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Published on: May 6, 2020
Comparison of time-segmented goal-directed teaching vs. traditional teaching for PICC among specialist nurse
Chang Xie1, Jie Zhang2, Ge Long3
1Health Management Medical Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
Introduction:
This randomized controlled trial compared the efficacy of Time-Segmented Goal-Directed Teaching (TSGDT) vs. Traditional Teaching (TT) in enhancing Peripherally Inserted Central Catheter (PICC) skills among specialist nurse trainees.
Methods:
A total of 104 specialist nurse trainees were randomized to TSGDT (n = 52) or TT (n = 52). TSGDT group segmented PICC operation into three temporally defined phases (pre-operative preparation, operational phase, and post procedure management & holistic care), each with explicit performance criteria and time-bound practice. TT delivered sequential didactic instruction of the entire procedure. Both groups received 4 hours of training. Primary outcome was Objective Structured Clinical Examination (OSCE) performance of PICC. Secondary outcomes included knowledge assessment, willingness, perceived confidence, and training satisfaction. Outcomes were measured immediately post-intervention and at 4-week follow-up.
Results:
Compared with the TT group, participants in the TSGDT group achieved significantly higher overall OSCE scores immediately after training (p < 0.0001). This advantage was evident across all key domains of pre-procedure preparation (p = 0.015), operational phase (p = 0.0017), and post procedure management/holistic care (p = 0.010). Additionally, participants in TSGDT group completed the OSCE scenario in significantly less time (p = 0.018). At the 4-week follow-up, the TSGDT group maintained significantly higher OSCE performance than the TT group (p < 0.0001). Notably, the magnitude of skill decay from immediate post-test to follow-up was significantly smaller in the TSGDT group (p < 0.0001), indicating enhanced skill retention and consolidation. However, no significant between-group difference was observed in theoretical knowledge test scores (p = 0.238). Regarding subjective outcomes, TSGDT participants reported significantly greater confidence in providing PICC care (p = 0.026), willingness to perform PICC under supervision (p = 0.030), perceived mastery (p = 0.038), and overall satisfaction with the training program (p = 0.027) compared to their TT counterparts.
Conclusion:
The Time-Segmented Goal-Directed Teaching method is a highly effective instructional strategy that significantly enhances PICC procedural competence, procedural confidence, and learning satisfaction among specialist nurse trainees, with superior skill retention at 4 weeks, which offering a superior alternative to traditional teaching for clinical skill acquisition.
