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HEALTH SCIENCE JOURNAL ® VOLUME 4, ISSUE 3 (2010)

Nurses’ attitudes regarding Continuing Professional


Development in a district hospital of Greece

Aris Yfantis1, Ioanna Tiniakou1, Eleni Yfanti 2

1. RN, MSc, Laboratory cooperator, Nursing Department, TEI of Lamia


2. Health Visitor , MSc, Laboratory cooperator, Nursing Department, TEI of Lamia

Abstract

Aim : The aim of the present study was to evaluate the concept of Continuing Professional
Development (CPD) in a provincial hospital and analyze whether the CPD can offer opportunities
for Advanced Professional Development (APD) in nursing staff.
Method and material: The study involved 23 clinical nurses of tertiary education employed in α
provincial hospital. Collection of data was performed using postal questionnaire. Statistical
analyses (descriptive) were conducted using the Statistical Package for Social Sciences 13.0
(SPSS, Chicago, Il, USA).
Results: 43% of the participants were working in the sector of emergency incidents, 22% in the
surgery clinic, 17% in the Intensive Care Unit and 9% in the Pathology and Cardiology clinic,
respectively. 22% of the participants had not participated in any kind of postgraduate training
programmes, 30% had attended two programmes and the largest percentage of 48% had attended
only one programme. 30% of the CPD activity took place in hospital and 70% in Centres for
Vocational Training. Regarding the benefits of CPD, 82.6% of the participants answered that
CPD helped them to plan their nursing care, whereas 17.4% that CPD helped them to thing
about what to do in practice. 78% of the participants reported the existence of barriers to CPD.
Regarding difficulties to attend the CPD activity, 17% reported that were unable to attend it
because the clinic was too busy, while 83% reported difficulty because the CPD programme was
already booked.
Conclusion: Nurses appeared to understand the concept of CPD as a part of lifelong learning and
faced difficulties to measure the effectiveness of CPD in use when dealing with a range of issues.
The study findings confirm that CPD remains a major issue for clinical nurses in Greece,
providing opportunities for advanced professional development. The study findings should help
those proving the CPD to plan more effectively and have implications for staff requirements and
retention.

Keywords: Continuing Professional Development, opportunities, health professionals,


development

Corresponding author:

Yfantis Aris, Nafpaktou 19A,


Pagrati PC 35100
Lamia
Tel 2231032840,
E-mail: aris_yfantis@yahoo.gr

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Introduction

P
atient expectations for high quality the country was ill prepared for such a large-
health care services lead health scale venture. As a result, shortcomings in
providers to improve the educational the quality and organization of training
status of health professionals in order to programmes were unavoidable.
meet these expectations. Continuing Nevertheless, some important steps towards
Professional Development (CPD) is the modernization of the field have indeed
considered as the systematic maintenance, been made.7 The Labour Force Employment
improvement and broadening of knowledge Organisation (OAED), Centres for Vocational
and skills, and the development of personal Training (KEK) and Education Departments of
qualities necessary for execution of various Ministries are the bodies that
professional, technical duties throughout the promote lifelong professional education.
individual’s working life.1 According to the The Labour Force Employment Organisation
literature, during the process of continuing (OAED) implements continuing vocational
professional development individuals take training courses seeking to cover the needs
control of their own learning and of the unemployed who require
development, by engaging in an on-going specialisation in order to find work, as well
process of reflection and action. On the as the needs of the employees, where
other hand CPD is based not only on the acquiring extra skills will facilitate their
needs of the individual but also on the career development. Centres for Vocational
employer needs as well as the profession as Training (KEK) are private sector bodies (for-
a whole and society.2,3 profit or not-for-profit) or public bodies
CPD as a subset of lifelong learning is providing continuing training which have
gaining increasing recognition in both its’ received positive evaluation and have been
personal and professional applications. It is certified by the National Accreditation
widely viewed as playing a pivotal role in Centre (EKEPIS) and have secured financing
meeting health service delivery needs and from national (Ministry of Labour) and
the learning needs of individual healthcare community resources (European Social Fund
professionals.4,5 However, many nurses and European Regional Development Fund).
encounter difficulties in gaining access to The KEK plan, organise and run continuing
CPD, and those opportunities for CPD that vocational training courses for employees
are provided may be restricted to traditional and the unemployed, graduates from all
methods such as formal academic levels of education, in various subject areas.
programmes. In a national study of turnover The Education Departments of various
in nursing and midwifery in the University Ministries also plan vocational training
College Cork (National University of Ireland), programmes both for the unemployed and
McGarthy et al.,6 found that a little more the in-house employees. The Ministry of
than half of the respondents (53%) reported Health and Welfare provides vocational
experiencing some form of CPD, typically in education and training courses in all areas of
the form of in service education (25%) and specialisation in the health sector for the
study days/seminars (28%), with fewer unemployed and the employees in the
respondents reporting having access to study National Health System, at its 32 continuing
leave (12%) and financial support (10%). The vocational training centres within hospitals
authors conclude that large numbers of of the National Health System and the
nursing staff do not have access to National Ambulance Service8 .
professional updating. In Lamia’s hospital only two
In Greece, during the last decade, programmes were established. These were
training programmes have increased the basic support and automatic
dramatically, mainly due to significant defibrillation and the Provision of nursing
funding from the European Union. However, treatment in Emergency Department. The

