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INSTITUTIONNOTEAVAILABLE FROM

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Mayne, Marion S.A Guide to Inscrvice Education for Nursing Personnelin Nursing Homes.California Univ.., Los Angeles. Univ. Extension.36p.Director, Western Center for Continuing Education inAdministration of Health Care Facilities, P.O. Box24902, UCLA Extension, Los Angeles CA 90024($1.50)

MF-$0.65 HC-$3.29Curriculum Development; Educational Objectives;*Guides; *Inservice Education; InstructionalMaterials; *Nurses; *Nursing Homes; *ProfessionalContinuing Education; Program Evaluation; TeachingMethods

ABSTRACTA guide is presented for the purpose of providing a

simple, basic outline for program development of inservice educationfor nursing personnel who care for the chronically ill and aged inextended care facilities. The following topics are included: (1)

inservice education defined, (2) responsibility for inserviceeducation, (3) educational philosophy, (4) objectives, (5)

educational principles, (6) program planning, (7) initiation ofcourse, development of course, and development of instructionalmaterial, (8) an outline comparison of some methods of instruction,and (9) program evaluation. (CK)

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U S OEPARTMENT OF HEALTH.EOUCATION & WELFARENATIONAL INSTITUTE OF

EOUCATIONTHIS DOCUMENT HAS BEEN REPROOUCEO EXACTLY AS RECEIVED FROMTHE PERSON OR ORGANIZATION OR1G.NATING IT POINTS OF VIEW OR OPINIONSsTA TEO 00 NOT NECESSARILY REPRESE NT OFFICIAL NATIONAL INST. TUTE OFEDUCATION POSITION OR PO..ICY

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FILMED FROM BEST AVAILABLE COPY

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A PUBLICATION OF THE WESTERN CENTERFOR CONTINUING EDUCATION

IN ADMINISTRATION OF HEALTH CARE FACILITIES

AGUIDE TOINSERVICE

EDUCATIONFOR

NURSING PERSONNELIN

NURSING HOMES

BY

MARION S. MAYNE, R.N.Public Health Nursing Consultant

Los Angeles County Health Department

Tho Western Center for Continuing Education in Administration of Health..a. 'acilitiPs is an activity of University of California Extension funded inpart, by a Grant from the W K. Kellogg Foundation. The Center is adminis-tered by University Extension, University of California, Los Angeles.

The Western Center develops and conducts university-based courses, seminarsand special conferences for the administrative and professional staff of healthcare institutions throughout the eleven western states, including Alaska andHawaii. The Center further provides consulting services to government agen-cies, universities and professional associations within the health care commu-nity who wish to develop continuing education programs.

Thomas C. Mclndoe, Directorid

TABLE OF CONTENTS

Introduction 1

Inservice Education Defined 3

A Statement of Responsibilities 4

A Statement of Philosophy 5

Objectives or Goals 6

Educational Principles 7

Planning the Program 11

Where to Begin 14

Developing the Course of Study 18

Developing Instructional Material 21

An Outline Comparison of SomeMethods of Instruction 23

Evaluating the Program 26

Bibliography 29

INTRODUCTION

Currently there is recognition of the need for betterprepared nursing personnel to provide good nursing careto the chronically ill and aging patients in extended carefacilities. Improvement of nursing care in this field dependsnot only upon basic preservice instructional programs butmore importantly upon inservice education programs whichprovide opportunities to increase knowledge, improve skills,and develop a deeper understanding of patients and theirneeds.

Inservice education is a significant component of staffdevelopment and needs the enthusiastic support of manage-ment and all personnel. It requires sound planning, definingneeds, formulating objectives, enlisting personnel for par-ticipation, developing instructional materials, and preparinginstruction manuals. As an aid in the development of aprogram, this Guide is offered to administrative nursingpersonnel who hold the responsibility for nursing staffdevelopment.

While it is recognized that details of program contentwill vary according to individual needs, interests, ap-proaches, and attitudes toward the entire field of inserviceeducation, the objective of the Guide is to provide a simple,yet basic outline for program development.

The principles and procedures are not limited to any onetype of instruction and can be applied to any segment of theprogram: orienting new employees; on-the-job skill training;continuing education; and leadership development.

