gms | German Medical Science

The taking of blood samples is a daily routine in hospitals and in private practice. Complications are rare, but with the mass of procedures not insignificant. Nonetheless, the requirements for the proper procedure of a venipuncture are often not or only partially met. In Germany the taking of blood samples belongs to the physicians´ delegable procedures [Ref. 1] and can be carried out by other caring professionals after an instruction had taken place. The previous knowledge transfer of venipuncture shall be for the individual physician and is therefore not standardized and often happens insufficiently or not at all, while in Australia and the United States accredited courses have to be completed and certificates have to be acquired to carry out venipunctures.

This paper deals with the implementation of a web-based training (wbt) in venipuncture as standardizable knowledge transfer. For this purpose we performed an experimental study with nursing students and compared the self-produced wbt with existing wbts of the same topic.

For the experimental study we tested a class of nursing students regarding to their previous knowledge by a forced-choice test (test 1) with tasks on venous blood collection. Thereafter, the study participants were divided and spatialzed in group A and B by using randomization. Group B completed a conventional teacher-led lesson based on a script, while group A used the self-produced wbt at the same time. The contents of conventional teaching and wbt were identical. After completing the wbt, group A filled in a questionnaire concerning the usability of the wbt. Then both groups completed test 1 again, as well as another forced-choice test (test 2). Finally, all study participants took blood samples from a test patient (skills test) while they were subjected to a structured observation. The assessment was based on a checklist.

Initially the contents of the self-produced wbt were listed for the comparison of the wbts. We payed particular attention to the topics patient safety, self-protection, skin flora, disinfection, complications, materials, practical procedure, and preanalytics. In addition, the various deployed media which were used to impart knowledge were listed, such as text, test items, graphics, photos, animation, film, and sound. We also took into account if the wbt is freely available or if the access is restricted and/or charged. The list was supplemented by different forms of media and content of the established wbts to account for different learning and teaching concepts. Data for technical realization, e.g. in context of a learning management system (LMS), has been collected.

For organizational reasons there was a different class time for the two groups. Group B had 135 minutes, group A 95 minutes teaching time (30% less). In test 1 we measured an increase in correctly answered questions (Group A 44% before, 70% after lessons; Group B 38% before, 73% after the lessons). In test 2 (after lessons) group A correctly answered 95% and group B correctly answered 70% of the questions. All study participants in group A evaluated the wbt positively, even 78% with very good or good. After an initial analysis of the skills test, the participants in group A made 7 mistakes on average, in Group B 10 mistakes on average by taking the blood samples.

For the comparison of the self-created wbt with existing wbts after an extensive research we compared the identified wbts based on the extended list. The various wbts of venipuncture or phlebotomy do not only include content of venipuncture, but also for capillary blood collection or other techniques. The contents are limited on the practical implementation and use of materials basically. Continuative content like in our self-produced wbt is not or only sporadically contained. In direct comparison the established wbts use less media forms significantly. They are limited to text, photographs, videos and short exams, while the self-produced wbt uses media such as test items, graphics, animations, and sound tracks on a larger scale. Our wbt to venipuncture is free in the LMS after registration. The wbts from the USA and Australia are charged. The various courses are provided by a LMS, by Adobe Flash or simply by HTML-Code.

The study shows that knowledge gained by using the wbt qualifies the learners equally or better for solving tasks as conventional lessons with demonstrations by a teacher does. With 25% more correct performed tasks in final test 2, a greater increase in knowledge is measured for the wbt group. Another advantage for the wbt is 30% less teaching time compared to the conventional teaching. With the wbt in venipuncture a more efficient tool for knowledge transfer in the field of taking blood samples has been developed. Because even in teaching practical skills the wbt group shows advantage in competence, it can be assumed that the use of this wbt increases the quality of taking blood samples and disburdens the existing structures of necessary instructions.

Compared with the established wbts, the self-produced wbt is characterized by free access through a LMS. The LMS environment offers many advantages, such as user communication or use in various examinations [Ref. 2]. The content of the course includes the topic of venipuncture from the upper extremity. Because of the specificity of the wbt the collection of other samples, e.g. capillary blood, is not discussed. For this purpose important knowledge about the patient safety, self-protection, skin flora, disinfection, complications, dissolving difficult situations, and preanalytics are imparted, which are not equally mentioned in any of the other wbts. The self-review by test items is designed userspecific insofar as a wrong response requests to renewed study of the corresponding section. A similar use of test items was not available in all other wbts.