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HEALTH SCIENCE JOURNAL ® VOLUME 4, ISSUE 3 (2010)

hospital of Lamia is in the centre of Greece their hospital and the CPD programmes they
and has about 300 beds. Many of these beds attended. The survey took place in August
accommodate accident and emergency 2007.
cases, as it is the only hospital in the town Distribution of questionnaires: Access to
(population approximately 70.000). This staff nurses was sought by phone contact to
situation enhances the importance of better the hospital manager. The manager was
health care, good management and high- asked for permission to access their staff and
speed services. These needs require that the was invited to nominate a link person (nurse
nursing staff has the appropriate experience leader) for the purposes of distribution of
and are able to identify their learning needs the questionnaires. This was in order to
and finally plan their work effectively. calculate the potential total numbers of staff
The aim of the study was to evaluate who might be invited to participate in the
the concept of Continuing Professional survey. Staff nurses were invited to
Development (CPD) in the hospital of Lamia participate. Nurses who had qualified from
and analyze whether the CPD can offer cities, towns and rural areas and were
opportunities for Advanced Professional working in Lamia’s hospital were
Development (APD) in the nursing staff. represented. In total 56 questionnaires were
distributed, of which 23 were returned,
Material and Method giving a response rate of 41%. The data was
analyzed using Excel, 2003 v.
Collection of data was performed Ethical considerations: The study had to
using postal closed –type questionnaires, provide definite assurances about
which were designed according to the participant’s anonymity and data
literature review and the objectives. This confidentially The first step was to approach
procedure was chosen mainly because of the the manager and asked for permission to
cyclical shifts of the nurses and the followed access their staff and was invited to
difficulty to find the appropriate date to nominate a link person (nurse leader) for the
distribute the questionnaires. On the other purposes of distribution of the
hand, choosing this kind of questionnaire as questionnaires. Secondly, the questionnaire
Oppenheim 9 suggests, would benefit the was anonymous so as to reduce or eliminate
researcher through firstly, low cost of data bias. Questions which asked from the
collection and secondly low cost of participants to criticize their colleagues or
processing. This approach therefore was a lot the leader because may be reluctant to say
less time-consuming for the researcher than something bad or not be objective in their
interviewing. comments which would cause biased results
The questionnaire was anonymous so were excluded.
as to reduce or eliminate bias. Moreover a
reasonable date for the return inside of the Results
letter which had been addressed with
stamped was given, thus reducing the The whole sample population were
possibilities of non-response of the women. Regarding years of working
questionnaires. The choice of answers was experience, 35% of the nurses (8) had been
created in accordance with DΥ.PΕ (is the working for 5-9 years, 22% for 10-14 years
responsible authority in Lamia), which and 17% less than five years and finally the
organized the programmes/seminars) which smallest group 4% (one person only) had been
informed the author of CPD programmes for working for 22 years.
that particular area and period Αccording to the place of graduation,
Participants were questioned about 65% were graduates of Technological
the definition of CPD, the role of CPD in Institution in Lamia, 22% of Technological
their clinical area, effectiveness and benefit Institution in Athens and 13% nurses in
of CPD, any CPD programmes established in Thessalonica. 43% of the participants were

Nurses’ attitudes regarding Continuing Professional Development in a district hospital of Greece 195
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HEALTH SCIENCE JOURNAL ® VOLUME 4, ISSUE 3 (2010)

