FACULTY OF NURSING AND ALLIED HEALTH SCIENCES

_________________________________________________________________________
NMNI5103
TRENDS AND ISSUES IN NURSING
ASSIGNMENT 1
SEPTEMBER SEMESTER 2016
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Task:

Discuss the CPD model available in your country. Propose suggestions and
recommendations to the current model of CPD practices/ process.

Name: MAIZATUL AKMAR BT IBRAHIM

Matric number: CGS01304221

NRIC: 720618145398

Telephone number: 0123817871

E-mail address: akmar1972@yahoo.com

Tutors name: Dr. Aini Binti Ahmad

Learning Centre: JOHOR BAHRU

SEPTEMBER SEMESTER 2016

INTRODUCTION
Professionalization is an important characteristic of in-service careers. Over the
years, many people spoken about professionalization in nursing and its features. Therefore,
there are multiple definitions and characteristics for professionalization in nursing. Nursing
profession have six criteria as described by Catalana (2000). Firstly, nurses must functions at
a high intellectual level. A necessity as healthcare has become advanced in technology,
treatment and care, for example: taking the temperature or blood pressure using automated
equipment; nursing need for assessment, planning and evaluation of care; and nurses must
have reflective thinking, critical and reasoning skills needed to provided quality care to the
patient. Second, nursing must have high level of individual responsibility and accountibility.
Nurses must accountable and responsible for the care provided to the patient and it is a
nursing requirement. Nurses are required to be resposible for their actions and the
consequences of their actions for both obligation and legalisation. Third, specialised body of
knowledge in nursing, that mean, nurses cannot continue to practice based on traditions,
intuition or the trial and error appoach. Research is needed to build nurses specialised body
of knowledge. At the moment, the specialised body of knowledge is still small and its
expansion would require nurses to be educated with the knowledge and skills on how to
conduct research activities. Fourth, the main focus of nursing practice is the public where
nurses serving the public with altruism. Altruism is needed because nurses face many deadly
diseases or serve in different locations during their career. Without it, nurses cannot provide
quality care and they would work under severe stress. Fifth, motivation of the profession is
the key to ensure quality of care. Nurses are not paid well when consider about the working
hours and working conditions. Lastly, and most important is the code of ethics to guide
nursing practice. The Malaysian Nursing Board (1998) has a code of conduct to guide
nursing. The Malaysian Nurses Association (1999) issues nursing standard for Malaysian
nurses to ensure their practices are of quality.
Nursing profession status is an inter-profession and intra-profession challenge.
Whether there is nursing professionalism or not is a challenge among nurses, sociologists,
and historians. For many years until 1970, nursing profession was considered as a female
work and women were considered as barriers to profesionalization in nursing due to their
high workload and part-time work. At that time, some factors such as slow formation of
scientific fundamentals of nursing, disagreement in educational requirements for nurses, lack
of academic education at the entry level of nursing courses, and lack of theory and theory-
based research were considered as barriers for nursing as a profession. Gradually,
development of educations standards and professional certificates led nursing move to
professional status. Having stronger powerful basis for theory and practice and professional
education in nursing discipline brought about social cognition. Social understanding about
nursing made the society consider nurses as cost-benefit health care providers and
independent decision makers. Therefore, nursing could receive more funds and governmental
financial aids. The need for more sophisticated nursing management and leadership to
respond to the clinical, organizational and fiscal challenges faced by the health care industry
has not gone unrecognized. Nurse managers and executives require clinical experience and
strong communication skills, as well as business acumen and knowledge of financial and
personnel management, organizational theory, and negotiation. A great need exists for
educational support for experienced nurses to be developed into nurse executives, prepared to
work competently alongside their business colleagues. Nursing schools are called on to
expand their core and continuing education programs to address these needs. Rapidly
envolving technology, increasing clinical complexity in many patient care settings, advances
in treatment, and the emergence of new diseases are all factors contributing to the increased
need for a strong emphasis on critical thinking and lifelong learning among professional
nurses. Further, new clinical roles, the need for managerial and executive talent, the
imperative to retain nurses in active practice over longer careers, and the desire by practicing
nurses to move up the economic ladder lead to the demand for continuing education and
career mobility and development. Schools of nursing have many core resources needed to
deliver continuing professional education and can provide appropriate courses efficiently and
effectively. Professional development opportunities need to engage health care professionals
in a process of growth. Professionalism in contemporary society includes the ability to
respond quickly to change. Such change can originate from government policy, new health
service provision or from market conditions where health care needs to change and to
respond to new health issues. Continuing Professional Development (CPD) is a responsibility
that extends across all levels of nurses within the health service whether in the community,
hospital or in education. It can be led through management or through teamwork. According
to The Department of Health, the quality of patient care is progress through continuing
professional development throughout ones professional career. This requires investment in
the workforce (Department of Health, 2000a, b, 2001), further emphasized by the movement
towards development of knowledge and skills for jobs and the assessment of these regularly
to ensure the appropriate skills for work (Department of Health, 2003). Leading and
managing professional development extends to work-based education or on job training that
includes mentorship and preceptorship. Professional development is complex involving
multiple stakeholders, including health service employers, registration bodies and
governmental bodies who are concerned with governance and litigation. It should be part of
the policies and structure of any health service to ensure that clinical knowledge and skills
advance with scientific and social expectations of health and disease. As part of the
governance structure, professional aims for development should reduce risk and lead to
improvement in clinical outcomes.

