Jul 7, 2017 - attitude and practice. Keywords: Continuous professional development (CPD), perception, Registered nurses,
The International Journal Of Science & Technoledge (ISSN 2321 – 919X)
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THE INTERNATIONAL JOURNAL OF SCIENCE & TECHNOLEDGE Perception of Registered Nurses Regarding Continuous Professional Development in District Swat, KPK, Pakistan Muhammad Asad Registered Nurse, Hayatabad Medical Complex Hayatabad, Peshawar, Pakistan Taskeen Mahmood Nursing Supervisor, Khyber Teaching Hospital Peshawar, Pakistan Muhammad Suliman Registered Nurse, Medical Ward A, Saidu Group of Teaching Hospital Saidu Sharif Swat, Pakistan Muhammad Sohail Registered Nurse, Indus Hospital Karachi, Pakistan Fakhrul Islam Principal, Royal College of Nursing Swat, Pakistan Abstract: CPD becomes need of the day in the health care arena and in that instance, the WHO stated that “ongoing education and training for heath care professional is seen as a key investment strategy”. This paper aimed to identify the perception and factors influencing continuous professional development of in-service nurses in district swat. Methods and Materials: A quantitative, simple descriptive cross sectional study design used and responses recorded from 200 nurses by pilot tested modified questionnaires. Probability simple random sampling technique used in the available lists of target population sampling frame (total 400 nurses). Results: Female respondents were 55%, majority of the participants 75% were in the age group 20-30yrs and mostly having diploma in nursing (141). Understood the term CPD (94.5%), willing to attend CPD sessions (95%), CPD sessions mandatory (67%) and CPD sessions held not according to their need (68.5%).In the CPD benefits section; CPD is beneficial for updating knowledge (95%), enhance quality clinical practices (95.5%), Chi square (p values) obtained for the variable CPD has a positive impacts; on knowledge, on overall practice, on clinical practice, on communication, towards higher education and on EBP respectively, were (p=0.000). Conclusion: From the results of this paper, we concluded that CPD has benefits for nurses; positive impact on knowledge, attitude and practice. Keywords: Continuous professional development (CPD), perception, Registered nurses, Pakistan 1. Introduction Development is inevitable for humans, especially if they are professional, then continuous professional grooming, polishing and development becomes integral part for professionals. Nursing is an art and science dealing with the actual, potential, risk, and wellness responds of the clients or individuals, families, groups, communities and public etc. Nurses considered one of the largest groups, being as health care team members spend most of the times busy in providing holistic health care services. In this global age, where technological advancement and rapid changes occurring in professions, transition and diversity is the need and demand of time. In this instance, nurses must pass through the professional development processes, to meet the challenges, trends and issues arising day by day. Accountability is considered important from nurses in the practice especially in the health care safety and competency in knowledge, attitude and skills. It is the responsibility of each nurse to maintain the competence for current practice. Maintenance of competence also includes participation in ongoing professional development, practice in clinical management education or research setting.1 Advancement in medical sciences and technological revolution made it easier to prolong life span, issues of quality of life and the focus for continuous professional development in health care arena, ongoing education and research, as an evidence required for the transitional nursing care in the context of evidence based nursing practice. Continuous professional developments of nurses are augmenting imperatively to sustain abreast of rapid transition in the field of nursing science and care. According to the WHO report on improving performance, “as knowledge change and new tools, technologies and procedures are developed, ongoing education and training for health care provider is seen as a key investment strategy”.2 Learning needs to take place at every point in time and especially for health care providers, as they need to be current about the latest research. Continuous professional development (CPD)
