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In response to changing trends in health care delivery, the nursing administration of the Good Samaritan Hospital (GSH), Lebanon, Pennsylvania, identified an opportunity to explore the use of crosstrained inpatient nurses and a case management model to facilitate the provision of quality patient care related to internal demands for resources. A major component of implementing this change in nursing care delivery included an understanding of the trends in health care delivery and the need for change on the part of staff nurses.
This paper provides a discussion of the issues confronted by nursing administration in planning for major change and the key role played by the continuing education program in enhancing staff nurse understanding and acceptance. The authors also present an overview of ongoing change techniques used to facilitate acceptance, and the analysis of staff nurse questionnaires on the effectiveness of these measures.
THEORETICAL BACKGROUND
The extent to which continuing education influences change in the knowledge, attitudes, and behavior of practicing nurses has been the focus of much research in recent years. Cervero (1985) proposed a rationale and conceptual framework for analyzing why continuing professional educational programs are successful in producing changes in the performance of professionals. He proposed four sets of variables to explain variation in the extent of behavior change. These included characteristics of the continuing professional education program, the individual professional, the proposed behavioral change, and the social system in which the professional operates. Meservy and Monson (1987) conducted a study of nursing personnel in three hospitals to deteimine the impact of continuing education on nursing practice and concluded that continuing education improves the quality of nursing practice and patient care. Warmuth's (1987) evaluation of a 1-day continuing education program queried participants 6 months after the program was offered and found that 142 specific uses of the offering were identified. She identified five types of use: changes in nursing practice, changes in nursing thinking /rationale, changes in nursing perspective, teaching others, and uses outside of work.
Ferrell (1988) studied nurses and their supervisors to determine self-reported change in behavior attributed to their attendance at continuing education offerings. She recommended more follow-up evaluation of program offerings, particularly at intervals weeks and months after the program was concluded. Peden, Rose, and Smith (1990) tested...