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In only a few studies have improved nurse-patient care outcomes associated with continuing education programs been assessed. Provided that professional development is among the most commonly used strategy to improve quality of patient care in health care settings, it is vital to test their efficacy, to identify their key components and to test their effects on direct patient outcomes.
Challenges exist in the design of studies to measure these effects. Situational and research factors contribute to the success of implementation of cost and burden conscious approaches to measurement which may impact sustainability. Triangulation, the use of more than one approach to the investigation of a research question in order to enhance confidence in the findings is essential to this process. The idea of triangulation has been extended beyond its conventional association with research methods and designs to include four forms: data triangulation; investigator triangulation; theoretical triangulation; and methodological triangulation.
Setting:
A northeastern state correctional system comprised of 12 jails and prisons participated over 3 years. Four hundred forty-three nurses (RNs 288; LPNs 138; 17 APRNs; including per diem nurses) who participated worked in 12 facilities (2-jails; 10 prisons; 1-women’s facility) serving over 18,000 incarcerated persons. Medical and psychiatric care is provided through a managed care contract. Institutional Review Board approval (# H13-307) was granted by the University of Connecticut Office for Research Compliance.
Methods:
A case study approach is utilized to provide an example of the mixed methods design and implementation of a state-wide correctional nurse competency program aligning with the ANA Correctional Nurse Scope and Standards of Practice. This one of a kind competency program provided a unique mobile simulation learning laboratory and required that both workforce and organizational issues be addressed. Reliability and validity of clinical assessment tools adapted for the correctional health environment was a necessary step in this process. This followed competency definition, role clarification activities and needs assessments. Triangulation strategies were mapped for implementation on a timeline. Repeated measures of educational data, observational data, interviews and secondary data sources were utilized to examine the multi-level effects.
Results:
All four forms of triangulation were utilized in addition to other research strategies to assure reliable and valid measurement. Multiple forms of data were sampled at different time points over a three-year period of time from the twelve facilities. Challenges of this case study research included need for repeat training, attention to data collection and quality, requests for supplemental data and support for performance of the research team. Attention to these challenges and the use of multiple forms of triangulation over time contributed to the validity of the findings for this state-wide project.
Significance:
To date, no correctional nurse competency programming or evaluation measures or strategies for these programs have been tested or published in the US. Documentation of the efficacy of this HRSA (grant # D11HP22212) funded program provides the basis for replication.