Burdett Trust for Nursing Final Report

Transcription

1 Burdett Trust for Nursing Final Report Health and Wellbeing for Nurses and Midwives Blake, H 1., Gartshore, E 2., Cooper, J 2. and Knowles, S 2. 1University of Nottingham, Nottingham. 2Nottingham University Hospitals NHS Trust, Nottingham. 1

2 Contents 1- Introduction- p Background- p Aim and Objectives- p Overview- p.4 2- Phase 1- Stakeholder Consultation- p Interviews and focus groups- p Events questionnaires- p Key Themes- p.6 3- Phase 2- Intervention Development- p Resource Aim- p Resource Objectives- p Content Design- p Peer review- p Challenges during development- p Phase 3- Evaluation- p Methodology- p Methods- pre and post- test research design- p Instrument- p Questionnaire development- p Sample- p Ethical considerations- p Data Analysis- p Demographic Characteristics- p Gender- p Age- p Occupation- p Length of time since qualifying- p Work setting- p Higher education students- p Pre and post questionnaire- p Distribution and normality- p Pre questionnaire analysis- p Post questionnaire analysis- p Evaluation- p Access to online tool- p Computer confidence- p Evaluation specific questions- p Perceived changes in health behavior- p Discussion and conclusion- p Stakeholder consultation- p Demographic characteristics of the pilot group- p Pre and post questionnaire analysis- p User evaluation- p Challenges of the study- p Development and software- p Pilot evaluation- p Conclusion- p Future work- p References- p Appendices Appendix 1- Peer Review sheet 1 Appendix 2- Peer Review sheet 2 2

3 Health and Wellbeing for Nurses and Midwives 1- Introduction This report will presents a 9- month project funded by The Burdett Trust for Nursing. The project took place between January 2015 and September The work was completed as a collaboration between the University of Nottingham and Nottingham University Hospitals (NUH) NHS Trust. The research was designed and guided by the principle investigator: Dr Holly Blake, Associate Professor of Behavioural Science & Chartered Health Psychologist, School of Health Sciences, University of Nottingham. Initial consultation, intervention development and evaluation were driven by Emily Gartshore, a staff nurse at NUH Trust. Blake provided direct supervision and mentoring to Gartshore, and as such the project built research capacity in a junior nurse researcher. Cooper and Knowles provided additional advice and support as required, regarding access to nurses and midwives, and review of study materials. This project provided Gartshore with experience of research, which contributed to her successful application for doctoral study starting in October This project focused on improving the health and wellbeing of NHS staff (nurses and midwives), which has been advocated in the media and in key government documents. New research is emerging which demonstrates that there is a link between nurse s health and wellbeing and the quality of care they feel they can provide to their patients. As such, there was an urgent need to develop initiatives that target nurses and midwives for support, and educate them on the link between their own health behaviours and lifestyle choices, and care quality. Since no such resources existed, this project aimed to develop, test and evaluate a resource that was developed in collaboration with frontline staff and key stakeholders. The final output of this study was a fully developed online resource, which has been used in practice settings. This resource is now publicly available and has been offered to NHS staff at NUH Trust as professional development training promoted by the trust employee health and wellbeing programme. It has also been used to advocate health and wellbeing in pre- registered nurses and midwives, and in healthcare educators Background Research has shown that the health behaviours exhibited by NHS staff can be less than exemplary; many are overweight or obese, many are not active enough to benefit their health, are smokers or have a poor diet (Blake et al, 2011; Blake et al, 2012; Blake et al, 2013). Nurses and midwives make up the largest occupational group within the NHS and similar patterns have been found both for nurses, and for student nurses, who are our next generation of health promoters (Malik, Blake and Batt, 2011). The NHS Health and Wellbeing Review (DH, 2009) flagged high levels of sickness absence in the NHS and associated lost working days, which if reduced by one- third would lead to an estimated annual direct cost saving to the NHS of 555 million. So aside from the implications for the health of individual nurses and midwives, the resource implications of a healthier NHS workforce are therefore indisputable. The Prime Minister s Commission on the Future of Nursing and Midwifery states that nurses and midwives should take responsibility for their own health and should acknowledge that they are public role models for healthy living (Blake, 2013; 2014; Blake and Harrison, 2013); a stance which is recognised and agreed with by nurses (Blake and Harrison, 2013; Blake and Patterson, 2015; Blake and Griffiths, in preparation). This is compounded by the potential implications for the quality of patient care, since our research has shown that nurses who are overweight or obese for 3

4 example, have reported feeling less willing, or even less able, to promote healthy diet and exercise in their patients (Blake and Patterson, 2015). Nottingham University Hospitals NHS Trust is a pioneer of workplace wellness, delivering a successful and sustainable programme accessible to over 13,000 NHS employees across three hospital sites and has demonstrated positive outcomes in evaluation (eg Blake et al, 2013). We have previously investigated barriers and determinants of healthy lifestyle practices in NHS nurses (eg Blake and Hallett, 2012; Mo, Blake et al, 2012). We have previously successfully delivered health promotion interventions using technology (eg Blake, Suggs et al, 2013), and have recently developed and tested an online multimedia intervention to promote workplace wellness for NHS staff following the same process as followed in this project (Gartshore and Blake, 2014). Previous research and consultation with local staff groups revealed a need to develop a resource that is specific to the needs of nursing and midwifery staff. As such, this project engaged with frontline staff through consultation with nursing and midwifery NHS workplace health champions, which helped us to ensure the tool developed was relevant and acceptable to the target audience (Blake and Chambers, 2012). We also involved student nurses and midwives since our previous work has shown that they exhibit a similar health profile (Blake et al, 2011) and attitude (Blake and Harrison, 2013) to registered staff and are our NHS health promoters of the future Aim and Objectives Aim To develop an online multimedia intervention to promote health and wellbeing in NHS nurses and midwives. Objectives To consult with nurses and midwives, NHS health champions and student nurses and midwives through interviews, focus groups and event questionnaires. To develop a storyboard of content using the key themes from the initial consultation and evidence. To develop a draft online health and wellbeing learning package for nurses and midwives. To evaluate and adapt the resulting online resource by peer review using independent experts in health and wellbeing and a user group. Once finalised, undertake a summative pilot evaluation of the tool using online before and after knowledge questionnaires and an assessment of usability and satisfaction Overview The project was split into three key phases, which will each be discussed in this report: Phase 1 - Stakeholder consultation. This involved interviews and focus groups with nurses, midwives and students. Questionnaires were also conducted at two conference events for nurses and midwives. Phase 2 - Development. This involved taking key themes from the initial consultation alongside best practice evidence and policy to develop an online resource to support health and wellbeing. Peer review by health and wellbeing experts and a user group took place to ensure accuracy, appropriateness and usability of the resource. Phase 3- Evaluation. Embedded pre and post questionnaires were used to evaluate the success of this resource. This included demographic information, a knowledge questionnaire and usability evaluation questions. 4

