Findings of a training needs analysis for qualified nurse practitioners

Construction of Training Program for Specialized Nurses in the Central Sterile Supply Department (CSSD) Based on Post Competency

Objective

The aim of this study is to analyze the construction of a training program for specialized nurses in disinfection supply center (CSSD) based on post competency.

Methods

Based on the theory of post competency, literature analysis, investigation, and expert consultation are used to establish training contents and methods.

Results

Two rounds of expert consultation were conducted in this study. In the first round of expert consultation, 22 questionnaires were sent out and 21 valid questionnaires were received with an effective recovery of 95.45%. Seven experts (31.82%) proposed 53 suggestions for modification. A total of 21 questionnaires were sent out in the second round of expert consultation and 21 were effectively received with an effective recovery rate of 100.00%. In the first round of expert consultation, the mean importance score of 63 third-level indicators was 4.00-5.00 points, the standard deviation was 0.00-1.00, and the full score rate was 46.54%-100.00%. In the second round of expert consultation, the mean importance score of 67 third-level indicators was 4.05∼5.00 points, the standard deviation was 0.00-0.88, and the full score rate was 20.00%∼100.00%. In the first round of expert consultation, the Kendall coordination coefficient was 0.187. In the second round of expert consultation, the Kendall coordination coefficient was 0.2196, and the differences were statistically significant after χ 2 test (P < 0.05). The coefficient of variation of each index in the second round of expert consultation ranged from 0.00 to 0.21.

Conclusion

The CSSD-specialized nurse training program based on job competency constructed in this study takes job competency as the theoretical basis and uses a literature analysis method, survey research method, and expert consultation method to establish the content and method of training, the above methods are scientific and reasonable, and experts are motivated. It is highly authoritative, and the consultation opinions of experts at all levels of indicators tend to be consistent, which can provide reference for the training of CSSD specialized nurses.

Perioperative nurses' experiences as students: the perceived status of being at university

Literature relating to student experience during post-registration education is limited, and focuses on the outcome of the education rather than on the perspectives of the practitioner about what it is like to be a student. This paper illustrates perceptions of 23 perioperative nurses (the participants) with respect to their experiences as students during continuing professional education. Interviews indicated that, whilst study could be stressful, all the nurses enjoyed their educational experiences. Possession of a university student identification card was perceived as symbolic of raised social status.

Continuing education for primary health care nurse practitioners in Ontario, Canada

The Council of Ontario University Programs in Nursing offers a nine-university, consortium-based primary health care nurse practitioner education program and on-line continuing education courses for primary health care nurse practitioners. Our study sought to determine the continuing education needs of primary health care nurse practitioners across Ontario, how best to meet these needs, and the barriers they face in completing continuing education. Surveys were completed by 83 (40%) of 209 learners who had participated in continuing education offered by the Council of Ontario University Programs in Nursing between 2004 and 2007. While 83% (n=50) of nurse practitioners surveyed indicated that continuing education was extremely important to them, they also identified barriers to engaging in continuing education offerings including; time intensity of the courses, difficulty taking time off work, family obligations, finances and fatigue. The most common reason for withdrawal from a continuing education offering was the difficulty of balancing work and study demands. Continuing education opportunities are important to Ontario primary health care nurse practitioners, and on-line continuing education offerings have been well received, but in order to be taken up by their target audience they must be relevant, readily accessible, flexible, affordable and offered over brief, intense periods of time using technology that is easy to use and Internet sites that are easily navigated.

Promoting occupational health nursing training: an educational outreach with a blended model of distance and traditional learning approaches

In 2009, occupational health nursing faculty and professionals at the University of Washington developed an innovative continuing nursing education offering, the OHN Institute. The OHN Institute was designed to meet the following objectives: (1) extend basic occupational health nursing training to non-occupational health nurses in Federal Region X, (2) target new occupational health nurses or those who possessed little or no advanced education in occupational health nursing, and (3) offer a hybrid continuing nursing education program consisting of on-site and distance learning modalities. Evaluation findings suggested that the various continuing nursing education modalities and formats (e.g., asynchronous vs. synchronous, online modules vs. live modules) were essentially comparable in terms of effectiveness. Perhaps most importantly, the OHN Institute evaluation demonstrated that quality continuing nursing education outcomes for occupational health nurses depended largely on knowledgeable and engaging faculty and a compelling vision of desired outcomes, including the application of learned content to professional practice.

