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DEPARTMENTS: NPD Scope and Standards

Informing the Nursing Professional Development Scope and Standards

Exploring Current and Future Nursing Professional Development Practice Through a World Café Methodology

Maloney, Patsy EdD, MSN, MA, RN, NPD-BC, NEA-BC; Harper, Mary G. PhD, RN, NPD-BC

Editor(s): Harper, Mary G. PhD, RN, NPD-BC; Maloney, Patsy EdD, MSN, MA, RN, NPD-BC, NEA-BC

Author Information
Journal for Nurses in Professional Development: 5/6 2021 - Volume 37 - Issue 3 - p 176-182
doi: 10.1097/NND.0000000000000735
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Abstract

In the rapidly changing healthcare environment, nursing and nursing professional development (NPD) practice must evolve to keep up with these changes. The American Nurses Association requires that specialty nursing associations revise their scope and standards every 5 years to ensure that current and future specialty practice is adapting to the changing environment. In 2014, the Association for Nursing Professional Development’s (ANPD) Board of Directors appointed a workgroup to revise the third edition of Nursing Professional Development: Scope and Standards of Practice. Concomitantly, Warren and Harper (2015, 2017) used a focus group, followed by one-to-one key informant telephone interviews and an eDelphi method, in their role delineation study that informed the third edition of the scope and standards. To inform the fourth edition of Nursing Professional Development: Scope and Standards of Practice, the authors of this article used an emerging qualitative method, the world café (WC), to explore expert NPD practitioners’ perspectives on current and future healthcare issues that impact NPD practice. This article discusses the WC as a qualitative methodology; the procedures that were followed in the first phase of the study, and the resulting themes that were used to develop an eDelphi survey to reach consensus. The second phase of the study using the eDelphi will be discussed in a follow-up column.

REVIEW OF LITERATURE: THE WC

The WC was originally designed as a participatory tool to harvest collective knowledge to change communities and organizations (Brown & Issacs, 2005; Koen et al., 2015; Löhr et al., 2020). It was developed “primarily to generate collective knowledge-sharing, webs of personal relationships, and new possibilities for action” (Brown & Issacs, 2005, p. 38). Recently, the WC evolved into a recognized qualitative data collection methodology. Löhr et al. (2020) compared the WC favorably with two well-known qualitative methods: focus groups and semistructured interviews.

Mary de Chesnay (2015) devoted a chapter of Nursing Research Using Data Analysis: Qualitative Designs and Methods in Nursing to the WC method. Yet, a paucity of nursing research using WC methods is found, and most of this research has been conducted outside the United States. During a 3-year period, three WC events were conducted by the British Association of Urological Nurses, the European Association of Urology Nurses, and the Australian and New Zealand Urological Nursing Society, with the aim of determining an educational framework for urological nurses (Marley et al., 2020). During the “Building Children’s Nursing” conference in 2019, WC was used to create nursing care outcome statements and related actions specific to the practice of pediatric nurses in African care settings (Coetzee et al., 2020). In South Africa, Van Graan et al. (2016) used WC methodology to explore the concept of clinical judgment as understood by practicing nurses. In addition, Du Plessis et al. (2013) employed WC to explore the experiences of nursing students after home visits. Community healthcare leaders in England used WC to solicit input from clinicians and support staff for the purpose of transforming and improving community services (Burke & Sheldon, 2010).

The WC has multiple advantages. First, it allows for a large number of participants. Participants engage in evolving rounds of conversation while remaining connected to a larger dialogue. Small, warm, and in-depth conversations are held at tables in a café-like setting. Each table conversation centers on meaningful discussion by answering relevant, well-crafted questions designed by the investigator. Participants move among tables at specified intervals, allowing them to join with and add to other discussions, enriching the content. This movement allows for new group formation at each table with each round, which can stimulate creativity and thwart power inequities among participants. Finally, because individual responses are not collected, confidentiality is protected.

One disadvantage of the WC as a research method is that direct interaction between participants and the investigator is rare, which interferes with the researcher’s ability to clarify and explore topics in depth. Despite this disadvantage, the WC is a resource-efficient method to collect the ideas and views of a large number of participants over a short time. It facilitates the exploration and verification of themes while benefiting the participants through engagement in dialogue and mutual learning (Löhr et al., 2020). The very name “world café” conjures an image of an informal, inclusive setting where safe conversations can occur, fostering creativity and innovation (Burke & Sheldon, 2010).

METHODS AND RESULTS

Aim

The purpose of this study was to explore trends impacting current and future NPD practice to inform the fourth edition of Nursing Professional Development: Scope and Standards of Practice.

Ethical Considerations

The University of Washington Institutional Review Board deemed both phases of this study exempt.

