AUC Academic Conference 'From Virtual to Reality' The University of
Queensland 1996AUC Academic Conference 'From Virtual to Reality' The University of
Queensland 1996
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Paper Title:
Development and evaluation of a computer-assisted instruction package in clinical pharmacology for nursing students
Presenter:
Peter R. Gee, BPharm(Hons), University of Tasmania
Authors:
Peter R. Gee, BPharm(Hons), Postgraduate Student
Gregory M. Peterson, BPharm(Hons), PhD, FSHP, AFAIPM, Senior Lecturer James F. Reeve, BPharm, GradDipAppComp, Graduate Research Assistant
Tasmanian School of Pharmacy
Faculty of Medicine and PharmacyJenny L. S. Martin, BAppSc(Nsg), RN, Lecturer
Tasmanian School of Nursing
Faculty of NursingUniversity of Tasmania
Keywords: CAI, Nursing Education
Faculty area: Pharmacy
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Abstract
Recent reports commissioned by the Australian Government have highlighted the need to improve medication use in both community and hospital settings. Nurses are ideally placed to promote safe and effective drug use. The aim of this project was to develop and evaluate a computer-assisted instruction package, to assist undergraduate nursing students improve their knowledge of clinical pharmacology and enhance their ability to contribute to the quality use of medications. In a collaborative project, staff of the Tasmanian Schools of Pharmacy and Nursing have produced the program PharmaCAL, using HyperCard¨ 2.2 for the Apple Macintosh¨. A wide range of clinical pharmacology units are extensively covered, based on body systems and concentrating on drugs in common use. Many colour illustrations have been included. Each unit has a set of multiple choice questions to provide feedback to students. The package was evaluated in two ways. A questionnaire was used to assess users' opinions of the package. Secondly, a multiple choice test on clinical pharmacology and therapeutics was administered to 24 third-year nursing students before and after a set of sessions using the package and to a control group of 28 nursing students who were not exposed to the PharmaCAL package. The tests had been validated in samples of pharmacy students, hospital pharmacists and pharmacy academics. The PharmaCAL package was generally well received by the nursing students. Clinical pharmacology test scores significantly improved after using the package and were significantly higher than for the control group of students. The program is a useful adjunct to the existing nursing curriculum. It could also be used in postgraduate nursing education and other health sciences.
Introduction
The National Health Strategy highlighted the need for significant improvements in the use of pharmaceutical drugs in Australia.1 The paper estimated that sub-optimal drug use in Australia results in 30,000 to 40,000 hospital admissions, at a cost of $68-87 million, and between 700 to 900 deaths annually. One of the key recommendations from the review was the development of drug education strategies targeting both health professionals and consumers. Nurses can have an important role in reviewing and improving community drug use.2
To effectively contribute to improved drug use, however, nurses must have a sound knowledge of clinical pharmacology and therapeutics, and there have been suggestions that nursing students and practitioners need to improve their knowledge in this area.3-8
At the University of Tasmania, the teaching of pharmacology to nursing students has been principally based on a formal lecture structure on the principles of basic pharmacology in the first and second year of the four-year course, with relatively little coverage of applied or clinical pharmacology issues. A considerable number of hours are devoted to teaching basic pharmacology in lectures and tutorials. Partly in response to students' dissatisfaction with the existing pharmacology curriculum, teaching staff were keen to supplement the basic pharmacology material with a module in clinical pharmacology. As a result, staff at the Tasmanian Schools of Nursing and Pharmacy entered into a collaborative effort to develop and evaluate a comprehensive computer-assisted instruction (CAI) package to assist undergraduate nursing students to learn clinical pharmacology.
Method
The PharmaCAL package was developed using the HyperCard¨ (version 2.2) authoring language for the Apple Macintosh¨, using a Macintosh¨ LC630. The advanced graphic capabilities and ease-of-use of the Macintosh¨ provide a particularly suitable environment for the development of interactive learning systems. Macintosh® computers were also chosen to present the software, as they are readily available for student use at our University's campuses.
