WEBVTT 00:00:00.758 --> 00:00:06.114 position:50% align:middle - [Woman] Dr. Cusack is an associate professor in the Adelaide Nursing School, South Australia. 00:00:06.114 --> 00:00:12.762 position:50% align:middle Lynette has many years working in regulation and recently completed her final term as the chair of the 00:00:12.762 --> 00:00:15.833 position:50% align:middle Nursing and Midwifery Board of Australia. 00:00:15.833 --> 00:00:22.073 position:50% align:middle Lynette has been involved in a wide range of nursing, midwifery, and healthcare policy development, 00:00:22.073 --> 00:00:24.131 position:50% align:middle research, and education. 00:00:24.131 --> 00:00:30.431 position:50% align:middle Contributions include leadership and management, regulation, professional practice development, 00:00:30.431 --> 00:00:32.834 position:50% align:middle and occupational resilience. 00:00:39.280 --> 00:00:44.592 position:50% align:middle - [Dr. Cusack] Hello, and thank you for the opportunity to present on this work. 00:00:44.592 --> 00:00:51.030 position:50% align:middle I would like to acknowledge that this study was funded by a grant from the National Council of State Boards 00:00:51.030 --> 00:00:57.133 position:50% align:middle of Nursing and also to acknowledge my co-researcher Naomi Verdonk and advisors, 00:00:57.133 --> 00:01:00.063 position:50% align:middle David Benton and Christine Penney. 00:01:00.063 --> 00:01:07.986 position:50% align:middle The purpose of this presentation is to summarize the findings from a bibliographic analysis of the indexed 00:01:07.986 --> 00:01:14.467 position:50% align:middle literature relating to the impact of regulation on continuing professional development in nursing, 00:01:14.467 --> 00:01:17.200 position:50% align:middle which I will refer to as CPD. 00:01:17.200 --> 00:01:23.582 position:50% align:middle This study came about because of my experience of a frequently asked question 00:01:23.582 --> 00:01:27.369 position:50% align:middle about why the regulator required CPD. 00:01:27.369 --> 00:01:35.540 position:50% align:middle There is extensive literature on a variety of aspects of CPD yet there appear to be some confusion 00:01:35.540 --> 00:01:40.234 position:50% align:middle amongst nurses I have met about the purpose of this regulatory requirement. 00:01:40.234 --> 00:01:46.909 position:50% align:middle I was left with the impression that, for some nurses, it was a matter of collecting the required hours or 00:01:46.909 --> 00:01:52.463 position:50% align:middle credits for their license or registration and not necessarily about maintaining 00:01:52.463 --> 00:01:54.369 position:50% align:middle or developing safe practice. 00:01:54.369 --> 00:01:56.655 position:50% align:middle This raised the question for me. 00:01:57.421 --> 00:02:03.292 position:50% align:middle What is the role and influence of nursing regulation on continuing professional development? 00:02:03.292 --> 00:02:11.641 position:50% align:middle The research design was a bibliometric analysis because it offered a quick insight into scientific activity 00:02:11.641 --> 00:02:17.033 position:50% align:middle by quantifying the volume of papers in a particular field of study. 00:02:18.539 --> 00:02:23.630 position:50% align:middle Many nurse regulators have, as part of their initial registration, or licensure, 00:02:23.630 --> 00:02:26.771 position:50% align:middle or renewal process, a requirement for CPD. 00:02:26.771 --> 00:02:32.128 position:50% align:middle From a regulatory standpoint, staying up to date with new nursing knowledge, 00:02:32.128 --> 00:02:37.197 position:50% align:middle research, practice, and information is integral to safe patient care. 00:02:37.197 --> 00:02:43.846 position:50% align:middle Evidence of CPD can demonstrate that nurses have kept current and informed about changes 00:02:43.846 --> 00:02:48.517 position:50% align:middle to professional practice, have remained connected to their profession 00:02:48.517 --> 00:02:52.450 position:50% align:middle and/or are suitably prepared to return to practice. 00:02:52.450 --> 00:02:59.944 position:50% align:middle Many regulators around the world have taken on CPD as part of the regulatory responsibility to confirm 00:02:59.944 --> 00:03:05.088 position:50% align:middle practitioners are keeping current and maintaining the knowledge they need to practice safely. 