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has a background of installment and learning programs used world widely in different Professions, especially in health care field workers like, doctors, nurses etc. As a example, USA began granting continue medical education (CME) recognition awards to doctors over forty years ago, have a longer history of CPD.3 Whether a statutory legitimate obligation or an unregulated voluntary option, in almost every country undertake some form of CPD. Research papers considered CPD systems in a wide range of countries, from Japan and Kenya, to Ireland and Canada. Some, such as Pakistan, are taking their first steps toward establishing a national CPD program.3 Despite of the many definitions of CPD for nurses, are classical argued by “ Jarvis’’ 1987 recognized that , “ nurses educators should not give nurses ‘packaged knowledge’ to pass exams, but cultivate professionals in such a way as to develop the self information directed , lifelong learners rather than becoming teacher dependent for information.4 Therefore, the aim of CPD is to ensure that nurses are able to “critically assess their clinical practice and to identify their own continuing education needs’’.5 Several studies conducted on nurses’ professional development in which one large scale was 236 interview respondents and a postal survey of 1500 qualified nurses, showed the study is valid and reliable in determining the outcomes for professional development in UK .6 Literature reviews find enormous research work on nurses CPD, while in Pakistan like other developing countries there is a gap and no significant amount of literature review found on the subject. In one review, it is mentioned that, CPD is not mandatory in Pakistan.7 In fact, there is no structured or systemic CPD programs for medical professionals in Pakistan. CPD activities are gradually understood, infrequently, unstructured and inadequate for a huge number of professionals. Once qualified and registered, a practitioner is licensed to practice for life.7 There are many factors of not occurring CPD programs in Pakistan, one of them is shortage of the professional nurses, as currently Pakistan has 162 registered nursing colleges with over 50 students enrolled in each of them annually.8 Pakistan has also been categorized as one of the 57 countries that are facing a human resources management in health crisis. It is well below the level defined by world health organization (WHO) to deliver essential health intervention required for achieving the previous millennium development goals (MDGs) by 2015.8 The challenges to professional development highlighted by the Audit Commission (2001) raised the issue of what value nurses, in both the NHS and private sector, placed on CPD, if the aim of it is to improve patient care.9 Another study which underlying theme explored factors influenced nurses’ perceptions of CPD found the absence of reflection from the learning process is evident in some instances and this reduces the impact on practice that educational intervention can have. A reduced inability to alter working practices is evident in nursing, not only caused by colleagues, but by the leadership styles of managers. A lack 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.10 This study aimed to identify the factors influencing continuous professional development of nurses and helps in fulfilling the gap regarding perceptions of nurses CPD in swat, Khyber Pakhtunkhwa. 2. Materials and Methods A simple descriptive cross-sectional study design was used in this study. The calculated study sample size was 197 participants (population 400), so a total of 200 participants were selected by keeping the drop out in mind. The sample was calculated through Raosoft sample size calculator (considering the prevalence as 50%, 0.05 significance level, 95% confidence level, and bound of error 05%).Simple random sampling strategy was utilized to select the participants in which lists of all registered nurses work in tertiary care hospitals of swat obtained and simple draw method were used to select the participants. Data was collected through primary investigator in the field by himself. Questionnaire was filled by the participants in the English language medium. Data analysis was done concurrently along with data collection. Each questionnaire was given a code number to maintain anonymity. Analysis was done simultaneously after data collection process. Statistical package for the social science (SPSS) version 16 was used for the analysis of the data. Permission was granted from the ethical review committee and heads of the nursing departments. All the respondents were taken an informed consent for data collection. Purpose of the study was clarified to all the respondents along with study information. The nature of participation was voluntary and the right of anonymity and confidentiality ensured. 2.1. Data Analysis The process which was applied systematically, statistically and reasonable techniques to define and demonstrate abbreviate, summarize and estimate data (Data Analysis). Field data was collected for this project; SPSS 16. Version was used for data analysis. The field data was containing some personal information and demographic data, the analysis of personal information and demographic data are given below (table 1).
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3. Results 3.1. Demographic and Descriptive Statistics S. No
Variables
1.
Gender
2.
Age
3.
Qualification
4.
Religion
5.
Marital Status
6.
