Barriers to Participation in Continuing Education Activities Among Rural and Remote Nurses

Effectiveness of Digital Flipped Learning Evidence-Based Practice on Nurses' Knowledge, Attitude, and Practice: A Quasi-Experimental Trial

Background: Evidence-based care has become critical in raising the quality of medical facilities. The implementation of evidence-based practice helps medical practitioners make better clinical decisions. Objective: The objective of this study was to investigate whether the innovative flipped teaching model could be as effective as the conventional teaching model in terms of knowledge, attitude, and practice and to confirm the continuous effect. Design: A quasi-experimental design using the flipped and conventional learning groups concurrently with repeat measurements was used. Setting: The setting was a 475-bed regional teaching hospital in Taiwan, from March to July 2020. Participants: The study included 114 licensed nurses who had worked longer than three months, with 57 participants each in two groups. Methods: The participants were assigned to two groups using a block randomization method. All participants completed questionnaires related to knowledge, attitude, and practice of EBP at four-time points: pre-test (T0) and immediately after intervention (T1), at month 1 (T2), and at month 3 (T3). Analysis of repeated generalized estimating equations was used. Results: The flipped and conventional learning groups had significant differences in knowledge, attitude, and practice at the T0 and T1 (p < 0.05). The flipped group was higher than the conventional group at T3 in the knowledge score (p = 0.001) and lower than the conventional group at T2 in the attitude score (p = 0.010). There were no significant differences between the two groups’ practice scores at different time points. There were no significantly different score changes for knowledge, attitude, and practice (p > 0.05). The interaction term only at T3 vs. T0 in the knowledge score was slightly different (p = 0.049) in primary outcome. Conclusion: The intervention methods of both groups were effective. Flipped learning is more flexible and has more time for discussion, which nurses favor. Under the policy promoted in the hospital, EBP combined with the nursing advancement system was standardized, and conventional learning also improved the learning effect.

Exploring nurses' experiences of social media and in-person educational interventions for professional development: a qualitative study

BACKGROUND

Nurses play an important role in health promotion, prevention strategies, and care. Therefore, nurses need to obtain and update their knowledge and skills via appropriate strategies. This study aimed to explore nurses' experiences of receiving social media and in-person education to integrate the findings into practice.

METHODS

This was a qualitative study using the directed content analysis approach. A sample of nurses with previous experiences of receiving social media and in-person education participated in the study. They were asked to express their experiences and indicate their preferences. The data were collected based on individual semi-structured interviews.

RESULTS

In total 15 participants took part in the study with a mean age of 40.6 ± 8.93 years and work experiences of 15.3 ± 9.21 years. During the process of content analysis, three main themes emerged: Approaches to nursing education and its adoption in the health system, Achieving effectiveness and efficiency in nursing education, and Health care policy and facilitating pathways for nursing education. Participants indicated several barriers to attending an educational program, including motivation, workload, time and place, and hospital politics.

CONCLUSION

Overall the findings suggest that regardless of any methods of education nurses cannot actively engage in the educational interventions while on duty. However, the findings suggest that nurses believe that the social media approach might be superior in reducing barriers and making the educational interventions work better.

Do educational interventions improve the attitudes of emergency nurses towards patients who self-harm? A systematic review

Negative nurse attitudes towards emergency department patients who self-harm may increase the risk of repeated self-harm and suicide. This article details a systematic review that aimed to examine the evidence on the efficacy of educational interventions to improve the attitudes of emergency nurses towards patients who self-harm. Eight articles describing six intervention studies, published between 2001 and 2018, met the criteria for inclusion. The review found that educational interventions for emergency nurses improved their attitudes to patients who self-harm, but there was a lack of consistency in the approaches used and a reliance on self-report measures. Further training for emergency nurses is needed because of their crucial role in self-harm and suicide prevention.

A Framework for Standardizing Emergency Nursing Education and Training Across a Regional Health Care System: Programming, Planning, and Development via International Collaboration

INTRODUCTION

The challenges related to providing continuing education and competence management for emergency nurses are not unique to any one organization, health system, or geographic location. These shared challenges, along with a desire to ensure high-quality practice of emergency nursing, were the catalyst for an international collaboration between emergency nurse leaders in Region Zealand, Denmark, and nurse leaders and educators from a large academic medical center in Boston, Massachusetts. The goal of the collaboration was to design a competency-based education framework to support high-quality emergency nursing care in Region Zealand. The core objectives of the collaboration included the following: (1) elevation of nursing practice, (2) development of a sustainable continuing education framework, and (3) standardization of training and nursing practice across the 4 emergency departments in Region Zealand.

METHODS

To accomplish the core objectives, a multi-phased strategic approach was implemented. The initial phase, the needs assessment, included semi-structured interviews, a self-evaluation of skills of all regional emergency nurses, and a survey regarding nursing competency completed by emergency nurse leadership. Two hundred ninety emergency nurses completed the self-evaluation. The survey results were utilized to inform the strategic planning and design of a regional competency-based education framework.

RESULTS

In 18 months, and through an international collaboration, emergency nursing education, training, and evaluation tools were developed and integrated into the 4 regional emergency departments. Initial feedback indicates that the education has had a positive impact. The annual competency day program has continued through 2021 and is now fully institutionalized within the regional emergency nursing continuing education program. Furthermore, use of this innovative education framework has expanded beyond the emergency department to other regional nursing specialties.