working in the sector of emergency Table 2. Nurses aspects on CPD role, meaning
incidents, 22% in surgery clinic, 17% in the and effectiveness
Intensive care ward and 9% in the Pathology Choices Number of Percentage
participants %
and the Cardiology clinic, respectively. Role of CPD
(Table 1). It enables staff to
continually develop new
Table 1 : Labour Features of the participants competencies/skills in
Number of order to remain up to
participants Percentage % date in the rapidly
Hospital changing world 5 22
division It allows nurses to
Emergency maintain professional
Department 10 43 competence 0 0
Surgery clinic 5 22 Its assists the
Pathology 2 9 organization and its
Cardiology 2 9 members to meet the
Intensive care various needs of
4 17 patients 7 30
unit/ward
Total 23 100 It supports flexible
Working years career pathways, helps
<5 4 17 career aspirations to be
5 to 9 8 35 met and assists
individuals retaining their
10 to 14 5 22
job 11 48
15 to 19 5 22 Total 23 100
20 to 24 1 4
Effectiveness of CPD
>30 0 0
It should be seen as an
Total 23 100
integral part of the life of 0 0
Regarding the role and meaning of an organization
CPD, 74% of the participants reported that It should be considered
CPD is a process of lifelong learning for all an investment in the
total skill base of the
individuals and teams which meets the needs 21 91.30
workforce and must be
of patients and delivers the health outcomes. intended to increase
On the other hand, 26% of the sample learning
answered that CPD can be recognised by CPD activity must be
keeping up to date with knowledge and assessed and evaluated
0 0
in order to measure its
skills. A small percentage of 22% answered effectiveness
that CPD role is to enable staff to continually Don't know 2 8.70
develop new competencies/skills in order to Total 23 100
remain up to date in the rapidly changing Meaning of CPD
world. The other choice that was answered Using learning to
by a larger number of participants than the improve nursing care 0 0
first one, which covered the 30% of the Keeping up to date with
knowledge and skills 6 26
sample found that the role of CPD is to assist Engaging in an on-going
the organization and its members to meet process of reflection and
the various needs of patients. Finally the action 0 0
greatest number of respondents 48% A process of lifelong
answered that CPD supports flexible career learning for all
individuals and teams
pathways, helps career aspirations to be met which meets the needs
and assists individuals retaining their job of patients and delivers
.The respondents were given three possible the health outcomes 17 74
answers to choose from as well as the Total 23 100
freedom to choose more than one answers in
the section of effectiveness. More than 90% When respondents were asked
preferred to tick all three answers. (Table 2) whether they attended any CPD programme
in the last two years, they had to make a

Nurses’ attitudes regarding Continuing Professional Development in a district hospital of Greece 196
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E-ISSN:1791-809X www.hsj.gr
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HEALTH SCIENCE JOURNAL ® VOLUME 4, ISSUE 3 (2010)

choice of seven different answers.. From the and the other two choices included small
sample of the present study investigated, group teaching and educational programmes
22% had not received any kind of accumulated which 30% each. (Table 4).
programmes, 30% had attended two
programmes and the largest percentage of Table 4. Barriers and Benefits of CPD
48% had attended only one programme. 30 % Choices N %
of CPD activity took place in hospital and Barriers to CPD
attendance
70% in Centres for Vocational Training. A Too busy ward 3 17
relatively large number of respondents, CPD/Training already fully
almost 70% Stated that this CPD activity booked 15 83
included a group of more than 20 CPD/Training cancelled 0 0
Training too expensive 0 0
participants. The rest 30% indicated that the
Total 23 100
programme had been attended by 11-20 Strategies involved
people. The respondents answered 100% that Formal seminar 9 40
this activity had been attended mostly by Small group teaching 7 30
nurses of the same grade.( Table 3). Educational programme 7 30
Other strategies 0 0
Total 23 100
Table 3. CPD programs and participation
Choices N % Benefits of CPD
Planning your nursing care 19 83
Number of CPD Programmes
0 5 22 Thinking about what you do
in practice 4 17
1 11 48
2 7 30 Evaluating your work and
moving to the next step 0 0
Total 23 100
Other 0 0
Institutions
None of these 0 0
T.E.I 0 0
Total 23 100
University 0 0 When participants were asked if they
Hospital 7 30
find support in applying the acquired
Other 16 70
Total 23 100 knowledge, 91% answered that they did not
Participation in find support, whereas 9% answered that they
recent programme did. Regarding the item : “Have you had any
11 to 20 7 30 formal training such as a course or workshop
>20 16 70 since you qualified in any of the following?”
Total 23 100
All the respondents answered ‘no’. In the
Qualification Question :“Was time away from the work
Some grade nurses 23 100 place allocated for you to attend the CPD?”
83% of the participants answered ‘no’ .
Regarding the benefits of CPD, 82.6%
(19) answered that CPD helped to plan their Discussion
nursing care and 17.4% (4) answered that
CPD helped them to thing about what to do According to the results of the
in practice. As for barriers to CPD, a large present study, the majority of the
number of the participants 78% answered participants were working in emergency
‘yes’ and 22% ‘no’. From the people that the department, secondly came the surgery
answer was ‘yes’, 17% gave the reason that clinic, then the Intensive care ward and
were unable to attend the CPD activity, finally the Pathology and the Cardiology
because the clinic was too busy in order to clinics. Trying to interpret these results, one
attend and the other percentage 83% found can assume that these clinics need good
difficulty because the CPD programme was management and high-speed services. These
already booked. As for the strategies needs require that the nursing staff are
involved, some nurses (40%) answered that highly educated, have the appropriate
the CPD activity took place in a seminar form experience, are able to identify their

