Umbrella review: Impact of registered nurses' continuing professional education informed by contemporary reviews of literature

Changing the delivery of continuing professional education: An action research approach

AIM

A participatory action research project was used to change the design and delivery of continuing professional education in a large Irish academic teaching hospital.

BACKGROUND

Participation in continuing professional education, designed as a short course, is often a method to maintain competence for many nurses. Structured short education courses are often used to orientate and upskill new staff to specialist clinical areas. Traditionally many courses relied on face-to-face delivery over a period of weeks which is challenging for one clinical area to release staff to attend theoretical days in person.

DESIGN

A six-stage participatory action research cycle over a 3-year period in a large Irish academic teaching hospital.

METHODS

Multiple methods were used in the cyclical process of participatory action research. Constructive alignment theory and instructional design principles were used to redesign the educational framework. Data collection included audits of courses, questionnaires and focus groups with key participants.

RESULTS

Analysis of the focus group themes included 1) underestimated time 2) the process of change 3) teaching and learning styles and 4) acceptance and integration. 20 learners completed the evaluation and reported a positive synergy between e-learning and clinical workshops. E-learning was reported as time-consuming. 75 % of learners reported they were motivated to learn. 90 % of the learners reported they gained new knowledge and skills, 84 % reported the clinical area benefited from the education and 80 % identified a direct improvement in their clinical skills in the specialist area.

CONCLUSIONS

Participatory action research supports organisational change in continuing professional education. Constructive alignment theory supports the value of outcomes-based learning. In this context it resulted in successfully blending theory and clinical skills for nurses working in specialist areas. The redesigned continuing professional education framework was positively evaluated across nurses in the organisation.

Simulation-based education as a provider of fieldwork insights - experiences of ambulance nurse specialist students

BACKGROUND

Medicine is facing a global shortage of nurses, including those with postgraduate education. One suggested educational method for undergraduate and postgraduate education, such as specialist ambulance nurse education, is simulation-based education (SBE). The implementation of SBE is motivated, in part, by the desire to attract and retain students, but also to contribute to student learning. Consequently, the use of SBE is increasing in specialist ambulance nurse education. The aim of this study was to explore how specialist ambulance nursing students experience SBE.

METHODS

This qualitative survey study involved the collection of study data using a purposefully designed, paper-based survey comprising five open-ended questions that required participant free-text answers. The answers were analysed using inductive content analysis and searching for descriptions of the participants' experiences. The survey was presented to 35 specialist ambulance nursing students.

RESULTS

The results are presented in two themes: SBE as learning and SBE as an educational method. Participating in SBE during the programme provides students with a realistic understanding of their future profession and its expected demands. The learning experience disregards prior work experience in ambulance services.

CONCLUSIONS

Based on the findings, conclusions are that SBE is an appreciated educational method among nursing students, regardless of their prior experience in the field of prehospital care. To some extent, this differs from previous research findings related to this subject. Furthermore, SBE contributes to the provision of field work insights, preparing the ambulance nurse specialist students.

Evidence for continuing professional development standards for regulated health practitioners in Australia: a systematic review

BACKGROUND

Health practitioner regulators throughout the world use continuing professional development (CPD) standards to ensure that registrants maintain, improve and broaden their knowledge, expertise and competence. As the CPD standard for most regulated health professions in Australia are currently under review, it is timely that an appraisal of the evidence be undertaken.

METHODS

A systematic review was conducted using major databases (including MEDLINE, EMBASE, PsycInfo, and CINAHL), search engines and grey literature for evidence published between 2015 and April 2022. Publications included in the review were assessed against the relevant CASP checklist for quantitative studies and the McMaster University checklist for qualitative studies.

RESULTS

The search yielded 87 abstracts of which 37 full-text articles met the inclusion criteria. The evidence showed that mandatory CPD requirements are a strong motivational factor for their completion and improves practitioners' knowledge and behaviour. CPD that is more interactive is most effective and e-learning is as effective as face-to-face CPD. There is no direct evidence to suggest the optimal quantity of CPD, although there was some evidence that complex or infrequently used skills deteriorate between 4 months to a year after training, depending on the task.

CONCLUSIONS

CPD is most effective when it is interactive, uses a variety of methods and is delivered in a sequence involving multiple exposures over a period of time that is focused on outcomes considered important by practitioners. Although there is no optimal quantity of CPD, there is evidence that complex skills may require more frequent CPD.

Development of a Standardized Simulation: Advance Care Planning Conversations for Nurses

BACKGROUND

Advance care planning conversations focus on articulating and documenting patients' healthcare goals. These conversations should occur early and iteratively but are often not completed. Clinicians, specifically registered nurses, lack the needed training in advance care planning to have effective conversations; hands-on teaching modalities are necessary to enhance these communication skills.

