Nursing Administration department Staff Development Dr. Fatma M. Baddar Faculty of Nursing Nursing Administration department February - 2005

Introduction Causes for staff development. Organization arrangement of staff development program. Different Scopes or components of staff development program. Steps or process of staff development program.

Introduction Increasing rate of technological discovery leads to the vast amount of knowledge to be learned, it has become a necessary that various education institutions, and health care agencies be more actively involved in providing continued learning opportunities within or outside the agency which directed towards meeting learning needs of all employees to perform more effectively

Causes or Needs for Staff Development The impact of new Technology and increase of sophistications of nursing science emphasized the need for continuing learning. Introduction of new concept in the nursing field as quality improvement, cost containment, changing methods of delivering nursing care has brought about the need for frequent interaction with Staff Development. The changes that add to the complexity of management functions give motive to the need for continuous Development. The complexity of human relationships in a society with changing values and life styles requires development of leadership styles.

Organizational Arrangement of Staff Development Programs Staff Development can be provided through various organizational Arrangements: Decentralization: with each patient care unit providing it’s own education program Centralization in a separate nursing education department Centralization in an institution – wide department of education and orientation

Scopes or components of staff development program Staff development programs in nursing are usually built around four areas of personnel needs. These needs are designed as: 1) orientation, 2) skill training, 3) leadership and management development, and 4) continuing education.

Orientation programs Orientation They are planned for the purpose of helping nurses who are new in the hospital - or position within the hospital – adjust to their new environment in the shortest time. Orientation program for new employees consists of two parts: Induction training program Job orientation

Skill Training programs Skills Skill training programs are often considered as a contribution of the orientation program, they are provided for new and older employees as well. These programs are directed toward providing employees with skills required for job and keeping them informed of the changing methods and new techniques that required for the efficient performance of their functions. These programs are not refer only to manual or technical skills but it includes communication skills (dealing and working with people, patients as well as peers), which are vital to good nursing care and teaching.

Leadership and Management development programs This program is designed for the purpose of equipping a selected group of employees for growing responsibilities in new positions in nursing. So this program is offered to: Personnel in any supervising position who have had insufficient preparation in the necessary management and leadership skills. Potentially capable personnel before they are assigned to management positions.

Continuing Education program This program is designed for the purpose of helping nurses keep updated with new concepts; acquire new knowledge and competencies in one particular area of nursing. This program includes learning activities within or outside the hospital such as seminars, workshops…etc. Continuing education can either be mandatory or voluntary. Mandatory continuing education has been supported by (N.L.N.) as the requirement for relic ensure to document currency and competency in nursing practice. On the voluntary side, (A.N.A.) supported it for professional nurses who are individually accountable and responsible for identifying their learning needs and acquiring continuing education that relates to their nursing practice. However, continuing education must be accepted as a human rights and social needs.

Staff Development Programming This is a systematic ongoing process. It involves four sequential but interrelated steps which begin with: 1) Identifying learner's learning needs. 2) Planning for the program: a- Establishing priorities. b- Formulating objectives. c- Selecting and organizing learning materials. d- Selecting teaching strategies. e- Designing plan for learning experience. f- Planning budget and financing. g- Design system of reports and records. 3) Implementing the program. 4) Evaluating the program.

1- Identifying learning needs Learning needs identified as a gap or discrepancy between what is desired knowledge and what is already known, that can be satisfied by an educational or learning experience. Sources of identifying learning needs: Three sources for identifying learning needs are: Society change and needs. Organization needs. Individual learning needs.

Methods of identifying learning needs: Staff development educators must be familiar with a variety of means to plan meaningful learning offerings. These methods include: Surveys: (are conducted in the form of a written questionnaire include open ended questions or direct questions or checklist) Work study or performance analysis: In which work done by the health workers is analyzed in the context of job description, learning needs are determined through observation, interview, and unit quality insurance findings. Nursing audit system, revision of incident reports, turnover and absenteeism records, performance appraisal and employment application records.