DISCUSSION AND CONCLUSION

Through this unique collaboration with regional and international participants, a sustainable, regional emergency nursing education program was developed that has elevated and standardized the practice of emergency nurses in Region Zealand, Denmark. This program development can serve as a model for region-wide or health care system-wide collaborations in other countries.

Factors Hampering the Participation of Nursing Staff in the Continuing Education Activities of Hospitals Centers in the Casablanca-Settat Region

Aim:

This study aimed to identify the factors hampering the participation of nurses in the activities of CE sessions at the level of hospitals in the region of Casablanca.

Background:

Continuing education (CE) for nursing staff represents a strategic asset for hospitals, identifying the constraints of nursing staff participation in continuing training could help improve the quality of care for patients and the population in general.

Objective:

This study aimed to identify the factors hampering the participation of nurses in the activities of CE sessions at the level of hospitals in the region of Casablanca.

Methods:

The study used a two-phase mixed method design. First of all, a questionnaire was administered to 930 nurses belonging to 9 hospital centers in the Casablanca-Settat region in order to explore and estimate the frequencies of the factors hindering the participation of nurses in the activities of the FC sessions at the level of hospitals, and a semi-structured interview with 9 persons in charge of continuing education from these different hospitals to complete and explain the data collected by the questionnaire.

Results:

The data analysis confirmed that the work overload is the first individual difficulty hindering the participation of nurses in CE sessions, i.e., 85.4%. The most mentioned organizational difficulties are schedule recommended in the FC not encouraging and not suitable, i.e., 23%, non-targeted content (does not meet the needs of the nursing staff), i.e., 66.7%. Finally, the absence of support measures in terms of monitoring and evaluation to maintain the knowledge and skills acquired during FC sessions in real situations at the workstation occupied is the first institutional difficulty mentioned by the interviewed (88%).

Conclusion:

Those responsible for training should take into account the factors nurse’s face in participating in continuing education sessions when designing, developing, and implementing continuing education sessions.

Maternity connect: Evaluation of an education program for rural midwives and nurses

BACKGROUND

Rural and regional health services often find it difficult to maintain their maternity service and skills of their maternity workforce and enable women to give birth close to home. The Maternity Connect Program is a professional development initiative aimed at supporting and upskilling rural and regional maternity workforces to meet their maternity population care needs.

AIM

To evaluate the Maternity Connect Program from the perspectives and experiences of participating midwives/nurses and health services.

METHODS

A retrospective audit of data routinely collected as part of the Maternity Connect Program: initial needs assessments (baseline survey), and one month and six months post-placement surveys completed by participants, placement health services and base health services. The main outcome measures were: participants' (midwives and health services) level of satisfaction with the Program; and changes in midwives'/nurses' perceived level of confidence in performing key midwifery skills after participating in the program.

RESULTS

Respondents (n = 97 midwives/nurses; n = 23 base health services; n = 4 placement health services) were satisfied with the program and there was an increase in midwives/nurses' confidence when providing specific aspects of maternity care (birthing, neonatal and postnatal). Midwives/nurses report transferring skills learnt back to their base health service.

CONCLUSION

The Maternity Connect Program appears to be a successful educational model for maintaining and increasing clinician confidence in rural and regional areas.

Nursing workload in intensive care units and the influence of patient and nurse characteristics

BACKGROUND

Understanding factors that can potentially influence patient care and nursing workload in intensive care units is important. Previous studies have shown contradictory outcomes about the relationships between nursing workload and patient and nurse characteristics.

AIMS AND OBJECTIVES

This study aimed to investigate nursing workload in intensive care units and examine the association between this in relation to patient and nurse characteristics.

DESIGN

A cross-sectional design was conducted.

METHODS

All nurses who were working in the intensive care units of five hospitals and met the study criteria were enrolled in the study. Two demographic questionnaires collected nurse and patient demographic information. The Nursing Activities Score was applied to determine nursing workload in three shifts (morning, evening, night) for each nurse. Data were analysed using the independent sample t-test, one-way analysis of variance, and multivariable linear regression analysis.

RESULTS

The Nursing Activities Score was calculated for 509 patients who were under the care of 105 intensive care unit nurses. The mean (SD) Nursing Activities Score was 72.84% (22.07%). Morning shifts, male patients, medical treatments, and referred patients from the emergency ward and other intensive care units imposed a higher workload for nurses. Specifically, female nurses, increased number of patients receiving care, and increased patient length of intensive care unit stay were directly associated with increased Nursing Activities Scores. Work in surgical and burn intensive care units were inversely associated with the Nursing Activities Score.

CONCLUSION

This study suggests that the workload of nurses in intensive care units can be affected by both nurse and patient characteristics.

RELEVANCE TO CLINICAL PRACTICE

The findings can be used to ensure appropriate staffing of intensive care units by nurses. However, nurse and patient characteristics should not be considered the only factors that influence nursing workload in intensive care units.

Communication tools and sources of education and information: a national survey of rural and remote nurses

Objective

This study examined accessibility of communication tools in the workplace, use of education to update nursing knowledge, and use of information to make specific decisions in practice among registered nurses (RNs) and licensed practical nurses (LPNs) in rural and remote communities in Canada.

Methods

Data were analyzed from the cross-sectional survey, “Nursing Practice in Rural and Remote Canada II,” of regulated nurses practicing in all provinces and territories of Canada. Data were collected from April 2014 to August 2015.