00:03:05.088 --> 00:03:11.041 position:50% align:middle The requirement for CPD may be embedded in the regulator's legislation or rules, 00:03:11.041 --> 00:03:14.953 position:50% align:middle and it is therefore mandatory for health practitioners to comply. 00:03:14.953 --> 00:03:20.814 position:50% align:middle Nursing regulation authorities have developed a range of CPD requirements. 00:03:20.814 --> 00:03:24.274 position:50% align:middle For example, in Australia, nurses are required to undertake 00:03:24.274 --> 00:03:27.288 position:50% align:middle a set number of hours per year for CPD. 00:03:27.288 --> 00:03:34.732 position:50% align:middle Many state regulators in the USA required continuing nursing education credits for ongoing 00:03:34.732 --> 00:03:36.693 position:50% align:middle maintenance of licensure. 00:03:36.693 --> 00:03:41.290 position:50% align:middle And in the United Kingdom, the Nursing and Midwifery Council has a process 00:03:41.290 --> 00:03:48.016 position:50% align:middle of revalidation that requires a set number of practice hours as well as practice feedback and written 00:03:48.016 --> 00:03:51.637 position:50% align:middle reflective accounts within a three-year renewal cycle. 00:03:51.637 --> 00:03:59.280 position:50% align:middle The use of a personal portfolio or certificates of attendance may be required by the regulator to be 00:03:59.280 --> 00:04:02.790 position:50% align:middle produced as evidence of the practitioner's compliance with CPD. 00:04:04.477 --> 00:04:12.515 position:50% align:middle The bibliometric approach included accessing a number of databases between August and September 2019, 00:04:12.515 --> 00:04:15.707 position:50% align:middle including CINHAL, Embase, and Proquest. 00:04:15.707 --> 00:04:23.889 position:50% align:middle Each database was searched to ensure all words related to nursing, regulation, and CPD were included. 00:04:23.889 --> 00:04:29.538 position:50% align:middle The reference list of all articles selected was screened for additional studies. 00:04:29.538 --> 00:04:32.534 position:50% align:middle Grey literature was not captured. 00:04:32.534 --> 00:04:39.433 position:50% align:middle Only articles published in English over a 10-year period were included 2009 to 2019. 00:04:39.433 --> 00:04:43.442 position:50% align:middle Three hundred and sixty-five records were identified. 00:04:43.442 --> 00:04:51.243 position:50% align:middle And after screening, 237 were removed, leaving 128 full-text studies 00:04:51.243 --> 00:04:53.162 position:50% align:middle for review for eligibility. 00:04:53.162 --> 00:05:03.090 position:50% align:middle If there were no references on impact of regulation on CPD in the body of the text, the records were excluded, 00:05:03.090 --> 00:05:06.096 position:50% align:middle leaving a final 30 studies. 00:05:07.450 --> 00:05:14.827 position:50% align:middle The process of bibliometric analysis only includes using titles and abstracts of the identified articles 00:05:14.827 --> 00:05:18.470 position:50% align:middle and was conducted using the VOSviewer package. 00:05:18.470 --> 00:05:25.730 position:50% align:middle This is a free software package developed by Nees Jan van Eck and Ludo Waltman at the University of Leiden. 00:05:25.730 --> 00:05:33.895 position:50% align:middle This package was specifically designed, analyzed, and displayed large bibliographic data sets. 00:05:33.895 --> 00:05:41.502 position:50% align:middle VOS stands for visualization of similarities and provides a means of identifying similarities and 00:05:41.502 --> 00:05:47.959 position:50% align:middle differences in data by placing them closely connected together items on a two-dimensional image 00:05:47.959 --> 00:05:52.057 position:50% align:middle with non-related items being placed at a distance from one another. 00:05:52.932 --> 00:05:59.389 position:50% align:middle Once the images were produced and the research team examined the different maps to identify underlying 00:05:59.389 --> 00:06:06.351 position:50% align:middle patterns in journal publication, volume of scholarly work, countries of origin, 00:06:06.351 --> 00:06:10.777 position:50% align:middle and central contributors and academic affiliations. 