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How do psychiatric nurses learn?: Modes of learning and learning self-directedness
How Do Psychiatric Nurses Learn?: Modes of Learning and Learning Self-Directedness Marilyn P. Verhey
Houle’s typology of continuing professional learning was used to investigate the phenomena of continuing professional learning and learning self-directedness in psychiatric nurses. Five research questions guided the study that was the first to examine the learning styles and preferences of psychiatric nurses. The results have relevance for those planning educational opportunities and programs for psychiatric nurses and for those psychiatric nurses interested in insight into the dynamics of their own continuing learning. Copyright 0 1993 bg W.B. Saunders Company
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HE RAPIDLY expanding body of knowledge in psychiatric nursing has reinforced the necessity for psychiatric nurses to engage in lifelong continuing learning to maintain competence in theory and practice. Increasing attention is being given by educators to the phenomenon whereby adult learners are expected, as a part of their professional role, to assume the primary responsibility and direction for their own continuing learning. A critical element in facilitating the process of continuing professional education is the building of a systematic understanding of the ways in which psychiatric nurses learn and the relationship of self-direction in learning to those learning modes. This article describes a study that investigated continuing professional learning and self-direction in psychiatric nurses. Several factors illuminate the importance of self-direction in learning as a component of continuing professional development (O’Connor, 1986). Self-direction in learning offers opportunities for growth that have individual meaning and allows the nurse to build on previous experiences and knowledge. The nurse retains control over the learning experience and can identify and meet learning needs as they occur. The process of Iearning can be designed to “fit within the framework of existing professional and personal interests and responsibilities” (O’Connor, 1986, p. 274). The principles and practices of continuing proArchiws of Psychiabic Nursing, Vol. VII, No. 3 (June), 1993:
fessional learning and self-direction in learning have been the foundation for nursing staff development programs and the subjects of numerous research investigations. However, studies of the nurse as a continuing self-directed learner have focused on general hospital medical-surgical and related specialty nurses. Nurses practicing in the specialty area of psychiatry, where theoretical and clinical intervention modalities are substantially different, have not yet been studied to investigate the vital professional phenomena of continuing professional learning and learning self-directedness. This study used Houle’s model of professional learning modes to investigate continuing professional learning and self-direction in learning among psychiatric nurses. It was hypothesized that, as with other professional groups, psychiatric nurses fall into a continuum of self-directedness in learning and that there are relationships among the variables of self-directedness in learning, frequency of continuing learning activities, and the modes of learning used.
From the Department of Nursing, San Francisco State University, San Francisco, CA Adakss reprint requests to Marilyn P. Verhey, PhD, RN, Department of Nursing, San Francisco State University, 1600 Holloway Aw, San Francisco, C4 94132. Copyright 0 1993 by W.B. Saunders Company 06a3-9417/93/07034004$3.0000/0
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CONCEPTUAL FRAMEWORK
Houle’s Modes of Continuing Professional Learning
A model and theoretical framework for lifelong continuing learning in the professions has been developed by Cyril 0. Houle (1980, 1984). He defines learning as “the process by which people gain knowledge, sensitiveness, or mastery of skills through experience or study” (Houle, 1980, p. xi). Continuing professional learning is a dynamic process that encompasses an entire career. Continuing professional learning has broad goals that enable professionals to use more complex knowledge and problem-solving capabilities and address ethical problems. Learning is viewed more broadly than that which occurs within formal systems of instruction and includes a variety of experiences with each professional being accountable for engaging in “a lifetime of learning” (Houle, 1980, p. 10). Houle (1980) has proposed a typology that identifies three major and overlapping modes of learning: inquiry, instruction and performance. Inquiry is defined as “the process of creating some new synthesis, idea, technique, policy, or strategy of action” (Houle, 1980, p. 31). Often, it is only after the learning process has occurred that the content of the learning is recognized. Examples of learning through inquiry by nurses in the hospital setting include participating in patient care conferences, assisting in planning programs, or assuming leadership of hospital groups. The second mode, instruction, is defined as “the process of disseminating established skills, knowledge or sensitiveness. Those who use it assume that the teacher (a person, a book, or any other source) already knows or is designed to convey everything that the student will learn.” (Houle, 1980, p. 32). Generally, the activities of the continuing education department fall into the mode of instruction as do individual self-directed activities such as consulting reference materials and completing self-directed instructional packages. Finally, the performance mode is described as “the process of internalizing an idea or using a practice habitually, so that it becomes a fundamental part of the way in which a learner thinks about and undertakes his or her work. . . . During the years of practice, the mode of performance may be fostered by formal use of the other modes of learn-
P. VERHEY
ing” (Houle, 1980, pp. 32-33). Nurses who develop sophisticated protocols and standards of care based on experience over time with certain types of patients are engaging in learning through the performance mode. Cervero and Dimmock (1987) empirically tested Houle’s typology with nurses and found that the inquiry and performance factors were consistent with the corresponding Houle modes. However, Cervero and Dimmock differentiated Houle’s instruction mode into two categories, group instruction and self-instruction, and proposed an analytical framework for a revised typology that includes four modes of learning instead of the original three. This four-mode typology has been used in two subsequent studies of nurses’ continuing professional learning (Lebold, 1987; Oddi, Robertson, & Ellis, 1989). Self-Direction in Learning
Houle (1980) identifies a “zest for learning” that ultimately controls the amount and kind of education a professional undertakes. According to Houle “continuing education must fulfill the promise of its name and be truly continuing-not casual, sporadic, or opportunistic. This fact means that it must be self-directed. . , . Each professional must be the ultimate monitor of his or her own learning. ’ ’ Related Literature
Studies have focused on nurses’ continuing professional learning (Cooper & Homback, 1966; Bevis, 1971; O’Connor, 1979; Schoen, 1979; Bell & Rix, 1979; and Jarvis, 1987). Other researchers have studied self-direction in nurses’ learning (Kathrein, 1981; Skaggs, 1981; O’Connor, 1982; Graeve, 1987; Lebold, 1987; Dixon, 1991). These studies have provided information about the characteristics of the continuing learner, the prevalence of continuing professional learning, motivational factors related to participation in educational programs, and the relationship of self-direction in learning to involvement in learning activities. PSYCHIATRIC NURSES AS A SPECIALTY GROUP
Research to empirically identify differences between psychiatric nurses and their more medically oriented counterparts is limited, outdated, and inconclusive. Studies conducted in the 1950s and
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1960s reported psychiatric nurses to be different from medical-surgical nurses (Navran & Stauffather, 1958; Lukens, 1965); different from maternal-child, and public health nurses (Miller, 1965); and similar to public health nurses (George & Stephens, 1968). The most recent study to investigate the contrasts in personality profiles among nursing specialty groups was published in 1975 (Gilbert, 1975). Medical-surgical and psychiatric nurses were reported to be markedly similar in the study.
