Effect of individualized learning plans on nurse learning outcomes and risk mitigation

A "Primary Learner Assessment" (PLA) was created to provide an individualized learning plan, offering education as part of a 4-step computer-based process. The PLA is intended to improve learner's knowledge, skills, and patient safety perceptions, regarding interpretation of electronic fetal monitoring (EFM) data and administration of appropriate interventions in a timely fashion to mitigate fetal and maternal risks. Research was conducted to determine if learner knowledge, skills, and patient safety perceptions improved after completion of a 4-step computer-based, individualized adaptive-learning process.

Participants were registered nurses (RNs) responsible for administering and interpreting EFM, from three U.S. hospitals with labor and delivery units. This mixed method pilot study was determined to be exempt by the institutional review board; all participants provided consent. The process included four steps. In step one, RNs completed the baseline PLA. Based on incorrect quantitative and EFM interpretation responses, computer-based EFM education courses were recommended (step two). After completion of recommended courses weeks or greater of practice (step three), the RNs completed a follow-up PLA (step four).

Of the 55 RN participants, most (85.5%) were clinical nurses, had a bachelor degree in nursing or higher (80.0%), and 11.2 average years of labor and delivery experience. There was a statistically significant improvement (P < .0001) in overall average percentage of correct PLA scores from baseline (76.7, SD = 9.1) to follow-up (82.5, SD = 6.9). Practice-related perceptions showed increased ranking of familiarity with the National Institute of Child Health and Human Development (NICHD) 2008 EFM terminology and guidelines from baseline of 49.0% to follow-up of 87.4% and of impact to which the participants integrated EFM administration and interpretation of NICHD EFM terminology and guidelines into practice from 52.8% at baseline to 94.5% at follow-up. In addition, RNs perceived improvement in their oxygen therapy competence and accuracy in interpreting EFM data with implementation of appropriate interventions.

These pilot study findings support a 4-step, computer-based individualized adaptive-learning process as RNs responsible for EFM to potentially mitigate fetal and maternal risk had improved knowledge and skills. Research is warranted in larger samples.