Institution
Frequency (n) Male 90 Female 110 20-30yrs 150 31-40yrs 48 41-50yrs 2 Diploma in nursing 141 Post RN 39 BSN 19 Master in Nursing 1 PhD in nursing 0 Muslim 198 Non Muslim 2 Single 90 Widow 0 Married 110 Divorced 0 Private 49 Government 151 Table 1: Demographic statistics
Percentage (%) 45.0% 55.0% 75% 24% 1% 70.5% 19.5% 9.5% .5% 0% 99.0% 1.0% 45.0% 0% 55.0% 0% 24.5% 75.5%
Cum % 45% 100% 75% 99% 100% 70.5% 90.5% 99.5% .5% 100% 99% 100% 45% 0% 0% 100% 24.5% 100%
The results of descriptive data showed that 45.0% of the participants were males and 55.0% were females. Majority of the participants part were in the age of 20-30 years, which were 150 out of 200 (75%). The participants, whose ages were from 31-40 31 years, were 48 out of 200 (24%) and participants, whose ages were from 41 41- 50years, were 2 out of 200 (1%).70.5% of the participants completed diploma in nursing, 19.5% were Post RN, 9.5% were ere BSN and 0.5% which was 1 participant has done master in nursing. 99% of the participants were Muslims and the remaining 1 % were Non Non-Muslims. Muslims. Regarding marital status the ratio of married were 45% and unmarried were 55%. Most of the participants were qqualified ualified from government institutes (75.5%) and the rest 24.5% were qualified from private institutes. 1% 41 41-50yrs
100% 80%
55% female
24% 31--40yrs
0.50%Master
19.50% Post Rn
60%
55% Married
75.50% Government
99% Muslim
40% 20%
1%Nonmuslim
9.50%Bsn
45% male
75% 20 20-30yrs
70.50% Diploma
45% Single
25% Private
0% GENDER
AGE
QULIFICATION
RELIGION
MARITAL STATUS
INSTITUTION
Figure 1: Presentation of demographic data
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S.NO
Variable
1.
Understanding the term CPD
2.
Willing to attend CPD sessions
3.
Sessions arranged in your organization for CPD
4.
Weekly Arranged
5.
Monthly Arranged
6.
Yearly Arranged
7.
CPD sessions held according to your need
8.
Attend any CPD session in past six months
9.
In-service CPD session is necessary
10.
CPD is beneficial for nursing care
11.
CPD is beneficial for planning NCP
12.
CPD is beneficial for updating knowledge
13.
CPD is beneficial for orientation towards EBP
14.
CPD is beneficial for quality clinical practices
15.
CPD is beneficial for evaluating own self
16.
CPD is beneficial for enhancing knowledge
17.
CPD is beneficial for enabling person to meet the needs of patient
18.
workload is the reason for not attending CPD sessions
19.
Lack of interest is the reason for not attending CPD sessions
20.
Unorganized session is the reason for not attending CPD sessions
21.
Lack of time is the reason for not attending CPD sessions
22.
Unavailability of staff is the reason for not attending CPD sessions
23.
Lack of motivation is the reason for not attending CPD sessions
24.
Non supportive authority is the reason for not attending CPD sessions
25.
Not according to the needs is the reason for not attending CPD sessions
26.
CPD has positive impact on knowledge
27.
CPD has positive impact on overall practice
28.