Several people have contributed to the Guide by re-viewing preliminary drafts and providing helpful sugges-tions for revisions. To the following individuals the authorexpresses sincere appreciation for their assistance: RobertL. Smith, M.D., Chief, Chronic Disease Control Division,Los Angeles County Health Department; Miss Jane Mc-Innis, R.N., Assistant Director, and Miss Marguerite

Harmeling, R.N., Educational Director, Bureau of PublicHealth Nursing, Los Angeles County Health Department;Miss Irene Weiss, R.N.; Nursing Director, BrierwoodTerrace Convalescent Hospital, and Chairman, ExtendedCare Facilities Nurses Association; Miss Fotine Drulias,R.N., Director of Inservice Education, Nursing Servicesand Education, Los Angeles County General Hospital; andMrs. Audrey Beatty, R.N., Director of Inservice Education,Childrens Hospital, Los Angeles.

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INSER VICE EDUCATION DEFINED

Often overlooked is the fact that inservice "learning"takes place in any employment situation. If not plannedfor, controlled, and guided, inservice "learning" can resultin poor working habits, acquisition of inaccurate or mis-interpreted information, and attitudes and behavior whichmay, in time, become detrimental not only to the employeeand employer, but to patients as well. The question thenbecomes not one of "can an employer afford to have aninservice program," but one of "can an employer affordnot to have one."

Inservice education holds a prominent place in thetriad of activities, along with selection and assignment,and supervision and evaluation, which forms the base forstaff development. It is an on-going process which assistsan employee to function at her highest level of capacity.It provides a means for the realization of personal as wellas job goals through self improvement, job satisfaction,and the opportunity to make a maximum contribution towardthe improvement of patient care.

There is general agreement that inservice educationconsists of four main program areas, i.e., orientation, skilltraining, continuing education, and leadership and manage-ment development. These areas are explored in other sec-tions of the guide.

A STATEMENT OF RESPONSIBILITIES

Although the overall responsibility for inservice pro-grams rests with top management, the nursing directorworks witl. the administrator in developing inservice edu-cation for nursing personnel. Each has managerial res-ponsibilities in analyzing what needs to be done, how to doit, and planning for action.

Certain agreements must first be reached relating topolicy. For example:

Will attendance be voluntary or compulsory?

Will meetings be held during working hours?

Will employees be compensated either in timeor wages for attendance at meetings during off-duty hours?

Will recognition be given to employees who re-gularly attend meetings?

Sharing the responsibility for inservice education aresupervisors, head nurses, and other members of the nursingstaff. Supervisory personnel promote acceptance and staffsupport, identify learning needs, and provide continuity oflearning experience through supervising practice, demon-strating skills, conducting case conferences, evaluating per-formance, and individual counseling. Individual members ofthe staff have the responsibility for cooperatingwith admin-istrative nursing personnel during the planning stages byrecognizing and giving serious thought to their learningneeds, making these needs known to immediate supervisors,and voicing opinions and beliefs which may contribute to thephilosophy and objectives of the program. They are alsoresponsible for supporting the program through regularattendance at planned meetings, participating in discussion,relating learning experience to job requirements, andapplying knowledge gained to job practice.

A STATEMENT OF PHILOSOPHY

The philosophy held by administrative personnel towardinservice education permeates every aspect of a program.This philosophy should be carefully defined, understood,and accepted as part of administrative policy. It may beexpressed in terms of premises, beliefs, tenets, or con-victions. For example, the inservice education programmight be based on the following:

A conviction that improvement in quality of nursingcare is principally brought about through nursingstaff development.

A belief that administrative personnel have anobligation to provide opportunities for staff toacquire and improve skills, knowledge, and com-petencies.

A premise that every member of the staff will-ingly assu. .3s responsibility for giving good nursingcare and for seeking opportunities to improve theirabilities.

A belief that all nursing personnel strive for successin their jobs.

A conviction that every member of the staff hasa potential for personal growth and the capacityto learn and develop improved job effectivenessand efficiency.

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OBJECTIVES OR GOALS

The formulation of objectives is important in givingdirection to the inservice program, setting the course ofaction, and in defining the end results expected. The tools ofthe educational program should contribute to the goals ofthe nursing service and of the facility as well.

Goals of inservice education can be either long-rangeor short-range. Long-range goals are usually concernedwith a continuous asaessment of staff needs in relation topatient care and changing patterns of patient care, fore-casting future needs, and planning for methods to meetthem.

Short-range goals are more related to the definedcomponents of orientation, skill training, or segments ofcontinuous education. For example, goals may be establish-ed to provide opportunities which help each member of thestaff:

To adjust to the new environment.

