Evaluating healthcare education: issues and methods

This paper analyses the methodological issues inherent in evaluating healthcare education and considers approaches for addressing these. Recent policies have exhorted practitioners to base their practice on evidence; however in healthcare education the evidence base is not extensive. Whilst educational evaluation has advanced in the last decades, standardised designs and toolkits are not available. Each evaluation has different aims and occurs in specific contexts, thus the design has to fit the circumstances, yet meet the challenge of scientific credibility. Indicators of educational processes and outcomes are not scientifically verified; no toolkit of standardised 'off-the-shelf' valid, reliable and sensitive measures exists. The evidence base of educational practice is largely derived from small-scale, single case studies; the majority of measures are self-devised, unvalidated tools of unproven reliability, thus meta-synthesis is not appropriate and results are not generalisable. Healthcare educational evaluators need valid and reliable assessments of both knowledge acquisition and its application to practice. The need to establish and explain attribution, i.e. the relationship between educational inputs and outcomes is complex and requires experimental/quasi-experimental design. In addition, educational evaluators face the pragmatic challenge of practice in healthcare contexts, where confounding variables are hard to control and resources are scarce.     

Evidence-based educational commissioning and policy making: a case for the prospective use of a psychometric approach in defining the role and preparation of the nurse practitioner in Australia

The concept of evidence-based care and the profile of the nurse practitioner (NP) have together assumed mounting importance as possible solutions to the problem of meeting escalating demands for high quality health care with decreasing resources. With regard to the former, concerted efforts to ensure that clinical practice has its base in scientific evidence, have resulted in health care delivery that is increasingly informed by research rather than ritual and tradition. This success notwithstanding, health management and policy-making have remained grounded in assumption, principally because of the paucity of available research in these areas. With regard to the NP, there is little agreement regarding the boundaries of professional practice and preparatory education, both of which need to be defined to some degree at the local level, if the health needs of the indigenous population are to be met. If these two issues are integrated, the policies regarding the preparation and occupational scope of the NP could incorporate research-based decision-making, and thus could simultaneously develop the NP according to locally specified needs, as well as meeting the requirements of the evidence-based care culture. This paper discusses a psychometrically valid and reliable instrument that has the capacity to provide research data which can inform strategic thinking regarding the definition, education and operation of the NP at a variety of levels. The technique has been used extensively in the UK, repeatedly demonstrating its value in NP educational commissioning. While the instrument has not yet been used to inform NP education in Australia, it has been administered to a cohort of acute sector nurses in Victoria. It is argued that the relevance of the instrument to the Australian health system, coupled with its proven importance in the development of the NP in comparable health care cultures, makes this approach worthy of consideration for the preparation of the NP for a variety of Australian health contexts.     

Undue industry influences that distort healthcare research,strategy, expenditure and practice: a review

Background

Expenditure on industry products (mostly drugs and devices) has spiraled over the last 15 years and accounts for substantial part of healthcare expenditure. The enormous financial interests involved in the development and marketing of drugs and devices may have given excessive power to these industries to influence medical research, policy, and practice.

Material and methods

Review of the literature and analysis of the multiple pathways through which the industry has directly or indirectly infiltrated the broader healthcare systems. We present the analysis of the industry influences at the following levels: (i) evidence base production, (ii) evidence synthesis, (iii) understanding of safety and harms issues, (iv) cost‐effectiveness evaluation, (v) clinical practice guidelines formation, (vi) healthcare professional education, (vii) healthcare practice, (viii) healthcare consumer's decisions.

Results

We located abundance of consistent evidence demonstrating that the industry has created means to intervene in all steps of the processes that determine healthcare research, strategy, expenditure, practice and education. As a result of these interferences, the benefits of drugs and other products are often exaggerated and their potential harms are downplayed, and clinical guidelines, medical practice, and healthcare expenditure decisions are biased.

Conclusion

To serve its interests, the industry masterfully influences evidence base production, evidence synthesis, understanding of harms issues, cost‐effectiveness evaluations, clinical practice guidelines and healthcare professional education and also exerts direct influences on professional decisions and health consumers. There is an urgent need for regulation and other action towards redefining the mission of medicine towards a more objective and patient‐, population‐ and society‐benefit direction that is free from conflict of interests.     