The practice of nursing in the inpatient hospital setting by a psychiatric nurse is different from that of nurses practicing in the specialties of medicalsurgical, critical care, obstetrical, or other content areas of nursing. The care of the mentally ill calls on a set of skills that rarely uses technology or procedures involving sophisticated equipment. The nature of psychiatric nursing practice involves the establishment of interpersonal relationships with patients and individual and group counseling focused on problem-solving and interpersonal growth (Carter, 1986). The inpatient psychiatric nurse establishes a therapeutic environment that is safe, humanistic, and conducive to crisis intervention. Other aspects of the role involve the administration of psychotropic medications and an ongoing assessment of their effectiveness and possible side effects, and health teaching about physical and emotional concerns. Although psychotic or severely depressed patients may need assistance in the activities of daily living such as eating and bathing, the goal of nursing care is to promote independence and a return to the highest possible level of functioning. A final critical element in describing the nature of psychiatric nursing practice is the role of the psychiatric nurse as a member of a multidisciplinary treatment team (Benfer, 1980). In the practice of inpatient psychiatry, each patient is treated by a team comprised of members of the medical, psychology, nursing, social work, and rehabilitation professions who collaborate to provide a comprehensive approach to the delivery of care. The members of the treatment team meet regularly, often daily, to share information, discuss the effectiveness of therapeutic interventions, and plan for the ongoing care of the patient. The potential differences between psychiatric nurses and their counterparts in other specialties and the characteristics of the practice of psychiatric
nursing relate to an understanding of the learning styles and patterns of this professional group. Psychiatric nurses may prefer different modes of learning than those used by nurses in other specialties. The degree to which psychiatric nurses are self-directed in their learning is not known. Finally, the relationship of self-directedness in leaming to the modes of learning used by psychiatric nurses has not been explored. RESEARCH QUESTIONS AND HYPOTHESES
Five research questions guided the investigation of psychiatric nurses’ learning self-directedness and preferred modes of learning: 1. Are there differences in the modes of continuing professional learning used by psychiatric nurses? 2. Are there differences in the modes of leaming used by those psychiatric nurses who participate in a large number of educational activities versus those psychiatric nurses who engage in a small number of educational activities? 3. Is there a relationship between the frequency of educational activities engaged in by the subjects and their self-direction in learning? 4. Which mode of continuing professional learning is most highly correlated with the degree of self-direction in learning? 5. How do selected demographic variables relate to preferred modes of learning and selfdirection in learning? The following hypotheses were investigated: 1. That nurses would have significantly higher scores in the modes of performance (first) and selfinstruction (second) than in the other modes of continuing professional learning. 2. That nurses who were highly active learners would score significantly higher in all four modes of leaming than those nurses who were less active learners. 3. There would be a significant correlation between a high frequency in the conduct of job-time educational activities and self-direction in learning as measured by the SDLRS. 4. The self-instruction mode would be most significantly correlated with the amount of selfdirection as measured by the SDLRS. 5. That individuals who are more self-directed will demonstrate a higher level of participation in inservice and continuing education programs.
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METHOD
The sample was comprised of 101 full-time and part-time staff nurses employed by three private psychiatric hospitals on the East Coast. The desired size of the sample was determined by conducting a power analysis using the techniques of Cohen (1977). The desired sample size for the product moment correlation was 84; for the stepwise multiple regression, 73; and for the analysis of variance, 104. The sample size of 101 satisfied the required number for a power of 0.80 for regression analyses. Post hoc power analyses for the analysis of variance procedures yielded a power of at least 0.99. The total number of years that the subjects had practiced as psychiatric nurses ranged from 1 to 29 years with a mean of 8.7 years of psychiatric nursing practice. Slightly over two thirds of the nurses were employed full-time, and none of the nurses worked fewer than 16 hours per week. Almost one half (45.4%, it = 46) of the nurses had a baccalaureate degree as their highest nursing degree, and 14 (13.9%) of the nurses had a masters degree in nursing. The remaining 40.6% (n = 41) had an associates degree or diploma. Twenty-seven of the respondents (26.7%) held additional degrees in fields other than nursing. Seventeen (17%) of the respondents were enrolled in formal academic programs at the time of the study. Thirty-one percent (n = 31) of the respondents were between 26 and 35 years of age and 34.6% (n = 35) of the respondents were between 36 and 45 years of age. Only seven of the subjects were under 26 years of age. Instruments Modes of continuing professional learning were measured using the Job Activities Survey (JAS) developed by Bevis (1972) and modified by Cervero and Dimmock (1987) and Lebold (1987). The instrument was designed to measure the jobtime participation of staff nurses in educational activities, defined as “a process in which an individual undertakes voluntarily, alone or in groups, to increase knowledge, skill or sensitivity” (Bevis, 1972, p. 24). Job-time was defined as “time spent on the assigned nursing unit . . . as well as any time outside of the normal working day for which the staff nurse is compensated by the employer in time or money” (Bevis, 1972, p. 24). Using a Likert Scale, the instrument asks nurses to indicate how often they take part in 47 specific job-time
P. VERHEY
learning activities that represent Houle’s four modes of continuing professional learning. In previous studies using the JAS (Cervero & Dimmock, 1987; Lebold, 1987; Oddi, Roberson & Ellis, 1989), total score reliability ranged from 0.87 to 0.91, and the reliability of each mode score ranged from 0.74 to 0.87. In this study, the reliability (Cronbach’s alpha) of the JAS total score was 0.89. The reliability of the four mode scores is as follows: Inquiry, 0.69; Performance, 0.69; Group Instruction, 0.74; and Self-Instruction, 0.82. The construct of self-direction in learning was measured using the Self-Directed Learning Readiness Scale (SDLRS) developed by Guglielmino (1977). The SDLRS consists of 58 items that assess how learners perceive that they have certain attitudes and characteristics associated with selfdirectedness in learning: openness to learning, self-concept as an effective learner, initiative and independence in learning, informed acceptance of responsibility for one’s own learning, love of learning, creativity, positive orientation to the future, and ability to use basic study skills and problem-solving skills. Numerous studies have been conducted to determine reliability of the SDLRS. In a recent analysis of 3,15 1 SDLRS test scores, a Pearson split-half reliability estimate of 0.94 was obtained (Guglielmino, Long, & McCune, 1989). At least 17 studies have been conducted specifically to examine the validity of the SDLRS, and it has been found to be a valid measure of learning self-directedness in adults. The frequency of educational activity was measured by the total JAS score and two self-report questions on a Demographic Data Questionnaire (DDQ) developed by the author. Influencing variables of educational degree, years of psychiatric and total nursing experience, full-time or part-time status, and age were also measured using the DDQ. Procedure Packets containing the instruments, a cover letter and a return envelope were distributed to 279 staff nurses in three East Coast psychiatric hospitals. Respondents were instructed to place their completed questionnaires in the return envelope and return it to their Nursing Education Department. All data were analyzed using the Statistical Package for Social Sciences X. The confidence level for acceptance of findings was 0.05 level of significance.
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HOW DO PSYCHIATRIC NURSES LEARN?
3. Item 512
RESULTS
The mean Self-Directed Learning Readiness Scale score was 235.2 with a SD of 22.1 and a range of 182 to 275. The highest obtainable score on the SDLRS is 285. The national mean score for adults completing the SDLRS is 214, SD 25.59 (Guglielmino, Guglielmino, & Long, 1987). The nurses in this study scored at the 79th percentile, which is significantly higher than the national norm (t = 9.59, p < .OOS). The mean Job Activities total score was 75.07 with a SD of 24.79 and a range of 30 to 154. The highest obtainable total score on the JAS is 235. The means, standard deviations, ranges, and highest obtainable scores for the JAS mode scores are presented in Table 1. Research Question 1: Differences in Modes of Learning
This question asked if there were differences in the modes of continuing professional learning used by the subjects. The hypothesis, that nurses would have significantly higher scores in the modes of performance (first) and self-instruction (second) than in the other modes of continuing professional learning, was supported (F = 485.535,~ < .OOO). The Performance mode of learning measures those learning activities that are likely to be inherent in the day-to-day job responsibilities of a staff nurse. For psychiatric nurses in particular, their role responsibilities as members of a multidisciplinary team that meets several times weekly are directly related to three of the eight items of the Performance factor: Discussed a patient’s hospital care 1. Item Jl with a specialist, such as a dietitian, clinical nursing specialist, or physician. 2. Item Jll Discussed a patient’s home care with a specialist, such as a social worker, physical therapist, or public health nurse.
