Background
The use of appropriate personal protective equipment (PPE) inhealthcare settings is a very important factor in infection control activities to improve patient safety and prevent transmission of infection [1]. In particular, with the outbreak of COVID-19, the importance of correct use of PPE is being emphasized to protect medical staff and patients from transmission of infection [2‐4]. For an effective use of PPE, Korea Disease Control and Prevention Agency (KDCA), Occupational Safety and Health Administration (OSHA), and Centers for Disease Control and Prevention (CDC) provide guidelines on the type and correct selection of PPE, circumstances, medical behavior indications, and methods of donning and doping PPE [5‐7]. In addition, previous studies have made efforts to improve infection control capabilities and block transmission to the community by conducting education on the use of PPE for hospital workers, confirming its effectiveness, or identifying related factors to increase knowledge and recognize levels [8‐15].
Accordingly, Although the number of nurses with PPE-related training and knowledge was higher than that with other infection control methods, the proportion of nurses among medical staff infected with COVID-19 was high, exceeding 60% [16‐18]. The cause of contamination was mostly exposure during the donning and doffing PPE process. It was found that parts of the body were exposed to the outside of the contaminated PPE and became infected [19]. To reduce the possibility of infection that might occur during the donning and doffing process, a standardized training method that is more advanced and practically applicable than the existing video-based training (VBT) or demonstration method is needed [12, 20, 21]. Although simulation education methods that reproduced clinical sites close to real situations or educational studies using virtual reality (VR) were reported to be effective in PPE-related knowledge, self-efficacy, confidence, and educational satisfaction, they were found to be ineffective in improving donning and doffing PPE performance [22, 23]. In addition, according to previous research, theoretical knowledge acquired through lectures had no significant correlation with donning or doffing PPE performance [24, 25]. Recently, interactive education methods are being studied to increase donning and doffing PPE performance through active intervention [2, 26, 27]. Methods such as recording video or monitoring by an observer, having a PPE helper directly visit the ward to observe and provide feedback on donning and doffing PPE performance [9], and applying fluorescent material for visual stimulation and checking after doffing PPE [10, 11, 28] are being studied. Infection control capabilities such as correct use of PPE are key factors that nurses must have to respond with sufficient capabilities. It is necessary to systematically train nursing students from undergraduate departments by applying standardized teaching methods [29, 30].
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In previous studies, it was found that the application of PPE by medical personnel was carried out according to existing educational experience and guidelines, and the lack of actual education and training was perceived as a barrier [31, 32]. Therefore, it was said that systematic education based on basic guidelines is needed starting from the undergraduate level, and that timely education must be provided according to various educational environments to ensure effective application and management of PPE [33].According to a study of Stuby et al. [34], in order to increase knowledge and performance together, it is important to increase proficiency by conducting face-to-face classes that present standardized donning and doffing PPE protocols along with theory classes on PPE selection and indications. In particular, unlike previous studies that confirmed the effects of various education, this study attempted to confirm the effectiveness of education by combining knowledge and behavior by applying Miller’s Pyramid [35, 36]. However, since students’ training in real situations can be exposed to risks, we intended to apply safer and visually effective fluorescent materials with video debriefing [37] in this study. Video debriefing has been shown to be effective in improving skill performance by a method based on the basic assumption that the more information you learn about yourself through video recording and viewing, the more your behavior improves [38, 39].
Additionally, several studies have reported that self-evaluation scores and observer evaluation scores are different [40‐42].Thus, it is necessary to find an accurate performance evaluation method by checking and comparing not only observer evaluation scores, but also self-evaluation scores before and after training.Therefore, this study aimed to provide an educational method applying fluorescent materials and video debriefing to nursing students and confirm its effectiveness.
Hypotheses of this study are as follows.
• hypothesis 1
• The experimental group with an education applying video debriefing will have a higher level of observer evaluation donning and doffing PPE performance than the control group with VBT.
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• hypothesis 2
• The experimental group with an education applying video debriefing will have a higher level of self-evaluation donning and doffing PPE performance than the control group with VBT.
Methods
Study design
This was a randomized study with a before and after design to verify effects of a donning and doffing PPE education applying video debriefing on nursing students.
