. In a study by Chau (2001) it was demonstrated that knowledge could be enhanced through the use of video taped vignettes that were allied to a task to engage the learner in critical thinking. For the project, staff from the addictions service put together their own role play scenarios. These were based around the three key areas that the addictions directorate had identified as of key importance. These were overdose risk, safeguarding children and suicide risk. Time for preparing the scenarios and recording the role play was quite limited and as a result the vignettes may not be absolutely perfect examples of practice. However this is not necessarily a negative aspect of the resource. It gives other learners the opportunity to compare themselves against their colleagues, and critically analyse how they may behave in such a situation enabling critical analysis of their own practice. One of the findings for Chau’s (2001) study was that students reported that they liked the deliberate mistakes incorporated into their video vignettes as it raised awareness of how practice could be improved. McConville and Lane (2006) also used video clips demonstrating the use of skills in difficult situations. Their study demonstrated that such resources are effective in enhancing the students sense of self-efficacy, that is their confidence in dealing with a particular situation. The videos used as a part of this e-learning resource are limited again by the resources available. Both in terms of time, available equipment and technical expertise.
The editing of the e-learning resource took some time. The content of the slides and audio were reviewed and final changes made. The videos were edited as far as possible to contain the pertinent points and these were linked to slides highlighting the key risk factors and management plan in such situations.
After discussion of a number of different options in terms of access to the resource it was decided to situate the resource on CityUniversity’s Website. This allowed for. ease of access to the resource by staff at their convenience. This generosity on behalf of the Trust has enabled the resource to be free access to any interested parties. Consideration of computer access and the learning environment by employers were deemed to be key considerations in a study by Atack (2003) in promoting the uptake of computer based learning. Although making the e-learning resource open access has been of benefit in many ways it made evaluation of the tool problematic. Initially a link was put into an on-line survey tool. This had to be reconsidered as the resource was available to anyone and it may have led to an unmanageable number of responses or responses being submitted that were non-genuine. To address this, a link was put into the resource where an evaluation form could be printed off and collated by the project lead. This also allowed for evidence that the training had been completed and used as part of supervision.
The overall feedback has been very good .The respondents all agreed that the resource was easy to use, appropriate to their role, was an appropriate length and was an appropriate method of delivering education within the workplace. There was a more mixed response to the question asking them if they preferred it to class-room teaching with the majority disagreeing or having no preference. One respondent preferred the e-learning to the class-room. The written feedback covered a number of different issues from the practicalities of using the resource, to reflection on it as a learning method. There were also some critiques which can be taken on board should such a project run again.
This was very much a pilot project both in terms of developing new skills and considering the viability of e-learning as a tool within the addictions directorate of East London NHS Foundation Trust. The key issues that have been learned are that to produce a perfect glossy e-learning tool requires significant investment and technological skill but a usable tool can be developed with limited resources and specialist knowledge. The feedback for learners has been generally positive and this project has demonstrated that within small niche services where educational requirements are more specialised in nature, this may be a delivery method that overcomes the difficulties in releasing staff from the clinical area en masse. This particular tool could also be used within a class-room setting allowing students to discuss the video role- plays and consider alternative strategies in a more blended style of learning.
The e-learning resource can be viewed at:
Atack. L. (2003) Becoming a web-based learner: registered nurses’experiences. Journal of advanced learning. 44(3) 289-297
Chau.J. Chang.A. Lee.I. Lee.D. Wooton. Y. (2001) Effects of using videotaped vignettes on enhancing students’ critical thinking ability in a baccalaureate nursing programme. Journal of Advanced Nursing. 36 (1) 112-119
McConville. S Lane.A. (2006) Using on-line video clips to enhance self-efficacy toward dealing with difficult situations among nursing students. Nurse Education Today. 26. 200-208
Ross. G. Tuovinen.J. (2001) Deep versus surface learning with multimedia in nursing education. Computers in Nursing. 19 (5) 213- 223