Review of Related Literature
This section shows the significant studies about the literatures on factors influencing continuing participation education among nurses in selected tertiary hospitals. This section talks about the discussions of the research. It is made up of the following; what is continuing professional education, Motivations to CPE, Barriers to CPE and the Requirements for CPE.
What is Continuing Professional Education or CPE?
Continuing Professional Education is a type of education that is conducted for participants in different professional fields that will help them keep their knowledge and skills updated and other relatable information that will aid them to achieve wider understanding of their selected profession. The CPE consist of programs that are properly arranged and planned set of activities, the implementation of the program requires the participation of well determined group of professionals that are seeking improvements with their knowledge and skill to maintain their capacity to work for their profession.
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The American Nursing Association defines continuing nursing education as education activities planned to construct the educational and experience base for professional nurses and to strengthen practice, education, administration, research or theoretical development, with a view to improving users’ health (Peña, Castillo, 2006). It is the responsibility and accountability of a professional to continue his/her professional development and is vital to organizational and professional success (O’Sullivan 2004).
Continuing Professional Education is considered as the systematic maintenance, improvement and broadening of knowledge and skills, and the development of personal qualities necessary for execution of professional, technical duties throughout the individual’s working life (A.Yfantis et al., 2010). The primary objective of continuing professional education is to facilitate continuous career growth, professional development and to improve nursing practices (National League for Nursing, 2001).
Motivation to Continue Professional Education
Motivation is what drives a professional to participate in an activity like continuing professional education that will help them improve their skills and knowledge regarding their profession to make them more competent and more reliable to execute things that should be done in their work area. In this area, the previous studies showed some motivational factors that affected the decisions of nurses to continue professional education. Improving quality of patient care involves the participation of nurses in continuing education (Rebecca, 2000).
The previous Jordanian study showed the consistency of result that for nurses to improve their knowledge and skills they have to participate in continuing education (Al-Bakheit, 1991). Professional reasons are what motivate nurses to participate in continuing education (F. Hayajneh, 2009). Upgrading skills and knowledge to increase professionalism are the factors that motivate Malayan nurses to participate in continuing professional education (Muthu, 2006). Increasing professional knowledge, compliance with the policy of the hospital, improvement of skills in taking care of patients and to meet the recommended goal of status are the major factors identified that motivate Hong Kong nurses to participate in continuing professional education (Lai, 2006).
The study found that participating in continuing professional development had a great beneficial effect in the planning of nursing care and formulating techniques and thinking what to do in practice (A. Yfantis, I, Tiniakou & E, Yfanti, 2010). Those nurses who are less satisfied with their career goals for income and advancement may realize that their work environment is stressful and they may believe that an additional nursing degree will afford them wider chance, and this will make them more motivated to enroll for higher degree program (J. I. Warren, M. E. Mills, 2009). The results showed that those nurses who are satisfied with their career are less likely to engage in continuing professional education because they are already contented with their job (J. I. Warren, et al., 2009). The patients are expecting high quality health care services from health care providers which lead them to enhance their educational status in order to meet the expectations of the patients (A. Yfantis et al., 2010).
The main goals of participating in continuing professional education are to enhance and improve practice and to make sure that the care being delivered is the highest quality that a professional can give for its patient (Claflin, 2005). Nurses supported the importance of lifelong learning and recognized the value of continuing education that assists them in coping with changes in their work environment (Hayajneh, 2009). The primary motivator to continue extended education came from personal desire, which quoted as consistent with the literature (Delaney & Piscopo, 2004; Reilley, 2003). Professional knowledge, professional advancement, relief from routine, compliance with authority, improvement in social welfare skills, and improvement in social relations and acquisition of credentials are the most common factors found in the previous studies that motivates professional nurses to participate in continuing education (Kristjanson& Scanlon, 1989; Thomas, 1986; Waddell, 1993).
Technology and nursing practice continually change, creating a need for nurses to pursue continuing education to remain competent (D. J. Schweitzer, T. J. Krassa, 2010). Intrinsic and extrinsic motivations are the reasons why nurses participate in continuing education (Kubsch, Henniges, Lorenzoni, Eckardt, & Oleniczak, 2003). With the attendance to continuing education, job satisfaction increases (Kubsch et al., 2003), burnout decreases (Espeland, 2006; Kubsch et al., 2003), and skills are updated (Sousher et al., 2999; Wood, 2006). Motivational factors includes nurses’ desire to be current, obtain immediate practical benefit, secure advancement, meet formal requirements, and interact with colleagues (Dealy & Bass, 1995). One way to keep on nursing advances is to attend continuing professional education opportunities (D. J. Schweitzer, T. J. Krassa, 2010).
Barriers to Continuing Professional Education
The barriers are the factors that hinder professionals to continue professional education hence, making them less competent or less reliable compared to those who are motivated to enhance their skills and knowledge to perform better in the work area. Here, we will see the different barriers identified by the previous studies that affect the decision and eligibility of nurses to join in activities that will improve their skills and knowledge as a professional. The common barriers include money, family, time and interest to pursue professional education.
These factors are still present since the past years and are not easy to eliminate in the list of barriers. The barriers includes the cost of tuition, responsibilities in the family, lack of information about program and work responsibilities, opinion of peers, and the attitudes (Glass, T. Atkinson, 1999).Lack of availability of courses on personal interests, lack of time, and difficulty in requesting time off from work are some of the barrier in continuing professional education (Lee, Tiwari, Choi, Yuen and Wong, 2005). Non supportive supervisors, non-supportive spouses, unchangeable work schedules, not enough funds and time, and distance of travel (Beatty, 2001). Schedule of work and responsibilities, lack of budget, travel distance to CE, and lack of available programs that will provide their needs were major barriers for nurses to continue education (Aucoin, 1998).
