319CHAPTER 15

Curriculum Development and Evaluation in Staff Development

Peggy Guin

Betty Jax

OBJECTIVES

Upon completion of Chapter 15, the reader will be able to:

OVERVIEW

This chapter applies the previous information on curriculum development and evaluation in academic settings to staff development programs in health care organizations. The staff development function involves the postlicensure education of nurses in health care organizations to ensure that members of the nursing staff have the most current, evidence-based knowledge and skills for nursing practice. In large health maintenance organizations (HMOs), university medical centers, major county hospitals, and other health care agencies, the staff development function is often centralized with responsibilities for the training and professional development of all personnel from custodial staff and unlicensed health care workers to nurses, physicians, managers, and administrators. For the purposes of this chapter, the terms staff development educator and APN are used. Other terms to describe educators with a staff development role include clinical nurse educator, 320hospital-based educator, education specialist, and education coordinator. APNs with a staff development component to their role include positions such as clinical nurse specialists (CNSs), nurse clinicians, and clinical nurse leaders (CNLs). These positions may be centralized, departmental, and/or population based; or de-centralized, providing leadership support to a specific nursing unit or area. How APNs are used in this capacity is highly variable and based on the needs of the organization, administrative structure, and its professional practice model.

Activities of staff development educators often include new graduate programs, orientation, competency assessment, cross training, new product and technology training, specialty practice education, research utilization education, leadership development, and continuing education to encourage lifelong learning. Additionally, staff development educators are often involved in providing ongoing education to ensure that health care providers have up-to-date information on standards and guidelines set by government and regulatory agencies such as state health departments, The Joint Commission, and the Centers for Medicare and Medicaid Services (CMS).

In accordance with the mission of a health care organization, additional areas of education may include quality improvement processes, interpersonal relationships, customer service, information technology, and health care economics. Through the provision of initial and ongoing support and education, staff development educators play a key role in the retention of nurses and other health care providers within an organization. APNs have an important role in the initial and ongoing professional development of nurses. As expert clinicians, APNs facilitate the provision of clinically competent care, critical thinking, and the development of good clinical judgment through role modeling, teaching, coaching, and/or mentoring. APNs’ abilities to demonstrate the translation of evidence into practice demonstrate and reinforce the importance of nursing interventions and their impact on the achievement of safe, quality, and cost-effective outcomes.

Clinical judgment and collaboration are used to enhance nursing care and its impact on the unique characteristics of the patient in order to devise a plan of care that ensures advocacy. By influencing nurses, other members of the health care team, and organization/systems, the APN meets the needs of diverse groups and enhances quality and cost-effective patient-centered care.

Most health care facilities have a major educational plan for staff development services. Curriculum development in staff development often involves revisions to the plan based on changes in health care delivery, population demographics, emerging health risks and health problems, advances in practice and technology, and program feedback from the recipients of educational programs. The intended impact of staff development is quality patient care by a well-prepared staff with an ultimate outcome of improved health and quality of life in the patient population served by the agency. Information in this chapter includes roles and responsibilities of nurse educators and APNs in the practice setting, adult learning theories appropriate for staff development programs, the emphasis on quality improvement and patient safety as it applies to staff education, a needs assessment of external and internal frame factors relevant to developing or revising staff development programs, adaptation of curriculum components to the practice setting, evaluation strategies, preparing and managing budgets, and issues in nursing education in the practice setting.

321QUALIFICATIONS, RESPONSIBILITIES, AND FUNCTIONS OF NURSE EDUCATORS AND ADVANCED PRACTICE NURSES IN STAFF DEVELOPMENT PROGRAMS IN HEALTH CARE AGENCIES

In addition to nursing and health care knowledge, the staff development educator needs knowledge and skills in program and curriculum development, learning theories, instructional design and technology, teaching strategies, program evaluation, and budget management. APNs need advanced assessment skills, expert use of the nursing process, organizational and systems leadership, knowledge about outcome focused patient care programs, and skills in evaluation, translation, and integration of evidence and practice standards into systems of health care delivery.

