Value of applying interactive micro-courses on occupational protection in operating room for nursing trainees : Medicine

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Research Article: Observational Study

Value of applying interactive micro-courses on occupational protection in operating room for nursing trainees

Wang, Cai-Xing MDa; Wu, Chao MDa,*

Author Information
Medicine 102(20):p e33679, May 19, 2023. | DOI: 10.1097/MD.0000000000033679
  • Open

Abstract

1. Introduction

The operating room, being a pivotal component of a hospital, assumes the crucial responsibility of conducting surgeries and providing critical care to patients.[1,2] Widely recognized as a high-risk department for hospital-acquired infections, the operating room is associated with significant risks. Surgery, being a traumatic procedure, not only inflicts physical trauma on the patient’s body, but also poses the risk of complications such as wound infections and poor healing, which can severely impact the patient’s postoperative quality of life.[3] Thus, the management of the operating room, including its nursing safety, is of utmost importance.[4] However, the current nursing management process in the operating room may be influenced by various factors, leading to safety events and sudden accidents, that can significantly impede the smooth implementation of surgical treatment and compromise patient safety.[5] Therefore, it is imperative for operating room nursing staff to employ a series of safety management theories and methods, taking into consideration practical issues, safety concerns, and existing hidden risks in previous nursing management. This will facilitate the development of high efficiency operating room safety management processes, informatization, predictability, and specialization, ultimately enhancing the overall quality and effectiveness of nursing safety management in the operating room.[6]

A micro class refers to a concise audio or video segment that utilizes multimedia technology to provide targeted explanations of specific knowledge points within a timeframe of approximately 5 to 10 minutes, guided by predetermined teaching design principles.[7–9] The core content of a micro class typically consists of classroom teaching videos, accompanied by supplementary teaching resources related to the teaching theme, such as design, courseware materials, teaching reflection, practice testing, student feedback, and teacher comments.[10] These components collectively create a semi-structured, thematic resource unit that is presented in a specific organizational manner, resembling a “small environment” for teaching. The micro class not only distinguishes itself from traditional teaching resources, such as examples, courseware, design, and reflection, but also represents a novel form of teaching resource that inherits and builds upon existing foundations.[11] An interactive micro class represents a further advancement of the micro class concept, incorporating information interaction with resources to stimulate students’ enthusiasm and enhance their interest in learning.[12,13] When applied in the context of occupational protection in the operating room, interactive micro classes can provide additional teaching resources for nursing education in this specialized area, leading to innovative teaching methods and achieving more desirable instructional outcomes for nursing interns. Hence, the purpose of this study is to explore the application value of the interactive micro classes for occupational protection in the operating room, specifically for nursing interns.

2. Materials and methods

2.1. Research object

The participants in this study were selected using cluster sampling, which focused on junior college nursing interns practicing at our hospital from June 2020 to April 2021. The sample size was determined using the following formula:

n = (Zα2pq)/d

with a significance level (α) of 0.05 and a Z-score (Z) of 1.96 (approximated to 2), where p represents the overall rate and q is equal to 1 − p. In this case, p was set at 0.8 and d was defined as a fraction of p, typically set at 0.1 p. Substituting these values into the formula, we obtain n = 400*q/p, which can be calculated as n = 400/4 = 100. Therefore, the initial sample size was set at 100 participants. To account for potential survey bias and invalid responses, the sample size was increased by 20%, resulting in a final sample size of 120 participants. However, due to the potential of incomplete information provided by the participants and uncertainty in the degree of individual differences and other factors, a total of 200 participants were ultimately included in the study. The participants were randomly divided into an observation group and a control group using a random number table method, with 100 participants in. Nurses with clinical work experience or education background other than junior college were excluded from the study. Ethical approval for this study was obtained from the ethics committee of Shanxi University of Traditional Chinese Medicine.

The comparison of baseline data between the 2 groups revealed no significant difference in terms of sex, age, place of origin, only child status, degree of preference for nursing major, and intention to engage in nursing work in the future (P > .05) (Table 1).

Table 1 - Comparison of baseline data of 2 groups.
Evaluating indicator Observation group Control group t/χ 2 P
Gender
 Male 9 7 0.354 .714
 Female 91 93
Age (yr) 20.28 ± 2.34 20.68 ± 2.64 0.823 .483
Place of origin
 Town 37 35 0.336 .724
 Countryside 63 65
The only child
 Yes 42 37 0.923 .54
 No 58 63
Degree of preference for nursing major
 Like it very much 23 21 3.255 .298
 Prefer 38 36
 Neutral 24 30
 Dislike 15 13
Willing to engage in nursing work in the future
 Yes 77 74 0.452 .664
 No 23 26

2.2. Research methods

The control group in this study were provided traditional teaching methods, whereby theoretical and practical coursework on catheter-related blood stream infection clinical nursing theory was delivered by nurses holding intermediate professional titles or above within our hospital.

