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Nursing Professional Development’s Spirit of Inquiry Focus Areas

Harper, Mary G., PhD, RN-BC; Warren, Joan I., PhD, RN-BC, NEA-BC, FAAN; Bradley, Dora, PhD, RN-BC, FAAN; Bindon, Susan L., DNP, RN-BC, CNE, CNE-cl; Maloney, Patsy, EdD, MSN, RN-BC, CEN, NEA-BC

Journal for Nurses in Professional Development: May/June 2019 - Volume 35 - Issue 3 - p 118–124
doi: 10.1097/NND.0000000000000515
Articles
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An Association for Nursing Professional Development (ANPD) task force was charged with redesigning the association’s small research grant process. One step in this process included identifying focus areas for the specialty’s spirit of inquiry. Using input from a round table discussion with ANPD annual convention attendees, the Journal for Nurses in Professional Development Editorial Board, and the convention evaluation query, 10 spirit of inquiry focus areas were identified that align with the Nursing Professional Development Practice Model.

Mary G. Harper, PhD, RN-BC, is Director of Nursing Professional Development, Association for Nursing Professional Development, Chicago, Illinois.

Joan I. Warren, PhD, RN-BC, NEA-BC, FAAN, is Executive Director of the Maryland Organization of Nurse Leaders, Inc./Maryland Nurse Residency Collaborative and Associate Professor, University of Maryland School of Nursing, Baltimore.

Dora Bradley, PhD, RN-BC, FAAN, is Associate Dean for Strategic Initiatives and Innovation, Clinical Associate Professor, Baylor University Louise Herrington School of Nursing, Dallas, Texas.

Susan L. Bindon, DNP, RN-BC, CNE, CNE-cl, is Assistant Professor and Director, Post-Master's DNP Program, University of Maryland School of Nursing, Baltimore.

Patsy Maloney, EdD, MSN, RN-BC, CEN, NEA-BC, is Senior Lecturer, University of Washington Tacoma.

Conflict of Interest: Dr. Harper is the Director of Nursing Professional Development with the Association for Nursing Professional Development.

ADDRESS FOR CORRESPONDENCE: Mary G. Harper, 1832 S. Central Avenue, Flagler Beach, FL 32136 (e-mail: mharper@anpd.org).

The Association for Nursing Professional Development’s (ANPD) goal is “to be acknowledged as the expert voice, advocate, and leading resource for nursing professional development practice” (ANPD, n.d.-a, para. 3). A strong scientific research base is integral to the nursing professional development (NPD) specialty. Since the inception of ANPD, now in its 30th year, its leaders have struggled with the best approach to build this scientific base. For many years, ANPD awarded small research grants to members who were interested in conducting a research study. Through this small grant program, many members gained new knowledge about conducting research. However, most of their studies went unpublished due to methodological design flaws and small sample sizes leading to nonsignificant or ungeneralizable results.

Although ANPD leaders acknowledged the importance of continued support of research, the Board of Directors (BOD) recognized that the small grant program was ineffective in contributing to and building the scientific knowledge base of the NPD specialty. As a result, the BOD decided to reexamine the research program. During this review process, the BOD struggled with how to build a sustainable research enterprise to advance the knowledge of the specialty while holding true to the organization’s value of supporting and mentoring members interested in conducting research. As a result, the BOD suspended the small research grant program and created a task force consisting of national NPD leaders to develop a solution. The purposes of the task force were twofold:

  1. To develop a comprehensive and cost-effective framework to advance the scientific research base of the NPD specialty
  2. To develop opportunities for members to participate in building the science of NPD

The task force convened in 2015 and completed its initial work in December 2016. This article describes one component of the task force’s work—identifying priority focus areas for inquiry.

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SPIRIT OF INQUIRY

At the first meeting, task force members exchanged ideas about the previous small research grant framework. Many members voiced concerns about the framework’s exclusive focus on research. Arguably, in the quest for knowledge, research is only one of many ways to scientifically investigate questions. Alternative methods such as innovation, evidence-based practice (EBP), and quality improvement (QI) are used daily by nurses to improve practice. Quality improvement consists of “Systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups” (Heath Resources and Services Administration [HRSA}, 2011, para 1). Task force members concurred that a program focused exclusively on conducting research limited the possibilities for growing and advancing the science of the NPD specialty.