00:06:10.777 --> 00:06:14.558 position:50% align:middle Let's have a quick look at some of these maps. 00:06:14.558 --> 00:06:18.891 position:50% align:middle For a close look at the mapping concepts, please refer to the article published in the 00:06:18.891 --> 00:06:25.153 position:50% align:middle Journal of Nursing Regulation, Volume 11, Issue 3, October 2020. 00:06:26.607 --> 00:06:34.521 position:50% align:middle This first map is an overview of the timescale with articles emerging from around 2013 to 2017 00:06:34.521 --> 00:06:42.921 position:50% align:middle with the main cluster being 2014, '15 and shows the temporal evolution of the concepts 00:06:42.921 --> 00:06:46.078 position:50% align:middle and the impact on the developmental scholarship research. 00:06:47.172 --> 00:06:54.286 position:50% align:middle This main map provides a forward analysis presented here, and the second map placed the word 00:06:54.286 --> 00:06:57.510 position:50% align:middle "regulation" at the center. 00:06:57.510 --> 00:07:04.066 position:50% align:middle The maps were reviewed to clarify overarching themes or concepts represented by each of the clusters. 00:07:04.066 --> 00:07:10.211 position:50% align:middle This formed the basis of developing a great, narrative description of each theme. 00:07:11.966 --> 00:07:18.945 position:50% align:middle Overall, there was very little research published relating to the influence of regulation on nursing CPD. 00:07:18.945 --> 00:07:23.462 position:50% align:middle There was no specific journal that regularly published on the topic. 00:07:23.462 --> 00:07:28.135 position:50% align:middle Within these articles, there are some international collaborations. 00:07:28.135 --> 00:07:33.022 position:50% align:middle However, most corresponding authors came from the United States or Australia. 00:07:33.022 --> 00:07:39.491 position:50% align:middle The main collaborations were within the same country, and the analysis did not show a pattern 00:07:39.491 --> 00:07:41.139 position:50% align:middle in authorship groups. 00:07:41.139 --> 00:07:46.662 position:50% align:middle International collaborations concerning work in Africa and Southeast Asia demonstrated some 00:07:46.662 --> 00:07:48.544 position:50% align:middle cross-over of authorship. 00:07:50.045 --> 00:07:54.969 position:50% align:middle Four clusters were identified after consensus with our advisors. 00:07:54.969 --> 00:08:00.287 position:50% align:middle Continuing competence framework in clinical practice was featured most frequently. 00:08:00.287 --> 00:08:06.734 position:50% align:middle These articles primarily explored the competence required and the development of nursing practice. 00:08:06.734 --> 00:08:12.600 position:50% align:middle This cluster was followed by regulation, CPD, and public health. 00:08:12.600 --> 00:08:18.804 position:50% align:middle This cluster featured a disproportionate number of articles on a single project concerning nursing 00:08:18.804 --> 00:08:24.191 position:50% align:middle regulation and key public health issues in Africa and Southeast Asia. 00:08:25.553 --> 00:08:32.108 position:50% align:middle The role of regulation was deemed important in these articles to enforce education and expand scope 00:08:32.108 --> 00:08:37.622 position:50% align:middle of practice to make urgent community health needs such as HIV management. 00:08:37.622 --> 00:08:44.127 position:50% align:middle And the last two clusters professional development programming for patient care and nursing education 00:08:44.127 --> 00:08:45.676 position:50% align:middle were similarly weighted. 00:08:45.676 --> 00:08:51.688 position:50% align:middle These themes highlighted the link between skill and knowledge development and education. 00:08:51.688 --> 00:08:55.462 position:50% align:middle What does this bibliographic analysis show? 00:08:56.541 --> 00:09:02.200 position:50% align:middle That nursing regulators have not been given a strong voice in the literature relating to the rationale 00:09:02.200 --> 00:09:09.123 position:50% align:middle for the inclusion of CPD into their professional practice framework and how this benefits both nurses 00:09:09.123 --> 00:09:10.792 position:50% align:middle and those they care for. 00:09:10.792 --> 00:09:18.131 position:50% align:middle This silence does not facilitate the nurse's understanding of why they should engage in CPD 00:09:18.131 --> 00:09:24.364 position:50% align:middle because most authors of papers very briefly mention that it is requirement for registration or licensure 00:09:24.364 --> 00:09:30.686 position:50% align:middle and then go on to focus only on strategies for the implementation of education or training programs. 