Post Registration Nurse Education in the CAWT Region

Centre for Nursing ResearchUniversity of Ulster

Submitted by:

Assumpta RyanKader ParahooMarian Cooper

January 2001

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List of Contents

Page No. Chapter 1 – Introduction1.1 Background 11.2 Continuing Education frameworks in the United Kingdom 21.3 Continuing Education Frameworks in the Republic of Ireland 31.4 Rationale for the present study 31.5 Research Objectives 51.6 Potential Benefits of the Study 5

Chapter 2 – Methodology2.1 Stage 1- Perceptions of nurses of their educational needs and other relevant 8

areas. 62.1.1 Questionnaire Objectives 62.1.2 Instrument Formulation 62.1.3 Sample and Sampling 72.1.4 Analysis 72.1.5 Ethical Issues 7

2.2 Stage 2 – Focus Group Interviews with Senior Nurse Managers 2.2.1 Focus Group Discussions 82.2.2 Participants 92.2.3 Analysis 92.2.4 Ethical Issues 9

2.3 Structured Interviews with Education Providers 92.3.1 Structured Interviews 102.3.2 Interview Schedule 102.3.3 Analysis 102.3.4 Presentation of Findings 10

Chapter 3 – Training Needs Analysis Questionnaires 123.1 Response Rate 123.2 Profile of Respondents 123.3 Qualifications 123.4 Length of Service 133.5 In-service and post-registration attendance rates 133.6 Frequently attended in-service courses 143.7 Frequently attended post-registration programmes 153.8 Courses currently undertook 163.9 Factors influencing decisions to attend and not to attend additional health related

training and education. 173.10 Personal Obstacles influencing additional health related training and education

attendance. 173.11 Support 193.12 Attitudes to in-service training and post-registration education. 203.13 Future Intentions 21

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Chapter 4 – Focus Group Interviews 244.1 Response Rate 244.2 Profile of Respondents 244.3 Current Provision 254.4 Current Educational Needs 264.5 How are the educational needs of nurses assessed? 274.6 Preparing for the future 294.7 Senior Nurse Managers views on CAWT 31

Chapter 5 – Semi-Structured Interviews 335.1 Research Questions 335.2 Results of Interviews with Educational Providers 335.3 Leadership and Management 375.4 Assessing the demands for in-service training and post-registration

education 395.5 Uptake of Courses 415.6 Delivery of Courses 425.7 Education provider’s views on CAWT 43

Chapter 6 – Summary and Recommendations 456.1 Summary of Key Points 456.2 Recommendations 47

References

Appendices

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List of Tables

Page No

3.1 Job Title 123.2 Qualifications 133.3 Length of Service 133.4 In-service attendance rates over the past 2 years 133.5 Post-registration attendance rates over the past two years 143.6 Frequently attended in-service courses 143.7 Diplomas completed over the past two years 163.8 Degrees completed over the past two years 163.9 Personal obstacles influencing additional health related education

and training attendance 18

4.1 The sample distribution of Focus Group participants 244.2 Job Titles of Focus Group Interviewees 244.3 The extent to which current educational frameworks address a

number of educational issues. 254.4 Top-Ten in-service needs. 274.5 Needs Assessment strategies employed by Sperrin Lakeland

Trust, Cavan General Hospital and Sligo General Hospital. 29

5.1 Current level of provision of clinical courses offered by the four providers and their duration 34

5.2 Current level of provision of leadership and management courses offered by they four providers and their duration 37

5.3 Current level of provision of education courses offered by the fourproviders and their duration. 38

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List of Appendices

Appendix 1 – Clinical, Leadership and Educational courses audited

Appendix 2 – Training Needs Analysis Questionnaires

Appendix 3 – Cover Letter

Appendix 4 – Focus Group Questionnaires

Appendix 5 – Interview Schedule for Semi- Structured Interviews

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Chapter 1

Introduction

1.1 Background

The CAWT (Co-operation And Working Together) initiative originated in July 1992 with the

formulation of a cross border project between the North Eastern and North Western Health

Boards in the Republic of Ireland and the Southern and Western Health and Social Services

Boards in Northern Ireland. Aimed at improving the health and social well being of its

resident populations the project provided a framework for groups and individuals to come

together on a range of common issues relevant to their service areas.

Through funding obtained from the Special Support Programme for Peace and Reconciliation

in 1999, CAWT was provided with the opportunity to investigate the possibility of sustainable

co-operative working arrangements and the further sharing of resources across the catchment

areas of Sperrin Lakeland Trust, Sligo General Hospital and Cavan General Hospital. This, it

is assumed would go a long way in actively supporting the border areas in an attempt to break

down the barriers created by borders that have inhibited economic and social development

over centuries (CAWT, 2000).

Various workshops were organised to map out potential projects and as a result a Nurse

Training and Education subgroup was established. The group proposed the establishment of a

Joint In-service Education Programme for qualified nurses. In-service education was selected

as a key issue for development as it is not only important from a CAWT perspective but a

fundamental requirement for the professional development of nursing in general. The present

study, therefore, aims to promote integration of nursing on both sides of the border, through

an in-service education programme that will incorporate clinical practice, education and

research to enhance the health and well being of the CAWT community.

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1.2 Continuing Education Frameworks in the United Kingdom

Over the past few years post-registration education and training has been subjected to

substantial change and development. The formulation of a Post-Registration Education and

Practice Project (PREPP, UKCC, 1990) for example, has led to significant changes in the

areas of post-registration education and training with the responsibility now being placed on

the practitioners themselves. For example, as part of this package nurses must complete a

minimum of five days in-service study activity or equivalent; maintain a personal professional

profile of learning activity and undertake a Return to Practice Programme from the 1 April

2000 if they do not undertake a minimum of 750 hours/ 100 working days in the five year

period leading to a renewal of registration (NBNI, 2000).

CATS (Credit Accumulation and Transfer Schemes) have also been introduced which now

gives nurses, midwives, and allied professionals, with diploma level qualifications, the

opportunity to ‘top-up’ to degree level through relatively short programmes of study.

Similarly, the introduction of APELS (Accreditation of Prior Experiential Learning Schemes)

now permits staff with the professional experience to ‘trade-in’ their experience to obtain

academic credit.

The recently published NHS plan (NBNI, 2000), while primarily concerning England, has

also served to create major changes within the area of education and learning. Its key

initiatives include:

The drive towards high quality and excellence, and systems being put in place to

achieve these

The emphasis on evidence-based healthcare and clinical effectiveness, and

establishment of research and development strategies and agencies to monitor and

facilitate this emphasis

The establishment of clear lines of clinical accountability through introduction of

clinical governance

The recognition of the vital contribution of the staff within the health services and the

commitment to education and training, and more specifically to a lifelong learning

orientation.

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1.3 Continuing Education in the Republic of Ireland

Continuing Education is defined by An Bord Altranais as ‘a life long professional

development process which takes place after the completion of the pre-registration nurse

education programme. It consists of planned learning experiences which, are designed to

augment the knowledge, skills, and attitudes of registered nurses for the enhancement of

nursing, practice, patient/client care, education, administration and research’ (The

Commission on Nursing 1998, p.100). This is the definition of continuing education that was

formally adopted by the Commission of Nursing in 1998. The Commission saw the need to

develop and strengthen the availability of professional development for all nurses and

midwives and suggested that it might be helpful to consider professional development under

the following three headings (Commission on Nursing, 1998):

In-service – which would consist of education on occupational health issues and work

orientation programmes.

Continuing Education – which would consist of education on developments in nursing and

the treatment of patient groups; and

Specialist Training – which would consist of dedicated educational programmes and

experience supporting a nurse seeking to practice at advanced level.

As a result of these educational developments the responsibility of Education for Specialist

and Advanced Practice was appointed to the National Council for the Professional

Development of Nursing and Midwifery. The Council, which held is first meeting in January

2000, was established in the hope that it would approve courses to ensure accessibility, a

geographic spread in the provision of specialist courses, as well as maximise the use of

educational resources. It is also hoped that the Council will develop ‘a comprehensive

database in relation to the provision of specialist post-registration nursing and midwifery

education and also determine the appropriate level of qualification and experience for entry

into speciality practice’ (An Bord Altranais, 2000, p 22).