CONTINUING PROFESSIONAL DEVELOPMENT

King (1964) in her theory publication pronounced the problems and prospect of
knowledge development in nursing. More than 30 years ago, the problem were identified as:
lack of professional nursing language; a theoretical nursing phenomena; and limited concept
development. Nowdays, the theories and conceptual frameworks have identified theoretical
approaches to knowledge development and utilization of knowledge in practice. Concept
development is a continuous process in the nursing science movement (King, 1988).
Concepts that represent phenomena in nursing are structured within framework and theory to
show relationships. According to King (1981), multiple concepts were identified from her
analysis of nursing literature. The concepts that provided substantive knowledge about human
beings (self, body image, perception, growth and development, learning, time and personal
space) were placed within the personal system, those related to small groups (interaction,
communication, role, transactions, and stress) were placed within the interpersonal system,
and to those related to large groups that make up a society (decision making, organisation,
power, status and authority) were placed within the social system ( King, 1995). However,
knowledge from all of the concepts is used in nurses interactions with individuals and groups
within social organizations such as the family, the educational system, and the political
system. Knowledge of these concepts came from her synthesis of research in many
disciplines. Concepts, when defined from research literature, give nurses knowledge that can
be applied in the concrete world of nursing. The concepts represent basic knowledge that
nurses use in their role and functions either in practice, education, or administration. In
addition, the concepts provide ideas for research in nursing.
Department of Health, United Kingdom in its Allied Health Professional Project
report (2003, p.9) stated that Continuing Professional Development (CPD) is defined as a
wide range of learning activities through which professionals maintain and develop
throughout their career to ensure that they retain their capacity to practice safely, effectively
and legally within their envolving scope of practice. Nurses work in an environment of
contant changes which include changing paterns of diseases, emergent and new emergence of
diseases, increasing public expectations and demands and increasing technological advances
in treatment and care. These types of changing environments necessitate nurses to have
continuing professional development (CPD) in order to cope. Amongst its many functions,
CPD aims to sustain competence and introduce new skills as required for contemporary
practice needs. CPD also offers the opportunity for nurses to maintain, improve and broaden
their knowledge, expertise and develop the personal and professional qualities required
throughout their personal lives. In many countries ongoing investment in sustaining current
evidence based knowledge to ensure appropriate provision of quality contemporary health
care is considered a fundamental ethical obligation for all nurses. Human resources are seen
as the most important contribution to health care. As knowledge changes and new tools,
technologies and procedures are developed, on-going education and training for health care
professionals is seen as a key investment strategy. Moves towards national registration and
CPD requirements for nurses and other health professionals have been considered for many
years in a number of countries. CPD is needed to ensure nurses work competently to gain
professionalism, autonomy and self-regulation. According to Levett-Jones (2005), nursing is
a practiced and knowledge-based profession, and the quality demands by healthcare
consumers dictate nurses to be knowledgeable and posesses high levels of technological
expertise and clinical skills. William (1996) cited in Levett-Jones (2005) stated that,
knowledge gained has a half-life of two and a half to five years, by the end of five years; it
will become out-dated. CPD is needed to keep nurses abreast with latest research and
development in their field and acquire the technological knowledge and skills necessary for
current practice and for nurses to use current knowledge and skills for practice. With CPD,
nurses would be able to practice with competency, confidence and autonomy. In addition,
CPD is not only important for nurses alone, it is also essential to develop nursing as a whole.
The Department of Health in the United Kingdom in its Allied Health Professional Project
(2003, p.15) reported that the elements of profesisonalism and CPD was: patient/ client-
focused practice underpinned by sound clinical reasoning and professional judgement, on-
going reflection and clinical application of evidence base; professional responsibility
manifested in adhering for Code of Counduct or standard of practice, undertaking structured,
evaluated CPD to meet learning needs and engaging with the full implications of clinical
effectiveness; professsional privillage expressed through professional autonomy and self-
regulation.
CONTINUOUS PROFESSIONAL DEVELOPMENT (CPD) IN MALAYSIA
Continuous professional development (CPD) is required for most medical
professionals including nurses. In Malaysia, the CPD programme shares the same concept
and principles of the Penilaian Tahap Kecekapan (PTK) assessment under the Sistem Saraan
Malaysia (SSM). They are both integral in the medical and health professional development.
The CPD programme, which has been in existence for many decades, has recently undergone
extensive revision. As a result of this revision, the CPD programme has a much wider scope
that encompasses the current PTK assessments, and incorporates an extensive evaluation and