CPD has positive impact on attitude
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YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES
Frequency (n) 189 11 190 10 72 128 8 192 30 170 34 166 63 137 46 154 134 66 189 11 183 17 190 10 179 21 191 9 145 55 184 16 160 40 174 26 105 95 136 64 142 58 140 60 100 100 115 85 119 81 194 6 189 11 157
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Percentage (%) 94.5 % 5.5 % 95 % 5% 36 % 64 % 4% 96 % 15 % 85 % 17 % 83 % 31.5 % 68.5 % 23 % 77 % 67 % 33 % 94.5 % 5.5 % 91 % 8.5 % 95 % 5% 89.5 % 10.5 % 95.5 % 4.5 % 72.5 % 27.5 % 92 % 8% 80 % 20 % 87 % 13 % 52.5 % 47.5 % 68 % 32 % 71 % 29 % 70 % 30 % 50 % 50 % 57.5 % 42.5 % 59.5 % 40.5 % 97 % 3% 94.5 % 5.5 % 78.5 %
Cum% 94.5 % 100 % 95 % 100 % 36 % 100 % 4% 100 % 15 % 100 % 17 % 100 % 31.5 % 100 % 23 % 100 % 67 % 100 % 94.5 % 100 % 91.5 % 100 % 95 % 100 % 89.5 % 100 % 95.5 % 100 % 72.5 % 100 % 92 % 100 % 80 % 100 % 87 % 100 % 52.5 % 100 % 68 % 100 % 71 % 100 % 70 % 100 % 50 % 100 % 57.5 % 100 % 59.5 % 100 % 97 % 100 % 94.5 % 100 % 78.5 %
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29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41.
Variable NO YES CPD has positive impact on job satisfaction NO YES CPD has positive impact on patient satisfaction NO YES CPD has positive impact on nurses NO YES CPD has positive impact on health care team members NO YES CPD has positive impact on quality of care NO YES CPD has positive impact on EBP NO YES CPD has positive impact on research NO YES CPD has positive impact on motivation towards higher education NO YES CPD has positive impact on clinical practice NO YES CPD has positive impact on critical thinking NO YES CPD has positive impact on communication skills NO YES CPD has positive impact on orientation towards new invention in nursing NO YES Recommended CPD in institutions NO Table 2: Response variables regarding CPD
Frequency (n) 43 164 36 167 33 161 37 170 30 189 11 187 13 175 25 178 22 170 30 152 48 157 43 188 12 193 7
www.theijst.com Percentage (%) 21.5 % 82 % 18 % 83.5 % 16.5 % 80.5 % 19.5 % 85 % 15 % 94.5 % 5.5 % 93.5 % 6.5 % 87.5 % 12.5 % 89 % 11 % 85 % 15 % 76 % 24 % 78.5 % 21.5 % 94 % 6% 96.5 % 3.5 %
Cum% 100 % 82 % 100 % 83.5 % 100 % 80.8 % 100 % 85 % 100 % 94.5 % 100 % 93.5 % 100 % 87.5 % 100 % 89 % 100 % 85 % 100 % 76 % 100 % 78.5 % 100 % 94 % 100 % 96.5 % 100 %
During data collection the participants were asked about the term Continuous professional development (CPD), in which the majority subjects (94.5%) understood the term CPD. 95% of the participants were willing to attend the CPD sessions. While arranging CPD sessions in their institutions, 36% of the participants’ responded, out of that 36% arranged CPD sessions, 4% stated that the sessions are arranged weekly, 15% said sessions arranged monthly and 17% marked CPD sessions arranged yearly.13.5% respondents data that these sessions are held according to their needs. 23% of the participants attended the CPD sessions in the past six months, 67% of the participants elaborated that the in-service CPD sessions are mandatory. 94.5% of the participants’ responded that those CPD sessions were beneficial for providing nursing care. 91% of the participants gave data that CPD session is beneficial for planning nursing care (NCP), 95% obtained responses said that CPD is beneficial for updating knowledge, 89.5% of the participants’ stated CPD is beneficial for orientation towards evidence base practice (EBP). 72.5% of the participants recorded data that CPD is beneficial for evaluating own self. 92% of the participants gave data that CPD is beneficial for enhancing knowledge and 80% said that CPD sessions are beneficial for enabling person to meet the needs of the patient. During the data collection, the participants were asked a question about the reasons for not attending the CPD sessions, the responses were, work load 87%, lack of interest 52.5%, unorganized sessions 68%, lack of time 71%, unavailability of fellow staff 70%, lack of motivation 50%, non-supportive authority’s 57.5%, CPD sessions are not according to the needs assessment 59.5%. During on asking about the CPD has a positive impact on which of the following; the responses were knowledge 97%, overall clinical practice 94.5%, attitude 75.5%, job satisfaction 82%, patient satisfaction 83%, coworkers (nurses) 80.5%, health care team members 85%, quality of care 94.5%, evidence based practice (EBP) 93.5%, research 87.5%, motivation towards higher education 89%, enhancing clinical practice 85%, critical thinking 76%, communication skills 78.5%, orientation towards new invention in nursing practice 94%. 96.5% participants recommended CPD in institutions the rest 3.5% did not recommend CPD in institutions.
