Research

This is our Nursing Education Research page. In the page below, you will be able to browse through the ReSearch proposal that we had put up for this year 2011. The title of the Nursing Education Research proposal is:

= Effectivenss of strategies in enhancing transfer of learning in the Newly Graduated Nurses =

Princple Investigator : Goo Lay Kian ( NUrse Educator )
Team Members : Ms Dinah Djong ( NUrse Educator ) Mr Eugene Teoh ( NUrse Educator ) Ms Tan Yew Hiang( NUrse Educator ) Ms Lim Siew Geok( NUrse Educator )

Recently, there has been a growing concern on the effort and resources invested on training yet its impact has not been positively reflected in the clinical settings (Callais, 2006; Chen et al, 2005; Clarke, 2002; Curry et al, 1994; Drewitt, 2008; Fitzerald, 2002; Harber & Sullivian, 2002; Merriam & Leahy, 2005)This has accentuated to Nurse Educators that despite having a well designed structured orientation programme especially for the newly graduated Registered Nurses (RN), the translation of knowledge and skills have not been evident in the clinical areas.

To close the gap, the authors hope to examine perceptions of the newly graduated Registered Nurses (RNs) have on their transfer of learning from classroom to the clinical areas based on the identified barriers. Concurrently, they will also aspire to explore the effectiveness of the proposed strategies that could impact their transfer of learning during their clinical setting which will ultimately be translated to benefit their patients that they are caring for and the organisation.

**LITERATURE REVIEW ** According to Harber & Sullivan (2002) & Subedi (2004), the transfer of learning is defined as the extent of retention and application of the knowledge, skills and attitudes from the training environment to the workplace environment. In the nursing context, though, the Newly Graduated RNs will undergo a six months Orientation Programme to prepare them to be competent in the clinical areas. However, some of the Nurse Managers had shared common feedback that the nurses failed to demonstrate the desired skills that they were taught to them. It is indeed critical to investigate, in the nursing context, to explore if the newly graduated RNs will be able to transfer their learning to level three, which is commonly refer to as transference of learning (Kirkpatrick, 1975). However, in the classroom sessions, the Nurse Educators will usually only be able to assess the learning to level two, which is commonly known in learning taxonomy as just a recall. Curry et al (1999) elaborated that level three transfer will be more realistic and meaningful (Calais, 2006) in the working profession, as manifested by the transfer of the newly learnt knowledge and skills from the classroom to the actual work environment. Therefore, it is the same expectation on the learning outcomes for the newly Registered Nurses to assess if learning in the classroom sessions must be transferred to the genuine ward environment so that ultimately their patients will benefit in receiving safe and competent care. However, in the quest to enhance effective transfer of learning, there are some prevailing evidences in many literatures that spelled out the potential barriers that could hinder the effective transfer of learning and the study will aim to explore if those potential barriers are present in the Nursing context.

Many literatures mentioned that there are three major components that influence positive transfer. They are (a) the learners’ characteristics, (b) training design and delivery characteristics, and (c) workplace or organisational environment characteristics (Merriam & Leahy, 2005; Calias, 2006; Drewitt, 2008; Subedi, 2004).

For learners’ characteristics, Merriam & Leahy (2005) highlighted that it encompasses characteristics such as learner’s ability to learn, application of knowledge, learning styles, personality factors and training expectations. Subedi (2004) illustrated that learners need to practice active learning where conscious effort to learn needs to be present. They similarly viewed that the learners will need to know why they are enrolled in the programme and specific learning outcomes that they are expected to achieve post programme. In other words, if the Registered Nurses do not have an understanding of how the programme can benefit them in the work place, they might not be enthusiastic about applying the newly learnt knowledge and skills to their job. Ultimately, the transfer of learning will not likely to take place (Chen et al, 2005).In the light of ensuring that transfer really happens, as shared by Drewitt (2008), one of the effective strategies that he used was to involve the learner to set learning outcomes and discuss specific action plans together with their supervisor prior, during and after taking part in the training programme. This much discussed strategy strongly encourages follow through to implement the newly acquired knowledge and skills to the clinical setting. Ultimately, it is indeed imperative to highlight to the learner that he is accountable for that transfer of learning.