Results

The survey was completed by 3,822 of 9,622 nurses (40% response), and the present analysis was conducted with a subsample of 2,827 nurses. High-speed Internet was the most accessible communication tool, and nurses used “online/electronic education” more often than “in-person education” to update their nursing knowledge. Internet searches were used more often than several other online/electronic sources to inform decision making. Compared to LPNs, RNs reported greater workplace access to most communication tools and greater use of online/electronic education as well as information sources in online/electronic and print formats. Compared to nurses in community-based health care and hospital settings, nurses in long-term care settings reported lower access to most communication tools, lower use of online/electronic and in-person education, and lower use of online/electronic information.

Conclusions

Access to continuing education and up-to-date information is important for effective patient care. This study points to a need for further research on the continuing education and information needs of rural and remote RNs and LPNs, and on their capacity to incorporate and apply new knowledge in practice.

Imminent birth education for rural and remote settings: An evaluation study

OBJECTIVE

To describe the development and evaluation of an educational resource that aimed to provide the non-midwifery workforce in rural and remote health facilities with basic knowledge and skills to assist women who present when birth is imminent.

DESIGN

Descriptive methods using surveys were employed to evaluate the resource named the Imminent Birth Education Program.

PARTICIPANTS

Health professionals employed in Queensland Health rural and remote non-birthing facilities.

INTERVENTION

An evidence-based, blended educational program comprising an online component, a face-to-face workshop and an education package for midwives to facilitate the workshop in their health service.

RESULTS

More than 600 participants completed the online course component, and the majority of these participants were employed in non-birthing facilities. Throughout the project, two project officers facilitated face-to-face workshops, training participants to facilitate the workshop in their own health services. The reach of the Imminent Birth Education Program was statewide with clinical staff from all 16 Hospital and Health Services participating.

CONCLUSION

The uptake of the Imminent Birth Education Program has been widespread across the state and positively evaluated by the rural and remote non-midwifery workforce in non-birthing facilities. This evidence-based program is an effective way to provide the knowledge, skills and confidence to assist health professionals to care for women who present to these facilities when birth is imminent.

Increasing rural nurses' awareness of a statewide health information resource: an educational outreach initiative

BACKGROUND

HEALWA is an online library of evidence-based health information resources that are available to Washington state health practitioners. To increase awareness and use of HEALWA among health practitioners in rural areas, the National Network of Libraries of Medicine Pacific Northwest Region and Washington State University Spokane co-funded an outreach librarian position to provide instruction on using HEALWA.

CASE PRESENTATION

After attempts at frequent in-person workshops failed due to lack of attendance, a one-hour-long webinar targeted at rural nurses was developed to be delivered once a month. These webinars introduced participating health professionals to HEALWA, including how to set up their access and how to navigate the resource. To accommodate the busy schedules and different learning styles of the target audience, the workshops occurred both as monthly webinars and in-person, when available, in addition to an online self-guided tutorial. Continuing education credit was obtained through the Washington State Nurses Association, and a partnership with the Washington State Nursing Commission improved promotion of the webinars. Evaluations for both the webinars and workshops have been largely positive.

CONCLUSIONS

The webinar series, coupled with in-person workshops and an online tutorial, reached nurses in rural areas of Washington state to increase awareness of HEALWA. To further facilitate access to HEALWA instruction, a recorded version of the live webinar is in development.

Development and psychometric evaluation of the Job Demands in Nursing Scale and Job Resources in Nursing Scale: Results from a national study

AIM

To develop and test the psychometric properties of the Job Resources in Nursing (JRIN) Scale and the Job Demands in Nursing (JDIN) Scale.

DESIGN

Cross-sectional survey.

METHODS

A three-phase process of instrument development and psychometric evaluation was employed: Phase 1: development of a 42-item JRIN Scale and 60-item JDIN Scale through extensive literature review, expert consultation and an iterative content evaluation; Phase 2: pilot survey of 89 nurses and use of item discrimination analysis to estimate the internal consistency reliability of each subscale and reduce the length of each scale; Phase 3: Modified scales were tested in a nationwide survey of 3,822 rural/remote nurses, including use of exploratory factor analysis.

RESULTS

The 24 items related to job resources favoured a six-factor structure, accounting for 63% of the variance, Cronbach's alpha 0.88. The 22 items related to job demands favoured a six-factor structure, accounting for 59% of the variance, Cronbach's alpha 0.84.

Nurses' experiences of working in rural hospitals: An integrative review

AIM

To critically analyse the international literature describing the experiences of nurses working in rural hospitals.

BACKGROUND

Nursing shortages in rural areas is an ongoing issue. Given the significant role nurses play in the delivery of rural health care, a sufficient workforce is essential. However, maintaining this workforce is challenging. Understanding the experiences of nurses working in rural hospitals is essential to inform strategies around job satisfaction and staff retention.

EVALUATION

An integrative review was conducted. Six primary sources were included related to the experiences of nurses working in rural hospitals.

RESULTS

Four themes emerged, namely: (a) Professional Development; (b) Workplace stressors; (c) Teamwork; and (d) Community.

CONCLUSION

There is a need for further research exploring the experiences of nurses working in rural hospitals and its impact on job satisfaction, turnover intention and patient safety.

IMPLICATIONS FOR NURSING MANAGEMENT

This review highlights some key issues impacting nurses' working in rural hospitals. This understanding can be used by nurse managers to inform strategies for recruitment and retention of nurses in these areas.

