Theses Doctoral

A Comparison Between Unit-Based Education and Centralized Education Among Staff Nurses

Campbell, Marilyn

Educating staff nurses is pivotal in the evolving healthcare environment. Two staff development models used in the healthcare setting are unit-based and centralized. Unit-based education is a staff development model that places educators on individual units. These educators direct the educational development of staff nurses on their assigned units. Centralized education meets generalized learning needs and provides nursing departments with scheduled education sessions or impromptu meetings regarding changes to policies and procedures. In addition, centralized educators are assigned to address the learning needs of the nurses on several units with universal orientation (Cummings & McCaskey, 1992), coordinate and implement intravenous and blood transfusion therapy courses, physical assessment courses, professional update programs, and universal workshops and conferences (Cummings & McCaskey, 1992). In contrast, unit-based educators are more familiar with the unit's practices and staff nurses while providing more individualized staff education than the centralized model.

This research was conducted to explore the association between the type of staff development model and staff nurses' evaluations of their clinical educators, their anxiety, and their clinical reasoning. The researcher used a quantitative descriptive comparative, cross-sectional, intact group design. The sample included staff nurses (N = 86) from a tertiary care medical center in New York City. The staff nurses were from two units with a unit-based educator and two units with a centralized educator. Data were collected from the first week of September 2022 to the first week of December 2022. Two reports are described below that are based on this research, which included administering four different scales. Not all respondents completed all four scales.

The first report concerns the findings on two instruments that measured the staff nurses' evaluation of clinical educators. The Clinical Educator Evaluation Questionnaire (CEEQ), developed for this study, measured nurses' perceptions of the extent to which their staff educators' methods were consistent with Malcolm Knowles's Adult Learning Theory. The Nursing Clinical Teacher Effectiveness Inventory (NCTEI) measured staff nurses' perceptions of their current staff educators as clinical educators. An exploratory factor analysis was conducted on the CEEQ questionnaire developed by the researcher, a Pearson’s correlation analysis between the two surveys, the CEEQ and the NCTEI, and a Chi-square analysis and independent t test was conducted to compare demographic variable among the unit-based and centralized education groups was also conducted. In addition, differences between group responses for independent sample comparisons were examined using t tests.

There were significant differences between the groups, t(100) = 3.31, p = .001, on the CEEQ. The 59 participants in the unit-based group scored higher (M = 119.76, SD = 19.62) than the 43 participants in the centralized group (M = 106.86, SD = 19.17) on perceptions of their instructors' methods as consistent with the adult learning theory. The groups also differed on the perceived effectiveness of their nurse educators as clinical instructors, t(94) = 2.66, p = .009, on the NCTEI. The 55 participants who represented the unit-based group (M = 250.5, SD = 70.34) had higher means than the 41 participants in the centralized group (M = 212.8, SD = 66.14).

The second report concerns staff nurses' anxiety during staff education as measured using the State Anxiety Inventory (SAI) and staff nurses' self-report of their clinical reasoning as measured by the Nurses Clinical Reasoning Scale (NCRS). Differences between the group responses for independent sample comparisons were examined using t tests. The anxiety of the 48 participants in the unit-based group (M = 35.7, SD = 11.47) was compared to the anxiety of the 38 participants in the centralized group (M = 37.2, SD = 11.35). No statistically significant differences were found, t(84) = -.633, p = .528. Similarly, there was no significant difference between the groups on the NCRS, t(85) = -.188, p = .852. The 48 participants who represented the unit-based group (M = 59.1, SD = 6.61) did not differ from the 39 participants in the control group (M = 59.3 SD = 6.80) on clinical reasoning. Findings showed that the staff nurses evaluated the unit-based educators more highly but that the two models did not differ regarding their effects on anxiety and clinical reasoning.

This is the first study to examine staff nurses’ evaluations of their clinical educators. Findings indicate that staff nurses reported more effectiveness for unit-based educators than centralized educators regarding practices that aligned with Malcolm Knowles’s Adult Learning Theory. In addition, this is also the first research study to examine the relationships of staff development models to anxiety and clinical reasoning during staff education. Although the two models did not differ on their effect on anxiety and clinical reasoning, additional research is recommended to explore other variables that may further justify the investment in unit-based education.

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More About This Work

Academic Units
Health and Behavior Studies
Thesis Advisors
O'Connell, Kathleen Ann
Ed.D., Teachers College, Columbia University
Published Here
June 7, 2023