Rinnakkaistallenteet Terveystieteiden tiedekunta
2020
In-service training to enhance the
competence of health and social care professionals: A document analysis of web-based training reports
Kallio, Hanna
Elsevier BV
Tieteelliset aikakauslehtiartikkelit
© 2020 Elsevier Ltd.
CC BY-NC-ND https://creativecommons.org/licenses/by-nc-nd/4.0/
http://dx.doi.org/10.1016/j.nedt.2020.104493
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In-service training to enhance the competence of health and social care professionals: A document analysis of web-based training reports
Hanna Kallio, Ari Voutilainen, Leena Viinamäki, Mari Kangasniemi
PII: S0260-6917(19)31471-6
DOI:
https://doi.org/10.1016/j.nedt.2020.104493Reference: YNEDT 104493
To appear in:
Nurse Education TodayReceived date: 30 September 2019 Revised date: 27 March 2020 Accepted date: 4 June 2020
Please cite this article as: H. Kallio, A. Voutilainen, L. Viinamäki, et al., In-service training to enhance the competence of health and social care professionals: A document analysis of web-based training reports,
Nurse Education Today(2020),
https://doi.org/10.1016/j.nedt.2020.104493
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In-service training to enhance the competence of health and social care professionals: a document analysis of web-based training reports
Hanna Kallio
PhD-student, junior researcher Department of Nursing Science Faculty of Health Sciences University of Eastern Finland, PB 1627
70211 Kuopio, Finland Ari Voutilainen
Adjunct Professor, PhD Data Manager
Institute of Public Health and Clinical Nutrition University of Eastern Finland
Kuopio Finland
Leena Viinamäki D. Soc. Sc (social policy) Principal Lecturer
Lapland University of Applied Sciences Social Services, Health and Spor Kemi
Finland
Mari Kangasniemi*
Adjunct Professor, PhD University Researcher
Department of Nursing Science Faculty of Medicine
University of Turku Finland
mari.kangasniemi@utu.fi +358 50 440 4285
*Corresponding author
CONFLICTS OF INTEREST
The authors declare no conflicts of interests.
SOURCE OF FUNDING
This work was supported by the Ministry of Education in Finland.
ETHICAL APPROVAL
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According to the Finnish research law this kind of study does not require ethical approval.
ACKNOWLEDGEMENTS
We thank the research team and steering committee of the project for sharing their valuable observations and comments regarding this study.
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In-service training to enhance the competence of health and social care professionals: a document analysis of web-based training reports
Abstract
Objective: To identify and describe what professional competencies have been addressed by in-
service training for health and social care professionals and what kind of teaching and evaluation methods have been used.
Design: Cross-sectional descriptive study.
Methods: A document analysis design was used to explore 7,817 in-service training project
documents relating to 203 projects carried out from 2002–2020. The project data were obtained from the websites run by the relevant health and social care organizations.
Results: The most frequent competencies that were addressed were health promotion and clinical
skills (17%), preventing social problems (16%) and promoting the wellbeing of children and families (15%) and older adults (14%). The main target groups were general health and social care
professionals (19%). A total of 222 training interventions were used by the 203 projects and the most frequently used methods were conventional classroom education (56%), followed by coaching and orientation (12%) and theme days (9%). Only 38% of the projects measured the effects of the training and the main method was collecting feedback from participants. We also found that collaboration between projects was necessary to ensure that training was not duplicated and transparent reporting played a central role in that process.
Conclusions: In order to achieve successful in-service training for health and social care
professionals, projects needed to recognize topical competence needs and provide the most appropriate training methods. Collaboration and transparent reporting helped to avoid duplication in training.
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Keywords: In-service training, competencies, document analysis, health and social care, integrated care, professionals
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INTRODUCTION
Achieving high-quality and effective health and social care requires competent health and social care professionals (HSCP) (Axley, 2008; Stein, 2016). The competency of HSCP has been reported to contribute to care quality and patient safety (Axley, 2008; Baumbusch, et al., 2017; Okuyama et al., 2011), but also to productive work (Almeida and Cho, 2012; ILO, 2010), meaningful work (Tashiro et al., 2013), wellbeing at work (Aiken et al., 2016) and confidence (Holt et al., 2010) and support for teamwork (Steven et al., 2018). Ensuring that HSCP staff are competent is both an ethical and statutory requirement for organizations (Gallagher, 2007; Peate, 2018).
