South West Regional Wound Care Program, Ontario, Canada.
School of Physical Therapy, Western University, London, Ontario, Canada.
Wound Manag Prev. 2020 Jan;66(1):14-23.
Electrical stimulation (E-Stim) involves applying low levels of electrical current. Despite high-level recommendations for E-stim use in many pressure injury (PrI) best practice treatment guidelines, clinicians seldom use E-Stim.
This quasi-experimental design study aimed to determine whether an educational program could improve health care providers' knowledge and attitudes regarding the use of E-Stim for treating PrIs in community-dwelling individuals with spinal cord injury living in 1 region of Ontario, Canada.
An educational intervention based on a university-level continuing education program was developed as part of a multifaceted knowledge mobilization project. Health care providers (eg, nurses, physicians, and allied health professionals) from multiple agencies were invited to participate. The instructional series included 8 online modules on background theory and knowledge and a hands-on workshop that familiarized participants with the equipment necessary to deliver E-Stim. Knowledge (percentage of correct answers using a knowledge test developed by the research team) and attitudes (assessed using the E-Stim Attitude Survey in which items were scored using a 5-point Likert scale (where 0 indicated a negative attitude and 5 a positive attitude) were evaluated 3 times (pre-education, post-online, and post-workshop). Data were aggregated into unit-weighted averaged composites of 3 attitude subscales (resources, evidence-based practice, and education), which were compared before and after educational sessions using a linear mixed effect model.
Among the 83 participants, a significant increase in knowledge scores was noted from pre-education (55.9%) to post-online (78.4%) and post-workshop (78.0%) (X² [2] = 89.34; P <.001). A significant increase in attitude scores was noted across time points (resources: X² [2] = 27.32, P <.0001; evidence-based practice: X² [2] = 38.93, P <.0001; and education: X² [2] = 92.88, P <.0001). For the evidence-based practice subscale, attitude increased significantly post-online (t[127] = 6.03, P <.0001). For the resources subscale, a significant increase was detected after post-workshop (t[113] = 5.23, P <.001].
Online education increased health care providers' knowledge about E-Stim; however, hands-on workshops were required to change certain attitudes about the use of E-Stim for wound healing. Further research is required to evaluate 1) whether a change in knowledge and attitude scores translates to a practice change for health care providers and 2) the potential importance of ongoing coaching and mentorship for a sustainable change in the clinical setting.
本准实验设计研究旨在确定教育计划是否可以提高医疗保健提供者对在安大略省一个地区居住的患有脊髓损伤的社区居民中使用电刺激（E-Stim）治疗压力性损伤（PrI）的知识和态度。
作为多方面知识动员项目的一部分，开发了基于大学水平继续教育课程的教育干预措施。邀请了来自多个机构的医疗保健提供者（例如护士、医生和联合健康专业人员）参加。教学系列包括 8 个在线模块，介绍背景理论和知识，以及一个实践工作坊，使参与者熟悉为提供 E-Stim 所需的设备。知识（使用研究团队开发的知识测试确定的正确答案百分比）和态度（使用 E-Stim 态度调查评估，其中项目使用 5 点李克特量表（其中 0 表示负面态度，5 表示正面态度）进行评分）评估了 3 次（教育前、在线后和工作坊后）。数据汇总为 3 个态度分量表（资源、循证实践和教育）的单位加权平均组合，使用线性混合效应模型比较教育前后的数据。
在 83 名参与者中，从教育前（55.9%）到在线后（78.4%）和工作坊后（78.0%），知识得分显著增加（X²[2] = 89.34；P<.001）。态度得分在时间点上显著增加（资源：X²[2] = 27.32，P<.0001；循证实践：X²[2] = 38.93，P<.0001；和教育：X²[2] = 92.88，P<.0001）。对于循证实践分量表，在线后态度显著增加（t[127] = 6.03，P<.0001）。对于资源分量表，工作坊后检测到显著增加（t[113] = 5.23，P<.001）。
在线教育提高了医疗保健提供者对 E-Stim 的了解；然而，需要实践工作坊来改变对 E-Stim 在伤口愈合方面的使用的某些态度。需要进一步研究评估 1）知识和态度得分的变化是否转化为医疗保健提供者的实践变化，以及 2）对于临床环境中可持续变化，持续指导和指导的潜在重要性。
