Most practitioners of adult education would concur that the best source for the identification and description of adult learning needs is with the learner. Leypoldt describes the adult education teaching/learning process as a "dynamic, interactive and cooperative" process that relies heavily on the adult learners' ability to take responsibility for discovering their own needs.1
McKenzie reminds the educator that in assessing needs both the learners' needs and the organization's needs must be considered.2 In the hospital setting, the staff educator must translate the organization's goals and objectives into needs and become adept at synthesizing these needs with those of the learners. This is a complex and highly demanding responsibility which the staff educator must assume. It is both time consuming and demands a relatively high degree of rhetorical sensitivity to the organization. Frequently the goals and directives of the organization are abstract, unrealistic, and even unattainable in terms of time and human resources available. The staff educators must develop a variety of skills and relationships within the working environment which will enable them to formulate program designs based on the composite input of many sources.
Traditional Methods of Needs Assessment
In order to begin any sort of adult learning needs assessment, the adult educator (in this case the hospital staff educator) must first have a well-founded framework to understand the adult learner. Some theory-base, whether from Havinghurst, Erikson, Maslow or some integration of theories on human development and the internal motivational forces which prompt us to learn, is a prerequisite to any needs assessment formulation. Thus, the skills and methods of staff educators will emerge from their beliefs about the adult learner, and about the nature of the teaching/learning experience.
From this theoretical framework the staff educator develops a schema for addressing the various persons and groups within the organization about their insights into the learning needs of the organization's staff. The staff educators may approach the administrative team for input on staff performance, for changing trends in practice, and for developments in technology which affect the skills that the nursing staff must possess. They may utilize the results of patient care audits, the minutes of committee reports, or the formalized goals and objectives of the administrative team. The staff educator may sit in on conferences, talk with patients, attend shift report, and generally undertake a wide variety of both obtrusive and unobtrusive measures in order to gather data on the learning needs of the nursing staff. Eventually the educator will need to ask the learner, and this is where the process tends to break down.
Traditionally, the staff educator is several organizational steps removed from the bedside nurse. In many systems the educator must rely on a wide variety of resources in order to connect with the actual learner of the as-yet-unplanned program content. Committees of staff nurses, frequently ill-attended due to staffing crises or rotation of shifts, can cause more confusion than help in finding out what staff members need to know. This situation is additionally compounded when the committee members do not understand the concept of "representative government" and bring to the committee their own views and biases rather than fairly representing the needs as they find them presented on the patient care units.
A typical strategy is to utilize a catchall question at the end of each educational offering presentation. It is usually at the very bottom of the formal evaluation and goes something like this: "What other programs would you like to see presented in the near future?" From this all-too-openended approach may come a grand diversity oí nice-to-know but not need-to-know program topics, or more frequently, in the rush to fill out the evaluation, such a question will go unanswered.
Another method, used more frequently in hospitals where the educator-to-staff nurse ratio is relatively manageable (1:50 to 1:100), is the direct conversation with "key informants": staff nurses who are both willing and able to keep the educator apprised of the changes, deficiencies, and gaps in the learning-to-doing process. Once again, the informants may have their own biases, but in systems where the educator can also validate the information by direct patient care-related observation, such information is quite valuable.
A final drawback to the traditional methods of needs assessment is the element of time. It may be weeks or even months between the discovery of a possible learning need to the time when program development plans can be set into motion. The staff educator may want to validate the need by talking to other informants, by examining actual patient care or care records, or by bringing the idea to the administrative team. This is particularly true if a high cost to the organization is a potential consequence of acting on the identified need. This time costs money. It costs the organization in efficiency, especially if the learning need really exists and the staff is functioning with an inadequate knowledge base. It costs in terms of staff satisfaction in that the organization, and the educational department in particular, may seem unresponsive to the needs of the working staff, and it costs when the need is not generalizable to a sizable majority of the nursing staff, often resulting in poor evaluations.
What is the educator to do? Should the needs be ascribed to the learner? Should the administrative team develop all the programs? Can the learner be trusted to identify real learning needs and bring them to the attention of the educational resource persons? Finally, can all this be done in such a way that the process from needs identification to actual program presentation is efficient and responsive and cost-effective? The solution to much of the frustration encountered in the learning needs assessment process can be overcome by using fairly simplistic computer technology strategies available to most modern health care facilities.
THE NURSE EDUCATOR AND THE COMPUTER
Today many schools of nursing are providing the undergraduate student with at least a core course in both statistics and computer technology. The typical complaint from the students is that such a prerequisite has no practical value in the patient care related work which they will be performing. Even in systems using a computer for patient care records, students may argue that they will learn all about computers when the time comes. As nurses we need to recognize that the time has come. Hospital departments from personnel to central supply have been making the transition to the use of computers. When nursing departments have turned to the computer, they have used it to project staffing patterns, describe the patient census, or tabulate the budget. Even this they have done with some measure of reluctance.