Planning for the program: It is the process by which the nature and sequence of future education events are determined and organized, it involves: a. Establishing priorities. After needs are determined, they are translated into action and priorities are established. Prioritizing needs depends on the following factors: economic factor, time factor and abilities of personnel. In analyzing the need, it is helpful to categorize it into: 1- Needs related to the administration of the program. 2- Learning needs related to individuals.

b-Formulating objectives. Stating objectives is very important because it provides criteria for selecting content of the program, selecting teaching strategies and a basis for evaluation. Objectives have been classified into two types; general objectives and specific objectives. General objectives: which are broad statements and describe those objectives that the learner should be able to demonstrate at the end of the program. These objectives should be stated in the introduction of the program. Specific objectives: should be stated for each program session in order to reach the general objectives of the program. Specific objectives describe the performance demonstrated by the learner at the end of each program session. The objectives for learning must be stated in such a way that they are measurable, logical, applicable and observable.

Three components of an objective: 1- Condition: the condition under which the behavior will be expected to occur. 2- Performance: what the learner will be able to do at the end of instruction and be acceptable to the instructor as a proof that learning has occurred (observable learner behavior). 3- Criteria: quantitative or qualitative criteria against which learner’s performance will be measured to determine successful learning. - Educational objectives are classified into 3 domains: 1- Cognitive: Those objectives concerned with knowledge, understanding and intellectual skills such as problem solving. 2- Affective: Those objectives concerned with feelings and emotions such as attitudes, values, appreciations and interests. 3- Psychomotor: Those objectives concerned with manipulative skills and coordinated.

Example for cognitive objective: Following a discussion related to nurse-patient interaction, the registered nurse will identify in writing four phases of nurse-patient relationship. Example for affective objective: Given the opportunity for attending a leadership development workshop, the registered nurse demonstrates interest by participating in discussion and completing written assignments. Example of psychomotor objective: After observing a demonstration of an intra muscular injection, the licensed practical nurse will repeat the demonstration in accordance with established procedure.

c-Selecting and organizing learning materials. After determining program objectives, the next step is the selection of learning materials in relation to desired objectives. Principles of adult learning also influence how learning materials are to be constructed. Adults learn best when learning materials are well organized. Maximizing the effect of organizing learning materials depends on three major criteria: Continuity: indicates relationship between different levels of the same subject. Sequence: it is the process of building on existing knowledge and skills to develop more comprehensive ability. Process of sequence should proceed from general to specific and from simple to complex. Integration: relating what is taught in one part of development program to what is taught in another part.

d-Selecting teaching strategies. Teaching strategies vary according to whether the learners must: Receive information. Be shown objects or procedures. Participate actively in their own learning. No approach is all “right” or all “wrong”. The staff development educator selects an approach that best facilitates the objectives of learning experiences, giving consideration to the economy of time and materials. A variety of teaching strategies can be used in staff development. For adult learners, the most effective teaching strategy that permits interaction, discussion, exchange of view points and participation are selected because adult learners learn best when they are involved in the learning process. They should be active learners instead of passive learners.

Teaching strategies that are widely used for staff development programs are: 1- Lectures 2- Demonstrations 3- Conferences 4- Discussion 5- Role playing

e- Designing plans for learning experiences. This step involves the actual development of the program and includes: teaching plan, time schedule and staff assignment. 1- The teaching plan: * All organized learning offering should proceed according to a teaching plan. The plan outlines what the teacher will do and reflects the desired outcomes. The plan is designed to meet a learning need or a group of needs. In order to have the learners meet the objectives within a realistic time period, it may be necessary to identify certain prerequisites in the plan. Prerequisites include: assigning selected readings, designating certain knowledge (e.g. basic anatomy, of the heart), identifying certain clinical skills (e.g. starting an intravenous infusion according to agency policies). * Another approach is the development of tests for the purpose of deciding whether or not the leaner needs to attend a certain portion of the course or cannot attend at all because of lack of knowledge or skills basic to understanding the content (e.g. correct knowledge of physiology is necessary for a course in nursing care of rental dialysis patients). * In formulating teaching plans, all the behavioral objectives should be identified as well as content and teaching methods. Also, it may be desirable to identify the teacher and the time block. These plans should be kept as a matter of record.

