ORIGINAL ARTICLE

Increasing Burn Prevention Knowledge: Web-Based Versus Classroom Education Carlee Lehna, PhD, APRN,* John Myers, MSPH, PhD†

Increasing burn prevention (BP) knowledge in nurse practitioners leads to better care for patients who suffer a burn injury. Web-based and classroom-based approaches to increasing an individual’s knowledge, in general and specifically to BP knowledge, is currently an area of interest for researchers. As a result, the purpose of this study was to test and evaluate the influence two methods (classroom and Web-based) has on BP knowledge; and whether a difference existed between teaching modalities. Generalized mixed-effects modeling techniques were used to test for differences in scores across three time points: 1) baseline, 2) immediately after viewing the educational module online (recall), and 3) at least 2 weeks after viewing the educational module (retention); and between the groups. There was no difference in scores between online vs classroom education method (P = .894); therefore, a pooled analysis was performed (n=54). Mean scores on the BP knowledge exam increased over time (P = .003) (regardless of educational method), establishing that the education module significantly increases BP knowledge in nurse practitioners over time. Mean score before receiving the education module was 75.6%; the mean score was 81.9% immediately after the module; and 85.6% 2 weeks after receiving the education module. Either method can be used to educate and train health care providers in BP, which may provide health care providers with useful and cost-effective ways in which to improve BP knowledge and the quality of care for patients who suffer a burn injury. (J Burn Care Res 2014;35:e387–e390)

To date, no research has been conducted to systematically evaluate the impact an educational intervention aimed to increase burn prevention (BP) knowledge can have on a nurse practitioner’s (NP) BP knowledge or to examine the difference between Web-based vs classroom education. While this has been done in a population of registered nurses (RN), similar work has not been performed in a population of NPs. In addition, no study has measured the impact of an increase in an individual’s BP knowledge has on the frequency of that individual teaching patients and family members about BP (eg, proper hot water heater temperature). Even though there is a body of work describing firemen’s efforts in teaching BP in schools, and although the need to have health care providers increasingly teach more about BP has been well established, there has From the *School of Nursing and †School of Medicine–Pediatrics, University of Louisville, Kentucky. Address correspondence to Carlee Lehna, PhD, APRN, University of Louisville, School of Nursing, 555 South Floyd St., Louisville, Kentucky 40292. Copyright © 2014 by the American Burn Association 1559-047X/2014 DOI: 10.1097/BCR.0000000000000022

been a paucity of research exploring the teaching habits of NPs concerning BP. Preliminary work by Lehna et al1 indicated that nurses in emergency department and pediatric settings do not teach BP to their patients, which was predicted by the nurses’ perceived lack of BP knowledge and their lack of ability to teach BP, thus indicating a potentially untapped opportunity. In addition, the nurses’ actual BP knowledge scores indicated they were not knowledgeable about BP. Unfortunately, the instrument used to evaluate BP knowledge performed poorly (Cronbach’s α = 0.254). As a result, Lehna and Myers2 developed a novel instrument that more accurately measures BP knowledge in nurses (Cronbach’s α = 0.604). Lehna and colleagues3 completed a study examining changes in nurses’ BP knowledge after participating in a Web-based education module. Results suggest that the Web-based education module increases a nurse’s BP knowledge over time. In addition, the increased BP knowledge leads to nurses’ perceived ability to teach BP as well as increasing nurses’ intention to teach BP more often. With this model it was expected that increasing NPs’ BP knowledge would increase their perceived knowledge and ability, which e387



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would result in the NPs providing more BP education for their patients. It was also hoped that an online education module could be used to increase the BP knowledge of NPs, thus extending the findings of the previous study. Also, it was hypothesized that there is no difference in knowledge between classroom and online approaches to providing BP education.

METHODS The current study aimed to evaluate whether Webbased and/or classroom education could improve BP knowledge in a group of NPs. If the results supported that the educational module improved BP knowledge for NPs, this would extend our previous findings that the Web-based educational module increased BP knowledge for RNs.3 To realize this goal we administered our validated and reliable instrument, which measures BP knowledge, at three time points: 1) before exposure to the educational module (baseline knowledge), 2) immediately after exposure to the educational module (recall knowledge), and 3) 2 weeks after exposure to the educational module (retention of knowledge).2 A higher score on the instrument indicated better BP knowledge. In addition, a threshold value of 80% correct responses has been advocated to indicate sufficient BP knowledge.2,3

Recruitment and Data Collection For the purpose of this study, an NP is defined as a student currently enrolled in an NP program and/ or is a practicing NP who has taken and successfully passed the NP certification exam in his/her specialty. NPs were recruited through posting on the state coalition of nurse practitioners’ Web site, hosting a dinner at the annual coalition meeting, and through hosting a local chapter meeting of the National Association of Pediatric Nurse Practitioners. The research team decided to implement another strategy by inviting NP students’ participation. Therefore, our sample included both NP students as well as practicing NPs. Participants either attended classroom presentations or accessed the existing Burn Prevention Education module Web site (http://www.burnpreventionstudy.com/). Participants completed the anonymous questionnaire containing demographic information, a short test,2 viewed or participated in the same PowerPoint BP education module, and completed two posttests. Test questions were developed and used previously in research.2,3 The

education module covered the BP areas of scalds, gasoline, elders, abuse, and juvenile fire setters.2,3

