The effectiveness of interactive computer assisted instruction compared to videotaped instruction for teaching nurses to assess neurological function of stroke patients: A randomized controlled trial
Background: Teaching inexperienced nurses to assess neurologic function of acute ischemic stroke patients poses challenges to educators in Taiwan. Objectives: The purpose of this study was to examine the effectiveness of two programs that teach nurses the use of the Chinese version of the National Institute of Health Stroke Scale (C-NIHSS), and to evaluate the level of learner satisfaction with these teaching programs. Design: An experimental research design with two groups, one pre-test and two post-tests was utilized. Setting: Six neurology and neurosurgery wards at two hospitals in southern Taiwan. Participants: Participating nurses were stratified based on their clinical level of experience and prior training on the National Institute of Health Stroke Scale (NIHSS). They were randomly assigned to either the experimental C-NIHSS interactive computer assisted instruction (ICAI) group (n = 44) or the Instructor-led videotape learning program (IVLP) group (n = 40) to learn the C-NIHSS. Methods: The measurement tools included the score verification unit (SVU) (score range from 0 to 45, content validity index, CVI = 0.96, percentage agreement = 84%) and the learner satisfaction scale (CVI = 0.92, Cronbach's alpha = 0.97). Results: Both groups' scores on the assessment of correctness significantly increased (F = 35.50, p = 0.00) after intervention. However, there was an insignificant difference between the changes in the two groups (F = 0.02, p = 0.89). After using one-way ANCOVA analysis, and adjusting for the length of experience in neurological nursing, the results showed that in the second post-test, the ICAI group's score was significantly higher than that of the IVLP group (F = 4.81, p = 0.03). There was a positive correlation between assessment correctness on the second post-test and length of experience in neurological nursing (r = 0.35, p < 0.05). It was concluded that nurses with less experience in neurological nursing, who receive ICAI will perform a better assessment of stroke patients than those who received IVLP. Conclusion: The C-NIHSS ICAI teaching program contributed to better assessment correctness after adjusting for the length of experience in neurological nursing, and to some extent increased satisfaction for the participating nurses. Therefore it is worth promoting the use of ICAI for in-service education of nurses, especially for nurses with less experience in neurological nursing, in order to enhance long-term effects of learning. © 2009 Elsevier Ltd. All rights reserved.