During the study HSW ability to accurately assess varying stages of skin severity did not improve post-training. There was actually a reduction in scores from pre-test (M=11.56, SD=2.439) to post-test 1 (M=10.96, SD=2.457). Studies investigating the effect of the PUCLAS 3 tool have shown that this e-learning improves performance. Findings in a study which employed similar knowledge testing methods showed that there was an increase inter-observer reliability from pre-test (k=0.24, IQR=.21) to post-test 1 (k=0.65; IQR=0.12) (Beeckman et al, 2008). Similarly, a study by
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Beeckman et al (2010) indicated that there was an increase in scores following an e-learning intervention: pre-test (44.6%; p=0.82) to post-test (62.8%; p=<0.0001). One suggested explanation for this increase in test scores in both studies was that the theoretical content was unambiguous. Findings for post-test 1 by Beeckman et al (2008) and Beeckman et al (2010) suggest that the increase in test scores could be because the supplied knowledge is partially memorised, and this cannot be excluded when interpreting the data. However, this does not concur with the writer’s research study. It strengthens the theory of the possibility of theoretical uncertainty among HSWs, and questions the e-learning tool as a suitable instruction method for them.
Weir (2015) recommends that all HSWs should, like their fellow healthcare colleagues, be taught the fundamentals of all care in order to reduce variations in standards and increase efficiency. Cavendish (2013) concurs with this finding, and is opposed to the idea that HSWs would have difficulty understanding certain theoretical concepts, suggesting that this assumption may often result in HSWs being denied the opportunity to learn in a shared manner. Skin assessment is one area of pressure ulcer prevention and management that has a basic core of knowledge (Beeckman et al, 2010). Thus, Gunningberg et al (2015) recommended that basic learning relating to skin assessment could be shared. It is imperative that health educators explore ways of transferring core knowledge regarding skin assessment in a shared manner, without compromising the quality and continuity of care for the patient (Swedberg et al, 2013).
The PUCLAS 3 e-learning tool, developed by Beeckman and Schoonhoven (2015), is the online instruction method employed in this research study. It has been developed as a solution for the ongoing difficulties experienced by healthcare professionals when assessing skin damage and classifying pressure ulcers. It can be independently operated, e.g. from any location using any computing device. This innovative, validated e-learning tool explores skin assessment in a comprehensive manner, and the information included is considered appropriate for all healthcare workers to understand and learn the skills required to confront this complex condition. Hence, the core knowledge for skin assessment is targeted, and questions of flexibility are addressed by the fact that it enables independent learning.
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However, the theoretical content could be regarded as ambiguous for this writer’s study, which can be inferred by the variance in the frequency of accurate responses in post-test 1. There was a decrease of 6% in pockets of excellence, where just 15% of respondents classified 14-16 pictures correctly.
Beeckman et al (2008) discussed the probability of decreased scores, identifying the target groups’ familiarity with computer technology as a factor. They advised that consideration must be applied to the fact that familiarity and therefore competency will be, at least in part, a function of age. This finding was echoed in a recent adult skills study completed by the National Adult Literacy Association (NALA, 2012). Problem solving testing by computer based assessment was completed amongst 5,983 Irish adults. Of those who participated, 42% scored below level 1 - this being the weakest literacy skill level. In this writer’s study, 32% of the study subjects had ≥ 16 years of service. There is a high probability that these participants had experience in only didactic teaching methods. This has ramifications for HSW familiarity levels with regard to computer based technology, and as such, could also be a causal factor in the negative post-test 1 results. However, since the introduction of the world wide web in 1991, many areas in modern life have been affected, for example the ways in which we communicate, with a dependence on the mobile phone for communication being one aspect of this evolving technology (Cook et al, 2008 and Koch, 2014). In Ireland, this is reflected in a national survey on technology use. The Central Statistics Committee (CSO) (2012) demonstrated that 5.5million people living in Ireland in 2011 had a mobile phone, indicating that there is a familiarity with some form of computer-based technology.
Additionally, Beeckman et al (2010) made the point that difficulties in assessment accuracy could be caused by photograph imagery being only two-dimensional, and that non-blanching erythema could not be fully represented. These influential factors should not be disregarded when interpreting the data in regard to incorrect responses. To alleviate this one would need to clinically assess participants undertaking skin assessment. However, to do this for every HSW in the community would require an inordinately large amount of time and resource allocation (Cavendish, 2013). One solution in such circumstances is the availability of telehealth (Marineau, 2007). This can assist in the delivery of care, communication
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to the nurses and others in ‘real time’ and also as a form of personal supervision when wanting to discuss and ‘audit’ a case, scenario, outcome or generally counsel a member of staff to support them in practice (Taylor et al, 2015). This is particularly critical when working in rural or remote areas (Rutledge et al, 2014). One major obstacle to this however is the availability of broadband in the country. Not only is the availability of ‘wifi’ in health centres almost non-existent (HSE, 2015), but ICT infrastructure within community practice is a hindrance to the progression of key roles or services.