Sought out an expert to help in understanding some part of a patient’s chart, such as a laboratory, pathology, or diagnostic test report. A fourth item in this factor also is relevant to the specific role of the psychiatric nurse. Given that the nature of psychiatric nursing practice involves the establishment of interpersonal relationships with patients, Item 56, “Conversed purposefully with a patient or family member to determine nursing needs, obtain a history of illness, plan home care, or some similar purpose” is particularly germane to day-to-day job responsibilities. Scores on the self-instruction mode were significantly higher (F = 308.436, p < -000) than scores on the group instruction mode. The comparison of the average item scores for each mode of learning for this study and the two other studies that have investigated Houle’s modes of continuing professional learning in nurses (Lebold, 1987; Oddi, Roberson & Ellis, 1989) is shown in Table 2. In all three studies, nurses scored highest in the performance mode, followed by self-instruction, inquiry, and group instruction. Because the standard deviations for the Oddi, Roberson, and Ellis (1989) study were not available, statistical analysis to determine differences among the three sets of scores was not possible. There are no apparent differences between the psychiatric nurses in this study and the nurse samples of the Lebold and Oddi, Roberson, and Ellis investigations. Research Question 2: Modes of Learning for Different Learners
The second research question asked if there were differences in Houle’s modes of learning used by those psychiatric nurses who participate in large numbers of educational activities versus
Table 2. Comparison of Average Mode Scoras in Three Table 1. Descriptive Statistics for JAS Factor Scores
Studias Measuring
Houle’s Modes of Continuing
Professional Learning Inquiry
Group
Self
Instruction
Instruction
Performance
23.97
Self Study
Mean
7.09
2.93
26.42
SD
5.99
3.62
10.42
6.72
Range Max. Poss.
O-25
o-22
8-54
4-36
35
45
60
40
Score
Lebold
Instruction
Inquiry
Group Instruction
3.62
2.22
1.27
0.61
3.16
2.43
0.70
0.51
3.02
2.19
1.13
0.33
Performance
Oddi, Roberson, & Ellis Verhey
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those nurses who engage in small numbers of educational activities. Two different measures, the JAS total score and the self-report of inservice and continuing education activity from the DDQ, were used to investigate this question. In analyzing the modes of learning used by those nurses who engaged in large versus small numbers of educational activities as measured by the JAS, there was a significant interaction between the two factors (F = 10.36, p < .OOO),with both groups scoring very low in the group instruction mode of learning. One explanation for this finding may be a potential dichotomy between the content of the JAS and the current financial climate in health care institutions. Within the past 3 to 5 years, increasing cost-containment measures and budgetary cutbacks have severely reduced or eliminated monies for conference fees and attendance on compensatory time. The JAS is very explicit in asking respondents to report only those learning activities that take place on paid or compensatory time. Six of the eight items in the group instruction factor of the JAS involve attendance at activities for which the registration fee would have been paid by their employer or for which compensatory time would have traditionally been granted before the institution of cost-containment measures. A seventh item, participation in a nursing-related media interview or panel discussion, involves an activity that is actually available to very few staff nurses. When frequency of educational activity was measured by the sample’s self-report of inservice and continuing education participation on personal and paid time, hypothesis two was supported. Those nurses who were highly active learners scored significantly higher (F = 214.06, p < .OOO)in all four modes of learning than those nurses who were less active learners. Research Questions 3 and 4: Self-Direction in Learning The third research question asked if there was a correlation between the frequency the subjects engaged in job-time educational activities and their self-direction in learning. The hypothesis, that there would be a significant correlation between a high frequency in the conduct of job-time educational activities and self-direction in learning as measured by the SDLRS, was supported (r = .232, p = .013). The fourth research question asked which mode of continuing professional learning is most highly correlated with the degree
MARILYN
P. VERHEY
of self-direction in learning, with the hypothesis that the self-instruction mode would be most significantly correlated with the amount of selfdirection as measured by the SDLRS. The hypothesis was supported (r = .1848, p < .038). These findings were consistent with those of other studies investigating the relationship between self-direction in learning and the frequency of educational activity and modes of learning as measured by JAS total and mode scores. In a study using the Oddi Continuing Learning Inventory (OCLI) as a measure of learning self-directedness, significant relationships were reported between OCLI scores and JAS total scores (Oddi, Roberson and Ellis, 1989). Lebold (1987) showed significant positive correlations between self-direction in learning as measured by the OCLI and the four modes of learning, with the highest correlation being with the mode of self-instruction. Research Question 5: Demographics, Modes of Learning, and Self-Direction
Research question five examined the relationship of selected demographic variables with Houle’s modes of learning and learning selfdirectedness. The only significant correlation of the variable nursing degree currently held was with the inquiry mode of learning score (r = .1815, p < .035). Nurses with masters degrees in nursing scored highest in this mode, followed by nurses with baccalaureate degrees, associate degrees, and hospital diplomas. Participation in educational activities correlated significantly with self-direction in learning as measured by the SDLRS (r = .1772, p < .045). In addition, more self-directed learners had a higher degree of participation in all modes of learning. These results support the assumption that individuals who are more self-directed will demonstrate a higher level of participation in inservice and continuing education programs. Finally, there were no significant correlations between the variable of full-time and part-time status and self-direction in learning or modes of leaming. In addition, there were no correlations between full-time or part-time status and amount of inservice and continuing education programs attended on either work or the nurses’ own time. IMPLICATIONS FOR PSYCHIATRIC NURSING
The results of this study have implications for those who are responsible for planning continuing professional learning opportunities for psychiatric
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HOW DO PSYCHIATRIC NURSES LEARN?
nurses and for those interested in the dynamics of keeping current in their field. A meta-analysis of 34 published and unpublished studies of the effects of continuing education on nursing practice was conducted by Waddell (1991). The meta-analysis yielded an overall mean effect size of 0.73, indicating that continuing professional nursing education positively affects practice. Thus, attention to the processes of planning and implementing continuing education programs affects patient care through the improvement of nursing practice. Several implications for education and staff development practice are derived from this study. This study showed that, for its sample of psychiatric nurses, there were no apparent differences in the modes of learning used between them and nurses in other specialties. Despite differences in practice modalities, the psychiatric nurses used the modes of continuing professional learning in a very similar pattern and frequency to their counterparts from other specialties. Although inpatient psychiatric nurses use the skills of interpersonal, individual, and group counseling, crisis intervention, and milieu management, skills that are substantially different from those used in medicalsurgical settings, their preferred modes of continuing professional learning did not differ from nurses working in a different practice area. The preference for self-directed learning activities of these psychiatric nurses is also congruent with previous research investigating the preference of nurses for self-directed versus other-directed leaming (Clark & Dickinson, 1976; Moran, 1977; Bell & Rix, 1979; O’Connor, 1979, 1982; Puetz, 1980; Dixon, 199 1). The results of this study support the most recent previous research comparing psychiatric and medical-surgical nurses (Gilbert, 1975) and are in contrast to the earlier studies conducted in the 1950s and 1960s (Navran & Stauffacher, 1958: Lukens, 1965; Miller, 1965). Until future research indicates otherwise, staff developers should consider studies of nonpsychiatric nurses in planning and implementing their educational programs. Programs using the group instruction mode of learning should be closely scrutinized to determine their relevance, and the development of opportunities for self-directed learning should be emphasized. Even though hospitals are experiencing severe cost-containment measures and educational monies are being cut from nursing budgets, staff development practitioners can provide a rich educational environment.