In the health sector, competence in HSCP has been emphasized in a number of areas that provide patient-centered clinical care, namely working in interdisciplinary teams and employing evidence- based practice (Dingwall et al. 2017; Greiner and Knebel, 2003). In social care, the need for competence tends to focus on promoting social change, solving problems around human relationships and empowering people (Trevithick, 2012). This means that social professionals’
interpersonal, cognitive and decision-making skills are central to their role (Dutton and Kohli, 2004).
Studies that have looked at the competencies of HSCP on a more general, common level, have highlighted the roles they play in caring for clients and patients, collaborating with clients and patients and other professionals and contributing to quality improvements (Dijkman et al., 2017;
Holt et al., 2009; Stein, 2016).
There are challenges in producing changes in high-quality care over time, as different dynamics can continuously alter HSCP procedures and changes in operational environments impose new
requirements. These changes include structural health and social care reforms, which lead to wide- ranging alterations in the competencies that professionals needs to carry out and document their work and their relationships with clients and patients (Stone and Bryant, 2012). Moreover, factors from outside the health and social care arena have an impact on the competencies needed by HSCP.
For example, as number of elderly citizens increase, HSCP may require new skills and knowledge to
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support their self-care and daily activities so that they can live at home longer. In addition, global trends pose new requirements for HSCP, as climate change indirectly increases population-level health problems, such as increases in vector-borne diseases. These lead to alterations in
professionals’ procedures, including infection control and their readiness for heath emergencies (ILO, 2010; Kreslake et al., 2018). One of the dynamics that alters the competencies needed by HSCP is new scientific knowledge and the fact that our understanding of the definition of effective and adequate care changes over time (Neely et al., 2006; Shaughnessy et al., 2016).
Formal pre-employment education in-service training has been used to support professionals by maintaining and updating their competencies (Almeida and Cho, 2012; Institute of Medicine, 2009).
Different teaching methods have been used for in-service training, such as lectures, group activities (Baumbusch et al., 2017), coaching and homework assignments have been used (Clausen et al., 2017). It has been emphasized that the suitability of the training method plays an essential role in learning (Institute of Medicine, 2009), but research on how effective these methods are has been sparse (Fukada, 2018). Moreover, the importance of assessing professionals’ training needs (Esmaliam et al., 2015) and the effects of training, namely the changes in competence that result from the training, has been highlighted (Clausen et al., 2017; Esmaliam et al., 2015; Fukada 2018;
Griscti and Jacono, 2006). In addition to service organizations, learning institutions, such as
universities of applied sciences, also provide training that focuses on individuals’ working life (Helle et al., 2006; WFCP, 2017).
In Finland, HSCP are legally obliged to maintain and develop their professional skills (Act 559/1994, Act 817/2015) and the local authorities, known as municipalities, must provide continuing education for staff (Act 1326/2010, Act 1383/2001). In-service training regimes for HSCP are currently
organized by care and service facilities, authorities and educational organizations (Lehtola & Wilen, 2010). Separate training is provided for the social and health care fields, but this has proved
challenging. This is because training has been fragmented and has rarely integrated into the strategic
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management of organizations. In addition, the needs of individual employees and care organizations have not been taken into account. (Ministry of Social Affairs and Health, 2004; Lehtola and Wilen, 2010; Kangasniemi et al., 2018.)
However, previous research on continuing in-service training for HSCP has also been fragmented and there has been a lack of research reviewing in-training projects in this context. The aim of this study was to identify and describe what professional competencies have been addressed by in-service training for health and social care professionals and what kind of teaching and evaluation methods have been used. We responded to for the following research questions:
1. What competencies have in-service training projects for HSCP covered to date?
2. Which HSCPs were involved?
3. What training methods were used?
4. How have has the effects of in-service training been evaluated by projects?
METHODS
Design
We used the document analysis method, as it enables researchers to systematically review and evaluate organizational and public reports and is suitable for examining multidimensional data (Bowen, 2009).