1.4 Rationale for the present study

The importance and relevance of continuing professional education to nurses has been

repeatedly illustrated throughout the literature (Hutton, 1987; Waddell, 1991; Nolan and

Owens, 1993; Waddell, 1993). Nolan and Owens (1993) for example, who undertook an

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evaluative study of the Welsh National Board’s Framework for Continuing Education

reported that the framework produced practitioners who indicated that they were more

knowledgeable, confident and assertive which enhanced their contribution to clinical care. A

meta-analysis conducted by Waddell (1993) adds further support to these claims and serves to

highlight how continuing professional education (CPE) can have a positive effect on nursing

practice.

However, despite the amount of research conducted on the effects of continuing professional

education (Nolan et al, 1995; Waddell, 1993) and the recent developments aimed at providing

flexible continuing education programmes, nurses are still deciding not to undergo additional

programmes of study due to a number of obstacles, which are making it increasingly difficult

(Mac Gregor and Dewar, 1997). Difficulty in obtaining study leave, lack of support from

managers, difficulty obtaining funding, low staffing levels, and the late advertisement of

courses (Studdy and Hunt, 1980; Lathlean, 1987; Rogers and Lawrence, 1987; Lindsay, 1990;

Chapman, 1992; Shepherd, 1995; Bariball and While, 1996) have frequently been reported as

major obstacles blocking access to additional nurse related training and education. Mac

Gregor and Dewar (1997) also indicate that staff generally want courses that are more flexible

than those currently available preferring short part-time courses that would permit them to

retain their jobs and use their own off-duty time as study time. A plethora of studies also

report personal obstacles such as domestic responsibilities (Lindsay, 1990; Larcombe and

Maggs, 1991) and a lack of individual motivation as greatly hindering CPE involvement.

As the research clearly demonstrates, nurses have a number of educational needs. The

consistency of certain factors therefore raises the need for these issues to be considered when

planning the provision of in-service and post-registration education. Shepherd (1994, p.68)

maintains that ‘training needs analysis is an essential part in the development of continuing

education programmes and their implementation into practice’. He added that individuals

know best what their educational needs are and can even identify the solutions. Bearing this

in mind, completing a quality needs assessment cannot assure, but almost certainly can assist

in, the development of appropriate cost-effective educational offerings.

A similar view is also shared by Farley and Fay (1988, p.15), who assert that ‘training needs

analysis result in educational programmes that are effective and contribute substantially to the

growth of the health care profession’. The primary aims of the present study are therefore to

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assess the current educational needs and existing education provisions across the CAWT

region, which includes Sperrin Lakeland Trust, Sligo General Hospital and Cavan General

Hospital, in an attempt to provide a baseline measurement of current in-service provision to

identify gaps and barriers in present in-service deliver. It is hoped that this will then provide a

framework against which an effective joint in-service structure can be devised so as to

identify and create long term, sustainable development, of shared services and co-operative

working arrangements in the border area under investigation (CAWT, 2000).

1.5 Research Objectives

In consideration of the primary aims of this study the research objectives are as follows:

1. To conduct a needs assessment to determine the educational needs of qualified nurses

in the CAWT region comprising Sperrin Lakeland Trust, Sligo General Hospital and

Cavan General Hospital.

2. To investigate post-registration education provision in the CAWT region in the

following areas (Appendix 1)

Clinical issues

Leadership issues

Education

3. To highlight priority areas and make recommendations on the structure and content of

a Joint In-service Education Programme for nurses on both sides of the border.

1.6 Potential benefits of the study

It is proposed that the present study will lead to a number of potential benefits.

The sharing of experiences in the context of the cross border culture. There will be a

geographical advantage that will be tailored to the local area, which will be

underpinned by cultural understanding.

The development of nursing skills in an attempt to address the specific needs of the

CAWT community.

The further evolvement of services in the move to ensure that the CAWT community

become self-sufficient in the provision of the health care.

The development of teaching staff skills.

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Chapter 2

Methodology

The objectives of the present study dictated that data were collected in three stages employing

three methods of data collection.

2.1 Stage 1 Perceptions of nurses of their educational needs and of relevant issues

Stage 1 involved conducting a questionnaire survey in order to determine the educational

needs of qualified nurses in the CAWT region and to establish their views on in-service

training and post-registration education provision. Because of the primary objectives of the

study, it was decided that the questionnaire should be written in a semi-structured format

containing both closed and open-ended questions so as to obtain both descriptive and

analytical data. The questionnaire, while containing a few questions chiefly concerned with

demographic data, was mainly concerned with eliciting perceptions of educational needs and

future educational intentions of nurses in the CAWT region.

2.1.1 Questionnaire Objectives

1. To assess if, and how many nurses in selected clinical areas are currently engaged in

post-registration education and in-service training programmes.

2. To identify those factors influencing participation in continuing education

programmes.

3. To identify areas in which these selected nurses require further education and training.

4. To examine the nurses’ attitudes to post-registration education and training.

2.1.2 Instrument Formulation

The research team assisted by an advisory group, chosen because of their expertise and

insights into the educational needs of nurses, developed this instrument (Appendix 2). Topics

were generated by the relevant literature concerning the educational needs of qualified nurses;

chiefly Shepherd’s (1995) training needs analysis, which was used to identify a post-

registration education framework for an amalgamated school of nursing in England.

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Distinctions were made between in-service and post-registration education using Chapman’s

(1992) definitions.

In-service: Study days, lectures and conferences, which tend to be informal and arranged locally.

Post-registration: specifiable courses that end with the issue of a certificate or qualification, for example degrees and diplomas.

The instrument was pilot tested by a small sample of 16 nurses of equal numbers from

Northern Ireland and the Republic of Ireland respectively. As a result of the pilot study, some

questions were rephrased to enhance clarity but there were no major changes to the

instrument.

2.1.3 Sample and Sampling

Opportunistic sampling techniques were employed during this particular research stage. A

number of wards, namely Medical Care, Surgical Care, Intensive Care and Elderly Care,

across The Erne Hospital, Tyrone County Hospital, Sligo General Hospital and Cavan

General Hospital were selected and the entire population surveyed (n = 564). A nurse

manager or administrator in each hospital distributed the questionnaires and a return envelope

to each of the four wards. A sealed box was provided for each ward for the return of

questionnaires. Reminders were sent to each of the four sites in an attempt to maximise the

response rate.

2.1.4 Analysis

Due to the structure of the questionnaire used in this study, two data analysis methods were

employed. Responses to demographic questions were analysed using the statistical package

SPSS. The approach taken to analyse the open-ended questions was thematic with key issues

and themes being extracted.

2.1.5 Ethical Issues

The research team were presented with no major ethical considerations throughout this

research stage. All questionnaires remained anonymous and the issue of confidentiality was

addressed by providing envelopes for completed questionnaires. A cover letter (Appendix 3)

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accompanied each questionnaire and this was used to inform participants about the purpose of

the study and their right to refuse to participate if they so wished.

2.2 Stage 2 Focus Group Interviews with Senior Nurse Managers

Stage 2 of the project utilised Focus Group Interviews to elicit the views of senior nurse

managers on post-registration and in-service education and training provision from a CAWT

perspective. By virtue of their position within the chosen organisations these nurses were in a

strong position to determine the educational requirements necessary to ensure the delivery of

quality care to a diverse client group.

2.2.1 Focus Group Discussions

Focus groups are well suited for a full range of qualitative studies and can be defined ‘as a

qualitative research technique using discussion among a small group of people (usually 4-12)

in a comfortable non-threatening environment to obtain perceptions about a particular

problem, area of interest, or topic of study’ (Lederman, 1990, p.121). According to McDaniel

and Bach (1994), this technique therefore provides insight and data that are not accessible

without the stimulus of the group discussion. In addition participants in this setting have an

opportunity to validate information given by agreeing or disagreeing with statements made by

others. This validation process in turn ‘helps the researcher to identify the essential themes in

the data’ (White, 1998, p. 148).

In this study the interviewers were interested in obtaining information on 4 main areas:

The benefits to be gained from cross border collaboration

The obstacles that must be overcome to ensure the success of the proposed CAWT in-

service initiative

The extent to which current in-service provision will provide for future educational

needs

The steps that must be taken in an attempt to address these future needs

The validity and reliability of the focus group interviews were further enhanced by, asking the

participants to complete a short questionnaire (Appendix 4).

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2.2.2 Participants

Out of the 20 individuals who were invited, 14 individuals attended the focus group

interviews. These individuals were divided into 2 groups. Group1 was comprised of 8

members from the original CAWT Nurse Education and Training sub-group, a body set up to

promote and encourage the cross border initiative. Group 2 consisted of 6 Senior Nurse

Managers, who represented the 4 hospitals included in the study.