00:09:30.686 --> 00:09:37.650 position:50% align:middle However, there is evidence where the role of the regulator and regulation was used to influence nurses 00:09:37.650 --> 00:09:40.060 position:50% align:middle to undertake specific CPD. 00:09:40.060 --> 00:09:48.705 position:50% align:middle The purpose of this was to make an impact on patient population outcomes for particular public health issues 00:09:48.705 --> 00:09:50.230 position:50% align:middle such as HIV. 00:09:50.230 --> 00:09:58.000 position:50% align:middle The clusters in the maps also suggest that researchers on regulators, continuing competence frameworks, 00:09:58.000 --> 00:10:04.892 position:50% align:middle and clinical practice is not strongly associated with the nurse's role in national health priorities 00:10:04.892 --> 00:10:06.836 position:50% align:middle and the change in scope of practice. 00:10:06.836 --> 00:10:13.212 position:50% align:middle Academic publications in professional development programming for the patient care cluster identifies 00:10:13.212 --> 00:10:19.941 position:50% align:middle links between knowledge and the varied quality of standards of CPD programs with comments relating 00:10:19.941 --> 00:10:26.396 position:50% align:middle to wanting regulators to have a role in assessing the quality of post-graduate education programs. 00:10:26.396 --> 00:10:34.754 position:50% align:middle This finding is evidenced by discussion around issues such as improving medication administration, 00:10:34.754 --> 00:10:39.642 position:50% align:middle computer literacy skills, training in specialized disciplines, 00:10:39.642 --> 00:10:43.002 position:50% align:middle and guidance when populations are facing epidemics. 00:10:43.002 --> 00:10:51.432 position:50% align:middle The analysis showed a clear indication that the role of regulation influences the need to undertake CPD. 00:10:51.432 --> 00:10:58.469 position:50% align:middle However, overall the commentary within the included articles did not explore the rationale behind the 00:10:58.469 --> 00:11:03.731 position:50% align:middle regulator's requirements for nurses to undertake CPD such as patient safety. 00:11:03.731 --> 00:11:11.146 position:50% align:middle Rather, they describe the implementation of CPD through a range of education strategies in both the education 00:11:11.146 --> 00:11:13.085 position:50% align:middle sector and the workplace. 00:11:15.222 --> 00:11:17.093 position:50% align:middle The limitations of the study. 00:11:17.093 --> 00:11:23.282 position:50% align:middle The findings of this bibliographic analysis need to be considered in light of several limitations. 00:11:23.282 --> 00:11:30.328 position:50% align:middle This analysis did not capture grey literature such as regulatory policy documents on CPD and conference 00:11:30.328 --> 00:11:36.160 position:50% align:middle abstracts because the focus of a bibliometric analysis was on published journal articles. 00:11:36.160 --> 00:11:42.752 position:50% align:middle Articles published in a language other than English were not included so there is a risk that relevant 00:11:42.752 --> 00:11:47.176 position:50% align:middle articles which are in another language were not included in this analysis. 00:11:47.176 --> 00:11:54.589 position:50% align:middle Another limitation is that articles published only between 2009 and 2019 were included, 00:11:54.589 --> 00:11:58.537 position:50% align:middle which may have excluded important earlier work on this topic. 00:11:58.537 --> 00:12:04.454 position:50% align:middle However, restricting articles by publication date helped to ensure that included articles reflected 00:12:04.454 --> 00:12:07.107 position:50% align:middle contemporary views on CPD. 00:12:07.107 --> 00:12:15.275 position:50% align:middle Additionally, the VOSviewer package analysis analyzes the title and abstract of uploaded articles and thus 00:12:15.275 --> 00:12:18.841 position:50% align:middle provides an overview of featured publications. 