The observation group in this study were provided interactive micro classes as an intervention to improve the teaching mode employed in the control group. The following enhancements were made: Implementation of the case teaching method: The case teaching method involves utilizing clinical cases as a teaching tool to enhance student’s ability to comprehensively analyze and solve practical problems. This modern teaching approach involves teachers delivering instruction, organizing student discussions, analyzing cases, requiring students to write case analysis reports, and guiding students through induction and summarization processes. Unlike traditional teaching methods, such as “full house” and “injection,” case teaching emphasizes practice, encourages student participation, and guides students to use scientific theoretical knowledge for analysis, deduction, reasoning, and summarization. This approach aims to consolidate relevant knowledge, strengthen comprehensive analytical ability, and apply learned knowledge to practical problem-solving. The task-driven teaching method involves designing the teaching content into specific tasks, which students complete progressively to master the teaching content and achieve the teaching objectives. This approach promotes active student learning and teacher-guided instruction, moving away from a linear progression of teaching content from easy to difficult, and instead using the completion of tasks as the driving force for teaching and learning. The task-driven teaching method is beneficial for students to master learning content and improve various abilities. Performance assessment serves as a crucial indicator for evaluating the quality of teaching and its efficacy. Historically, the evaluation of students’ performance has been predominantly reliant on final theoretical examination results, which not only lacks comprehensiveness but also fails to foster students’ holistic abilities. Given the practical nature of clinical nursing, it is imperative that the assessment of nursing students’ abilities in a clinical setting primarily tests their capacity to solve real-world problems.

2.3. Observation indicators

The evaluation indicators related to teaching of the 2 groups were collected, including clarity of teaching objectives, learning atmosphere, rational use of learning resources, effectiveness of teaching process regulation, and degree of students’ participation in activities. Additionally, the score of occupational protection assessment in the operating room was obtained, which encompassed evaluation of physical, chemical, biological, environmental, and physiological and psychological factors.

2.4. Statistical analysis

Statistical analysis was conducted using SPSS 22.0 software. Measurement data were presented as mean ± standard deviation, and comparison between 2 groups was performed using the t test. Count data were expressed as n (%) and comparison between 2 groups was conducted using the chi-square test. Statistical significance was defined as P < .05.

3. Results

3.1. Comparison of teaching-related evaluation indicators between 2 groups

The comparison results of teaching-related evaluation indicators between the 2 groups revealed statistically significant differences. Specifically, the observation group showed significantly higher scores compared to the control group in the following indicators: clarity of teaching objectives (P = .007), learning atmosphere (P < .001), rational use of learning resources (P < .001), effectiveness of teaching process regulation (P = .01), and degree of students’ participation in activities (P < .001) (Table 2).

Table 2 - Comparison of teaching related evaluation indicators between the 2 groups
Evaluating indicator Observation group Control group t P
Clarity of teaching objectives 14.32 ± 4.43 10.81 ± 3.55 2.732 .007
Learning atmosphere 15.30 ± 3.92 10.33 ± 3.67 4.932 <.001
Rational utilization of learning resources 15.66 ± 3.53 9.66 ± 3.89 5.577 <.001
Effectiveness of teaching process regulation 14.13 ± 3.34 10.88 ± 3.66 2.582 .01
Degree of students’ participation in activities 15.24 ± 3.43 10.56 ± 3.75 3.91 <.001

3.2. Comparison of examination scores of occupational protection in operating room between 2 groups

The comparison results of the assessment scores of occupational protection in the operating room between the 2 groups indicated no statistically significant difference before the intervention (P > .05). However, following the intervention, statistically significant differences were observed between the 2 groups in the following factors: physical (P < .001), chemical (P = .001), biological (P < .001), environmental (P < .001), and physiological and psychological (P < .001) (Table 3). Notably, the observation group exhibited higher scores in all items compared to the control group.