Participants and data sources
Of a total of 78 third-year students, 70 agreed to participate after explaining the purpose and method of this study at a university in Incheon, South Korea. The inclusion criteria are as follows. Junior who were scheduled to clinical training were recruited. Study participants had not conducted PPE use training before. The effect size was set to 0.70 based on the results of a previous study [28] to set the target subject population, the sample size of the study. Using G*power program 3.1.9 [43] and with a power (1-β) of 0.80, a significance level of 0.05, an effect size of 0.70, and two-tailed independent t-test resulted in a sample size of 34 people per group. Initially, 70 people who had no experience receiving training in the use of PPE participated. The researcher assigned groups through random sampling using a random number table from the list of research subjects who agreed to participate. Therefore, 35 subjects in the experimental group with an education on donning and doffing PPE applying video debriefing and 35 subjects in the control group with VBT were included. During the intervention process after the preliminary investigation, one person in the control group withdrew due to cold symptoms. Thus, the final analysis was conducted with data from 35 people in the experimental group and 34 in the control group (Fig. 1).
Fig. 1
Flow chart showing the selection of study participants. PPE = personal protective equipment; VBT = video based training
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Intervention
First, interviews were conducted with one simulation education expert, one nursing professor, and one epidemiological investigator from the Korea Disease Control and Prevention Agency to obtain advice on the content and direction of the education. As a result of analyzing the contents of the consultation, it was suggested that PPE using education is a necessary topic for nursing college students and is an essential skill not only in practice but also in the field. In addition, there was a common opinion that it was timely for the training to be conducted at a time when the general public’s interest in infection control and disaster nursing has recently been increasing. The opinion was that the method of debriefing and reflecting on it as an educational method and the selection of a measurement tool were appropriate. The intervention of this study was conducted at free time without regular classes. Educational contents and methods provided to the experimental group are shown in Table 1. One group consisted of 15 to 20 people divided into a total of four groups (2 experimental groups and 2 control groups). Education was provided in groups. Each class operated different dates and time so that they were not notified in advance of whether they were included in the experimental group or the control group. In order not to share information on education among participants, the control group was conducted first and then the experimental group intervention was applied.
Table 1
Structure of donning and doffing PPE Education using video debriefing on nursing students PPE = personal protective equipment
Topic (minute) | Subtopic (minute) | Teaching methods | Evaluation |
|---|---|---|---|
Orientation (10) | Lecture | ||
Lecture about expertise theory (50) | • Infectious disease prevention and control act • How to apply PPE • How to donning and doffing PPE • Glycerin enema skll • Environment and medical waste management • Understanding the structure of negative pressure isolation facilities | Lecture | |
Break time (10) | |||
Video learning (10) | Donning and doffing PPE | Video | |
Practice (40) | • Donning PPE (10) • Glycerin enema (10) • Doffing PPE (10) • Check fluorescence exposure (10) | Fluorescent material application practice | |
Debriefing (60) | • Video debriefing • Writing a reflection on one’s feelings | video debriefing | |
Summary (10) | Evaluation | • Observer evaluation donning and doffing PPE performance • Self-evaluation donning and doffing PPE performance • Satisfaction |
Table 2
Homogeneity Test of Demographic Characteristics of Participants (N = 69)
Variables (Range) | Total (N = 69) | Exp. (n = 35) | Cont. (n = 34) | χ2 or t (p) |
|---|---|---|---|---|
n(%) or Mean ± SD | ||||
Gender Male | 16(23.2) | 6(17.1) | 10(29.4) | 1.46 (0.265) |
Female | 53(76.8) | 29(82.9) | 24(70.6) | |
Age (year) | 24.44 ± 5.81 | 23.65 ± 5.38 | 25.44 ± 6.24 | -1.35 (0.181) |
Adult nursing grade score (0∼100) | 85.12 ± 7.50 | 84.24 ± 6.73 | 86.21 ± 8.33 | -1.14 (0.258) |