The creation and integration of a nurse educator position in two hospitals in Haiti

BACKGROUND

Continuing education is an integral part of nursing professional development and improving healthcare delivery, but literature on continuing education initiatives in low-resource settings is limited.

PURPOSE

To describe the creation and integration of a nurse educator (NE) position in two Haitian hospitals and highlight barriers and facilitators experienced by the NEs in their role.

METHODS

Four NEs and three support staff involved in the creation and integration of the NE positions were interviewed. Supplementary data were gathered through participant observation and document review. Data were compiled and summarized.

DISCUSSION

NEs were hired to assess learning needs, evaluate skills, train and mentor nurses, and provide ongoing support to assure application of new knowledge. Barriers included lack of specialized training and limited informational resources to develop education activities, role confusion and heavy workload, poor attendance and disparate education needs of nurses, and insufficient hospital resources and support to implement practice changes. Facilitators included previous management experience, peer support, and a perception of being valued by patients and colleagues and making a difference regarding nursing care and patient outcomes.

CONCLUSION

The NE is a leadership role and a promising, sustainable initiative for developing the nursing profession in Haiti.

Using local clinical educators and shared resources to deliver simulation training activities across rural and remote South Australia and south-west Victoria: A distributed collaborative model

PROBLEM

There is a lack of access to simulation-based education (SBE) for professional entry students (PES) and health professionals at rural and remote locations.

DESIGN

A descriptive study.

SETTING

Health and education facilities in regional South Australia and south-west Victoria.

KEY MEASURES FOR IMPROVEMENT

Number of training recipients who participated in SBE; geographical distribution and locations where SBE was delivered; number of rural clinical educators providing SBE.

STRATEGIES FOR CHANGE

A distributed model to deliver SBE in rural and remote locations in collaboration with local health and community services, education providers and the general public. Face-to-face meetings with health services and education providers identified gaps in locally delivered clinical skills training and availability of simulation resources. Clinical leadership, professional development and community of practice strategies were implemented to enhance capacity of rural clinical educators to deliver SBE.

EFFECTS OF CHANGE

The number of SBE participants and training hours delivered exceeded targets. The distributed model enabled access to regular, localised training for PES and health professionals, minimising travel and staff backfill costs incurred when attending regional centres. The skills acquired by local educators remain in rural areas to support future training.

LESSONS LEARNT

The distributed collaborative model substantially increased access to clinical skills training for PES and health professionals in rural and remote locations. Developing the teaching skills of rural clinicians optimised the use of simulation resources. Consequently, health services were able to provide students with flexible and realistic learning opportunities in clinical procedures, communication techniques and teamwork skills.

Nurses who work in rural and remote communities in Canada: a national survey

BACKGROUND

In Canada, as in other parts of the world, there is geographic maldistribution of the nursing workforce, and insufficient attention is paid to the strengths and needs of those providing care in rural and remote settings. In order to inform workforce planning, a national study, Nursing Practice in Rural and Remote Canada II, was conducted with the rural and remote regulated nursing workforce (registered nurses, nurse practitioners, licensed or registered practical nurses, and registered psychiatric nurses) with the intent of informing policy and planning about improving nursing services and access to care. In this article, the study methods are described along with an examination of the characteristics of the rural and remote nursing workforce with a focus on important variations among nurse types and regions.

METHODS

A cross-sectional survey used a mailed questionnaire with persistent follow-up to achieve a stratified systematic sample of 3822 regulated nurses from all provinces and territories, living outside of the commuting zones of large urban centers and in the north of Canada.

RESULTS

Rural workforce characteristics reported here suggest the persistence of key characteristics noted in a previous Canada-wide survey of rural registered nurses (2001-2002), namely the aging of the rural nursing workforce, the growth in baccalaureate education for registered nurses, and increasing casualization. Two thirds of the nurses grew up in a community of under 10 000 people. While nurses' levels of satisfaction with their nursing practice and community are generally high, significant variations were noted by nurse type. Nurses reported coming to rural communities to work for reasons of location, interest in the practice setting, and income, and staying for similar reasons. Important variations were noted by nurse type and region.

CONCLUSIONS

The proportion of the rural nursing workforce in Canada is continuing to decline in relation to the proportion of the Canadian population in rural and remote settings. Survey results about the characteristics and practice of the various types of nurses can support workforce planning to improve nursing services and access to care.

Evaluating trauma nursing education: An integrative literature review

OBJECTIVE

A review of the current literature evaluating trauma nursing education.

BACKGROUND

A variety of trauma nursing courses exist, to educate nurses working in trauma settings, and to maintain their continuing professional development. Despite an increase in the number of courses delivered, there appears to be a lack of evidence to demonstrate the effectiveness of trauma nursing education and in particular the justification for this resource allocation.

DESIGN

Integrative literature review.

DATA SOURCES

A search of international literature on trauma nursing education evaluation published in English from 1985 to 2015 was conducted through electronic databases CINAHL Plus, Google Scholar, PubMed, Austhealth, Science Citation Index Expanded (Web of Science), Sciverse Science Direct (Elsevier) & One file (Gale). Only peer reviewed journal articles identifying trauma course and trauma nursing course evaluation have been included in the selection criteria.

REVIEW METHODS

An integrative review of both quantitative and qualitative literature guided by Whittemore and Knafl's theoretical framework using Bowling's and Pearson's validated appraisal checklists, has been conducted for three months.