Students' views of enquiry-based learning in a continuing professional development module

The purpose of this study was to explore whether qualified nurses who had undertaken a continuing professional development module at a UK university, which utilised enquiry-based learning (EBL) as the educational strategy, believed that their nursing practice had been influenced by this educational approach. This study was underpinned by the assumptions of Gadamerian hermeneutic phenomenology; semi-structured interviews were conducted with eight nurses who had undertaken a continuing education module utilising an EBL approach. The responses in this study indicate that participants believed that their practice of nursing had been positively influenced by engaging in EBL. They felt that by becoming self-directed, critical, reflective practitioners, they were better able to deliver evidence-based practice/care. Self reports of practice change attributed to engaging in EBL were provided, with the patient identified as the principal beneficiary, echoing the espoused aims of continuing professional development. EBL was credited with being a motivating, energizing and enjoyable way of learning but participants were critical of the lack of preparedness of both the students and facilitators. Consideration needs to given as to whether EBL is viewed as a philosophy of learning or as a facilitative strategy used alongside other educational methods.

Nurses' motivations for studying third level post-registration nursing programmes and the effects of studying on their personal and work lives

Internationally nurses' motivations for post-registration education and the effects of studying are important concerns for the profession. This paper describes Irish nurses' motivations for studying post-registration nursing programmes and the effects of studying on their personal and work lives. Eighteen nurses participated in this qualitative study. Data were collected using three focus groups and a one-to-one interview. Data were analysed using the qualitative data analysis method Framework [Ritchie, J., Spencer, L., 1994. Qualitative data analysis for applied policy research. In: Bryman, A., Burgess, R. (Eds.), Analyzing Qualitative Data. Routledge, London, pp. 173-194]. Three themes were identified: "I want to keep up and I want to keep in there," "It's about juggling and getting the balance" and "I'm looking at things differently." Findings revealed that nurses studied to aid their professional development. Contextual factors influenced their motivations including a free fees initiative and Irish nursing developing into an all graduate profession. The impact of studying on their personal and work lives was broader in scope than their motivations.

Nurses', midwives' and health visitors' perceptions of the impact of higher education on professional practice

AIM

This study examines the perceptions of qualified nurses, midwives and health visitors of the impact of higher education on professional practice.

METHODOLOGY

This is a qualitative study using a phenomenological approach. A non-probability convenience sample of 12 qualified nurses, midwives and health visitors who had enrolled upon a Master of Science programme in Professional Practice at a United Kingdom Higher Education Institution in the East Midlands were interviewed using semi-structured interviews, which were audio-taped and analysed using Colaizzi (1978) [Colaizzi, P., 1978. Psychological research as a phenomenologist views it. In: Valle, R., King, M., (Eds.), Existential Phenomenological Alternatives for Psychology. Oxford University Press, New York, pp. 48-71] approach. Approval to undertake this study was received from the University's Research Ethics Committee.

RESULTS

Four themes emerged from the interview data. These were personal and professional motivation, workplace constraints, valuing "hands-on" nursing and client contact, and challenging and questioning practice. From the respondents' perspective, there was a strong view that higher education has a positive effect in practice, but a significant number of factors including time and support seemed to inhibit the possible benefits in practice. These are discussed in relation to the findings from similar studies.

CONCLUSION

This study has highlighted the need for further research to explore the impact of higher education on client care and service delivery.

An evaluation of perceived education and training needs of staff nurses and care officers

This study was carried out to ascertain the specific education and training needs of nursing and care officer staff working at the Central Mental Hospital (CMH) in Dublin, Ireland, which provides national forensic psychiatric services. This is the first time an education and training needs analysis was conducted for all nursing and care officer staff.