The theoretical education was conducted based on the KDCA epidemiological investigator infection control training course and previous research [28], selecting infection control items related to PPE donning and doffing, and implementing the content after expert verification in a 1-hour education period. One hour of theoretical education was equally provided to both groups. The theoretical education content conducted through lectures included six topics, including infectious disease prevention and control regulations, PPE application methods, donning and doffing PPE procedures [5], glycerin enema procedures [44], environment and waste management, and understanding the structure of negative pressure isolation facilities. The reason for selecting the glycerin enema technique was to follow standards of the Korea Occupational Safety and Health Agency (KOSHA) included in PPE operability evaluation, which included five movements (walk for 2 min; moving head left and right for 2 min; moving head up and down for 2 min; walk while reading a sentence out loud for 2 min; walk for 2 min) [45]. The glycerin enema procedure followed the protocol suggested by the Korean Accreditation Board of Nursing Education [44]. After the theoretical lecture, the experimental group was provided with an educational program that included donning and doffing PPE (level D) video lesson for 10 min provided by the KCDA, donning and doffing PPE practice using fluorescent materials (40 min), and video debriefing (60 min). The educational program was conducted by the lead researcher in the practice lab. The practice sequence for donning and doffing PPE using fluorescent materials was as follows. First, participants wore all equipment (protective clothing, overshoes with laces, two gloves, goggles, and N95 masks) in the PPE (level D) set while looking at the donning checklist and checked the whole body with a mirror. Afterwards, the researcher applied a fluorescent lotion designed for hand washing education to the hood, zipper, wrists, and so on and immediately performed the glycerin enema procedure on a training mannequin. After the procedure was over, students looked at the checklist, doffed using hand sanitizer and tissues, and then immediately entered a dark room. The researcher used ultraviolet (UV) light to identify body parts that were stained (contaminated) with fluorescent materials, marked them in pictures, and showed them to students. After watching their own video of the PPE donning and doffing process, they performed video-debriefing, expressing in words what they felt and what needs to be improved. In addition, they checked which part was exposed and at what stage, and discussed among colleagues what additional solutions should be taken to control infection and wrote a reflection journal. Differently, the control group practiced donning and doffing PPE for 2 h while watching and followingtheeducational video and checklists provided by the KCDA.Since the control group was only provided with video-based training, the same education applied to the experimental group was provided after the post-survey.
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Measurement
Donning and doffing PPE checklist
The checklist for PPE donning and doffing was based on the guidelines of the Korea Disease Control and Prevention Agency(KDCA). Afterwards, three experts (two epidemiologists and one nursing professor) analyzed the CVI and selected items with a CVI of 0.8 or higher [5]. The donning PPE checklist consisted of 15 questions and the doffing PPE checklist consisted of 25 questions, each taking 5 to 10 min. The donning PPE checklist was a five-point scale consisting of hand hygiene, inner gloves, protective clothing, over-the-top wear, N95 mask wearing, mask close-up verification, goggles wearing, hood wearing, outer gloves, and donning status verification, with 5 points for implementation, 3 points for deficiency, and 0 points for non-compliance (total points in a range of 0–75). The doffing PPE checklist was a five-point scale consisting of hand hygiene, contamination verification, unwinding of padded straps, removing outer gloves, removing hood and protective clothing, removing goggles, removing masks, removing inner gloves, disinfecting shoes, and others, with a range of 0-125 points for implementation, 3 points for shortage, and 0 points for non-compliance. A higher score indicated higher donning and doffing PPE skills. The internal reliability or Cronbach’s α was 0.834 for the donning and 0.875 for the doffing.
Satisfaction
The six questions developed by this study were evaluated immediately after intervention by the experimental group. Learner satisfaction was measured only in the experimental group that received simulation training using a scale measuring satisfaction with simulation training. 3 items were five-point scale consisting of overall satisfaction with education, appropriateness of training time, the degree of confidence improvement. And the most confident, beneficial, and interesting topic were asked to choose.
