Leading Australian university delivers just-in-time education aimed to upskill nurses and frontline workers amidst COVID-19 outbreak

Summary

On the 11th of March 2020, the World Health Organization declared the COVID-19 outbreak a global pandemic. After an initial wave of the pandemic began with the first person to test positive for the virus in Australia in late January 2020, a second and larger wave commenced in Victoria on 11 June 2020, with the State of Victoria accounting for 75% of Australia’s cases and 90% of deaths.

The healthcare system in Victoria was largely disrupted due to the spread of COVID-19. Nurses and healthcare workers face the ethical obligation to provide safe care, whilst knowing that providing care to patients carries a high risk of both developing the infection themselves and spreading it to their family members.
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It was necessary for nurses in acute care wards in Victorian hospitals to be upskilled for work in critical and high dependency or intensive care settings, while nurses in the sub-acute and long-term care areas would need to be upskilled for work in acute care and medical wards.

The challenge to healthcare was elevated by the following:

• A large geographical area encompassing Victoria
• The number of nurses affected by the disease
• A need to change practice in both metropolitan and rural health services
• The changing roles of disparate healthcare workers used to meet this crisis.

Our response in equipping frontline workers during a critical time

Australian Catholic University (ACU) was approached by the Department of Health and Human Services to prepare a program for sub-acute nurses that addressed all these requirements. The program had to be developed in a very short time frame to assist with the pandemic. It also needed to be a short and agile course that would present the plethora of continuously evolving and emerging information and evidence in a meaningful and structured manner.

The COVID 4 NURSES project was initiated by the Australian Catholic University, School of Nursing, Midwifery & Paramedicine (VIC) in response to the urgent need to upskill Victorian nurses during the early stages of the COVID-19 pandemic. The online course was launched in early July 2020, shortly after the onset of the second wave of COVID-19 through community transmission in Victoria. It was delivered online to enable wider participation from nurses working in the Victorian health system.

The specific aims of the project were to:

• Provide an online program to educate sub-acute nurses on the management of COVID-19 to prepare them in case of a second wave of the COVID-19 pandemic in Victoria in 2020.
• Assess whether online learning programs are an effective method of increasing the skills and knowledge of nurses working in a stressful environment.

The ability to use sub-acute nurses in acute care wards was an important part of the strategy of the Victorian Government in managing staffing for the COVID-19 pandemic. Education of sub-acute nurses was considered to be an important management strategy for enabling nurses to move between different ward areas to manage COVID-19 patients.

Due to an increasing prevalence of the virus, health care organisations in Victoria were requiring the upskilling of nurses, as it was expected that nurses from sub-acute areas would need to move to more acute areas in order to manage a potential nursing deficit. It was also expected that sub-acute nurses would have the responsibility of caring for patients with known or suspected COVID-19.

Online, asynchronous learning, appears to be a successful method of improving the knowledge of nurses when experiencing challenging clinical circumstances

The COVID 4 NURSES program was effective in creating a significant shift in knowledge and understanding the requirements of providing nursing care in a COVID-19 environment. There was a very strong uptake by Victorian nurses, and the online format on the OpenLearning platform has been deemed a highly successful method of education delivery to a geographically dispersed learner audience.

The content for the program was developed by ACU academics over 4 weeks. OpenLearning was chosen as a partner in this project as they were able to provide an online learning platform that not only facilitated state-wide access, but it's agility allowed the update and delivery of rapidly evolving information in real time.

The move of education to online platforms demonstrated many advantages. The OpenLearning platform was chosen as it satisfied the specific needs of ACU, including:
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• The ability to obtain real time data on participant activity and engagement
• Accommodation for evolving knowledge
• Flexibility and diversity in the learning experience
• Effective engagement between the facilitator and the participants

Delivery of the program through the OpenLearning platform ensured that the crucial learning experiences could include significant peer interaction and the flexibility to cater for different learning styles and the geographical spread.

To determine if the program was effective, a pre-post survey was used. This enabled visibility of any shift in knowledge and skills. Participants demonstrated an increase in knowledge through analysis of the pre and post questionnaires. The average score prior to completing the program was 75%, with a post score average of 94%. This demonstrates an increase in knowledge of an average of 25% for participants who completed both questionnaires.

Of the 975 participants who enrolled in the program, there was a significant completion rate of 27.3%. This compares to industry reports, where up to 15% of those students who start free online courses complete them. For example, a 2018 Columbia University study on edX and Coursera courses showed MOOC Certificate programs having a completion rate of 15% or less.

Participant comments demonstrated appreciation for having access to an evidence-based educational program. The discussion forums used, allowed nurses to see that they were not alone, that they were a part of a larger effort.

The course was designed to provide information in a wide range of media. Care was taken to restrict completion settings within each page to avoid overwhelming the learner, allowing them to focus on important learning activities.

The agile nature of the platform enabled ACU to continually ‘live’ update the program as new information became available, making COVID 4 NURSES a program for skills and knowledge development as well as a reference source for the most current information on COVID-19 nursing care.

Activities were designed based on a social constructivist pedagogy, encouraging learners to bring ideas, experiences, information and artefacts of learning to be shared among a community of practice. These activities were designed to stimulate conversations and knowledge sharing among members of the community.

Before completion of the course, learners were expected to complete a pre- and post-multiple-choice knowledge test that provided ACU with information and data regarding the shift in knowledge, skills and awareness of the important information, practices and processes.

Online certificates were issued to participants who completed all the activities in the course, excluding the pre- and post-questionnaire.

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Two program facilitators monitored the program, facilitating participant discussion, checking eligibility of participants, monitoring program completion, updating content as changes arose and troubleshooting any challenges.

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