A common element among the various methods of scientific inquiry is genuine curiosity, referred to as a spirit of inquiry (SOI). According to Melnyk, Gallagher-Ford, and Fineout-Overholt (2017), cultivating an SOI is the essential ingredient for developing curiosity in nurses, thereby raising nurses’ awareness to question the status quo and seek answers. Acknowledging the depth, breadth, and importance of this concept, the task force elected to broaden its scope and develop a framework for cultivating SOI. Within this framework, research would be just one of many ways to seek answers to questions.

SOI in the context of NPD practice was defined and operationalized as follows: “A spirit of inquiry (SOI) is a consistent, intentional, and applied professional curiosity and is a key element of modern NPD practice” (ANPD, n.d.-b, para. 1). NPD practitioners must champion and sustain their own and others’ SOI.

The following characteristics of SOI as related to NPD practice were delineated (ANPD, n.d.-b, para. 2):

  • Informs NPD practice
  • Guides NPD practitioners to question the status quo
  • Transforms the current state and inspires innovation
  • Influences professional growth by seeking to develop new knowledge or refine current assumptions
  • Ensures progression of the science of the NPD specialty through a collective SOI

Once the definition and characteristics of SOI were codified by the ANPD BOD, task force members began to discuss using a systems model consisting of inputs, throughputs, and outputs to align the SOI with the NPD Practice Model as depicted in Figure 1 (Harper & Maloney, 2016). After thoughtful discussion, task force members concluded NPD practitioners and relevant stakeholders should determine SOI focus areas and decided to collect information from both groups.

FIGURE 1

FIGURE 1

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INFORMATION COLLECTION METHODS

The ANPD SOI task force created a systematic information collection process to acquire input from a broad representation of ANPD members and stakeholders. Although random selection processes and qualitative data analysis methods were used to add rigor to the sampling frame and identification of themes, the task force members elected not to conduct a research study. Task force members opted to use multiple information gathering methods to obtain ANPD members’ consensus on the SOI focus areas. The following steps were used to gather information:

  1. Collecting input from randomly selected ANPD convention attendees using a round table discussion
  2. Querying the Journal for Nurses in Professional Development (JNPD) Editorial Board
  3. Including an open-ended question on the ANPD annual convention evaluation beginning in 2016
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NPD Practitioner Round Table Discussion

The initial step of the information collection process was to obtain a geographically representative sample of 2016 ANPD convention attendees for the round table discussion. Using a table of random numbers, 20 convention registrants were selected. To ensure geographical diversity, individuals from the same states within the United States were excluded. The selection process continued until 20 participants from different states were identified. In addition to the 20 selected registrants, six ANPD committee chairs were invited to participate. Invitations to participate in the round table discussion were sent to the registrants and committee chairs. One contact hour of continuing nursing education was awarded to participants. Eleven NPD practitioners attended the round table discussion.

At the beginning of the round table discussion, members introduced themselves and provided their name, workplace, role, and years of experience in NPD. Each participant was given a piece of paper to use to write notes and ideas. The participants were informed that these papers would be collected at the end of the session.

The following questions, developed by the SOI task force, were asked during the round table discussion, which was facilitated by an NPD expert:

  • What are the major issues you are facing in your current NPD role?
  • Don’t think about today—what do you see coming in the next 1–2 years?
  • If given a large amount of money for research, what kind of question or research idea might you examine?

To facilitate responses, the facilitator posed each question and gave the participants a few minutes to write down their thoughts on the paper provided. After a few minutes, the facilitator asked the participants to share their thoughts using a nominal group technique, which allowed each participant to provide input in turn before general discussion was permitted. Two scribes were used, with one writing input on large sheets of paper that were affixed to the wall and the other taking notes that included specific ideas as well as emerging thoughts or observations. At the end of the discussion, participants were asked to review the notes written on the papers on the wall and to provide clarification or additions. As participants departed, their notes were collected.