Data collection
The period of data collection was from March 27, 2023 to April 21, 2023. In the recruitment process, a research subject recruitment document was posted, including the purpose, target, recruitment period, recruitment manager and phone number, and participation procedures and methods using SNS group Talk. The researcher explained the purpose and ethical matters of this study to subjects who showed intention to participate. In the case of participating in this study based on sufficient understanding, confidentiality and anonymity related to the subject and the fact that it could be withdrawn at any time without disadvantage during participation in the study were fully explained and a written consent was obtained. To ensure individual anonymity, personally identifiable information was encrypted after data collection. In addition, it was stated and explained that participation in this study and survey data collected were not related to their grades.Collected names were given numbers so that personal privacy and confidentiality could be protected. Research consent forms and questionnaires of the students who participated in the study were stored in lockers of the researcher. Both experimental and control groups confirmed the prior homogeneity of study subjects through observer evaluation and self-evaluation PPE performance before receiving theoretical education. Even in the clinical field, the degree of performance of donning and doping PPE was evaluated using a self-evaluation method. Self-assessment was performed immediately after donning and immediately after doffing. Afterwards, to block the maturity effect of study subjects, observer evaluation and self-evaluation PPE performances were measured immediately after the intervention was completed. For this study, both groups performed a total of more than three times of donning and doffing PPE through pre-investigation, intervention education, and post-investigation.
Data analysis
Collected data were analyzed using the SPSS/WIN 21.0 program. As a result of conducting the Shapiro-Wilk test prior to analysis, the significance probability of the dependent variable was over 0.05, confirming that it was normally distributed. Dependent variables and general characteristics of subjects were analyzed using descriptive statistics. An independent t-test was used to verify the hypothesis and prior homogeneity of experimental and control groups. In addition, differences between self-evaluation and observer evaluation scores were analyzed by a paired t-test.Because the evaluator evaluated the video footage, there was no missing data.
Results
Homogeneities between the experimental group and the control group
Regarding general characteristics of study subjects, there were 16 males and 53 females (χ2 = 1.46, p = .265). Mean age of subjects was 24.44 ± 5.81 years (t = − 1.35, p = .181). As a result of confirming the adult nursing grade score before the study, homogeneity was secured between the two groups (t = − 1.14, p = .258). These results are summarized in Table 2.
As a result of comparing prior observer evaluations of donning PPE performance (t = 0.80, p = .428), prior observer evaluation of doffing PPE performance (t = 1.45, p = .152), prior self-evaluation of donning PPE performance (t = 0.86, p = .390), and prior self-evaluation doffing PPE performance (t = 1.58, p = .121) between the two groups, there were no significant differences in total scores. These results are summarized in Table 3.
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Table 3
Homogeneity of Donning and Doffing PPE performances Test between Experimental and Control Groups (N = 69)
Variables (Range) | Total (N = 69) | Exp. (n = 35) | Cont. (n = 34) | χ2 or t (p) |
|---|---|---|---|---|
n(%) or Mean ± SD | ||||
Observer evaluation donning PPE (0∼75) | 35.09 ± 10.52 | 36.09 ± 11.75 | 34.06 ± 9.14 | 0.80 (0.428) |
Observer evaluation doffing PPE (0∼125) | 58.91 ± 20.46 | 62.40 ± 18.17 | 55.32 ± 22.27 | 1.45 (0.152) |
Self-evaluation donning PPE (0∼75) | 65.45 ± 9.53 | 66.43 ± 9.31 | 64.44 ± 9.79 | 0.86 (0.390) |
Self-evaluation doffing PPE (0∼125) | 103.05 ± 19.29 | 106.60 ± 15.03 | 98.76 ± 22.99 | 1.58 (0.121) |
Testing of hypotheses
As a result of analyzing collected data to test hypothesis 1, the control group’s observer evaluation donning PPE performance difference between their pre- and postscores was 16.06 ± 8.77 and the experimental group’s observer evaluation donning PPE performance difference between their pre- and postscores was 34.94 ± 11.07. As a result of testing differences between the two groups, the average score of the experimental group was significantly higher than that of the control group (t = 7.84, p < .001).The control group’s observer evaluation doffing PPE performance difference between their pre- and post-scores was 22.09 ± 18.81 and the experimental group’s observer evaluation doffing PPE performance difference between their pre- and post-scores was 47.69 ± 13.47. As a result of testing differences between the two groups, the average score of the experimental group was significantly higher than that of the control group (t = 6.52, p < .001). The experimental group with an education applying video-debriefing had higher level of observer evaluation donning and doffing PPE performance than the control group with VBT. Thus, hypothesis 1 was supported.