Collaboration with nursing managers and administrators can lead to the development of opportunities for nurses that use the performance, inquiry, and self-instruction modes of learning and integrate learning with the direct provision of patient care. The significant correlation between the Inquiry mode of learning scores and the educational preparation of the psychiatric nurses in this study has particular implications for the planning of educational experiences using the inquiry mode. In a study of decision-making skills and criticalthinking ability among masters, baccalaureate, associate, and diploma-prepared nurses, Pardue (1987) showed that there was a significant difference in critical thinking among these four groups. Masters degree nurses scored highest on the Watson-Glaser Critical Thinking Appraisal Test, followed by baccalaureate, diploma, and associate degree nurses. The learning mode of Inquiry as described by Houle involves those cognitive skills defined by Matthews and Gaul (1979) as being involved in critical thinking: comprehension, application, analysis, synthesis, and evaluation. Educational opportunities that use the Inquiry mode of learning and enhance critical thinking skills should be provided, especially for those nurses with diplomas or associate degrees. Based on the results of this study, efforts to plan specially-designed programs for the less active learner and the part-time employee are not indicated. Dixon’s (1991) study of self-directed leaming showed a similar pattern. She investigated time spent in professional and personal learning, both self-directed and teacher-directed, and reported that nurses who experienced a high amount of one kind of learning were active in all other kinds of learning, and less active learners in one kind of learning were less active in all kinds of learning. Dixon states: “It may no longer be as important to study the kinds of learning nurses participate in as it is to investigate why some nurses are very active in learning and others are inactive” (p. 2 17). However, the consistent results across studies showing that all nurses, including those practicing in the psychiatric specialty, prefer self-directed learning activities should direct staff-development practitioners in their program design. CONCLUSION
This study yielded information useful to those planning continuing education programs for psy-
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chiatric nurses as noted previously. It is the only study to date that examines the learning styles of psychiatric nurses as a specialty group. Additional research on the provision of continuing professional education for psychiatric nurses is needed. Research is also needed to focus on the differences between active and passive learners and how to meet the continuing education needs of both groups. REFERENCES Bell, F., & Rix, P. (1979). Attitudes of nurses toward lifelong learning: One hospital examines the issues. Journal of Continuing Education in Nursing, 10, 15-20.
Benfer, B.A. (1980). Defining the role and function of the psychiatric nurse as a member of the team. Perspectives in Psychiatric Care, 18, 166-177. Bevis, M.E. (1971). Role conception and the continuing learning activities of neophyte collegiate nurses. Unpublished doctoral dissertation, University of Chicago, Chicago, IL. Bevis, M.E. (1972). An instrument designed to measure the job-time educational participation of staff nurses. Journal of Continuing Education in Nursing, 3, 24-30.
Carter, E.W. (1986). Psychiatric nursing: 1986. Journal of Psychosocial Nursing and Mental Health Services, 24, 26-30.
Cervero, R.M., 8r Dimmock, K.H. (1987). A factor analytic test of Home’s typology of professionals’ modes of learning. Adult Education Quarterly, 37, 125-139. Clark, K.M., & Dickinson, G. (1976). Self-directed and otherdirected continuing education: A study of nurses’ participation. Journal of Continuing Education in Nursing, 7, 16-24.
Cooper, S.S., & Homback, M. (1966). Profile of the continuing learner in nursing. Nursing Outlook, 14, 28-31. Dixon, E. (1991). Brief: Nurse readiness and time spent in self-directed learning. Journal of Continuing Education in Nursing, 22, 215-218. George, J.A., & Stephens, M.D. (1968). Personality traits of public health nurses and psychiatric nurses. Nursing Research, 17, 168-170.
Gilbert, M.A. (1975). Personality profiles and leadership potential of medical-surgical and psychiatric nursing graduate students. Nursing Research, 24, 125-130. Graeve, E.A. (1987). Patterns of self-directed professional learning of registered nurses. Unpublished doctoral dissertation, University of Minnesota, Minneapolis, MN. Guglielmino, L.M. (1977). Development of the self-directed learning readiness scale. Unpublished doctoral dissertation, University of Georgia, Athens, GA. Guglielmino, P.J., Guglielmino, L.M., & Long, H.B. (1987). Self-directed learning readiness and performance in the workplace: Implications for business, industry, and higher education. Higher Education, 16. 303-317. Guglielmino, L.M., Long, H.B., & McCune, S.K. (1989). Reactions to Field’s investigation into the SDLRS. Adult Education Quarterly, 39, 235-245.
P. VERHEY
Houle, C.O. (1980). Continuing learning in the professions. San Francisco, CA: Jossey-Bass. Houle, CO. (1984). Patterns of learning. New perspective on life-span education. San Francisco, CA: Jossey-Bass. Jarvis, P. (1987). Lifelong education and its relevance to nursing. Nurse Education Today, 7, 49-55. Kathrein, M.A. (1981). A study of self-directed continuingprofessional learning of members of the Illinois Nurses’ Association: Content and process. Unpublished doc-
toral dissertation, Northern Illinois University, DeKalb, IL. Lebold, M.M. (1987). The relationship between levels of nursing practice and continuing professional learning among registered nurses. Unpublished doctoral disser-
tation, Northern Illinois University, DeKalb, IL. Lukens, L.G. (1965). Personality patterns and choice of clinical nursing specialization. Nursing Research, 14, 210221.
Matthews, C.A., &Gaul, A.L. (1979). Nursing diagnosis from the perspective of concept attainment and critical thinking. Advances in Nursing Science, 2, 17-26. Miller, D.I. (1965). Characteristics of graduate students in four clinical nursing specialties. Nursing Research, 14, 106113.
Moran, V. (1977). Study of comparison of independent leaming activities vs. attendance at staff development by staff nurses. Journal of Continuing Education in Nursing, 8, 14-21. Navran, L., & Stauffacher, J.C. (1958). A comparative analysis of the personality structure of psychiatric and nonpsychiatric nurses. Nursing Research, 6, 64-67. O’Connor, A.B. (1979). Reasons nurses participate in continuing education. Nursing Research, 28, 354-359. O’Connor, A.B. (1982). Reasons nurses participate in selfstudy continuing education programs. Nursing Research, 31, 371-374.
O’Connor, A.B. (1986). Nursing staff development and continuing education. Boston: Little, Brown. Oddi, L.F., Roberson, J.E. & Ellis, A.J. (1989). Continuing learning among registered nurses employed in a community hospital. Journal of Nursing Staff Development, 3. 30-35.
Pardue, S.F. (1987). Decision-making skills and critical thinking ability among associate degree, diploma, baccalaureate, and master’s_prepared nurses. Journal of Nursing Education, 26, 354-361.