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REASONS FOR NOT ATTENDING CPD Lack of time Not according to the needs No supportive authorities Lack of motivation NO Unavailability of staff
YES
Unorganized session Lack of interest workload 0%
20%
40%
60%
80%
100%
reasons’ for not attending CPD Figure 2: Bar graph of reas
BENEFITS OF CPD enabling person to meet the need of patient beneficial for enhancing knowledge
20.00%
27.50% 4.50%
beneficial for orientation towards EBP beneficial for updating knowledge
10.50% 5.00%
beneficial for planning NCP beneficial for nursing care
98%
2.00%
beneficial for evaluating own self beneficial for quality clinical practices
80%
8.50% 5.50% YES
72.50% 95.50% 89.50% 95% 91.50% 94.50%
NO
Figure 3: Benefits of CPD in participants’ opinion
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3.2. Inferential Statistics S.N O
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Impact of CPD sessions
CPD has positive impact on quality of care
Yes No Yes 187 7 CPD has positive impact on knowledge No 2 4 CPD has positive impact on overall practice Yes 183 5 No 5 6 CPD has positive impact on attitude Yes 153 4 No 36 7 CPD has positive impact on job satisfaction Yes 159 5 No 30 6 CPD has positive impact on patient satisfaction Yes 161 6 No 28 5 CPD has positive impact on nurses Yes 155 6 No 34 5 CPD has positive impact on health care team me Yes 163 7 mber No 26 4 CPD has positive impact on EBP Yes 181 6 No 8 5 CPD has positive impact on research Yes 169 6 No 20 5 CPD has positive impact on motivation towards h Yes 173 5 igher education No 16 6 CPD has positive impact on clinical practice Yes 168 2 No 21 9 CPD has positive impact on communication skills Yes 154 3 No 35 8 CPD has a positive impact on Yes 184 4 orientation towards new invention in nursing No 5 7 Recommended CPD in institutions Yes 185 8 No 4 3 Table No. 3: CPD Sessions positive impact on quality of care versus overall impact
P
.000 .000 .002 .005 .020 .041 .064 .000 .006 .000 .000 .000 .000 .004
Explanation: CPD sessions positive impact on quality of care has been compared to the overall impact of the sessions found mostly significant in 13 categories; that is, CPD has positive impact on knowledge (p = .000), CPD has positive impact on overall practice (p =. 000), CPD has positive impact on attitude (p = .002), CPD has positive impact on job satisfaction (p = .005), CPD has positive impact on patient satisfaction(p = .020), CPD has positive impact on nurses(p = .041), CPD has positive impact on EBP(p = .000), CPD has positive impact on research (p = .006), CPD has positive impact on motivation towards higher education (p = .000), CPD has positive impact on clinical practice (p = .000), CPD has positive impact on communication skills (p = .000), CPD has a positive impact on orientation towards new invention in nursing (p = .000), and the last but not the least one Recommended CPD in institutions (p = .004), the only non-significant question was ‘CPD has positive impact on health care team member (p = .064),Table 3.