As a result of analyzing collected data to test hypothesis 2, the control group’s self-evaluation of donning PPE performance difference between their pre- and post-scores was 4.64 ± 7.72 and the experimental group’s self-evaluation of donning PPE performance difference between their pre- and post-scores was 6.63 ± 8.92. As a result of testing between the two groups, there was no significant difference (t = 0.98, p = .330). The control group’s difference in self-evaluation of doffing PPE performance between their pre- and post-scores was 8.22 ± 13.98 and the experimental group’s self-evaluation of doffing PPE performance difference between their pre- and post-scores was 8.83 ± 14.61. As a result of testing between the two groups, there was no significant difference (t = 0.17, p = .869). The experimental group with an education applying video-debriefing had not a higher level of self-evaluation donning and doffing PPE performance than the control group with VBT. Thus, hypothesis 2 was rejected (Table 4).
Table 4
Comparison of Donning and Doffing PPE performances between Experimental and Control Groups (N = 69)
Variables (possible range) | Groups | Before | After | t (p) | Difference (After-before) | t (p) | |
|---|---|---|---|---|---|---|---|
Mean ± SD | Mean ± SD | Mean ± SD | |||||
Donning PPE (0∼75) | Exp. (n = 35) | 36.09 ± 11.75 | 71.03 ± 5.30 | 10.19 (< 0.001) | 34.94 ± 11.07 | 7.84 (< 0.001) | |
Observer evaluation | Cont. (n = 34) | 34.06 ± 9.14 | 50.12 ± 10.76 | 16.06 ± 8.77 | |||
Doffing PPE (0∼125) | Exp. (n = 35) | 62.40 ± 18.17 | 110.09 ± 10.01 | 8.92 (< 0.001) | 47.69 ± 13.47 | 6.52 (< 0.001) | |
Cont. (n = 34) | 55.32 ± 22.27 | 77.41 ± 18.95 | 22.09 ± 18.81 | ||||
Self-evaluation | Donning PPE (0∼75) | Exp. (n = 35) | 66.43 ± 9.31 | 73.06 ± 3.61 | 2.77 (0.008) | 6.63 ± 8.92 | 0.98 (0.330) |
Cont. (n = 34) | 64.44 ± 9.79 | 69.79 ± 5.80 | 4.64 ± 7.72 | ||||
Doffing PPE (0∼125) | Exp. (n = 35) | 106.60 ± 15.03 | 115.43 ± 7.59 | 2.11 (0.040) | 8.83 ± 14.61 | 0.17 (0.869) | |
Cont. (n = 34) | 98.76 ± 22.99 | 109.61 ± 13.55 | 8.22 ± 13.98 | ||||
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Comparison of performance score between observer evaluation and self-evaluation
There were statistically significant differences in both pre-score and post-score when performance scores between evaluators were compared. In the experimental group, both students’ pre-self-evaluation donning scores (t = -14.05, p < .001) and post-self-evaluation donning scores (t = -2.53, p = .006) were significantly higher than observer evaluation results. Doffing scores (t = -12.69, p < .001) and post-self-evaluation doffing scores (t = -3.23, p = .003) were significantly higher in students’ pre-self-evaluation than in observer evaluation. In the control group, donning scores (t = -13.03, p < .001) and post-self-evaluation donning scores (t = -8.94, p < .001) were all significantly higher in students’ pre-self-evaluation than in observer evaluation and donning scores (t = -7.43, p < .001) and post-self-evaluation donning scores (t = -7.51, p < .001) were all significantly higher in students’ pre-self-evaluation than in observer evaluation. Therefore, in both the experimental and control groups, the students’ self-evaluation scores for donning and doffing were higher than the observer evaluations.(Table 5).