Immediately following the round table, task force members who managed the discussion met to debrief about the process and the input from participants. Notes from this debriefing were recorded to use during the analysis.

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JNPD Editorial Board Discussion

JNPD is recognized as the official journal of ANPD and regularly publishes research, QI, integrative reviews, and other work directly relevant to NPD practice and the role of the NPD practitioner. Popular topics include orientation, preceptorship, new graduate residency programs, regulatory requirements, safety, communication, financial, technology, and leadership aspects of NPD practice. The Editorial Board consists of NPD experts from diverse settings across the United States and Canada with various expertise and perspectives. The Editorial Board is an advisory body to the Journal’s editorial and publishing teams. Led by the JNPD co-editors, the board’s responsibilities include, among others, advocacy for the Journal and professional and continual environmental scanning for trends and issues relevant to JNPD readership.

At the 2016 JNPD Editorial Board meeting, which was held just before the ANPD annual convention, the co-editors asked the group to consider what the NPD specialty’s research or inquiry priorities should be for the next 3–5 years. Following a robust discussion, the group agreed upon 21 topics of interest (see Table 1), which the co-editors shared with the SOI task force.

TABLE 1

TABLE 1

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ANPD Annual Convention Evaluation

The final source of information consisted of the responses to a question added to the electronic overall ANPD annual convention evaluation. These responses were used to validate identified inquiry categories from the round table discussion and the JNPD Editorial Board and to identify additional categories. All convention attendees who completed an evaluation were asked the following:

  • What are the two major issues you are facing in your NPD practice?

Free text responses were obtained from this query. Five hundred thirty-nine responses were received.

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FINDINGS

The results from the NPD practitioner round table discussion and notes from the debriefing session that followed it were compiled and placed in a spreadsheet. Two members of the SOI task force independently conducted a modified content analysis to identify categories and overall themes. The analysis process involved the following steps:

  1. Read through all the information at once and make clarifying notes.
  2. Go back through the information and identify similar and nonsimilar ideas.
  3. Create categories of information.
  4. Compare and contrast identified categories.
  5. Using the identified categories, reread all information and validate results.

Pursuant to theme identification, the two SOI task force members met via phone and compared their overall findings, which were quite similar. Eight categories, as shown in Table 2, were identified. The two reviewers then reexamined the information categories to establish general themes, which are delineated in Table 3.

TABLE 2

TABLE 2

TABLE 3

TABLE 3

The next phase of the information analysis was to validate the themes identified from the input of the round table discussion and the JNPD Editorial Board using the input received on the ANPD annual convention evaluation. Narrative information from the aforementioned query on the convention evaluation was compiled (n = 539). A comparative method was used to determine if the initial themes reflected the input from the convention attendees. Two individuals, an expert in NPD practice and a graduate student with experience in education, conducted this phase of the information analysis. The themes in Table 3 were listed in a tabular format, and each of the 539 responses were reviewed and matched to a theme. The results demonstrated most items were consistent with the initial themes, although four items, which were determined to be outside the NPD scope of practice, were excluded from the comparison. As a result, this phase of information analysis validated the results from the round table discussion and the JNPD Editorial Board and identified professional practice gaps for consideration in future ANPD educational initiatives.

At the request of the ANPD president, the themes were consolidated into 10 areas of focus, which were subsequently approved by the ANPD BOD (ANPD, n.d.-b, para. 4). These themes included the following:

  • Determination of strategies that significantly increase engagement of learners
  • Types of technology that enhance learning
  • Development of learning outcome metrics
  • Strategies to sustain behavior change pursuant to NPD intervention
  • Strategies that result in successful career and care continuum transitions
  • NPD practices and/or programs that significantly impact outcomes (residencies, onboarding, competency management, life support, etc.)
  • Examine models (Lean, Six Sigma, QI, etc.) that create more efficient and effective NPD practices
    • o Time studies
    • o Interruptions
  • Examine stakeholder’s views that impact the perceived value of NPD practice/role/influence
    • o Chief nursing officers
    • o Managers
    • o Chief financial officers
    • o Academic educators
  • Factors that increase “buy-in” of stakeholders and target audience
  • Strategies that influence adoption of interprofessional development

In an effort to ensure ongoing relevance, the SOI task force maintains a query on the ANPD annual convention evaluation. The purpose of this query is to validate the current SOI focus areas and identify shifts in convention attendees’ issues that may warrant additional consideration as a focus area. This ongoing process ensures that the SOI focus areas are dynamic and reflect changes in the complex healthcare environment.