A review of outcomes of individualised nursing interventions on adult patients

Aims and objectives. This review describes the outcomes of individualised nursing interventions on adult patients. Background. Although the delivery of individualised nursing interventions is important there is limited evidence about how these interventions enhance patient outcomes. Methods. A computerised search was undertaken using the Cochrane Library, MEDLINE, CINAHL and PsycINFO. The selection criteria chosen were: reports of individualised nursing interventions focusing on adult patients in a variety of health care settings and using experimental designs. These involved randomised controlled trials, clinical controlled trials and pre‐ and posttest controlled studies. After a four‐stage inclusion strategy 31 documents were accepted for the review. Results. The studies were mostly focused in preventative arenas such as health promotion and counselling. Others were care of older people in the community and in hospital and patients with chronic diseases. Over half of the nursing interventions (58%) involved educational or counselling activities which seem to be more effective than ordinary, standardised or routine education and counselling. Overall, 81% of the studies reported a positive impact of individualised interventions on patient outcomes showing that there is evidence, though limited, that individualised interventions can produce positive patient outcomes. Conclusions. There is sufficient evidence, especially in specific areas such as patient education and counselling, to acknowledge that individualised interventions are superior to non‐individualised interventions. Evidence for this effect within clinical nursing interventions on patient outcomes was limited by the scarcity of research in this area. There is a need for additional intervention studies to determine the effect of individualised interventions in a wide variety of contexts. Relevance to clinical practice. Experience of health is individual. Therefore, nursing interventions should also be individualised to each patient. These findings show some promise that individualised interventions may be useful in delivering positive patient outcomes.     

The potential advantages and disadvantages of introducing interprofessional education into the healthcare curricula in Spain

The complexity of contemporary clinical practice demands that increasingly skilled high quality health and social care is provided to individuals. However, the failure of health and social care professionals to work collaboratively has been widely reported in the international literature. Hence, interprofessional education has been suggested as a means of improving both interprofessional understanding and respect across a diverse range of practice disciplines. In this way, functional barriers can be challenged or broken down; teamwork enhanced and healthcare outcomes improved. Lack of conclusive evidence to substantiate the above healthcare benefits has been attributed to weak methodological approaches when evaluating such educational initiatives. In Spain barriers to implementing interprofessional education are potentially less challenging. Recent legislative demands following the Bologna Agreement on European Higher Education is compelling Spanish higher education institutes to engage in radical educational reforms. Consequently, this paper examines some of the advantages and disadvantages of introducing interprofessional education into health and social care curricula in Spain to see when and how interprofessional initiatives might be assimilated into the health care curricula. In this way lessons learned from a thorough review of the relevant literature might help to inform such educational reforms across mainland Europe and beyond.     

The Potential of Disease Management for Neuromuscular Hereditary Disorders

Neuromuscular hereditary disorders require long‐term multidisciplinary rehabilitation management. Although the need for coordinated healthcare management has long been recognized, most neuromuscular disorders are still lacking clinical guidelines about their long‐term management and structured evaluation plan with associated services. One of the most prevalent adult‐onset neuromuscular disorders, myotonic dystrophy type 1, generally presents several comorbidities and a variable clinical picture, making management a constant challenge. This article presents a healthcare follow‐up plan and proposes a nursing case management within a disease management program as an innovative and promising approach. This disease management program and model consists of eight components including population identification processes, evidence‐based practice guidelines, collaborative practice, patient self‐management education, and process outcomes evaluation ( Disease Management Association of America, 2004 ). It is believed to have the potential to significantly improve healthcare management for neuromuscular hereditary disorders and will prove useful to nurses delivering and organizing services for this population.     

A Cross-Cultural Tool To Identify Continuing Education Needs

Cost-controlled health reforms have created the need for training nurses to provide evidence-based care in new contexts. Planning for nurses' continuing education must thus target the appropriate personnel and simultaneously consider local healthcare needs and training requirements. To plan such educational programmes, a training needs analysis instrument was developed in the UK and used to compare the training needs of nurses in Australia, the USA and the UK. Below, the findings of this survey.     