To understand her role RE a member of the s .ifand of the organization, its purposes, -'A espe-cially the objectives of the nursing servi-....

To develop skills, attitudes and behavior patternsthrough which she can make a maximum contribu-tion to good nursing care of the patients.

Goals may also be set for a specific area, as for example,a training course to develop a particular skill. Object-vesin this instance might be stated in terms of:

Standardizing methods and procedures.Improving quality and efficiency.Increasing productive work.Improving morale.Reducing staff turnover.Reducing accidents and injuries.Lowering equipment and maintenance costs.

EDUCATIONAL PRINCIPLES

Education or training is a process through which be-havior patterns are changed, and people are guided to think,feel, and do things in the "right" way to reach objectives.These may be acquiring skills or knowledge, solvingproblems, handling people, or changing attitudes. Many timespeople learn by themselves without instruction. For example,a nursing aide may watch another aide making a bed; she maytry it out on her own with some degree of success or failure;or she may read a text or look at diagrams on how to doit. Even though the goal may be reached, much time and effortcan be expended in these unorganized activities. Goals arereached more quickly and efficiently when learning takesplace in an orderly way provided through training programsbased on aund educational principles. Some of these prin-ciples include:

Basic Principles of Learning

Each individual employee:

Learns by doing.

Tell her tow to do it, show herhow to do it, have her dg it.

Learns when ready to learn.

Arouse her curiosity, make thelearning meaningful, help her seethe value to herself, and providea good learning atmosphere.

Connects new learning to what is al-ready known.

Previous learning provides afoundation on which to build newlearning and experience. If thisfoundation is faulty with incorrectinformation, misinformation, andpoor work habits, it may needto be rebuilt.

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Learns one thing at a time.

Although it may seem that theemployee learns several things atonce, actually learning proceedsone step at a time dealing witheach new thing to master.

Must understand what is learned.

Words, phrases, and other mate-rials can be memorized. Skillswhich apply to a specific situa-tion can be acquired. But unlessthe employee knows the meaningof words and understands themeaning of the underlying prin-ciples involved, she is unable toapply the learning in new anddifferent situations.

Learns faster when the results aresatisfying.

Motivation to learn must be main-tained. When progress is made,the employee is motivated to goon. When progress is blocked,the learning process is slowed orthe employee may become frus-trated and quit.

Develops through practice.

When skills are first practiced,each step involved must be re-membered, thought through andcarried out. For example, whenlearning to drive a car, eachstep is recalled individually, butwith practice they become auto-matic and a habit has been devel-oped. It is essential that the em-ployee begins in the "right" wayto prevent faulty habits from de-veloping.

Varies in skills, abilities, and back-ground, and learns at different rates.

People have great differences inpast experiences, motives, in-herent abilities, and attitudeswhich influence the rate withwhich they learn. These individ-ual differences should be givenconsideration in the learning sit-uation.

Basic Principles of Teaching

Those who give instruction to othersshould:

Determine and clearly definegoals to be reached through in-struction.

Establish standards of accom-plishment for the trainee.

Utilize teaching methods withrelation to the established goals.

Adapt instruction to meet individ-ual needs.

Select a setting with good learningconditions.

Motivate trainees to want to learn.

Present material one step at atime and relate it to what thetrainees already know.

Assist the trainees to thinkthrough problems and situations.

Provide for repetition to furtherclarify material and improveskill.

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Follow through to assure thattrainees have acquired skills,knowledge, and understanding forpractice.

Re-teach if there is evidence ofweakness in areas of trainee'slearning.

4PLANNING THE PR RAM

To be effective, an inservice program should be tailoredfor the personnel in the individual facility. Each nursingdirector should assess and define the learning needs of thestaff in order to determine the areas and subjects to becovered, to select and plan the learning methods, and toestablish priorities.

Various methods may be used to determine general areasof learning needs, for example:

Record review and examination

Individual personnel records: ed-ucational background; previous workexperience; educational courses at-tended since employment; safety re-cord; absentee and illness record.

Reports and comments receivedfrom: administrative and supervi-sory personnel; patients; families;and other personnel.

Individual job performance evalua-tions.

Observation and operation analysis ofpotentigproblem areas

Work situation: uneven flow of work;below established standards -- bothas to quantity and quality; poorwork habits.

Work patterns and behavior: lack ofcooperation; unwillingness to share;resistance to change; sensitivenessto failure; failure to follow direc-tions.