00:12:20.098 --> 00:12:27.868 position:50% align:middle This bibliographic analysis identified a gap in the literature in that nursing regulators have not engaged 00:12:27.868 --> 00:12:32.762 position:50% align:middle broadly with the profession through the literature why CPD is important. 00:12:32.762 --> 00:12:41.392 position:50% align:middle Regulatory bodies could collaborate with academics to publish and emphasize why CPD is embedded in the 00:12:41.392 --> 00:12:44.555 position:50% align:middle professional practice framework of the regulator. 00:12:44.555 --> 00:12:52.431 position:50% align:middle For example, CPD is valuable because it informs the scope and progression of nursing practice and 00:12:52.431 --> 00:12:54.379 position:50% align:middle contributes to patient safety. 00:12:54.379 --> 00:13:01.700 position:50% align:middle Any discussion by regulators with registrants about the professional practice framework should highlight the 00:13:01.700 --> 00:13:08.910 position:50% align:middle reason why regulators have the condition for CPD and the importance of applying the cycle of CPD 00:13:08.910 --> 00:13:15.726 position:50% align:middle related to the context of practice and not just the requirement itself for the number of hours or credits. 00:13:15.726 --> 00:13:24.106 position:50% align:middle Regulators could influence nurse leaders to role model and advocate for supporting the application of the CPD 00:13:24.106 --> 00:13:28.643 position:50% align:middle cycle in the workplace no matter what nursing position they hold. 00:13:28.643 --> 00:13:34.943 position:50% align:middle The perceived lack of importance of CPD by some nurses who do not see this 00:13:34.943 --> 00:13:40.385 position:50% align:middle as part of their professional responsibility has, I think, been further highlighted 00:13:40.385 --> 00:13:42.933 position:50% align:middle by the recent pandemic. 00:13:42.933 --> 00:13:47.850 position:50% align:middle In Australia, for example, there were a number of requests for all of the health 00:13:47.850 --> 00:13:51.778 position:50% align:middle practitioner national boards to discount CPD for the year. 00:13:51.778 --> 00:13:58.180 position:50% align:middle Yet I think that nurses for the first time in a long time have been given more opportunities 00:13:58.180 --> 00:14:04.183 position:50% align:middle for professional development including free courses and in-work time than ever before. 00:14:04.183 --> 00:14:12.578 position:50% align:middle Yet, if a board has agreed not to mandate CPD for the year as part of registration or licensure renewal, 00:14:12.578 --> 00:14:18.496 position:50% align:middle what is the message that is being given to the profession about the importance of CPD into the future 00:14:18.496 --> 00:14:25.210 position:50% align:middle and what is the consequence for the regulator in continuing to mandate CPD as part of the 00:14:25.210 --> 00:14:27.188 position:50% align:middle professional practice framework? 00:14:27.188 --> 00:14:28.808 position:50% align:middle Thank you for your time. 00:14:51.010 --> 00:14:57.191 position:50% align:middle Hello, and thank you very much for the opportunity to present at the Scientific Symposium. 00:14:57.191 --> 00:15:04.818 position:50% align:middle Since undertaking this bibliographic analysis, my colleague and I decided to do a more depth review 00:15:04.818 --> 00:15:06.190 position:50% align:middle of the literature. 00:15:06.190 --> 00:15:14.582 position:50% align:middle As I mentioned to you in my presentation, a bibliometric analysis is very much a scoping of the 00:15:14.582 --> 00:15:16.555 position:50% align:middle key points of view. 00:15:16.555 --> 00:15:23.282 position:50% align:middle So we decided to go back in and actually undertake a proper scoping review of that literature. 00:15:23.282 --> 00:15:27.950 position:50% align:middle And we've now submitted that to the journal for peer review. 00:15:27.950 --> 00:15:30.102 position:50% align:middle So we'll see how that goes. 00:15:30.102 --> 00:15:37.412 position:50% align:middle But I think it gave a more in-depth understanding of those overall themes that have been presented 00:15:37.412 --> 00:15:38.957 position:50% align:middle through to you. 00:15:38.957 --> 00:15:48.406 position:50% align:middle And I think, in undertaking bibliometric analysis, it is a really good way of having a quick look 00:15:48.406 --> 00:15:52.125 position:50% align:middle and overview of what literature is doing. 