The Distance Teaching Practice of Combined Mode of Massive Open Online Course Micro-Video for Interns in Emergency Department During the COVID-19 Epidemic Period

Introduction

At the end of 2019, COVID-19 broke out in Wuhan, Hubei Province, and it rapidly spread both nationally and internationally. The population was generally susceptible to the disease because of its fast spread and wide range. The World Health Organization (WHO) lists the epidemic as a public health emergency of international concern.^1–5 The disease has been listed as a Class B infectious disease stipulated in the Law of the People’s Republic of China on the Prevention and Treatment of Infectious Diseases, and it is managed according to Class A infectious diseases.⁶ The emergency department (ED) serves as an important line of defense for the prevention and control of this epidemic; thus, medical staff not only have more comprehensive professional, theoretical, and practical skills but also should master the basic requirements of infection prevention and control during each period of the epidemic. These abilities directly affect the quality of life and prognosis of patients. Interns are prevented from experiencing cross-infection because of their contact with doctors and patients due to an unfamiliar environment, unskilled processes, weak protection awareness, and other reasons; simultaneously, they can also complete the teaching practice tasks of the ED according to the stipulated requirements. The combined mode of Massive Open Online Course (MOOC) micro-video was applied to the online training of emergency nursing interns during the COVID-19 epidemic period, and this achieved good results.

Materials and Methods

General Data

Sixty (n) emergency nursing interns from a hospital were enrolled in this study. According to the time sequence and the principle of random control, the interns during the non-epidemic period from January 6 to January 19, 2020 were selected as the control group (group 1). The interns during the epidemic period from February 10 to 23, 2020 were included in the experimental group (group 2). There were 29 females and 1 male in group 2 who were 20–24 years old, and the average age was 22.06 ± 0.56. There were 28 females and 1 male in group 1 who were 20–24 years old, and the average age was 22.10 ± 0.63. Both groups comprised undergraduate students.

Intervention Methods of Group 2

Setting up a micro-video practice skills group

The members of the micro-video practical skills group mainly include one nursing teaching supervisor (obtaining professional teacher qualification certificate, engaged in clinical nursing work for more than 10 years) and one clinical nursing expert (engaged in clinical nursing work for more than 20 years). There were four members of the nursing skills group and one photographer. The nursing teaching supervisor had rich experience in classroom and clinical teaching, acted as the leader of this study, carried out overall control for the ideas related to research design and research direction, and was responsible for the distribution and collection of follow-up questionnaires. Clinical nursing experts guided and modified the content of the micro-video. The nursing skill group of the ED (those who take part in the excellent training of this specialty every year) included four people, and task division and recording were carried out according to the content of the emergency science and technology training. The photographer was responsible for the recording and editing of the micro-video.

Determination of the teaching content of micro-video

The content was based on the syllabus of The Fourth Edition of Emergency and Critically Ill Nursing, and the operation of specialized nursing skills involved in the ED was summarized in the training content, with a total of 10 class hours (Table 1).

Shooting micro-video

Micro-video teaching is a new mode of a new generation of information education, which takes micro-video as an information medium to produce a unique visual impact. The shooting content of micro-video is divided into four parts.

1.	Operation demonstration: A complete and coherent demonstration was carried out according to the class hours and sequence under the guidance of teaching content of micro-video. The presenters were all members of the emergency nursing skills group, and patients with strong performance and communication skills were also selected from the emergency nursing skills group.
2.	Step-by-step analysis: Each item was sorted out and demonstrated step by step according to the nursing operation scoring standard, and every detail in the operation was grasped.
3.	Content expansion: The operation flow demonstration was integrated and promoted with the core knowledge points in the theoretical part of the textbook Emergency and Critically Ill Nursing; on the basis of the descending ladder thinking mode of the ED combined with standard prevention, according to the specific operation content, the possible exposure risk of emergency and the protection level of transmission route were added to the teaching content of micro-video (such as cardiopulmonary resuscitation (CPR) technology and artificial airway patency and other operations that may produce aerosols). We should take three levels of protective measures for respiratory tract isolation.7.During gastric lavage technology, sample collection and hemostasis, bandaging, and fixation, interns may come into contact with blood and secretions; thus, they should take blood body fluid isolation more than secondary protective measures. During defibrillator and electrocardiogram monitoring, interns may be exposed to high-risk intensity and they should take more than secondary protective measures.
4.	Expert summary: For the interns who have not come into contact with the ED, some operations and knowledge are difficult, and their essence cannot be understood by the imagination alone. In such cases, it is necessary for the emergency clinical nursing experts to analyze and guide each step, so that the interns can understand the significance of each step and to prevent blind memory among the interns.