Design

Phase 1 of this study consisted of an exploratory, qualitative design using the WC method to guide participatory exploration and verification of themes. This method has seven guiding design principles: setting the context, creating a hospitable space, exploring significant questions, fostering everyone’s contributions, sharing and connecting diverse points of view while retaining common focus on questions, collectively listening for patterns and deeper insights, and harvesting the collective insights (Brown, 2002; Brown & Issacs, 2005).

Café questions

Questions were posed during the WC to determine the utility of the current scope and standards for NPD practice and to envision future NPD practice. Carrying out the theme of WC, two “hemispheres” were created—one representing current NPD practice and the other representing future practice. Participants rotated to three tables in one hemisphere before moving to the other hemisphere. One question was posed at each table with approximately 10 minutes for discussion. Participants ultimately rotated to each table during the session to ensure the opportunity to provide feedback on each topic. The questions included the following:

  • Hemisphere 1 (H1): Where are we now?
    • o H1.1 (Table 1): What is working?/How have you successfully used the scope and standards?
    • o H1.2 (Table 2): What component of the scope and standards has not seemed realistic or were you unable to successfully implement?
    • o H1.3 (Table 3): What have you looked for in the scope and standards that you have been unable to find?
  • Hemisphere 2 (H2): Where are we going?
    • o H2.1 (Table 1): What are the major factors influencing your current NPD practice?
    • o H2.2 (Table 2): What does NPD practice look like in 2025?
    • o H2.3 (Table 3): What additional skills/competencies do you need to successfully practice in 2025?
TABLE 1 - Successful Uses of the Current Scope and Standards
Theme Topics
Advocacy for the NPD specialty Communication about specialty
Justification of specialty
Demonstration of value of the specialty
Establishment of credibility
Demonstration of ROI for NPD practice
Clarification of the NPD role
Communication about specialty
NPD performance management Creation of position descriptions
Delineation of responsibilities
Framework for NPD orientation
Differentiation of generalist and specialist competencies
Framework for NPD career advancement
Framework for performance evaluation
Graduate nursing education Framework for curriculum development
Note. NPD = nursing professional development; ROI = return on investment.

TABLE 2 - Challenges Using the Current Scope and Standards
Theme Topics
Role of champion for scientific inquiry Differentiation of research, EBP, and QI as methods of scientific inquiry
Clarification of NPD responsibility as champion for research, EBP, and QI
Clarification of DNP and PhD responsibilities for EBP and research, respectively
Alignment of roles and responsibilities Clarification of relationships between roles and responsibilities
Generalist vs. specialist Purpose of differentiating NPD generalist and NPD specialist
Clarification of the use of NPD “practitioner”
Importance of “NPD” in job titles
Lack of role clarity Differentiation of NPD from other specialties that provide nursing education
Clarification of NPD responsibility for interprofessional colleagues’ continuing development
Clarification of NPD’s role in organization development
Differentiation of NPD from other specialties that provide nursing education
Note. EBP =evidence-based practice; QI = quality improvement; NPD = nursing professional development.

TABLE 3 - Current Issues and Trends
Theme Topics
Resources Resource scarcity
Shifting payment models
Burgeoning technology for patient care
Burgeoning technology for education delivery
Instructional/graphic designers, etc.
Disasters/crises/epidemics/pandemics Educational emergencies
Inclusion of NPD in disaster planning
Education and training for emergency redeployment of staff
Education and training for prevention and mitigation of disease
Dealing with moral distress of NPD practitioners and frontline staff
Articulating the value of NPD practice
Systems integration related to mergers/acquisitions Standardization of processes and procedures
Integration of local needs with system requirements
Note. NPD = nursing professional development.

Each table was hosted by a member of the 2021 Scope and Standards Workgroup. Each host remained at one table, posing the discussion question and recording notes. Notes were shared with subsequent rounds of participants, but no names were attributed to responses. As participants were individually rotated to a different table to consider and discuss a different question, they had the benefit of having the shared notes of the previous group.

Setting

Initially, the WC was to occur in person prior to the ANPD convention in Chicago on April 28, 2020. The plan was to use a large room with round tables covered with red and white checkered tablecloths and white placemats for the participants to write their ideas and leave at the table. To further carry out the WC theme, white chef’s aprons were obtained for each table host.

This WC plan came to an abrupt halt with the arrival of the COVID-19 pandemic and cancelation of the in-person ANPD convention. The researchers quickly explored a virtual café using a virtual meeting platform with breakout rooms. Because no previous models or articles describing a virtual WC were found, this adjustment required significant creativity and multiple rehearsals. The researchers used a virtual café background image with inviting café tables covered with red and white checkered tablecloths, and WC language was maintained to simulate a real café and foster conversation. Breakout rooms became café tables with welcoming table (breakout room) hosts. Hosts were provided with written instructions and attended a group rehearsal prior to the virtual WC. During the WC, the researchers remained in the meeting platform’s main room, tracking time and assisting participants with technology issues.