00:15:52.125 --> 00:15:57.163 position:50% align:middle Not many people tend to do them, but I think it's something that is worth considering 00:15:57.163 --> 00:16:03.384 position:50% align:middle if an issue arises and you haven't got the time to do an in-depth scoping review or systematic review. 00:16:03.384 --> 00:16:14.260 position:50% align:middle Now, I think we have been very lucky in Australia with the pandemic so that nurses have had opportunities 00:16:14.260 --> 00:16:21.966 position:50% align:middle to undertake CPD but very much aware that in other places that probably just has not been possible. 00:16:26.660 --> 00:16:34.590 position:50% align:middle Still no further questions from anyone about presentation or their thoughts on the current situation 00:16:34.590 --> 00:16:36.526 position:50% align:middle in CPD and regulation? 00:16:41.100 --> 00:16:42.320 position:50% align:middle Thank you, LaDonna. 00:16:42.320 --> 00:16:44.110 position:50% align:middle Very interesting topic. 00:16:44.110 --> 00:16:44.957 position:50% align:middle Thank you very much. 00:16:50.400 --> 00:16:53.780 position:50% align:middle A question from Anna, "Do you think the results would have been very 00:16:53.780 --> 00:16:58.310 position:50% align:middle different if regulatory body reports have been included?" 00:16:58.310 --> 00:17:00.870 position:50% align:middle I think, yes, it would have been. 00:17:00.870 --> 00:17:08.100 position:50% align:middle If we had actually looked at the grey literature, we absolutely would have had a different story 00:17:08.100 --> 00:17:10.375 position:50% align:middle but that is only the regulators' story. 00:17:10.375 --> 00:17:16.081 position:50% align:middle It wouldn't have been the stories that are out there that the majority of people are actually reading. 00:17:16.081 --> 00:17:23.671 position:50% align:middle So that's why we didn't include the grey literature only because bibliometric analysis doesn't allow us 00:17:23.671 --> 00:17:26.060 position:50% align:middle to do that, but you're quite right. 00:17:26.060 --> 00:17:33.170 position:50% align:middle We know that the regulators certainly do have a lot to say about this but it's not something that is moving 00:17:33.170 --> 00:17:36.674 position:50% align:middle from the regulator out into our professions. 00:17:36.674 --> 00:17:43.118 position:50% align:middle David, "Could you say a little bit more about the findings regarding the link between CPD and HIV?" 00:17:43.118 --> 00:17:45.183 position:50% align:middle Yes, this is very good, David. 00:17:45.183 --> 00:17:50.555 position:50% align:middle Clearly, in the countries where these articles, which is in Africa, were featured, 00:17:50.555 --> 00:17:54.549 position:50% align:middle there was an epidemic of HIV. 00:17:54.549 --> 00:18:02.848 position:50% align:middle And so public health worked with nursing regulation in those countries to mandate that all nurses actually had 00:18:02.848 --> 00:18:10.432 position:50% align:middle to have training in the management of HIV because they really needed to deal with it on a population level. 00:18:10.432 --> 00:18:17.726 position:50% align:middle So that was a very clear indication of how regulation can be used to impact public health issues. 00:18:26.660 --> 00:18:28.913 position:50% align:middle "Does the scoping review support your...?" 00:18:28.913 --> 00:18:30.422 position:50% align:middle Yes, it does actually. 00:18:30.422 --> 00:18:37.167 position:50% align:middle The scoping review does support the overall view that the bibliometric analysis gave us but what we've been 00:18:37.167 --> 00:18:44.509 position:50% align:middle able to do is to go into more in-depth understanding of why we think this is the case. 00:18:44.509 --> 00:18:50.171 position:50% align:middle So it was certainly worth doing after the bibliometric analysis. 00:18:55.570 --> 00:19:01.232 position:50% align:middle And, Dennis, [inaudible] message I sent about CPD and regulation. 00:19:11.278 --> 00:19:12.445 position:50% align:middle Okay, thank you.