Establishment and implementation of teaching platform

The ED network training platform was established, and micro-video was published in the form of frequent webcasts. A group of interns was established in the ED, group notification was used to convey the information to everyone, and it was ensured that every intern participated in this training on time as far as possible. After watching, an interactive feedback link was used to share one’s experience of this micro-video, and also to check and fill the gaps in the problems that may arise in the actual operation. After the live broadcast of micro-video, one could watch the content of micro-video repeatedly according to one’s own learning situation, and this would enable one to both review the past and learn the new. In addition to operating the micro-video network course every week, there was MOOC teaching and learning about the textbook Emergency and Critically Ill Nursing, and there was also a fixed time every week for everyone to answer questions about the content of the textbook.

Intervention Methods in Group 1

Group 1 was modeled on the textbook Emergency and Critically Ill Nursing, and the teaching methods were carried out in two parts: traditional theoretical face-to-face teaching and clinical practice.

1.

Theoretical part. The training time is 1 week, and the theoretical knowledge is divided into five parts, namely, pre-hospital first aid and disaster nursing, cardiac arrest and cardiopulmonary–cerebral resuscitation, trauma, environmental injury, common first aid techniques, and other theoretical courses.

2.

Practice part: The training time is 1 week, and training is undertaken by clinical teachers, all of whom are qualified teachers with certain clinical experience. If in doubt, one can consult the theoretical training notes or consult the instructor. After the training, the practical examination is conducted. Under the teaching supervision of the ED, we established a group of interns in the ED in 2020 to communicate and learn from each other, and arranged a fixed time for feedback, focusing on discussion and answering questions.

Evaluation Method

Examination of theoretical knowledge

The assessment of theoretical knowledge adopts the method of the online questionnaire star examination, which mainly involves theoretical knowledge such as pre-hospital first aid and disaster nursing, cardiac arrest and cardiopulmonary–cerebral resuscitation, trauma, environmental injury, common first-aid techniques, etc., including 25 single-choice questions (1 point per question), 5 multiple-choice questions (1 point per question), 20 blank questions (0.5 points per question), and 2 question-and-answer questions (10 points per question), with a full score of 60 points. The examination time is set at 60 min, and there will be a unified marking by the computer after submission.

Simulation examination of practice dialogue

The nursing department of our hospital was based on the scoring standard of various nursing operation techniques, and the scoring standard of oral simulation of practice dialogue was designed by the micro-video practice skill group. The assessment methods are as follows:

1.

The content of each person’s assessment was determined by random drawing in the form of situational cases.

2.

The examiners and the examinees adopted the one-to-one video call mode, and the overall evaluation was carried out according to the four dimensions of pre-operation preparation, operation steps, matters needing attention, and comprehensive evaluation. Four dimensions and eight items were designed according to the four major parts of the operational assessment, and a 5-point scoring system was adopted. The higher the score, the better the mastery, with a full score of 40. Finally, the results of theory and practice are summarized as the total score.

