The Journal of Continuing Education in Nursing

Administrative Angles 

Embracing the Value of Confidence and Intention in Program Design

Karen S. Reed, DHSc, MSN, RN, CNE, CNL, CRRN

Abstract

Assessing participants' degree of confidence and intention related to use of knowledge and skill gained during continuing education programming provides insight into the effectiveness of methodologies used during program delivery. An analysis of participant confidence and intention levels from two programs demonstrates how using active learning strategies can positively influence the confidence and intention levels of learners. [J Contin Educ Nurs. 2021;52(1):5–7.]

Abstract

Assessing participants' degree of confidence and intention related to use of knowledge and skill gained during continuing education programming provides insight into the effectiveness of methodologies used during program delivery. An analysis of participant confidence and intention levels from two programs demonstrates how using active learning strategies can positively influence the confidence and intention levels of learners. [J Contin Educ Nurs. 2021;52(1):5–7.]

Merriam-Webster defines confidence as “a feeling or consciousness of one's powers or of reliance on one's circumstances and the quality or state of being certain” (Merriam-Webster, n.d.-a). Intention is defined as “a determination to act in a certain way” (Merriam-Webster, n.d.-b). Is this not how nurse planners hope all nurses feel upon completion of a continuing education activity, full of confidence and intention? How do you know if participants leave a program confident in their new knowledge or skill with intention to apply what they have learned? Why is assessing for participant confidence and intention important? This article explores the constructs of confidence and intention as measures of program evaluation and their value in determining the effectiveness of chosen learning strategies within program design.

Evaluating for Participant Confidence and Intention

Assessing a nurse's confidence and intention is not a new concept. Several situation-specific tools exist, such as the Nursing Anxiety and Self-Confidence with Clinical Decision Making scale (White, 2014) or the Self-Reporting Confidence and Educational Needs in Hospice Care instrument (Kwon et al., 2008). Additionally, there have been studies that assessed nurses' or nursing students' confidence and intention as part of an effort to determine professional development needs, as well as training effectiveness (Bambini et al., 2009; Johnson et al., 2020; Kim et al., 2017; Rautava et al., 2013; Wellings et al., 2017).

Evaluating participant confidence and intention goes beyond self-assessment of knowledge or skill gained. Self-assessment of confidence and intention is based on an individual's belief in their capacity to produce specific performance outputs and willingness to expend the energy necessary to meet the goal of behavioral performance (Kwon et al., 2008; Wellings et al., 2017). This brings us back to the question in the opening paragraph: How do you know if participants leave an educational activity confident in their new knowledge or skill and have the intention of implementing what they learned? Soliciting participant confidence and intention is useful for our provider unit to evaluate achievement of learning outcomes, as well as determining whether (or not) the teaching methods contributed to the development of participant confidence and intention.

Method of Evaluation

Our provider unit routinely includes questions addressing confidence and intention in an anonymous evaluation tool provided at the end of each educational activity. This generates useful data for the educational design process and supports the American Nurses Credentialing Center (ANCC, 2015, 2019) Standards:

  • Educational Design Process 3: Identifying and measuring change in knowledge, skills, and/or practices of the target audience that are expected to occur because of participation in the educational activity.
  • Educational Design Process 7: How the summative evaluation data for an educational activity are used to analyze the outcomes of that activity and guide future activities.

The questions on our provider unit's evaluation tool are adapted based upon the target population and their role: What is your level of self-confidence in incorporating the knowledge or skill gained from today's program into your teaching activities as a faculty member? What is your level of intention to incorporate knowledge gained in your activities as a faculty member? Participants self-assess using a 5-point scale, where 1 = no confidence/no intention and 5 = high confidence/high intention.