Moving Evidence Forward: Addressing the Barriers to Evidence-Based Practice in Radiotherapy

Improving the quality of care is an ongoing challenge for medical professionals in the Canadian healthcare system. One generally accepted method of improving health outcomes has been the clinical implementation of evidence-based practice. Historically, the barrier in clinical settings has been efficient access to reliable information. Point-of-care (P-O-C) tools have been proven to be effective and help promote evidence-based practice in professions outside radiation therapy. To examine the potential usefulness of a P-O-C tool for radiation therapists, a Canada-wide survey was distributed to practicing radiation therapists. Results showed a clear desire by radiation therapists for a P-O-C tool. Sixty-nine percent of surveyed practitioners stated that having a practitioner-focused evidence resource would change their daily work practice, but stipulated that the proper integration of resources into the day-to-day workplace is crucial to supporting clinical evidence-based decision-making. Study participants also highlighted several barriers to their ability to do so, including access to evidence-based data, differing organizational research philosophies and practices, lack of resources to promote discipline-specific practitioner research, and necessary integration of educational and mentoring programs into daily practices. Although they have not been found to be an all-encompassing remedy, P-O-C tools have the potential to aid front-line healthcare providers in fostering evidence-based practice.     

Standardized testing in nursing education: Preparing students for NCLEX-RN® and practice

Standardized testing that predicts nursing student success accurately and identifies weak content areas has played a critical role in nursing education. Critics of such testing lament the harm of this type of testing, often misinterpreting common practices as well as overlooking all value. The goal of nursing school is to graduate competent professionals with adequate knowledge to practice safely, who can pass the NCLEX-RN® and gain employment. The use of standardized exit exams or comprehensive exams that are valid and reliable should be embraced as evidence-based, academically rigorous evaluation tools, much like the discipline of education has embraced the Praxis Exam. This paper will present evidence supporting the value of “program exit standardized testing” and address the importance of assessing students and focusing on minimum competency. As a profession that prides itself on the use of evidence to guide practice, we need to use evidence to guide policy development with respect to the use of standardized testing in nursing education.     

The concept of hope in nursing 6: research/education/policy/practice

This article, the last in the series, focuses on future international research, education, policy and practice issues that centre around the concept of hope. While a growing literature is accumulating, it needs to be acknowledged that the area of hope and hope inspiration remains under-researched and is consequently not well understood. However, this article highlights future research questions around hope which have been grouped under the broad headings of: (1) the structure of hope; (2) the assessment of hope; (3) the enhancement of hope; (4) the potential outcomes of hope. The article also declares how our current body of knowledge relating to hope has had limited visibility outside professional journals, has not received the funding necessary, and has not been reflected in relevant policies within our healthcare and educational institutions. If the goal is to conduct interdisciplinary research across countries and to gain a global understanding of hope, then greater resources are needed. There is a need to prepare nurses and other healthcare professionals to deal with the challenge of enhancing and maintaining hope in those that they care for in their practice, as well as in themselves.     

High engagement,high quality: A guiding framework for developing empirically informed asynchronous e‐learning programs for health professional educators

E‐learning involves the transfer of skills and knowledge via technology so that learners can access meaningful and authentic educational materials. While learner engagement is important, in the context of healthcare education, pedagogy must not be sacrificed for edu‐tainment style instructional design. Consequently, health professional educators need to be competent in the use of current web‐based educational technologies so that learners are able to access relevant and engaging e‐learning materials without restriction. The increasing popularity of asynchronous e‐learning programs developed for use outside of formal education institutions has made this need more relevant. In these contexts, educators must balance design and functionality to deliver relevant, cost‐effective, sustainable, and accessible programs that overcome scheduling and geographic barriers for learners. This paper presents 10 guiding design principles and their application in the development of an e‐learning program for general practice nurses focused on behavior change. Consideration of these principles will assist educators to develop high quality, pedagogically sound, engaging, and interactive e‐learning resources.     

Interprofessional education and working in mental health: in search of the evidence base

Aim To explore interprofessional attitudes arising from shared learning in mental health. Background Inter‐professional education in healthcare is a priority area for improving team‐working and communication. Many studies have attempted to evaluate its benefits and challenges, although few emanate from the mental health arena. However, producing evidence to link educational input with clinical outcomes is notoriously difficult. This project attempted to produce evidence for changes in interprofessional attitudes and stereotypes. Method(s) Mental health nursing students and clinical psychology trainees participated in inter‐professional education. An evaluation tool was designed to evaluate the experience and outcomes, and to consider implications for interprofessional working. Results There was an increase in clarity regarding roles, approaches and resources, and how to collaborate in practice. There was no significant change in professional identity. Many challenges were identified, including differences in academic level, previous experience, expectations, assessment, motivation and effort. Conclusion Despite the challenges, it remains important to offer collaboration with future mental health colleagues as a foundation for effective team‐working. Recommendations are made for creating inter‐professional education opportunities for diverse student groups. Implications for Nursing Management Mental health professionals need to work effectively in multidisciplinary teams. Drawing on available guidance, managers should encourage and support team members to undertake shared learning where possible, both within clinical settings and through more formal educational provision. In this way, managers can facilitate collaborative relationships which will pay dividends for the provision of effective mental health care. This project adds to the limited knowledge currently available on interprofessional learning and attitudes within a mental health context.     