Training needs analysis. A literature review and reappraisal

Training needs analysis is the initial step in a cyclical process which contributes to the overall training and educational strategy of staff in an organisation or a professional group. The cycle commences with a systematic consultation to identify the learning needs of the population considered, followed by course planning, delivery and evaluation. Although much has been written about training needs analysis in relation to post-registration nursing education, there is disagreement concerning its impact on the training cycle and its potential to influence service delivery. This stimulated the literature review presented below. Initial searches of nursing databases identified 266 works. Twenty three (8.6%) contained empirical findings relating to post-registration nursing education in which assessment of training needs was presented as the major aim. Most of these accounts were concerned with the training needs of nurses in more than one organisation and were classified as macro-level training needs analysis. However, seven studies were concerned with a single, specific organisation (micro-level training needs analysis). Despite their smaller scale and more limited scope, micro-level training needs initiatives demonstrated greater methodological rigour, were more likely to consider the stakeholder perspective, to generate findings which could positively influence the rest of the training cycle and showed the greatest potential for influencing service delivery and quality of patient care. The review drew attention to the similarities between the training cycle and the audit cycle and resulted in the development of a model which could be used to evaluate the effectiveness of the process and outcomes of future training needs analysis initiatives.

Taking a degree after qualifying as a registered general nurse: constraints and effects

In recent years, there has been a growing emphasis on nurses obtaining degrees with many arguing for an all graduate profession. Traditionally trained nurses may feel increased pressure to obtain degrees to compete with their diploma and degree trained successors. This paper presents findings from the sixth questionnaire in a Department of Health-funded, longitudinal study into the careers of traditionally trained nurses who qualified in 1990/91. It discusses the experiences of a cohort of 620 nurses eight years after qualification, in terms of the proportion who had taken/were taking a degree, the support offered by employers and the perceived effects of a nursing/healthcare degree on their work. The findings showed that almost half did not plan to take a degree and that a main constraint was the difficulty of combining paid work with studying, especially for women with childcare responsibilities. However, for the minority who had taken/were taking a degree, the perceived effects included increased self-confidence, with the majority reporting enhancement of clinical skills and better career prospects. The findings point to a need for employers to address issues of flexible working, study leave and funding in order that nurses are given every opportunity for career development.

The impact of part-time post-registration degrees on practice

AIM

This study aimed to identify how graduates from part-time, post-registration degree courses in nursing and midwifery perceived that their practice had changed as a result of the knowledge and skills acquired on their courses.

BACKGROUND

Despite increasing investment in continuing professional education and expansion of nursing roles, little work has been undertaken to assess the impact of graduates' skills on nursing care and clinical outcomes.

METHOD

Postal questionnaires were used to survey all graduates of post-registration Bachelor's and Master's courses in nursing and midwifery from one institution in the United Kingdom (UK) (n=60). Respondents were asked to describe how they felt their graduate skills were used in practice and if this was influenced by any factors in the workplace. Data were analysed descriptively, and by content analysis.

FINDINGS

Forty-three of 58 graduates contacted responded (74%). The majority (33/43, 77%) of respondents felt that their graduate skills were used in practice. Although most felt that their clinical practice had changed as a result of their degree studies, no practical examples of this were given, despite specific questioning. Many examples of academic and research skills acquired on the course were cited, which raises the question of whether the degree courses provided graduates with academic rather than clinical knowledge. There was ambivalence as to their perceptions of barriers in the workplace, which may have impeded the application of knowledge acquired on the courses.

IMPLICATIONS

The clinical effectiveness of education initiatives depends on the learners, the course and the workplace. To maximize the benefits accruing to patients from continuing professional education and role expansion, further exploration of the contribution of higher education programmes to clinical practice is required.