Impact of Active Learning Strategies

Active learning strategies, when used in professional development programming, have been shown to improve participant confidence and intention (Cabral & Baptista, 2019; Gleason et al., 2011). Active learning allows participants to share problems, ideas, and viewpoints as they collaborate in learning best practices relevant to their own work environment or life experiences, which in turn fosters participant confidence and intention (Cabral & Baptista, 2019; Reineke, 2017). Exemplars include:

  • Accommodating group interactions: Providing opportunities for group discussion, collaboration, and group problem solving (Malamed, 2019).
  • Microlearning: Designing an educational opportunity focusing on small concepts. For example, rather than a professional development program on wound care management, narrow the focus to management of exudating wounds. This helps to address the specific identified learner gap and makes learning more relevant.
  • Chunk information: Organizing information delivery into small chunks builds confidence as the learning becomes logical and organized. It also guides participants in creating connections without feeling overloaded with information.
  • Facilitate exploration: Providing resources, references, videos, and podcasts for participants to explore after the program to build momentum and permanent change.
  • Active learning: Think-pair-share, carousel, unfolding case studies, and gallery walks.

Tale of Two Programs

Collecting information on participant confidence and intention helps to evaluate the expected outcomes for an activity, as well as the influence of learning strategies used. This in turn provides insight in determining best practices for future programming. Our provider unit organized a 6-contact hour program, Creating Valid Student Assessments, and another program, Course Mapping Camp, for 4.5-contact hours. Table 1 demonstrates the confidence and intention levels reported by participants in both programs. Although the participants in both programs noted their confidence and intention levels as “high” or “moderately high,” it is valuable to examine the types of learning strategies used in each of the programs that contributed to the scores reported (Table 2).

Comparison of Confidence Levels and Learning Strategies in Continuing Education Programs

Table 1:

Comparison of Confidence Levels and Learning Strategies in Continuing Education Programs

Comparison of Learning Strategies in Continuing Education Programs

Table 2:

Comparison of Learning Strategies in Continuing Education Programs

Program One: Creating Valid Student Assessments

Participants attending this workshop identified their level of confidence as high (75%) and moderately high (25%) and their level of intention as high (81.2%) and moderately high (18.8%) in terms of their ability to effectively create student assessments. The learning strategies used by the speaker were presentations, followed by discussions and question-and-answer periods. Retrospectively, additional active learning strategies may have increased participant confidence and intention. For example, learners could work in small groups to examine test questions they have in development and suggest ways to strengthen the questions using a think, pair, and share format. Additionally, it may have been helpful for the provider to offer the speaker copies of overall examination statistics before the workshop so polls or questions could be embedded within the presentation to evaluate participant understanding of test analysis processes. This action step is a type of formative evaluation that would have provided the speaker with real-time feedback for adjusting the pace and content for the remainder of the workshop.

Program Two: Course Mapping Camp

Conversely, participants who attended the Course Mapping Camp reported both their level of confidence and level of intention as high (91.7%) and moderately highly (8.3%), which are robust figures of confidence and intention when compared with the other program. The speaker chose active learning strategies that require participant engagement. Each participant was given their own flip chart board to map out a course the participant had under development or revision. As each chunk of information was delivered, participants immediately put the learning into meaningful practice with relevance to the participants' respective teaching content. Flip chart boards were quickly covered with brightly colored Post-it® notes and notecards, and participant body language appeared energized. A gallery walk provided opportunities for peer sharing and reflection.

Conclusion

Based on the feedback collected from these programs and others, our approved provider unit has reenvisioned our role in program development. Nursing professional development practitioners play a key role in consulting with presenters throughout the educational design process, including encouraging incorporation of active learning strategies that promote participant confidence and intention. In turn, confidence and intention are strategic criteria in the evaluation process, assessing learner achievement of learning outcomes and providing key insights for future programming.