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Opinion polls, questionnaires and inter-views

Interviews with new employees.

"Exit" interviews with terminatingemployees.

Elicit opinions and interests of thestaff.

Forecasting

New methods, procedures, and equip-ment.

One method for analyzing learning needs of the staff isthrough the development and use of a skill inventory)The inventory may include not only manual skills necessaryto carry out functions but also behavioral skills, com-munication skills, and others. Skills may be listed in simpleterms of "knowing how to" and "doing." Cross-sectionedwith this list is the personnel roster of one level of workers,

- 12 - e.g., nurses' aides. Each worker is rated on the skillthrough use of a coding system, e.g., 1 = performs ade-quately; 2 = needs improvement; and 3 = full training re-quired.

Skill Inventory(Example) Personnel

Skills Vf"0 ,g

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Answer patient call signal 1 1 2 1 1 3Bathe bed patient 1 1 2 1 1 1

Transfer patient from bed to chair 3 2 3 2 2 3Record observations & care of patient 3 1 2 1 2 3Care of equipment and supplies 1 1 1 1 1 1

Position patient in bed 2 2 3 1 3 3Answer telephone 2 1 2 1 2 2

Range of motion technique 3 3 3 2 3 3Participate in staff meeting 1 1

1 For a complete discussion of skill inventories see Miller, Mary Annice,Inservice Education /or Hospital Nursing Personnel, National League for Nurs-sing, New York, N.Y., 1958.

From analysis of this inventory (which lists a limitednumber of examples o' skills), it is obvious that learningneeds are not in the area of "how to" handle and care forequipment and supplies. It does show, however, real learn-ing needs for rehabilitation nursing care and techniques.It also shows a need for learning "how to" improve record-ing on patient records. And finally, there is an indicationof need for improving communication skills and publicrelations.

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WHERE TO BEGIN

Assessment of staff and service needs should be the basisfor decision in selecting orientation, skill traiping, continuingeducation, or leadership development as a starting point.

Orientation

Where personnel records show a high staff turn-over, general breakdown in effecting personnelpolicies, together with evidence of lowered morale,there is indication for the initiation of an organizedorientation program. Unfortunately, orientation isoften the stopping point rather than the startingpoint. On the other hand, when it is included as onecomponent of a total inservice program, orientationprovides the "off to a good start" aspect so essentialto employee job satisfaction, security, stability andefficient performance.

Keeping in mind that most new employees haverather neutral attitudes and limited knowledge ofthe new work situation, that they are fearful, con-fused, and insecure, the orientation content shouldinclude:

What they must know --

Where, when, and to whom to report for work.

Rules and regulations (uniforms, etc.).

Wages -- amount and when paid.

Payroll deductions -- for what purpose.

Work shifts, days off.

Lunch and coffee breaks -- when and where.

How to do the job.

What they want to know --

Employee benefits -- vacations, sick leave,insurance.

Wage increases and opportunities to advance.

How work is evaluated and by whom.

Employee privileges (phone calls, etc.).

Co-workers -- classifications and numbers.

Patients -- types, conditions, and case loads.

What the employer wants them to know --

History of the organization.

Importance of the facility in the community.

Significance of the employee's contribution to,and responsibility for good patient care.

Public relations aspects of the employee'swork.

Management operation and administrativepolicy, the nature of and reasons for policiesfrom management viewpoint.

Lines of administrative authority.

Personnel policies, including hiring, firing,layoffs, and grievances procedures.

Skill Training

Skill training is often part of and integrated intoan orientation program particularly for new em-ployees with limited previous experience. Thistraining answers the need of "how to do the job."It not only involves learning manual skills necessaryto performing the job but also the behavioral andcommunicative skills. Manual or technical skill isrequired to transfer a patient from bed to chair,but just as important are the human relations and

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communication skills necessary to help the patientunderstand what is being done and why.

Skill training programs are essential for existingstaff prior to the introduction of new methods andprocedures, new equipment, new drugs, or additionof new services. Unless the staff had been preparedthrough a special skill training program, a facilitywhich previously did not accept emphysema patientsmight find it difficult to provide good nursing careto these patients, should the admission policy bechanged.

Continuing Education

It is in the area of continuing education that pro-grams are designed and developed with the interestsof the staff as a guide. Through the staff's expresseddesire to gain additional knowledge and experience,programs may be arranged to motivate staff towardexamination of current practice and exploration ofnewer and improved methods of nursing care. Con-tinuing education also allows for the utilization ofcommunity resources in bringing to the staff the

-16 - knowledge of specialty areas.