Puetz, B.E. (1980). Differences between Indiana registered nurse attenders and nonattenders in continuing education and nursing activities. Journal ofContinuingEducation in Nursing, 11, 19-26.
Schoen, D.C. (1979). Lifelong learning: How some participants see it. Journal of Continuing Education in Nursing, 10, 3-16. Skaggs, B.S. (1981). The relationships between involvement of professional nurses in self-directed learning activities, loci of control and readiness for self-directed learning measures. Unpublished doctoral dissertation, Univer-
sity of Texas at Austin, Austin, TX. Waddell, D.L. (1991). The effects of continuing education on nursing practice: A meta-analysis. Journal of Continuing Education in Nursing, 22, 113-l 18.
Houle’s typology of continuing professional learning was used to investigate the phenomena of continuing professional learning and learning self-directedness in psychiatric nurses. Five research questions guided the study that was the first to examine the learning styles and preferences of psychiatric nurses. The results have relevance for those planning educational opportunities and programs for psychiatric nurses and for those psychiatric nurses interested in insight into the dynamics of their own continuing learning. Copyright 0 1993 bg W.B. Saunders Company
T
HE RAPIDLY expanding body of knowledge in psychiatric nursing has reinforced the necessity for psychiatric nurses to engage in lifelong continuing learning to maintain competence in theory and practice. Increasing attention is being given by educators to the phenomenon whereby adult learners are expected, as a part of their professional role, to assume the primary responsibility and direction for their own continuing learning. A critical element in facilitating the process of continuing professional education is the building of a systematic understanding of the ways in which psychiatric nurses learn and the relationship of self-direction in learning to those learning modes. This article describes a study that investigated continuing professional learning and self-direction in psychiatric nurses. Several factors illuminate the importance of self-direction in learning as a component of continuing professional development (O’Connor, 1986). Self-direction in learning offers opportunities for growth that have individual meaning and allows the nurse to build on previous experiences and knowledge. The nurse retains control over the learning experience and can identify and meet learning needs as they occur. The process of Iearning can be designed to “fit within the framework of existing professional and personal interests and responsibilities” (O’Connor, 1986, p. 274). The principles and practices of continuing proArchiws of Psychiabic Nursing, Vol. VII, No. 3 (June), 1993:
fessional learning and self-direction in learning have been the foundation for nursing staff development programs and the subjects of numerous research investigations. However, studies of the nurse as a continuing self-directed learner have focused on general hospital medical-surgical and related specialty nurses. Nurses practicing in the specialty area of psychiatry, where theoretical and clinical intervention modalities are substantially different, have not yet been studied to investigate the vital professional phenomena of continuing professional learning and learning self-directedness. This study used Houle’s model of professional learning modes to investigate continuing professional learning and self-direction in learning among psychiatric nurses. It was hypothesized that, as with other professional groups, psychiatric nurses fall into a continuum of self-directedness in learning and that there are relationships among the variables of self-directedness in learning, frequency of continuing learning activities, and the modes of learning used.
From the Department of Nursing, San Francisco State University, San Francisco, CA Adakss reprint requests to Marilyn P. Verhey, PhD, RN, Department of Nursing, San Francisco State University, 1600 Holloway Aw, San Francisco, C4 94132. Copyright 0 1993 by W.B. Saunders Company 06a3-9417/93/07034004$3.0000/0
pp. 139-146
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CONCEPTUAL FRAMEWORK
Houle’s Modes of Continuing Professional Learning
A model and theoretical framework for lifelong continuing learning in the professions has been developed by Cyril 0. Houle (1980, 1984). He defines learning as “the process by which people gain knowledge, sensitiveness, or mastery of skills through experience or study” (Houle, 1980, p. xi). Continuing professional learning is a dynamic process that encompasses an entire career. Continuing professional learning has broad goals that enable professionals to use more complex knowledge and problem-solving capabilities and address ethical problems. Learning is viewed more broadly than that which occurs within formal systems of instruction and includes a variety of experiences with each professional being accountable for engaging in “a lifetime of learning” (Houle, 1980, p. 10). Houle (1980) has proposed a typology that identifies three major and overlapping modes of learning: inquiry, instruction and performance. Inquiry is defined as “the process of creating some new synthesis, idea, technique, policy, or strategy of action” (Houle, 1980, p. 31). Often, it is only after the learning process has occurred that the content of the learning is recognized. Examples of learning through inquiry by nurses in the hospital setting include participating in patient care conferences, assisting in planning programs, or assuming leadership of hospital groups. The second mode, instruction, is defined as “the process of disseminating established skills, knowledge or sensitiveness. Those who use it assume that the teacher (a person, a book, or any other source) already knows or is designed to convey everything that the student will learn.” (Houle, 1980, p. 32). Generally, the activities of the continuing education department fall into the mode of instruction as do individual self-directed activities such as consulting reference materials and completing self-directed instructional packages. Finally, the performance mode is described as “the process of internalizing an idea or using a practice habitually, so that it becomes a fundamental part of the way in which a learner thinks about and undertakes his or her work. . . . During the years of practice, the mode of performance may be fostered by formal use of the other modes of learn-
P. VERHEY
ing” (Houle, 1980, pp. 32-33). Nurses who develop sophisticated protocols and standards of care based on experience over time with certain types of patients are engaging in learning through the performance mode. Cervero and Dimmock (1987) empirically tested Houle’s typology with nurses and found that the inquiry and performance factors were consistent with the corresponding Houle modes. However, Cervero and Dimmock differentiated Houle’s instruction mode into two categories, group instruction and self-instruction, and proposed an analytical framework for a revised typology that includes four modes of learning instead of the original three. This four-mode typology has been used in two subsequent studies of nurses’ continuing professional learning (Lebold, 1987; Oddi, Robertson, & Ellis, 1989). Self-Direction in Learning
Houle (1980) identifies a “zest for learning” that ultimately controls the amount and kind of education a professional undertakes. According to Houle “continuing education must fulfill the promise of its name and be truly continuing-not casual, sporadic, or opportunistic. This fact means that it must be self-directed. . , . Each professional must be the ultimate monitor of his or her own learning. ’ ’ Related Literature
Studies have focused on nurses’ continuing professional learning (Cooper & Homback, 1966; Bevis, 1971; O’Connor, 1979; Schoen, 1979; Bell & Rix, 1979; and Jarvis, 1987). Other researchers have studied self-direction in nurses’ learning (Kathrein, 1981; Skaggs, 1981; O’Connor, 1982; Graeve, 1987; Lebold, 1987; Dixon, 1991). These studies have provided information about the characteristics of the continuing learner, the prevalence of continuing professional learning, motivational factors related to participation in educational programs, and the relationship of self-direction in learning to involvement in learning activities. PSYCHIATRIC NURSES AS A SPECIALTY GROUP
Research to empirically identify differences between psychiatric nurses and their more medically oriented counterparts is limited, outdated, and inconclusive. Studies conducted in the 1950s and
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1960s reported psychiatric nurses to be different from medical-surgical nurses (Navran & Stauffather, 1958; Lukens, 1965); different from maternal-child, and public health nurses (Miller, 1965); and similar to public health nurses (George & Stephens, 1968). The most recent study to investigate the contrasts in personality profiles among nursing specialty groups was published in 1975 (Gilbert, 1975). Medical-surgical and psychiatric nurses were reported to be markedly similar in the study.