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Impact of CPD sessions
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Willing to attend CPD sessions
Yes Yes 187 No 3 CPD has positive impact on overall practice Yes 181 No 8 CPD has positive impact on attitude Yes 153 No 37 CPD has positive impact on job satisfaction Yes 161 No 29 CPD has positive impact on patient satisfaction Yes 162 No 28 CPD has positive impact on nurses Yes 158 No 32 CPD has positive impact on health care team member Yes 165 No 25 CPD has positive impact on quality of care Yes 184 No 6 CPD has positive impact on EBP Yes 182 No 8 CPD has positive impact on research Yes 171 No 19 CPD has positive impact on motivation towards higher Yes 173 education No 17 CPD has positive impact on clinical practice Yes 166 No 24 CPD has positive impact on communication skill Yes 154 No 36 CPD has a positive impact on Yes 183 orientation towards new invention in nursing No 7 Recommended CPD in institutions Yes 185 No 5 Table No. 4: Willing to attend CPD sessions versus overall positive impact CPD has positive impact on knowledge
No 7 3 7 3 4 6 3 7 5 5 3 7 5 5 5 5 5 5 4 6 5 5 4 6 3 7 5 5 8 2
P
.002 .012 .008 .000 .012 .001 .008 .000 .000 .000 .002 .001 .001 .000 .041
Explanation: The question of ‘nurses willing to attend CPD sessions has been compared to the overall impact of the sessions found mostly significant in all of the 16 categories; in which: CPD has positive impact on knowledge (p = .002), CPD has positive impact on overall practice (p =. 012), CPD has positive impact on attitude (p = .008), CPD has positive impact on job satisfaction (p = .000), CPD has positive impact on patient satisfaction(p = .012), CPD has positive impact on nurses(p = .001), CPD has positive impact on health care team member (p = .008), CPD has positive impact on quality of care (p = .000), CPD has positive impact on EBP(p = .000), CPD has positive impact on research (p = .000), CPD has positive impact on motivation towards higher education (p = .002), CPD has positive impact on clinical practice (p = .001), CPD has positive impact on communication skills (p = .001), CPD has a positive impact on orientation towards new invention in nursing (p = .000), and Recommended CPD in institutions (p = .041),Table 4. 4. Discussion Many things have change from tradition and authority to science and technology and for the instance; nurses also should have a step towards change, as the slogan of the council was, “Nurses: A force for change – A vital resource for health” in the year 2014, consecutively, “Nurses: A force for change – care effective, cost effective” in 2015, and “Nurses: A force for change – improving health systems’ resilience” in 2016.11 Even the future will be secure by achieving the maintainable evolutionary progressions, which is stated in the new theme of ICN for 2017, that is, “Nursing: A voice to lead – Achieving the Sustainable Development Goals.11” The inspiration behind this topic came from such slogans stated and in that regard studied that topic. Identifying perceptions regarding continuous professional development, many of the nurses do have a disposition about the blessings of technologies but still do not share such activities. The nurses do understand the concept of CPD as a part of lifelong learning but face difficulties in measuring its effectiveness when dealing with a range of issues.12 The present study assessed whether nurses are well-equipped in terms of CPD and to identify lapses, highlighting those areas more specifically in future directions with an ultimate aim of improving CPD sessions delivery system in Pakistan.