Subjects which might be covered by communityagency representatives could include: heart dis-eases, cancer, chest diseases, communicable dis-eases, arthritis, sociological aspects of aging,social needs of the patient, mental health, disasterand mass casualty planning, and others. 2

Interests of the staff must be stimulated, elicited,and guided so that programs are developed whichrelate to nursing service in the facility. Forexample, an expressed interest by a few membersof the staff for knowledge of current treatment ofdiarrhea of the newborn would hardly seem an ap-propriate subject in a nursing home.

2Miller, Mary Annice. Sotsces Joe Assistance in lnservice Education. De-

partment of Hospital Nursing. NLN Code 420-688. New York. National Leaguefor Nursing. 1962.

Leadership Development

Nursing supervisors and other administrative per-sonnel are in a position to recognize leadershippotential in staff members. Leadership qualitiesare not necessarily related to levels of employmentpositions, and leadership is "practiced" in all grouprelationships whether or not it is recognized. Po-tential leaders should be selected and given anopportunity to develop these qualities. It is entirelypossible that a nursing aide who has a warmpersonality, inspires confidence in her peers, showsinitiative, uses good judgment, makes decisions, andis motivated to gain additional knowledge, could,with recognition, guidance, and professional educa-tion become a nurse leader in the future. Ornursing aides who display these qualities, might,with encouragement, instruction, and supervision,be of great value as "instructor aides," or as"aide team leaders."

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DEVELOPING THE COURSE OF STUDY

Once learning needs have been identified, objectives de-fined, and priorities established, a course outline and contentcan be developed for the selected subject of study or field ofpractice in which they will be used (e.g., techniques andskills of rehabilitation nursing).

Course outlines may be worked out in a variety of ways.There are numerous textbooks and publications containingspecific subject course outlines which can be used in wholeor in part. However, in using course outlines which havebeen prepared and used elsewhere, it must be kept in mindthat conditions under which they were used may nave beendifferent from those for which the present course is beingdesigned. These outlines though, are useful in providing aguide for content and to check for inclusion of material tosatisfy the current need.

Another approach is through an analysis procedure oflooking at the selected field for which thecourse is intended,making a breakdown of component parts, and studying eachspecific part to determine its inclusion in the course. Thisprocess can be accomplished by an individual or by a groupof people familiar with the field.

Still another method is observing others, expert in teach-ing practice. If possible, time spent with inservice educatorsin other facilities and agencies should prove to be veryrewarding.

Whatever the approach or method used, certain steps willneed to be taken before the course is finally prepared. Amongthese steps are the following:

Set broad limits for the course content.

In broad terms state clearly what the coursewill cover, and define limitations. For ex-ample, a proposed course may be in the fieldof Rehabilitation Nursing Care to include e-valuation of patient care needs, nursing careplans to meet these needs, and measures to

restore the patient to his fullest potential ofindependent functioning.

List all pertinent topics and items, not necessarilyin order, which might be included in the content.

The items may be compiled from recall ofpast experience in the field, suggestions of thestaff, review of current literature, and fromcourses given elsewhere. In the cited ex-ample, items vould include, for example:

Appraisal of the patient's condition.Positioning of the bed patient.Footboards.Types of wheelchairs.Skin care.External catheters.Anatomy and physiology of urinary and

intestinal tracts.Transfer techniques.Nursing care plans.Prevention of pressure sores.Measuring fluid intake and output.

From the mass of heterogeneous items,classify them into groups from which cat-egories may be set up.

For example, from the above items, it canreadily be seen that anatomy and physiologyof the urinary and intestinal tracts, measuringfluid intake and output, and external catheterscan be grouped (along with items not listed)to form a category of the course outline, i.e.,bowel and bladder management of the in-continent patient.

Arrange the groups of items in logical sequenceto form the outline.

Review and. study of the items at this pointmay point up duplications, omissions, andpossibly the desirability of deletion of some.Selection of topics should take into accountthe background of the trainees, importanceto the subject, and practicality of use. Forexample, it might be interesting for the

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trainees to hear about diseases of the kidneys,but it is hardly essential to acquiring theknowledge and skills involved in a bladdertraining program.

Select and separate items into teaching units.

