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  1. Dickerson, Pamela S. PhD, RN,C


Traditional methods of evaluating continuing nursing education have focused on end-of-session feedback and/or testing related to the learning experience. A continuous quality improvement (CQI) framework and associated statistical process control tools provide an alternative approach to assessing both processes and outcomes of continuing nursing education. One implementation example demonstrates the value of this approach. The CQI model offers an exciting option to continuing education/staff development educators looking for creative and beneficial ways to evaluate educational activities.


Continuing nursing education is an ongoing process of expanding knowledge and skills beyond the level of basic education (American Nurses Association, 1994). This expansion stimulates the professional growth of the nurse and contributes to his or her ability to provide quality health care in various areas of nursing practice.


Continuing education plays a significant role in equipping nurses to deal with the major changes currently making an impact on health care. Nurses today need knowledge and skills in "soft" areas of communication, critical thinking, and collaboration as well as strong technological expertise. Continuing education offers the opportunity for both types of capability enhancement.


How is the effectiveness of continuing education in accomplishing its goals determined? Several techniques have been used. These include:


* Assessing the "happiness index" (individuals' perceptions of objectives, content, faculty, and facilities at the end of a learning activity). This is a requirement of the American Nurses Credentialing Center's Commission on Accreditation (American Nurses Credentialing Center, 1996) and provides valuable short-term feedback helpful in planning future similar activities.


* Assessing cognitive knowledge gain through pre- and posttests. This technique gives a sense of short-term recall. It also can be helpful in evaluating the activity and planning for future sessions.


* Assessing skills capability through return demonstration or performance of technical procedures that have been taught. Frequently included as part of the process of assessing "competence," skills testing provides short-term data indicating whether the learner has mastered technical capability in a specific situation at a specific time.


While these three evaluative parameters provide valuable data and have their place in the continuing education process, none provide information related to the goal of increasing the ability of the learner to provide quality care.


The goal of learning is to produce new behaviors (Fox, 1996). Following the learning activity, the learner reflects on new material in relation to his or her practice environment and considers ways to apply new knowledge and skills. Such thoughtful consideration enables the learner to develop strategies for incorporating new knowledge into practice. This is particularly important given the current scope of change within the healthcare environment. The learner may need several days, weeks, or months to incorporate new learning into practice, and it is important to allow time for this process to occur. Senge (1994, p. 45) stated that "You don't pull up the radishes to see how they're growing," suggesting that patience is required to see evidence of learning.


New behaviors incorporated into practice over time result in new processes or methods of providing care. To truly test the effectiveness of learning, one must consider how processes have changed. Change in process will produce change in outcomes in relation to specific customer-related goals. Process change also results in different ways of carrying out activities, such as improved framework, better communication, and more effective problem solving. Thus, evaluating process is an essential component in monitoring outcomes.


Traditional methods of statistical analysis often fall short in evaluating learning processes and outcomes because they focus on uniquely quantifiable facts collected at one point in time and do not take into account the processes of reflective thinking, innovation, creativity, and change. However, these traits are essential in generalized understanding of concepts and application of new knowledge to varied and unique circumstances; Benner (1984) stated that these capabilities are the hallmark of proficient and expert nurses.