From ward-based critical care to educational curriculum 1: a literature review

There has been recent recognition in the literature, and a longer standing awareness amongst clinicians, that critically ill patients are to be found outside of intensive care units. These patients are not always well managed and some have concluded that their care is 'suboptimal' [Br. Med. J. 316 (1998) 1853] and that they die of preventable clinical problems [Extremes of Age: the 1999 Report of the National Confidential Enquiry into Perioperative Deaths (1999) NCEPOD]. Whilst the cause of this situation in the NHS probably involves a complex interplay of factors including failures in management, policy and the evidence/information base for practice, education failures have also been blamed. In response the government has mandated formal critical care education for ward nurses [Comprehensive Critical Care: a Review of Adult Critical Care Services (2000) Department of Health]. In this two-part paper, the literature around education for ward-based critical care is examined (Part 1) prior to a report of the findings (Part 2) of a case study exploring the everyday practices, context and culture of an acute surgical ward where seriously ill patients were cared for prior to the introduction of a critical care outreach service (Part 2). Implications for practice, education and future research are discussed.

A critical review of the Delphi technique as a research methodology for nursing

The Delphi technique is an approach used to gain consensus among a panel of experts. This is normally achieved through a series of rounds where information is fed back to panel members using questionnaires. It has been used extensively within social science research and is being increasingly employed by nurse researchers. This popularity has meant that the technique has been adapted in various ways and there is the possibility that the rigour associated with the original format has been threatened. This signals the need for a critical review of the Delphi as a robust and systematic approach to data collection. While there is a great volume of literature surrounding the "Delphi", there is a dearth of papers critically analysing the technique. This paper aims to examine critically the Delphi technique from a range of perspectives. Discussion will focus on problems of definition and the advantages and disadvantages and the techniques' application in nursing. The critique will be structured through an analysis of the key aspects of the Delphi process. These key aspects include analysis of sampling, anonymity, use of experts, rounds and application. The critical analysis highlights the increasing popularity of the Delphi and the modifications to the process which may cause methodological problems. Ultimately, the Delphi has much to offer in terms of gaining consensus from a wide range of individuals on specific topics.

A New Module in Caring for Older Adults: Problem-Based Learning and Practice Portfolios

It is not often that educators have the chance to design a new educational program on the basis of up-to-date and locally relevant research findings. We describe the process by which we designed a new module, aimed at registered nurses who care for older adults in the community. The content of the new module was derived from an analysis of educational needs of the potential student population. The mode of delivery was strongly student-centered, using problem-based learning. Assessment was through the building up by students of a practice portfolio. This paper focuses on a description of the new module and how it relates to the findings of the educational needs analysis. The National Board for Nursing, Midwifery and Health Visiting for Scotland put out a tender in 1995 for a community research project on "Educational Provision for Evolving Roles in Community Health Care" (Nursing Times, June, 9, 1995) with the aim of piloting and evaluating an "innovative program which meets changing needs in community health care." A joint bid by Napier University and the University of Glasgow not only proposed to pilot and evaluate the educational program, but also first to develop the content of the program itself through an educational needs analysis. In this paper, we will first provide an outline of the research that underpinned the educational program. Then, we will describe how the results of the needs analysis were implemented into an innovative educational module. Finally, we will give a brief summary of the new module.

Child care responsibilities and participation in continuing education and training: issues relating to motivation, funding and domestic roles

Changes in the organization and funding of health services and in the education and training of NHS staff have placed increased influence in the hands of employers and individual students as users of continuing professional development. Against this policy context an interview study was carried out with students participating in a range of continuing professional development activities. The sample included 89 participants attending a range of courses. Approximately half of the sample had children. Many of the participants were attending courses in their own rather than in their employers' time and several were self-funding. The influence of domestic responsibilities on motivations, along with the impact of course participation on home and family life, were examined. Results revealed that those with children were less likely to perceive continuing education in a positive light compared to those without. The impact of course participation on home and family life was invariably negative and for some the consequences were serious. The policy implications of findings are discussed.