RESULTS

Only 17 studies met the inclusion criteria, including 14 on trauma course evaluation and 3 on trauma nursing course evaluation. Study findings are presented as two main themes: the historical evolution of trauma nursing education and evaluation of trauma nursing education outcomes.

CONCLUSION

Trauma nursing remains in its infancy and education in this specialty is mainly led by continuing professional development courses. The shortage of evaluation studies on trauma nursing courses reflects the similar status in continuing professional development course evaluation. A trauma nursing course evaluation study will address the gap in this under researched area.

Predictors of attrition for a sexual assault forensic examiner (SAFE) blended learning training program

INTRODUCTION

Participant attrition is a major concern for online continuing education health care courses. The current study sought to understand what factors predicted health care professionals completing the online component of a sexual assault forensic examiner (SAFE) blended learning training program (12-week online course and 2-day in-person clinical skills workshop).

METHODS

The study used a Web-based survey to examine participant characteristics, motivation, and external barriers that may influence training completion. Hierarchical logistic regression was utilized to examine the predictors of training completion, while the Cox proportional hazards (Cox PH) regression model helped determine the factors associated with the timing of participant attrition.

RESULTS

Results show that 79.3% of the enrolled professionals completed the online component. The study also found that clinicians who work in rural communities and those who were interested in a 2-day clinical skills workshop were more likely to complete the online course. In terms of when attrition occurred, we found that participants who were motivated by the 2-day clinical workshop, those who worked in a rural community, and participants interested in the training program because of its online nature were more likely to complete more of the online course.

DISCUSSION

Blending an online course with a brief in-person clinical component may serve as a motivator for completing an online course because it provides the opportunity to develop clinical skills while receiving immediate feedback. Participant attrition appears to be less of a concern for rural clinicians because this modality can reduce their barriers to accessing continuing education.

The facilitators and barriers to nurses' participation in continuing education programs: a mixed method explanatory sequential study

Background:

Since several factors affect nurses’ participation in Continuing Education, and that nurses’ Continuing Education affects patients’ and community health status, it is essential to know facilitators and barriers of participation in Continuing Education programs and plan accordingly. This mixed approach study aimed to investigate the facilitators and barriers of nurses’ participation, to explore nurses’ perception of the most common facilitators and barriers.

Methods:

An explanatory sequential mixed methods design with follow up explanations variant were used, and it involved collecting quantitative data (361 nurses) first and then explaining the quantitative results with in-depth interviews during a qualitative study.

Results:

The results showed that the mean score of facilitators to nurses’ participation in Continuing Education was significantly higher than the mean score of barriers (61.99±10.85 versus 51.17±12.83; p<0.001, t=12.23). The highest mean score of facilitators of nurses’ participation in Continuing Education was related to “Update my knowledge”. By reviewing the handwritings in qualitative phase, two main levels of updating information and professional skills were extracted as the most common facilitators and lack of support as the most common barrier to nurses’ participation in continuing education program.

Conclusion:

According to important role Continuing Education on professional skills, nurse managers should facilitate the nurse’ participation in the Continues Education.

Psychometric properties of an instrument to measure facilitators and barriers to nurses' participation in continuing education programs

Background:

Continuing education programs are one of the professional principles in health-related disciplines, including nursing. The aim of this study was to develop an instrument measuring facilitators and barriers to nurses’ participation in continuing education programs.

Methods:

In the first phase, the items generated for the instrument were drawn from a comprehensive literature review along with a polling of experts. Then the psychometric properties were measured.

Results:

A Scale-Level Content Validity Index of 0.90 for the primary instrument with 36 items was obtained. The factor structure of inventory was identified by undertaking a Principal Component Analysis in a sample of 361 nurses. Three factors were extracted with a total variance account of 62.67%. Reliability was demonstrated with Cronbach’s alpha coefficient = 0.92. Consistency of instrument was established with test-retest reliability (Intra Cluster Correlation = 0.93, P<0.001).

Conclusion:

The major focus of this study was to develop a locally sensitive instrument to assess the facilitators and barriers to Iranian nurses’ participation in continuing education programs.

A cross-sectional study of facilitators and barriers of Iranian nurses' participation in continuing education programs

Background:

Continuing education is one of the modern strategies to maintain and elevate knowledge and professional skills of nurses which in turn elevate the health status of society. Since several factors affect nurses’ participation in continuing education, it’s essential to know promoters and obstacles in this issue and plan accordingly.

Methods:

In this cross-sectional study, 361 Iranian nurses who were recruited by convenience sampling method completed an anonymous, self-administered questionnaire from October 2012 to April 2013. Topics covered the participants’ attitudes towards facilitators and barriers of their participation in continuing education.

Results:

Mean and standard deviation of participants’ age were 37.14±7.58 years and 93.94% were female. The maximum score of facilitators and barriers to nurses’ participation in continuing education were related to “Update my knowledge” and “Work commitments” respectively. The results showed among Iranian nurses, the mean score of personal and structural barriers was significantly higher than the mean score of interpersonal ones (F=2122.66, p<0.001).

Conclusion:

Results highlight policy makers and nursing managers’ role on improving the accessibility to provided continuing education programs by enforcement of facilitators and reducing barriers focusing on the personal and structural barriers.

Development and mixed-methods evaluation of a pain assessment video training program for long-term care staff

INTRODUCTION

Inadequacies in pain assessment and management in long-term care have been well documented. Insufficient pain education and inaccurate beliefs about the nature of pain and aging have been identified as possible contributors. The present study addresses the need for improved, efficient and feasible continuing pain education through the use of an assessment training video.