5 2- Phase 1- Stakeholder Consultation 2.1- Interviews and focus groups Stakeholder consultation was used to understand some of the key health and wellbeing issues nurses and midwives face while in the workplace. Nurses and midwives were recruited to broadly represent the demographics of the acute trust. As the trust does not provide specific learning disability or mental health services, nurses from this specialty were not recruited for the study. Recruitment for interviews and focus groups took place through direct invitation through correspondence in which the purpose of the study was outlined and a detailed information sheet was provided. This successfully recruited 20 participants who varied in age, specialty, pay band and length of service. At the start of each interview the study was again explained fully and information sheets were again made available, written consent was gained for all participants taking part in interviews or focus groups. Participants had the right to terminate the interviews at any time with their right to withdraw respected. Nurses, midwives, student nurses and student midwives were recruited to take part in Phase 1 of this study. Detailed consultation took place with 20 participants from the local trust, details of these can be seen in Table 1. Table 1. Participant Interviewee Interview or Focus Group Specialty 1 Nurse 1 Interview Adult Nursing- Practice Development 2 Nurse 2 Interview Child Nursing- Renal 5 3 Nurse 3 Interview Child Nursing- PICU 5 4 Nurse 4 Focus Group Child Nursing- PICU 5 5 Nurse 5 Focus Group Child Nursing- PICU 5 6 Nurse 6 Focus Group Child Nursing- PICU 5 7 Nurse 7 Focus Group Child Nursing- PICU 7 8 Nurse 8 Focus Group Child Nursing- PICU 7 9 Nurse 9 Interview Adult Nursing- Oncology 5 10 Nurse 10 Interview Adult Nursing- Surgical 5 11 Nurse 11 Interview Adult Nursing- Surgical 5 12 Nurse 12 Interview Adult Nursing- Surgical 5 13 Nurse 13 Interview Adult Nursing- Surgical 5 14 Midwife 1 Interview Midwifery- Labour Suite 5 15 Midwife 2 Interview Midwifery- Antenatal 6 16 Midwife 3 Interview Midwifery- Labour Suite 5 17 Student Nurse 1 18 Student Nurse 2 Interview Adult Nursing 1 Interview Adult Nursing 3 Band/ year of study 6 5

6 19 Student Nurse 3 20 Student Midwife 1 Interview Adult Nursing 3 Interview Midwifery 2 Consultation interviews ranged from minutes in length and were semi- structured following five key themes: The context of care Health behaviours Challenges to being healthy at work Health promotion How to make health and wellbeing at work easier By following these themes the interviews allowed participants to share their experiences, providing detailed information to inform the developed resource. Transcription of these qualitative interviews allowed for key themes to be drawn and analysed alongside key theories and workplace policy. These interviews have provided in depth evidence about the lived experiences of the participants, with detail of the challenges of achieving health and wellbeing at work for this occupational group Events questionnaires For further consultation with frontline staff an event stand was used to disseminate questionnaires at two trust events; The Shared Governance Conference and a Band 7 nursing and midwifery time out day. These events were used to gain a wide number of responses from key stakeholders, giving them an opportunity to share their views and comments about the project by answering three key questions: 1. How does your health and wellbeing affect your work and the care you provide? 2. What are the barriers to achieving health and wellbeing in your workplace? 3. What could be included in an online intervention to help nurses and midwives achieve health and wellbeing? This was conducted by asking them to write down their questionnaire responses and to pin these to a board. If respondents wanted to respond confidentially, or in more detail, questionnaire sheets were available to be posted into a response box. The Shared Governance Conference- In attendance there were 96 nurses and midwives from across a local NHS acute trust. Approx. 84 nurses, 12 midwives. This consisted of band 2-7 grade staff members. At this event 77 questionnaire responses were received in total. Band 7 time out day- In attendance there were 220 senior nurses and midwives from across a local NHS acute trust. This consisted of band 7 and 8 grade staff members in nursing/midwifery leadership/management positions. At this event 65 questionnaire responses were received in total. Key themes were also drawn from these 142 questionnaire responses. This information was used alongside the interviews and focus groups to tailor the content of the online resource. Ensuring that the tool developed was supporting this staff group with specific elements of health and wellbeing that they thought were important Key Themes The themes drawn from the interviews were: 1. All participants felt their health and wellbeing had an impact on quality of care. 2. Challenges with managing workload, working through breaks, expectations to stay behind after work, unable to maintain nutrition and hydration during shifts. 6

7 3. Challenges with managing shift work, hour shifts, night shift working. 4. Challenges for students to manage work- life balance. Theme 1: All interviewed felt health and wellbeing was essential for care they provided, with impact on compassion, role modeling, documentation and patient safety. These findings reinforced the need for a resource to support health and wellbeing for nurses and midwives. If you don t feel bright and well in yourself, you don t feel like you are giving good care, its hard to be caring and empathetic. (Nurse 2) If I am not being healthy then I am just being hypocritical when I promote health to my patients. (Nurse 5) I feel that is I am being a positive role model, being healthy and active, I am representing health care in the right way. (Student Nurse 1) I rush to get home, like I rush my writing and stuff, because I am so tired by the end of the day that I don t feel like I want to stay behind and do my best with paperwork. There is nothing you can do at that point, because you are just too tired. (Nurse 10) Nurses health is so important, cause you are giving dangerous drugs, in large quantities and you need to do this safely. You have got to concentrate, you cannot do that with your stomach grumbling and your legs crossed. (Band 7 N&M event) Theme 2: Challenges to achieving health and wellbeing were discussed. Key issues were that there is not enough time during shifts- no protected breaks and not leaving on time after shifts. Participants described that this makes it difficult to maintain their mental health, as well as physical health such as nutrition and hydration. Not enough hours to achieve everything, it s emotionally draining. (Nurse 3) It s challenging, working through breaks to get home on time, but not achieving that either. (N&M event) Sometimes on the ward, even just getting a drink is a god send actually. And sometimes you are holding your bladder for so long that it hurts. (Nurse 5) I genuinely cannot count the number of times that I have missed my breaks, because I am busy, I m running late, I ve got loads of writing to do. (Nurse 6) Theme 3: Participants described the challenges of maintaining health through shift working hours shifts, night shifts and managing the transition between nights and days. Night shifts especially. I think my, that change in my body clock really upsets my eating habits, my eating patterns. My ability to go to the gym if I wanted to. I think that to myself it would always lower my mood too. (Nurse 1) No consistency with rota patterns, only staff with children get set rotas or shifts. I find I am finishing nights on Saturday morning and being on a long day Sunday. There is no time to recover. (Band 7 N&M event) Its hard to be healthy with long working days, over 12 hours. You end up working much more hours than you are paid for, with no time for your life, let alone being healthy. (Shared Governance event) 7