Table 5
Comparison of performance score between Observer-evaluation and self-evaluation (N = 69)
Groups | Variables (possible range) | Evaluation subject | Before | t (p) | After | t (p) |
|---|---|---|---|---|---|---|
Mean ± SD | Mean ± SD | |||||
Exp. (n = 35) | donning PPE (0∼75) | Observer evaluation. | 36.09 ± 11.75 | -14.05 (< 0.001) | 71.03 ± 5.30 | -2.53 (0.016) |
Self-evaluation. | 66.43 ± 9.31 | 73.06 ± 3.61 | ||||
doffing PPE (0∼125) | Observer evaluation | 62.40 ± 18.17 | -12.69 (< 0.001) | 110.09 ± 10.01 | -3.23 (0.003) | |
Self-evaluation t | 106.60 ± 15.03 | 115.43 ± 7.59 | ||||
Cont. (n = 34) | donning PPE (0∼75) | Observer evaluation | 34.06 ± 9.14 | -13.03 (< 0.001) | 50.12 ± 10.76 | -8.94 (< 0.001) |
Self-evaluation | 64.44 ± 9.79 | 69.79 ± 5.80 | ||||
doffing PPE (0∼125) | Observer evaluation | 55.32 ± 22.27 | -7.43 (< 0.001) | 77.41 ± 18.95 | -7.51 (< 0.001) | |
Self-evaluation | 98.76 ± 22.99 | 109.61 ± 13.55 |
Learner satisfaction
To evaluate learner satisfaction, 35 subjects in the experimental group were surveyed for their satisfaction with six questions immediately after finishing the intervention. The overall satisfaction had an average score of 4.33 ± 0.82 points out of 5 points. Their satisfaction with the amount and time of learning had 3.49 ± 0.62 points out of 5 points. The degree of confidence improvement had 3.85 ± 0.62 points out of 5 points. The most confident topic was donning PPE (54.3%). The fluorescent material application practice was the most beneficial (68.6%) and interesting topic (60.0%).
Analysis of reflection content
After practicing the use of fluorescent materials, results of analyzing contents of the reflection journal written after watching their turning and doping performances in videos were as follows. ‘When I actually performed it, I learned that doffing was a more complex and important process than donning,’, ‘I was unfamiliar with hand hygiene for each item in my mask,’, and ‘I thought I did it according to the educational video, but I was very surprised to see fluorescent substances on it.’ They said that ‘I could see what procedure was wrong by watching the video’. In particular, they said that the most memorable learning was the part where the contaminated part was visually checked through the process of identifying the fluorescent substance.
Discussion
The purpose of this study was to provide donning and doffing PPE education applying video debriefing and verify its effectiveness in order to improve donning and doffing PPE performance as one of the infection control competencies for nursing students. This study is meaningful in that it applied Miller’s pyramid to enhance the effectiveness of self-learning by combining reflection through the application of fluorescent materials and video debriefing along with theoretical education according to the “knows-knows how-how-does” progression, and confirmed the ability of PPE attachment and detachment [47, 48].
As a result of verifying the effectiveness of this study, both the donning performance and the doffing performance evaluated by the observer showed that the experimental group improved the score after intervention compared to the control group. This indicates that an education on donning and doffing PPE applying video debriefing is more effective than VBT and simple practice. This was similar to results of a previous study showing a significant difference in performance between groups by confirming the use of PPE for reducing contamination after reality-based education [11]. According to one study [46], which provided hand washing education to families visiting a pediatric ward, an auditory stimulation method through visual data and audio voice was effective in improving hand washing performance. It was found that it would be appropriate to introduce educational methods that could stimulate sensations such as fluorescent substance identification and self-video in order to lead to such practical behavioral changes and increase performance. In this study, self-learning could be effectively achieved by applying video debriefing to reflect on one’s performance.To further reduce contamination and achieve perfect performance in the donning and doffing PPE process, it is necessary to combine hands-on helper intervention, which corresponds to the ‘does’ part of Development ‘s assessment pyramid, with repetitive training [9, 47, 48].
However, self-evaluation of donning and doffing performances showed no significant difference between the two groups after intervention. The reason for this was that the measured value of self-evaluation was different from the measured value of the observer, as shown in results of comparing performance scores between observer’s evaluation and self-evaluation in this study. Average scores of the control group and intervention group evaluated in advance by the observer were 35.09 ± 10.52 and 58.91 ± 20.46, respectively, compared to average scores of 65.45 ± 9.53 and 103.05 ± 19.29 for the two groups evaluated in advance by self-evaluation. Therefore, the difference in the intervention effect was unclear because both groups had few self-evaluation differences in (after-before) scores. Previous studies examining the effectiveness of hand hygiene practice also showed that the observed compliance rate increased significantly after intervention to 47–80%, while the self-evaluation compliance rate remained almost unchanged at 87% regardless of hand hygiene practice [40]. Self-evaluation differs from an observer’s evaluation because it reflects the error that one is performing better than he or she actually is [1].As a result of reviewing studies examining association between self-report and observational data for behaviors relevant to controlling an infectious disease outbreak during the COVID-19 pandemic, it was found that measurements obtained through self-evaluation were overestimated by up to five times more than objective evaluation [39]. In addition, the validity of self-assessment is lowered when beginners do not have confidence in evaluating their own abilities, and this study results also show that there is no effect between self-assessments [49]. To accurately measure intervention effectiveness and performance, objective measurement methods should be preferred.When verifying the effectiveness of an educational program, it is necessary to increase the reliability of the measurement method using image monitoring through environmental and system construction and evaluation with feedback from observers using staff. In addition, the higher the grade level, the higher the technical ability, the more similar the self-evaluation score measured to the observer evaluation score. Thus, repetitive training rather than one-time training is required [41].