The practice of nursing in the inpatient hospital setting by a psychiatric nurse is different from that of nurses practicing in the specialties of medicalsurgical, critical care, obstetrical, or other content areas of nursing. The care of the mentally ill calls on a set of skills that rarely uses technology or procedures involving sophisticated equipment. The nature of psychiatric nursing practice involves the establishment of interpersonal relationships with patients and individual and group counseling focused on problem-solving and interpersonal growth (Carter, 1986). The inpatient psychiatric nurse establishes a therapeutic environment that is safe, humanistic, and conducive to crisis intervention. Other aspects of the role involve the administration of psychotropic medications and an ongoing assessment of their effectiveness and possible side effects, and health teaching about physical and emotional concerns. Although psychotic or severely depressed patients may need assistance in the activities of daily living such as eating and bathing, the goal of nursing care is to promote independence and a return to the highest possible level of functioning. A final critical element in describing the nature of psychiatric nursing practice is the role of the psychiatric nurse as a member of a multidisciplinary treatment team (Benfer, 1980). In the practice of inpatient psychiatry, each patient is treated by a team comprised of members of the medical, psychology, nursing, social work, and rehabilitation professions who collaborate to provide a comprehensive approach to the delivery of care. The members of the treatment team meet regularly, often daily, to share information, discuss the effectiveness of therapeutic interventions, and plan for the ongoing care of the patient. The potential differences between psychiatric nurses and their counterparts in other specialties and the characteristics of the practice of psychiatric
nursing relate to an understanding of the learning styles and patterns of this professional group. Psychiatric nurses may prefer different modes of learning than those used by nurses in other specialties. The degree to which psychiatric nurses are self-directed in their learning is not known. Finally, the relationship of self-directedness in leaming to the modes of learning used by psychiatric nurses has not been explored. RESEARCH QUESTIONS AND HYPOTHESES
Five research questions guided the investigation of psychiatric nurses’ learning self-directedness and preferred modes of learning: 1. Are there differences in the modes of continuing professional learning used by psychiatric nurses? 2. Are there differences in the modes of leaming used by those psychiatric nurses who participate in a large number of educational activities versus those psychiatric nurses who engage in a small number of educational activities? 3. Is there a relationship between the frequency of educational activities engaged in by the subjects and their self-direction in learning? 4. Which mode of continuing professional learning is most highly correlated with the degree of self-direction in learning? 5. How do selected demographic variables relate to preferred modes of learning and selfdirection in learning? The following hypotheses were investigated: 1. That nurses would have significantly higher scores in the modes of performance (first) and selfinstruction (second) than in the other modes of continuing professional learning. 2. That nurses who were highly active learners would score significantly higher in all four modes of leaming than those nurses who were less active learners. 3. There would be a significant correlation between a high frequency in the conduct of job-time educational activities and self-direction in learning as measured by the SDLRS. 4. The self-instruction mode would be most significantly correlated with the amount of selfdirection as measured by the SDLRS. 5. That individuals who are more self-directed will demonstrate a higher level of participation in inservice and continuing education programs.
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METHOD
The sample was comprised of 101 full-time and part-time staff nurses employed by three private psychiatric hospitals on the East Coast. The desired size of the sample was determined by conducting a power analysis using the techniques of Cohen (1977). The desired sample size for the product moment correlation was 84; for the stepwise multiple regression, 73; and for the analysis of variance, 104. The sample size of 101 satisfied the required number for a power of 0.80 for regression analyses. Post hoc power analyses for the analysis of variance procedures yielded a power of at least 0.99. The total number of years that the subjects had practiced as psychiatric nurses ranged from 1 to 29 years with a mean of 8.7 years of psychiatric nursing practice. Slightly over two thirds of the nurses were employed full-time, and none of the nurses worked fewer than 16 hours per week. Almost one half (45.4%, it = 46) of the nurses had a baccalaureate degree as their highest nursing degree, and 14 (13.9%) of the nurses had a masters degree in nursing. The remaining 40.6% (n = 41) had an associates degree or diploma. Twenty-seven of the respondents (26.7%) held additional degrees in fields other than nursing. Seventeen (17%) of the respondents were enrolled in formal academic programs at the time of the study. Thirty-one percent (n = 31) of the respondents were between 26 and 35 years of age and 34.6% (n = 35) of the respondents were between 36 and 45 years of age. Only seven of the subjects were under 26 years of age. Instruments Modes of continuing professional learning were measured using the Job Activities Survey (JAS) developed by Bevis (1972) and modified by Cervero and Dimmock (1987) and Lebold (1987). The instrument was designed to measure the jobtime participation of staff nurses in educational activities, defined as “a process in which an individual undertakes voluntarily, alone or in groups, to increase knowledge, skill or sensitivity” (Bevis, 1972, p. 24). Job-time was defined as “time spent on the assigned nursing unit . . . as well as any time outside of the normal working day for which the staff nurse is compensated by the employer in time or money” (Bevis, 1972, p. 24). Using a Likert Scale, the instrument asks nurses to indicate how often they take part in 47 specific job-time
P. VERHEY
learning activities that represent Houle’s four modes of continuing professional learning. In previous studies using the JAS (Cervero & Dimmock, 1987; Lebold, 1987; Oddi, Roberson & Ellis, 1989), total score reliability ranged from 0.87 to 0.91, and the reliability of each mode score ranged from 0.74 to 0.87. In this study, the reliability (Cronbach’s alpha) of the JAS total score was 0.89. The reliability of the four mode scores is as follows: Inquiry, 0.69; Performance, 0.69; Group Instruction, 0.74; and Self-Instruction, 0.82. The construct of self-direction in learning was measured using the Self-Directed Learning Readiness Scale (SDLRS) developed by Guglielmino (1977). The SDLRS consists of 58 items that assess how learners perceive that they have certain attitudes and characteristics associated with selfdirectedness in learning: openness to learning, self-concept as an effective learner, initiative and independence in learning, informed acceptance of responsibility for one’s own learning, love of learning, creativity, positive orientation to the future, and ability to use basic study skills and problem-solving skills. Numerous studies have been conducted to determine reliability of the SDLRS. In a recent analysis of 3,15 1 SDLRS test scores, a Pearson split-half reliability estimate of 0.94 was obtained (Guglielmino, Long, & McCune, 1989). At least 17 studies have been conducted specifically to examine the validity of the SDLRS, and it has been found to be a valid measure of learning self-directedness in adults. The frequency of educational activity was measured by the total JAS score and two self-report questions on a Demographic Data Questionnaire (DDQ) developed by the author. Influencing variables of educational degree, years of psychiatric and total nursing experience, full-time or part-time status, and age were also measured using the DDQ. Procedure Packets containing the instruments, a cover letter and a return envelope were distributed to 279 staff nurses in three East Coast psychiatric hospitals. Respondents were instructed to place their completed questionnaires in the return envelope and return it to their Nursing Education Department. All data were analyzed using the Statistical Package for Social Sciences X. The confidence level for acceptance of findings was 0.05 level of significance.