Educational input and patient outcomes: exploring the gap

Over the last two decades, the health care professions in the United Kingdom have seen an unparalleled expansion of continuing professional education (CPE) and development (CPD) programmes; however, there is little empirical evidence that these enhance the care delivered to patients. Further research is also needed to demonstrate that these initiatives are linked to improved patient outcomes. If health care educators are to move towards an 'evidence-based curriculum', some restructuring of courses may be needed. Priorities should be set and decisions made, based on the results of reliable and valid research into the clinical outcomes of CPE. To evaluate courses and demonstrate educational effectiveness solely in terms of student satisfaction is not enough; to survive in the world of evidence-based care, educators must also demonstrate their contribution to clinical effectiveness. However, the neoteric field of impact evaluation lacks not only validated research methods, but also an agreed agenda for future research. Drawing on interviews undertaken with nurses who have participated in education evaluations and the relevant literature, this paper discusses the available data collection instruments and the development of viable research designs and methods, which are urgently needed to assess the outcomes of professional education programmes.

Evaluation of open learning material designed for part of the diploma level research module for pre- and post-registration nurses

With the increase in the number of nurses wishing to upgrade their professional qualification to diploma or degree level, there has been a corresponding increase in the number of research modules purchased by education purchasing consortia. One approach to deal with this increase in the number of students, and also to enable students to study at their own pace and in a location convenient to them, is to develop open learning materials. The data presentation and analysis session for the diploma level research module delivered by the Institute of Health Studies at the University of Plymouth has recently been designed using text based material. An opportunity to evaluate this material has arisen during the author's participation in a teaching and learning in higher education course. Twelve out of 25 post-registration students undertaking the diploma level module agreed to take part in the study; six were randomly allocated to the self-study group, and six to the taught session. Information was also collected from the students who did not wish to take part (n = 11). A questionnaire was designed to evaluate knowledge, attitudes to presentation of the material and the method of teaching. Results revealed few differences between the two groups in terms of knowledge and attitudes to presentation of the material and the method of teaching. Of note is that there was an increase in knowledge scores between pre- and post-session assessments for more of the taught session group than the others; and the overall rating was higher for the teaching method than for the self-study material. Reasons given by the 11 who did not wish to take part in the study all related to a preference for a taught session. The implications of these findings are discussed in the context of the limitations of the study, and the development of teaching material in general.

Assessing educational effectiveness: the impact of a specialist course on the delivery of care

An exploratory study was undertaken in South Wales to assess the changes in clinical practice brought about by a specialized pharmacology module designed for Community Mental Health Nurses (CMHNs), in our institution. The respondents were the seven CMHNs who completed the course in 1997 and returned to clinical practice, and seven CMHN comparators, matched on the basis of work experience and location. In order to assess the impact of the module, the practice, attitudes and knowledge of the respondents were investigated before and after the course and 6 months later, using semistructured interviews, nonparticipant observation and questionnaires. The three data sets were analysed using the constant-comparative method, and relevant themes were identified and refined. While we obtained some objective measures of positive educational impact, these should be considered in relation to contextual and confounding variables. Both reported and observed behaviours indicated that the main benefit from the course was increased awareness and monitoring of the side-effects of medication. Respondents had not implemented change uniformly; several factors determined how they modified working practices, including service pressures and the support of colleagues.

Students' expectations of postregistration degree programmes

The needs of postregistration students pursuing degree-linked clinical courses have received little attention and there are few insights concerning their aspirations when they enrol on such courses. Thus the aim of this study was to explore postregistration students' perceptions of the specific needs of their patient/client group and to examine how they envisaged the course on which they had just enrolled might help them to meet these needs in addition to their own requirements for professional and personal development. Data were collected by group interview from 62 students enrolling on eight different postregistration courses, all employed in an acute hospital trust. The results were analysed inductively. They indicated that students had internalized the state of the healthcare market and were keenly aware of the need to fulfil the expectations of employers and the public, while fulfilling their own needs for education and pursuing their own professional and career trajectories. They appeared ambitious and yet appeared to demonstrate empathy for patients and their families and felt a tremendous desire to provide care of a high quality through the optimal development of technical expertise. Students' emphasis on the importance of keeping abreast of technological developments should not be lightly dismissed considering its prominent position within the acute areas where they were employed, especially as it did not replace their desire to promote the caring aspects of their work.