The package was purposely designed to be enjoyable and simple to use. Considerable effort was also taken in the program design to ensure that the content of PharmaCAL can be easily modified or updated by a lay person. Another aim in the design of the program was to minimise the amount of unnecessary text that was on the computer screen. The program was designed to be self-paced, with each student having access to a computer. Network support was included in the program. This involved giving each student a user name and password that allowed them to resume their previous sessions with the program from any computer attached to the University's Macintosh® computer network.
The PharmaCAL program was divided into 17 modules based on body systems, which covered a wide range of clinical pharmacology topics and concentrated on drugs in common use. A wide range of nursing and pharmacology journal articles and textbooks were utilised when developing the content of the modules and questions.9-14
Figure 1 An example screen shot from the PharmaCAL program.
The text was presented on a screen with two scrolling text fields, with navigation buttons below (Figure 1). This method was used to reduce the amount of text on the screen. The top field contained the body of the text, with the field below displaying further information if it was required. Underlined words in the text had a dictionary style definition available, with over 100 definitions included in the completed package. Tables and figures were incorporated in the text as pictures.
Students were given a reference sheet which described the use of the program and the function of each selectable icon in the program. A brief tutorial and supervision accompanied the initial sessions with the program. Each module was designed to take approximately 2 hours of student time to complete. Approximately 15 multiple choice questions were asked at the completion of each module to provide students with an indication of their progress. Multiple choice questions were marked by the computer at the user's request by clicking on a mark icon, with explanations provided for incorrect answers. A record of question use and answers entered for each question by individual users was maintained by the package, and the time spent using the package was automatically stored.
Two groups of third-year undergraduate nursing students from the University of Tasmania participated in a controlled evaluation of the PharmaCAL package. Both groups of students were on clinical rotation placements in a hospital setting. The study group (n = 24) was situated at the Royal Hobart Hospital while the control group (n = 28) was based at the Launceston General Hospital. It was assumed that each group's exposure to clinical pharmacology in their respective settings, the two major teaching hospitals in the State, would be similar. Students in each group did not receive any additional form of structured clinical pharmacology instruction. The students in the study group had nine, one hour sessions covering four modules (angina, asthma, peptic ulcer and pain) in the PharmaCAL program using Macintosh¨ LC II and LC575 computers.
The PharmaCAL package was firstly evaluated by anonymously surveying the nursing students exposed to the package to assess their opinion of its usefulness as a learning aid. Secondly, the effectiveness of the program as a teaching tool was determined by comparing the changes in test scores on a multiple choice question test, administered anonymously to the two groups of students, before and after the study group had been exposed to the PharmaCAL program. Different multiple choice question tests on clinical pharmacology and therapeutics were devised for the pre- and post-tests, primarily to reduce the possibility of students memorising questions and answers.
Each of the tests was analysed for reliability and validity. Validation of the tests involved the completion of both the pre- and post-tests by groups of first year pharmacy students, third year pharmacy students and experts pharmacists (including academic and hospital pharmacists). Differences in the test scores between the groups were assessed using analysis of variance. Fisher's least significant difference test for multiple comparisons was used to ascertain the origins of any significant (p < 0.05) analysis of variance results. Differences in the test scores between the study and control groups of nursing students, before and after the implementation of the PharmaCAL program, were similarly assessed using analysis of variance. Reliability analyses on both the pre- and post-tests were also completed, using Chronbach's a correlation coefficient.15,16
Results
The results of the subjective evaluation of the PharmaCAL program were generally favourable, with the main concern expressed by students was the slowness of the program, which was expected given the speed of the computer that were available.
The students generally agreed that the program had increased their awareness of pharmacology in nursing practice, that they had been able to apply pharmacology knowledge from the tutorial to nursing practice, and that their personal pharmacology knowledge had increased greatly from using the program. Most of the students who completed the tutorials rated themselves as computer literate and did not feel apprehensive about using the program.
Figure 2 Validation results of the pre-test, with the error bars indicating ± SEM.
Figure 3 Validation results of the post-test, with the error bars indicating ± SEM.