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3. Item 512
RESULTS
The mean Self-Directed Learning Readiness Scale score was 235.2 with a SD of 22.1 and a range of 182 to 275. The highest obtainable score on the SDLRS is 285. The national mean score for adults completing the SDLRS is 214, SD 25.59 (Guglielmino, Guglielmino, & Long, 1987). The nurses in this study scored at the 79th percentile, which is significantly higher than the national norm (t = 9.59, p < .OOS). The mean Job Activities total score was 75.07 with a SD of 24.79 and a range of 30 to 154. The highest obtainable total score on the JAS is 235. The means, standard deviations, ranges, and highest obtainable scores for the JAS mode scores are presented in Table 1. Research Question 1: Differences in Modes of Learning
This question asked if there were differences in the modes of continuing professional learning used by the subjects. The hypothesis, that nurses would have significantly higher scores in the modes of performance (first) and self-instruction (second) than in the other modes of continuing professional learning, was supported (F = 485.535,~ < .OOO). The Performance mode of learning measures those learning activities that are likely to be inherent in the day-to-day job responsibilities of a staff nurse. For psychiatric nurses in particular, their role responsibilities as members of a multidisciplinary team that meets several times weekly are directly related to three of the eight items of the Performance factor: Discussed a patient’s hospital care 1. Item Jl with a specialist, such as a dietitian, clinical nursing specialist, or physician. 2. Item Jll Discussed a patient’s home care with a specialist, such as a social worker, physical therapist, or public health nurse.
Sought out an expert to help in understanding some part of a patient’s chart, such as a laboratory, pathology, or diagnostic test report. A fourth item in this factor also is relevant to the specific role of the psychiatric nurse. Given that the nature of psychiatric nursing practice involves the establishment of interpersonal relationships with patients, Item 56, “Conversed purposefully with a patient or family member to determine nursing needs, obtain a history of illness, plan home care, or some similar purpose” is particularly germane to day-to-day job responsibilities. Scores on the self-instruction mode were significantly higher (F = 308.436, p < -000) than scores on the group instruction mode. The comparison of the average item scores for each mode of learning for this study and the two other studies that have investigated Houle’s modes of continuing professional learning in nurses (Lebold, 1987; Oddi, Roberson & Ellis, 1989) is shown in Table 2. In all three studies, nurses scored highest in the performance mode, followed by self-instruction, inquiry, and group instruction. Because the standard deviations for the Oddi, Roberson, and Ellis (1989) study were not available, statistical analysis to determine differences among the three sets of scores was not possible. There are no apparent differences between the psychiatric nurses in this study and the nurse samples of the Lebold and Oddi, Roberson, and Ellis investigations. Research Question 2: Modes of Learning for Different Learners
The second research question asked if there were differences in Houle’s modes of learning used by those psychiatric nurses who participate in large numbers of educational activities versus
Table 2. Comparison of Average Mode Scoras in Three Table 1. Descriptive Statistics for JAS Factor Scores
Studias Measuring
Houle’s Modes of Continuing
Professional Learning Inquiry
Group
Self
Instruction
Instruction
Performance
23.97
Self Study
Mean
7.09
2.93
26.42
SD
5.99
3.62
10.42
6.72
Range Max. Poss.
O-25
o-22
8-54
4-36
35
45
60
40
Score
Lebold
Instruction
Inquiry
Group Instruction
3.62
2.22
1.27
0.61
3.16
2.43
0.70
0.51
3.02
2.19
1.13
0.33
Performance
Oddi, Roberson, & Ellis Verhey
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those nurses who engage in small numbers of educational activities. Two different measures, the JAS total score and the self-report of inservice and continuing education activity from the DDQ, were used to investigate this question. In analyzing the modes of learning used by those nurses who engaged in large versus small numbers of educational activities as measured by the JAS, there was a significant interaction between the two factors (F = 10.36, p < .OOO),with both groups scoring very low in the group instruction mode of learning. One explanation for this finding may be a potential dichotomy between the content of the JAS and the current financial climate in health care institutions. Within the past 3 to 5 years, increasing cost-containment measures and budgetary cutbacks have severely reduced or eliminated monies for conference fees and attendance on compensatory time. The JAS is very explicit in asking respondents to report only those learning activities that take place on paid or compensatory time. Six of the eight items in the group instruction factor of the JAS involve attendance at activities for which the registration fee would have been paid by their employer or for which compensatory time would have traditionally been granted before the institution of cost-containment measures. A seventh item, participation in a nursing-related media interview or panel discussion, involves an activity that is actually available to very few staff nurses. When frequency of educational activity was measured by the sample’s self-report of inservice and continuing education participation on personal and paid time, hypothesis two was supported. Those nurses who were highly active learners scored significantly higher (F = 214.06, p < .OOO)in all four modes of learning than those nurses who were less active learners. Research Questions 3 and 4: Self-Direction in Learning The third research question asked if there was a correlation between the frequency the subjects engaged in job-time educational activities and their self-direction in learning. The hypothesis, that there would be a significant correlation between a high frequency in the conduct of job-time educational activities and self-direction in learning as measured by the SDLRS, was supported (r = .232, p = .013). The fourth research question asked which mode of continuing professional learning is most highly correlated with the degree
MARILYN
P. VERHEY
of self-direction in learning, with the hypothesis that the self-instruction mode would be most significantly correlated with the amount of selfdirection as measured by the SDLRS. The hypothesis was supported (r = .1848, p < .038). These findings were consistent with those of other studies investigating the relationship between self-direction in learning and the frequency of educational activity and modes of learning as measured by JAS total and mode scores. In a study using the Oddi Continuing Learning Inventory (OCLI) as a measure of learning self-directedness, significant relationships were reported between OCLI scores and JAS total scores (Oddi, Roberson and Ellis, 1989). Lebold (1987) showed significant positive correlations between self-direction in learning as measured by the OCLI and the four modes of learning, with the highest correlation being with the mode of self-instruction. Research Question 5: Demographics, Modes of Learning, and Self-Direction
Research question five examined the relationship of selected demographic variables with Houle’s modes of learning and learning selfdirectedness. The only significant correlation of the variable nursing degree currently held was with the inquiry mode of learning score (r = .1815, p < .035). Nurses with masters degrees in nursing scored highest in this mode, followed by nurses with baccalaureate degrees, associate degrees, and hospital diplomas. Participation in educational activities correlated significantly with self-direction in learning as measured by the SDLRS (r = .1772, p < .045). In addition, more self-directed learners had a higher degree of participation in all modes of learning. These results support the assumption that individuals who are more self-directed will demonstrate a higher level of participation in inservice and continuing education programs. Finally, there were no significant correlations between the variable of full-time and part-time status and self-direction in learning or modes of leaming. In addition, there were no correlations between full-time or part-time status and amount of inservice and continuing education programs attended on either work or the nurses’ own time. IMPLICATIONS FOR PSYCHIATRIC NURSING
The results of this study have implications for those who are responsible for planning continuing professional learning opportunities for psychiatric
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HOW DO PSYCHIATRIC NURSES LEARN?