8 Theme 4: Achieving work- life balance was a specific challenge that came through for the students interviewed, reporting that it was difficult to balance commitments of placement, university and home life. My biggest problem is getting a balance. As a student nurse I am neglecting my family. I go to placement, when I get home my kids are in bed, on my day off I go to the library to do my assignments. The list never ends cause I have to do part time work too, and all the jobs are still there Making lunch boxes, sorting dinner, cleaning. (Student nurse 2) Mentors don t understand it. When they go home after a long day, they can relax, I go home to 3 assignments, my portfolio and reflections. I find it hard to sleep, and the last thing I want to do is prepare lunch for the next long day. (Student midwife 1) I struggle to take care of myself. Keeping on top of assignments, lectures and placement is really hard. I feel tired and stressed, which makes it harder to concentrate and then I feel even more tired and stressed. It, well I think it has a big impact on my learning. I wish I had known how to manage my time better. Time management is the hardest part. (Student nurse 2) 3- Phase 2- Intervention Development Figure 1 In the development phase of this project, a 45- minute online health and wellbeing resource was created using University of Nottingham Xerte (2015). Development followed the Centre for Excellence in Teaching and Learning in Reusable Learning Objects (RLO- CETL) Agile Development Workflow (2009) (Figure 1). The process involved development of a storyboard containing the draft content, resources and details of interactive elements. This was followed by development of draft content into an online resource, with peer review at each stage. E- learning is an essential tool for meeting the mandatory and continual development needs of healthcare professionals (McVeigh, 2009). E- learning can deliver consistent content to a large number of people (Jefferies, 2001), and with similar outcomes to classroom teaching (Lahti, et al, 2014) it has additional benefits of enhanced flexibility, accessibility and independent working (Blake, 2010; Joint Information Systems Committee, 2004). However, the development of these tools requires a significant investment in both time and resources (Weller, 2004). The time required for developing e- learning tools is variable, influenced by the amount and depth of information, the activities included and the length of the e- learning programme. E- learning packages of this length (45-60 minutes) have previously been suggested to require between 30 and 200 hours of input (MacLeod, 2000). However, as the tool was developed by an inexperienced individual the development time was likely to increase to 500 or even 1000 hours (Horton, 2000). As such, the time required to design and develop the e- learning tool itself was a significant resource requirement in this project and thus required early development of the resource to ensure completion within the 9- month time frame. 8

9 In order to minimise the financial costs of this project, the content, design and development of the e- learning tool was undertaken by the researcher using a free University of Nottingham Xerte (2015) software. The resulting resource was 45 minutes in duration, including time for completion of the online before and after questionnaire. This was accessible via a University of Nottingham web link and was distributed to NHS nursing and midwifery staff, healthcare educators, and nursing/midwifery students ( Resource Aim To improve nurses and midwives understanding of their own health and wellbeing and how this impacts on the care they deliver Resource Objectives To improve nurses and midwives understanding of why their health is important. To provide information to help nurses and midwives maintain mental and physical health while at work. To enhance understanding of workplace policy and how to manage working shifts Content Design Content included information on the importance of health and wellbeing for nurses and midwives for their own health and implications for the NHS and their health promotion practices. The content of the online resource was then split into key sections to provide methods to support health and wellbeing for nurses and midwives; these were identified through the consultation stage of development. The tool presents methods to promote mental health including the five ways to wellbeing and mindfulness techniques. Physical health included physical activity and eating and drinking- specifically looking at techniques to help people eat healthily while working shifts. The resource finishes with looking at specific advice for working shifts and breaking down workforce policy around shift working. Presentation of materials included the use of images, videos, interactions, quizzes, scenarios and activities (Joint Information Systems Committee, 2004) since interactivity is known to enhance engagement of the user (Cheong Li, Wong and Cheung, 2015; Clark and Mayer, 2011; Horton, 2006; Cook, Levinson and Garside, 2008, 2010). Examples of the content and different types of interactivity used can be seen in Figure 2. During the development of the e- learning tool appropriate images, interactions and quizzes were chosen to enhance the educational value of the package. In order to test the quality of the e- learning tools interactivity, frequent checks of all technical aspects were undertaken by the authors. Moreover, the review by a user group and health and wellbeing experts were used to determine if the interactive and visual elements enhanced the e- learning content. The copyright of all images was respected and indicated in the image references in the e- learning tool. Permission from source was sought for a number of images supplied by the Nottingham University Hospital NHS Trust, however all other images used were under a Creative Commons License which allows the use of images without having to gain permission from the rights holder (Creative Commons, 2013). Figure 2 9

10 3.4- Peer review 10

11 Initial content was drafted by a nurse and a health psychologist and developed into a storyboard of content. Following the RLO- CETL development process, interim review was planned in the form of a peer review session with 7 participants including both nurses and midwives. However, by the date of the focus group only 1 participant was still able to attend. Due to time constraints for development, we decided to continue with the online development of our storyboard content, with a full peer review planned after full completion of the tool. Once the draft online tool was developed, full peer review of content and usability was undertaken with a user group and a group and health and wellbeing experts. Six health and wellbeing experts completed the tool providing detailed peer review feedback on the resource, commenting on the accuracy and appropriateness of design and content, as well as its usability and design (RLO- CETL, 2005). Feedback was given using University of Nottingham RLO Peer Review forms 1 and 2 (Appendix 3 and Appendix 3). A user group of 23 nurses and midwives completed the tool to provide further detailed feedback on content and presentation. Demographics of this group can be seen in Figure 3. This user feedback allowed for the online tool to be revised in accordance with the learning needs of the group and improve essential elements such as the use of activities and images, allowing users to attain a higher level of understanding (Horton, 2006). Final alterations were made to the tool based on peer review feedback; this included an increase in interactivity adding reflection, videos and changes to the images. Throughout the tool the amount to block text was reduced to make the resource more user friendly. Navigation was also improved through the addition of a contents page. Figure 3- User group demographics- 23 participants. Age Job Role under Nurse Midwife Student Nurse Student Midwife Other How long have you been qualivied Year of Study under 1 year 1-5 years 3 Year years years years 7 2 Year 2 Year 3 over 30 years 3.5- Challenges during development 11

