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Following involvement by Jacqui Hall (Senior Lecturer at Northumbria University), who teaches manual handling, Gavin approached her and asked if the University would be interested in carrying out a small scale survey of students who could attempt this learning programme free of charge. In return he asked if the students could give him constant feedback as they were working through the programme in order to improve the quality of the programme and interactive experience.

Three Programme Leaders were approached from the Diploma in Higher Education Registered Nurse curriculum and a Guidance Tutor for a 1st year 2nd year and 3rd year group was identified to enlist some volunteers to attempt the programme of learning based on manual handling.

From a possible maximum of 25 students for each group attempt, there were 10 first years, 12 second years and 10 third year students who enrolled on the course.

The groups were given 4 weeks to complete the on-line course with support from the web-master offered throughout. The first group commenced in January 2009. They were a first year group with limited knowledge or experience of manual handling.

The second group commenced in February 2009 which was the third year students and the last group to carry out the programme were the second year students who commenced in April 2009.

Despite less than 50% up take from the students, those that completed the programme gave the results as seen on the charts below.

Programme contents.

The programme followed a series of topics commonly advocated for a manual handling course (National Back Exchange, 1997, Aitchison, 1999, Health and Safety Executive, 2004 and Smith, 2005).

Legislation, Anatomy and Physiology, Risk Assessment and Practical Skills are relevant areas of study. The students were able to attempt the module quiz over and over again until they passed the module. Only then were they able to progress to the next topic/module.

As an interactive package, there was scope to explore a variety of ways for students to obtain information from a number of resources, although if the student covered the course material thoroughly, there was more chance of them getting a pass in each module. Those who attempted to short-cut to the quiz before completing the course material were likely to spend more time attempting the quiz to find the right answer. Ultimately some students found they had to refer back to the course material in order to complete the quiz, thus spent even more time than they had intended.

Time spent completing the material.

The average time taken to complete the course material for the 1st years was 4 hours 6 minutes, (this is the average of the 8 people that completed the course and doesn't include the 2 that didn't complete). In comparison, the second and third year students took an average 2 hours 14 minutes and 2 hours 42 minutes respectively. What needs to be taken into consideration is that the programme was being continually updated to meet the student’s requests. Thus, when the students in the first group asked the web master to increase the speed in changing the page/window, this lessened the time spent by the second and third year students in covering the material.

Another factor which could explain the difference in time taken is when comparing the number of attempts at each section (especially the practical). It was apparent that the 3rd year students were more likely to attempt the final questions prior to going through the material. They would then need to “hunt down” the answers when they were responding incorrectly.

Legislation

It would appear that the legislation was covered fastest by the second year students with the first years requiring an average 2 attempts to complete. The third years required more time indicating a lack of knowledge that was surprising for this stage of their development.

Anatomy and Physiology

If the students followed the programme material there should have been little problem in completing this module. However, the second year students were showing a greater understanding and knowledge than the first or third years in this module.

Risk Assessment

This was a disappointing result for the third years as they should have been up to date on risk assessment due to the nature of the emphasis on management and risk assessment in the third year programme of the Dip HE/RN.

As many organisations move towards e-learning in a bid to not only save money, but also as a means of making the learning experience more interactive, the question was posed as to whether this would be an appropriate medium in a practical subject such as moving and handling. A trial was organised and brought to the attention of Northumbria University through the Owner of the Moving and Handling Instructors web site, Gavin Wright. Gavin has been keen to provide on-line instruction and approached a number of Back Care Advisers to trial his programme in back in December 2008. Since then the programme has become commercially available and continues to be developed.

The results indicated that the first and second year students took a comparable time to complete the module although as stated earlier, the first year students were at a slight disadvantage for timings due to the updating of the web based format.

The Practical Skills component.

The average number of attempts for the practical module remained high throughout all three groups. The second years’ results were skewed by two individuals where if they were removed from the equation, would give an average of 4.3 attempts which is comparable to the first year student group. As for the third year group, this result was rather worrying. It took the third years longer to find the correct answers to the quiz for the practical module yet they would have had more practical skills in patient handling than the other two student groups. These results suggest that the practical skills session with hands on practice is required to support the theory. There is also a problem here that needs to be addressed regarding the knowledge and skill base of the third year student in practical skills, if they are inferior to the second and first year student. Indeed it would appear the student gets worse instead of better at practical skills. Could this be something to do with the reduction in taught hours devoted to practical skills to students in their second and third years of education and training?