Table 3 - Comparison of scores of 2 groups in the assessment of occupational protection in the operating room.
Evaluating indicator Before intervention After intervention
Observation group Control group t P Observation group Control group t P
Physical factors 7.01 ± 4.11 7.84 ± 3.90 0.953 .429 15.56 ± 4.84* 10.99 ± 3.59 3.464 <.001
Chemical factors 7.32 ± 4.03 7.18 ± 2.92 0.358 .624 14.84 ± 4.47* 10.43 ± 6.02 3.062 .001
Biological factors 7.89 ± 4.32 7.61 ± 4.05 0.389 .603 15.42 ± 4.93* 10.71 ± 4.50 3.514 <.001
Physiological and psychological factors 7.45 ± 4.23 7.25 ± 4.28 0.283 .697 17.02 ± 4.66* 11.25 ± 4.90 4.527 <.001
Environmental factor 7.09 ± 4.20 7.03 ± 4.65 0.117 .783 15.93 ± 4.90* 11.02 ± 4.17 3.267 <.001
Total 38.49 ± 11.34 38.39 ± 16.80 0.221 .712 78.05 ± 11.44* 55.79 ± 16.43 3.936 <.001
*Indicates that the score of the observation group is higher than that of the control group after the intervention, and the difference is statistically significant.

4. Discussion

Based on the Research Report of the Institute of Medicine (1999), accidents have been identified as a significant cause of mortality, with nearly 10,000 deaths annually, ranking as the eighth leading cause of death.[14] In 2004, adverse events in the operating room in the United States were found to be concentrated in surgical errors, drug treatment errors, fire alarms in the operating room, retention of foreign bodies, and surgical infections[15,16] Therefore, effective nursing safety management in the operating room should include strict implementation of inspection systems, enhanced management of special drugs, adherence to procedures for effective communication among medical staff in special circumstances, prevention of patient errors in surgical positioning and operation methods, strict implementation of hand hygiene, establishment of clinical laboratory critical value reporting systems, prevention and reduction of patient falls, mitigation of stress injuries, active reporting of adverse medical safety events, and encouragement of patient participation in safety measures. Through the implementation of a series of nursing safety management theories and methods, potential safety hazards in the operating room can be mitigated, the occurrence of adverse safety events can be reduced, the overall quality of nursing safety management in the operating room can be comprehensively improved, patient safety can be ensured, and patient prognosis can be optimized.

In the current practice of nursing safety management in the operating room, several limitations and influencing factors have led to a series of issues significantly impacting the overall quality of nursing safety and increasing the risk of adverse safety events and potential hazards.[17,18] This study highlights 2 main areas of concern. Firstly, the concept of nursing safety management in the operating room is relatively outdated. Some hospitals prioritize the acquisition of advanced instruments, equipment, and treatment technologies, but neglect the importance of technology-related training for nursing staff. Consequently, nurses lack the necessary knowledge and skills in this area, revealing backwardness and hysteresis in the concept of nursing safety management in the operating room.[19] Furthermore, the existing management system for nursing safety in the operating room is often inadequate, particularly in the context of difficult surgeries and innovative surgical technologies. This deficiency reflects a traditional and routine-oriented approach to nursing safety management in hospitals, failing to keep pace with the demands of modern medical development. Secondly, the nursing staff in the operating room lack systematic and regular training management. Despite the critical role of training in ensuring nursing safety, some hospitals overlook the importance of full-time training management. This oversight undermines the competence and preparedness of the nursing staff in the operating room, potentially compromising patient safety. In the context of managing nursing safety in the operating room, certain hospitals tend to focus solely on the training of nurses during the pre-employment stage. However, once nurses are hired, there is often a relaxation of vigilance, and a lack of regular organization for operating room nurses to participate in ongoing training that aligns with the needs of nursing management in the operating room. This approach fails to guide nurses in continuously learning and improving themselves in the information age. Furthermore, after employing highly skilled operating room nurses, some hospitals do not implement changes in the team management structure, which can result in inadequate nursing support in the operating room. In addition, nursing safety management in the operating room often neglects the cultivation of psychological well-being and responsibility consciousness among nursing staff, focusing predominantly on their professional skills and quality. This oversight leads to nursing staff becoming complacent in their duties in the operating room, and unable to provide personalized nursing services for patients. Such recurrent issues in nursing safety management in the operating room hinder the improvement of overall quality in nursing safety management. Another area of concern is the inadequate attention given to infection control management in the operating room. Infection control is a critical aspect of nursing safety management in the operating room, yet some hospitals lack a robust inspection mechanism for infection control and do not regularly inspect and analyze the related work. This results in nurses lacking awareness of vigilance and responsibility in their day-to-day tasks. Furthermore, some hospitals fail to regularly organize comprehensive evaluations and feedback analyses of infection control in the operating room for operating room nurses and lack a proper evaluation mechanism for nursing safety management. As a result, it becomes challenging to identify, analyze, and address the root causes of nursing safety problems in the operating room, leading to the frequent occurrence of safety issues. This approach undermines the effectiveness and clinical value of nursing safety management in the operating room as a whole.[18,20,21]