Nurses’ attitudes regarding Continuing Professional Development in a district hospital of Greece 197
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E-ISSN:1791-809X www.hsj.gr
Health Science Journal® All Rights Reserved
HEALTH SCIENCE JOURNAL ® VOLUME 4, ISSUE 3 (2010)

learning needs and finally plan their work in the last two years, they had to make a
effectively, in accordance with CPD choice of seven different answers. According
objectives.10 to the results of the study, 21.7% had not
Continuous professional development received any kind of programmes, 30.4% had
(CPD) is essential in modern day nursing and attended two programmes and the largest
it is not restricted simply to lifelong percentage of 47.8% had attended only one
learning. Nonetheless, most respondents programme. This is entirely different from
appeared to understand the concept as a abroad, where CPD programmes are a
part of lifelong learning and not as an on- incorporated in continuous nursing
going process of reflection and action.2 A education.7 This finding could also mean that
possible explanation for this finding is that their perception around the definition of CPD
This probably happened because of the lack is limited within the boundaries of improving
of expert nurses on CPD. The programmes the service towards the patients rather than
that are taking place in hospitals usually improving their competences.
focus on general nursing subjects between Of the results of this study, it was
nurses and patients. However, in practice also found that CPD had beneficial effects in
disciplines, such as nursing, learning can be planning the nursing care and thinking what
maximised through experience located in the to do in practice. On the contrary, choices
clinical setting. Feedback and “moving to the such as “evaluating your work” and “moving
next step” are essential in this process and to the next step” or something else were
experiences in 'real-life' settings need to be avoided. Lifelong learning is a requirement
effectively facilitated to obtain the desired for all nurses. Structured continuing
outcomes.11,12 education programs are just one method of
In the question that asked the acquiring knowledge. Non-structured, self-
participants to find ways to approach the directed methods of development often are
effectiveness of CPD, four possible answers overlooked in this process. This study
were given to choose from, as well as the indicates that RNs need a stimulating work
freedom to choose more than one answers. environment, including mentoring and
This seemed to be convenient for them since support to enable continuous professional
a rate of more than 90% preferred to tick all development in health care. On the other
three answers. From this rate of response it hand, Gould et al.,10 stated that CPD
could be suggested that their knowledge remains a major issue for clinical managers
about the means of measuring CPD in the United Kingdom and that providing
effectiveness was very limited which as a opportunities for such development may be
result this pushed them to this multiple an important factor in enhancing job
choice. One possible explanation for this satisfaction. According to Magginson and
finding is that since the programmes are new Whitaker2 individuals through CPD activities
the nurses cannot measure the effectiveness, gain experience based on curiosity and the
as they do not have previous experience. questioning of various issues that assist in
Another possible explanation is that they did opportunity spotting. Furthermore
not use portfolios which CPD suggests as a individuals are motivated through the
useful tool in order to transfer the learning constant development of new skills and
outcomes in daily clinical practise. The become more focused and productive.
literature provides positive indications for Patients on the other hand are benefited
portfolio use in CPD in nursing. Much because CPD helps nurses to respond better
discussion surrounds the use of the portfolio to their needs and offer a high quality
as an assessment tool in pre- service.17,18
registration/undergraduate nursing Un regard to barriers in attending a
education programmes.13-16 CPD programme, participants reported that
When respondents were asked “ busy clinic” and a “fully booked
whether they attended any CPD programme programme” were the most significant. It is

Nurses’ attitudes regarding Continuing Professional Development in a district hospital of Greece 198
pp:193-200
E-ISSN:1791-809X www.hsj.gr
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HEALTH SCIENCE JOURNAL ® VOLUME 4, ISSUE 3 (2010)

worth mentioning that a small number of answered ‘no’ probably had approached staff
programmes are taking place and the members who were either unaware or did
number of participants in each seminar is not have time to spare. One more reason is
limited. More in detail, there are 86 TE that the programmes/seminars taking place
nurses in the hospital and the seminar in the form of lectures and not in the clinic,
accepts only 20. Moreover within this number which means that nurses cannot find support
of 20 are usually included nurses of when face barriers or problems in clinical
University Education, health visitors, practise. In practice disciplines, such as
physiotherapists and doctors. Thus, there is a nursing, learning can be maximised through
need for the government to organize more experience located in the clinical setting.
educational programmes in order all health Theoretical knowledge or knowledge that has
professionals have the chance to attend such previously been 'distal' to practice could be
seminars/programmes. In other countries integrated into immediate practice via
there are certain regulatory bodies acting mutual collaboration of nursing team
as a means for nurses to demonstrate members. 11,23
continuous learning and professional growth.
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