METHODS

A total of 148 long-term care staff viewed and evaluated the training video. Knowledge changes and pain beliefs were assessed postvideo and at a four-week follow-up. Beliefs about pain, as well as pain and aging, were also examined using multivariate procedures to determine whether these variables influenced participants' evaluation of the video. Focus groups were also conducted, and transcripts were analyzed using thematic content analysis.

RESULTS

Pain assessment knowledge improved postvideo and at the four-week follow-up. Participants positively evaluated the content and quality of the video. Individuals who held stronger beliefs (at baseline) about the organic nature of pain provided more positive evaluations. Barriers to implementation of practices in the video identified by the focus groups (and qualitative analysis) included time, workload and resistance to change. Facilitators to implementation included continued management support and observing the benefits to implementation.

DISCUSSION

The present study provides support for the use of video training. However, based on the focus group results, top-down implementation approaches with ongoing management involvement throughout the implementation process may be needed to achieve sustained changes in pain assessment practices. A model useful for sustained implementation was proposed and discussed, and is hoped to facilitate future research.

Continuing education to go: capacity building in psychotherapies for front-line mental health workers in underserviced communities

OBJECTIVE

To address the gaps between need and access, and between treatment guidelines and their implementation for mental illness, through capacity building of front-line health workers.

METHODS

Following a learning needs assessment, work-based continuing education courses in evidence-supported psychotherapies were developed for front-line workers in underserviced community settings. The 5-hour courses on the fundamentals of cognitive-behavioural therapy, interpersonal psychotherapy, motivational interviewing, and dialectical behaviour therapy each included videotaped captioned simulations, interactive lesson plans, and clinical practice behaviour reminders. Two courses, sequentially offered in 7 underserviced settings, were subjected to a mixed methods evaluation. Ninety-three nonmedical front-line workers enrolled in the program. Repeated measures analysis of variance was used to assess pre- and postintervention changes in knowledge and self-efficacy. Qualitative data from 5 semistructured focus groups with 25 participants were also analyzed.

RESULTS

Significant pre- and postintervention changes in knowledge (P < 0.001) were found in course completers. Counselling self-efficacy improved in participants who took the first course offered (P = 0.001). Dropouts were much less frequent in peer-led, small-group learning than in a self-directed format. Qualitative analysis revealed improved confidence, morale, self-reported practice behaviour changes, and increased comfort in working with difficult clients.

CONCLUSION

This work-based, multimodal, interactive, interprofessional curriculum for knowledge translation of psychotherapeutic techniques is feasible and helpful. A peer-led group format is preferred over self-directed learning. Its application can build capacity of front-line health workers in helping patients who suffer from common mental disorders.

Clinical nurses' perception of continuing professional education as a tool for quality service delivery in public hospitals Calabar, Cross River State, Nigeria

This study was conducted to determine the perception of nurses on various aspects of continuing professional education (CPE). A mixed method design (quantitative/qualitative) was adopted. A self-explanatory, semi-structured questionnaire was validated and used to collect data in addition to unstructured interview. One hundred and fifty nurses were selected through stratified random sampling from two hospitals in Calabar, Nigeria and served as participants. Participants generally perceived CPE as valuable and worthwhile and participated because it is mandatory and helps them to retain their jobs. The content of CPE were perceived to be more relevant for clinicians than for nurse educators; clinical skills and quantitative research methodology were adequately covered while evidence-based practice, attitudinal issues, nursing theories and patient safety were inadequately covered. CPE was perceived to be fragmented without gaining points, follow-up monitoring and evaluation after CPE which make it difficult to objectively assess the influence of CPE on quality of care. It is recommended that nurse leaders in Nigeria should develop online CPE modules for nursing, and allocate points to them so that participation may contribute to career progression. Effective monitoring and evaluation systems should be put in place to assess impact of CPE on staff competence and patient outcomes.

Impact of eLearning course on nurses' professional competence in seclusion and restraint practices: 9-month follow-up results of a randomized controlled study (ISRCTN32869544)

eLearning may facilitate continuing vocational education, but data on the long-term effects of an eLearning course are lacking. The aim of this study was to explore the long-term impact of an eLearning course entitled ePsychNurse.Net on psychiatric nurses' professional competence in practicing seclusion and restraint and on their job satisfaction and general self-efficacy at 9-month follow-up. In a randomized controlled study, 12 wards were randomly assigned to the ePsychNurse.Net (intervention) or training as usual (control). Baseline and 9-month follow-up data on nurses' knowledge of coercion-related legislation, physical restraint and seclusion, their attitudes towards physical restraint and seclusion, job satisfaction and general self-efficacy were analysed for 137 completers (those who participated in the 9-month follow-up assessment). No between-group differences were found on any variable, with the exception of a change in attitude to seclusion in favour of the control group. The findings of the long-term effects did not differ from the immediate outcomes (3-month follow-up) and the improved level of knowledge acquired and further consolidation of that knowledge did not take place in the 6-month period after the 3-month ePsychNurse.Net course. The ePsychNurse.Net should be further developed and its future modifications will require additional studies, probably with some new outcome measures.

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.

A qualitative study of continuing education needs of rural nursing unit staff: the nurse administrator's perspective

BACKGROUND

This study reports perceptions of the continuing education (CE) needs of nursing unit staff in 40 rural healthcare facilities (10 hospitals and 30 long-term care facilities) in a rural Midwestern U.S. region from the perspective of nurse administrators in an effort to promote a community-based academic-practice CE partnership.