Teaching satisfaction

The satisfaction questionnaire was designed by those who conducted the study, and an anonymous questionnaire survey was conducted with online questionnaire stars to survey the satisfaction of 60 interns who participated in this training. The questionnaire consists of five items, using a 4-point scale, from 1 to 4 points indicating “very dissatisfied” to “very satisfied.” The higher the score, the higher the satisfaction. The questionnaire was uniformly distributed by the teaching supervisor of the ED. A total of 60 questionnaires were sent out, and 60 were actually recovered, with a recovery rate of 100%. The questionnaire has been reviewed by experts and has good reliability and validity. The Cronbach’s α coefficient was 0.83.

Statistical methods

Statistical software SPSS 23.0 was used for data processing and analysis; the measurement data were expressed as (x ± s); and the counting data were described by percentage, and compared with t test and χ² test. p < 0.05 means that the difference was statistically significant.

Results

Comparison of Theoretical and Practical Examination Results Between the Two Groups of Interns

The theory, practice, and total scores of the two groups of interns were compared: The total scores of theoretical assessment and practical assessment were 60 and 40, respectively, with 100 points in total. For the theory and practice of group 2, there was no significant difference between the two groups in terms of theory and practice (t = 0.463, p = 0.654; t = 0.237, p = 0.813; t = 1.357, p = 0.180) (Table 2).

Comparison of teaching satisfaction between the two groups of interns

Compared with the control group, the interns’ teaching satisfaction of group 2 was higher than that of group 1: There was overall satisfaction, the form was easy to understand, the teachers’ evaluation and harvest were higher than those of group 1, and there was significant difference between the two groups (t = 2.408, p = 0.020, t = 2.121, p = 0.039; t = 2.633, p = 0.012; t = 2.249, p = 0.029). There was no significant difference in content rationality between the two groups (Table 3).

Discussion

Combined mode of MOOC micro-video is a kind of utilization of modern network tools to present theoretical and practical courses in a unique way, and it is a better alternative when face-to-face and practical courses can no longer be carried out. On the one hand, taking the more common clinical cases as the starting point, the situation of each practical operation should be perceived, to obtain the real clinical experience, so as to enhance the subjective initiative and interest in learning.⁸ After the live broadcast of the training video, it can be watched repeatedly according to different degrees of absorption, prompting interns to transform passive education into active learning, which greatly improves the training effect.⁹ In the study of Yu et al.,^10,11 the six-step loving communication method micro-video was applied to the communication ability training of new nurses, which enabled nurses to inculcate a strong interest in learning and achieve good training results. In this study, interns have a high overall satisfaction with the use of micro-video teaching (t = 2.408, p = 0.020), and they express their recognition of the training mode. On the other hand, the research group uses micro-video to show practical skills, which involves four stages: (1) demonstration, (2) analysis, (3) expansion, and (4) summary. Based on case orientation, the standard prevention and protection level strategies involved in nursing operation during the COVID-19 epidemic period were demonstrated by way of real-scene interpretation; the cases were analyzed and studied in depth, and they were presented in a simulated perceptual world. This technique can better combine theory with practice.^12,13 In this study, there is no significant difference between the two groups of interns in terms of theory and practice, indicating that the new mode can produce the same effect as the traditional mode.

Conclusion

Wuhan, Hubei Province is the area that was affected by the COVID-19 outbreak this year. To prevent the spread of the virus and cross-infection of disease and to protect the personal safety of interns, the combined mode of MOOC micro-video was applied to interns’ theoretical and practical skills training. At the same time, COVID-19-related prevention and control knowledge was transferred to interns, and a good training effect was achieved. Micro-video teaching not only helps to alleviate the lack of clinical nursing teaching resources, practice venues, and other deficiencies but can also improve the initiative of students to learn independently. Therefore, in the future intern training in the ED, the micro-video teaching mode will be integrated into the traditional teaching mode to stimulate interns’ interest in learning and win the recognition and approval of interns, which is worthy of clinical application and promotion.^14,15 Due to the small sample size of this study, whether this kind of micro-video teaching can be further promoted after its inception remains to be further practiced and discussed.

Disclosure Statement

No competing financial interests exist.

Funding Information

No funding was received for this article.