On the other hand, According to (Yfantis, A., Tiniakou, I., and Yfanti, E, 2010) another finding is that nurses doesn’t have past experiences and also can’t assess the effectiveness because of the new programs that are established. There were consistent deterrents over the last 20 years of study regarding continuing professional education and these include lack of quality or interesting topics, lack of benefit in attending continuing education, lack of support from the administration, and peer opinions and attitudes (D. J. Schweitzer, T. J. Krassa, 2010).
There were five major factors listed that prevented nurses from participating in continuing professional education and these are work commitments, time constraints, schedule of continuing education programs, domestic responsibilities, and the cost of courses which is consistent in the previous studies about continuing professional education (M. C. Chong, K. Francis, K. L. Abdullah, 2011).
In the past 20 years, there were identified deterrents that are consistently present in the list of barriers and these are lack of quality or interesting topic for the participants, lack of benefit in attending Continuing Education, lack of support from the administration and the peer opinions and their attitudes. All these deterrents have a great effect on the motivation of a professional to pursue continuing education (D. J. Schweitzer, T. J. Krassa, 2010). Minimal research has been conducted to investigate the perception of rural health care providers regarding the availability and accessibility of relevant continuing education (A. Jukkala, S. Henly, L. Lindeke, 2008). There are multiple barriers experienced by the rural health care professionals when they try to access continuing professional education, geographic isolation (Curran, Fleet, & Kirby, 2006; Hegge, Powers, Hendrickx, & Vinson, 2002), lack of financial resources (Alexander, Chadwick, Slay, Petersen, & Pass, 2002), and inability to take time away from work (Hendrickx). There are identified natural barriers to participation in distant continuing education and these are rough geographic terrain and inclement weather which makes travel in rural areas complicated (A. Jukkala, S. Henly, L. Lindeke, 2008).
Top reasons selected for not pursuing higher education included: too old, won’t earn more money, not needed by hospitals, and not needed to give good care (Altmann, 2011). Work commitments, domestic responsibilities, time constraints, scheduling of CPE activities, and cost of course are the top five most important factors that prevented nurses from participating in CPE based on the previous studies (M. C. Chong, K. Francis, K. L. Abdullah, 2011). Time constraint and family commitment were factors affecting the flexibility of the nurses’ availability for CPE such as arrangement for household chores and child care, travelling, and access to computers during nonworking time are other barriers (M. C. Chong, K. Francis, K. L. Abdullah, 2011). Younger and less experienced nurses participated in continuing professional education to a lesser level because of the financial implications associated with accessing continuing professional education (M. C. Chong, K. Francis, K. L. Abdullah, 2011). Participation in continuing education was made as an obligation to the nurses in other countries because they knew that professionals are lacking in motivation to voluntarily update their skills and knowledge when there is no external pressure (Peña et al., 2006).
Requirements for Continuing Professional education
There are things that a professional must have to make them eligible to participate in an activity that can help them grow as a more trustworthy person in their chosen career. In this area, the different studies showed some of the requirements needed to make a professional be engaged in an activity that will make them more proficient. In continuing professional education it is important to develop a positive attitude to benefit more and to have a significant improvement in professional self-development and growth of an individual (F. Hayajneh, 2009). Professional reasons like improving knowledge and nursing skills to provide better care for patients are stated as the reason why nurses are participating in continuing education. Study showed also that nurses are aware that they need to enhance their knowledge and skills in nursing to provide a more quality care for their patients (F. Hayajneh, 2009).
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Recent studies showed that senior nurses are more capable of participating in continuing education because of their higher income compared to those nurses in lower position (M. C. Chong, K. Francis, K. L. Abdullah, 2011). But this finding was contradicted by Bariball and While (1996) stating that younger and less experienced nurses favored continuing professional education. Enabling continuous professional development in health care needs a revitalizing work environment, mentoring and support for the registered nurses.
Clinical managers in the United Kingdom stated that Continuing Professional Development is a very important factor in enhancing job satisfaction. Having an attainable and high level continuing educational programs are connected to job satisfaction (Andrews et al., 2005; Levett-Jones, 2005). The capacity of group to encourage and maintain health care professionals is greatly needed to convince nurses to continue professional education (Booth & Lawrence, 2001; Brewer, Zayas, Kahn, & Sienkiewicz, 2006). Specialization requires that nurses keep up-to-date with new information in nursing science (Hayajneh, 2009). Positive attitudes will increase the number of nurses who participate. Program developers can focus on needed continuing education content within their institutions to develop and maintain professionally and scientifically guided care for patients (Hayajneh, 2009). In order for nursing profession to achieve professionalism, nurses must develop greater skills, undertake higher education, and engage in lifelong learning (Happell, 2004). Nursing prudence demands that nurses continue to advance their knowledge in nursing and its foundational disciplines (Orem, 2001). Full commitment of health care agencies and schools of nursing with dedicated mentors at all sites can identify and motivate nurses to enrol for an advanced degree. Admission, registration, advisement, and instructional support designed to ease transition to the student role are effective. Tuition support and instructional flexibility are major incentives (J. I. Warren, M. E. Mills, 2009).
The nursing degree curriculum in Malaysia generally encompasses nursing sciences, behavioral science, health sciences, and information technology and communication skills. Research is an important component of degree program, student are required to attend three credit hours of research and biostatic courses, and to conduct a project with contribute six credit hours of the courses (Chong et al., 2011).
The Nursing Board of Malaysia in 1998 was influenced by the globalization wave regarding development in nursing to include the requirement of CPE in the Nurses’ Code of Conduct. All nurses should have at least ten hours in CPE activities per year (Chong et al., 2011). The Malaysian Nurses’ Board required the participation of nurses in a minimum of hours of education and training each year (Chong et al., 2011).
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