12 One of the challenges to the development of the online tool development was the length of time required for the development phase. Gartshore and Blake had previously developed an e- learning programme, although Gartshore (the nurse researcher) had limited technical development experience and no prior experience of using the Xerte (2015) software. The researcher accessed online training available through videos and documents on the Xerte website to improve competence and efficiency during development. Time remained a major resource implication for this project, which was estimated to take a minimum of 200 hours, approximately half of the total research time for this project (MacLeod, 2000; Horton, 2000). As such, we made the decision to develop the full package online and then have content and usability peer reviewed by users and topic experts at the same time, to ensure that the project was completed on time. Another challenge during the development phase was the use of free University of Nottingham Xerte software. This software is specifically designed for inexperienced users to be able to make online learning resources, primarily for the use in higher education. A benefit of this was that there were many online tutorials and documents to explain how to use the software. However, the challenge of using this software was its ability to run only on specific browsers. During the peer review pilot, no users experienced problems with the way that the tool ran and accessed it using a variety of browsers (internet explorer, google chrome, firefox, safari) without any software issues. Once the final tool was complete, we found on testing that the tool was no longer supported by internet explorer, and would only run on alternative browsers. This was due to the use of additional features added following peer review, such as a contents page and videos. Due to time constraints of the project, the tool could not be redeveloped using an alternative software programme that could support the use of these features on internet explorer. As such, this acted as a barrier to access for some participants. Particularly as the main browser used by staff within Nottingham University Hospitals NHS Trust is Internet Explorer. 4- Phase 3- Evaluation During the evaluation stage an online pre and post questionnaire was used to assess participants knowledge before and after the intervention. This also included questions to capture demographic characteristics and evaluation questions to review the tools usability. A pilot evaluation of the resource was undertaken with 31 participants Methodology Previous papers that have implemented e- learning programmes have been criticised for using evaluations based on subjective user opinions, as these do not fully reflect educational outcomes (Bloomfield, 2008). As the health and wellbeing tool is an educational intervention, a quantitative research method was utilised to measure knowledge and provide numerical data to measure and analyse knowledge scores. Evaluation questions and open- ended questions were also used to capture users subjective opinions of the tool Methods- pre and post- test research design The pilot study used an experimental one- group pre and post- test method to examine changes in knowledge following exposure to the online health and wellbeing educational intervention. The pre and post- test method was chosen as it can be used to measure change in the dependant variable following introduction of an intervention (Nelson, 12

13 Drumville and Torgerson, 2010). However, pre and post- test designs do not identify the cause of change and only recognise that change has occurred (Nelson et al, 2010). Polit and Tatano- Beck (2008) identify that if pre and post- testing takes place immediately before and after the intervention it is plausible that the intervention is the cause of any identified changes. This provides the rationale for immediate before and after knowledge testing of participants carrying out the e- learning tool; to reduce the likelihood of temporal and testing effects having an influence on the results (Nelson et al, 2010). After consideration of different possible methods, a pre and post- test comparison design was used, assessing nurses and midwives knowledge of workplace health and wellbeing before and after the e- learning intervention Instrument Questionnaires are widely used in healthcare to measure satisfaction, care quality and for use in a significant amount of nursing and healthcare research (Jack and Clarke, 1998). In research, questionnaires are used to measure knowledge, attitudes and intentions (Gerrish and Lacey, 2006; 2010). Therefore questionnaires were an appropriate instrument for this study, which also allowed for online delivery alongside the online resource. To evaluate the e- learning tool an electronic pre and post- test multiple choice knowledge questionnaire and some post- test evaluation questions were embedded within the online e- learning tool. Evaluation questions were adapted by the researcher from the RLO- CETL (2005) evaluation toolkit, and related to whether participants found the tool engaging, useful and if they would recommend it to others. Open- ended questions were also used to enable users to comment on which elements of the tool they liked, and which elements could be improved. For example, the ease of use or interactivity. The research instrument used within this study was a specifically developed multiple choice questionnaire designed to assess knowledge before and after participants carried out the health and wellbeing for nurses and midwives e- learning tool Questionnaire development The questionnaire was developed using close- ended questions providing presubscribed response alternatives. This type of questionnaire facilitates analysis and allows for quantitative comparability of responses (Polit and Tatano- Beck, 2013). Multiple choice questionnaires are quick to complete, and by using online questionnaires this method is highly cost- effective and easy to disseminate to participants, which is of particular benefit to this project where funding and time constraints exist (Polit and Tatano- Beck, 2013; Hughes and Hayhoe, 2007). Fifteen knowledge questions were specifically selected where answers were provided in the e- learning tool, using concepts from the constructive alignment theory (Biggs, 1999). The e- learning tool aligned learning activities with the stated learning outcomes and the assessment questions were also selected to test the learning outcomes of the educational tool (Houghton, 2004). The post- questionnaire contained the same questions as the pre- questionnaire with the addition of evaluation questions. The post- questionnaire included 10 likert- type questions in order to determine the participants level of agreement with statements (Polit and Tatano- Beck, 2013). These were used alongside three open- ended questions to form the main evaluation of the e- learning tool (Polit and Tatano- Beck, 2008). 13

14 4.5- Sample For the pilot evaluation a sample of 31 participants were recruited to represent the target audience. This included nurses, midwives, student nurses and student midwives. More detail on the demographic characteristics of this group will be explored in the data analysis Ethical considerations In all research studies, participants have the right not to be physically or emotionally harmed, the right to full disclosure and privacy, anonymity and confidentiality (International Council of Nurses, 2012). For this reason, all empirical research using human subjects must obtain ethical approval from an appropriate governing body (Wood and Ross- Kerr, 2011). Due to this project being to develop an educational resource for local trust staff and students, ethical approval was not required. However, permission was sought and granted from the Nottingham University Trust Head of Nursing and Midwifery Research and from the Nursing and Midwifery Education leads at the University of Nottingham. Ethical implications considered included consent, right to withdraw, anonymity and data protection. 14

15 5- Data analysis The questionnaire was conducted using the Bristol Online Suvery, linked directly to the e- learning tool. Once development was complete, the online resource was made available to the pilot group. Questionnaires were marked and standardised scores were derived using the following equation: (number of correct scores/maximum score) x 100. The data was then reviewed for outliers and numerical values that were not in the coding system, before proceeding with analyses using Statistical Package for the Social Sciences (SPSS) version Descriptive statistics were used to display the participants demographic characteristics, and to analyse the evaluation questionnaire responses. The statistical significance of the relationship between the intervention and knowledge was explored using t- test. Significance was set at p<0.05 for all statistical comparisons Demographic characteristics The demographic questions were situated in the pre- questionnaire and were completed by all 31 of the pilot group participants Gender This data shows that participants within the evaluation study were predominantly female, making up 83.9% (n=26) of the sample population data (Table.2). The over- representation of females reflects the gender ratio of the population since nursing and midwifery are female dominated professions. The NMC (2008) indicated that 89.3% of registered nurses and midwives were female in 2008, reflecting this same gender imbalance. Table 2. What is your gender? Frequency Percent Valid Percent Male Female Figure 4. 15