2.2.3 Analysis

Qualitative findings from the focus group interviews and the questionnaires were analysed

using a Content Analysis approach (Weber, 1990) with key themes and issues being

extracted.

2.2.4 Ethical Issues

Like Stage 1 this research stage was faced with no major ethical considerations. The

questionnaires were anonymous and remained confidential. The participants were briefed

before distributing the questionnaires, and commencing the interviews. All participants were

aware of their right to withdraw at any time if they wished

2.3 Stage 3 Structured Interviews with Education Providers

Stage 3 of the project was concerned with identifying post-registration education provision

across the CAWT region. In-depth semi-structured interviews were carried out with

education providers with a remit for in-service training and post-registration education in

Sperrin Lakeland Trust, Cavan General Hospital and Sligo General Hospital. The main

purpose of the interviews was to determine the current level of provision across the following

areas (Appendix 1):

Clinical issues

Leadership

Education.

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2.3.1 Structured Interviews

In this, the final stage of the study, two experienced researchers conducted one-to-one

interviews with four individuals responsible for post-registration education provision across

the CAWT region. Open-ended questions were used so that an array of information, relevant

to the study’s objectives, could be obtained.

2.3.2 Interview Schedule

The interview schedule was semi-structured in nature and centred around the following

issues:

Current in-service and post-registration education provision

How the demand for in-service education is assessed

The current uptake of courses

Delivery of courses and existing links with other institutions or organisations

Views of the educational providers on the problems and challenges associated with

joint provision of training and education.

The use of individual interviews was used to provide insight into current in-service provision

so that current overlaps and potential gaps across each of the four sites could be identified.

Each interview lasted approximately 1 hour and was conducted at the interviewee’s

convenience. Notes were taken and then transcribed as part of the analysis process.

.

2.3.3 Analysis

As qualitative data collection methods were employed Stage 3 also dictated a content analytic

approach (Weber, 1990) with recurrent themes and headings being extracted.

2.3.4 Presentation of Findings

In Chapter 3 the results from the Training Needs Analysis questionnaires will be reported. In

Chapter 4 the findings from Stage 2 (Focus Group Interviews and short questionnaires) will

15

be presented. Chapter 5 will report on the findings of the final stage of the investigation and

the results on the individual interviews with education providers. Both the qualitative and

quantitative findings will be integrated into each chapter, with the quantitative findings being

followed by individual quotes.

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Chapter 3

Training Needs Analysis Questionnaires

3.1. Response Rate

Within the present study a total of 196 nurses returned completed questionnaires, giving a

response rate of 35% (n=564). This ranged from 13.3% to 36.7% across each of the four

hospitals and 10.7% to 39.8% across each of the four wards.

3. 2. Profile of Respondents

The sample used in this research stage was comprised mostly of Staff Nurses (92.3%) with

the remainder including 8 Ward Sisters (4.1%), 3 Clinical Placement Co-ordinators (1.5%), 1

Services Sister, 1 Clinical Nurse Manager and, 1 Bed Manager. The sample was composed

mostly of full-time staff (65.3%) with the majority working both day and evening shifts

(75.5%).

Table 3.1: Job Title

Job Title Frequency %Staff Nurse 181 92.3Ward Sister 8 4.1

Clinical Placement Co-ordinator 3 1.5Day Services Sister 1 .5

Clinical Nurse Manager 1 .5Bed Manager 1 .5Non responses 1 .5

Total 196 100

3.3 Qualifications

The main qualifications held were 91.8% RGN’s, 7.1% EN’s, 3.1% RMN’s and RSCN’s,

1.5% RMNH’s and 16.8% Dip He’s. In addition to these qualifications 18.5% of the sample

had completed degrees and 11.1% had obtained ENB Certificates. In addition 34.6% of

participants also reported to being Registered Midwives.

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Table 3.2 Qualifications

Qualifications Frequency %RGN 180 91.8

Dip He 33 16.8EN 14 7.1

RMN 6 3.1RSCN 6 3.1RMNH 3 1.5

3.4 Length of Service

Length of service in present job varied across the sample. Table 3.3 shows that the majority of

the sample (56.1%) had served a period of 0-5 years. In addition, 19.4% had served a period

of 6-10 years, 11.2% 11-15 years, 5.1% 16-20 years and 6.1% 20+ years.

Table 3.3 Length of Service

Length of Service Frequency %0-5 110 56.16-10 38 19.411-15 22 11.216-20 10 5.120+ 12 6.1

Other including non responses 4 2Total 96 100

3.5 In-service and Post-Registration Attendance Rates

Of the 196 participants who completed questionnaires, 77.6% indicated that they had

undertaken at least one in-service training programme over the past 2 years. The majority of

the sample (21.9%) has completed a minimum of two courses and some (1%) have completed

as many as eight.

Table 3.4 In-service attendance rates over the past two years.

Number of in-service courses completed Frequency %

0 44 22.41 33 16.82 43 21.93 32 16.34 22 11.25 12 6.16 2 1.07 6 3.18 2 1.0

Total 196 100

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From the questionnaires it emerged that 74.5% of respondents have failed to engage in any

post-registration programmes over the past two years. It was found that 21.9% of participants

have completed one post-registration programme and 3.6% having completed two.

Table 3.5 Post-Registration attendance rates over the past two years.

Number of Post-Registration courses completed Frequency %

0 146 74.51 43 21.92 7 3.6

Total 196 100

3.6 Frequently attended in-service courses

Those most popular in-service courses attended include IV Additives and Cannulation

(27.6%), and the mandatory courses of Advanced and Basic Life Support (16.4%), Moving

and Handling (44%) and CPR (26.3%). Other frequently attended courses include Wound

Care Management (9.7%), Fire lectures (12%), Cancer Care (7.9%), Palliative Care (7.2%),

Clinical Supervision (6%), and Preceptorship (6%).

Table 3.6. Frequently attended in-service courses

In-Service Course Attended Frequency % (*)IV Additives and Cannulation 42 27.6Advanced and Basic Support 25 16.4

Moving and Handling 67 44Wound Care Management 15 9.7

Fire Lectures 18 12CPR 40 26.3

Cancer Care 12 7.9Palliative Care 11 7.2

Clinical Supervision 9 5.9Preceptorship 9 5.9

Legal Aspects of Documentation 5 3.3Mentorship Training 6 3.9

Diabetic Update 7 4.6Resuscitation Study day 5 3.3

Respiratory Care 10 6.6

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* Courses will not total 100% as respondents attended more that one courses.

While a number of courses attended were representative of all staff across each of the four

hospitals a number of courses attended were only relevant to each individual site. For

example only those nurses representative of The Erne Hospital attended Advanced Life

Support (ALS) Training, Counselling Skills Training, Cardiac Disease Training and

Critical Care Modules.

Additional In-service Courses attended by nurses from The Erne

ALS training Counselling skills training Cardiac disease training Critical care modules Catheter care Complaints procedure

Additional In-Service Courses attended by nurses from Tyrone County

Care pathways Disability awareness Major incident training Common core foundation course Research skills

Additional In-service Courses attended by nurses from Sligo General

Pain management Service planning Pressure sore management Legalities in nursing

Additional In-Service Courses attended by nurses from Cavan General

Incontinence and continence promotion Care planning Professional and practice development Nursing update/quality assurance CAWT cardiovascular study day Bereavement

3.7 Frequently attended Post-Registration programmes

Of the 25.5% of participants who have undertook post-registration education during the past

two years 44% had completed diplomas and 18% had successfully completed degrees. The

most popular Diplomas include the Professional Development in Nursing Programme ran by

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the University of Ulster (18%) and the Stroke Pathways Diploma ran by Queens’ University

Belfast (9%). Similarly those degrees of interest include Health Studies, a three-year degree

programme ran by Queens University Belfast (44.4%) and the Professional Development

Degree programme offered by the University of Ulster (22.2%). Table 3.5 and table 3.6

illustrate those diploma and degree programmes of particular interest.

Table 3.7 Diplomas completed over the past two years.