METHODS

Qualitative data collection involving naturalistic inquiry methodology was based on key informant interviews with nurse administrators (n=40) working and leading in the participating health care facilities.

RESULTS

Major themes based on nurse administrators' perceptions of CE needs of nursing unit staff were in four broad conceptual areas: "Cultural issues", "clinical nursing skills", "patient care", and "patient safety". Major sub-themes for each conceptual area are highlighted and discussed with narrative content as expressed by the participants. Related cultural sub-themes expressed by the nurse administrators included "horizontal violence" (workplace-hospital and LTC nursing unit staff) and "domestic violence" (home-LTC nursing unit staff).

CONCLUSIONS

The uniqueness of nurses' developmental learning needs from a situational point of view can be equally as important as knowledge-based and/or skill-based learning needs. Psychological self-reflection is discussed and recommended as a guiding concept to promote the development and delivery of relevant, empowering and evidence-based CE offerings for rural nursing unit staff.

Mandatory continuing professional development requirements: what does this mean for Australian nurses

Background

This paper presents a discussion related to the recent decision in Australia to introduce mandatory Continuing Professional Development (CPD) for nurses. Historically there has been international debate surrounding mandatory CPD requirements; this debate is ongoing as Australian nurses face a diverse range of CPD offerings from a variety of providers.

Discussion

The purpose of this paper is to examine how mandatory CPD requirements for national nursing registration in Australia have evolved and to present an analysis of what this will mean for Australian nurses. What is yet to be determined is how to measure professional development and the effectiveness of professional development education. This is important to the international community with consensus in the literature that professional development is linked to ongoing education. Contradicting arguments are presented about whether this professional development should be mandatory.

Summary

Presenting a contemporary discussion about the current and potential impact of mandatory CPD requirements for nurses, this discussion paper utilises the case of Australia’s current national policy and CPD operation to examine the choices that nurses make in order to fulfil their legislative requirements. Additional arguments are presented about the barriers nurses face in undertaking CPD. The quest for effective CPD is complex and should incorporate different situations for nurses and individual learning styles.

Nursing intellectual capital theory: testing selected propositions

AIMS

To test the selected propositions of the middle-range theory of nursing intellectual capital.

BACKGROUND

The nursing intellectual capital theory conceptualizes nursing knowledge's influence on patient and organizational outcomes. The theory proposes nursing human capital, nurses' knowledge, skills and experience, is related to the quality of patient care and nurse recruitment and retention of an inpatient care unit. Two factors in the work environment, nurse staffing and employer support for nurse continuing professional development, are proposed to influence nursing human capital's association with patient and organizational outcomes.

DESIGN

A cross-sectional survey design.

METHODS

The study took place in 2008 in six Canadian acute care hospitals. Financial, human resource and risk data were collected from hospital departments and unit managers. Clearly specified empirical indicators quantified the study variables. The propositions of the theory were tested with data from 91 inpatient care units using structural equation modelling.

RESULTS

The propositions associated with the nursing human capital concept were supported. The propositions associated with the employer support for nurse continuing professional development concept were not. The proposition that nurse staffing's influences on patient outcomes was mediated by the nursing human capital of an inpatient unit, was partially supported.

CONCLUSION

Some of the theory's propositions were empirically validated. Additional theoretical work is needed to refine the operationalization and measurement of some of the theory's concepts. Further research with larger samples of data from different geographical settings and types of hospitals is required to determine if the theory can withstand empirical scrutiny.

Nurses' attitudes toward continuing formal education: a comparison by level of education and geography

The education of nurses has an influence on patient safety and outcomes, the nursing shortage, the faculty shortage, and nurses' attitudes and actions. This article reports on a dissertation study designed to examine the attitudes of nurses, initially registered with an associate degree or diploma in nursing, toward continuing formal education. Actively licensed registered nurses in the eastern and western United States (n=535) participated. The main finding of this study was that, although nurses held positive attitudes overall, attitudes ranked barely above neutral. The findings suggest that work needs to be done to improve nurses' attitudes toward continuing formal education and research needs to be undertaken to understand what would entice nurses back to school. Implications for nursing practice and education are discussed along with suggestions for future research.

"Finding my own time": examining the spatially produced experiences of rural RNs in the rural nursing certificate program

CONTEXT

Rural nurses require access to education that exposes them to the most up-to-date information and skill development. However, since most education opportunities are located in urban centers and focused on providing skills to urban nurses, geography effectively acts as a barrier to accessing education that meets the needs of rural nurses. The Rural Nursing Certificate Program is a post-basic education program that addresses these concerns by providing rural-relevant content online, with limited campus sessions.

PURPOSE

Does online delivery of rural nursing curriculum overcome challenges related to geography?

METHODS

This study employed surveys with some open-ended questions. Analysis included descriptive statistics and content analysis.

FINDINGS

Students reported that online delivery improved access. Benefits included not having to relocate; being able to continue working; and, flexibility. Challenges included travel for practical experiences and time management related to staffing shortages, personal-professional overlap and family responsibilities.

CONCLUSIONS

Online learning improved access to nursing education. However, the realities of rural nursing made it impossible to completely overcome geography: sense of obligation to work overtime, cost and time of traveling to workshops and practicums, uneven access to the Internet and computer services, and distance from peer and university support remained challenges.