Each of the multiple choice question tests used in the evaluation of PharmaCAL was assessed to determine their appropriateness as a measure of clinical pharmacology knowledge. The pre- and post-tests were administered to several groups of individuals with anticipated differences in their pharmacology knowledge. It was expected that first year undergraduate students, with comparatively little pharmacology knowledge, would record a score of approximately 50% in the test, which would be consistent with guessing the answers. It was expected that the 'experts' would achieve the highest test scores, with the third year pharmacy students giving an intermediate response. These assumptions were accurately reflected in the results, with both the pre-test validation (Figure 2) and the post-test validation (Figure 3) demonstrating a trend toward higher test scores with greater anticipated pharmacology knowledge. Analysis of variance revealed significant differences between the groups in both the pre-test (F = 84.9, 4 and 100 df, p < 0.0001) and post-test (F = 66.6, 4 and 77 df, p < 0.0001) scores. According to Fisher's least significant difference test, the results for each group were significantly different from each other, with the exception of the pre-tests for the control and study nursing student groups, and the post-tests for the control group and first year pharmacy students. High reliability coefficients (Cronbach's a) were obtained for the combined results for each of the pre-test (0.86) and post-test (0.90).
Figure 4 Demonstrates the increase in test score results for the study group (lighter) in comparison to the control group (darker), with the error bars indicating ± SEM.
A comparison of mean test scores (Figure 4) clearly illustrates the increase in test scores for the study group of nursing students in comparison to the control group. Analysis of variance confirmed the presence of a significant difference between the groups in the test scores (F = 27.3, 3 and 83 df, p < 0.0001). According to Fisher's least significant difference test, the post-test results, but not the pre-test results, were significantly different between the groups. For both the study and control groups there were a significant increase in test score results between the pre- and post-tests.
DiscussionIt has been noted that nursing students often find science-based subjects difficult and fail to appreciate the relevance of these subjects to practice.4,17 This study investigated the use of CAI as one option to assist students to learn pharmacology and its importance in nursing practice.
CAI was chosen as a teaching aid since it was thought that it would provide an interesting and innovative adjunct to the pharmacology lectures that the nursing students had received earlier in the undergraduate course. CAI has been shown to be at least as effective as other forms of education across a range of disciplines,19-26 including nursing.26
In contrast to the report of Thede et al. that nursing students were often reluctant to use CAI,27 the PharmaCAL program was well-accepted by the sample of nursing students. It was particularly encouraging that the students generally considered that the program was easy to use and beneficial to nursing students, their personal pharmacology knowledge had increased greatly from using the program, the program had increased their awareness of pharmacology in nursing practice and that they had been able to apply pharmacology knowledge from the tutorial to nursing practice, and that the program should be made a permanent part of the undergraduate nursing course.
The use of validated multiple choice tests in clinical pharmacology clearly demonstrated that use of the PharmaCAL package had produced increases in knowledge. Test scores also increased with time, by a smaller extent, in the control group of nursing students, but this was not unexpected as it was likely that the students increased their knowledge of clinical pharmacology during their practical placement in a hospital setting.
The use of CAI is steadily growing in nursing education.26-29 This trend is likely to continue, particularly since significant increases in the quality and ease of use of development programs in the past few years have made it possible for educators and practitioners to produce their own CAI materials. This study has demonstrated that CAI represents an effective educational means of supplementing conventional lecture-based courses in pharmacology for nursing students, and may be generally useful for facilitating the teaching of science-based subjects in nursing curricula.
¨Registered tradename * References available from author on request.
Acknowledgements
This study was partly funded as a National Teaching Development Project through the Committee for the Advancement of University Teaching, Commonwealth Department of Employment, Education and Training. The project had some hardware support from Apple Australia through a grant from the Apple University Development Fund. The authors thank the nursing students who took part in the evaluation of the program and the participating staff members of the Tasmanian School of Nursing.
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Peter Gee
Tasmanian School of Pharmacy
Faculty of Medicine and Pharmacy
University of Tasmania
GPO Box 252C,
Hobart, Tas. 7001Phone: 61-02-202190
Fax: 61-02-202870E-mail: pgee@postoffice.sandybay.utas.edu.au
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