16 Age Participants were predominantly aged years, with 67.8% of the sample population falling within this age category. The rest of the sample included participants aged (16.1%) and (16.1%) years. No participants were under 18 or over 55 which is broadly comparable with the target population of participants in higher education or employment (Table. 3). Table 3. What is your age? Frequency Percent Valid Percent Valid 18 to Figure to to to Total

17 Occupation The occupation of participants was predominantly nurses (32.3%) and student nurses (51.6%). Since nursing accounts for a larger proportion of acute services at the local trust and occupies more university spaces than midwifery, this imbalance was expected. Midwives (9.7%) and student midwives (6.5%) were still represented within this sample to reflect the views of the target audience for this e- learning tool. (Table 4.) Table 4. What is your current occupation? Frequency Percent Valid Percent Valid Nurse Figure 6. Midwife Student nurse Student midwife Total

18 Length of time since qualified For qualified nursing and midwifery staff (n=13) the length of time since qualified was measured. Table 5. shows the percentage of staff in each group, revealing diversity in length of service, which ranged from under 1 year qualified through to 21 to 30 years since qualified. Table 5. How long have you worked as a nurse or midwife? Frequency Percent Valid Percent Valid under 1 year Figure 7. 1 to 5 years to 10 years to 20 years to 30 years Total

19 Work setting The nursing and midwifery staff (n=13) were also asked what setting they currently work in. This reflected that the majority of staff worked in an Acute Setting (69.2%). This again reflected the target audience of the tool as NUH NHS Trust is a large acute teaching hospital (Table 6). Table 6. What setting do you currently work in? Frequency Percent Valid Percent Valid Acute Figure 8. Community Other Total

20 Higher education students Of the student nurses and midwives, two students were in part- time postgraduate education whilst working as a nurse, to make a total of n=20 students in the sample. All other 18 students were pre- registered nurses (undergraduates). The majority (95%) were studying at degree level, with one participant studying at maters level (Table 7.) Table 7. What course are you currently undertaking? Frequency Percent Valid Percent Valid Degree Masters Total The majority of students were in their second year of study (55%), with 20% in year 1 and 25% in year 3. Table 8. What year of study are you in? Frequency Percent Valid Percent Valid Year Figure 9. Year Year Total

21 5.2- Pre and post questionnaire All participants (n=31) fully completed the pre- questionnaire and post- questionnaire knowledge questions. Scores for both questionnaires were marked out of 15, for analysis the percentage response accuracy of the results was used Distribution and normality Before analysing the statistical data from the knowledge questions, the distribution of the data needed to first be considered. Descriptive statistics were used to determine if the data showed a normal distribution. The pre- questionnaire P- P Plot shows the normal pattern of knowledge scores, these scores have a normal distribution with the data closely following the Expected Cumulative Probability line (Figure 10.). The P- P Plot data indicates that the cases are unweighted for both the pre- questionnaire and post- questionnaire scores (Table 9.). Following the e- learning tool intervention, the post- questionnaire scores also indicate a normal distribution. However, this data shows more deviation from the Expected Cumulative Probability line than seen in the pre- questionnaire (Figure 10.). Table 9. Normal Distribution Estimated Distribution Parameters Total Score Accuracy Pre- questionnaire Total Score Accuracy Post- questionnaire Location Scale Figure

22 The normality of the data was further confirmed through the use of two normality tests. The post- test accuracy score demonstrates a low p- value for the post- questionnaire Total Score (Table. 10). From this data it can be assumed that there is a normal association between scores as both Kolmogorov- Smirnov and Shapiro- Wilk tests demonstrate significant values at the p<0.05 level. Therefore the null hypothesis can be rejected (at this 5% significance level) and we can conclude that there is a difference between the workplace wellness knowledge mean response accuracy between participants before and after the e- learning tool intervention. Table 10. Total Score Accuracy Time Statistic Tests of Normality Kolmogorov- Smirnov a n Sig. Shapiro- Wilk (p value) Statistic n Sig. (p value) Pre Post The skew of the data, presented in the descriptive statistics again reflects that there is a normal distribution of the pre- questionnaire data, showing skewness value of , which is close to the no skew value of 0 (Table 11.). The normal distribution of the scores before the intervention can be seen in the Frequency Percentage Histogram (Figure 11.), showing an even and normal distribution of the data. However, post- intervention the Total Score data shows a negative skew of higher test scores, with a skew of This can be seen in Figure 11. although the Total Score data has shifted the normal distribution curve is still present. Moreover the boxplot in Figure 12 further shows the change in accuracy distribution. Table 11. Total Score Accuracy Pre- questionnaire Total Score Accuracy Post- questionnaire Descriptive Statistics N Minimum Maximum Mean Std. Deviation Variance Skewness Statistic Statistic Statistic Statistic Statistic Statistic Statistic Std. Error

23 Figure 11. Pre and post total score accuracy distribution histograms. Figure 12. Boxplot of pre (pink) and post (blue) total score accuracy. The P- P Plots, normality tests and skewness data all show that there is a normal data distribution in the pre- questionnaire knowledge Total Score before the intervention. Post- intervention, the knowledge data shows a normal distribution curve that has a negative skew, as a result of a higher Total Score Accuracy mean of 80.4% (Table 11.) As the data revealed a normal distribution, the statistical significance of the relationship was explored using a one- way between- groups analysis of variance (ANOVA) test. The mean score was found to increase significantly (F=11.369) from the pre- questionnaire to the post- questionnaire Total Scores; with a probability of significance score of p=0.001 (p<0.05), it is unlikely that this difference is due to chance (Table 12.). 23

24 Table 12. ANOVA Total Score Accuracy Sum of Squares df Mean Square F Sig. Between Groups Within Groups Total Pre questionnaire analysis The mean response accuracy for the pre- questionnaire was 67.96%±15.05% accuracy (Table 11). The distribution of pre- questionnaire scores can be seen in Figure. 11, ranging from 33.3% accuracy (5/15) to 100% (15/15) Post questionnaire analysis There is a clear difference in the mean accuracy of score between all of the pre- questionnaire (n=31) and post- questionnaire (n=31) results; 67.96% mean accuracy in the pre- questionnaire to a statistically significant (as shown by Table 12. ANOVA) 80.44% mean accuracy in the post- questionnaire. The changes in score are also apparent in the frequency histograms, showing a negative skew towards higher knowledge scores in the post- questionnaire results (Figure 11.). Table 13. Paired Samples Statistics Mean N Std. Deviation Std. Error Mean Pair 1 Total Score Accuracy Pre- questionnaire Total Score Accuracy Post- questionnaire