Excellence in communication is critical to building support for the program, interacting with the public and vendors, and fostering relationships with administrators, advisory boards, staff, academic faculty and students, other agency personnel, patients, families, and the community. While many of these qualifications come with experience, additional education is recommended, preferably at the master’s or doctorate level. Additionally, it is preferable for nurses working in staff development and advanced practice roles to be certified in their specialties and/or in continuing nursing education or nursing professional development (NPD). Information on specialty certification can be found at http://www.nursecredentialing.org (American Nurses Credentialing Center [ANCC], 2014). The NPD Role Delineation Study (RDS) summary outlines the practice of NPD based on the results of a ANCC (2012) national study of NPD practice. The study results can be found at http://www.nursecredentialing.org/Certification/NurseSpecialties/Nursing Professional Development/NPD-RelatedLinks/2012-RDS-Survey.pdf

The current standards for NPD were published by the American Nurse’s Association (ANA) in 2010. Just as nurses have a responsibility to lifelong learning in order to maintain and increase competence in their practice, so do staff development educators and APNs (ANA, 2010). The Education Standard in the Scope and Standards of Practice for Nursing Professional Development requires that in order to maintain current knowledge and competency, all registered nurses must:

In addition, the graduate-level prepared specialty nurse and APN should use current health care research findings and other evidence of expanded clinical knowledge, skills, abilities, and judgment to enhance role performance, and to increase knowledge of professional issues (ANA, 2010, pp. 49–50).

The role of the staff development educator and APN is multifaceted and can vary on a daily, sometimes even hourly, basis. Activities of staff development educators often include preparation and support of new graduate programs, orientation, competency assessment, cross training, new product and technology training, specialty practice education, research utilization education, leadership development, and continuing education to encourage lifelong learning. To sustain and build on research and evidence-based practice along the novice to expert continuum (Benner, Kyriakidis, & Stannard, 2011), APNs work with nurses to foster a practice environment that is congruent with clinical inquiry and evidence-based nursing actions. The role of the APN in staff development often varies according to how the role is positioned in the organization. For example, CNSs are often in “central” positions, having expertise within three spheres of influence (patient, nurse and nursing, and organization/systems) around a specific type of patient population. Staff development activities of CNSs therefore are directed at sharing their expertise as it relates to their area of clinical practice. This may be done through didactic teaching, case studies, patient care rounds, module development, patient advocacy, education regarding the evaluation and use of clinical practice guidelines, evidence-based practice, and research.

In contrast, CNLs are expert practitioners in the management and coordination of care for a group of patients on a particular nursing unit or area. They are often involved in unit-level activities that pertain to quality and education. Staff development activities include unit-based orientation, preceptor development, ongoing inservice, and continuing education activities to support clinical and quality initiatives on the unit.

In an ever-changing health care environment with a renewed focus on patient safety and quality outcomes, staff development educators and APNs provide leadership roles in ensuring that nurses and other health care professionals have the knowledge and resources to provide evidence-based care. Through the provision of initial and ongoing support and education, staff development educators and APNs play a key role in the retention of nurses and other health care providers within an organization.

With the renewed focus on patient safety and quality outcomes in health care organizations, the nursing profession is held accountable for nursing-sensitive quality indicators such as skin integrity, hospital acquired infections, and patient falls. The application of research utilization and evidence-based practice in nursing highlights one of the many roles of nurse educators and APNs in the practice setting and their potential to impact patient safety and outcomes. Acting as change agents, the staff development educators and APNs are key to creating a culture of inquiry, promoting research utilization, and preparing nurses and other health care providers 323to seek out and evaluate the evidence, and ultimately improve the quality of care within their organizations (Krugman, 2003; Strickland & O’Leary-Kelley, 2009).

Also, with regard to patient safety and quality outcomes, nurse educators and APNs are responsible for educating nurses about the “measurement, improvement, and benchmarking of clinical costs, quality, and outcomes specific to nursing” (Gallagher, 2005, p. 39). To this end, nurse educators and APNs must be engaged in data gathering and evaluation activities and, more importantly, in communicating findings and benchmarking information to nursing staff. It is difficult, if not impossible, to change practice and improve outcomes if knowledge about current performance and progress is not shared with the nurses who are actually providing interventions and evaluating patient care at the bedside. Staff development educators and APNs are challenged to implement teaching methodologies that prepare bedside nurses to continually question the effectiveness of their interventions, determine if the evidence supports their practice, and utilize their clinical judgment to impact the outcomes of the care they are providing (Durham & Sherwood, 2008).

The responsibilities and functions of the staff development educator and APN include program planning, implementation, and evaluation. If the educator is the sole person responsible for the educational program, other nursing staff members and/or health care providers are consulted for their content expertise in developing educational sessions and the management staff for infrastructure support. In contrast, a large health care system will have an administrator or director of the staff development program, administrative staff, and educators to implement the program. In either case, all of the components of educational program development, implementation, management, and evaluation apply.