The course should ultimately consist of aseries of units. A teaching unit may includeone or more items in a group, depending uponthe learning results expected, method ofinstruction, instructional setting, and otherfactors. For example, the item "positioningthe bed patient" will probably require a dis-cussion of principles involved, a special in-structional setting, equipment, demonstra-tions by trainees, evaluations and correct-tions, and practice. This one item couldpossibly comprise an instructional unit inthe course as compared to the item "meas-uring fluid intake and output" which can becombined with other items to form a unit.

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DEVELOPING INSTRUCTIONAL MATERIAL

Following preparation of the course of study, the typesof instructional material to be used must be determined.Generally, there are two broad groups of materials: thosefor the trainee, and those for the instructor.

Trainee materials usually consist of:

A Job, duty, or task sheet which tells the traineewhat to do, specific steps to follow, and in whatsequence. It may also state reasons why the taskis to be carried out. Items of materials, equip-ment and supplies to do the job are listed, and"how" to do it.

A procedure sheet which shows the trainee how todo the job, and which supplements the job sheet byshowing how each step is to be carried out. It maycontain drawings, photographs and other illustra-tions which demonstrate how to perform the task.

An information sheet which provides informationto help the trainee understand the basic principlesrelated to the Job, the processes involved, andother material. It furnishes the %Sly of the task.

An assignment sheet which furnishes a study guidefor the trainee. it includes sources of referencematerial, where they may be obtained, and specificpage numbers to be read.

A test sheet with questions to be answered or pro-blems to be solved

3Test Reservoir for Aide Instructors in Ntesing. Evaluation Service, Na-

tional League for Nursing. New York, National League for Nursing, 1965.

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Instructor materials include:

Methods for developing skill and knowledge foreach training unit: lecture, demonstration, dis-cussion groups, role-playing, problem solving, orcase study.

Lesson plans for each unit outlining the points to becovered, listing the materials required, methodsfor motivating trainees, suggested assignments, anditems to check in determining the trainee's prog-ress.

Teaching aids, including models, graphs, charts,films, film strips, and exhibits.

Training-aid guides which summarize content offilms, film strips, tape recordings and other aids.It may also list points to highlight, and a "test"covering the content, together with the correctanswers.

Work assignments for trainees designed to rein-force the learning process in each unit.

Oral and written examinations to evaluate thetrainee's overall progress.

Records and reports, including schedules, rosterof attendees, skill inventories and individual traineerecords which reflect progress or lack of progress.

AN OUTLINE COMPARISON OF SOME METHODS OFINSTRUCTION

Lecture Method -- a directive method from lecturer tostudent.

Advantages:

Saves time -- material is organized and preparedin advance.

Allows for a larger group of students.

Advance preparation allows for a logical andsmooth flow of ideas and presentation.

No specialized equipment required.

Capitalizes on expert knowledge of theinstructor.

Disadvantages:

Lack of communication -- no feedback.

Knowledge of group members not utilized.

Influence of instructor's opinions or prejudices.

Controlled Group Discussion Method -- the group partici-pates with the leader in control but not dominatingthe discussion. The leader's ideas are not used toinfluence the group.

Advantages:

Interest easily aroused and held.

Learning process is facilitated.

Knowledge of group members is shared.

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Disadvantages:

Limited size of group.

Conference room arrangement required.

Some knowledge of the subject is required of all.

Greater amount of time required.

Role Playing -- participants act out assigned roles in givensituations.

Advantages:

An effective learning technique if the given situa-tion simulates a realistic one.

Interest easily aroused and held.

Reasonable time factor.

Disadvantages:

- 24- Demands skillful leadership.

Situations must be carefully selected and developed.

Group members must be "conditioned" and pre-pared for participation.

Individual Instruction Method -- instructor works with oneperson at a time.

Advantages:

Maximizes the instructor's effect on the student.

Allows concentration on areas of needs.

No special training facilities required.

Minimizes student time in learning.

Disadvantages:

Extremely costly in instructor time.

Restriction of numbers of students who can beinstructed.

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EVALUATING THE PROGRAM

Employee reactions to what is observed, experiencedand practiced is an on-going process in the work environ-ment, and particularly in a lea_ ling situation. When judg-mental reactions are anticipated, encouraged, and plannedfor, they become an important phase of the overall evalua-tion process.

Planning for evaluation of an inservice education programshould not be delayed until a specific unit or segment ofthe program is completed, but should be included as partof the initial planning and integrated into the total program.The stated objectives or goals of the program, based onlearning needs, become the pattern for direction of evalua-tion.