Data
We collected data in Finland and the institutions we focused on were health care, social service and educational organizations (Table 1). Our data consisted of 7,817 publicly available electronic documents gathered from the organizations’ web pages during August 2017 and 2,731 of these projects focused on the health and social sector. We focused on eight different types of institutions and organizations who provided in-service training. In Finland health and social care is provided by a
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network of municipalities, or local authorities, and five regional hospital districts that center around university hospital and a network of smaller hospitals and social and healthcare centers. We
included the five hospital districts in Finland, as they are responsible for providing specialized medical treatments in their fields. We also included municipal alliances who work together to provide social and health services and organizations that organize services for their local residents and also provide the same services for other municipalities. Organizations who provide in-service training on a regional level were also included. The educational institutions that were included were universities of applied sciences, vocational schools and centers for excellence on social and health care. Finally, we included the Innokylä-portal, which is a public open access platform for all kind of educational and clinical projects in social and health care. In order to select the projects that
specifically focused on the competencies of HSCP, we based the four-phase selection process on pre- defined inclusion and exclusion criteria (Table 1). The first step was for one researcher to review the project abstracts (xx) and select the projects that referred to competencies in health and social care.
At least the title and aim of the project needed to be available. Phases 2–4 were based on the entire project document, not just the abstract and these were conducted by two researchers (xx, xx). In phase 2, the researchers selected projects that focused on the competencies needed by HSCP and this meant, for example, that projects that focused on, patients’ and clients’ competencies were excluded. In phase 3, the researchers excluded projects that focused on organizational structures, projects that did not provide formal education or if the documents did not provide enough information to evaluate the project’s eligibility to be included. In the final phase, the researchers excluded projects that were a part of a larger project if the aims of the sub-project were not clearly defined. Team meetings were held by the researchers (xx, xx, xx) to reach a consensus about which projects should be included and this identified 203 projects.
Table 1 goes about here Analysis
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We used document analysis (Bowen, 2009) and an observation matrix to process the data. During the first phase of the process, a researcher (xx) read all the data to get an overview of the project.
The second phase involved extracting the relevant information from the project documents and the third phrase involved placing them into an observation matrix. The matrix comprised two parts:
section A provided information about the project profile (Table 1), such as the project name, service field and duration and section B included information about the HSCP training. The fourth phase focused on calculating the descriptive frequencies, percentages and the mean values from the data.
We decided to report the results at a descriptive level, due to the heterogeneity of the data and missing information.
Rigor of the research
The use of existing documents can both improves and decreases the rigor of a study. Because the documents are not provided for research purposes, relevant information can be missing and this is a weakness. However, the strength of this kind of material is that they these documents have been produced without the researcher’s involvement (Bowen, 2009). We ensured the representativeness of the data, and the validity of the studies, by carefully selecting target organizations and building a diverse observation matrix. We included all Finnish public health and social service organizations and educational institutions so that we could map working life projects related to HSCP competencies as widely as possible. After building a tentative observation matrix, we randomized 16 project
documents – two for each type of organization – and modified the matrix based on these projects.
We also improved the matrix during the data extraction process and re-reviewed all the data for additional information.
Ethics
The ethical considerations of this study included getting permission to use the data and conducting and reporting the study in an honest manner (Polit and Beck, 2010). We drew the data from the publically available web pages of organizations and reported the findings anonymously. This meant
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that there was no ethical need for us to approach each organization for permission to include their data in our study. We have also reported the data search, selection and analysis in a transparent way (Polit and Beck, 2010).
Overall description of the projects
Documents related to 203 projects that had been completed or on-going were included in the analysis (Table 2). The dates of the projects spanned 2002–2020.
Table 2 goes about here.
RESULTS
Competencies covered by the projects
The competencies covered by the training were divided into nine core themes (Table 3) and the most common areas were: health promotion methods and clinical work (17%), preventing social problems and addressing them (16%), promoting the wellbeing of children and families (15%), aging (14%), general health and social sector practice and management (12%) and informatics and
recording (11%).
Table 3 goes about here.