The 2017 convention evaluation query results were reviewed by the same NPD expert who analyzed the 2016 results and a different graduate student who had limited experience with NPD practice. Again, most items matched an initial theme except for items that were out of the NPD scope of practice. The narratives addressed more items related to using technology and social media in “new ways” than in the previous review and less about preceptors. More comments were received on mergers and working with corporate education departments. In addition, a growing need to have valid and reliable strategies to identify and mitigate true knowledge gaps was identified.

The 2018 ANPD annual convention evaluation included the same query. As of this writing, the convention evaluation process is ongoing. When complete, these responses will be analyzed, and recommendations to changes in the focus areas will be made to the ANPD BOD as indicated.

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DISCUSSION

NPD has historically had a dearth of scientific evidence to support its practice (Krugman & Warren, 2011). The halftime report for the Future of Nursing (National Academies of Sciences, Engineering, and Medicine, 2015) indicates progress toward the goal of doubling the number of nurses with doctorates by 2020, with a concomitant increase in research, EBP, and QI implementation. An integrative review of literature is currently underway to determine progress in development of the scientific basis for NPD practice since Krugman and Warren’s (2011) review (Stephanie Bennett, personal communication, March 2017).

The last NPD research priorities were published in 2012 by a National Nursing Staff Development Organization’s (now ANPD) Research Committee task force using a modified electronic Delphi technique (Harper, Asselin, Kurtz, MacArthur, & Perron, 2012). Using the Donabedian model, the task force identified 13 research priorities that were categorized into structure, processes, and outcomes. Pursuant to identification of the 2012 research priorities, the NPD Practice Model was revised during the update of Nursing Professional Development: Scope and Standards of Practice (Harper & Maloney, 2016). This systems model, depicted in Figure 1, provides the framework for organization of the current foci for inquiry, as shown in Table 4.

TABLE 4

TABLE 4

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Environment/Inputs

Two foci for inquiry apply to both the environment and inputs of the NPD Practice Model (Harper & Maloney, 2016):

  • Factors that increase “buy-in” of stakeholders and target audiences
  • Strategies that influence adoption of interprofessional development

The NPD Practice Model, as updated in 2016, expanded the learning and practice environments to include an interprofessional focus. This expanded scope was recognized by participants in this priority-setting process and demonstrates that NPD practitioners interact and function within complex systems.

Although these two areas for inquiry apply to the learner, no topics related to the NPD practitioner or environmental scanning were gleaned during this process. This lack of focus on the NPD practitioner is not consistent with Harper et al. (2012), who identified methods for developing and evaluating competency and skills of NPD practitioners as a research priority. However, since 2012, an NPD role delineation study identified seven roles and accompanying competencies for NPD practitioners (Warren & Harper, 2017). The findings from the role delineation study were incorporated into the updated NPD scope and standards (Harper & Maloney, 2016) and may have clarified role expectations.

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Throughputs

Five foci for inquiry apply to the throughputs of the NPD Practice Model (Harper & Maloney, 2016):

  • Strategies that significantly increase engagement of learners
  • Types of technology that enhance learning
  • Strategies that result in successful career and care continuum transitions
  • NPD practices and/or programs that significantly impact outcomes (residencies, onboarding, competency management, life support, etc.)
  • Examination of models (Lean, Six Sigma, QI, etc.) that create more efficient and effective NPD practices, including time studies and interruptions

These foci encompass each of the NPD responsibilities included in the throughputs of the NPD Practice Model, except research/ EBP/QI. A recent national survey of 253 NPD practitioners found that NPD practitioners lacked competence in EBP, particularly in developing PICOT (population, intervention, comparison, outcome, time) questions for inquiry and leading interprofessional teams (Harper et al., 2017). Although the findings of this research study were based on self-report, NPD practitioners’ self-reports were similar to those of other healthcare professionals, including staff nurses and nurse executives. This self-perceived lack of competence in EBP might have led to NPD practitioners’ responsibility for research/EBP/QI being overlooked by participants in the current SOI priority-setting process.

