The Effect of Toolbox Trainings on Nursing Sensitive Quality Indicators: A Randomized Controlled Trial

Toolbox training or toolbox talks is short-term training to improve occupational health and safety practices in various sectors. These on-the-job trainings provide employees with opportunities to ask questions and share experiences, facilitating the enhancement of workplace safety practices. The aim of this study is to determine the impact of toolbox trainings provided to nurses on nursing-sensitive quality indicators (pain management, pressure ulcer, patient falls, peripheral venous catheter complications, and adverse event reporting) in the workplace.

Randomized controlled, pre-test, post-test, and control group design.

Before the toolbox training, pretest measurement instruments were used for the nurses in both the experimental and control groups, and the nursing-sensitive quality indicators were monitored by two independent observers. Toolbox training was provided to nurses in the intervention group on their shift in the respective units. Both groups were followed up at the 8th and 12th weeks after the training. Descriptive tests, independent sample t-tests for intergroup comparisons, and repeated and mixed ANOVA for intragroup comparisons were utilized in data analysis.

Significant differences were found between pre-test and post-test scores of the nurses in the group who received toolbox training in terms of falls, pressure ulcers, pain management, peripheral venous catheter, and adverse event reporting (p < 0.01). It was observed that the application scores significantly differed among all nurses who received toolbox training according to the findings of both observers, generally increasing in the second follow-up compared to the first, but decreasing in the third follow-up (p < 0.05). Evaluated according to unit quality indicators, it was determined that the number of patient falls (mean 4.04, 2.32, and 1.95 respectively), pressure ulcer occurrences (mean 4.48, 2.69, and 2.45 respectively), and the number of patients experiencing peripheral venous catheter complications decreased (mean 26.79, 16.46, and 15.42 respectively) in the units where nurses who received toolbox training worked. The average number of correctly managed pain patients (mean 37.82, 71.61, 69.07 respectively) and the number of reported adverse events (mean 2.79, 6.60, 6.42 respectively) were observed to increase in the second follow-up but decrease in the third follow-up.

As a result, it was determined that on-the-job trainings increased nurses' knowledge level regarding nursing-sensitive quality indicators, improved their practices, and enhanced unit quality indicators. According to the findings of this study, on-the-job trainings provided to nurses were found to be an effective method, and it is recommended to use them in addition to traditional training methods in nurses' in-service education.

There is a growing demand for shorter and different training methods in nurses' education. In addition to classical in-service training methods, this training method, which was applied for the first time in the field of nursing, contributed to the improvement of quality indicators sensitive to nursing. Our findings emphasize that it will be useful to use this training method in future studies on improving and developing nursing-sensitive quality indicators.

The study has been registered with ClinicalTrials.gov (NCT05853588).