Statistical Analysis Initially, descriptive statistics for the sample population were calculated to describe the study sample. Subsequently, repeated measures analysis of variance was used to test whether BP knowledge (scores on the BP knowledge instrument) increased over time via the Web-based educational module or classroom education method. A generalized linear mixed-effects model using the normal distribution and identity link function was developed to test for change in BP knowledge scores over time adjusted for age, years in practice, and years in area. Similarly, a generalized linear mixed-effects model using the binomial distribution and the logit link function was developed to test for changes in the proportion that had sufficient BP knowledge (80% cutoff) over time adjusted for age, years in practice, and years in area. A secondary analysis compared NP students and practicing NPs to examine whether level of training was a confounder.

RESULTS Both the handwritten surveys from the classroom approach (n=17, 31.5%) and those submitted online (n=37, 68.5%) were entered into SPSS-20 for analysis. Initially researchers investigated whether differences existed between NPs who completed handwritten surveys and those who submitted online surveys. No significant differences existed; so all 54 surveys were combined into one complete set for analysis. As seen in Table 1 the NPs’ area of work was extensive, with most having a Bachelor’s degree (48.1%) or Master’s degree (40.7%). A majority perceived they had average BP knowledge (46.3%), but a majority perceived they had high capability to teach BP (53.5%). Few had taught BP subsequent to the educational module (18.5%). Few had sufficient BP knowledge (80% cutoff) at baseline (25.9%). The NPs were relatively young (37.3 years of age) and had some experience in practice (6.1 years) and in their area of work (6.0 years). The average baseline BP knowledge score was low (75.6%) for this sample population. As seen in Table 2 and Figure 1, BP knowledge scores significantly increased over time (P < .001). Post hoc comparisons of time points suggest that scores significantly improved from baseline to immediately after exposure to the educational module (P < .001); although, there was no significant

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Table 1. Demographics and baseline burn prevention knowledge for the sample population Categorical Variable Area  Family   Adult health  Emergency  Pediatrics  Other Education   BSN (nurse practitioner students)  Masters   After Masters Perceived burn prevention knowledge  Low  Average  High Perceived teaching burn prevention capability  Low  Average  High Taught burn prevention subsequently Baseline proportion with sufficient burn prevention knowledge Continuous Variable Age Years in practice Years in area Baseline burn prevention score

N=54 (%) 14 (25.9%) 9 (16.7%) 7 (13.0%) 12 (22.2%) 12 (22.2%) 26 (48.1%) 22 (40.7%) 6 (11.2%) 11 (20.4%) 25 (46.3%) 14 (25.9%) 3 (7.0%) 17 (39.5%) 23 (53.5%) 10 (18.5%) 14 (25.9%) Mean (SD) 37.3 (12.1) 6.1 (8.3) 6.0 (69) 75.6% (10.6%)

difference in BP scores from immediately after exposure and at 2-week follow-up (P = .573). As seen in Table 2 and Figure 2, the proportion of NPs who had sufficient BP knowledge significantly increased over time (P = .003). Post hoc comparisons of time points suggest that scores significantly improved from baseline to immediately after exposure to the educational module (P = .001); although, there was no significant difference in BP scores from immediately after exposure and at 2-week follow-up (P = .754). As seen in Table 3, time point independently affected BP knowledge scores over time (β=7.24, 95% confidence interval [CI] 6.81–7.70, P < .001 for immediately after the educational module; β=9.86, 95% CI 9.08–10.56, P < .001 at 2-week follow-up). Age (P = .586), years in practice (P = .453), years in

Figure 1.  Burn prevention scores over time. Scores significantly improved from baseline to immediately following the intervention (p .05). As such, only pooled results are shown.

DISCUSSION Supporting previous findings by Lehna and colleagues,3 NPs who participated in this study demonstrated BP knowledge gain and retained this information over time. Interestingly, the NPs had lower baseline BP knowledge when compared with the nurses in that study by Lehna and colleagues. Retention scores in both groups were very similar: 85.4%3 vs 85.6% in the current study. In the previous study by Lehna and colleagues, years in practice and years in current area significantly influenced individuals’ BP knowledge scores over time.3 The current study does not support these findings.

Table 2. Mean burn prevention scores and proportion of nurse practitioners with sufficient burn prevention knowledge over time Outcome Mean burn prevention score (SD) Proportion with sufficient knowledge

Baseline

Immediately After

Two-Week Follow-Up

P

75.6% (10.6%) 14 (25.9%)

81.9% (239%) 37 (68.5%)

85.6% (19.1%) 40 (74.1%)

Increasing burn prevention knowledge: Web-based versus classroom education.

Increasing burn prevention (BP) knowledge in nurse practitioners leads to better care for patients who suffer a burn injury. Web-based and classroom-b...
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