In formalizing the evaluation process, certain aspectsneed consideration in terms of an orderly approach. For

- 26 - example:

The purposes of evaluation --

To determine the progress of the employee,growth in competence, ability to apply ac-quired knowledge and skills in patient care,and changes in attitudes and behavior.

To determine the effectiveness of the programwith respect to established goals, both long-range and short-range.

To identify gaps and weaknesses in the presentprogram, identify other learning needs, andprovide a base for future planning.

To compare different methods of teaching.For example, in terms of results, the lec-ture method may be compared to group dis-cussion or case conference methods in orderto determine the effectiveness of the method.

To provide a sound justification of the pro-gram as reflected in greater efficiency,higher quality of patient care, reduced staffturnover, improved morale, and other iden-tifiable evidence.

The procedures of evaluation --

Refer to the specific objectives of the par-ticular program to know exactly what isbeing measured. When objectives are welldefined and clearly stated, the results of aninservice program should be measurable.As an example, a stated objective for aRehabilitation Nursing Care program mightbe to provide the employee with knowledgeand skills necessary to safe practice forherself and the patient. Measurable evidencewould include a reduction in accidents (backstrains, slips, falls) and workmen's com-pensation claims, and decreased absentee-ism.

Determine appropriate measuring methodsand techniques. These may vary with thenature of the objectives, available time, andavailable data. They may include:

Performance measures --

Improved patient care.Increased efficiency in handling

workload.Reduced absenteeism and tar-

diness.Reduced staff turnover.Decreased cost of supplies and

equipment maintenance.

Response and reaction measures --

Tests of knowledge, skills, at-titudes, and understanding.

Questionnaires for participants'appraisal of program.

Opinionnaires.Job performance evaluations.

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Interview measures --

Interviews with supervisors.Interviews with other staff.Interviews with patients and fami-

lies.

Observational measures --Observation during learning ex-perience of participation, attend-ance, attitudes and behavior.

Followup observation of practice.

Collect the data -- the administration ofthe measuring technique.

Analyze and interpret the results.

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BIBLIOGRAPHY

Abdallah, Mary C. Nurse's Aide Study Manual. Philadelphia,W. B. Saunders Company, 1965. 182 p.

Blueprint for Action in Hospital Nursing. Department ofHospital Nursing. NLN Code #20-1164. New York, NationalLeague for Nursing, 1964. $3.75. 107 p.

Cherescavich, Gertrude D. A Textbook for Nursing As-sistants. St. Louis, C. V. Mosby Company, 1964. 468 p.

Guidelines for the Practice of Nursing on the RehabilitationTeam. Prepared by the Conference Group of the VRA-ANA Special Project on Rehabilitation Nursing. ANAPub. #S-71. New York, American Nurses' Association,1965. 500.

Inservice Education Activities in Nursing Services. ProgramGuide, Nursing Service, Veterans Administration. VAHCode #G-9. M-2, Part V. Washington D.C., Super-intendent of Documents, U.S. Government Printing Office.30¢.

Instructor's Manual, How to be a Nurse's Aide in a NursingHome. PHS Publication #1426. Washington, D.C.,Superintendent of Documents, U.S. Government PrintingOffice, April 1966. 55¢.

Mager, Robert F. Preparing Objectives For ProgrammedInstruction. San Francisco, Fearon Publishers, 1962.$1.75. 62 p.

Miller, Mary Annice. Inservice Education for HospitalNursing Personnel. Department of Hospital Nursing.New York, National League for Nursing, 1958. $2.50.73 p.

Miller, Mary Annice. Sources for Assistance in InserviceEducation. Department of Hospital Nursing, NLN Code#20-688. New York, National League for Nursing, 1962.50¢. 18 p.

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Pin le, F. Anne. "Why, What, and How of Inservice Educa-tion." Nursing Outlook 12:47-51, January 1964.

Reese, Dorothy. Erickson. How to be a Nurse's Aide in aNursing Home. Washington, D.C., The American NursingHome Association. $2.50. 195 p.

Sutton, Audrey Latshaw. Bedside Nursing Teachniques inMedicine and Surgery. Philadelphia, W. B. SaundersCompany, 1964. 374 p.

Test Reservoir for Aide Instructors in Nursing. EvaluationService, National League for Nursing. New York, Na-tional League for Nursing, 1965. $5.00 per set.

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ERIC Clearireham

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Reprinted March 1971