Hotspots critical care evaluation

Abstract

This report evaluates a series of critical care education interventions for nurses which took place within Southampton University Hospital Trust (SUHT) and Portsmouth Hospital Trust (PHT) in 2004 and 2005. These interventions were funded by the Hotspots project and commissioned by the Hampshire and Isle of Wight Workforce Development Directorate (WDD). As part of the ongoing commitment to incorporate evidence into practice, the WDD commissioned an independent impact evaluation of these interventions. This evaluation was undertaken collaboratively by the Health Care Innovation Unit (HCIU) and the School of Management at the University of Southampton.

Prior to the empirical work, the researchers undertook a review of literature relating to critical care training, learning transfer and evaluation. Critical care literature points to the fact that policy drivers and the increasing acuity of patients on wards have necessitated enhanced skill levels amongst ward nurses, which are not provided by pre-registration training in its current form. Post registration training is varied and results in a lack of standardisation of nursing competencies (‘post code competencies’) (Scholes et al, 1999). Post registration education can also be characterised by a theory-practice gap resulting from the separation of nursing education provision from service provision. The literature suggests a number of potential benefits which could result from enhanced critical care skills amongst ward staff. These include better patient care, earlier detection and intervention in instances of deterioration and improved interdisciplinary team working. To investigate this fully, long term evaluation is called for which goes beyond comments on teaching received and begins to investigate lasting impacts on practitioners and patients.

The literature on learning transfer identifies a need for further research to identify how learning is passed from an individual and integrated on an organisational level. Whilst a significant amount of money is spent on training interventions, this aspect is not generally given enough attention. However, it is suggested that lack of relevance has a detrimental effect on learning transfer; if skills cannot easily be implemented into the participant’s job role, learning will be lost. Conversely, two factors which foster learning transfer are identified as social support and opportunity to use new skills.

By using an adapted version of Kirkpatrick’s (Kirkpatrick 1994) evaluation framework, the research employed a mainly post hoc methodology of questionnaire, semi-structured interviews and collection of Performance Indicator (PI) data. Software packages were used to analyse the interview and questionnaire data.

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