First year students 

Overall, the first year students did quite well despite the initial disadvantage of being the first group to attempt the programme. The timings did alter for the other two groups so it was difficult to compare a true like for like comparison between the three groups. However based on the number of attempts to complete the quiz and move on to the next module, the first years did very well indeed, particularly in the practical module. These students would have had a recent practical skills session with their lecturers only a few months before undertaking this web based programme.

Second year Students

Generally the second year students performed very well. The average number of attempts at each module for the 2nd years went down on all but the practical section. As mentioned previously, this increase was down to two individuals. If these two individuals were taken out of the equation the figure was 4.3 attempts which correspond to the average for the first years.

 

Third year students

All of the average figures went up for the third years. On closer inspection what was apparent was the third years (also the two 2nd years mentioned in point 3) were far more likely to attempt "short cuts" by attempting the quiz as a first priority, so that eventually, (on the 17th attempt for one person)the student would return to look at the course content in order to complete the quiz. This, though, as can be seen from the average times between the three different years, was a false economy. In terms of time management, it begs the question of whether student nurses by their third year apply more emphasis to getting something done quickly rather than to getting it done correctly. Do they learn to cut corners? If so, are they aware of the errors this can invoke? Risk management is about risk reduction and these third year students are giving us cause for concern.

Conclusions and Recommendations

From the results of these students taking part in this web based programme in patient handling and moving, there can be some conclusions to be made. Despite the trial being a simple survey of the results from three small groups of 1st, 2nd and 3rd year student nurses, it has given an impression of the level of knowledge and skill in manual handling and their approach to an e-learning tool.

The student’s comments allowed the Web master to alter the speed of the delivery of the course material (which needs to be considered when comparing the results between these groups). The number of attempts by the students to meet the pass mark for the quiz to move on to the next module, did give some significance on the ability of the learner and their behaviour towards completing the tasks set, for each of the modules.

The students were given 4 weeks to complete the programme which gave them an opportunity to update their knowledge and skill in patient handling and moving. Those that completed the course/programme received a certificate of completion, which has been used as evidence of further learning for the student’s Portfolio and Placement assessment document.

The web based course material is a useful update for students, there is some merit to its inclusion in a student’s programme of learning (Usoro, 2007). The academic level would need to be considered for inclusion to a Higher Education programme.

What has also been identified is the need for practical skills demonstration and practice, for the student to be more aware of the correct procedures in practical skills assessment and application of theory to practice (Hignett et al 2003, BackCare, 2005, and Smith, 2005).

Risk Assessment (Health and Safety Executive, 1999 and Royal College of Nursing, 2000) is vital in the workplace as well as in Nursing Studies and it is regrettable that this was the area where the third year students seemed to flounder. Perhaps more emphasis should be made on this subject area to reinforce the importance of such a subject.

Written by Jacqui Hall Northumbria University

& Gavin Wright

The course is available for £8 per person or can be licensed, giving significant savings, by educational institutions, NHS trusts and other health care organisations.

References:

Aitchison E (Ed.) (1999) Safer Handling in the Community.

BackCare:.Middlesex.

BackCare (2005) A Carer's Guide to safer moving and handling of patients 2nd

edition. BackCare:.Middlesex.

Health & Safety Executive (1999) The Management of Health and Safety at Work

Regulations, guidance on regulations HSE: Sudbury

Health & Safety Executive (2004) Manual Handling Operations Regulations, Guidance on Manual Handling Regulations,L23. HSE: Sudbury.

Hignett S, Crumpton E, Ruszala S, Alexander P, Fray M Fletcher B. (2003) Evidence-Based Patient Handling. Tasks, equipment and interventions. London: Routledge.  

National Back Exchange (1997) The Inter-professional Curriculum Framework.NBE: Towcester.

Royal College of Nursing (2000) Manual Handling Assessments in Hospital and

The Community. Royal College of Nursing: London.

Smith, J.(Ed.) (2005) The Guide to The Handling of People. 5th Ed. BackCare

In collaboration with the Royal College of Nursing and the National Back Exchange:

Middlesex.

Usoro, A and Abid,A (2007) Delivering quality higher education through e-learning: A conceptual view. Higher education in the twenty-first century.pp163-176