Trained health and social care professionals
The trained professionals were divided in 10 groups (Figure 1) and the most common groups were:
general HSCP staff (19%), staff working with children, youths and families (17%), social care staff (16%), healthcare staff (16%) and staff working with elderly people (13%).
Figure 1 goes about here.
Training methods
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We found that 145 (71%) of the 203 projects we included reported that they had used a number of different methods to train professionals and some had combined several different methods. There were a total of 222 training interventions reported (Figure 2). Approximately half of the training methods (56%) were standard education, namely classroom sessions and e-learning, and these were described in more detail in 29 of the projects. In five cases these were learning tasks; two involved exercises and one project each reported using group techniques, blended techniques, flipped learning and repetition. The educational sessions had also been tailored to meet the needs of specific professional groups in three instance, and implemented in multi-professional contexts in another two. The use of implementation forms used were reported by 11 projects and these were used in distance teaching in seven cases, face-to-face teaching in two cases and in a combination of both methods in two cases. In addition to standard education, the most frequently used training methods were coaching and orientation (12%), seminars, conferences or theme days (9%), and networks, forums and visits (8%).
Figure 2. goes about here.
Just under half of the projects (46%) had produced new printed or electronic material to support the professionals' competency and training (Figure 3). Most of the material produced for these 93 projects focused on different procedures and operational models (23%), web portals and learning platforms (19%), guides and handbooks (15%) and journal articles and web publications (12%).
Figure 3. goes about here.
Evaluating the effects of training
Of the 113 completed projects, 38% reported that they used one or more methods to evaluate the effects of the training (Figure 4). The most frequently used methods by these 43 projects were requesting feedback from the participants during the training sessions (46%) and other self- evaluation methods completed by the HSCP (25%). The feedback collected during the training
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sessions often focused on whether the participants had been satisfied with the content and delivery of the training. One project asked patients to assess staff competencies and the other asked patients to compare the performance of staff before and after training. In 10% of the 203 projects, the staff’s competencies and, or, their training needs were assessed before training, but only one project also assessed them afterwards. Two of the 20 evaluations that were carried out before training were web-based, but no information was available on the other 18.
Figure 4. goes about here.
DISCUSSION
This study provides new knowledge about the in-service training provided for HSCP. It shows that organizations aimed to enhance the competencies of HSCP working with patients and clients of all ages, but there was a specific emphasis on children and the elderly. Projects that focused on particular professional groups were limited and training tended to be based on common topics, as this enabled a wider audience to take part. The competency training provided for health
professionals covered both practical and health promotion skills and projects aimed at social care professionals looked at different social problems, such as the wellbeing of disabled people and the quality of child welfare. In general, the main training topics covered conventional aspects of the health and social care fields and focused on person-centered care. However, the subjects covered were influenced by trends in society, such as environmental responsibility, entrepreneurship, multiculturalism and technology. In particular the importance of environmental competences (Kallio et al. 2018) and entrepreneurship (Eckelman and Sherman, 2016; Marques et al., 2018) have been estimated to increase in future. As the aim of HSCP in-service training was to improve their
performance and organizational functioning (Steven et al., 2018), and trainers needed to be able to check that those aims have been achieved. A noteworthy finding was that only one of the 203 projects had actually assessed whether the training had resulted in improved competencies. In
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future, we need to examine the changes made to delivering training for HSCP staff in previous decades.
We found that the effects of the in-service training were often assessed using superficial questions after the training sessions and that was if it was conducted at all. The projects’ final reports often measured the success of the training by how many people had attended and this, on its own, cannot be used to measure any improvement in competency (Gallagher, 2007). Earlier research also found a lack of assessment with regard to training (Jones et al., 2018). For example, Clausen, et al. (2017) reviewed studies of health care managers’ inter-professional training and found that a lack of adequate assessment methods was common and this limited the rigor of the studies. Studies of nursing staff have also highlighted a lack of, or insufficient, evaluation (Eslamian et al., 2015) and found that just using self-assessment was not enough (Vernon et al., 2013). In addition, it has been unclear, what kind of training and patient outcomes have been expected (Jones et al., 2018).
Collecting training feedback from participants has been shown to be beneficial if the selected arrangements promoted or inhibited the learning experience. For example, they could provide views on the suitability of the selected training methods.