Currently, the field of nursing safety management in the operating room has witnessed diverse developments in line with technological development. These developments encompass various theoretical frameworks, including the medical failure mode and effect analysis theory, lean management theory, Plan-Do-Check-Act (PDCA) management theory, business process reengineering theory, and broken window theory.[22] The medical failure mode and effect analysis theory is a team-based, forward-looking, and systematic risk analysis system that predicts and evaluates the occurrence of adverse medical events. It provides a reference basis for formulating risk management strategies, and reevaluation after intervention is necessary to determine if the problem has been effectively resolved, forming the basis for quality improvement and promotion. In 2002, the American Federation for Medical Research applied this theory to medical institutions, resulting in a reduction in the incidence of medical risks.[23] However, successful application of the medical failure mode and effect analysis theory requires nursing staff to possess comprehensive strength and quality. It is worth noting that the risk priority index in this theory is determined through team consensus, which may have subjective elements. To improve the authenticity and objectivity of the management theory and enhance the management of high-risk processes, it is recommended that managers establish a multidisciplinary cooperative comprehensive nursing team in the operating room. This will enable the pooling of expertise and utilization of the full potential and value of the medical failure mode and effect analysis theory. Furthermore, in lean management theory, the concept of “precision” primarily focuses on minimizing resource waste, reducing operation costs and time, optimizing resource utilization, and enhancing the quality of nursing safety management. The notion of “benefit” encompasses both social and economic advantages, as well as improving competitiveness. The fundamental principle of this theory is to achieve maximum value output with minimal resource input. Lean management theory continually refines and innovates core management tools and cycles, such as on-site walking diagrams, 5S method, and comprehensive value stream mapping, to attain excellence. By employing lean management theory in healthcare settings, the failure rate of endoscopic equipment can be significantly reduced, waiting time during operations can be shortened, operation safety can be enhanced, and medical costs can be minimized while ensuring patient safety. Currently, this theory has been widely adopted and extended across various hospitals, allowing for scientific and rational allocation of hospital resources, including funds, manpower, equipment, space, and time, resulting in optimal resource utilization and the provision of safe and effective medical services to patients. Additionally, the PDCA (Plan-Do-Check-Act) management theory encompasses a series of management principles, including planning, implementation, inspection, and optimization, in the context of nursing safety management in the operating room. This approach requires all tasks to be planned, executed, and evaluated based on their implementation outcomes, with successful ones incorporated into the standard procedures and unsuccessful ones addressed in the subsequent cycle. Such a method serves as the fundamental approach to nursing safety and quality management in the operating room and is a universal requirement for safety management in this setting. Moreover, the theory of business process reengineering centers on transforming business processes, with the management objective of addressing patients’ needs and surgical safety. It involves identifying shortcomings in the existing processes, replacing traditional hierarchical structures with modern management techniques and information technology, and flattening the organizational structure of the processes to optimize the quality of medical care. The application of business process reengineering theory in nursing safety management in the operating room can enhance the utilization of high-value consumables, facilitate the reengineering of the management process for such consumables, and leverage the benefits of hospital informatization to construct a management model that is adaptable and data-driven. Through in-depth analysis of the weak links in the surgical process using information data, the safety of surgery can be improved. Finally, the broken window theory postulates that neglecting to promptly repair broken glass can lead to public indifference and a decline in the environment, sending a negative signal. Applied to the operating room context, the broken window theory entails establishing archives of the operation cooperation process and promoting strict adherence to workflow and corresponding rules and regulations by the nursing staff. As managers and staff in the operating room, adopting the broken window theory can help prevent surgical accidents and minimize their impact on operations.[24–26]