competence development for the staff at Ministry of Health (MOH) in both the Kompetensi
Khusus (Core/ Clinical Competency) and to some degree Kompetensi Umum (Generic/ Non-
core Competency). In this context CPD is defined as a process of Lifelong learning aimed
at meeting patients needs and improving health outcomes by systematic improvement and
boardening of knowledge, understanding and skills and the development of personal qualities
necessary for the execution of professional duties, including the acquisition of new roles and
resposibilities by Friedman et al. (2000) cited in Lawton and Wimpenny (2003). There is a
need for CPD in order to maintain professional competence in an environment of numerous
challenge, rapid organization changes, information technology, increasing public expectations
and demand for quality and greater accountability. Nurses face these challenges of embracing
new methods of care delivery which will provide a quality service that is truly patient/ client
centered. In ensuring the quality standards of nursing practice in the country, the Nursing
Board Malaysia (NBM) have taken serious concern regarding continuous profession
development activities from a number of espects namely equity of access, its relevance to
practice, and the integration of new knowledge into practice. With the cooperation from the
CPD Unit, Ministry of Health, the Nursing Division/ Nursing Board Malaysia is pleased to
present this CPD guideline which reviews the activities of nurses in relation to continuing
professional development. Nurses provide the majority of direct care to patients/ clients of the
health service on a twenty four hour basis. They comprise the largest group of health service
workers and as such have great potential to further contribute to population health and help to
achieve the goals of the National Health Policy under the leadership of the Ministry of Health
Malaysia. Hence, this guideline make recommendations regarding CPD for nursing personnel
who must be developed based on needs assessment and outcome evaluation. The programme
recommended is relevant to individual practice and help to maintain standards and
competence. In addition, it also incorporates group-based activities such as workshops and
conferences hence facilitate greater interaction and integration of health professionals. It is
also hoped that this guideline is beneficial for the enhancement of career development and
job satisfaction among nurses hence, enchancement of nursing service provision.
The objectives of continuing professional development (CPD) among nurses are to
have a competence and excellent nursing workforce. This CPD guideline is used to
maintain professional competency and to ensure high standard of care, broaden knowledge
and refine skills. With this CPD, nurses will accept responsibility and greater accountability
in nursing practice. The CPD guideline is act as documented evidence for the purpose of
integration of CPD with Penilaian Tahap Kecekapan (PTK), annual appraisal and
recertification, this is to provide a record for all health professionals on their CPD activities
and PTK assessments. The CPD guideline also can assist the officer and Head of Department
to identify and plan the needs for training and personal development. It also to enable the
Head of Department and the individual to monitor CPD and PTK activities. Fleck and Fyffe
(1997) contend that, in order to achieve the greatest benefits for health care service, it is
essential that nurses acquire the skills to learn continuously. According to McCarthy and
Evans (2003), the impact of continuous education programmes on nurses have both personal
and professional benefits such as: the new skills learnt during their courses were transferable
to their work environment; the new knowledge improved their convidence and
communication skills with regard to patient management; and nurses become more aware of
the need for research and evidence-base practice as part of their role within the clinical area.
CPD is an investment that nurses make in themselves and planning their development that
links learning directly to practice. CPD can help nurses to keep their skills up-to-date and
prepare nurses for greater responsibilities. CPD can help nurses become more creative in
tackling new challenges and boost their confidence and strenghten their professional
credibility. As organisations shift the responsibility for personal development back to
individual, the ability and insight to manage their own professional growth is seen as a key
strengh. CPD helps maximise staff potential by linking learning to actions and theory to
practice and also can helps Human Resource professionals to set spesific, measurable,
achievable, realistic and time-bound objectives, for training activity to be more closely linked
to business needs. CPD promotes staff development. This leads to better staff morale and a
motivated workeforce helps given a positive image to organisations. Adds value, by
reflecting it will help staff to consciously apply learning to their role and the organisations
development. Linking to appriasals, this CPD guideline is a good toll to help staff focus their
achievement throughout the year.
 CPD is a personal commitment in nursing to keeping their professional knowledge
up-to-date and improving their capabilities. Its focuses on what nurses learn and how they
develop throughout their career. As a professional, CPD helps nurses turn that accountability
into a positive opportunity to identify and achieve their own career objevtives. CPD is an
opportunity to do themself some good; the nature and scale of the benefits depends entirely
on them. The credibility of this profession is based on the willingness of each professional to
