The purpose of this pre-post intervention assessment proposal was to develop, implement, and evaluate novel computerized simulation training programs for the reduction of infectious disease risk in registered nurses. Healthcare workers, including nurses, are at risk for a wide range of occupational health hazards, including the risk from infectious diseases such as bloodborne pathogens and tuberculosis. In order to reduce morbidity and mortality associated with occupationally acquired infections, a number of risk management strategies have been developed. While, safety training programs are acknowledged as an important part of an overall risk management strategy, there are however, a number of challenges and barriers to effective health and safety training, especially in the healthcare work setting. These include time constraints, paucity of experienced trainers, limited training facilities available, limited staff resources which make training in large groups difficult if not impossible, and probably most troubling of all, general dissatisfaction with training materials (i.e., boring, repetitious, especially for annual updates). Importantly, there is a general lack of evaluation research on the efficacy of training programs in the health care setting, including those designed to address blood borne pathogens infection control. To address this problem, our multidisciplinary team of researchers partnered with two large medical centers and a professional nurses' association in order to develop and evaluate an innovative approach to blood borne pathogens safety training for nurses. After a review of the literature and consultation with leading experts in adult based continuing education, we decided to develop realistic simulation exercises, which are based on embedded testing theory and shown to be effective in safety training in other occupational settings (e.g., mining). Simulations tell the story of a "real" situation, which the participant can readily identify with. At certain points along the study, decisions have to be made, and this provides an opportunity for participants to can use their decision making skills. Impotently, these types of exercises not only improve knowledge, but help to change or reinforce safety related beliefs. Thus they are powerful tools for developing a strong understanding of why certain safety precautions are necessary. The conceptual model suggests that once participants understand why the precautionary or compliance behaviors are necessary, they will change their intentions of safe work practices, and thus ultimately their safety-related behaviors. Guided by participatory action research, a simulation team was formed to develop several simulation exercises targeting blood borne pathogens. After extensive pre and pilot testing, the exercises were then formatted into a computerized interactive web-based version and administered to volunteer registered nurses who were recruited with assistance from our partner collaborators. Participants received one continuing education unit (CEU) for each of three simulations they completed as an incentive for participation. The exercises were linked to the participating hospitals own infection control or blood borne pathogens home web pages so that participants could readily access information specific to their home institution,. The exercises also provided numerous informational links (e.g., Centers for Disease Control (CDC), Occupational Safety and Health Administration (OSHA), National Institute for Occupational Safety and Health (NIOSH), and American Nurse Association (ANA) and others so that participants could readily avail themselves of a wealth of information available. The links were also important in terms of helping the participants lean more about the responses to questions that they answered incorrectly, as the exercise were designed so that at certain key points in the story line, the participant was asked a question; forward movement was precluded until the question was answered correctly. Therefore within the stories, everyone had to archive a score of 100%. To evaluate the program we used three mechanisms: (1) a pre-test of knowledge, intentions to report serious exposures, barriers to reporting, and perceived safety climate, (2) a post-test which included all of the preceding constructs except barriers, and (3) an evaluation of the nurses' satisfaction with simulation exercises and with the computer-based training format. The results of this study may have important implications for effective health and safety training for nurses.
Robyn RM. Gershon, DrPH, Principal Investigator Mailman School of Public Health Columbia University 600 W 16Sth Street, 4th floor New York, NY 10032