Secondly, training design and delivery characteristics play an essential role in influencing transfer of learning too. As illustrated by Subedi (2004) and Merriam & Leahy (2005), the strategies towards an effective instructional system design, participatory training delivery are equally crucial in enhancing the learning transfer. It has highlighted that learning outcomes need to be aligned with their learning needs so that the learners are able to appreciate the validity and the practicality of the content to be transferred. The Safe Manual Handling session was selected as there has been constant concern over this set of essential skills that the newly graduated RNs are required to be competent on. The Safe Manual Handling is a full day session that comprises of a half day of didactic session and half day of practical session. At the end of the day session, there will be practical assessment by the Nurse Educators on the skills learnt. A wide variety of instructional methods are used in the session (including active participation and skills demonstrations). However, the above mentioned skills are not seen consistently been demonstrated in the clinical areas. It is indeed the Educators’ concern as the new RNs are expected to be competent to apply and demonstrate the Safe Manual Handling skills, so as to protect their back but also in the prevention of pressure ulcers for their patients.

In the last dimension of a transfer partnership, supervisory and peer support are critical. (Callais, 2006; Chen et al, 2005; Clarke, 2002; Curry et al, 1994; Drewitt, 2008; Fitzerald, 2002; Harber & Sullivian, 2002; Merriam & Leahy, 2005). Drewitt (2008) reiterated the importance of goal setting and follow through. He introduced goal setting before, during and post program using an online goal setting tool to get them to review their goals. This encourages them to examine the organisation impact, the barriers they encountered and how they could overcome them. Merriam & Leahy (2005) and Edgar et al (2007) emphasized that close supervision and follow up post intervention are highly associated with successful learning transfer. Other means of follow through as proposed by (Merriam & Leahy, 2005) will be the use of a learning contract, which is another tool to monitor the learners’ progression post programme.

Finally, the organisation culture will predominantly set a common platform to encourse the process of learning transfer, according to (Simon,1998; Meyer et al, 2007; Leberman et al, 2009) where both the supervisor and the learner should share the accountability so that transfer of learning can take place. Meyer et al (2007) further deliberated that for the notion of learning transfer, sufficient allocated time and opportunities to practice and share new skills with peers are equally also impact on the extent of transfer.

With much illustration from above, it has geared the study to explore the type of known barriers that could influence newly graduated RNs on the transfer of learning post orientation programme (safe manual handling). Besides, it is also through this study that aims to explore the effectiveness of the strategies used to overcome known barriers towards the transfer of learning. At the same time, it is also to explore if there is any differences in their transfer of learning between the interventional group and the control group in the newly graduated Registered Nurses.

**RESEARCH QUESTION ** Our proposed research questions are:


 * 1) What are some of the known barriers that could affect the transfer of learning in the newly graduated RNs?


 * 1) Do the suggested strategies enhance the transfer of learning in these newly graduated Registered Nurses?

<span style="font-family: 'Arial','sans-serif'; line-height: 150%; margin: 0cm 0cm 0pt;">The dependent variable in this study will be the Learning System Transfer Inventory. As for the Independent variables, it will be the strategies that could influence the outcome on the transfer of learning. We will also like to explore the effectiveness of the proposed strategies.

**<span style="color: #0000ff; font-family: 'Arial','sans-serif'; line-height: 150%; margin: 0cm 0cm 0pt;">ETHICAL ISSUES ** <span style="font-family: 'Arial','sans-serif'; line-height: 150%; margin: 0cm 0cm 0pt;">Participation of the nurses will be strictly on a voluntary basis. They will be informed that withdrawal from the study is allowed at anytime without affecting the relationship with the researchers at present or in the future. Anonymity and confidentially of the participant will be strictly maintained throughout the study. The aims and the details of the procedures involved will be explicitly explained to the participants. Informal consent will be obtained from them prior to the study. Research findings will not be promulgated without the consent of the hospital authority. Data and records of the research findings will only be accessible by the researchers involved in the study.

**<span style="color: #0000ff; font-family: 'Arial','sans-serif'; line-height: 150%; margin: 0cm 0cm 0pt;">METHODOLOGY **

**<span style="font-family: 'Arial','sans-serif';">Design ** <span style="font-family: 'Arial','sans-serif'; line-height: 150%; margin: 0cm 0cm 0pt;">A quasi-experimental pre and post methodology will be used in this study using a self report ratings to examine the factors influencing the transfer of learning. The purpose of this quasi- experimental design to explore the effectiveness of the proposed strategies on the transfer of learning outcome

**<span style="font-family: 'Arial','sans-serif';">Sampling ** <span style="font-family: 'Arial','sans-serif'; line-height: 150%; margin: 0cm 0cm 0pt;">A purposive sampling of 66 newly graduated Registered Nurses from a local tertiary institution will be selected for this study. This group of graduates have undergone three years of full time nursing programme. This group of newly graduated Registered Nurses will be immediately enrolled to the hospital orientation programme after graduation. The inclusion criteria of the sample will be that the nursing graduates will be from the same tertiary institution. For this group, it will include local Nursing graduates and international nursing graduates. Power calculation will not be required as the sample is readily available.