embrace new skills, knowledge and experience. There are two parts to the CPD process.
Both parts need to be satisfide to meet the criteria for upgrading. These are: CPD
development record, this lists the activities that nurses have to carried out during the last 12
months, with an explaination of why they were undertaken, what was learned and how this
learning was or is to e applied; CPD development plan, this sets out their aims and objectives
and their proposed action for the next 12 months. It must include resource required, success
criteria, and target dates for review and completion. The CPD log book is designed to guide
nursing professionals in recording and updating whatever CPD activities that they have been
involved in. There is a requirement for annual minimum Credit Points achievement for each
professional group. For nurses, the Nursing Board of Malaysia have recommended: Tutor,
Matron and Sister is 35 40 points per year; Staff Nurses is 25 30 points per year; and
Jururawat Mayarakat is 15 20 points per year CPD credit to collect. However, there is no
upper limit in acquiring points for CPD especially when there is growing evidence of the
need to link CPD with organisational goals. As outlined in the CPD Credit Points System, a
health professional may be involved in or attend many CPD activities of the same category,
but only the maximum credit points of that category would be taken into consideration for the
annual minimum. For example, a person who has attended a congress twice in that year will
awarded 40 CPD points. However, for the annual minimum credit point only a maximum of
20 CPD points will be taken into consideration for that year. Each CPD activity undertaken
must be recorded in the log book and be verified by the Supervisor or Head of Department
with documented proof. At the end of the year, an individual has to submit the completed and
supervisor-signed log book to the Head of Unit or Discipline for evaluation and endorsement.
The log book will be kept with the annual assessment report/ LNPT and a summary sheet
which contains a summary of the relevant information will be summited for use to apply
Annual Practicing Certificate (APC) from the Nursing Board of Malaysia.
Compared with another countries about continuing professioal development (CPD)
practice in Malaysia, in Australia, all nurses must meet the continuing professional
development (CPD) standards. This standard has been approved by the Australian Health
Workfocse Ministerial Council on 31 March 2010 pursuat to the Health Practitioner
Regulation Law (2009) (the National Law) with approval taking effect from 1 July 2010. The
Nursing and Midwifery Board of Australia (NMBA) regulates the practice of nursing in
Australia, and one of its key roles is to protect the public. The NMBA does this by
developing standards, codes and guidelines for nurses in which they are required to practice.
This standard sets out the minimum requirements for CPD. CPD must be directly relevant to
the nurses context of practice. Context of practice refers to the conditions that define an
individuals nursing practice. These include the type of practice setting for example: in
healthcare agency, educational organisation or in private practice; the location of the practice
setting such as at urban, rural or at remote area; these include the characteristics of patients or
client with her or his health status, age and her or his learning needs; the focus of nursing
activities such as health promotion, research and management; the complexity of practice; the
degree to which practice is autonomous; and the resources that are available, including access
to another healthcare professionals (Australian Nursing and Midwifery Council (ANMC),
2009). The CPD cycle involves reviewing practice, identifying learning needs, planning and
participating in relevent learning activities, and reflecting on the value of those activities
(ANMC, 2009).
The Nursing and Midwifery Board of Australia (NMBA) reserves the right to give
exemptions in individual cases. The requirement of this CPD is for nurses on nursesregister
will participate in at least 20 hours of continuing nursing professional development per year.
Registered nurses who hold scheduled medicines endorsements or endorsements as nurse
practitioners under the National Law must complete at least 10 hours per year in education
related to their endorsement. One hour of active learning willl equal one hour of CPD. It is
the nurses responsibility to calculate how many hours of active learning have taken place.
The CPD must relevant to the nurses context of practice and if CPD activities are relevant to
nursing profession, those activities may be counted in each portfolio of professional
development. Nurses must keep written documentation of CPD that demostrates evidence of
completion of a minimum of 20 hours of CPD per year. Documentation of self-directed CPD
must include dates, a brief description of the outcomes, and e effect s or thlevitiarning actithd
on the value of the number of hours spent in each activity. All evidence should be verified. It
must demonstrate that the nurse has: identified and prioritised their learning needs, based on
an evaluation of their practice against the relevant competency or professional practice
standards; developed a learning plan based on identified learning needs; participated in
effective learning activities relevant to their learning needs; and reflected on the value of the
learning activities or the effect that participation will have on their practice. Participation in
mandatory skills acquisition may be counted as CPD. The Nursing and Midwifery Board of
Australia (NMBA) have a roles includes monitoring the competence of nurses and the Board
will therefore conduct an annual audit of a number of nurses registered in Australia.