The community gerontological nurse: themes from a needs analysis

With the move of care into the community, the role of nurses caring for older people is changing. However, nurses may not be adequately prepared to cope with this changing role, especially if their training and experience have been primarily hospital based. This study involves an educational needs analysis of registered nurses working in the care of older people in nursing homes and clients' own homes. It is based on focus groups with registered nurses and individual interviews with other professionals, as well as group discussions with older people. The aim of this project is to provide research-based input into the design of a new community care of older people module, to be offered at Napier University, Edinburgh from February 1998. The results presented here consist of three themes or patterns that have emerged from the interview data. The specialist/generalist theme concerns issues of role definition and gerontological specialism. The social/medical theme addresses the shift towards a social model of care when nurses move into the community settings. Finally, the physical health/mental health theme represents the need for greater integration of skills and knowledge from both mental health and general health nursing in the field of community care for older people. The results indicate the need for significant attitude changes and provide a major challenge to educationalists.

Motivational forces affecting participation in post-registration degree courses and effects on home and work life: a qualitative study

Over the past decade, pre- and post-registration education for nurses and midwives in the United Kingdom has undergone major change, creating an atmosphere where continuing professional development is a matter of priority for individual health care staff. Against this context of change, and as part of a larger study of continuing education and training in the National Health Service, a cohort of participants in a part-time health studies degree course were interviewed using a semi-structured schedule. Twenty-nine nurses, midwives and allied professional staff described their motives for participation in the course and its effects on their professional and personal lives. Data collected in interviews were analysed using qualitative methods and revealed that participation was encouraged by both professional and personal factors. For many staff participation was prompted by negative feelings about themselves and their professional status. Participation in the course was associated with (largely negative) changes in home and family life and most participants faced additional financial burdens. The findings of the study have implications for policy relating to the funding of continual professional education for nurses and other health care staff. Health care staff are receiving mixed messages about continuing education from policy makers and employers. Dependence on willingness and ability to pay for post-registration degree-level studies is unlikely to be an efficient or equitable means of ensuring lifelong learning for healthcare staff.

Using the Delphi technique to identify the content and context of nurses' continuing professional development needs

In order to identify and prioritize the development needs of medical and surgical nurses, their possible approaches to learning, and the contextual factors influencing their professional development, a Delphi survey was carried out using a panel of 28 participants. Current development needs included skills in essential clinical care, specialist nursing, changing roles, patient care management, research and practice development. Although there was ambivalence about changing nurses' clinical roles, participants expected roles to diversify in the future. The need for responsiveness to change was emphasized, as was the need to maintain current areas of expertise. Professional development activity could take many forms, but fostering an organizational climate in which development was inherent in everyday working practices was felt to be as valuable as formal course attendance. Restricting factors included lack of time, resources, support and recognition. The survey has enabled professional and practice development activities to be prioritized locally, and the method used could be readily applied to other settings.

From classroom theory to clinical practice: evaluating the impact of a post-registration course

This paper is concerned with the translation of bioscience theory into clinical practice. The empirical data form part of an action research study undertaken to investigate the clinical outcomes of the bioscience component of a post-registration, day release diploma in nursing taught in a higher education institution. Evidence for the impact of the course on patient care was collected by academic diary, questionnaire and interview. The triangulated data indicated that by adapting the pedagogic interpretation of the biosciences, it is possible to bridge the theory-practice gap. As a result, some nurses related the substance of the lessons to their patients, in order to bring about improvements in care. This paper examines the reasons behind the successes and failures of this continuing professional education initiative.

The biological sciences in nursing: an empirical paper reporting on the applications of physiology to nursing care

This action research study was undertaken to address practical concerns over curriculum development in nursing. The applied physiology component of a post-registration nursing diploma was evaluated in terms of its impact on patients rather than on the nurses themselves. The reported data were triangulated, all the findings indicated that patient care could be enhanced when nurses applied their knowledge of physiology to practice. Despite its limitations of scale, this study contributes to the curriculum debate in nurse education.