**<span style="font-family: 'Arial','sans-serif';">Instrument ** <span style="font-family: 'Arial','sans-serif'; line-height: 150%; margin: 0cm 0cm 0pt;">There will be three instruments that will be utilised in the study. The first instrument is the LSTI, to assess the transfer of learning for the newly graduate RNs. The second instrument is the learner’s action plan for the newly graduated RNs to follow through with her trainer (preceptor) and the Nurse Manager on goals setting. The third instrument will be the observation checklist for the trainer (preceptor) to monitor the application of the Safe Manual Handling skills in the clinical setting. <span style="font-family: 'Arial','sans-serif'; line-height: 150%; margin: 0cm 0cm 0pt;">As for the first instrument will be in a questionnaire format. It consists of two sections. The first section will address questions on demographic data (Question 1-5). Followed by the second section, the Learning Transfer System Inventory (LTSI) will be used. It is a self rated inventory, which consists of a Likert Scale ranging from 0 to 5 (strongly agree to strongly disagree). It is comprehensive as it covers sixteen factors that could simply affect the transfer of learning. The version of the LTSI used in the study contained sixty-eight items and additional of twenty items. It include questions addressing the LTSI on (a) Learner readiness (b) Motivation to Transfer (c) Positive Personal Outcome (d) Negative Personal Outcomes (e) Personal Capacity for Transfer (f) Peer Support (g) Supervisor Support (h) Supervisor Sanctions (i) Percieved Content Validity (j) Transfer Design (k) Opportunity to use and some other general scales which include transfer effort expectations performance outcome expectations, resistance or openness to change, performance self efficiency and performance coaching. Positive Personal Outcome Alpha=.69; Personal Capacity for Transfer, alpha=.68; Supervisor sanction ,alpha=.63 ; <span style="font-family: 'Arial','sans-serif'; line-height: 150%; margin: 0cm 0cm 0pt;">Opportunity to use learning, alpha=.7; Performance Coaching, alpha=.70 (Chen et al, 2005).

<span style="font-family: 'Arial','sans-serif'; line-height: 150%; margin: 0cm 0cm 0pt;">The LTSI is valid and reliable as it is well tested in many human resource training perspectives and it is used as the only research based instrument for assessing factors affecting transfer of learning (Holton, Bates & Ruona, 2000).

**<span style="font-family: 'Arial','sans-serif';">PROCEDURE ** <span style="font-family: 'Arial','sans-serif'; line-height: 150%; margin: 0cm 0cm 0pt;">The data collection will be initiated in two phases. The first phase will be conducted using the two weeks following clinical placement after the Safe Manual Handling session using the LSTI. The second phase will be one month post programme at the first week of 3rd week of July 2011. Participants will be recruited during their orientation period. A letter of information will be given to each participant informing them about the purpose and the content of the study. Below illustrate the strategies which will be proposed for the new RNs, preceptors (trainers) and the Nurse Managers. <span style="font-family: 'Arial','sans-serif'; line-height: 150%; margin: 0cm 0cm 0pt;">The detail procedure will be as illustrated below: <span style="font-family: 'Arial','sans-serif';">1) **<span style="font-family: 'Arial','sans-serif';">Two weeks before the Safe Manual Handling **  · <span style="font-family: 'Arial','sans-serif';">The preceptor (trainer), Nurse Managers (NM) in the respective intervention group will be briefed on the purpose of the study, their  <span style="font-family: 'Arial','sans-serif'; line-height: 150%; margin: 0cm 0cm 0pt 72pt; tabstops: list 72.0pt; text-indent: -36pt;">involvement in the study and the use of the preceptor observational checklist and the action plan form.   · <span style="font-family: 'Arial','sans-serif';">The trainer from the control group will only be briefed on the follow through using the preceptor observational checklist with the new  <span style="font-family: 'Arial','sans-serif'; line-height: 150%; margin: 0cm 0cm 0pt 72pt; tabstops: list 72.0pt; text-indent: -36pt;">graduate nurses.

<span style="font-family: 'Arial','sans-serif';">2) **<span style="font-family: 'Arial','sans-serif';">On the actual day of the Safe Manual Handling session **  · <span style="font-family: 'Arial','sans-serif';">Nurse Educator will highlight the expected learning outcomes of the session.