It was found that learning satisfaction was effective in the evaluation stage after the educational program. It was probably because intervention was timely provided during the recent COVID-19 pandemic when nursing students’ demand for epidemiological investigations and infection control methods were increased [50]. In addition, they had interest in the teaching method using fluorescent material. They also had the opportunity to reflect on themselves through video debriefing, which might have increased their satisfaction. After analyzing contents of the reflection journal, they recognized that the doffing process was more complex, consistent with previous studies [1, 8, 19] mentioning the importance of doffing PPE. Thus, it is necessary to supplement and strengthen training on doffing using standardized protocols. During pandemic periods such as COVID-19, medical workers complained of anxiety symptoms due to fear of exposure to infectious diseases and lack of experience. To reduce such anxiety symptoms, donning and doping PPE training should be conducted periodically [51]. In the nursing education field, it is necessary to apply video debriefing not only for PPE, but also for various nursing skills during training to improve their performances.
This study is an experimental study that evaluated the effectiveness of education, and there is a need to devise further methods to increase the internal validity of future interventions. If self-learning and non-face-to-face methods using video debriefing developed in this study are applied to standardized programs/education to enhance practice, deviations depending on the intervention instructor can be reduced, but on the other hand, the level of reflection varies depending on the individual student. Therefore, there is a need to develop a standardized self-reflection form.
Since practice in actual clinical situations can be exposed to risks, this study provided nursing students with a safe educational environment and effective self-learning opportunities. In addition, by applying the educational method of this study to not only students, but also medical workers, it is thought that it will be effective in preventing infectious diseases and preventing transmission in the future when responding to a disaster crisis caused by infectious diseases.
Conclusions
This study identified the effectiveness of education applying video debriefing for nursing students and evaluating nursing students’ donning and doffing PPE performances. As a result of operating education application video debriefing, it was found that donning and doffing PPE performances were improved after video debriefing compared to performances after VBT and simple practical education. If the education developed in this study is used as a self-learning method to improve the infection control capacity necessary to respond to a disaster crisis caused by infectious diseases, it is considered to be useful for preventing the transmission of infectious diseases in the future. It would be effective to encourage self-study by applying the teaching method developed in this study during open lab practice during the nursing curriculum. There is a need to integrate the advantage of being able to reflect on one’s own performance of complex skills and receive immediate feedback using the mobile video function into existing teaching methods. This study found that self-evaluation score and observer evaluation score were not compatible. Therefore, it was found that self-evaluation can be exaggerated and has limitations in reliability. Thus, it is necessary to find a more objective way to perform performance evaluation in educational institutions or practical field.
This study has several limitations. By performing donning and doffing of PPE in a simulated environment rather than the real world, they knew they were being observed and this may have influenced their behavior (Hawthorne effect). Additionally, this study was conducted at one university, so the results cannot be generalized. Nevertheless, this study is meaningful in that it confirmed the effectiveness of video debriefing and discussed the results of self-assessment methods that are currently mostly implemented. Based on results of this study, education can be applied to various medical workers. Repeated studies on the learning effects are needed. In addition, follow-up research is needed to see if the education applying video debriefing is actually effective in preventing contamination by medical staff.
Acknowledgements
Not applicable.
Declarations
Ethics approval and consent to participate
This study was approved by the public Institutional Review Board designated by Ministry of Health and Welfare of Korea to protect ethical concerns of study subjects (P01-202303-01-026). The consent that was obtained from all of the participants was informed.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
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