Developing and piloting an online graduate nursing course focused on experiential learning of qualitative research methods

Despite the turmoil of a worldwide economic crisis, the health sector remains largely understaffed, and the nursing shortage represents a major issue that jeopardizes graduate nursing education. Access to education remains a challenge, particularly in rural and remote areas. This article reports the process of developing an asynchronous online qualitative research course. This online course was piloted among 16 interdisciplinary students. Participants agreed that experiential learning was useful to understand the intricacies of qualitative research. Within this constructivist approach, students were immersed in real-life experiences, which focused on the development of skills applicable to qualitative research. Based on the findings, we suggest that constructivism and the Four-Component Instructional Design (4C/ID) model (a four-part approach for fostering the development of complex skills) represent valuable ontological and pedagogical approaches that can be used in online courses. Triangulating these two approaches is also congruent with the student-centered philosophy that underpins nursing graduate programs.

Impact of eLearning course on nurses' professional competence in seclusion and restraint practices: a randomized controlled study (ISRCTN32869544)

Education on the care of aggressive and disturbed patients is fragmentary. eLearning could ensure the quality of such education, but data on its impact on professional competence in psychiatry are lacking. The aim of this study was to explore the impact of ePsychNurse.Net, an eLearning course, on psychiatric nurses' professional competence in seclusion and restraint and on their job satisfaction and general self-efficacy. In a randomized controlled study, 12 wards were randomly assigned to ePsychNurse.Net (intervention) or education as usual (control). Baseline and 3-month follow-up data on nurses' knowledge of coercion-related legislation, physical restraint and seclusion, their attitudes towards physical restraint and seclusion, job satisfaction and general self-efficacy were analysed for 158 completers. Knowledge (primary outcome) of coercion-related legislation improved in the intervention group, while knowledge of physical restraint improved and knowledge of seclusion remained unchanged in both groups. General self-efficacy improved in the intervention group also attitude to seclusion in the control group. In between-group comparison, attitudes to seclusion (one of secondary outcomes) favoured the control group. Although the ePsychNurse.Net demonstrated only slight advantages over conventional learning, it may be worth further development with, e.g. flexible time schedule and individualized content.

Aging in Rural Canada: A Retrospective and Review

La recherche sur le vieillissement en milieu rural s’est développée considérablement depuis la publication du livre,Aging in Rural Canada(Butterworths, 1991). Le but de cet article est double : de fournir une rétrospective sur les questions de viellissement en milieu rural tirée de ce livre, et une revue de la littérature canadienne sur le vieillissement en milieu rural depuis sa publication. L’examen met en évidence les nouvelles orientations dans les définitions conceptuelles du « rural », et dans les questions de l’engagement social, l’indépendance, les réseaux familiaux et sociaux et les services ruraux et la santé. Deux perspectives principales de recherche sont évidents. Le point de vue ou l’optique d’analyse de la marginalisation se concentre sur les personnes âgées en milieu rural ayant des problèmes de santé, mais n’a pas inclus celles qui sont marginalisées par la pauvrété ou le sexe. L’optique d’analyse du vieillissement sain se concentre sur les contributions et l’engagement, mais a omis la recherche sur les relations sociales et la qualité de l’interaction familiale. Le rapport comprend un appel s’interroger sur l’interaction entre les gens et leur lieu de vie et à comprendre les enjeux de la diversité en milieu rural et le processus de vieillissement en milieu rural.

What influences malaysian nurses to participate in continuing professional education activities?

PURPOSE

A cross sectional descriptive study, which involved government hospitals and health clinics from Peninsular Malaysia sought to identify the continuing professional education (CPE) needs and their readiness for E-learning. This paper focuses on the first phase of that study that aimed to determine the factors that influence nurses' participation in CPE.

METHODS

Multistage cluster sampling was used to recruit 1,000 nurses randomly from 12 hospitals and 24 health clinics from four states in Peninsular Malaysia who agreed to be involved. The respondent rate was 792 (79.2%), of which 562 (80%) had participated in CPE in the last 12 months.

RESULTS

Findings suggested that updating knowledge and providing quality care are the most important factors that motivate participation in CPE, with respective means of 4.34 and 4.39. All the mean scores for educational opportunity were less than 3.0. Chi-square tests were used to test the association of demographic data and CPE participation. All demographical data were significantly associated with CPE participation, except marital status.

CONCLUSIONS

Implementation of mandatory CPE is considered an important measure to increase nurse's participation in CPE. However, effective planning that takes into consideration the learning needs of nurses is recommended.

Benefits, barriers, and intentions/desires of nurses related to distance learning in rural island communities

BACKGROUND

This study assessed distance learning needs among nurses on the Neighbor Islands in Hawaii.

METHODS

An exploratory study was conducted using a descriptive qualitative design. Of the 37 nurses who completed the study, 7 were nurse administrators and 30 were staff nurses. There were 18 focus groups of nurses recruited from six public hospitals on the Neighbor Islands.

RESULTS

Three major themes related to distance learning emerged in this study: benefits, barriers, and intentions/desires. Each major theme had several linkages to categories and subcategories.

CONCLUSION

Overall findings were as follows: (1) cost was mentioned more often in three major thematic areas (benefit, barriers, and intentions/desires); (2) the need to revisit and address current curriculum approaches and practices in distance learning programs was identified; and (3) strong recommendations were made for programs and organizational support for distance learning in hospital settings. These findings have implications for nursing research, education, and practice.