25 Table 14. Paired Samples Test Paired Differences Mean Std. Deviatio n Std. Error Mean 95% Confidence Interval of the Difference Lower Upper t n Sig. (2- tailed ) Pai r 1 Total Score Accuracy Pre- questionnair e - Total Score Accuracy Post- questionnair e As the data was normally distributed, parametric testing was used to explore the effects of the intervention upon score. A paired samples t- test was used, this test looks at changes in mean scores in one group of participants making it an appropriate test to determine changes in knowledge before and after the e- learning tool intervention. The number of participant scores used in the t- test was n=31. The t- test showed a significant difference between knowledge scores: t(31)= , p < (Table 14). Due to the means of the before and after scores and the direction of the t- value, it can be concluded that there was a statistically significant improvement in Total Score following exposure to the workplace wellness e- learning tool from 67.96±15.05 to 80.44±14.08(p < ); an improvement of 12.48±12.74 (Table 13; Table 14). 25

26 5.3- Evaluation The post- questionnaire at the end of the e- learning package contained a series of evaluation questions to assess the usability of the e- learning tool Access to the online tool The majority of participants accessed the tool at home (64.5%). Smaller numbers also accessed the resource in university (6.5%) or whilst at work (16.1%). As previously discussed, a possible reason why only 5 participants accessed this resource from work is that the tool software would not work on internet explorer, the main browser used in the local trust. Figure Computer confidence The majority of participants self- rated their confidence in computers as high or very high (74.2%). This could indicate voluntary bias due to the self- selecting nature of the study (Burns and Grove, 2010), with people who have poor computer confidence not accessing the e- learning package. However, as no data was collected from those who did not access the e- learning tool, no comparison in computer competence can be made. Figure Evaluation specific questions The post- questionnaire had 10 specific evaluation question items, which all 31 participants completed. For all evaluation questions, the majority of participants responded that they either agreed or strongly agreed to each statement (Figure 15.) 26

27 Figure 15. Frequency histograms for 10 evaluation likert questions 27

28 28

29 Perceived changes in health behaviour As this study did not have scope to measure participants health behaviours, they were also asked how they felt this online course would help to influence their health behaviours in the future. 87.1% of participants felt they would use the information learned through the tool to help improve their health behaviours at work (Figure 16.) Figure

30 6- Discussion and Conclusion 6.1- Stakeholder consultation The use of a stakeholder consultation to inform the content of the online tool helped to ensure that the content was relevant to current health and wellbeing issues for nursing and midwifery staff at the local trust. This revealed four key themes : 1. All participants felt their health and wellbeing had an impact on quality of care. 2. Challenges with managing workload, working through breaks, expectations to stay behind after work, unable to maintain nutrition and hydration during shifts. 3. Challenges with managing shift work, hour shifts, night shift working. 4. Challenges for students to manage work- life balance. These were used to inform the content of the online tool Demographic characteristics of the pilot group Demographic information suggested that the sample was broadly representative of the total population of nurses and midwives. Participants reflected the gender ratio of the population, with females making up the majority of participants, as is commonly seen in these female dominated professions (NMC, 2008) Pre and post- questionnaire analysis Knowledge testing demonstrated that the tool was successful in enhancing nursing and midwifery staff and students knowledge of health and wellbeing for nurses and midwives. This was not only revealed in improvements in knowledge questionnaire accuracy, but also in the evaluation questions, with the majority of the sample agreeing or strongly agreeing that their knowledge and understanding in this area had improved. Although it was beyond the scope of this study to assess actual changes in health and lifestyle behaviours whilst at work, the majority of participants felt that the information provided in the tool would help them to make positive changes towards improving their health behaviours at work. The assessment questions were directly aligned with e- learning content and learning objectives (Biggs, 1999) to achieve a cohesive educational tool (Houghton, 2004). To ensure the appropriateness of these questions in assessing health and wellbeing knowledge, the panel of experts reviewed and adjusted the knowledge questionnaire (Polit and Tatano- Beck, 2013; Keeny et al, 2010). The use of developed closed questions is noted to yield similar conclusions to open- ended questions, whilst avoiding miscellaneous responses often seen in open- ended questions (McColl, Jacoby, Thomas, et al, 2001). Although this is a benefit of this instrument, it could be criticised that questions are often biased and infer correct responses to participants (McColl et al, 2001). Overall, significant measures were taken to ensure the accuracy and appropriateness of the instrument used in this study. It can therefore be assumed that the findings were an accurate interpretation of participant knowledge. The paired t- test showed a statistically significant improvement in the mean accuracy of score between the pre- questionnaire and post- questionnaire results, thus revealing the success of the e- learning package as an educational tool. From the statistical analysis, it can be concluded that the e- learning tool is a successful method for improving health and wellbeing knowledge amongst nurses and midwives. Poor health behaviours of NHS employees has been identified as a significant issue (Blake et al, 2012), which not only influences the health of NHS staff and contributes to high sickness absence rates (CIPD, 2009; DH, 2009), but also impacts on their ability to promote health to others and be role models for patients and the public (Blake and 30

31 Harrison, 2013; Blake, et al, 2011). A recent report by The Point of Care Foundation (2014) identified the need to improve staff health and wellbeing, showing that patient satisfaction is consistently higher in trusts with better rates of staff health and wellbeing. Moreover, the report linked higher staff satisfaction to lower rates of mortality and hospital- acquired infection. Consequently, this study responds to national calls for improving the health and wellbeing of nurses and midwives and responds to key recommendations that resources targeting multiple health behaviours should be implemented in the workplace for NHS staff (Blake et al, 2012) User evaluation Participants self- reported experiences of the e- learning tool reflected that they found it improved knowledge of workplace wellness, and was useful and engaging (Figure. 15). The majority of staff and students also reported that they enjoyed being able to learn on their own and would recommend the tool to others. Open- ended feedback reflected participants reasons for enjoying the e- learning tool. These included: the information/content provided, ability to engage with the tool, interactive quizzes throughout, and the use of engaging images and interactions. These responses also revealed that the content within the e- learning tool was concise and the tool was easy to use. However, it should be noted that the responses given in e- learning evaluations may have been influenced by the self- selecting nature of the sample, and thus possible bias from participants interest and enthusiasm for their workplace health (Burns and Grove, 2010; Deniz and Citak, 2010). Although individuals who have an interest in the subject are more likely to access and complete the e- learning tool (Denis and Citak, 2010; Gerrish and Lacey, 2006; 2010), other e- learning studies have found similar results, with participants valuing the engaging, interactive and flexible nature of e- learning (Keefe and Wharrad, 2012; Lymn et al, 2008 and Windle et al, 2010) Challenges of the study Development and software As discussed in section 3.5 there were two specific challenges during the development stage. Due to restrictions in development time, the content of the e- learning tool was peer reviewed alongside usability review of the developed online tool, rather than peer reviewing taking place at storyboard stage. Although this meant the study deviated marginally from the RLO CETL (2005) Agile development framework, this did not hinder the tool development as all processes were adhered to, with peer review occurring alongside expert review, within the tool development stage. Moreover, as discussed elements of the final online tool software are not compatible with Internet Explorer. This may be a barrier to people accessing this resource in areas where Internet Explorer is the primary browser. However, the tool is fully accessible using other browsers (e.g. Chrome, Safari) and handheld devices such as IPods and IPads which are becoming commonplace at the local hospital trust Pilot evaluation The evaluation of the online resource was a pilot study, with a sample of 31 participants from the target audience. Although this evaluation indicates the success of the online tool with regards usability, participant perceptions and knowledge improvement, this needs to be confirmed in a larger evaluation study. 31

