Wright Ian M R, Wake Chris H, Anderson Helene, Graham Shirley
Kaleidoscope Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, New South Wales, Australia.
BMC Health Serv Res. 2009 Feb 11;9:28. doi: 10.1186/1472-6963-9-28.
New approaches are often introduced to the neonatal intensive care unit (NICU) and other areas of the health service in either a haphazard or cataclysmic fashion. The needs of staff education are often addressed incompletely or too late. Rarely is education assessed after the introduction of a major change. We changed the basis of our NICU respiratory support. We conducted a major educational and support program before this intervention. This study documented and assessed the educational components of this change in our health service provision.
Senior medical and nursing staff attended training abroad and an education program was applied for one year prior to the change. Multidisciplinary educational support for doctors, nurses and allied health was continued after the change. Assessment was by anonymous questionnaire, prior to change, at one and at nine months. Our hypothesis was that dissatisfaction with education would be greatest at one month.
Both theory education and practical education aspects of the new approach were rated as good to very good and this did not change with time. Difficulty of applying the technique was rated as ambivalent initially but decreased significantly over 9 months until it was rated easy to very easy (p < 0.001). Over all, the change was rated by staff as beneficial, both at the end of the education period and at nine months, with no decrease at one month.
If education and training reaches all staff, with a system of mutual and continued support, even large changes in clinical practice can be achieved without the dissatisfaction with the educational process that is often otherwise seen.
新方法常常以一种随意或灾难性的方式引入新生儿重症监护病房(NICU)及其他医疗服务领域。员工教育需求往往得不到充分满足或处理过晚。在重大变革引入后,很少对教育情况进行评估。我们改变了NICU呼吸支持的基础。在此次干预之前,我们开展了一项重大的教育和支持项目。本研究记录并评估了我们医疗服务提供方面这一变革的教育组成部分。
高级医护人员出国参加培训,并在变革前一年实施了一项教育项目。变革后继续为医生、护士及相关健康专业人员提供多学科教育支持。通过匿名问卷调查在变革前、变革后1个月和9个月进行评估。我们的假设是,对教育的不满在1个月时最为严重。
新方法的理论教育和实践教育方面均被评为良好至非常好,且并未随时间变化。应用该技术的难度最初被评为好坏参半,但在9个月内显著降低,直至被评为容易至非常容易(p < 0.001)。总体而言,员工在教育期结束时和9个月时均认为这一变革是有益的,在1个月时也没有下降。
如果教育和培训覆盖所有员工,并建立相互持续支持的体系,那么即使临床实践发生重大变革,也能实现变革,而不会出现常见的对教育过程的不满。