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The current study was aimed to assess the perception of nurses regarding continuous professional development. Most of the participants (94.5%) were understood the term CPD in this study, which is comparable and a bit better in the term of knowing CPD, that is, in the study done among nurses in a district hospital of Greece in which the results were 74%.12Only 32% respondents said, CPD in-service sessions are arranged for them in organization, which was approximately equal to a study conducted in one of the district hospital of Greece, in which the results were 30%.12Seventy seven 77% of the participants have not attended any CPD session, which was far much high as compare to the same study conducted in district hospital of Greece in which only 22% nurses did not attend any CPD session.12CPD is beneficial for nursing care 94.5%, compared to a study conducted in district hospital of Greece, the result were 82.6%.12 Moreover, willing to attend CPD session have the positive impact on overall nursing practice as shown in (table 4), the significance found in all the variables, in which related to nursing care, CPD has positive impact on quality of care (p = .000). One of the barrier to CPD in an institutions in their opinions; that was “wards too busy to attend the CPD session” in our study, a large number of the participants, that was 87 % answered ‘Yes’ and 13% responded ‘No’, compared the exact question, “clinic was too busy”, responded 17 % to the study conducted in district hospital of Greece.12While continuing barriers, “non-supportive authorities” is the reason for not attending CPD sessions were 57.5%, comparing to a study conduct in district hospital of Greece in which the results were 91%.12During this study, the question, ‘Is lack of time the reason for not attending CPD sessions?’ the results were 71% compared to the study conducted in district hospital of Greece, in which the results were 83%.12 A grand report was made by the intelligence unit research on doctors in many countries of the world, showed CPD conduction, its requirements, accreditations, delivery, credits / year and even sanctions.13(Appendix A). In Pakistan, the CPD activities even for doctors are entirely voluntary, no credits per year, no formal accredited provider body, no regulatory body as well as no sanctions.13 Once qualified and registered, a doctor is licensed to practice for life.7 Another literature said, there are over fifty professional organizations which provide CPD, but their activities are not regulated and are not coordinated.14 The similar is the case with the nursing in Pakistan, once you got a license to be a registered nurse, you enjoy the whole life as a nurse except the renewal of the license with fee when it gets expired, without any examination at all. In inferential statistics in our study, obtained chi-square values for the variables, willing to attend CPD sessions versus overall positive impact of CPD sessions showed significant “p” values in all the categories of nurses’ knowledge, attitude and practice (as reference to table 4). As compare to a study conducted on 200 nurses working with 2 National Health Services (NHS) trusts and 13 nursing homes in UK applied the diverse methodology of quantitative as well as qualitative approach found the results and concluded that, “Nurses perceive professional development in a positive manner irrespective of their clinical environment in the main. Moreover, they preceded that, despite this it can be seen that the impact of CPD in the nursing profession is diminished for several reasons. Further, the absence of reflection from the learning process is evident in some cases and this reduces the impact on practice that educational intervention can have in that study. A reduced inability to alter working practices is evident in nursing, not only caused by colleagues, but by the leadership styles of managers in that study”.15
Respondents recommended CPD YES
NO 4%
97%
Figure 1: Recommendations for CPD in institutions 5. Recommendations More researches need to have on CPD by applying the more robust methods, by keeping its benefits in mind. CPD plays a key role in the development of nurses. It is very necessary that a nurse should be up-to-date with new knowledge, skills, behaviors and technologies. It is recommended, that government should make CPD sessions mandatory in all institutions and make it an integral part of the profession. Likewise, the Pakistan nursing council (PNC) should take their own part by regularly assessing, examining, arranging and monitoring nurses by keeping compulsory credentials with an optimum span of time, thus to enable nurses to drive for lifelong learning process. Moreover, this study serves to be a basis for other research studies need to be conducted on CPD not only on nurses but on other health care professionals as well in regional and national context.
