Effectiveness of ELMO

The evaluation of the ELMO used by the nurses of various designations to develop clinical skills and knowledge at The Hospital indicated that effectiveness was measured in terms of developing new clinical skills and knowledge. The different

response patterns among the different nursing levels answered the first research question. The responses are listed below:

• NUMs—engaging way to develop clinical skills

• SDNs—helping, effective and engaging way to develop clinical skills • RNs—enjoyable way to develop clinical knowledge

• ENs—engaging way to develop clinical skills and enjoyable way to develop clinical knowledge.

The above responses suggested that both NUMs and SDNs found ELMO to be less effective with respect to clinical skills. This could be related to the role of NUMs and SDNs. NUMs and SDNs focus on developing clinical skills and knowledge for their staff. Therefore, NUMs and SDNs may have had higher expectations of ELMO for developing clinical skills, and subsequent greater disappointment. RNs could have found ELMO to be less effective in developing clinical knowledge in an enjoyable manner. However, for RNs, developing knowledge was adequately possible with ELMO. For ENs, ELMO was less effective in terms of engagement for developing clinical skills and enjoyment in developing clinical knowledge.

Blended learning might be a useful implementation strategy at The Hospital to improve the engagement and effectiveness of ELMO. This could be provided by the flexible approach offered by blended learning in presenting content. Complex topics can be presented in an environment in which a facilitator, such as SDNs, teach content and have discussions to ensure that nurses understand the topic. By using a variety of mediums and techniques in teaching, blended learning can cover all adult learning styles and improve the effectiveness of ELMO. An example of content in ELMO where blended learning could be applied is the Aseptic Technique Program. Currently, ELMO provides theoretical knowledge on aseptic technique, followed by an online assessment in applying aseptic technique. Aseptic technique is a complex topic because it aims to prevent pathogenic organisms (in sufficient quantity to cause infection) being introduced to susceptible sites by hands, surfaces and equipment (National Health and Medical Research Council, 2010). Its focus is on protecting patients during invasive clinical procedures by employing infection control measures that minimise, as far as practicably possible, the presence of pathogenic microorganisms. To ensure nurses understand how to apply aseptic technique, a face-

to-face demonstration of the skill by an SDN would be beneficial to grasp the principles of the technique. As an organisation, a topic that can reduce the risk of healthcare-associated infections should include a face-to-face practical assessment of nurses demonstrating aseptic technique to ensure that they have understood the principles of the technique and are able to perform procedures by applying these principles. This will ensure patient protection and reduce the risk of infection.

6.3.1 Barriers

The barriers that inhibit nurses’ engagement with ELMO at The Hospital include lack of time, lack of management support, lack of technological support and limited access to computers. This has also been acknowledged by other studies (Atack & Rankin, 2002; Bindon, 2017; Kivuti & Chepchirchir, 2011; Moule et al., 2010; Pullen, 2006; Riley & Schmidt). However, these barriers were also found to be significantly different for nurses of various designations at The Hospital. SDNs indicated the highest barriers, followed by NUMs, RNs and ENs. This answered the second research question. A possible explanation for this is the different roles of staff and their expectations in learning and development. SDNs’ rating of the highest barrier may be related to their role as educators. SDNs are required to ensure that their staff are competent and prepared to deliver care in a highly regulated environment. Thus, SDNs routinely support and maintain professional development for nurses in the workplace. Therefore, the SDNs may have had higher expectations of ELMO and subsequently greater disappointment. To implement e-learning in healthcare, it may be useful to involve SDNs in the strategic planning stages of implementing the e-learning training package. SDNs could ensure that the implementation process of the e-learning training package is effective and meets the educational needs of nurses. Meeting nurses’ educational needs would promote a more efficient and productive nursing workforce.

6.3.2 Enabling Factors

Evident throughout the analysis and findings of this study was the vast need for nurses to have a flexible mechanism to continue their professional development. ELMO has flexible characteristics because it is available 24/7. This characteristic enabled nurses to access ELMO, even with the barriers identified above. A second enabling factor was training and education in the use of e-learning, which was provided to nurses at

The Hospital. This helped the nurses log in, navigate ELMO and attend to hospital requirements in terms of assessment components. Ongoing support for training and education in the use of e-learning is necessary, particularly because e-learning is widely used by corporate environments for learning and development of their staff. The final enabling factor was the age of nurses. The typical profile of the e-learning