LEARNING THEORIES

Chapter 4 describes in detail classic and postmodernistic learning theories applied to nursing education. For the health agency setting, adult learning theories usually prevail in educational programs, especially for staff development. The five assumptions described by Malcolm Knowles (Knowles, Holton, & Swanson, 1998), an influential leader in the field of adult education, are outlined below:

When developing and implementing staff development courses, adult learning principles must be utilized to engage the learner. Nursing staff must see the relevancy of the learning to their immediate work or life situation. Learning activities 324must draw from the experiences of the staff and be interactive whenever possible. Case studies, role playing, group discussion with problemsolving, and simulation are effective learning modalities for the adult learner in the classroom setting. Online learning activities must engage the nurse through learning activities such as case examples, pertinent data, videos, and interactive questions.

Access to education resources in real time is critical for the adult learner in the fast-paced hospital and other health care settings. Staff needs to be able to access current and evidence-based information online. Some facilities are able to financially provide an authoritative suite of online, evidence-based learning and clinical information at the point of care. Smaller institutions can provide staff with information on websites that have been vetted for accuracy and relevancy.

NEEDS ASSESSMENT

Curriculum development for staff development programs begins with a needs assessment that examines the frame factors that are external and internal to the organization and have an impact on the curriculum (Johnson, 1977). Chapters 6 and 7 provide a comprehensive discussion of the adaptation of the Johnson model to current curriculum development activities. The discussion to follow applies these same frame factors to a needs assessment for developing and revising curricula for staff development educators.

EXTERNAL FRAME FACTORS

External frame factors to consider are the community (including changes in population demographics), health needs of the population served by the health care agency, the physical, social, and economic environment, the health care system, the nursing workforce, regulations and accreditation requirements for staff development programs, resources for staff education programs, and the need for program development or revision. See Table 15.1 for a summary of the external frame factors to consider.

TABLE 15.1 GUIDELINES FOR ASSESSING EXTERNAL FRAME FACTORS

Health status reports provide data on current or emerging health risks and health problems as well as existing morbidity and mortality data in a given region or specific patient population. These reports yield information useful for developing and/or revising staff development programs. Health status reports relevant to the population served by health care organizations are usually available in print form from local libraries or online from city, county, state departments of health, or the federal government. The U.S. Department of Health and Human Services publication Healthy People 2020 (2010) is an excellent resource for targeting major health problems in the populace and strategies for promoting health and preventing disease (http://www.healthypeople.gov). More than likely, the health care agency itself has demographic and health status data available on the client population served in recent years, such as the most common diagnoses, diagnoses-related groups (DRGs), injuries and surgeries, thereby providing a basis for determining current needs and projecting trends for the future.

The Health Care System and Nursing Workforce

An assessment of major health care providers in the area, such as managed care systems, health insurance programs, public health services, hospitals, clinics, voluntary health care organizations, other health care facilities, and social services in the area reveal community resources that may be tapped for staff development support as well as potential partners for collaboration. This assessment should include the nursing workforce in the area served by the health care organization, number of nurses employed by the health care organizations, level of education from the licensed practical/vocational nurse to nurses prepared at the doctorate level, numbers of APNs by type (nurse practitioner, CNS, nurse midwife, nurse anesthetist), and critical areas of nursing shortage in the health care organization.

Regulations and Accreditation Requirements

As an integral part of program development or revision, the most current regulations, standards of practice, and accreditation criteria governing staff development are reviewed to ensure that new and revised programs are in compliance. Staff 327development educators in states with mandatory continuing education for nurses need to review their state regulations for receiving approval for continuing education offerings. The current standards for NPD include continuing education, staff development, and academic education as areas in which nurses may take advantage of professional development opportunities.

Need for Program Development or Revision

Since most staff development departments have a major education plan in place, it is rare that a staff development educator actually develops a new staff education program from the ground up. The need for program revision often arises from the changing demographics and health status in the population served by the health care organization and in response to emerging threats to the health of the community. In addition, feedback from staff, patients, families, health facility managers, and administrators indicate areas of program weakness needing change and improvement. Prior evaluations of staff education programs provide information on the satisfaction of program recipients and the extent to which the program goals of each were achieved.

INTERNAL FRAME FACTORS

Internal frame factors to consider in developing staff education curricula are the mission, philosophy, and goals of the institution; characteristics of the health care setting such as organizational structure, including the decision-making structure, particularly as it applies to staff development; institutional economics, including resources for staff development; the characteristics and learning needs of staff; and potential educators for staff development programs. See Table 15.2 for a summary of the internal frame factors to consider.

TABLE 15.2 GUIDELINES FOR ASSESSING INTERNAL FRAME FACTORS

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