It is neither possible nor probable that for every staff education position available it would be required that the nurse educator be well- versed in statistical and computerrelated methodologies, but that day may come. Our counterparts in industry, those persons who function as human resource development specialists, or organizational development trainers in large corporations usually must demonstrate some computer-related competence. That day may come for nursing as well. Now is the time to prepare for it, to begin utilizing the computer services available to us to improve our skills in many areas, including educational needs assessment.
The computer offers the nursing staff educator three main advantages over any other method of needs assessment commonly practiced in the hospital setting. First, it allows for the organizational needs to find expression. Second, it permits each nurse a "vote"; all nurses involved are able to declare their own sense of need. Third, it provides a rapid access of information and permits the educator to examine the total authence for shifts or trends in learning needs based on demographic distributions such as the age of the nurse-learner, the type of undergraduate preparation, or the number of years in the setting.
The best way to demonstrate these three advantages is to use the example of a computerized needs assessment which was prepared and implemented by the Staff Development Committee of Nursing Services for Children at Indiana University Hospitals. This tool was the product of a close working task force of staff nurses who worked with the Staff Development Coordinator to develop and construct an instrument that would quantify the most urgent learning needs of the nursing staff at this 200-bed pediatric faculty. Their efforts, along with the encouragement of their fellow committee members, paid off in an actual return rate of almost 80%. This means that virtually every nurse in the service participated and that the data collected were not merely a representative sample of the needs which could be generalized to a larger population, but that in fact the entire population had responded to the instrument. No generalization was needed; from this instrument, we knew what the urgent learning needs were.
DEVELOPING THE INSTRUMENT
Developing an instrument that is both responsive to the kind of information desired and suitable to the computer's abilities to categorize, sort, and restructure information is indeed a difficult endeavor. The group which set forth on this task was by no means highly qualified in computer technology. Many mistakes are described along with the actual benefits of the experience; both provided learning and have moved the state-of-the-art along considerably in this setting.
The instrument was developed as a tool to elicit staff nurse responses to primarily clinical-skill items. It was, therefore, divided into sections by body system or assessment parameters, much like a physical examination might be. Each of the subheadings provided the organizational framework for a set of questions directly related to the body system and the nursing care-related skills. Individual items were collected by the task force members and validated through several drafts with both staff and leadership nurses. The final instrument was a 97-item questionnaire of which six items were demographic in nature and allowed us to categorize responses based on the nurse's age, years of clinical experience, years of experience in this particular setting, and work status (RN, LPN, GN, GPN, student, fulltime, part-time, and the unit on which he/she worked).
EXPECTED PERCENT OF NURSES INDICATING OVERALL HIGH NEED BY YEARS OF EXPERIENCE AT THIS SETTING
The instrument was set up in such a way that the respondent was asked to make two responses to each item. The first response indicated the learners' degree of need which they sensed for the identified topic to be presented as an educational offering. This was meant to be an indication of how urgently they felt that such a program was needed. The second response was geared to the needs of the educational department. It requested that the respondent indicate how often such an educational offering would need to be made available on the given topic in order to assist the learner to maintain a satisfactory degree of clinical competence in the given skill area. This question was put before the learners in order to get their appraisal of the scheduling of offerings. Many institutions have questioned the need for repeating programs over and over again for the same staff. Certification programs such as cardio-pulmonary resuscitation or fire and safety classes have recently come under mandate from accrediting agencies, and institutions such as hospitals must document evidence that staff members attend yearly repetitions of the same information. As a result, many departments are faced with requests that other "skill" inservice classes be repeated frequently. It was our desire, through this questionnaire, to find out what the learner had to say about the need for such a scheduled repetition of skill learning.
It was our belief that we would receive a 15 to 20% return on our questionnaire, so the instrument was devised for hand scoring. It was our intention to utilize the computer only for correlation coefficients and to group data by demographic distributions. As it turned out, our staff nurses responded with overwhelming cooperation. We received 176 questionnaires and that was our first problem.
The laborious task of translating 33,088 pieces of data into meaningful information became formidable. It was not possible to do by hand; therefore, it was coded onto coding sheets by the task force members, and these coding sheets were used to produce hand key-punched data cards (three cards per respondent) which were in turn printed out. The computer print-out was hand-validated by teams of two task force members who corroborated the key-punched information as precisely matching the hand-coded data. All of this took weeks. From it we have learned never to do a needs assessment without the benefit of optical-scanning sheets which can be read by the computer. It would have been possible to utilize a design that fit into the opticalscanning format, but as it turned out, our only pre-thought for computer use was in statistical computation. Next time we will utilize the computer throughout the design and plan the instrument on optical-scanning tools. This will avoid much unnecessary delay.