References

  • American Nurses Credentialing Center. (2015). ANCC primary accreditation provider application manual.
  • American Nurses Credentialing Center. (2019). Streamlining and revising the 2015 ANCC accreditation criteria and requirements.
  • Bambini, D., Washburn, J. & Perkins, R. (2009). Outcomes of clinical simulation for novice nursing students: Communication, confidence, clinical judgment. Nursing Education Perspectives, 30(2), 79–82 PMID:19476069
  • Cabral, A. & Baptista, A. (2019). Faculty as active learners about their practice: Toward innovation and change in nursing education. The Journal of Continuing Education in Nursing, 50(3), 134–140 doi:10.3928/00220124-20190218-09 [CrossRef] PMID:30835324
  • Gleason, B. L., Peeters, M. J., Resman-Targoff, B. H., Karr, S., McBane, S., Kelley, K., Thomas, T. & Denetclaw, T. H. (2011). An active-learning strategies primer for achieving ability-based educational outcomes. American Journal of Pharmaceutical Education, 75(9), 186 doi:10.5688/ajpe759186 [CrossRef] PMID:22171114
  • Johnson, J., Masaba, A., Munir, S., O'Dwyer, R., Smith, A., Elawad, K. & Al Abdulla, S. (2020). Assessing knowledge, attitude, and practice of nursing after a continuing professional development program: A qualitative study. International Journal of Health-care, 6(2), 8–13 doi:10.5430/ijh.v6n2p8 [CrossRef]
  • Kim, S., Park, C. & O'Rourke, J. (2017). Effectiveness of online simulation training: Measuring faculty knowledge, perceptions, and intention to adopt. Nurse Education Today, 51, 102–107 doi:10.1016/j.nedt.2016.12.022 [CrossRef] PMID:28043723
  • Kwon, S., Ynag, S., Park, M. & Choe, S. (2008). Assessment for the needs to develop hospice training program for nurses. Korean Journal of Hospice and Palliative Care, 8(2), 147–155.
  • Malamed, C. (2019). Get your audience pumped: 30 ways to motivate adult learners. https://theelearningcoach.com/elearning_design/isd/30-ways-to-motivate-adult-learners/
  • Merriam-Webter. (n.d.-a) Confidence. Merriam-Webster.com dictionary. https://www.merriam-webster.com/
  • Merriam-Webter. (n.d.-b) Intention. Merriam-Webster.com dictionary. https://www.merriam-webster.com/
  • Rautava, V. P., Palomäki, E., Innamaa, T., Perttu, M., Lehto, P. & Palomäki, A. (2013). Improvement in self-reported confidence in nurses' professional skills in the emergency department. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 21(16), 16 doi:10.1186/1757-7241-21-16 [CrossRef] PMID:23497683
  • Reineke, P. R. (2017). Let's cooperate! Integrating cooperative learning into a lesson on ethics. The Journal of Continuing Education in Nursing, 48(4), 154–156 doi:10.3928/00220124-20170321-04 [CrossRef] PMID:28362461
  • Wellings, C. A., Gendek, M. A. & Gallagher, S. E. (2017). Evaluating continuing nursing education: A qualitative study of intention to change practice and perceived barriers to knowledge transition. Journal for Nurses in Professional Development, 33(6), 281–286 doi:10.1097/NND.0000000000000395 [CrossRef] PMID:29095214
  • White, K. (2014). The development and validation of a tool to measure self-confidence and anxiety in nursing students while making clinical decisions. Nurse Educator, 1(53), 14–22.

Comparison of Confidence Levels and Learning Strategies in Continuing Education Programs

Continuing Education ProgramLevel of Self-ConfidenceLevel of Intention


HighModeratelyHighModerately High
Creating Valid Student Assessments75%25%81.2%18.8%
Course Mapping Camp91.7%8.3%91.7%8.3%

Comparison of Learning Strategies in Continuing Education Programs

Continuing Education ProgramLearning Strategies Used
Creating Valid Student Assessments

PowerPoint® presentations

Discussion

Questions and answers

Course Mapping Camp

Post-it® notes, index cards, and flip charts

Small-group work using course syllabi of their choosing

Gallery walk

Authors

Dr. Reed is Clinical Assistant Professor and Director, Office of Professional Nursing Development, University of Florida, College of Nursing, Gainesville, Florida.

The author has disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Karen S. Reed, DHSc, MSN, RN, CNE, CNL, CRRN, Clinical Assistant Professor and Director, Office of Professional Nursing Development, University of Florida, College of Nursing, PO Box 100197, Gainesville, FL 32610; email: ksreed@ufl.edu.

10.3928/00220124-20201215-03

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