We found that in-service training was often provided using standard educational methods and this was in line with previous studies (Jones et al., 2018). In several projects it was combined with other training methods, such as visits or workshops. This was a positive finding, as some studies have shown that using different methods together has been shown to promote learning (Baumbusch et al., 2015; Härkänen et al. 2016). However, as there has been little research about what kind of teaching methods truly and most effectively support learning (Härkänen et al., 2016), it was a somewhat expected finding that the use of the different teaching methods had been poorly reflected in the project reports.
Participants’ perspectives can provide valuable information that can be used to design further training initiatives, but they do not address the true impact or efficiency of the training. Identifying a
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lack of competency, and the true effect of training in addressing those skill gaps requires objective evaluation methods. Measuring levels of competence before training means that it is possible to identify actual shortages in competencies and use this information to design training. Asking participants about their training needs is also important as it can help trainers to tailor the contents of courses and make them more relevant to the work of the participants (Peña and Alonso, 2006). It also increases participation, which has been found to improve how people engage in training and its effectiveness (Griscti and Jacono, 2006; Steven et al. 2018). Repeating competence measurements after training enables trainers and participants to see the immediate effects of the training and shows participants that they learnt new skills that can be used in their work. Even if the training does not result in significant changes in the participants’ knowledge, it may improve their perceptions of the subject that the training course focused on (Baumbusch et al., 2017). It should be noted that measuring competence immediately after training does not guarantee the sustainability, or
efficiency. These need to be measured some point after the training has taken place. For example, it is useful to observe whether providing nurses with pharmaceutical training reduces medication mistakes on the ward.
The questions raised by our findings include the reporting of, and collaboration between, various projects. We rarely found references to collaboration between the projects. However, effective collaboration means that positive results from previous projects can be used to inform training and education. It can also be more focused and not duplicate material that is already available. As there is sparse knowledge about effective teaching methods, and how to evaluate changes in
professionals’ competencies, it could be highly beneficial to share experiences, observations and information between organizations when planning training that aims to enhance the competencies of HSCP. Moreover, sharing lessons learnt helps to prevent others from making the same mistakes (Anbari et al., 2008) and increases collaboration between projects.
Conclusions and implications
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This study produced new knowledge about in-service training that focused on developing the competencies of health and social care professionals. Our findings showed that there was lack of oversight and that the effects of training were rarely evaluated. This needs to be addressed by defining how the competencies needs to be enhanced and how any improvements should be objectively measured. This process should occur in the early planning stage of any project and it requires developers to acquire certain research skills in this area. In addition, open reporting is to be encouraged, as it allows collaboration between projects and decreases duplication in training.
Information about projects tackling health and social care competencies should be available on the Internet, including transparent post-project reporting of the methods, results and perceived limitations. In addition, regional or national coordination of in-service projects would help to run effective projects and avoid any duplication or gaps in training.
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In-service training to enhance the competence of health and social care professionals: a document analysis of web-based training reports
Author statement
Hanna Kallio: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Resources, Software, Validation, Visualization, Roles/Writing – original draft
Ari Voutilainen: Formal analysis, Methodology, Software, Supervision, Validation, Writing – review &
editing
Leena Viinamäki: Conceptualization, Methodology, Resources, Validation, Writing – review & editing Mari Kangasniemi: Conceptualization, Data curation, Formal analysis, Funding acquisition,
Investigation, Methodology, Project administration, Resources, Supervision, Validation, Visualization, Roles/Writing – original draft
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Figure 1. Roles of the trained professional groups targeted by the 203 competence projects
0% 5% 10% 15% 20%
HSCP working with immigrants HSCP in private firms and associations HSCP in home care HSCP in drugs, alcohol and mental