32 6.6- Conclusion Development of the e- learning tool was a significant part of this project, requiring a substantial amount of time from the researcher, 6 experts, a peer review user group and a group of pilot participants. This process followed a recognised pathway to ensure appropriate and high quality content and design of the e- learning programme, with some amendments made to work within the 9- month timeframe for this project. Key themes from the stakeholder consultation were used alongside best practice evidence to inform the content of the tool. Following the detailed development process, the e- learning tool was made available online and a pilot evaluation study was completed. Analysis of evaluation data demonstrates that this e- learning tool improved knowledge about workplace health and wellbeing in nursing and midwifery staff and students. It was also widely accepted by participants as a useful resource that they would recommend to others. The output of this study is a fully developed and available online health and wellbeing resource for nurses and midwives, which is being actively promoted within NUH NHS Trust, and can be made available elsewhere in the NHS. Future plans will include wider dissemination of this resource and a larger- scale evaluation of its use, which will follow the same methodological structure as used in the pilot evaluation that this project presents Future work The health and wellbeing for nurses and midwives online package is to be disseminated across local hospitals with suggestion that it is utilised as continual professional development (CPD) and to provide health and wellbeing support to staff. We recommend that this resource is used in the following ways: to be offered as continual professional development (CPD) associated with NHS workplace health programmes and/or staff education and development programmes to be incorporated into return to work interviews for nurses and midwives after they have had sick leave. to support induction materials for newly qualified nurses and midwives. to be incorporated into undergraduate and postgraduate teaching in nursing and midwifery. 32

33 7- References Biggs, J. (1999). Teaching for Quality Learning at University. Buckingham: SRHE and Open University Press. BLAKE, H and PATTERSON, J, Paediatric nurses attitudes towards the promotion of healthy eating in children and their families British Journal of Nursing. 24(2), doi: /bjon BLAKE, H, Nurses recognise their own health can affect care quality Nursing Times. 110(38), 9 BLAKE, H, BENNETT, E and BATT, ME, Evaluation of occupational health checks for hospital employees International Journal of Workplace Health Management. (In Press.) BLAKE, H, Commissioned commentary: Should nurses be role models for health? Nursing Times. 8 January(Online Issue) BLAKE, H, SUGGS, L.S., AGUIRRE, L, TENNYSON, R, ZHOU, D and BATT, M.E., Technology- based intervention to promote physical activity in a UK healthcare workplace in June- Sept 2012 In: Eur J Public Health; 23 (suppl 1): ckt doi: /eurpub/ckt BLAKE, H, MO, P.K.H, LEE, S and BATT, M.E., Health in the NHS: Lifestyle behaviours of hospital employees Perspectives in Public Health. 132, BLAKE, H and HALLETT, S, Inactivity in the NHS workforce: barriers and determinants to physical activity among pre- registered nurses In: Proceedings of the UK Society for Behavioural Medicine, 8th Annual Scientific Meeting, Manchester December Blake, H. (2010). Computer- Based Learning Objects in Healthcare: The Student Experience. International Journal of Nursing Education Scholarship 7(1): Blake, H. and Chambers, D. (2011). Supporting nurse health champions: Developing a 'new generation' of health improvement facilitators. Health Education Journal 1-6. Blake, H. and Harrison, C, (2013). Health behaviours and attitudes towards being role models. British Journal of Nursing 22 (2): pp Blake, H., Malik, S., Mo, P. and Pisano, C. (2011). 'Do as say, but not as I do': are next generation nurses role models for health? Perspectives in Public Health 131(5): Blake, H., Mo, P., Lee, S. and Batt, M. (2012). Health in the NHS: Lifestyle behaviours of hospital employees. Perspectives in Public Health 132: Blake, H., Zhou, D. and Batt, M. (2013). Workplace wellness intervention in the NHS: Outcomes at five years Division of Sport & Exercise Psychology Annual Conference Proceedings. Available online at: Bloomfield, J. (2008). Using computer assisted learning for clinical skills education in nursing: integrative review. Journal of Advanced Nursing 63 (3): Boorman, S. (2009). NHS Health and Wellbeing Final Report November London: DH. Burns, N. and Grove, S. (2010). Understanding Nursing Research: Building an Evidence- Based Practice. London: Elsevier Health Sciences. Centre for Excellence in Teaching and Learning in Reusable Learning Objects (RLO- CETL) (2009) CETL Agile Development Workflow. Available online at: cetl.ac.uk/whatwedo/developmentframework.php (Accessed ). 33

34 Centre for Excellence in Teaching and Learning in Reusable Learning Objects (RLO- CETL) (2005) Evaluation Toolkit. Version 1. Available online at: cetl.ac.uk (Accessed ). Chartered Institute of Personnel and Development (CIPD) (2009). Absence Management Annual survey report Available online at: Cook, D., Levinson, A., Garside, S., (2008). Internet- based learning in the health professions. Journal of American Medical Association 30(10): Cook, D., Levinson, A., Garside, S., (2010). Instructional design variations in internet- based learning for health profession education: a systematic review and meta- analysis. Academic Medicine 85 (5): Chung, M., Melnyk, P., Blue, D., Renaud, D. and Breton, M. (2009). Worksite health promotion: the value of the Tune Up Your Heart program. Population Health Management 12(6): Clark, P. (2004). An Emergency Department Staff Tackles the Healthy Workplace Initiative A Staff Nurse Perspective. Topics in Emergency Medicine 26(4): Creative Commons (2013). About the licences. Available online at: Deniz, K. and Citak, G. (2010). The investigation of factors affecting university students attitudes towards participation in scientific research. Procedia Social and Behavioural Sciences 2: Department of Health (DH) (2009c). NHS Health and Well- being Final Report November Available online at: Gartshore, E and Blake, H. The development and evaluation of a computer based e- learning tool to enhance knowledge of workplace wellness in a healthcare setting (under review). Gerrish, K. and Lacey, A. (2006). The Research Process in Nursing (5th Ed) Oxford: Wiley- Blackwell. Gerrish, K. and Lacey, A. (2010). The Research Process in Nursing. (6th Ed). Oxford: Blackwell Publishing. Horton, W. (2000). Designing web- based training. New York: John Wiley & Sons Inc. Horton, W. (2006). E- learning by design. New York: John Wiley & Sons Inc. Houghton, W. (2004). Engineering Subject Centre Guide: Learning and Teaching Theory for Engineering Academics. Loughborough: HEA Engineering Subject Centre. Hughes, M. and Hayhoe, G. (2007). A Research Primer for Technical Communication: Methods, Exemplars, and Analyses. Abingdon: Routledge. International Council of Nurses (2012). The ICN Code of Ethics for Nurses. Geneva: International Council of Nurses. Jack, B. and Clarke, A. (1998). The purpose and use of questionnaires in research. Professional Nurse 14 (3): Jeffries, P. (2001). Computer versus lecture: a comparison of two methods of teaching oral medication administration in a nursing skills laboratory. Journal of Nursing Education 40: Joint information systems committee (2004). Effective Practice with e- Learning A good practice guide in designing for learning. London: Higher Education Funding Council for England. Keefe, G. and Wharrad, H. (2012). Using e- learning to enhance nursing students' pain 34