<span style="font-family: 'Arial','sans-serif';">3) **<span style="font-family: 'Arial','sans-serif';">First day of the ward induction post orientation programme **  · <span style="font-family: 'Arial','sans-serif';">In the intervention group, the New RNs will discuss with the preceptor  <span style="font-family: 'Arial','sans-serif'; line-height: 150%; margin: 0cm 0cm 0pt 36pt;">(trainer) on the action plans to achieve and set the review dates using the <span style="font-family: 'Arial','sans-serif'; line-height: 150%; margin: 0cm 0cm 0pt 36pt;">action plan form (Appendix B).   · <span style="font-family: 'Arial','sans-serif';">New RNs will then discuss with the NM on the set goals to achieve after  <span style="font-family: 'Arial','sans-serif'; line-height: 150%; margin: 0cm 0cm 0pt 36pt;">discussed with preceptor( trainer).

<span style="font-family: 'Arial','sans-serif';">4) **<span style="font-family: 'Arial','sans-serif';">Weekly preceptor (trainer) observation **  · <span style="font-family: 'Arial','sans-serif';">Preceptor will need to be on the same shift as the preceptee at lease twice a week.    · <span style="font-family: 'Arial','sans-serif';">In the intervention group, the preceptor will need to use the observation checklist to observe if the RN assigned has demonstrated  <span style="font-family: 'Arial','sans-serif'; line-height: 150%; margin: 0cm 0cm 0pt 72pt; tabstops: list 72.0pt; text-indent: -36pt;">and comply with using the Safe Manual Handling skills effectively using the observation checklist (Appendix C).   · <span style="font-family: 'Arial','sans-serif';">Indirect observation will be used by the preceptor ( trainer).

<span style="font-family: 'Arial','sans-serif';">5) **<span style="font-family: 'Arial','sans-serif';">Fortnightly review on goals setting with preceptor (trainer) **  · <span style="font-family: 'Arial','sans-serif';">New RN will review the established action plans with the preceptor (trainer)if they are achieved or needs improvement.

<span style="font-family: 'Arial','sans-serif';">6) **<span style="font-family: 'Arial','sans-serif';">End of the month post orientation programme ( 3rd week of July 2011) **  · <span style="font-family: 'Arial','sans-serif';">New RN will review the goal setting with both the preceptor and the Nurse  <span style="font-family: 'Arial','sans-serif'; line-height: 150%; margin: 0cm 0cm 0pt 36pt;">Manager.   · <span style="font-family: 'Arial','sans-serif';">2nd set of the LSTI will be given concurrently to both the interventional and  <span style="font-family: 'Arial','sans-serif'; line-height: 150%; margin: 0cm 0cm 0pt 36pt;">control group of newly graduated RNs at one single sitting. <span style="line-height: 150%; margin: 0cm 0cm 0pt 36pt; tabstops: list 36.0pt left 63.0pt; text-indent: 0cm;"> · <span style="font-family: 'Arial','sans-serif';">Submission of the action plan form and preceptor observational checklist to  <span style="font-family: 'Arial','sans-serif'; line-height: 150%; margin: 0cm 0cm 0pt 36pt;">the researchers. <span style="font-family: 'Arial','sans-serif'; line-height: 150%; margin: 0cm 0cm 0pt 36pt;">To minimise the risk for contamination, all the preceptors (trainers), Nurse Managers involved in the study will be reinforced that they <span style="font-family: 'Arial','sans-serif'; line-height: 150%; margin: 0cm 0cm 0pt 36pt;">will need to keep the information confidential and not shared with other ward colleagues.

**<span style="color: #0000ff; font-family: 'Arial','sans-serif'; line-height: 150%; margin: 0cm 0cm 0pt;">DATA ANALYSIS **

<span style="font-family: 'Arial','sans-serif'; line-height: 150%; margin: 0cm 0cm 0pt;">The data collected will be coded, summarised and analysed using the computer software-Statistical Package for Social Sciences for Windows (SPSSWIN) version 17.0 to determine the nominal level of measurement. Descriptive statistics on socio-demographic scores and the details of the LTSI will be analysed. The effectiveness of the strategies suggested with the outcome of the LTSI will also be examined using the paired t test as comparison will be done to paired data. Individual scores for each segment will be analysed. Besides, linear regression will be used to explore the other potential interventions that could influence the outcome on transfer of learning.

<span style="font-family: 'Arial','sans-serif'; line-height: 150%; margin: 0cm 0cm 0pt;">As for the data collected on the preceptor observation checklist and the action form will be collated as descriptive data.

**<span style="font-family: 'Arial','sans-serif'; font-size: 14pt; line-height: 150%;">REFERENCES **

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