Annotated Bibliography for Performing Needs Assessment on Adult Learners

Nursing -- Annotated Bibliography

Annotated Bibliography

Case, Bette. (1996). Breathing AIR into adult learning. Journal of Continuing Education in Nursing, 27(4), 148-158.

Bette Case reviews an organizational scheme for adult learning called 'AIR', short for active involvement, individual differences, and relevance and motivation. Of the three learning strategies, active involvement is given the most attention. Active involvement seems to capture any learning technique that empowers the students and moves beyond the traditional didactic format for communicating knowledge and skills. The central thesis of active involvement seems to be teaching students how to be self-directed in the learning process. Students should be encouraged to take part in defining the competency objectives, choosing the learning method, and determining the evaluation criteria. Linear lessons plans could also be dispensed with and replaced with collaborative mind maps or matrices. A large number of examples and suggestions are provided to move the students out from behind the desk to take part in a joint effort to make the learning experience more engaging and meaningful. The section on individual differences is both a call to increase sensitivity training in terms of race, ethnicity, and gender, but also to harness the diversity of experience and background that today's workplaces can offer. In terms of sensitivity, assumptions should be validated and emotionally charged words banned. More relevantly, one teaching strategy may be more effective for one demographic and not another. Case suggests using multiple teaching methods for diverse classes. The section on relevance and motivation discusses how the instructor can help the students 'own' the subject matter by making it personal. The main strategy for accomplishing this is defining the real world need for the material being presented. The motivational aspect is in essence engaging students through personal interactions, asking them to connect the material to their personal experiences, and bring energy into the room. In summary, Case provides an excellent overview of non-traditional learning strategies designed to engage students and foster self-learning.

DeSilets, Lynore D., Dickerson, Pamela S., and Riggs, Connie J. (2010). Taming the pedagogy dragon. Journal of Continuing Education in Nursing, 41(9), 388-389.

The authors of this brief article provide a concise and therefore valuable overview of student-centered learning. They argue that pedagogy, which is the use of a lecture format where the expert presents information and the students are expected to be sponges, should be abandoned as a teaching method for nursing continuing education. Instead, andragogy, or student-centered learning, should be the primary teaching model. Andragogy recognizes that the nursing professionals bring with them valuable experience and insights that can enrich the material being presented in the class, therefore recruiting students to become collaborators in their own learning experience will not only provide a deeper grasp of the material but also help keep students focused and motivated. The role of the instructor is therefore to organize, manage, and orchestrate the learning experience, in contrast to simply presenting. Towards this goal, the authors provide a wealth of information on just two pages to help instructors stay focused on the most important concepts underlying student-centered learning. Probably at the top of this list is the emotional intelligence of the instructor; a trait that allows the instructor to recognize and adapt to the learning needs of students with diverse clinical experiences and learning method preferences. Another important concept is the recognition in students that they need to relate the new material to what they already know; a need that demands a more open and collaborative learning experience. This requires that all students engage in the learning experience, even the shy ones, so an informal style is the best approach. This article should be required reading for anyone responsible for the continuing education of working nurses, not only because the argument of the authors is sound, but because the student-centered teaching strategy list is so concise and comprehensive.

Dyson, Lyn, Hedgecock, Bronwyn, Tomkins, Sharon, and Cooke, Gordon. (2009). Learning needs assessment for registered nurses in two large acute care hospitals in urban New Zealand. Nurse Education Today, 29, 812-828.

Dyson and colleagues were interested in conducting a needs assessment concerning the competency needs of clinical nursing staff at two busy acute care hospitals in New Zealand. The anonymous questionnaire consisted of 71 questions probing clinical RNs and their direct supervisors about client care, the health care team, and professional issues. Answers were based on a seven-item Likert scale. Demographic information was also collected. The response rate was 35% for the clinical RNs (N = 563) and 63% for their supervisors (N = 101). Interestingly, only 60% of the respondents first registered as nurses in New Zealand, which revealed an ethnically diverse workforce. At the top of the clinical RN list for the greatest learning need was in client care. More specifically, interpreting the results of a diagnostic test (81%) and coordinating an emergency situation (78%). The primary concern of the clinical RNs in terms of health care team was managing conflicts within the team. The questions on professional issues revealed considerable concern about the Health Practitioners Competency Assurance Act. The clinical RNs direct supervisors believed their staff could benefit from learning to how to use evidence in their practice and to discuss it with colleagues. Another interesting result from this study was the felt need to have a better understanding of a foreign culture by RNs who had immigrated to New Zealand. Overall, the findings of this study reveal that Clinical RNs in these two institutions were primarily concerned about competency in providing direct client care. One of the inherent limitations of the survey is that the survey findings may have little to do with increasing the quality of care. For example, learning how to better interpret a diagnostic test result may have little to no impact on the prevalence of nosocomial infections. Despite this limitation, the responses of experienced RNs and their direct supervisors should provide valuable insights in what this workforce feels it needs and help instructors identify competency objectives.

Hauer, Julie and Quill, Timothy. (2011). Educational needs assessment, development of learning objectives, and choosing a teaching approach. Journal of Palliative Medicine, 14(4), 503-508.