2- Time schedule: A time schedule should be used to show each instructor/trainer’s class and clinical schedule in order to determine where the staff development educators are located and what learning offerings are scheduled for the designated time. 3- Staff assignment: One of the best methods in making staff development is based on clinical expertise because it is impossible for all staff development educators to be experts in all of the clinical areas. f- planning budget and financing The hospital must specify a budget that provides adequate funds for planning ,conducting and evaluating an education program ,the hospital administrator must help in providing facilities and resources appropriate for conducting the program ,such as audio-visual aids ,reading materials ,library facilities and conference room .

g- Design system of reports and records Reports and records should be designed to provide the data base for the agency’s information needs .such document serve as specific purpose in providing information concerning statistical data ,documentation of activities ,follow up evaluation and references needed .

3- Program implementation. Refers to actual presentation of the content and learning experiences that were selected and organized during the planning phase. Implementing the program requires preparing of the climate setting. This is significant in the implementation of the program because it can facilitate or hinder the achievement of effective teaching-leaning process. Climate setting refers to physical environment in relation to sound, light, temperature and arrangement of furniture, which affect learner’s ability to concentrate and retain information. Also, they influence the choice of teaching strategy. Climate setting also refers to the relation of a comfortable learning atmosphere that allows participants to know each other, be familiar with their purpose in attending a specific offering. If there are more than one group, they can be given up to 15 minutes to exchange information about themselves. Also, free flowing communication between clinical personnel, planners and relationships that focus on the teacher as a helper or facilitator are vital elements in establishing a climate conductive to learning.

Time schedule for a staff development program that was previously developed in the planning phase must be handled for both learners and instructors. It must indicate duration of the program, duration of each session, outline content of each session, instructor responsible for content presentation, method of teaching used, as well as methods of evaluation.

4- Program evaluation. Evaluation is an integral part of the program. It is a continuous and ongoing process for: Measuring the extent to which the desired objectives have been met, i.e. the degree to which adult learners achieved leaning objectives. Outcome can be in the form of change in learner’s knowledge, practice and attitudes and the effect of these behavioral changes on job performance and patient outcome. Judging the worth of the program, quality of teaching techniques used and instructors, i.e. how learners feel about the program. E.g. Is the program content relevant to the objectives? Is the time adequate for attending objectives? Are instructors qualified for teaching the content? Are teaching strategies effective and permit participation of learners? Is climate conductive to learning? Is the program implemented as planned?

Types of evaluation: Evaluation has two types. Both types are used in evaluating staff development programs: Formative evaluation: Provides data allowing changes in the course while it is being taught. These data facilitate adjustment of both course content and method of teaching to meet learners’ needs. Formative evaluation can be conducted before or during the program. Summative evaluation: Examines the achievement of specific learning objectives as change in knowledge, practice and attitudes through measuring practice in the clinical area and patient outcome.

Methods of evaluation: There are different methods that can be used in program evaluation, the choice of the method depends on: Desired information, i.e. evaluation of the outcome or worth of the program. What is to be evaluated, i.e. knowledge, skills, attitudes. Availability of time and resources. For evaluating outcome of the program: i.e. to what extent the learner achieved learning objectives. For evaluating cognitive aspects (Knowledge): it can be evaluated through written pre, post test, written post test, oral test. For evaluating skills or performance: it can be evaluated through clinical observation using a checklist or rating scale, self-evaluation, anecdotal record, skill demonstration, peer review, audit, patient outcome and patient satisfaction questionnaire. For evaluating attitudes: rating scale, questionnaire, observation and surveys.

For evaluating worth of the program or learner’s feelings about the program: This can be evaluated through the use of: A structured questionnaire that asks learners about effectiveness of the program regarding its content, method of teaching, quality of presentation, value, time of conducting the program. Participation, attendance of participants or learners in learning session acts also as indicator of program effectiveness. Giving feedback is very important to participants. After the evaluation of the program, there is a need to move into a systematic follow up plan for the improvement, and modification of the program. This can be achieved through periodical workshops that can be conducted by nurse managers and staff development educators.