Exploring ward nurses' perceptions of continuing education in clinical settings

doi:10.1016/j.nedt.2013.07.003

Nurse Education Today

Volume 34, Issue 4, April 2014, Pages 655-660

https://doi.org/10.1016/j.nedt.2013.07.003 Get rights and content

Summary

Background

Health care systems demand that nurses are flexible skilful workers who maintain currency and competency in order to deliver safe effective patient centered care. Nurses must continually build best practice into their care and acquire lifelong learning. Often this learning is acquired within the work environment and is facilitated by the clinical nurse educator. Understanding clinical nurses' values and needs of continuing education is necessary to ensure appropriate education service delivery and thus enhance patient care.

Objectives

To explore clinical ward-based nurses' values and perceptions towards continuing education and what factors impact on continuing education in the ward.

Design

A case study approach was utilized.

Setting

A major teaching hospital in Melbourne, Australia.

Participants

A range of clinical nursing staff (n = 23).

Methods

Four focus groups and six semi-structured individual interviews were undertaken. Focus group interviews explored participants' values and perceptions on continuing education through a values clarification tool. Thematic analysis of interviews was undertaken to identify themes and cluster data.

Results

Three central themes: ‘culture and attitudes’, ‘what is learning?’ and ‘being there–being seen’, emerged reflecting staffs' values and perceptions of education and learning in the workplace.

Conclusions

Multiple factors influence ward nurses' ability and motivation to incorporate lifelong learning into their practice. Despite variance in nurses' values and perceptions of CE in clinical environments, CE was perceived as important. Nurses yearned for changes to facilitate lifelong learning and cultivate a learning culture. Clinical nurse educators need to be cognizant of adult learners' characteristics such as values, beliefs, needs and potential barriers, to effectively facilitate support in a challenging and complex learning environment. Organizational support is essential so ward managers in conjunction with educational departments can promote and sustain continuing education, lifelong learning and a culture conducive to learning.

Introduction

The role of the Clinical Nurse Educator (CNE) in Australia is considered to be a provider of educational services for nurses, linking with the organizational and patients' needs. The UK role of Practice Education Facilitator (PEF) is similar although PEFs' role also includes mentoring and preceptorship training. Perceptions about education and the role of the CNE vary. There is uncertainty about the extent of the role, how education is delivered, and varying and competing needs of the individual, ward and organization. These elements impact on the culture of learning, and vicariously on patient care. The CNEs' role is therefore complex, with little to guide practice (Conway and Elwin, 2007). Misconceptions from ward nurses and managers create further difficulty for CNEs to lead change (Conway and Elwin, 2007, Manley and McCormack, 2003).

Nurses are required to be flexible, critical thinkers striving to deliver safe and effective patient centered care. Hence, fostering lifelong learning and educational opportunities within clinical practice is important. Facilitating this learning requires gaining nurses' acceptance and integration of education into their everyday practice and the ward team. There is, however, a scarcity of literature that examines nurses' needs and values of education provision and how this might contribute to nurses' professional development. Continuing education (CE), defined as post registration activities that facilitate learning within the workplace, can augment the professional self (Billett, 2004, Osmond, 2003).

Section snippets

Background

The current global challenges of economic downturn, cultural shifts, technological advancements and overpopulation have impacted on all workplaces, where adaptable, skillful workers engaged in continuous professional development are required (Bastable, 2008, Health Workforce Australia, 2011, Watson, 2003). The demanding, complex health care system of today has seen the nurse's role in Australia extended and expanded to a recognized professional, offering an essential element in managing patient

Aims

This qualitative, descriptive study sought to explore clinical ward based nurses' values and perceptions towards continuing education (CE) and professional development. Within one acute ward in a major teaching tertiary hospital in Victoria, Australia, the research sought to examine:

1.
In what ways is education valued by nurses and how do they perceive their role in CE?
2.
What factors, if any, impact on CE in the ward? and
3.
What aspects of CE would nurses like to see developed in their ward?

Study Population

Permanent

Method

The study utilized the theoretical framework of case study (Anthony and Jack, 2009, Baxter and Jack, 2008, Yin, 2009). The focus of the case was to examine ‘how’ nurses view and perceive CE, their experiences and ‘what’ they see as CE within the real-life context of their ward environment.

Both focus groups and individual interviews were used as data collection methods. Four interactive focus groups with 23 nurses were held initially, followed by individual interviews (n = 6). The focus group

Findings

Three themes were identified: culture and attitudes, what is learning, and being there–being seen, that encapsulate the central focus of clinical nursing staff's values and perceptions of CE. These themes offer insight into the nurses' values and perceptions and while they highlight a desire for a learning culture, the factors that impact and impede CE within the ward are also illustrated. To enable the participants' comments to be read in context, they are grouped according to broad categories

Discussion

Working within the current complex health care system is proving difficult for nurses and is impacting on the assimilation of CE and learning. For nurses to maintain professional development they need CE to be integrated into the workplace. The findings of this study indicate that CE is seen by the majority of participants as a necessary element to being able to provide appropriate patient care. Yet, some nurses appeared apathetic to CE along with some inconsistency between many nurses'

Conclusion

In considering CE it is important to acknowledge the learning possibilities that participation in everyday practice does or does not generate (Boud and Hager, 2012). Certainly in this study, the values clarification exercise challenged many nurses to uncover their beliefs within their practice setting, and how CE is integrated into their workplace culture. The role of the CNE was debated and questioned; illustrating the need for CNEs to have a clear role definition and be comfortable with their

Acknowledgments

The authors would like to thank the nurses who so willing participated in this study and all those who supported the first author through the progression of this research.

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Exploring ward nurses' perceptions of continuing education in clinical settings

Summary

Background

Objectives

Design

Setting

Participants

Methods

Results

Conclusions

Introduction

Section snippets

Background

Aims

Study Population

Method

Findings

Discussion

Conclusion

Acknowledgments

Accident & Emergency Nursing

Nurse Education in Practice

Nurse Education Today

Nurse Education in Practice

Nurse Education Today

Qualitative case study methodology in nursing research: an integrative review

Journal of Advanced Nursing

Continuing Competence Framework

Nurse as Educator: Principles of Teaching and Learning for Nursing Practice

Qualitative case study methodology: study design and implementation for novice researchers

The Qualitative Report

Workplace participatory practices: conceptualising workplaces as learning environments

Journal of workplace learning

Re-thinking continuing professional development through changing metaphors and location in professional practices

Studies in Continuing Education

The Adult Learner at Work: A Comprehensive Guide to the Context, Psychology and Methods of Learning for the Workplace

The Adult Learner at Work: The Challenges of Lifelong Education in the New Millennium

Understanding Nursing Research: Building an Evidence-Based Practice

Learning, the Treasure Within: Report to UNESCO of the International Commission on Education for the Twenty-First Century

Becoming and being active learners and creating active learning workplaces: the value of active learning in practice development

Opportunities and challenges facing the future global nursing and midwifery workforce

Journal of Nursing Management

Informal learning in the workplace

Studies in Continuing Education

Learning from other people in the workplace

Oxford Review of Education

Learning in the professional workplace: relationships between learning factors and contextual factors

National Health Workforce Innovation and Reform Strategic Framework for Action-Draft for Consultation

Creating supportive clinical learning environments: an intervention study

Journal of Clinical Nursing