OBJECTIVES

The aim of this study was to increase knowledge and comfort in communication about advance care planning; therefore, a validated and standardized simulation was developed and tested among registered nurses. We examined the feasibility of an advance care planning simulation called Conversations Had at Trying Times to explore changes in knowledge, attitudes, and self-efficacy among registered nurses.

METHODS

The National League of Nursing Jeffries simulation theory and Bandura's self-efficacy theory framed the study, which consisted of two stages: (a) simulation development and (b) simulation testing. Construct and content validity guided simulation development; standardization was achieved through International Nursing Association for Clinical Simulation and Learning standards. Testing consisted of a pilot one-group pretest/posttest.

RESULTS

Conversations Had at Trying Times, a researcher-designed high-fidelity validated simulation, enhanced nurses' communication skills. Thirty-six registered nurses completed the simulation; knowledge, attitudes, and self-efficacy increased pre- to posttest. Postsimulation evaluations confirmed the feasibility of the simulation. The greatest variation in results was among registered nurses with less than a year of experience.

DISCUSSION

The study findings support the feasibility and effectiveness of the Conversations Had at Trying Times simulation in its development and outcome measurements of knowledge, attitudes, and self-efficacy in advance care planning. Simulation is an educational modality underutilized, and Conversations Had at Trying Times is one of the few validated simulations for nurses. Further analysis showed that years of experience was a significant factor. Younger, inexperienced nurses had positive outcomes, but not to the extent of other practicing nurses, which suggests that simulation tailoring is necessary for newer nurses or alternative education modalities need to be explored. In addition, more training in advance care planning communication is needed for newer nurses through nurse residency programs, staff development, and mentorship. Finally, advance care planning communication needs to be addressed in undergraduate education to better prepare new graduate nurses.

Transferring Healthcare Professional's Digital Competencies to the Workplace and Patients: A Pilot Study

The new times, marked by immediacy, globalization, and technological advances, has forced health professionals to develop new competencies to adapt to the new challenges. However, necessary skills such as using digital tools are primarily ignored by institutions, hospitals, and universities, forcing professionals to undertake training in these areas independently. This research aims to analyse if there is a transfer of what has been learned in the digital healthcare field to their professional practice and patients. To perform the study, 104 healthcare professionals, mostly nurses, who had completed online training in digital competencies answered a questionnaire with 17 questions. These questions were related to the transfer of learning to professional practice and its use for developing patient resources. Almost 60% of the professionals said that they have used what they learned in the course in their professional work, but only 16% of the participants use it daily. The main barrier to not having applied what was learned during the course, according to participants, was the situation experienced during the COVID-19 pandemic, followed by a lack of time and lack of resources. Only 23 people out of 104 developed patient resources after the course; the most created were infographics and videos. In addition, 38 people used what they learned to improve their personal productivity: searches, storage, calendars, etc. Only 11 used it for research purposes. People between 31 and 40 years old create the most patient resources and use what they learn most frequently. There is a need to improve e-learning to provide quality training that can transfer good behaviour to professional practice in the health field.

Use of pudendal nerve block among midwives in Norway: A national cross-sectional study

INTRODUCTION

Pudendal nerve block (PNB) is an effective analgesic during the second stage of labor and for suturing. With the introduction of epidural and spinal analgesia, PNB use decreased considerably. Most midwives receive some teaching on PNB during their midwifery education. The aim of this study was to examine the use of PNB by midwives in Norway.

METHODS

This was a cross-sectional study, in January 2020, using an electronic questionnaire which was distributed to approximately 1500 midwives.

RESULTS

A total of 527 midwives responded to the questionnaire (35%). Less than half (44.6%) of the midwives used PNB, of whom only half (123/235) used it frequently (at least once a month). The use of PNB was most common at specialized obstetric units with ≥1500 births per year. Midwives who reported good theoretical knowledge and practical skills of PNB used it significantly more often than midwives not reporting these (p<0.001). Reasons for not using PNB were: the lack of practice and experience (72.6%), and never having been taught (42.8%). Midwives reported needing training (83%) and clinical support to start using PNB (43%).

CONCLUSIONS

Few midwives use PNB regularly. To increase the use of PNB, midwifery education needs to include both theoretical and practical skills teaching. Midwives with insufficient knowledge and skills require the same teaching and training. In the clinical area, midwives require clinical support and supervision to practice and gain experience. Women are not offered PNB as long as midwives are not confident in providing this method of pain relief.