Participants

To achieve 30 participants in the WC, a purposive sample of 32 NPD experts were invited to participate in this study to allow for attrition. Inclusion criteria included certification in NPD and a minimum of master’s preparation in a discipline relevant to NPD practice. The researchers identified experts from the ANPD Board of Directors, as well as ANPD committees and task forces. Recommendations were also solicited from the Scope and Standards Workgroup and ANPD Board of Directors. In addition, researchers placed a notice on LinkedIn targeting NPD practice experts for self-nomination. The expertise of self-nominated individuals was validated with their curriculum vitae. All 32 invitees participated in the virtual WC—a 100% response rate. Participants were provided with written instructions via e-mail for accessing the virtual meeting platform and moving among breakout rooms.

Data Collection

The virtual WC was conducted in the spring of 2020. A 10-minute welcome with a recap of instructions and the purpose of the study was conducted by the investigators, followed by 10-minute discussion sessions in each breakout room as described above. The rotation process was followed by a 40-minute harvest, a conversation of the whole, in the virtual platform’s main meeting room to visibly share the collective knowledge and insight. A facilitator who was not one of the researchers conducted the harvest debrief session, eliciting from the table hosts the patterns and insights learned from the progressive conversations held at their table. The table hosts used their notes to guide this dialogue and asked all participants to amplify and clarify as needed. The facilitator validated the responses with the participants and captured this shared knowledge through shared on-screen notes. This process continued until consensus that the collective discoveries were harvested was achieved. The table notes and harvest notes were saved for subsequent analysis by the researchers.

Data Analysis

The facilitator’s harvest (debrief) notes and each table host’s notes were analyzed using thematic analysis individually by each researcher to identify themes. This analysis was validated by comparing results and discussing differences until consensus was achieved between the investigators.

Results

The resulting of independent thematic analyses are shown in Tables 1–4. As recommended by Belton et al. (2019), the findings of the WC exploration phase were categorized and collated into a list of items to be included in Phase 2 of this study, an eDelphi method designed to achieve consensus of the expert participants.

The WC supported all six areas of NPD responsibility identified by Warren and Harper (2015, 2017): onboarding/orientation; competency management; education; role development; collaborative partnerships; and research, evidence-based practice, and quality improvement. In addition, the roles of learning facilitator, leader, champion for scientific inquiry, and advocate for the NPD specialty were clearly articulated during the WC harvest (debrief). Although table hosts’ notes included activities that could be organized under the roles of change agent, mentor, and partner for practice transitions, these roles were not clearly supported during the harvest. As a result, the researchers decided to include these three roles in the eDelphi to determine support for these items as distinct NPD roles. The eDelphi will be discussed in detail in the next Scope and Standards Column.

TABLE 4 - Skills and Competencies for Future NPD Practice
Theme Topics
Advocacy Competency(ies) related to political advocacy
Competency(ies) related to specialty advocacy
Competency(ies) related to advocacy for population health
Organizational alignment Competency(ies) related to alignment with organization’s mission
Competency(ies) related to alignment with organization’s vision
Competency(ies) related to alignment with organization’s values
Competency(ies) related to alignment with organization’s culture
Transition to practice programs Needs of diverse learners (i.e., second career vs. new entry into workforce)
Transitions in practice for experienced nurses transitioning to new specialty/role
Department/organizational structure Clarification of micro-, meso-, and macro-organizational levels
Differentiation of centralized and decentralized NPD departmental structures
Healthy work environment (HWE) Competency(ies) related to creating HWE
Competency(ies) related to sustaining HWE
Contributions of NPD practitioners to staff retention
Emotional intelligence
Teaching others to be resilient
Leadership in scientific inquiry Expertise in EBP (DNP preparation)
Expertise in research (PhD preparation)
Technology Virtual meeting platforms
Virtual education platforms
Virtual reality
Artificial intelligence
Data literacy
Teaching humanity in virtual environment
Instructional design
Virtual competency validation
Virtual competency documentation
Learner engagement in virtual environments
Communication skills for virtual environments
Conflict management within virtual environments
Just-in-time training/education
Leadership and business skills Project management
Financial stewardship
Contingency planning
Multisite NPD system management
Multistate NPD system management
Health policy decision-making
Implementation science
Note. NPD = nursing professional development; EBP =evidence-based practice.