health welfare
Nursing staff HSCP working with elderly Health care professionals Social care professionals HSCP working with children, youths and
families
HSCP in general
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Figure 2. Training methods adopted by the 203 projects
0% 10% 20% 30% 40% 50% 60%
Bulletins, purchasing literature for the staff Consultation Workshops and groupwork Peer mentoring/assessing Networks, forums, visiting Seminars, conferences, theme days Coaching, orientating Classroom teaching and e-learning
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Figure 3. Material produced to support competency and training
0% 5% 10% 15% 20% 25%
Posters and conference presentations Orientation and self learning -material New knowledge of the topic Patient and client information and…
Theses and final projects Journal papers and web publications Guide and handbooks Web portals and learning platforms Procedures and operation models
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Figure 4. Methods used to evaluate the effectiveness of training
0% 10% 20% 30% 40% 50%
Competence mapping before and after training
Evaluation by patients and clients Evaluation requested by an external
body
Evaluation assessed by the project team Evaluation by the project collaborators Self-evaluation by the HSCP Feedback collected during training
sessions
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Type of organization
Heal th and socia l- secto
r proje
cts n =
Phase 1 Included:
i) projects referring
to competen
ces in health and
social - sector, ii) at least name and aim of a
project available
Phase 2 Include
d:
projects focused in the HSCP compet ences
Phase 3 Excluded:
projects focusing in
i) organizatio
nal structures
and ii) formal
degree education,
iii) unclearly described projects
Phase 4 Exclude
d:
part projects, of which organiza
tion’s own aims not
availabl e
Hospital districts 2
0 2 6 6
266 134 75 52 46
Municipal alliances 3
1 7 9
79 30 19 13 13
Host municipalities 2
8 2 1 6
216 67 8 6 5
Provincial federations 1 8
3 0 9
53 52 18 16 5
Universities of applied sciences
1
2
3 2 7 6 5
503 368 94 39 38
Vocational schools
14 8
2 7 9 6
228 154 37 24 24
The centers of excellence on Social and Welfare
1 1
2 6 1
261 233 75 59 50
Innokylä-portal – 1
1 2 5
1125
2
46 39 22 22
Projects in total 7 8 1 7
2731 1084 365 233 203
1 In which health and social sector education offered 2 Wellbeing and health –field
Selection of the data
Organizations N = Projects (all sectors) N = The data
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Table 1. How we selected the 203 projects we included
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Table 2. Overview of the 203 competence projects included in this review
N %
Status at time of study (August 2017)
Completed 113 56
On-going 89 44
Planned 1 1
Total 203 100
Duration 1–24 months 73 36
25–36 months 91 45
37–48 months 8 4
49–120 months 6 3
Information not available 25 12
Total 203 100
Main project/part of larger project
Part of larger project 94 46
Main project 47 23
Information not available 62 31
Total 203 100
Specialist field Health and social care 109 54
Social care 56 28
Health care 38 19
Total 203 100
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Table 3. Competencies covered by the 203 training projects
Core competence groups and the contents
N %
Health promotion methods and clinical work 34 17
Patient examinations and care 17
Lifestyle guidance 8
Sexual health promotion 2
Promoting healthier lifestyles in patients 3
Ensuring nurses have a healthy working life 2
Methods of health promotion 2
Preventing social problems and tackling them 33 16
Drug and alcohol addictions and mental health work 18
Preventing and tackling social exclusion 7
Preventing and tackling gaming addictions 3
Social rehabilitation 3
Providing and implementing social work services 2
Promoting the wellbeing of children, youths and families 31 15
Working with families 18
Early childhood education 8
Developing and implementing child welfare services 3
Recognising and tackling violence in the home 2
Addressing the health and service needs of elderly people 29 14
Health and care for elderly people 15
Developing and implementing elderly services 14
General health, social sector practice and management 25 12
Guiding clients and assessing service needs 9
Developing and implementing home care services 4
Health and social reform 4
Managing the health and social sectors 3
Developing new initiatives in the health and social sectors 2
Environmental responsibility in health care 2
Crisis management and planning 1
Information technology and records 23 11
Information technology and digital services 19
Recording patient and client records 4
Promoting the wellbeing of disabled people 13 6
Disabled peoples’ health and participation 9
Providing services for disabled people 4
Multiculturalism 9 4
Increasing knowledge of multiculturalism 7
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Sexual health promotion of immigrants 2
Teaching and tuition in health and social care 6 3
Simulation techniques 3
Guiding health and social care students 2
Guiding health and social care volunteers 1
Total 203 100%
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