Deborah Hennessy

Development of a psychometrically valid training needs analysis instrument for use with primary health care teams.

The growing demand for professional updating and training within the health service has created a proliferation of post-registration courses, many of which fail to reach the appropriate personnel or the real training objectives of the participants and their managers. One reason behind this problem relates to the fact that many such courses are constructed and delivered in a haphazard way, without systematic reference to the direct and indirect consumers of the educational programmes. A more rational approach to post-experience provision of this sort might involve the methodical collection of information regarding the training needs of target health professional populations. Such a data base would afford a global overview of competencies and deficiencies, both within and between individuals. From this the content, level and focus of training could be customized to meet the reported needs, thereby streamlining the commissioning process to enhance efficiency and effectiveness. Previous attempts to rationalize provision through the prior use of training needs analysis instruments have been compromised by the shortcomings of the analysis tool. This study, then, was an attempt to redress this problem, using a training needs analysis instrument developed along traditional psychometric principles. The tool was intended to be used with primary health care teams because of the increasing role this sector of the health service will play in the future delivery of care, although this would not preclude its use with other health care professionals (following appropriate modification), since the principles behind its construction and format are transferable. The instrument has demonstrable construct, content and face validity and significant reliability. Moreover, preliminary investigations suggest that it also has criterion validity in the areas tested. These findings suggest that the instrument is unique of its kind. Early use of the tool has demonstrated its value in a variety of ways, such as in team building exercises and skill mix reviews as well as in precise and effective commissioning of training and education in a range of areas.

The training and development needs of nurses in Indonesia: paper 3 of 3

BackgroundIndonesias recent economic and political history has left a legacy of widespread poverty and serious health problems, and has contributed to marked inequalities in health care. One means of responding to these challenges has been through a reconsideration of the professional roles of nurses, to enable them to deal with the range and complexity of health problems. However, there are currently a number of obstacles to achieving these aims: there is a serious shortfall in trained nurses; the majority of nurses have only limited education and preparation for the role; and there is no central registration of nurses, which means that it is impossible to regulate either the profession or the standards of care. This study aimed to establish the occupational profiles of each grade of nurse, identify their training and development needs and ascertain whether any differences existed between nurses working in different regions or within hospital or community settings.MethodsAn established and psychometrically valid questionnaire was administered to 524 nurses, covering three grades and coming from five provinces.ResultsSignificant differences in job profile were found in nurses from different provinces, suggesting that the nature of the role is determined to some degree by the geographical location of practice. The roles of hospital and community nurses, and the different grades of nurse, were fairly similar. All nurses reported significant training needs for all 40 tasks, although these did not vary greatly between grade of nurse. The training needs of nurses from each of the provinces were quite distinct, while those of hospital nurses were greater than those of community nurses.ConclusionThe results suggest that the role of the nurse is not as diverse as might be expected, given the different levels of preparation and training and the diversity of their work environments. This may reflect the lack of a central registration system and quality framework, which would normally regulate clinical activities according to qualifications. The differences in training needs between subsections of the sample highlight the importance of identifying skills deficits and using this information to develop customized post-registration education programmes. Together, these results provide a rigorous and reliable approach to defining the occupational roles and continuing education needs of Indonesian nurses.

The training and development needs of midwives in Indonesia: paper 2 of 3

BackgroundThere is a shortfall in midwives in Indonesia (an estimated 26 per 100 000 people), which means that the quality of antenatal, perinatal and postnatal care varies widely. One consequence of this is the high rate of maternal and perinatal mortality, which has prompted a number of health initiatives. The current study was part of a review of the existing complex system of midwifery training and the development of a coherent programme of continuing professional development, tighter accreditation regulations and clearer professional roles. Its aims were to identify the occupational profiles and development needs of the participating midwives, and to establish whether any differences existed between grades, geographical location and hospital/community midwives.MethodsA psychometrically valid training-needs instrument was administered to 332 midwives from three provinces, covering both hospital and community staff and a range of midwifery grades. The instrument had the capacity to identify occupational roles and education/training needs of the respondents.ResultsThe occupational roles of the midwives varied significantly by province, indicating regional service delivery distinctions, but very little difference in the roles of hospital and community midwives. The most educated midwives attributed more importance to 35 out of the 40 tasks, suggesting an implicit role distinction in terms of level of activity. All midwives reported significant training needs for all 40 tasks. The most-educated midwives recorded training needs for 24 tasks, while the less-educated had training requirements for all tasks, which suggests that new training programmes are effective. Few differences in training needs were revealed between hospital and community midwivesConclusionThe results from this survey suggest important regional differences in how the midwifes role is discharged and underline the importance of this sort of research, in order to ensure the suitability of basic and postbasic educational provision. The study also highlights the need for further development and training of midwives in a wide range of tasks. These results provide a systematic and reliable overview of current midwifery roles and development needs and could serve to inform future training.