Hauer and Quill begin their overview of contemporary approaches to continuing education within the medical field by quoting the definition of professional competence, thus defining the focus of their review. They argue that competence is achieved by the use of needs assessments, identifying the learning objectives, and adapting the teaching approach to the needs of the students. Although the authors initially focus on physicians as students, the learning approach is valid for medical professionals in general. The needs assessment can take a variety of forms, including self-assessment, interviews, surveys, test scores, focus groups, and informants. Its purpose is to identify gaps in knowledge and skills below the desired competency level, thereby providing the information needed to formulate a continuing education class or program. Towards this goal, the authors discuss in detail the process of needs assessment design and the various forms that a needs assessment can take. Once a need has been identified, the learning objectives and outcomes are defined and formally presented to the students. Doing so in a concise and clear way helps the students begin the process of self-assessment and reflection. To help instructors achieve this goal, the authors discuss the different criteria that define a well-designed objectives and outcomes statement and provide suggestions for further reading. The final section in the article by discusses the selection of a teaching method that will best achieve the stated objectives and outcomes. In essence, this section consists of a long list of teaching approaches that have proven successful in the past for a given goal. Student-centered learning styles are discussed, as is the class size -- from a large group to one-on-one mentoring. In essence, this review provides a valuable overview of the three main steps required to provide an effective learning experience. While this may not be enough of a guide for a more experienced instructor, it would be a good reference for anyone beginning to take on the task of providing continuing education for medical professionals.

Horton-Deutsch, Sara and Sherwook, Gwen. (2008). Reflection: An educational strategy to develop emotionally-competent nurse leaders. Journal of Nursing Management, 16, 946-954.

Horton-Deutsch and colleagues reviewed the role that reflection can play in improving clinical competency. From their perspective, self-awareness and emotional competence are essential for achieving clinical competence and this can only be obtained through the practice of reflection. Reflection is also important for narrowing the gap between theory and practice. Although the act of reflection may depend on cognitive processes that seem far removed from the pragmatic needs of a clinical nurse, according to the authors, reflection allows the clinician to minimize the influence of personal biases and habits towards an evidence-based practice. Critical reflection therefore represents a form of learning and way of being that can be transformative and lead to significant improvements in the quality of care provided. Traditional learning methods in clinical practice have relied heavily on the reflexive approach, which emphasizes training students to develop psychomotor habits that can be relied on during clinical practice. What reflective learning does is to train the mind think about not only on how to do a procedure, but why. Reflective learning, argue the authors, is essential for developing the capacity for becoming an effective leader, because the ability to consider one's own contributions to events will lead to increased competency in the future. Accordingly, the authors review what is known about reflective learning, acquiring reflective learning skills, and evaluating success in teaching reflective learning skills, which constitutes the last half of the article.

Landmark, Bjorg TH., Hansen, Grethe Storm, and Bjones, Ingebjorg. (2003). Clinical supervision -- factors defined by nurses as influential upon the development of competence and skills in supervision. Journal of Clinical Nursing, 12, 834-841.

Landmark and colleagues were interested in developing a deeper understanding of what factors help clinical supervisors attain supervisory competence. When they looked back over the research that had been conducted in this area over the past decade they realized clinical nursing supervisors themselves had not been interviewed extensively concerning what factors determined supervisory competence. To remedy this shortcoming in the research literature, Landmark and colleagues relied on a focus group approach to stimulate the discovery of both individual and consensus opinions that would help the authors identify these factors. With the cooperation of three hospitals in Norway, three focus groups consisting of six to eight participants spent approximately 90 minutes together six times over a 4-month period. All participants were nurses with experience as clinical supervisors and six of these had experience in clinical practice development. The mean length of time was 4.3 years for clinical supervision. The findings from this study reveal that the responses from the focus groups could be categorized into didactics, role function, and organization framework. With respect to didactics, the participants expressed a need to better connect theory with practice both for themselves and their students. In addition, the roles of clinical supervisor need to be better defined, because the role of student supervision is rarely recognized by both the supervisor and the healthcare organization. This latter point highlights the need for a continuing education infrastructure that fosters interactions between clinical supervisors and students, which is the responsibility of the organization. While the limitations include a small, demographically uniform sample, this study begins the process of identifying the factors that influence supervisory competence from the perspective of clinical supervisors.

Lenburg, Carrie B. (1999). The framework, concepts and methods of the Competency Outcomes and Performance Assessment (COPA) model. Online Journal of Issues in Nursing, 4(2). Retrieved 12 May 2013 from http://gm6.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume41999/No2Sep1999/COPAModel.htm.

Carrie Lenburg is interested in increasing practice competency through the utilization of what she calls a "cohesive conceptual framework" for communicating best practice methods and conducting performance evaluations. She argues convincingly that the field of nursing education and workplace training is unorganized and too subjective. To help remedy the situation, she has developed through years of research the Competency Outcomes and Performance Assessment (COPA) model. At the core of this model are four criteria that must be addressed: (1) define the essential competency and what the outcome should be, (2) chose the indicators that best define the competency, (3) utilize the best method for teaching the competency, and (4) develop an effective competency evaluation strategy. While fulfilling all these requirements will not be easy, the COPA model, as presented in the current article, represents a useful checklist and guide because it is so detailed. While identifying the competency may be relatively easy, the real work begins with formulating the outcome statement, indentifying the indicators, and choosing the instruction method. The outcome statement requires the conversion of competency objectives into outcomes using action statements like the student will be able 'to do', 'write about', 'perform, or 'know.' Competency indicators can include clinical observation, simulation, or verbal or written examinations, in addition to numerous modifiers that increase the specificity of the evaluation. The list of considerations are too numerous to review here; however, Lenburg's review of COPA presents a detailed and comprehensive consideration of the essential elements needed to formulate a teaching and evaluation approach for nursing continuing education needs.