Something else we learned from the development of our instrument was that several biases were built into the tool. This is a common dilemma in instrument development. Having worked with the particular service for some time, we had some hypotheses on how the data would fall out. We had expected a bimodal curve with its first peak to be around the two-year mark. We anticipated the second peak to occur at the five-year mark. This did not occur, and will be discussed further in the analysis of the data form needs assessment.
WHAT THE STAFF NURSES TOLD US ABOUT THEiR LEARNING NEEDS
What we did most was generate paper. We had stacks of computer print-outs, some eight inches thick. The staff nurses told us a great deal, but some of what we learned came from what they did not tell us.
In the demographic portion of the instrument, we found that the nurses who responded were almost a perfectly matched representative sample of the entire staff. That is, we found 84% of our sample to be made up of RNs, 8.5% to be made up of LPNs, 4% to be made up of students in nursing education programs who worked for pay, and 3.4% of our sample was made up of newly graduated GNs and/or GPNs. This matched the percentages in our typical staffing patterns almost precisely.
The sample also matched our employment patterns on other variables, assuring us that the sample was not contaminated by a host of false cases. This was most reassuring as we examined the data more closely.
Frequency distributions were performed for each of the variables. Out of the 91 clinical items, nine emerged as being highly desirable among the staff nurses for high priority program planning. A housewide cutoff point of 60% was deemed necessary to slot a topic as highly desirable and of significant priority. This was done on the basis of costefficient planning. If less than two-thirds of the staff required the program, and on any given day or shift you have a potential authence of less than one-third of your staff present, attendance, unless mandatory, will be minimal.
ACTUAL PERCENT OF NURSES INDICATING OVERALL HIGH NEED BY YEARS OF EXPERIENCE AT THIS SETTING
Data were examined not only by percentages in terms of the clinical items but by correlating demographic variables to clinical items, thus permitting the task force members to see which groups of nurses had specific needs by age, unit, or years of experience. This was particularly helpful for unit-based program planning, and for the identification of program topics which were pertinent across particular units. Needs correlated with years of experience was of great interest. As stated earlier we had anticipated a bimodal curve. Figures 1 and 2 demonstrate what was expected as opposed to what was found.
It was by the comparison of these two curves, the hypothesized one and the real one, that we learned of our biases. The instrument was not particularly sensitive to the needs of our more experienced staff and did not discriminate well after about the two- to three-year mark. In examining this lack of fine discrimination, we realized that the task force members who had designed the tool were all in the lessthan-three-years-experience category. This would logically make them unable to build into the instrument discriminators able to detect the differences among our more experienced nurses. We learned from this, too. Next time, the instrument design team will also be representative of the larger population.
In the end, we found that the nine items that scored most highly on the questionnaire will be able to be put to the staff again. From a second brief analysis we will be able to hone in on what the details of the program content should be. This will become the framework for our objectives and from there, programs can be developed which respond to the learning needs of the adult learner as they were identified.
We also learned from what the staff did not say. In many cases, the nurses left the second set of responses blank, writing in by hand, "I don't know." This was a fair response. The learner probably does not know how often a program should be made available. Another typical response was for all items to be checked as being needed on a six-month frequency schedule. This told us that what the learner wants is information to be available as it is needed. How typical of the adult learner, who learns best when the content or experience is relevant to the circumstances.
The use of computers to assist in staff learning needs assessment is invaluable. The amount of information and the rapidity of turnaround on such information is an enormous benefit to the staff educator. Programs can be planned that are relevant to staff needs and responsive to organizational directions. The educator can focus in on where needs are and address them on-site, perhaps by unit or by classification of personnel, if this is how the need is diagnosed. It is to the educator's advantage to learn as much as possible about the use of computers and the statistical packages available, particularly those dealing with the social sciences (SPSS and others). The demand for such accessibility of data is upon us. The organizational benefits are not yet fully understood, but seemingly they are enormous.
Finding ways to tap into the hidden resources of the computer services around you is the key. Developing the computer skills, or finding reliable resource persons who will assist you in your early explorations is a must. The future lies in the educator's ability to demonstrate costeffective, efficient, responsive programming. A neglected tool lies at your disposal. I would encourage you to use it.
- 1 . Leypol dt MM : The teaching-learning process with adults. Adult Leadership, 1967, pp 212-233.
- 2. McKenzie L: Adult education: Areas of proficiency for nurseeducators. J Cont Educ Nurs 1974; 4:6-9.