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
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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’
25
‘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’
32
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’
34
‘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
35
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
48
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
References
An Bord Altranais (2000). Review of Scope of Practice for Nursing and Midwifery: Final Report.
Barriball, K.L. & While, A.E. (1996). Participation in Continuing Professional Education in Nursing: Findings of an Interview Study. Journal of Advanced Nursing 23, 999-1007.
Chapman, R. (1992). Post-Registration Education in Three Fields of Practice. Nursing Times 88, 53-56.
CAWT (2000). Working Together for Cross Border Partnership. A Feasibility Study into the Cross Border Development of Selected Acute Care Services.
Farley, J.K. & Fay, P. (1988). A system for assessing the leaner needs of Registered Nurses. Journal of Continuing Education in Nursing 19, 13-16.
Government of Ireland (1998). Report of the Commission on Nursing. A Blueprint for the future.
Hutton, C.A. (1987). Impact of Mandatory continuing education: A review of research on nurses’ attitudes and perceived outcomes. Journal of Continuing Education in Nursing 18 (6), 209-213.
Larcombe, K. & Maggs, C. (1991). Processes for identifying the Continuing Professional Education Needs of Nurses, Midwives and Health Visitors: An Evaluation. ENB, London.
Lathlean, J. (1987). Are you prepared to be a staff nurse? Nursing Times 86 (29), 50.
Lederman, L.C. (1990). Assessing educational effectiveness. The Focus Group interview as a technique for data collection. Communication Education, 38 (4), 117-127.
Lindsay, B. (1990). Assessing the demand for continuing education. Nursing Times, 86, (29), 50.
Mc Daniel, R.W., & Bach, C.A. (1994). Focus Groups: A data-gathering strategy for research. Nursing Science Quarterly, 7 (1), 4-5.
Mac Gregory, J. & Dear, K. (1997). Opening up the options: Making the inflexible into a flexible framework. Nurse Education Today, 17, 502-507.
National Board for Nursing, Midwifery and Health Visiting for Northern Ireland (2000a). Procedures and standards for the Approved and Monitoring of Institutions
54
and Courses in Nursing, Midwifery and Health Visiting. Circular No. NBNI/ 00/ 2. Belfast NBNI. National Board for Nursing, Midwifery and Health Visiting for Northern Ireland (2000b). Continuing Education and Professional Development: From present to future. Circular No. OP/ NB/ 7/ 00. Belfast: NBNI.
North Eastern Health Board (NEHB). Education and Training Strategy. Facilitating Mangers to develop staff 1997-2001.
North and West In-service Education Consortium (NWIEC) (2000). Programmes available from September 2000 to June 2001. Produced by North and West In-service Education Consortium.
Nolan, M., & Owen, R.G. (1993). Into the Frame: An evaluation of the Welsh National Board’s Framework for Continuing Education. The Development of Professional Practice. Report for the Welsh National Board for Nursing, Midwifery and Health visiting. Cardiff: WNB.
Nolan, M., & Owen, R.G., & Nolan, J. (1995). Continuing Professional Education: Identifying the Characteristics of an effective system. Journal of Advanced Nursing, 21 (3) 551-560.
Rogers, J., & Lawrence. J. (1987). Continuing Professional Education for Qualified Nurses, Midwives and Health Visitors: A report of a survey and case study. Cited in Shepherd, J.C. (1995). Findings of a Training Needs Analysis foe Qualified Nurse Practitioners. Journal of Advanced Nursing, 22, 66-71.
Shepherd, J.C. (1994). Training needs analysis model for qualified nurse practitioners. Journal of Advanced Nursing 22, 66-71.
Shepherd, J.C. (1995). Findings of a training needs analysis for qualified nurse practitioners. Journal of Advanced Nursing, 22, 66-71.
Studdy, S., & Hunt, C. (1980). A computerised survey of learning needs. Nursing Times 76 (25), 1084-1087.
United Kingdom Central Council for Nursing, Midwifery and Health Visiting (1994). The future of Professional Practice. The Council’s Standards for Education and Practice following Registration. London: UKCC.
Waddell, D.L. (1991). The effects of continuing Education on Nursing. Journal of Continuing Education in Nursing, 22, 113-118.
Waddell, D.L. (1993). Why do nurses participate in Continuing Education? A meta-analysis. Journal of Continuing Education in Nursing, 24 (2) 52-56.
White, K. (1998). What are the factors that influence learning in relation to nursing practice? Journal of Nurse in Staff Development, 14, 147-153.
55
Weber, R.P. (1990). Qualitative Applications in the Social Sciences. A Sage University Paper. Sage Publications, Inc.
56
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