The RCN's online learning resource on VTE is intended for a nursing audience ranging from health care assistants with little or no prior medical training, to registered nursing staff who have completed a degree. The resource was developed in response to the recommendation from the National VTE Leadership Summit (hosted by the All Party Parliamentary VTE Group and the Department of Health) for focussed learning content for nursing staff to further embed VTE prevention and the NICE guideline CG92, into mainstream clinical practice. The resource utilises engaging and accessible e-learning to deliver the content throughout the NHS and independent health care sectors to support the achievement of the required learning outcomes for this 'time challenged' audience.
Aims and objectives
Recognising that an e-Learning solution would provide the most effective solution to a national training need, the RCN's online learning developers reviewed the existing e-Learning for Health VTE distance learning module and evaluated the 'e-VTE' content. Although suited to the learning needs of senior nurses, doctors and pharmacists, it was less appropriate to the needs of health care assistants, student and newly registered nurses.
The RCN undertook to develop an online learning resource for more junior members of the nursing team which focussed on the role of the implementation of the NICE clinical guideline for the prevention of VTE. The College's commitment to deliver this learning extends beyond the NHS to reach nursing staff throughout the UK (and internationally) so open and free access was made available via a 'quick link' from the RCN website's home page. An added benefit being that members of the public (potential patients) are also able to access the learning.
The identified learning need for nursing staff focussed on the practical aspects of VTE prevention, the tasks they need to DO rather than the theory they needed to KNOW. No assumptions could be made about familiarity with e-Learning so the user interface is as intuitive as possible. With little training time available to nursing staff, the content needed to achieve the required learning outcomes 'in the smallest possible nutshell', utilising all the engaging and interactive devices the technology has to offer. The primary objectives for the RCN were to:
1) Develop an engaging learning resource that would increase nursing staffs' awareness of NICE Clinical Guideline 92 and to implement it as standard clinical practice.
2) Deliver the resource in the most flexible way in order to ensure its uptake is easy and attractive for individual nursing staff as well as health care employers throughout the UK who could blend it into their institution's VTE programme.
The secondary objective (beyond the RCN's means to measure quantitatively) was to ensure the learning content contained the required information to support the following learning outcomes:
1) explain what the acronym 'VTE' stands for
2) describe the basic anatomy and physiology of VTE formation
3) identify at least three kinds of 'typical' patient at risk of developing VTE
4) understand when and how, to carry out a VTE risk assessment
5) explain the difference between 'pharmacological' and 'mechanical' prophylaxis, and it is appropriate/inappropriate to use each one
6) describe the key points when fitting patients for anti-embolism stockings
7) describe the key points when fitting patients for other anti-thromboembolic mechanical devices including intermittent pneumatic compression devices and footpumps
8) describe the key points when talking to patients/carers about VTE risk and prevention.
Reasons for implementing your project
Recognising an e-Learning solution would provide the most effective and efficient solution to a national training need, the existing e-Learning for Health VTE distance learning module (e-VTE) was evaluated. The modules were assessed as well suited to the learning needs of senior nurses, doctors and pharmacists but was less suited to those of health care assistants, student nurses and newly registered nurses.
Consequently, the RCN developed an online learning resource to compliment the e-VTE modules. Designed for more junior members of the nursing team it focusses on the nursing role in the implementation of the NICE Clinical Guideline 92. In this way, the RCN's content adds value to the e-VTE module and, with kind permission of e-Learning for Health, re-used some of the video elements to reduce development costs and ensure consistent messages across both resources.
The RCN's VTE online learning is freely available via the website in an effort to reach the widest possible number of nursing staff throughout the UK (and internationally) and to make blending this learning as part of a health care provider's VTE programme simple and straightforward. An added benefit of providing open access is that members of the public are also able to access the learning.
How did you implement the project
No assumptions could be made about familiarity with eLearning so the user interface is as user friendly and intuitive as possible. With little training time available and so many competing information demands on nursing staff, the content needed to achieve the required learning outcomes 'in the smallest possible nutshell', utilising all the engaging and interactive devices eLearning technology has to offer in order to:
1) Reduce the reading load by focusing on the practical elements of what nursing staff needed to DO and providing information to support those outputs rather than lots of theory through the use of animations, video and audio elements.
2) Maximise learner engagement with the content by ensuring it is relevant and immersive through the use of: authentic audio-visual material; engaging animations and interactive elements such as quizzes and case studies; and practical tools such templates for an action plan and a reflective learning record to support the learning into practice.
The content is divided into four key, stand-alone, learning sections each designed to take no longer than 20-minutes to finish. This enables nursing staff to dip in and out of the learning as time (and location) permits completing the sections in an order that suits individual learning needs, via a web browser or mobile device.
Collaborative support from Lifeblood, King's College Hospital and the Dept of Health together with access to video content from e-Learning for Health, enabled this resource to be developed within the RCN's core budget and did not incur any additional costs.
Feedback from individual nursing staff demonstrated the content was supporting them to implement guideline 92 into standard practice with 92% reporting the resource as relevant to their clinical practice and comments such as: "I had no idea the assessment should be carried out more than once because the medical staff do it. I can now ask for a review if patients condition changes and flag up the review prior to discharge".
The resource has also been successfully incorporated into health care providers' local training programmes as evidenced by the following comment: "[With] the need to train over 3,000 staff, I embarked on the task of developing our own VTE E-Learning package. Having a link to the RCN-NICE care-preventing venous thromboembolism is just so invaluable to all our staff, to enable them to access facts, guidelines, assessment tool guidance, videos and practical help. I would like to thank you for all your support on behalf of the Pennine Acute Trust" (Clive Laight - Thromboprophylaxis Nurse, Pennine Acute Hospitals NHS Trust).
The resource is listed in the Education and best practice resources section of the Fifth Annual Audit of Acute NHS Trusts' VTE Policies (2011) and is also being signposted to via other websites as evidenced by this feedback request: "It's all very worthwhile. Make no mistake; it will help save many lives. Excellent stuff. Can we link it to the Lifeblood website please?" (Beverley J Hunt, Medical Director, Lifeblood the Thrombosis Charity).
Key learning points
Collaboration was freely provided by: Lifeblood - the Thrombosis charity; King's College Hospital; and the Dept of Health VTE Programme. Video content was reproduced with kind permission from eLearning for Healthcare, Dept of Health.