Diploma Title Location Frequency %Professional Development in

NursingUniversity of Ulster 4 19

Palliative Care Thames Valley LondonUniversity College Dublin

3 14.2

Nursing University of Ulster 3 14.2Stroke Pathway QUB 2 9.5

Reflexology Fermanagh College FE 2 9.5Applied Psychology RCS Dublin 1 4.8

Health Care University of Manchester 1 4.8Aromatherapy Dundalk 1 4.8

Psychology and Counselling University College Galway 1 4.8Physiology RCSI Nursing faculty 1 4.8

Gerontology RCSI Nursing Faculty 1 4.8Nurse Management NCEA 1 4.8

Total 21 100

Table 3.8 Degrees completed over the past two years.

Degree Title Location Frequency %BSC Hons Health Studies QUB 4 44.4

BSC Hons Health care QUB 1 11.1Social Sciences QUB 1 11.1

Professional Development in Nursing

University of Ulster 1 11.1

BNS Hons Nursing Trinity College Dublin 2 22.2Total 9 100

Other Post-Registration courses pursued include C.L.A.I.T. programmes (9%), City and

Guilds Teaching and Assessing certificates provided by South Thames University (9%),

PGCE’s provided by University of Greenwich (9%), and Access to Nursing Degree courses

provided by Trinity College Dublin (9%).

3.8 Courses currently undertook

It was reported that at present, approximately 74% (n=145) of participants are currently not

engaging in any additional nursing or health related training. Of the 26% (n=51) who are

currently engaged 23.5% are completing diplomas. Diploma topics pursued include Palliative

Care, Professional Issues in Nursing, Gerontological Nursing and Nurse Education. In

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addition 6% of participants at present are completing Masters in Trinity College Dublin, 6%

are completing Post Graduate Diplomas at the University of Ulster and 12% are completing

degrees in Fermanagh College of Further Education.

Of the 26% of individuals who are actively engaged in additional nursing or health related

training 25.5% are also currently attending in-service events. A range of in-service topics was

reported. These include:

Palliative Care Leadership Programmes Cancer Care Research Skills Research Methods, Evaluation and Utilisation Infection control Evidence Based Practice

3.9 Factors influencing decisions to attend and not to attend additional health related

training and education.

As reported above approximately 74% of participants are currently not engaging in any

additional nursing or health related courses. Reasons for not undertaking such additional in-

service and post-registration training include lack of time (16%), inadequate study leave from

work (12%), lack of funding (9.2%), distance to travel (13.3%), and family commitments

(14.3). Other factors reported include the expense of courses (11.7%), having to sacrifice

days off to complete additional courses (7.6%) and the difficulty of trying to balance study

with working full time (7.6%)

‘I officially work 39 hours per week but usually work 45-50 hours, this leaves little time for concentrating on my Msc’

On a more positive note however, those underlying factors that tend to promote further

education and training include personal development (6.1%), the need to increase knowledge

and be updated with current trends and practices (33.2%), to improve promotional prospects

(13.3%) and out of a personal interest in further education (8.7%).

3.10 Personal obstacles influencing additional health related training and education

attendance

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Participants when asked to indicate personal obstacles influencing additional nursing or health

related training and education attendance reported lack of time (28%) as the primary factor.

Participants reported:

‘They simply take up too much of my time and my money’

‘ To be able to continue to give 100% to my job and my study is like a juggling game all the time trying to meet deadlines with assignments and trying to stay on top of things at work’

Other obstacles reported (See Table 3.9) include lack of financial assistance (18.4%), distance

to travel (23%), inadequate study leave from work (18.4%), domestic responsibilities

(25.5%), and the expense of courses (17.3%).

‘Funding is the biggest obstacle, we all have responsibilities associated with family etc. and as a mother my son’s educational needs must come first’

‘Distance is a huge obstacle for us in the North West as most of the Post-Registration courses are in Dublin’

‘I am completing a part-time degree at present. I was only allowed 5 days paid leave for the course. Having to give up one of my days off was very difficult and very tiring’

‘Family too young and work is frequently too stressful both physically and mentally to think about going home to study’

‘At the moment one major obstacle for me is the price of courses. My degree in UCG cost £2500 and I am still paying that back’

Table 3.9 Personal obstacles influencing additional health related education and training attendance

Personal Obstacles Frequency %*Lack of time 55 28

Domestic Responsibilities 50 25.5Courses are very expensive 34 17.3

Inadequate study leave 36 18.4Distance to travel 45 23Lack of funding 36 18.4

Work load 33 17Personal Commitments 9 4.6

Lack of Support 8 4.1Personal Commitments 9 4.6

Lack of opportunity/ Access to courses 8 4.1Lack of Motivation 6 3.1

Age 4 2.0Other 9 4.6

* Percentages do not add up to 100 percent as individuals gave more than one response

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3.11 Support

In-service

73% of participants are of the opinion that adequate support is given by their employer with

regards to their in-service training needs. Forms of support listed include study leave,

encouragement, and financial relief. Respondents stated:

‘I am able to take a days unpaid leave each week which is a great help’

‘I find my line manager to be very encouraging and supportive’

‘Normally if your application is in early enough you will get 15% towards fees’

While the majority of participants responded favourably, with regards to the levels of support

given by their employers, a small percentage are of the opinion that adequate support is not

given (27%). For example, 24.5% of respondents indicated that due to low staffing levels,

leave from work to complete courses is not available.

‘In-service, you just don’t get to go if the ward is busy’

‘It is only feasible to attend in-service events if the ward is legally covered with adequate staff numbers’

A small percentage of participants also expressed dissatisfaction with the levels of financial

aid (5%) and the unequal opportunities to particular groups of staff (3%).

‘Being a junior member, I am always last on the list for any further training. When applying for my course, my application was rejected because I was a temporary member of staff’

Post-Registration

Results indicate that 32% of respondents are of the opinion that employers give adequate

support with regard to their post-registration needs. Forms of support listed include leave

from work to attend additional courses (9.7%), financial aid (8.2%), and encouragement (2%).

While a few individuals responded favourably the majority of the participants (42.3%)

maintain that employers, with regards to their post-registration educational needs, do not give

adequate support. 13% of respondents indicated that it can be difficult to obtain study leave as

a result of staff shortages, and 7.6% are dissatisfied with current funding provisions.

24

‘It can be difficult to obtain time off for courses and if this becomes a problem its sometimes easier not to bother at all’.

‘Post-registration needs appear to come secondary to other financial commitments that the Trust may have. I believe that if they set precedence with one applicant they have to follow it through with all other applicants’

25.5% of respondents failed to answer this question. Reasons included:

‘In relation to post-registration education, I haven’t approached my employer as I haven’t made a decision as to what I want to study’

‘I’m not long enough in a permanent job to answer’

Having answered questions with regards to the current levels of support given by employers

nurses were asked to indicate the forms of support that they would find beneficial. The

majority of the sample (39.3%) indicated that study leave from work would be the most

valuable. Other forms of support viewed to be beneficial include funding (19.4%),

recognition for completing courses (5%), encouragement (5%), providing more information

about courses (5%), and providing more relief nurses to cover wards on days when in-service

days occur (5%).

3.12 Attitudes to in-service training and post-registration education

Almost all of the participants expressed a value in in-service training and post-registration

education. 98.5% of respondents expressed a value in-service education and 89.8% expressed

a value in post-registration education. The underlying reason behind these high percentages

in both categories can be attributed to the need to be updated with current trends and

practices. Respondents stated:

‘The changing face of nursing as a profession urges all professionals to update their knowledge and skills via a recognised route, the steps are there and I hope to avail of these up to degree level if possible’ (Staff Nurse, The Erne Hospital)

‘It is important to keep up to date as nursing is changing all the time’

Other reasons stated include the need to increase knowledge, to improve promotional

prospects, to improve the quality of care given, to meet PREP requirements and to enhance

professional and personal development.

‘I feel since I have completed my degree I can critique my nursing practice and have the confidence to bring forward new and improved practice within the team’

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‘Knowledge is a powerful tool when involved in patient care. The patients recognise a nurse with a high standard of education and understanding of their condition’

Reasons for not valuing additional nurse related training and education, particularly post-

registration, include the fact that there is no monetary gain for nurses who have completed

courses.

‘I can survive without it (post-registration education) and certainly when there’s no monetary gain from doing it why bother. In-service days will keep me a breast of what’s happening. Anyone that has done further education says its very far removed from everyday work’

Other responses include:

In-service courses can be very repetitive Completing additional courses does not necessarily lead to promotion.

‘Having a degree/ diploma is beneficial if promotion is in mind but the openings for promotion in the hospital setting or the community is slim in this area’

3.13 Future Intentions

Interest in further study was expressed by 82.1% of the participants. 7.1% of respondents are

unsure at this present time what avenues they will pursue and 10.7% are not considering any

additional training in the future. For those individuals who wish to undertake additional

training, a number of topics and courses of interest were specified.

In-Service

In-service courses of particular interest include those clinical courses of Diabetes, Cancer

Care, ECG workshops, and IV Training. Counselling was also reasonably popular across

each of the four sites along with Legal Issues and Bereavement. Computer Training was a

common request made by those respondents from both Cavan General, and Sligo General

Hospitals.

An array of other in-service courses was also reported and these varied across each of the four

hospitals. Respondents from The Erne reported an interest in:

Venepuncture Parkinson’s disease Acute emergencies.

Participants from Tyrone County Hospital reported an interest:

Palliative care Presentation skills

26

Care pathways Intubation.

Sligo General representatives reported an interest in:

Phlebotomy Cannula insertion Customer care Wound care management Infection control

Cavan General respondents reported an interest in:

Stress management Pain management Cardiac drug updates Communication skills Pharmacology.

Post-Registration

The majority of participants, interested in pursuing additional training and education,

displayed an interest in completing diplomas, degrees, or masters (39%) programmes. A

small percentage also expressed an interest in completing post-graduate diplomas (5%).

Diploma topics that respondents would like to undertake in the future include Diabetes,

Human Resource Management, Nursing and Health Service Management. MSC topics

include Health Promotion, Nurse Education, Advanced Nursing and Psychology. Degree

programmes include Health Studies, Nursing, and Nursing Science.

Other clinical areas that respondents would like to complete at post-registration level include:

Palliative care Oncology Coronary care Basic and advanced life support Critical care Accident and emergency

In addition to these courses, nurses from The Erne expressed an interest in courses on Health

Education, and Counselling. Tyrone County respondents displayed interest in the areas of

Multiple Sclerosis and Stroke Care. Sligo General representatives demonstrated interest in

the areas of Pain Management, Family Planning, Maternity and Reflexology while Cavan

General participants expressed an interest in the areas of Heart Failure Management, Chest

Pain Management, Health Promotion and Surgical Nursing.

27

28

Chapter 4

Focus Group Interviews

4.1 Response Rate

Out of the 20 individuals that were invited, 14 people attended the Focus Group discussions.

A number of factors contributed to this non-attendance including holidays, sickness, and prior

meetings. Despite this non-attendance, each of the four hospitals were adequately represented

with five individuals attending from Sperrin Lakeland Trust, five attending from Sligo

General Hospital and four representing Cavan General Hospital.

Figure 4.1-The sample distribution of focus group participants.

Hospital/ Trust Frequency Percent

Sperrin Lakeland Trust 5 35.7

Sligo General 5 35.7

Cavan General 4 28.6

Total 14 100

4.2 Profile of respondents

While the interviewees were primarily Senior Nurse Managers (57.1%), a small percentage of

Ward Sisters (14.2%) and Practice Co-ordinators (21.4%) were interviewed. The remainder

of the sample included a Clinical Placement Co-ordinator and a Chairperson of a Nurse

Education Committee.

Table 4.2 - Job Titles of Focus Group Interviewees.

Job Titles Frequency Percent

Senior Nurse Managers 8 57.1

Practice Co-ordinators 3 21.4

Ward sisters 2 14.3

Placement Co-ordinators 1 3.6

Nurse Education Chairperson 1 3.6

Total 14 100

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4.3 Current Provision

Participants, when asked to give their views on a range of issues with regards to current

educational frameworks, were of the opinion that the existing frameworks addressed the

majority of the issues moderately well. As illustrated in Table 4.3 the majority of participants

(78.6%) when asked to comment on the amount of in-service courses on offer reported that

their system addressed this issue moderately well. 64.3% of respondent’s reported that the

variety of in-service courses on offer was addressed moderately well, and similarly 78.6% of

respondents believed that the educational needs of post-registration nurses was moderately

well addressed. With regards to the issue of support networks however, only 35.7% of the

sample believed this issue to be moderately well addressed with the majority of the sample

(50%) assuming this issue to be addressed to only a little extent.

Table 4.3 illustrates the extent to which current educational frameworks address a

number of educational issues.

Great

Extent

Moderate

Extent

Little

Extent

No Extent Total %

Issue No. % No. % No. % No %

The amount of in-service courses on offer 2 14.3 11 78.6 1 7.1 14 100

The variety of in-service courses on offer 3 21.4 9 64.3 2 14.3 14 100

Information with regards to the scheduling of

courses5 35.7 8 57.2 1 7.1 14 100

Educational resources/ facilities available 5 35.7 6 57.2 1 7.1 14 100

The educational needs of post-registration nurses 11 78.6 3 21.4 14 100Support Networks for

Post-Registration nurses 5 35.7 7 50 2 14.3 14 100

These findings were also replicated in the Focus Group discussions as the area of support,

primarily lack of it, was well documented. Respondents generally felt that nurses at present

were not getting enough support, and this is something, which is very often requested.

Responses included:

‘There are quite a number of in-service training courses available but some senior nurse managers do not facilitate and encourage staff to attend and emphasise the value and benefit of these courses’

30

‘In-service education is provided for, however the key issues are that staff do not attend because of lack of support locally in their services etc.’

‘Some senior nurse managers fall short of playing a role in in-service training’

4.4 Current Educational Needs

As mentioned above, support emerged as a major issue from both the questionnaires and

Focus Group discussions. Throughout the questionnaires however a number of other

educational needs were documented. While these differed somewhat from hospital to hospital

the needs recognised were almost all applicable to each of the four sites. For example, the

majority of participants (57%) recognised the need for a return to basic practice with an

increased need for research-based programmes. 64% also recognised the need for additional

computer courses while 36% identified the need for improved staff nurse development

programmes.

These findings were further confirmed in the Focus Group Discussions.

‘Personally I feel that there is a real need to return to basic learning programmes such as basic research skills and computer training, such as word, excel and power point’

‘We need more research programmes to encourage a return to learning. It will also serve to promote active thinking’.

‘What I believe we need is more computer courses and more research based programmes. This will serve to encourage those individuals who have not taken any additional training recently back into learning based practice’.

‘I think improvements should be made with regards to Nurse development programmes. More should be done to encourage those older nurses back to the classroom’.

While computer based programmes were documented by many of the participants a number

of other in-service courses were also identified. For example requests ranged from basic

mandatory courses like CPR and Moving and Handling to more specialised courses like

Diabetes. Managerial courses were also frequently requested. While some frequently

requested courses were representative for each of the hospitals, several of the courses

identified were only applicable to the hospital from where they were reported. Those courses

of particular need are illustrated in Table 4.4.

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Table 4.4 Top ten in-service needs

In-service courses requested

FrequencyN=14

%(of sample requested)

Computer Training 9 64.3

Research Skills 8 57

Management Skills 6 43

CPR 4 28.6

Moving and handling 4 28.6

Wound Care 4 28.6

Diabetes care 4 28.6

Documentation 3 21.4

Clinical Supervision 3 21.4

IV Cannulation 3 21.4

* Percentages are more than 100 percent as some participants identified more than one educational

need.

Other courses specifically requested by Sperrin Lakeland Trust representatives

include Palliative Care, Asthma Care, Respiratory Care and Preceptorship.

Cavan General representatives identified additional PEG feeding, Nutrition and

Continence as important educational needs.

Sligo General representatives requested courses on career pathway development,

Critical Care, Renal Care and Infection Control.

4.5 How are the educational needs of nurses assessed?

Respondents in the groups reported a number of needs assessment strategies, although they

varied across each of the four sites. One method that was applicable to all of the hospitals

however was Needs Analysis Surveys as this was reported to be the most popular method

across each of the sites.

‘ Training Needs Analysis is provided by each head of department and co-ordinated by the Professional Development Senior Nurse’.

‘Questionnaires concerned with educational needs are distributed following every in-service lecture given’.

‘Educational needs are assessed by carrying out an annual training needs analysis’

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Another common method reported by the majority of participants (43%) was staff meetings,

which, included meetings with Education Consortia, Senior Managers, Ward Managers and

Staff Nurses and took the form of Focus Groups or unstructured interviews.

‘Nurse education meetings are a way of keeping up to date with staffing needs’.

‘We have regular meetings with the Education Consortia members in an attempt to assess the educational needs of our staff’.

Other methods reported by Sperrin Lakeland Trust representatives include direct contact with

personnel from Queens and The University of Ulster, The Regional DHSSP, Trust Strategic

documents and a template used by Senior Nurse managers.

‘A template for ward managers are used for formulating their training needs so that all are judging their training needs from the same criteria’

Those individuals representing Sligo General Hospital reported that educational needs were

assessed using An Bord Altrainais guidelines and the Nurse Education Committee.

33

Table 4.5 Needs assessment strategies employed by Sperrin Lakeland Trust, Cavan

General Hospital and Sligo General Hospital.

Needs Assessment Strategies

Frequency(n=14)

%(of sample requested)

Needs Analysis Surveys 8 57.1

Interviews 6 43

Service Needs 2 14.3

Trust Strategic Documents 1 7.1

Current Levels of Education and competency

1 7.1

Personal Staff Development 1 7.1

Nurse Education Committee 1 7.1

The Rolling Programme 1 7.1

Staff Request Information themselves

1 7.1

Direct Contact with QUB and UU

1 7.1

UKCC guidelines 1 7.1

The Regional DHSSP 1 7.1

Assess patients needs 1 7.1

Template for Senior Nurse Managers

1 7.1

* Percentages do not add up to 100 percent as the participants gave more than one response.

4.6-Preparing for the future

Having completed questions on the educational needs of their staff and the needs assessment

strategies employed, the interviewees were asked to comment on what steps could be taken to

prepare for the future with regards to the educational needs of staff. While the respondents

did recognise that particularly good practice exists across the CAWT region a list of measures

were reported. The majority of the sample (57 %) emphasised the importance of additional

research skills.

‘We need more research programmes to encourage a return to learning and active thinking’

‘We need more research programmes. This will serve to encourage those individuals who have more than 10-15 years experience and are apprehensive of going back to learning’

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‘I believe that the way forward is research programmes. We have a good network of in-service programmes but yet individuals fail to avail of these opportunities. We must teach library and other research skills so as to motivate staff especially older staff towards learning based practice’

This idea of encouraging older members of staff back to post-registration courses was further

supported by a moderate percentage of the sample. A small percentage of participants also

stressed the importance of reflective practice while others reported the need for a period of in-

service rotation and prioritisation.

‘ I believe that what we must do is think back and reflect on what we were suppose to do. If we can recognise where we went wrong then we can devise ways of going forward’.

‘We must rotate and prioritise in-service programmes. This will ensure that everyone will have equal opportunities, as at present with the wards being busy a lot of nurses cannot avail of the services that are provided’

From the responses given it was evident that the respondents were optimistic about the future

recognising the importance of in-service and in particular post-registration education.

‘Education particularly post-registration education is the way forward for nursing. We are in my opinion heading towards a graduate profession where education is a must’

Bearing this in mind it was suggested that what was needed was:

A planned professional development programme over the next 5-7 years’ to facilitate those members of staff trained more than 5 years ago to access higher education.

While a number of measures were generated from the Focus Group discussions a number of

in-service courses were also documented as being important for any future educational

frameworks. From the Focus Group discussions and the questionnaires, research based

modules were particularly common requests made from each of the hospitals included.

Courses deemed important by all four sites included:

Management skills Political skills

Additional courses deemed to be important by representatives of Sligo General Hospital included:

Health and Safety Critical Care

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Renal care Short accredited courses at higher education level Ongoing post-registration courses specific to midwifery and children’s nurses Respiratory care

Additional Courses deemed to be important by Cavan General Hospital representatives included:

Manual Handling, Customer Care Parentcraft Legal issues

Sperrin Lakeland Trust representatives emphasised the need for quality clinical education

delivered by highly skilled, knowledgeable nurse practitioners.

4.7 Senior Nurse Managers views on CAWT

From both the questionnaires and the Focus Group discussions it became apparent that all of

the interviewees looked favourably on the CAWT project, identifying a number of benefits to

be gained. The pooling of educational resources was viewed to be the most beneficial with

100% of the sample stating this view. This, it was believed would serve to avoid the repetition

of courses, which in the long term would save money and make courses more viable. An

additional benefit documented includes the production of a transient workforce, as an

understanding of both Health Care systems will be gained. A great deal of cross border traffic

already exits and nurses at present are unsure of what practices exists in their cross border

counterparts. CAWT will therefore serve to provide a continuity of care for those individuals

who avail of services both in Northern Ireland and in The Republic of Ireland.

A range of other benefits was also recognized. These included the views that:

Nurses would now be employable on both sides of the border.

There will be an increased accessibility of post-registration courses, as nurses will no

longer have to travel long distances to avail of courses.

As less time will be spent travelling more nurses will be able to be released from work

to attend additional courses.

While a number of benefits were illustrated the representatives also identified a number of

challenges, which must be met so as to ensure the success of the CAWT initiative. In

particular, the problem of dual registration where in-service courses must be jointly

36

recognised by both the UKCC and An Bord Altranais accrediting bodies. Other challenges

recognised include the location and funding of courses and the need for education providers to

become aware of the cultural and legislative systems of the entire CAWT community. An

additional theme, which also emerged, was the fear that staff may be ‘poached’, especially at

times of staff shortage.

37

Chapter 5

Structured Interviews

The aim of phase 3 is to investigate post-registration education provision in the CAWT region

comprising the catchment areas of Sperrin Lakeland Trust, Cavan General Hospital and Sligo

General Hospital.

Individual interviews were carried out with the four key providers of in-service and post-

registration courses in these areas. The following questions were addressed:

5.1 Research Questions

What is the level of provision of in-service and post-registration courses in the areas listed

in the CAWT proposal?

1. How are demands for post-registration education and training assessed?

2. What is the current level of uptake for the courses offered?

3. How are courses currently delivered and what links exist with other

organisations/institutions

4. What are the views of education providers on the opportunities and challenges

associated with cross-border provision of nurse education and training?

5.2 Results of Interviews with educational providers

In all, four interviews were carried out with key providers in the North Eastern Health Board

(NEHB) area servicing Cavan General Hospital, the North Western Health Board (NWHB)

area servicing Sligo General Hospital and the North-West In-service Education Consortium

(NWIEC) servicing the Sperrin Lakeland Trust.

Current level of provision of in-service and post-registration education in the following areas

(as per CAWT proposal) was investigated:

CLINICAL ISSUES

Critical care Palliative care Anaesthetic nursing Pain management Wound care/Tissue viability Management of incontinence

38

The elderly patient Role of the nurse in health promotion Management of workload within the clinical environment (planning,

completing, supporting, evaluation) Care of the cancer patient in the clinical environment

LEADERSHIP

Managing change Developing staff potential Human resource management (to include disciplinary matters etc) Nursing “the profession”… the changing face/political issues…. to include

commissioning of services Audit (planning, completing, supporting, evaluating) Developing research based practice Business Case planning

EDUCATION The adult learner Creating and supporting the learning environment Supporting students in the learning environment…exposure to the concept

of forthcoming educational change re diploma/degree courses

Table 5.1 Current level of provision of clinical courses offered by the four providers and duration.

Courses* North Eastern Health Board

North & West In-service Education Consortium

School of Nursing at Sligo General Hospital

St Angela’s College, Sligo

Duration of Course

ClinicalPalliative Care 1 day 4 days Not offered at

present but potential exists for links with

the North west Hospice

Not offered at present but potential exists for links with

the North west Hospice

Anaesthetic Nursing Not offered Diploma module Peri-Operative(Sept 01)

Not offered

Pain Management 1 day Half-day Offered as necessary.Also in Higher Diploma modules.

Not offered

Wound Care/Tissue Viability 3 days Half-day Leg Ulcer Course (6-month duration) offered to Public Health Nurses.

Also in Higher Diploma modules.

Not offered

Management of Incontinence 4 days Diploma module Not offered Not offered

39

The elderly patient 5 days Diploma module In Higher Diploma modules

Not offered

Role of the nurse in health promotion

1 day In all courses and Higher Diploma module.

Diploma module

Care of the cancer patient 5 days 4 days Not offered Not offered

While it was possible to identify “Clinical Issues” courses because their titles were similar,

bear in mind that it was not possible to compare “like with like”. For example, while the

North & West In-Service Education Consortium (NWIEC) offers only a half-day course in

Acute Pain Management, this topic is also covered in the course on Epidural Analgesia

Infusions and in Palliative Care.

Nurses in the NWIEC catchment area can also access the following modules validated by the

University of Ulster:

40

Introduction to Cancer Nursing Promotion of Continence Introduction to Palliative Care Occupational Health Nursing Diabetes Nursing Stoma Care

Renal Nursing Cardiac Nursing Nursing Elderly People Rehabilitation Nursing Anaesthetic Nursing

Anaesthetics in Electro convulsive Therapy Safe Moving and Handling in Clinical Practice Counselling Skills in Clinical Practice Management of Wound Care

These modules (of 12 weeks duration) can be accessed for in-service training (without taking

the assessment) or nurses can be awarded credit points toward the award of the Higher

Education Diploma if they take the assessment.

The following courses are also ran by the School of Nursing, Sligo General Hospital in

partnership with the Nursing Department at St Angela’s College, Sligo and validated by the

National University of Ireland, Galway.

Higher Diploma in Nursing Studies (Peri-operative Nursing) Duration = 1 academic year

Higher Diploma in Nursing Studies (Critical Care)comprising Intensive Care and Coronary Care Nursing.

Duration = 1academic year

Higher Diploma in Nursing Studies(Accident and Emergency Nursing). Duration = 1academic year

Higher Diploma in Nursing Studies (Orthopaedic Nursing). Duration = 1academic year

Nurses in the Sligo General Hospital area can also access a ‘Return to Nursing Practice’

course which runs twice-yearly over four week period at Sligo General Hospital.

Nurses in the CAWT region under investigation can also access the following modules

offered by Fermanagh College, Enniskillen as part of the Dip HE Professional Development

in Nursing and validated by the University of Ulster:

Introduction to research

Professional issues in nursing

Preceptorship

41

Quality standards in health and social care

Principles of management

Counselling

Principles of nutrition

Health promotion

Information technology

Human physiology

Socio-pyschological perspective and

Study skills

Leadership and Management

The titles of the ‘Leadership and Management’ and ‘Education’ courses offered by the

providers in the CAWT area under consideration differ to the extent that it is neither possible

nor helpful to offer any comparisons. However, an attempt has been made to map available

courses against the topics identified in the original proposal. The following table presents a

list of relevant courses offered by the four providers.

Table 5.2 Current level of provision of leadership and management courses offered by the four providers and their duration.

Leadership and Management Courses

N E H B NWIEC School of Nursing, Sligo General Hospital

St Angela’s College, Sligo

Developing your leadership potential (2 days)

Management Development Programme offered jointly by NWHB and the University of Brighton(12 months)

Research Appreciation in Nursing.(1/2 module on Diploma Access Course)

Developing your staff (1 day)

Service Planning (1 day repeated as necessary)

Research Methods IResearch methods IIResearch Methods III(Modules on the BNS degree programme)

Effective decision-making (1 day)

Leadership and empowerment (3 days)

Legal Issues in nursing(1 day repeated as necessary)

Promoting Quality Care. (Module on BNS degree programme

How to manage competing Management of Patient Innovations and Changing

42

demands (1 day)

Care (Higher Diploma module).

Trends in Nursing(Module on BNS degree programme)

Standards, Quality and Audit (1 day)

Developing skills in audit (1 day)

Leadership in Nursing.(Module on BNS degree programme)

Service planning – Concepts and Issues (1 day)

Cascading evidence into practice (Half-day)

Professional Issues in Nursing(Module on BNS degree programme

Clinical effectiveness and evidence-based decision-making 3 days)

Research in Nursing (3 days)

43

Table 5.3 Current level of provision of education courses offered by the four providers and their duration.

Education Courses

N E H B NWIEC School of Nursing, Sligo General Hospital

St Angela’s College, Sligo

The Nurse as an Educator (2 days)

Action Learning Group (half-day)

Preceptorship course (2 days per month)

Introduction to Adult Learning and the Use of Information Technology.(Module on Diploma Access Course).

Communications skills in Practice (1 day)

Presentation skills (1 day) ECDL (European Computer Driving Licence) offred by IT Learning Centre, SGH.

Education Issues in Nursing(1/2 Module on Diploma Access Course)

Developing facilitator skills (1 day)

Essential skills for facilitating groups (half-day)

Communication in pastoral Care/Teaching and assessing in Clinical Practice

Westcare organises courses and workshops that can be accessed by staff in Sperrin Lakeland

HSS Trust as part of continuous professional development. They are designed to develop the

knowledge, skills and attitudes of staff in the following areas:

Human Resources Personal Development Management Business

The Health Promotion Department of Western Health & Social Services Board (WHSSB)

offer health promotion courses such as:

Managing stress at work Stress management training for

trainers Substance misuse Moving to music Physical activity module Understanding groups Stop smoking counsellor course

training and Caring for the suicidal person

training

44

These are only a selection of courses to show that the education providers offer all the

areas identified in the CAWT proposals. However, a larger number of courses

including those on assessing and utilising library facilities and information technology

are offered (see Appendix 6). It is clear that more or less the same courses are on

offer and that they are of similar duration. Therefore, there is great potential for

collaboration and for avoiding duplication.

Most of the courses offered by the NEHB take place in Ardee. However, an in-

service programme is also in operation at the hospital level (Cavan and Monaghan).

Examples of these local courses/updates include:

CPR Ward Sisters’ development programme Scope of practice Incontinence management and many others

5.4 Assessing demands for in-service training and post-registration education

The NWIEC formally conducts a Training Needs Analysis of staff in its catchment

area. As explained in the foreword to its prospectus (p.4), “It seeks to listen and

discuss with practitioners and managers their professional in-service education needs

and aspirations”. A training needs analysis form is sent to line managers and the data

collected form the basis of the type and duration of programmes on offer.

Additionally, the education service also responds to any new or urgent in-service

nurse education requirements that may emerge from time to time. For example, to

meet the service demands for ’flu vaccination of persons over 65 years old, district

and other community nurses required refresher courses. Individual nurses can also

contact the Consortium staff to discuss their professional development. The NEHB

organises focus groups to discuss their education and training needs as well as reasons

for poor up-take, format and location of course and other issues. In its Education and

Training Strategy, it states, as part of its quality assurance, that:

Individuals are encouraged to identify their own needs

Line managers must be actively involve in diagnosis of training needs, and in

planning, delivery and monitoring the development activities of their own staff.

45

A policy of developing a career development profile for individuals has been started.

The belief is that education and training needs are more accurately assessed if staff

identify their own needs and line managers have ownership of staff development.

Education and training are also offered on a ‘response mode’ basis, as for example

when problems arise such as an increase in the incidence of cystic fibrosis when a

nutrition support group had to be set up.

The needs of nurses in the Sligo General Hospital catchment are assessed in a number

of ways. All registered nurses in the NWHB areas have recently been surveyed to

determine their educational needs. A working group established by the North

Western Health Board carried out the study but the final report has not yet been

published.

Staff at the School of Nursing in Sligo General Hospital utilise a questionnaire to

conduct a training needs analysis and this exercise is carried out on a regular basis. A

Nurse Education Committee comprising representatives from nursing management,

practice and education has been established within the hospital and this group meets

once a month to discuss the training and education needs of the workforce. The

demands for in-service training and education are consistent with those identified in

the original proposal but an increase in the demand for courses on Research and Legal

Aspects of Nursing has been noted. The hospital also employs a Nurse Practice

Development Co-ordinator who plays a key role in in-service training and nurse

education in collaboration with the tutorial staff in the School of Nursing .

St Angela’s College, a Recognised College of the National University of Ireland does

not currently provide in-service training but rather, concentrates on diploma and

degree level provision. The demand for post-registration education is assessed by the

Strategic Course Development Group which comprises members from St Angela’s

College in addition to representatives from Sligo General Hospital (General Nursing),

Cregg House (Learning Disability Nursing), and St Columba’s Hospital (Mental

Health Nursing). Programmes offered by the college are also influenced by the

46

demand for specialist nursing programmes at diploma level and by the move towards

an all graduate nursing profession within the Republic of Ireland

5.5 Uptake of Courses

The NWIEC experiences high uptake of courses. In a two-month period when 254

programmes were offered, only 15% were cancelled because of insufficient numbers.

Every three months each Director of Nursing receives an up-date on attendance at

these courses for their own Trust. In addition the Director of the Consortium and the

Directors of Nursing meet on a regular basis to discuss the up-take of courses and

other relevant issues.

