1. OUTCOMES OF ONLINE VERSUS TRADITIONAL END-OF-LIFE CARE CONTINUING EDUCATION IN NURSING: IMPACT ON NURSING COMPETENCE
Emily Wolff | DePaul University, School of Nursing
Overall, the reported outcomes of online and traditional PC education programs did not vary significantly.
Both learning environments offered effective settings for nurses to improve their competence in PC and EOL care delivery.
Only recorded differences between the two delivery methods were participant-reported preferences.
Online PC education advantages:
User flexibility and accessibility;
Provides learning opportunities for nurses who do not have access to on-site continuing professional development (CPD) activities, or lack the workplace engagement, motivation and cooperation for CPD activities
Disadvantages of online programs:
Reliant on available technology where glitches can occur, and
Technology limits personal interaction, engagement, and support, which had a more profound negative impact on participants when the program presented emotionally charged content such as death and EOL care
The success of an online education program relies on the focus and motivation of the user. It is better suited for the motivated learner.
Conversely, advantages of FtF education:
Format that favors hands-on, experiential learners who prefer structure;
Interactive, collaborative environment that can be culturally-catered to the specific nursing or patient population;
Offer participatory activities in the form of simulations, field visits, and skills practicums that allow users to put their learnings into practice;
Present networking and team bonding opportunities, and
Provide a supportive learning environment.
Disadvantages of the traditional format:
Travel and accommodation costs;
Time-specific; rigid schedule requirements,
Not beneficial to nurses who are physically unable to attend the course.
BACKGROUND
SUMMARY
Professional nurses spend more time with patients who are dying than any other health care professional. Yet, studies show that nurses feel unprepared, or unequipped, to provide adequate end-of-life (EOL) care to these patients, which has directed many organizations to dedicate resources to the development of effective EOL care education programs. Time continues to be of the essence for patients who are at the end of life, stressing the need to ascertain and utilize the most effective EOL care education method to respond to nurses and patients’ needs. However, few studies compare the impact of online and traditional EOL care (PC) education methods on nurses’ clinical and professional competence. Thus, it is necessary to determine which educational approach, online or traditional (face-to-face [FtF]), is the most effective and efficient method for improving nurses’ clinical and professional competence related to EOL care.
FINDINGS
Figure 1. Online Education.
Figure 2. Traditional Education.
Author(s), Year
Key Findings
Borglin & Bohman, 2015
Improved pain assessment knowledge, pain assessment tool knowledge and confidence to undertake pain assessments in EOL care after taking the online learning module
Christensen et al., 2015
Participants preferred the locally-facilitated training versus videoconference (VC)-enabled, remotely-facilitated education; but, it had no measured impact on knowledge
Daniels & Downing, 2018
>80% of respondents graded the e-learning courses highly; rating them as clear, understandable, accessible, and useful; 75% of respondents reported improved knowledge, skills and change in attitude; 61% reported a change in practice
Ersek et al., 2005
Statistically significant improvement in EOL knowledge, self-evaluation of EOL care skills and supervisors’ evaluations of participants’ EOL skills after the FtF education
Murray, Stacey, Wilson, & O'Connor, 2010
Participants demonstrated improved quality of EOL decision support and greater knowledge than the control group­­­­­ after taking the mixed-method educational program
Petersen et al., 2017
Statistically significant gains in EOL spiritual care competence over the three months after participants’ completion of the online educational program, improved knowledge of and attitudes toward spiritual care at the end of life
Quinn, Hudson, Ashby, & Thomas, 2008
Majority reported increased interest, knowledge, and confidence in relation to PC after the FtF training program
Shipman, Burt, Ream, Beynon, Richardson, & Addington-Hall, 2008
All confidence in PC competency scores and PC knowledge scores showed statistically significant improvement after participating in the mixed-method education program
Silverdale & Katz, 2005
Respondents self-reported improved knowledge, skills and attitudes after the online education
Steven, White, Marples, & Atkinson, 2014
Significant improvement in nurses’ confidence and competence in providing EOL care after the FtF program 
Van Boxel, Anderson, & Regnard, 2003
88% of participants across both groups demonstrated increased PC knowledge. No significant differences in learning outcome between the FtF and VC formats. Participants preferred FtF delivery to VC format
Whitehead, Anderson, Rediccan, & Stratton, 2010
Increased perceived knowledge of EOL care and dying after FtF education
Wilson, Tariman, & Graf, 2018
Online education is an acceptable way to educate nurses on PC and EOL concepts. The Online PC Education Program positively impacted the nurses’ confidence level related to PC and EOL care decision-making process
PURPOSE
To examine the existing research regarding the efficacies of online and traditional EOL care education methods for professional nurses because the reported benefits of both delivery methods lack adequate comparison. The resulting comparative analysis serves to guide the development and delivery of future EOL care education practices for professional nurses.
METHOD
Whittemore and Knafl’s five-step integrative method guides the organization and analysis of the data in this literature review. The steps include:
1. Problem identification
2. Literature search, including inclusion and exclusion criteria;
3. Data evaluation
4. Data analysis using extraction and reduction; and
5. Presentation.
Conclusions were drawn from analysis and results are presented in Table 1.
Table 1. Comparison of Online, Traditional, Mixed-Method and Comparative Studies Identified by Integrative Literature Review. .
IMPLICATIONS
Implications for nursing practice include utilizing a mixed methods approach when delivering PC and EOL care education to nurses. A combination of online and traditional formats allows the disadvantages of each method to be offset and caters to the broadest nursing population. This recommendation can be applied to broader nursing practice and nursing education. Moreover, the recommendation requires facility participation and dedication of resources; faculty support, and motivated nurses committed to advancing their nursing competence.
CONTACT
Emily Wolff
DePaul University
Phone: