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PubMed2006

Creating enduring change: demonstrating the long-term impact of a faculty development program in palliative care.

BACKGROUND: Improved educational and evaluation methods are needed in continuing professional development programs. OBJECTIVE: To evaluate the long-term impact of a faculty development program in palliative care education and practice. DESIGN: Longitudinal self-report surveys administered from April 2000 to April 2005. PARTICIPANTS: Physician and nurse educators from North America and Europe. All program graduates (n = 156) were invited to participate. INTERVENTION: Two-week program offered annually (2000 to 2003) with 2 on-site sessions and 6-month distance-learning period. Learner-centered training addressed teaching methods, clinical skill development, and organizational and professional development. MEASURES: Self-administered survey items assessing behaviors and attitudes related to palliative care teaching, clinical care, and organizational and professional development at pre-, postprogram, and long-term (6, 12, or 18 months) follow-up. RESULTS: Response rates: 96% (n = 149) preprogram, 73% (n = 114) follow-up. Participants reported increases in: time spent in palliative care practice (38% preprogram, 47% follow-up, P < .01); use of learner-centered teaching approaches (sum of 8 approaches used "a lot": preprogram 0.7 +/- 1.1, follow-up 3.1 +/- 2.0, P < .0001); and palliative care topics taught (sum of 11 topics taught "a lot": preprogram 1.6 +/- 2.0, follow-up 4.9 +/- 2.9, P < .0001). Reported clinical practices in psychosocial dimensions of care improved (e.g., assessed psychosocial needs of patient who most recently died: 68% preprogram, 85% follow-up, P = .01). Nearly all (90%) reported launching palliative care initiatives, and attributed their success to program participation. Respondents reported major improvements in confidence, commitment to palliative care, and enthusiasm for teaching. Eighty-two percent reported the experience as "transformative." CONCLUSIONS: This evidence of enduring change provides support for the potential of this educational model to have measurable impact on practices and professional development of physician and nurse educators.

Chi-Square Distribution↗
PubMed2001

An extended epistemology for fostering transformative learning in holistic nursing education and practice.

The transformation from traditional nursing practice to holistic nursing is one that requires recognition of multiple ways of knowing. Transformative learning theory reflects a strong bias toward cognitive epistemology and propositional knowing. This epistemology, labeled here as truncated, rests on an understanding of experience derived from pragmatism. This article describes an extended epistemology derived from the work of John Heron that better reflects the full range of knowing utilized by holistic nurses. This epistemology provides a foundation for innovative approaches for the development of holistic awareness in the training and continuing professional development of nurses. One such approach, collaborative inquiry, is described.

Clinical Competence↗
PubMed1998

Partnerships for sound practice.

Our research into clinical supervision is continuing and project members are disseminating clinical supervision throughout the organisation. Evaluation clearly shows that at least 25% of registered nurses are already engaged in clinical supervision. There are no distinct clinical areas that have not supported staff members participating in the project, indicating its widespread acceptance. In addition, we have discovered that staff with the least prior experience of clinical supervision, such as school nurses and health visitors, are committed to its practice. Clinical supervision is no longer seen as the preserve of mental health nurses. The project is enhancing relationships at all levels between nurses. Service development and rigorous research have been closely linked, while, for individual nurses, continuing professional development is offering a pathway to academic qualification.

Community Mental Health Services↗
PubMed2006

Continuing education in nursing: a concept analysis.

The importance of continuing education for nurses has been increasingly emphasized in the nursing literature since the beginning of the profession. The concept of continuing education is often used as a substitute for associated terms such as continuing professional development and lifelong learning, thus highlighting a need for its clarification. The purpose of this article is to explain and describe continuing education, in order to encourage a broader understanding of the concept among nurses. The concept analysis is directed by Rodgers' [Rodgers, B.L., 1989. Concept analysis and the development of nursing knowledge: the evolutionary cycle. Journal of Advanced Nursing 14, 330-335] 'evolutionary approach' which is viewed as an ongoing dynamic process, and one that identifies the shared meaning of concepts. Examining everyday discourse used in the nursing literature identified the critical attributes, antecedents and consequence of continuing education in nursing. As a result, the emerging attributes of the concept are synthesised into a conceptual model. The article concludes with an exploration of the application of the concept of continuing education within nursing and its implications for professional development.

Concept Formation↗
PubMed1995

The potential of the professional portfolio for nursing.

Professional profiles and portfolios have recently been identified by nursing's regulatory bodies in the UK as ways of recording each nurse's career and professional development. Although the use of portfolios is widespread in education, the concept of a developmental portfolio to support continuing professional development on an individual basis is recent. As an innovation in nursing the portfolio is to be used for periodic registration with the UK Central Council (UKCC), for the on-going recording of learning, both formal and experiential, and as a way of accrediting prior learning for academic purposes. This paper argues that the potential of the portfolio is wider than the purposes already identified in that the knowledge generated from experiential learning and identified by reflective practice is of specific interest and value to the nursing profession as a whole. In particular portfolios are likely to record the knowledge embedded in practice, which is often hard to describe, yet represents nursing's expertise. For this potential to be realized pragmatic issues such as finance, time and verification of experiences need to be addressed, and an infrastructure created to support the nurse compiling the profile.

Documentation↗
PubMedDate not supplied

The development of an academic rated induction programme in a high dependency unit.

The commissioning of a new high dependency unit in a large district general hospital prompted the need to develop a comprehensive structured induction programme. A simple training needs analysis (TNA) tool was developed and used to assess the training requirements of 12 nurses who would make up the team. The results of the TNA gave an indication of where to channel resources into a month-long induction programme. The programme was linked to the outcomes of a diploma module to ease the processes of accreditation of prior learning (APL) for those who chose to access higher education programmes beyond the duration of the induction. The programme was evaluated positively and is seen as a way forward for the future of flexible, accessible, practice-based, continuing professional development opportunities.

Critical Care↗
PubMed2000

The development of a conceptual framework for advancing cancer nursing practice in Europe.

Continued professional development through formal education programmes is essential for improving the quality of care provided to patients with cancer. This paper describes a European Oncology Nursing Society project concerned with advanced cancer nursing education. While the development of an education programme for advanced cancer nursing practice in Europe proves difficult at this time, this project has provided the opportunity to examine some of the key elements of advanced cancer nursing work. In turn, the information gained has enabled the development of a conceptual framework for advancing cancer nursing practice in Europe to be constructed.

Journal Article↗
PubMedDate not supplied

Critical care competencies.

In the absence of nationally accepted critical care competencies, each educational institution providing critical care programmes is forced to define the essential competencies necessary for practice, leading to variations in expected practice and the emergence of 'postcode' competencies. This research report aims to build upon competency activity for all areas of nursing practice within critical care levels 1, 2 and 3. A functional analysis to elicit core critical care competency statements was conducted and a modified Delphi technique was used to generate consensus opinion from a pan-London purposive sample of nurses working in critical care. The functional analysis group identified four competency statements and elements of competencies. Consensus agreement of 80% was achieved with mean agreement scores that exceed 97%. A core critical care competency framework was refined and developed by expert nurses drawing on their own experience and knowledge of critical care nursing. The framework could be useful to: educationalists designing competency-based curricula; critical care managers as a tool for recruitment and retention and for education and training of staff; individual critical care nurses to facilitate continuous professional development.

Clinical Competence↗
PubMed2001

Opportunities on the Web: a role for information professionals, using the development of the BMA Library Online Service as a case study.

The paper considers how attributes and skills fundamental to the information profession may be applied to the development and management of Web-based services and resources. It also looks at the need for the acquisition of new skills as part of a continuing professional development programme. The report considers the changing role of the Webmaster and the implications this might have in terms of the role of information professionals. To offer a practical example, from within the healthcare sector, the article goes on to describe the development of BMA Library Online. This is the BMA Library's own suite of Web-based information services and resources for personal members, institutional members and staff. The library's own Web team has been responsible for the development and maintenance of BMA Library Online. To conclude, the paper looks forward to future possibilities for information professionals as Web developers and at how this might be influenced by changes in the Webmaster role. It is crucial that skills and expertise are shared as the roles that go to make up a Webmaster or Webmaster team continue to merge and evolve, and with the possible wider distribution of provision of Web content within organizations.

Information Management↗
PubMed2005

Progressing evidence-based practice: an effective nursing model?

AIMS: This paper presents findings from telephone interviews completed with link nurses 2 years into the project to explore how participation progressed achievement of evidence-based practice where the link nurses worked. BACKGROUND: In 2001, an innovative practice development initiative was launched in Scotland. A national network of experienced nurses from across the country was recruited to form the inaugural Community of Practice. This involved describing gerontological nursing, pioneering a nurse-sensitive methodology to craft care guidance that reflects the agreed practice model, and constructing a virtual college based on a situated learning model. METHODS: A volunteer sample of link nurses took part in telephone interviews exploring experiences of using the virtual college and the extent to which the description of gerontological nursing and the first best practice statement on nutrition had influenced practice. FINDINGS: Five components (themes) were identified as facilitating the attainment of evidence-based practice. These focussed on confidence-building and the positive benefits of achieving vision and clarity for gerontological nursing. Membership of a national Community of Practice afforded status and strengthened sense of professional identity. The inclusive knowledge synthesis methodology used to prepare, pilot and support implementation of the best practice statement was highly valued. Progress towards evidence-based practice in all affiliated areas was reported. Major challenges for nurses in participating in the virtual college included the absence of a learning-at-work culture, lack of time and doubts about the legitimacy of internet-based learning. CONCLUSION: The evaluation indicates the potential merits of e-practice development, particularly for nurses who feel geographically and professionally isolated or disenchanted with available continuing professional development opportunities. Participation in the virtual college appeared to enrich practice and foster a culture of change.

Aged↗
PubMed1998

Changes in professional development. Educating the gastroenterologist for the year 2000.