35 management education. Nurse Education Today 32(8): Keeny, S., Hasson, F. and McKenna H. (2010). The Delphi Technique in Nursing and Health Research. New York: John Wiley & Sons Inc. Lahti, M., Hatonen, H. and Valimaki, M. (2014). Impact of e- learning on nurses' and student nurses knowledge, skills, and satisfaction: A systematic review and meta- analysis. International journal of nursing studies 51(1): Lymn, J., Bath- Hextall, F. and Wharrad, H. (2008) Pharmacology education for nurse prescribing students - a lesson in reusable learning objects. BMC Nursing 7(2): MacLeod, D. (2000). Clever business. Guardian Education Tuesday, 28 November. MALIK, S, BLAKE, H and BATT, M., How Healthy Are Our Nurses? New and registered nurses compared. British Journal of Nursing. 20(8), McColl, E., Jacoby, A., Thomas, L. et al (2001). Design and use of questionnaires: a review of best practice applicable to surveys of health service staff and patients Health Technology Assessment 5(31). McVeigh H. (2009). Factors influencing the utilisation of e- learning in post- registration nursing students. Nurse Education Today 29(1): Mo, P., Blake, H. and Batt, M. (2011). Getting healthcare staff more active: The mediating role of self- efficacy. British Journal of Health Psychology 16(4): Nelson, E., Dumville, J. and Torgerson, D. (2010). Experimental research. In. Gerrish, K. and Lacey, A. (Editors) (2010) The Research Process in Nursing. 6th edition. Oxford: Blackwell Publishing. Nursing and Midwifery Council (NMC) (2008). Statistical Analysis of the Register 1 April 2007 to 31 March London: NMC. The Point of Care Foundation (2014). Staff Care: how to engage staff in the NHS and why it matters. London: The Point of Care Foundation. Polit, D. and Tatano- Beck, C. (2008). Nursing Research: Generating and Assessing Evidence for Nursing Practice. Philadelphia: Lippincott Williams and Wilkins. Polit, D. and Tatano- Beck, C. (2013). Essentials of Nursing Research: Appraising Evidence for Nursing Practice (7 th Ed). Philadelphia: Lippincott Williams and Wilkins. University of Nottingam Xerte (2015). Online Software: Weller, M. (2004). Learning objects and the e- learning cost dilemma. Open Learning 19: Windle, R., McCormick, D., Dandrea, J. and Wharrad, H. (2010). The characteristics of reusable learning objects that enhance learning: A case- study in health- science education. British Journal of Educational Technology 42(5): Wood, M. and Ross- Kerr, J. (2011). Basic Steps in Planning Nursing Research, from question to proposal (7 th Ed). Sudbury: Jones and Bartlett Publishing. 35

36 8.2- Appendix 1 Reusable Learning Object Peer Review (1) - Specification Reusable Learning Object to be reviewed: Title RLO ID RLO author: Phone Number Reviewer Date requested Date Review required Instructions Reviewers, please read through the specification sheet and any additional materials supplied, then complete the 10 questions contained within this form. Where ever possible, please contact the author to discuss your comments and suggest revisions.if necessary, continue on additional sheets and label these with the RLO ID number. Authors, on receiving the reviewers comments, please complete the Author s revision boxes on the form. You may wish to submit a revised specification and then cross reference the changes onto this form. Once the form is completed, please return it by the date shown to: Address 36

37 1) Is the learning objective clear and do all sections of the RLO support it? Is Revision Required? Yes No Author s revisions 2) Is the content factually correct? Date requested Date Review required Is Revision Required? Yes No Author s revisions 3) Is the text well written in short, clear, sentences? Date requested Date Review required Is Revision Required? Yes No Author s revisions 4) Does the glossary cover all the terms required for a general audience? Date requested Date Review required Is Revision Required? Yes No Author s revisions Date requested 37 Date Review required

38 5) Is the structure and sequence of information helpful? Is Revision Required? Yes No Author s revisions 6) Are the suggestions/examples for images/animations/video appropriate? Date requested Date Review required Is Revision Required? Yes No Author s revisions 7) Is sufficient interaction proposed to support active learning? Date requested Date Review required Is Revision Required? Yes No Author s revisions 8) Will the assessments measure attainment of the learning objective? Date requested Date Review required Is Revision Required? Yes No Author s revisions 38

39 9) are the keywords appropriate? Are others needed? Is Revision Required? Yes No Author s revisions 10) Are the suggested links OK? Are there others that you could suggest? Date requested Date Review required Is Revision Required? Yes No Author s revisions Have you discussed your review with the authors? Yes No Nature of the communication (eg face-to-face, etc) Date requested Date Review required Additional comments or continuations of above sections Please continue on additional sheets as required 39

40 8.3- Appendix 2 Reusable Learning Object Peer Review (2) - Media Reusable Learning Object to be reviewed: Title RLO ID URL RLO author: Phone Number RLO Developer: Phone Number Reviewer: Date requested Date Review required Reviewers instructions Please work through the RLO at the URL address above. Then complete the relevant sections of this form. You may wish to discuss the feedback with the author. Please indicate below whether this discussion has occurred. Once completed, please return it by the date shown to the person named below: Authors instructions Once you receive the form completed by the reviewer, please note any amendments that you wish to make in the Author s revisions boxes. You should discuss these with the RLO developer and/or mentor before proceeding. Please return the form to the person named below and arrange to discuss the suggested revisions with your developer. Address 40