An assessment continuum: How healthcare professionals define and determine practice readiness of newly graduated registered nurses

BackgroundHealthcare services require graduate nurses to be practice ready, however growing evidence implies that this is not the case. There is a lack of clarity in the literature around the concept of practice readiness and how this is determined. Without a clear definition to guide assessment processes, decisions about graduate nurse practice readiness will remain poorly defined and graduate nurses inadequately supported.AimAs part of a larger body of work, this paper reports on how healthcare providers in one state in Australia define and determine graduate nurse practice readiness.MethodsThis study employed an instrumental collective case study design using multiple methods of data collection and grounded theory methods of data analysis. Sixty-seven healthcare professionals located in four sites in one state in Australia participated.FindingsThis study found that practice readiness is a multidimensional concept encompassing overlapping personal, clinical, industry and professional capabilities. These capabilities held true for participants in all contexts of practice. Practice readiness is assessed across a continuum as the graduate makes the transition from student to registered nurse. Graduates’ level of confidence was found to be a critical factor in both demonstrating and determining practice readiness.DiscussionDecisions about graduate nurse practice readiness are largely subjective. An agreed understanding of practice readiness is required to ensure assessments and decisions about practice readiness are reliable and consistent and support the needs of graduate nurses and healthcare providers.ConclusionA graduate nurse’s first year of practice is an extension of their learning and development to become a competent registered nurse. Graduate nurses require experience as a registered nurse to be practice ready and achieve the necessary confidence and required competence for safe practice. In the current model of nurse education, meeting this need is difficult.     

Student attitudes and educational support in caring for older people--a review of literature

The ageing population is currently one of the main issues facing UK healthcare systems. Nurses of the future will be faced with the task of caring for this elderly population. Meanwhile, care standards and government policies have emphasized the need for preparing students to care for the older people. Preparing nursing students to meet the care needs of an expanding ageing population is a challenge for nursing education. Moreover, caring for older people are often not seen by students as an attractive option, a perception that exerts a considerable influence on the values that inform their future professional practice. This paper examines the literature related to the students’ perceptions of caring for older people and suggests the need for specific curricular content, teaching and a structured approach to the educational preparation and support of students for their practice experience. If students are provided with the relevant preparation and support, they can engage in enriched learning experiences, deliver quality care and develop positive attitudes in caring for older people in their professional practice.     

Evaluating educational preparation for a health education role in practice: the case of medication education

Current health care policy and practice contexts in the UK point to the importance of nurses' ability to make an effective contribution to educating patients about medication, as part of their role in health education and health promotion. Nurses' potential contribution to this important activity will inevitably be dependent on knowledge and skills acquired during preregistration and postregistration programmes of education. Against this backdrop, changes in pre and postregistration nurse education in the UK in the past decade highlight the importance and timeliness of evaluating the adequacy of educational preparation for a medication role. This paper reports on the findings from an evaluation of UK educational preparation for a medication education role in practice. A case study design was used to investigate current educational preparation at three education institutions. Multiple methods of data collection at each site involved focus group discussions with lecturers and practitioners, individual interviews with key personnel, nonparticipant observation of teaching sessions, postobservation interviews with students and curriculum analysis. Findings highlighted the importance of a number of dimensions of preparation for practice of such a role: the need for sufficient taught pharmacology; opportunities for application and integration of prerequisite knowledge and skills; the importance of practice-based learning; the need for an evidence-based curriculum, and the importance of clarifying outcomes and competencies required for a medication education role within pre and postregistration curricula. The paper concludes with a discussion and implications of the findings.     