Recent changes in society, the practice in medicine, the health care delivery and new technologies will have a direct impact on the development of the medical profession. Thus, there is a need for more efficient, evidence-based and evaluated continuing medical education (CME) programs. But CME in one's own speciality interest is not enough. CME has to be extended into a broader context of continuing professional development (CPD) including personal, social and political aspects of medical practice. New methods have to concentrate on adult learning principles, individual needs and self-directed learning and have to promote performance-based assessment, outcome evaluation, communication skills, patient education and the use of computers and telecommunication technologies. All principles have to begin before entering medical school and then be continued and supported through a new medical curriculum from undergraduate to postgraduate training according to the 'lifelong learning' principle. All honorable gastroenterology, hepatology and endoscopy societies throughout the world should further define professionalism and develop leadership and management programs for their members. Nevertheless, every doctor always has a personal responsibility for lifelong learning.

Education, Medical, Continuing↗
PubMed2002

Geriatric medicine on the web.

A major website has been developed containing almost all of the information doctors require to manage any older medical patient. It caters for geriatricians, for those with an uneven, basic knowledge of geriatric medicine, and for differing international requirements. The validity and reliability of the site were assured by a specialist review board recruited from the American and British Geriatrics Societies, World Health Organisation, and the Pan American Health Organisation. This paper describes the development of the site, and outlines the planning and development process for a further web site. This will allow a doctor's practical knowledge of geriatric medicine to be assessed on-line, in an interactive educational way as a means of continued professional development.

Aged↗
PubMedDate not supplied

Why lifelong learning?

The importance of professional development and what it means for nurses was described in a previous issue of International Nursing Review (March/April 1997). Below is a look at lifelong learning as reflected in continuing professional development for nurses, some international trends that influence health care, the international linkages taking place and the areas to be targeted for future professional development programmes.

Community Health Nursing↗
PubMed2001

[The Cusum score. A tool for evaluation of clinical competence].

INTRODUCTION: The cusum analysis (cummulative summation) is a statistical technique used to assess the competence of medical trainees. We wanted to re-examine the validity of the test as a technique for qualitative assessment of competence, as well as a technique for monitoring the level of specialists' competence. METHODS: Doctors in two anaesthetic departments were asked to plot the cusum as they performed the following procedures: epidural and spinal analgesia, insertion of central venous and arterial cannulae. RESULTS: Data were collected over a year. Thirty-five doctors were asked to plot the cusum. The plots were returned by 75% (9/12) of the first year trainees, 50% (4/8) of the second- and third-year trainees, and 20% (1/5) of the four- and five-year trainees. From the specialists and consultants on the staff, we received 66% (4/6) and 50% (2/4). The correlation, according to the level of competence respecting spinal and epidural techniques, is shown in Figures 1 and 2. DISCUSSION: We found, that the cusum analysis is a valid and practical technique for the qualitative assessment of clinical competence as well as a tool for monitoring continuous professional development. The technique can be used in a number of settings. With the increasing demand in health care for continuous quality assurance, the analysis can be used both in personal professional monitoring and in monitoring of performance during training.

Anesthesia, Epidural↗
PubMed2003

Expert leaders for healthcare administration.

This commentary explores the role of graduate programs in developing future leaders in health administration. The five-stage Dreyfus model for skill acquisition is applied to graduate education and continuing professional development, and barriers to producing the type of leader capable of transforming the healthcare system are discussed.

Administrative Personnel↗
PubMed1996

Development of human resources for medical research.

Acknowledges that progress in health care depends on achievements in biomedical research. Discusses the continuing professional development of research workers and the role of international organizations such as the WHO and UNESCO. Argues that a creative approach is necessary to ensure stability in health development.

Community Health Planning↗
PubMed2001

A new paradigm for practice education.

This paper explores the complex nature of professional practice. It suggests that educating for all practice disciplines is about to undergo a paradigm shift whereby the value of practical education and experience will be better understood, more rigorously analyzed and integrated with propositional knowledge in the construction of personal professional knowledge and identity. It relates this cross disciplinary position to the present problems of skills deficits which are evident in nurses at the point of registration and demonstrates how routinization and internalization of process and tacit knowledge can create problems for students and newly qualified staff nurses. It also suggests how this can be addressed. It discusses the present culture of 'clinical education by default', unavailability of mentors and resources, and general lack of formal collaborative structures between education and service institutions and suggests that the present system cannot sustain the complex demands, expectations and pace of the clinical context and the evolution of nursing practice. Clinical credibility is an issue as is the current heavy clinical workload of staff nurse mentors, and several collaborative clinical education models are outlined which ensure that staff nurses or resident clinical educators are available and can make clinical teaching their priority. History and the present crisis in nursing suggest that there is a case for mandatory collaborative education/service structures to ensure adequate funding and to monitor the effectiveness of selected models so that staff nurse mentors can work with lecturer colleagues to articulate and teach the complexities of clinical practice through related research. It is predicted that this collaborative approach is capable of addressing both the skills deficits and the wider intellectual challenge of developing a new paradigm of practice education and providing an integrated base for continuing professional development.

Clinical Competence↗
PubMed2003

Achieving lifelong learning for all health service professionals.

Plans are in place to make lifelong learning accessible for all health-care staff, whatever their profession. However, as the second of two articles on continuing professional development reveals, there is still wide variation across trusts in access to education.

Career Mobility↗