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Outputs

Two foci for inquiry apply to the outputs of the NPD Practice Model (Harper & Maloney, 2016):

  • Development of learning outcome metrics
  • Strategies to sustain behavior change pursuant to NPD intervention

Development of learning outcome metrics was previously a research priority identified by Harper et al. (2012) and reflects the continuing focus on cost-effective, high-quality, and safe patient care. Harper and colleagues defined sustained behavior change more narrowly as “knowledge retention” (p. 141). The expanded focus on behavior reflects the evolution of the NPD role as a change agent.

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Feedback

One focus for inquiry applies to the feedback loop of influence in the NPD Practice Model (Harper & Maloney, 2016):

  • Examine stakeholders’ views that impact the perceived value of NPD practice/role/influence including chief nursing officers, managers, chief financial officers, and academic educators.

As noted in the NPD scope and standards, NPD practice is highly dependent upon our practice environment. An understanding of stakeholders’ views provides the context for decision-making and allows us to adjust our roles to align with organizational strategic plans.

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IMPLICATIONS

The NPD focus areas for scientific inquiry are intended to guide NPD scholars, practitioners, and academic educators as they seek to advance the science of NPD practice and incorporate evidence into their specialty practice.

As the professional organization for NPD, ANPD is tasked with maintaining a current, relevant list of priorities to guide the SOI among NPD practitioners. The ongoing process of asking annual ANPD convention attendees to name the two major issues affecting their practice allows ANPD to stay abreast of the current issues needing immediate inquiry. In addition, ongoing discussions with the JNPD Editorial Board provide a futuristic view of healthcare trends that may impact NPD practice. As SOI priorities change, they will be updated on the ANPD website (ANPD, n.d.-b).

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References

Association for Nursing Professional Development. (n.d.a). About ANPD. Retrieved from http://www.anpd.org/page/about
Association for Nursing Professional Development. (n.d.b). ANPD spirit of inquiry program. Retrieved from http://www.anpd.org/page/anpd-spirit-of-inquiry-program
Harper M. G., Asselin M. E., Kurtz A. C., MacArthur S. K., & Perron S. (2012). Research priorities for nursing professional development: A modified e-Delphi study. Journal for Nurses in Staff Development, 28(3), 137–142. doi:10.1097/NND.0b013e3182551543
Harper M. G., Gallagher-Ford L., Warren J. I., Troseth M., Sinnott L. T., & Thomas B. K. (2017). Evidence-based practice and U.S. healthcare outcomes: Findings from a national survey with nursing professional development practitioners. Journal for Nurses in Professional Development, 33(4), 170–179. doi:10.1097/NND.0000000000000360
Harper M. G., & Maloney P. (Eds.) (2016). Nursing professional development: Scope and standards of practice (3rd ed.). Chicago, IL: Association for Nursing Professional Development.
Heath Resources and Services Administration [HRSA}. (2011). Quality Improvement. Retrieved from hrsa.gov/quality/toolbox/methodology/qualityimprovement/index.html
Krugman M., & Warren J. (2011). Professional development research literature from 1996 to 2006: An integrative review. Journal for Nurses in Staff Development, 27(3), 104–115.
Melnyk B. M., Gallagher-Ford L., & Fineout-Overholt E. (2017). Implementing evidence-based practice competencies in healthcare: A practical guide for improving quality, safety, & outcomes. Indianapolis, IN: Sigma Theta Tau.
National Academies of Science, Engineering, and Medicine. (2015). Assessing progress on the Institute of Medicine report The Future of Nursing. Washington, DC: The National Academies Press.
Warren J. I., & Harper M. G. (2017). Transforming roles of nursing professional development practitioners. Journal for Nurses in Professional Development, 33(1), 2–12. doi:10.1097/NND.0000000000000320
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