Caring for people with severe brain injuries: improving health care professional communication and practice through online learning

Introduction: Severe brain injuries can leave people in prolonged disorder of consciousness resulting in multifaceted medical, nursing, and rehabilitative needs that can be challenging for even the most experienced multidisciplinary team. The complexities of care, communication with families, and best interest decision-making about medical interventions means there is a need for ongoing training in clinical, social, ethical, and legal aspects. Methods: Using a combination of group discussions, interviews, and questionnaires with learners, this article reports an evaluation of designing and delivering an interprofessional, online work-based course to health care professionals caring for prolonged disorder of consciousness patients. Results: There were challenges for staff uptake because of COVID-19, but engaging with it increased knowledge in defining and diagnosing patients' conditions, understanding multidisciplinary team roles, communicating with families, and navigating legal and ethical issues. Course participation also enhanced critical and reflective thinking skills, provided a sense of connection to other professionals, and generated plans to improve service provision. Discussion: Online learning that enables health care professionals to engage at their own pace and also come together as an interprofessional community can provide invaluable continuing professional development and help to enhance joined up, holistic patient care. However, achieving this requires significant investment in creating research-led, multimedia, learning materials, and courses that include synchronous and asynchronous delivery to combine flexible study with the opportunity for peer networks to form. It also depends on a commitment from organizations to support staff online continuing professional development. In response to the COVID-19 pandemic, most forms of continuing professional development (CPD) for health care professionals (HCPs) had to move rapidly online. Since then, National Health Service (NHS) and health education strategies1 have prompted further strategic thinking about how to move beyond emergency online delivery to a more sustainable and positive engagement with the potential of online CPD. This article evaluates a multimedia online course designed to develop HCPs' skills in caring for patients with prolonged disorders of consciousness (PDoC). Prolonged disorders of consciousness is an umbrella term for three conditions—coma, vegetative, and minimally conscious states. These conditions, caused by severe brain injury, are associated with profound motor, cognitive, sensory, and functional deficits that require full and continuous care.2 The complexity of such patients' needs is complicated further by social, ethical, and legal contexts. Our own research has highlighted urgent training requirements for HCPs including clarification around diagnosis, improving communication with families, and enhancing decision-making about life-sustaining interventions.3–7 In a bid to address these learning needs, we (members of the Coma and Disorders of Consciousness Research Centre) had already delivered in-person talks and training days to over 5000 practicing HCPs since our formation as a research center in 2010 (see list at: www.cdoc.org.uk). In 2018, we started to develop an online learning course designed to be delivered over a ten-week period for interprofessional CPD in workplace settings, combining online interactive self-study modules with “real-time” virtual seminars and tweet chats. The course consists of three learning sets, each involving two or three modules (Table 1); each set involves between four and 8 hours of independent study, depending on the learner's knowledge base and the depth to which they wish to explore each area

Technology supported patient’s narratives to enhance healthcare student’s learning.

Narratives of illness experience have been used to enhance Healthcare professional’s learning at Cardiff University. This is primarily to enable students to consider the illness experience and psychosocial aspects of person centred healthcare. These learning opportunities were designed to broaden the students understanding of the psychosocial issues and psychological impact of a range of neurological, respiratory and musculoskeletal long term conditions. A variety of ways were utilised to engage patients in telling their stories, both in person and video and audio recording and online technology. Expert patients were invited in to talk about their experiences, be interviewed in small groups. These stories were made available to view the Universities online portal, via the University’s Panopto recording system. These were created with the support of a learning technologist who ensured the material was accessible to the student’s mobile devices. The perspectives the contributors gave changed the student’s perceptions about illness experiences. Formal feedback was obtained by a short questionnaire with open questions and the University Quality Assurance online system. 82% of students strongly agreed that the content and delivery of the session had met their expectations. Many comments were asking for more time to be given to this type of learning experience. The value of hearing about patient’s experiences is good preparation before students have to take the responsibility for decision making of treatments. These additional learning opportunities enhance the student’s portfolio of learning to promote person centred care