In the NEHB, uptake can be problematic. Recently when the attendance rate was less

than 50%, the educators discussed the issue with nurse managers and reviewed the

courses on offer to enhance relevance to practice. This measure was effective and

resulted in a 70% increase in attendance. Two main problems have been linked with

poor attendance rates. The first relates to the fact that most continuing education

programmes are offered at the Regional College in Ardee. Secondly, releasing staff to

attend courses is not always feasible. To save travelling time and increase attendance,

there is a deliberate plan to organise short-duration workshops for in-service training

locally.

In the NWHB, the picture is not very different form the NEHB. While in service

training programmes are generally well supported, replacement costs remain a key

issue and render it difficult to predict attendance. The need for a more strategic

approach to in-service training provision was highlighted by one of the education

providers interviewed. This would enable ward managers and unit-nursing officers to

plan staffing levels to maximise attendance at in-service training programmes.

Programmes at St Angela’s College are also well supported and this has been

influenced by the new funding arrangements aimed at increasing the number of

graduates in nursing in the Republic of Ireland. As St Angela’s College is only a

relatively short distance from Sligo town, staff have easy access to the full range of

programmes on offer. In effect, this means that staff no longer have to travel long

47

distances to Dublin, Galway, Coleraine or Belfast for diploma or degree level

programmes.

5.6 Delivery of courses

The NWIEC delivers most of its own in-service training programmes and in order to

meet the demand for courses consortium staff numbers have increased by three since

its establishment in 1997. Westcare provides some of the training and the Health

Promotion Department at Leeds University offers the ‘Leadership and Empowerment’

three-day course. As explained earlier, nurses can also access some modules offered

by the University of Ulster as part of in-service training or use the credit points

towards the Diploma in Higher Education.

In-service training in the NEHB is offered by staff from the Beeches Management

Centre (Belfast), the Irish Cancer Society, the Health Promotion Unit (Ardee) and

other education and management consultants. A number of years ago the Royal

College of Surgeons, Dublin offered Diplomas in Gerontology and in Physiology but

this provision has been discontinued. The NWIEC has delivered courses such as

‘Legal Aspects of Documentation’ and ‘Care Planning’ in the NEHB. Two more

courses are planned for the near future. Nurses in the NEHB can also access Diploma

and Degree programmes at Dundalk Regional College.

St Angela’s College delivers its own graduate programmes for example a part-time

Bachelor of Nursing Degree. If the expertise to deliver part of a particular

programme is not available in the college, then contracts are established with external

individuals/agencies to secure provision in this area. The college collaborates with

the School of Nursing at Sligo General Hospital, Mental Health Services and Cregg

House in delivering the higher diplomas specified at the beginning of this section of

the report.

The School of Nursing delivers most of its programmes and this will be greatly

enhanced by the new multi-disciplinary library in the Research Education Foundation,

SGH. The School also links with the Health Promotion Unit in the NWHB for the

delivery of courses on health education and health promotion. Links have been

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established with Letterkenny General Hospital for the delivery of the course on

‘Managing Incontinence’ and the ‘Higher Diploma in Gerontology’ validated by

Trinity College, Dublin.

5.7 Education providers’ views on CAWT

All of the providers interviewed were positive about CAWT and the benefits of cross-

border collaboration. In particular the pooling of resources was deemed particularly

beneficial as it would enhance the cost-effectiveness of existing in-service and post-

registration education within the CAWT area comprising Cavan General Hospital,

Sligo General Hospital and Sperrin Lakeland Trust.

The benefits of joint planning and teaching as a means of reducing duplication were

also highlighted by the education providers interviewed. There was agreement that

co-operation and collaboration could lead to more standardisation and consistency in

the education and training services provided. There was general agreement that

nurses on both sides of the border had a lot to learn form one another and in doing so

raise the standard of care throughout the region. The benefits of accessing placements

on both sides of the border was mentioned by education providers who currently

experience difficulty securing suitable placements for students on their programmes

with the result that many students have to travel to Dublin or Galway for the practice

component of their programme.

However, a number of potential challenges were also raised. The need to ensure

comparability of structures and standards was raised particularly in relation to post

registration education. Recognition of the different cultural, political and legal

contexts governing health care provision was also deemed crucial to the success of

any cross-border initiative. The interviewees also felt that the location of courses

could be problematic and some expressed an interest in a distance learning mode of

delivery where appropriate. On a similar note, the providers also stated that they

would like to see universities providing opportunities for nurses to undertake their

diploma and degree programmes at local levels.

Another issue raised by some of the education providers relates to the limitations of

the specified CAWT boundary for this initiative. Some education providers serve a

49

larger constituency than that specified in the original proposal. For example, the

NEHB covers the geographical areas of Cavan, Monaghan, Louth and Meath.

Concern was expressed that another ‘body’ may be created thereby negating many of

the beneficial effects of the initiative

50

Chapter 6

6.1 Summary of Key Points

A high percentage (77.6%) of participants have completed at least one in-service

training programme over the past 2 years. Almost three-quarters (74.5%) of

respondents have failed to engage in any post-registration programmes over the past

two years. 21.9% of participants have completed one post-registration programme and

3.6% have completed two.

The most popular in-service courses attended include IV Additive and

Cannulation, Basic and Advanced Life support, Moving and Handling, and

CPR.

Of the 25.5% of participants who have undertook post-registration education

during the past 2 years 44% have completed diplomas and 18% have

successfully completed degrees.

The most popular diploma undertaken is the Professional Development in

Nursing Programme ran by the University of Ulster. The most popular degree

is the Health Studies Degree ran by Queens University Belfast.

Approximately 74% of respondents are currently not engaged in any

additional nursing or health-related training.

Reasons for not undertaking additional in-service and post-registration

education include lack of time, inadequate study leave from work, lack of

funding, distance to travel and family commitments.

Those factors, which tend to encourage further education and training, include

personal development, to increase knowledge, to be updated with current

trends and practices, and to improve promotional prospects.

Many (73%) of participants are of the opinion that adequate support is given

by their employer with regards to their in-service training needs. Forms of

support listed include study leave, encouragement and financial relief.

The majority of participants maintain that employers, with regards to their

post-registration needs, do not give adequate support.

51

Almost all of the participants expressed a value in in-service training and post-

registration education.

Interest in further study was expressed by 82.1% of the participants.

In-service courses of particular interest include those clinical courses of

Diabetes, Cancer Care, ECG Workshops and IV Training.

The majority of participants, interested in pursuing additional training and

education displayed an interest in completing diploma, degree, or masters.

Lack of support networks for nurses.

Research based programmes, IT training, and Management Skills are areas

that need to be addressed.

While needs assessment surveys are commonly employed by all of the

hospitals a number of other methods are used.

Recommendations made with regards to addressing future needs include

periods of reflection, in-service rotation and prioritisation, staff development

strategies and professional development programmes.

Benefits identified include the pooling of resources, the emergence of a

transient workforce, increased accessibility, and a larger employment pool of

homegrown nurses.

Challenges documented include the need for dual registration, the poaching of

staff, and the location and funding of courses.

Courses are currently offered in all the areas identified in the CAWT proposal.

Many of these courses/workshops seem to be similar in duration and content.

A large number of courses other than those specified in the CAWT proposal

are available to nurses and other health professionals. Some of these courses

are repeated and/or offered on different sites to meet demands

The skills-based courses in Leadership, Management and Education are multi-

disciplinary.

Some providers deliver their own courses, while others ‘buy-in’ expertise.

Education providers also work with outside bodies to provide some of these

courses.

North-South collaboration in the delivery of courses exists, although to a small

extent.

52

The education providers interviewed serve a larger constituency than proposed

in this CAWT initiative.

The education providers perceive the potential for collaboration and mutual

benefits positively.

6.2 Recommendations

Consideration should be given to the establishment of a Joint In-Service

Education Programme.

Key stakeholders on both sides of the Border including senior nurses and

education providers should be involved in the planning, delivery and

evaluation of such a programme.

The content of the initial programme should focus on generic issues such as

evidence-based practice; information technology, leadership and management

skills, student support and exchange programmes.

Challenges relating to dual registration should be explored.

Consideration should be given to ways in which nurses can be more

adequately supported to undertake additional training/education.

Cross-border collaboration in the field of nurse education should recognise

the different cultural, political and legal contexts governing health care

provision on both sides of the border.

53

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