In China, the adoption of micro-class teaching mode has been relatively recent. Hu et al[27] first introduced the concept of micro-class in China in Guangdong Province in 2010. Since then, the concept of micro-class has been continuously refined, with the proposal that micro-class refers to targeted micro-network teaching videos that are produced for subject knowledge points, guided by the theoretical framework of cognitive load theory, and utilizing teaching videos as the main instructional tool. As such, WeChat has emerged as a significant platform to support information-based teaching, enabling flipped classroom and micro-class teaching approaches. It facilitates the sharing, networking, and refinement of teaching resources, thereby enhancing access to relevant disciplinary knowledge for learners at different levels. This promotes a mutually beneficial approach to online and offline synchronous learning. In nursing education in China, influenced by the medical teaching mode, the knowledge system is typically divided into 2 modules: public knowledge and professional knowledge. For instance, Li et al[28] conducted a study on nursing English teaching, where 241 students were randomly assigned to a micro-class teaching method experimental group and a traditional teaching control group. After the course, the micro-class teaching experimental group showed significantly better results in terms of learning attitude, autonomous learning ability, learning efficiency, and test scores compared to the traditional teaching group. Similarly, Liu et al explored the application of micro-class in physiology teaching in higher vocational nursing colleges through a controlled variable experiment.[29] The research demonstrated that the construction of a micro-class teaching platform with video as the core is an effective auxiliary teaching method for physiology, enhancing overall teaching effectiveness. Wang et al investigated the application of micro-class in the teaching of internal medicine nursing for nursing students in higher vocational colleges using a controlled variable experiment.[30] The findings indicated that the micro-class group outperformed the control group in terms of the total score of the final examination, learning interest, learning initiative, and learning efficiency, effectively helping students grasp the key contents of the course. This suggests that micro-courses, whether in basic or professional courses, are feasible and practical in the nursing education process. Research on WeChat in China has shown a rapid growth trend, with nursing-related studies primarily focused on educational research, continuing education, and social services, with educational research being the most active area of investigation. Scholars have proposed that the application of micro-courses in teaching has a positive impact on students’ knowledge, abilities, and emotions. However, currently, micro-videos recorded in various teaching processes are often limited to applied learning within schools and lack effective sharing. In the future, WeChat can be utilized as an instant learning resource to establish a platform system that promotes resource sharing. Furthermore, the design of micro-courses should not be confined to the teaching content of a single unit or task module in a course but should be extended to encompass the overall design concept and scheme of the entire course.

With the advancement of nursing practices in the operating room, from traditional nursing mode to perioperative holistic nursing and specialized nursing mode, it has become evident that efficient and safe quality and safety management of the operating room cannot rely solely on the capabilities of the head nurse. To achieve optimal results, a method of quality and safety control and management needs to be implemented to alleviate the workload of the head nurse, allowing them to devote more time to engaging in discussions with senior management to analyze and predict potential safety hazards in the operating room. The quality management of the operating room can be categorized into various aspects, including first-aid skills, nursing safety, instrument and equipment management, hospital feeling management, and nursing document writing. Through the establishment of a safety and quality control team, appropriate quality control standards and scope of work can be formulated to meet the specific needs and actual conditions of nursing safety management in the operating room. Subsequently, the members of the quality control team can carry out corresponding quality inspections, supervision, and management activities. Regular summarization and analysis of examination results should be conducted, with prompt feedback provided to the head nurse, who can then utilize their own supervision and management mechanisms to optimize nursing safety and quality management in the operating room to the highest possible level.[31–33]

Interactive micro-classes are a product of the information age, and their introduction into nursing education can be highly effective in helping students master nursing knowledge, simplifying abstract concepts, and saving on teaching costs, while maximizing teaching time. These micro-classes break away from traditional teaching methods, where students passively receive knowledge, and instead promote active learning. They are accessible anytime and anywhere, and are enriched with multimedia content such as videos, animations, and audio, which can easily engage students’ interest and significantly enhance learning efficiency. However, there are a few limitations that need to be considered. Firstly, the small sample size of the study conducted may be a major limitation, as it may not fully represent the diverse population of learners. Secondly, the study was conducted among the Chinese population, which may limit its generalizability to other cultural and geographic contexts.

In conclusion, interactive micro-classes can be a valuable tool for improving the teaching quality of occupational protection in the operating room for nurses, and they are worth considering for application in clinical teaching. However, it is also important to be mindful of their limitations and further research is needed to explore their effectiveness in different settings and populations.

Author contributions

Conceptualization: Cai-Xing Wang, Chao Wu.

Data curation: Cai-Xing Wang, Chao Wu.

Formal analysis: Cai-Xing Wang, Chao Wu.

Funding acquisition: Cai-Xing Wang, Chao Wu.

Investigation: Cai-Xing Wang.

Methodology: Chao Wu.

Resources: Cai-Xing Wang, Chao Wu.

Software: Cai-Xing Wang.

Supervision: Cai-Xing Wang, Chao Wu.

Validation: Cai-Xing Wang.

Visualization: Cai-Xing Wang, Chao Wu.

Writing – original draft: Cai-Xing Wang.

Writing – review & editing: Chao Wu.

Abbreviation:

PDCA
Plan-Do-Check-Act

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Keywords:

interactive micro class; occupational protection; operating room; teaching quality

Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.