Information technologies and the transformation of nursing education

Higher education is facing new challenges with the emergence of the Internet and other information and communication technologies. The call for the transformation of higher education is imperative. This article describes the transformation of higher education and its impact on nursing education. Nursing education, considered by many a pioneer in the use of educational technologies, still faces 3 major challenges. The first challenge is incorporation of the Institute of Medicine's recommendation of 5 core competencies for all health professionals. The second challenge focuses on the preparation of nurses to practice in informatics-intensive healthcare environments. The last challenge is the use of emerging technologies, such as Web 2.0 tools, that will help to bridge the gap between the next generation and faculty in nursing schools. Nurse educators need to understand and use the power of technologies to prepare the next generation of nurses.     

A systematic review of the collaborative clinical education model to inform speech-language pathology practice

Abstract

A shortage of clinical education placements for allied health students internationally has led to the need to explore innovative models of clinical education. The collaborative model where one clinical educator supervises two or more students completing a clinical placement concurrently is one model enabling expansion of student placements. The aims of this review were to investigate advantages and disadvantages of the collaborative model and to explore its implementation across allied health. A systematic search of the literature was conducted using three electronic databases (CINAHL, Medline, and Embase). Two independent reviewers evaluated studies for methodological quality. Seventeen studies met inclusion/exclusion criteria. Advantages and disadvantages identified were consistent across disciplines. A key advantage of the model was the opportunity afforded for peer learning, whilst a frequently reported disadvantage was reduced time for individual supervision of students. The methodological quality of many included studies was poor, impacting on interpretation of the evidence base. Insufficient data were provided on how the model was implemented across studies. There is a need for high quality research to guide implementation of this model across a wider range of allied health disciplines and to determine educational outcomes using reliable and validated measures.     

Current trends in interprofessional education of health sciences students: A literature review

There is a pressing need to redesign health professions education and integrate an interprofessional and systems approach into training. At the core of interprofessional education (IPE) are creating training synergies across healthcare professions and equipping learners with the collaborative skills required for today's complex healthcare environment. Educators are increasingly experimenting with new IPE models, but best practices for translating IPE into interprofessional practice and team-based care are not well defined. Our study explores current IPE models to identify emerging trends in strategies reported in published studies. We report key characteristics of 83 studies that report IPE activities between 2005 and 2010, including those utilizing qualitative, quantitative and mixed method research approaches. We found a wide array of IPE models and educational components. Although most studies reported outcomes in student learning about professional roles, team communication and general satisfaction with IPE activities, our review identified inconsistencies and shortcomings in how IPE activities are conceptualized, implemented, assessed and reported. Clearer specifications of minimal reporting requirements are useful for developing and testing IPE models that can inform and facilitate successful translation of IPE best practices into academic and clinical practice arenas.     

Educational input and patient outcomes: exploring the gap

Over the last two decades, the health care professions in the United Kingdom have seen an unparalleled expansion of continuing professional education (CPE) and development (CPD) programmes; however, there is little empirical evidence that these enhance the care delivered to patients. Further research is also needed to demonstrate that these initiatives are linked to improved patient outcomes. If health care educators are to move towards an 'evidence-based curriculum', some restructuring of courses may be needed. Priorities should be set and decisions made, based on the results of reliable and valid research into the clinical outcomes of CPE. To evaluate courses and demonstrate educational effectiveness solely in terms of student satisfaction is not enough; to survive in the world of evidence-based care, educators must also demonstrate their contribution to clinical effectiveness. However, the neoteric field of impact evaluation lacks not only validated research methods, but also an agreed agenda for future research. Drawing on interviews undertaken with nurses who have participated in education evaluations and the relevant literature, this paper discusses the available data collection instruments and the development of viable research designs and methods, which are urgently needed to assess the outcomes of professional education programmes.     

发展以角色为基础的护理研究生教育

虽然大多数护士在临床一线工作,但卫生事业的发展要求护理专业能具有不同角色的专业人才,如教育者、高级实践者和管理者.护理教育和实践发展的密切结合才可加速护理专业的发展.发展以角色为基础的护理研究生教育可促使护理专业角色的发展.教师需要掌握教育理论和方法以提高教学质量,高级实践护士需要掌握以实证为基础的临床知识和技能来提高护理质量,管理者必须了解如何与大环境协调及卫生保健的重点以确保优质服务.本文的目的是介绍美国以角色为基础的研究生课程设置包括护理教育、高级护理实践和护理管理.