PROPOSE HOW TO STRENGHTEN THE CPD MODEL

World Health Organisation (WHO) in its Munich Declaration (2000) stated that,
nurses should step up their action to strenghten links between lifelong learning and CPD to
enable nurses to work efficiently and effectively to realise their full potential both as
independent and interdependent professionals. McCarthy et al. (2002) in his study was found
that the large numbers of nursing staff do not have access to professional updating. The
Office of Health Management (2002), has highlighted the importance of staff development
and investment in people as critical factors in organisational performance and success, along
with a number of other good practices in human resource management. Nurses highlighted
critical issue relating to their CPD. Concerns expressed about CPD activities included equity
of access, relevance to practice, integration of new knowledge into practice, and the limited
opportunities to access and engage in CPD because of staff shortages and changes in skill
mix. They also described engagement of staff in CPD activities from an organisational point
of view as being frequently ad hoc with no pre-determined professional development plans
for the individual, ward or unit. There have some barriers for nurses engage in CPD,
including financial constraints due to lack of funding and personal cost and has been noted as
a significant barriers. Nurses are requesting financial support for reasonable costs associated
with professional activity. However, this often is not available because of no budjet and many
nurses have initiative and self-fund their own training. This lack of support by employer
occurs regardless of the acknowledgement of both employer and nurses for the need for
professional development. Lack of financial support relates to the lack of time available
during during work due to workload, as well as staff not being replaced when away on CPD
activities and this has been noted as significant issue. Personal factors associated with barriers
to CPD engagement has referring to on-going professional development of nurses. The issue
of family life are precious as a barrier to professional development where there are limited
access to childcare and the days off is a key concern for parents but caring for other
dependents is also barriers to finding time for CPD. Participants energy and motivation was
noted as both being a benefit but shift work caused tiredness and reduced motivation also a
barrier and linked to self-efficacy associated with CPD. The need for appropriate professional
development, particular for clinical relevant learning was an important issue for nurses.
Continuing Professional Development (CPD) is combination of approaches, ideas and
techniques that help to manage their own learning and growth. As a professional, nurses have
a resposibility to keep their skills and knowledge up-to-date. CPD helps nurses turn that
accountability into a positive opportunity to identify and achieve their own career objective.
At least once a year, CPD guideline recommend nurses rewiew their learning over the
previous 12months, and set their objectives for the coming year. Reflecting on the past and
planning for the future, in this way will makes their development more methodical and easier
to measure. This is a particularly useful exercise prior to their annual appraisal. These records
and logs are useful tools for planning and reflection, it would be dificcult to review their
learning and learning needs yearly without regularly recording in some ways their
experiences. Before joining any continuing professional activity, DiMauro (2000) suggested
nurses to do some personal planning, take an internal inventory and be informed and
anticipate change. In personal planning, there is: identify own needs which have to conduct