Applying psychometric principles to the development of a training needs analysis questionnaire for use with health visitors, district and practice nurses:

Much health service research relies on the use of questionnaires, some of which are poorly constructed and therefore have the potential for yielding unreliable databases1 . The application of the formal principles of psychometrics to questionnaire design can eliminate many of these problems. This paper reports the development of a training needs analysis tool following some of these essential parameters. The overall aim of the exercise was to identify the nature and extent of the training and education required by health visitors, practice and district nurses in a range of occupational areas, but with specific reference to research competencies. The results demonstrated that within the domain of post-basic training needs, there is a need to employ data collection techniques which go beyond the standard wish-list approach typically adopted, and to use, instead, questionnaires which embrace some of the guiding principles of psychometric science. In this way, educational provision can be more reliably informed and limited budgets more systematically targeted.

An alternative technique for evaluating the effectiveness of continuing professional development courses for health care professionals: a pilot study with practice nurses

BACKGROUND Increasing recognition of the need for continuing professional development (CPD) for health professionals has created an inevitable expansion in course provision. One criterion of a successful course demands that CPD must meet local health service needs, as well as the personal and professional requirements of the participants. At a more general level, a key pedagogical requirement of any educational course is that the content and process must meet the stipulated aims and objectives, and this requires appropriate evaluation procedures. Within health care CPD, very little course evaluation routinely takes place, possibly because the area is relatively new, and secondly because relevant evaluation may be difficult to operationalize. AIMS The current study reports a small exploratory pilot investigation into the use of a valid and reliable training needs analysis questionnaire as a means of evaluating a nurse practitioner (NP) training scheme for practice nurses (PN). METHODS Using a before/after design, the instrument involved the participants in a pre and post course self-assessment on a range of tasks. These assessments were made according to three criteria: how critical each task is considered to be to the effective delivery of the respondents current PN role; how critical each task is considered to be to the effective delivery of the role of the NP; and how well each task is currently performed. Various comparisons of the ratings provide a considerable amount of information that may be of use to the nurse manager in planning NP programmes. Of particular relevance to the current paper, however, are the comparisons between salience of tasks for the NP role and performance on these, before and after the course. This provides an assessment of the extent to which the course has met educational requirements. RESULTS The present study demonstrated that overall, the course reduced skill deficits in all but seven of the tasks. Of these, six related to research and audit and the seventh to clinical examination of patients. CONCLUSION The study is discussed in terms of the implications of the technique for course development and planning to take account of local needs, as well the instruments reliability and validity, for use in this way.Background Increasing recognition of the need for continuing professional development (CPD) for health professionals has created an inevitable expansion in course provision. One criterion of a successful course demands that CPD must meet local health service needs, as well as the personal and professional requirements of the participants. At a more general level, a key pedagogical requirement of any educational course is that the content and process must meet the stipulated aims and objectives, and this requires appropriate evaluation procedures. Within health care CPD, very little course evaluation routinely takes place, possibly because the area is relatively new, and secondly because relevant evaluation may be difficult to operationalize. Aims The current study reports a small exploratory pilot investigation into the use of a valid and reliable training needs analysis questionnaire as a means of evaluating a nurse practitioner (NP) training scheme for practice nurses (PN). Methods Using a before/after design, the instrument involved the participants in a pre and post course self-assessment on a range of tasks. These assessments were made according to three criteria: how critical each task is considered to be to the effective delivery of the respondents current PN role; how critical each task is considered to be to the effective delivery of the role of the NP; and how well each task is currently performed. Various comparisons of the ratings provide a considerable amount of information that may be of use to the nurse manager in planning NP programmes. Of particular relevance to the current paper, however, are the comparisons between salience of tasks for the NP role and performance on these, before and after the course. This provides an assessment of the extent to which the course has met educational requirements. Results The present study demonstrated that overall, the course reduced skill deficits in all but seven of the tasks. Of these, six related to research and audit and the seventh to clinical examination of patients. Conclusion The study is discussed in terms of the implications of the technique for course development and planning to take account of local needs, as well the instruments reliability and validity, for use in this way.

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.

An alternative methodology for clinical skill-mix review: a pilot case study with a primary health care team

Clinical skill mix is acknowledged to be one solution to the problem of providing high quality health care within a framework of restricted resources within the British National Health Service (NHS), but there are methodological difficulties inherent in its effective implementation. Of particular relevance here is the problem of taking accurate measurements of clinical outcomes following a set of treatment inputs, which contributes to the inconclusive and disappointing results of skill-mix reviews. This paper considers an alternative methodology which, rather than looking at clinical and fiscal outcomes as the primary indices of a successful skill mix, focuses on the relevance of task inputs within a given clinical domain. Using a psychometrically valid and reliable instrument, health care practitioners in a large primary health care team were asked to evaluate both the importance of a range of job tasks to the provision of quality care within their primary care role and their performance on them. Any perceived skill deficits thus revealed could inform either the commissioning of further training to improve performance levels or, alternatively, the future selection of staff to compensate for skills shortfall. The technique, although at an early stage of development for use in this way, is none the less potentially valuable for conducting skill mix-reviews and informing planning and education.