Presentation
A Pilot Evaluation of Macrocognitive Skill Training for Indwelling Urinary Catheter Insertion
SessionPoster Session 2
DescriptionPrevious research has shown that inserting an indwelling urinary catheter (e.g., a Foley catheter) requires cognitive skills that support risk recognition and mitigation. Healthcare workers must be able to anticipate risks before the procedure, such as patient characteristics that may complicate catheterization, and must also recognize risks that arise during the procedure, such as breaks in sterility. Anticipated risks can often be addressed through planning and preparation, whereas risks that occur during the task require active monitoring and real-time decision making to be mitigated effectively.
In collaboration with ShadowBox LLC, we developed four interactive, online training modules designed to target “macrocognitive” skills underlying risk recognition and mitigation for catheter insertion. Each module provided opportunities to practice sensemaking, monitoring, planning, and decision making, and to receive expert feedback. We piloted the four modules with two undergraduate nursing classes (N = 96; 37 juniors, 59 seniors) at a single institution. Students were randomly assigned to complete one of the four modules. To evaluate training effectiveness, students were also randomly assigned to complete assessments of knowledge, skills (i.e., self-efficacy), and attitudes either immediately before starting or after completing a module. All study activities were approved by the Emory University Institutional Review Board.
Knowledge was measured using ten short video clips, half containing a break in sterility and half without. Students could rewatch clips before responding and rating their confidence. Performance was measured using a rate-correct score (number of correct trials divided by total response time across trials). Self-efficacy was measured with three items that assessed confidence in three skills: preparing for a sterile task, recognizing breaks during a task, and mitigating them appropriately. Attitudes were measured with three items assessing the importance of monitoring for breaks, planning for breaks, and the acceptability of compromising sterility due to competing priorities. Attitude and self-efficacy items were rated on a 7-point (dis)agreement scale. Attitudes and self-efficacy were analyzed using separate MANOVAs with Training Module (1–4), Class (Junior, Senior), and Assessment Point (Pre-, Post-Training) as between-subjects factors; knowledge performance was analyzed using an ANOVA with the same between-subjects factors.
Students assessed after training achieved significantly higher rate-correct scores than those assessed before training (p < .001). This effect, however, varied by module and class (p < .001), with juniors tending to improve as much, or more, than seniors across modules. For self-efficacy, students reported higher overall scores post-training (p = .010), with especially strong confidence in their ability to respond appropriately to breaks in sterility (p = .001). Lastly, results showed that students assessed after training reported more favorable attitudes overall compared to those assessed before training (p = .046), though no individual attitude item was significantly different.
In summary, macrocognitive skills training improved students' ability to recognize breaks in sterility and increased their confidence in responding appropriately. These findings provide early evidence that macrocognitive skills training can strengthen knowledge, attitudes, and self-efficacy for sterile procedures. The observation that junior students tended to benefit more from this training than seniors suggest that introducing this type of training earlier in nursing education may be particularly valuable. More broadly, this pilot demonstrates a scalable approach for integrating cognitive-skills training into infection prevention education.
In collaboration with ShadowBox LLC, we developed four interactive, online training modules designed to target “macrocognitive” skills underlying risk recognition and mitigation for catheter insertion. Each module provided opportunities to practice sensemaking, monitoring, planning, and decision making, and to receive expert feedback. We piloted the four modules with two undergraduate nursing classes (N = 96; 37 juniors, 59 seniors) at a single institution. Students were randomly assigned to complete one of the four modules. To evaluate training effectiveness, students were also randomly assigned to complete assessments of knowledge, skills (i.e., self-efficacy), and attitudes either immediately before starting or after completing a module. All study activities were approved by the Emory University Institutional Review Board.
Knowledge was measured using ten short video clips, half containing a break in sterility and half without. Students could rewatch clips before responding and rating their confidence. Performance was measured using a rate-correct score (number of correct trials divided by total response time across trials). Self-efficacy was measured with three items that assessed confidence in three skills: preparing for a sterile task, recognizing breaks during a task, and mitigating them appropriately. Attitudes were measured with three items assessing the importance of monitoring for breaks, planning for breaks, and the acceptability of compromising sterility due to competing priorities. Attitude and self-efficacy items were rated on a 7-point (dis)agreement scale. Attitudes and self-efficacy were analyzed using separate MANOVAs with Training Module (1–4), Class (Junior, Senior), and Assessment Point (Pre-, Post-Training) as between-subjects factors; knowledge performance was analyzed using an ANOVA with the same between-subjects factors.
Students assessed after training achieved significantly higher rate-correct scores than those assessed before training (p < .001). This effect, however, varied by module and class (p < .001), with juniors tending to improve as much, or more, than seniors across modules. For self-efficacy, students reported higher overall scores post-training (p = .010), with especially strong confidence in their ability to respond appropriately to breaks in sterility (p = .001). Lastly, results showed that students assessed after training reported more favorable attitudes overall compared to those assessed before training (p = .046), though no individual attitude item was significantly different.
In summary, macrocognitive skills training improved students' ability to recognize breaks in sterility and increased their confidence in responding appropriately. These findings provide early evidence that macrocognitive skills training can strengthen knowledge, attitudes, and self-efficacy for sterile procedures. The observation that junior students tended to benefit more from this training than seniors suggest that introducing this type of training earlier in nursing education may be particularly valuable. More broadly, this pilot demonstrates a scalable approach for integrating cognitive-skills training into infection prevention education.
Event Type
Poster Presentation
TimeTuesday, March 244:45pm - 6:15pm EDT
LocationRhinelander Gallery
Simulation and Education