self-evaluation or assessment; determine professional goal; determine methods to achieve this
goal; and select a suitable learning opportuinity. Different strategies have been adopted by
different countries to evaluate whether healthcare professionals become more competent with
CPD. The key principles behind continuing professional development (CPD) are: it is self-
directed and is base on learning needs identified by individual; CPD builds on an individuals
existing knowledge and experience; links and individuals learning to their practice; and
includes an evaluation of the individuals development. CPD is a critical mechanism in
ensuring that all members of nursing professions are able to deliver high quality nursing care
and service and keep pace with healthcare developments that effect their practice. There is no
compulsory or prescribed activities for nursing continuing professional development. The
important point is that, the activities are relevant to the individual nurses context of practice
and are able to meet their learning needs. Nurses are require to participate in CPD activities,
in order to renew their nursing licence. Nurse manager have to provide information about
upcoming professional development opprtunities to her staff and make CPD requisite to
employment. Nurse Manager should have to make mapping for regular participation required
for all nurses and should plan further CPD activities for all nurses in the ward. Nurse
Manager should be proactive and must review the nurses CPD log book at least 3 monthly to
document the point that their nurse have achieved. The log book is designed to guide nursing
professional in recording and updating whatever activities they have been involved in. When
register the CPD points on the MyCPD online, there must have discriptive summary about
CPD as evidence that nurse are attended that CPD. All evidence should be verified by Nurse
Manager. Nurse Manager need to be involved in identifying learning and development need,
so that those needs arising at service delivery level can be coordinated and managed across
the wider organisation.

CONCLUSION
Nurses perceive professional development in a positive manner irrespective of their
clinical environment in the main. Despite this it can be seen that the impact of CPD in the
nursing profession is disminished for several reasons. The absence of reflection from the
learning process is evident in dome cases and this reduces the impact on practice that
educational intervention csn have. A reduced inability to alter working practices is evident in
nursing, not only caused by colleagues, but by the leadership styles of managers. Alack of
support has culminated in the frustration and disempowerment of nurses who are unable to
improve their practices because of staffing, time and financial constraints. It is important that
the nursing professions adopts a problem-solving approach to the challenges surrounding
professional developmen, so it can offer the mordern service that the government has
visualised. CPD as a subset of lifelong learning is gaining increasing recognition in both its
personal and professional application. It is widely viewed as playing a pivotal role im
meeting health service delivery needs and the learning needs of individual healthcare
professionals. However, many nurses encounter difficulties in gaining access to CPD, and
those opportunities for CPD that are provided may be restricted to traditional methods such as
formal academic programmes or in-service training concerned with the performanve of
functional tasks. The development of competencies, personal development planning, lifelong
learning, career guidance and choice, professional portfolio development and job satisfaction
are all processes that are reflected positively and they are key component in the continuum
CPD.

4816 Words
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