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6. Conclusion From the results of this study showed earlier, we can conclude that the nurses perception regarding CPD has an overall positive, as evidenced by positive impact on knowledge, enhance and update knowledge, improve overall quality clinical practices, orientation towards Evidence based practice and new inventions in nursing, planning overall nursing plans and care. Barriers identified by nurses for not attending CPD sessions were; workload, lack of time, unavailability of staff for coverage, unorganized sessions, were some of the reasons of the participants. This led us to conduct the in-service teaching sessions and seminars regularly for nurses, plan to overcome on barriers and motivation for nurses should be the key strategies. The gap identified in this paper can be a focus for initiating fruitful educational programs such as novice nurses’ orientation programs, teaching sessions, certifications, ongoing continue higher education programs, new trainings etc. 7. Limitations The feasibility and expense were the two major constraints of the study to conduct on a larger scale. A more valid and diverse responses were possible by utilizing subjective responses of the nurses. We found it difficult to identify enough research literature on the topic in regional and national context, a well organized grand and diverse studies can provide a good comparison, a more valuable results and a precise generalization could possible by taking large sample sizes in tertiary care hospitals of Pakistan. 8. References i. ANMC. The Code of Professional Conduct for Nurses in Australia. Canberra: Australian Nursing & Midwifery Council; 2008. ii. WHO. The World Health Report. Health systems: Improving performance. Geneva: World Health Organization; 2000. iii. Gary Culliton, ‘Medical Practitioners Act Update’, Irish Medical Times, 14 May 2009,http://www.imt.ie/opinion/guests/2009/05/medical-practitioners-act-update.html [accessed 17 June 2011] iv. Jarvis P (1987) Lifelong education and its relevance to nursing. Nurse Education Today. 7, 2, 49-55. v. Barriball KL, While AE, Norman IJ (1992) Continuing professional education for qualified nurses: a review of the literature. Journal of Advanced Nursing. 17, 9, 1129-1140. vi. Nolan M, Owen R, Curran M, Venables A (2000) Reconceptualising the outcomes of continuing professional development. International Journal of Nursing Studies. 37, 5, 457-467. vii. 5 National Consultation, p.8. viii. Sunday,magazine,December7th2014.www.tribune.com.pk/story/801156/nursing_in_pakistan_handle_with_care /. ix. Audit Commission (2001) Hidden Talents: Education, Training and Development for Healthcare Staff in NHS Trusts. Audit Commission, London. x. Hughes E (2005) Nurses’ perceptions of continuing professional development. Nursing Standard. 19, 43, 41-49. xi. http://www.icn.ch/publications/international-nurses-day/ xii. Aris Yfantis, Ioanna Tiniakou and Eleni Yfanti:Nurses’ attitudes regarding continuing professional development in a district hospital of Greece. xiii. George B. Murgatroyd (July 2011) CONTINUING PROFESSIONAL DEVELOPMENT the international perspective, UK: General Medical Council. xiv. Zarrin Seema Siddiqui, CPD of Medical Doctors in Pakistan, p.3. xv. Hughes E (2005) Nurses’ perceptions of continuing professional development. Nursing Standard. 19, 43, 41-49. Date of acceptance: January 18, 2005.
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Appendix A Country Austria Belgium France Germany
CPD Requirement Voluntary Voluntary None Compulsory
Credits / Year 50 20 + 2 PRs 50
CPD Scheme Delivered By… Regulator Accredited Providers Accredited Providers
Greece
Compulsory
20
Hungary Italy
Compulsory Compulsory
50 50
Accredited Providers Medical Assoc. Accredited Providers Accredited Providers
Norway Australia
Compulsory Compulsory
40 40
Universities + societies Specialist societies
New Zealand Canada
Compulsory
50
Compulsory
80
Regulator or Specialist boards Specialist Colleges
Jamaica USA
Compulsory Compulsory
10 12 - 50
Kenya South Africa Japan Malaysia Pakistan
Compulsory Compulsory
5 30
Voluntary Voluntary Voluntary
-
87
Accredited Providers Accredited Provs/Specialty Board Accredited Providers Universities, Specialist societies Medical Association -
Vol 5 Issue 7
CPD Activities Accredited By Regulator Regulator Regulatory Body(Regional) Medical Association Medical societies Regulatory Body (Regional Medical Association Societies or Regulator Specialist boards Specialist Colleges Regulator Medical Association Regulator Medical Association -
Sanction No sanctions No sanctions License loss /fees reduced. No sanctions Retake examinations Loss of status + fees Suspension from register Can suspend from register Possible removal of license Varies – fine, reprimand -
-
July, 2017