Strengths and Limitations of WC Research Methodology

The WC is a relatively new tool for qualitative data collection. The researchers’ initial inclination was to replicate the methodologies used to inform the third edition of the Nursing Professional Development: Scope and Standards of Practice—a focus group followed with one-to-one key informant interviews and consensus of themes from an eDelphi (Warren & Harper, 2017). After discovering the known advantages of WC (Koen et al., 2015; Löhr et al., 2020), the researchers opted to proceed with this creative methodology. According to Löhr et al. (2020), the collaborative nature of WC provides opportunities for diverse participants to reflect on their lived experiences and use these reflections to create an in-depth conversation related to the WC questions. Another strength of the methodology is the sharing of ideas through progressive rounds of conversation. Each new table group had the notes from the previous table group to build upon. Finally, these progressive rounds were completed in a simulated café—a neutral, informal space that encourages authentic dialogue.

Some advantages of the virtual WC were unforeseen. For example, the virtual WC required typing both the harvest notes and the table host notes in order for them to be viewed using screen share technology. This sharing allowed all participants to simultaneously correct notes as the discussion moved forward. These typed notes were subsequently given to the researchers, eliminating the time-consuming and perhaps erroneous work of deciphering handwritten notes. The virtual WC also allowed NPD experts from across the nation and potentially from across the globe to participate without travel and the related expenses and inconveniences.

Two potential disadvantages of WC are caused by the lack of interaction between the researchers and the participants. The researcher is not available to redirect participants who stray from the topic. Also, the researcher is not able to probe or clarify as in an interview. These disadvantages were minimized in this study by preparing the table hosts to keep participants focused on the question at hand and clarify meaning by making notes on a shared screen, visible to all. These notes remained at the table (breakout room) for each round, and the table host shared these during the harvest, allowing all participants the opportunity to clarify. Although listed as disadvantages, these issues can be interpreted as the advantage of protecting the process from undue researcher influence. Interestingly, the potential disadvantage of collecting and reading hand-written table notes was eliminated by the unanticipated switch to a virtual WC.

A limitation of this study was that no guiding model or literature was available to guide the transformation from an in-person to virtual WC. Nevertheless, the transition was smooth, with excellent (100%) participation—even during the early throes of the pandemic.

Some minor issues were encountered, with participants not being allowed to enter their chosen breakout room (café table). This problem was quickly remedied by a researcher, who had hosting capability on the virtual platform and facilitated participants’ entrance into the chosen room (table).

Participant engagement was not inhibited by the virtual format. Several participants shared their unsolicited gratitude and excitement after experiencing WC as shown in Table 5.

TABLE 5 - Unsolicited Participant Feedback for Virtual World Café
Thank you and your team for hosting such a great collaboration event. The organization and preplanning made this a valuable, engaging, and inspiring experience!
Nice work on the World Café yesterday; what a fun exercise! And great data!
Thank you for providing the virtual platform for the World Café and making it such a positive experience for all of us down to the detail of creating the welcome room with the café.
Thank you for hosting our World Café yesterday. It was lovely to see your faces and collaborate with such a fine group. While disappointing that we could not do so in person, I thought it worked rather well.
It was a great effort and fun at the same time!
It was great to be…at the table and to have the opportunity to influence the next draft of the scope and standards, or as I like to say “my work bible.” I appreciated the forum and creative way in which you hosted the World Café and really enjoyed the break from day-to-day operations to participate in such rich, thoughtful, and meaningful conversations.
Thank you again for allowing me to participate in this creative and engaging opportunity.
BRAVO—Well done!!! I was so impressed. Loved seeing everyone.
My head might be spinning a little, but I thoroughly enjoyed myself!! I am thankful to be part of this experience and was eager to hear what everyone had to say. They did not disappoint. Overall, I think the format worked well, and the participants seemed to appreciate and resonate with the dialogue.

IMPLICATIONS OF USING A VIRTUAL WC AS A RESEARCH METHOD

Although the researchers found no use of the WC in nursing research in the United States, WC has been used globally. Given the advantages of the WC, the support of expert qualitative researchers (de Chesnay, 2015; Löhr et al., 2020) and the ease of converting it to an inclusive, informal virtual environment, it offers great potential for qualitative data collection in future research studies.

SUMMARY AND CONCLUSION

This article described the use of a relatively new, yet remarkable qualitative method, the WC, to explore expert NPD practitioners’ perspectives on current and future healthcare issues that impact NPD practice. The article discussed WC as a qualitative methodology, data collection using a virtual WC, data analysis, and the results that were used to develop an eDelphi survey to reach consensus on the categorizations and items. The advantages and disadvantages of WC as well as its use in nursing research were explored.

The virtual WC is an inclusive, power-neutral methodology that connects and captures individual narratives in a community dialogue. It is a powerful qualitative research tool, perfect for exploring NPD practitioners’ perspectives on current and future healthcare issues impacting their practice. More information about the WC is available on the WC (n.d.) website.

This first phase of research was combined with an eDelphi method in Phase 2 to inform the fourth edition of the Nursing Professional Development: Scope and Standards of Practice. The results of Phase 2 will be reported in the next Scope and Standards column.

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