nurses and for those interested in the dynamics of keeping current in their field. A meta-analysis of 34 published and unpublished studies of the effects of continuing education on nursing practice was conducted by Waddell (1991). The meta-analysis yielded an overall mean effect size of 0.73, indicating that continuing professional nursing education positively affects practice. Thus, attention to the processes of planning and implementing continuing education programs affects patient care through the improvement of nursing practice. Several implications for education and staff development practice are derived from this study. This study showed that, for its sample of psychiatric nurses, there were no apparent differences in the modes of learning used between them and nurses in other specialties. Despite differences in practice modalities, the psychiatric nurses used the modes of continuing professional learning in a very similar pattern and frequency to their counterparts from other specialties. Although inpatient psychiatric nurses use the skills of interpersonal, individual, and group counseling, crisis intervention, and milieu management, skills that are substantially different from those used in medicalsurgical settings, their preferred modes of continuing professional learning did not differ from nurses working in a different practice area. The preference for self-directed learning activities of these psychiatric nurses is also congruent with previous research investigating the preference of nurses for self-directed versus other-directed leaming (Clark & Dickinson, 1976; Moran, 1977; Bell & Rix, 1979; O’Connor, 1979, 1982; Puetz, 1980; Dixon, 199 1). The results of this study support the most recent previous research comparing psychiatric and medical-surgical nurses (Gilbert, 1975) and are in contrast to the earlier studies conducted in the 1950s and 1960s (Navran & Stauffacher, 1958: Lukens, 1965; Miller, 1965). Until future research indicates otherwise, staff developers should consider studies of nonpsychiatric nurses in planning and implementing their educational programs. Programs using the group instruction mode of learning should be closely scrutinized to determine their relevance, and the development of opportunities for self-directed learning should be emphasized. Even though hospitals are experiencing severe cost-containment measures and educational monies are being cut from nursing budgets, staff development practitioners can provide a rich educational environment.
Collaboration with nursing managers and administrators can lead to the development of opportunities for nurses that use the performance, inquiry, and self-instruction modes of learning and integrate learning with the direct provision of patient care. The significant correlation between the Inquiry mode of learning scores and the educational preparation of the psychiatric nurses in this study has particular implications for the planning of educational experiences using the inquiry mode. In a study of decision-making skills and criticalthinking ability among masters, baccalaureate, associate, and diploma-prepared nurses, Pardue (1987) showed that there was a significant difference in critical thinking among these four groups. Masters degree nurses scored highest on the Watson-Glaser Critical Thinking Appraisal Test, followed by baccalaureate, diploma, and associate degree nurses. The learning mode of Inquiry as described by Houle involves those cognitive skills defined by Matthews and Gaul (1979) as being involved in critical thinking: comprehension, application, analysis, synthesis, and evaluation. Educational opportunities that use the Inquiry mode of learning and enhance critical thinking skills should be provided, especially for those nurses with diplomas or associate degrees. Based on the results of this study, efforts to plan specially-designed programs for the less active learner and the part-time employee are not indicated. Dixon’s (1991) study of self-directed leaming showed a similar pattern. She investigated time spent in professional and personal learning, both self-directed and teacher-directed, and reported that nurses who experienced a high amount of one kind of learning were active in all other kinds of learning, and less active learners in one kind of learning were less active in all kinds of learning. Dixon states: “It may no longer be as important to study the kinds of learning nurses participate in as it is to investigate why some nurses are very active in learning and others are inactive” (p. 2 17). However, the consistent results across studies showing that all nurses, including those practicing in the psychiatric specialty, prefer self-directed learning activities should direct staff-development practitioners in their program design. CONCLUSION
This study yielded information useful to those planning continuing education programs for psy-
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chiatric nurses as noted previously. It is the only study to date that examines the learning styles of psychiatric nurses as a specialty group. Additional research on the provision of continuing professional education for psychiatric nurses is needed. Research is also needed to focus on the differences between active and passive learners and how to meet the continuing education needs of both groups. REFERENCES Bell, F., & Rix, P. (1979). Attitudes of nurses toward lifelong learning: One hospital examines the issues. Journal of Continuing Education in Nursing, 10, 15-20.
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Cervero, R.M., 8r Dimmock, K.H. (1987). A factor analytic test of Home’s typology of professionals’ modes of learning. Adult Education Quarterly, 37, 125-139. Clark, K.M., & Dickinson, G. (1976). Self-directed and otherdirected continuing education: A study of nurses’ participation. Journal of Continuing Education in Nursing, 7, 16-24.
Cooper, S.S., & Homback, M. (1966). Profile of the continuing learner in nursing. Nursing Outlook, 14, 28-31. Dixon, E. (1991). Brief: Nurse readiness and time spent in self-directed learning. Journal of Continuing Education in Nursing, 22, 215-218. George, J.A., & Stephens, M.D. (1968). Personality traits of public health nurses and psychiatric nurses. Nursing Research, 17, 168-170.
Gilbert, M.A. (1975). Personality profiles and leadership potential of medical-surgical and psychiatric nursing graduate students. Nursing Research, 24, 125-130. Graeve, E.A. (1987). Patterns of self-directed professional learning of registered nurses. Unpublished doctoral dissertation, University of Minnesota, Minneapolis, MN. Guglielmino, L.M. (1977). Development of the self-directed learning readiness scale. Unpublished doctoral dissertation, University of Georgia, Athens, GA. Guglielmino, P.J., Guglielmino, L.M., & Long, H.B. (1987). Self-directed learning readiness and performance in the workplace: Implications for business, industry, and higher education. Higher Education, 16. 303-317. Guglielmino, L.M., Long, H.B., & McCune, S.K. (1989). Reactions to Field’s investigation into the SDLRS. Adult Education Quarterly, 39, 235-245.
P. VERHEY
Houle, C.O. (1980). Continuing learning in the professions. San Francisco, CA: Jossey-Bass. Houle, CO. (1984). Patterns of learning. New perspective on life-span education. San Francisco, CA: Jossey-Bass. Jarvis, P. (1987). Lifelong education and its relevance to nursing. Nurse Education Today, 7, 49-55. Kathrein, M.A. (1981). A study of self-directed continuingprofessional learning of members of the Illinois Nurses’ Association: Content and process. Unpublished doc-
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Moran, V. (1977). Study of comparison of independent leaming activities vs. attendance at staff development by staff nurses. Journal of Continuing Education in Nursing, 8, 14-21. Navran, L., & Stauffacher, J.C. (1958). A comparative analysis of the personality structure of psychiatric and nonpsychiatric nurses. Nursing Research, 6, 64-67. O’Connor, A.B. (1979). Reasons nurses participate in continuing education. Nursing Research, 28, 354-359. O’Connor, A.B. (1982). Reasons nurses participate in selfstudy continuing education programs. Nursing Research, 31, 371-374.
O’Connor, A.B. (1986). Nursing staff development and continuing education. Boston: Little, Brown. Oddi, L.F., Roberson, J.E. & Ellis, A.J. (1989). Continuing learning among registered nurses employed in a community hospital. Journal of Nursing Staff Development, 3. 30-35.
Pardue, S.F. (1987). Decision-making skills and critical thinking ability among associate degree, diploma, baccalaureate, and master’s_prepared nurses. Journal of Nursing Education, 26, 354-361.
Puetz, B.E. (1980). Differences between Indiana registered nurse attenders and nonattenders in continuing education and nursing activities. Journal ofContinuingEducation in Nursing, 11, 19-26.
Schoen, D.C. (1979). Lifelong learning: How some participants see it. Journal of Continuing Education in Nursing, 10, 3-16. Skaggs, B.S. (1981). The relationships between involvement of professional nurses in self-directed learning activities, loci of control and readiness for self-directed learning measures. Unpublished doctoral dissertation, Univer-
sity of Texas at Austin, Austin, TX. Waddell, D.L. (1991). The effects of continuing education on nursing practice: A meta-analysis. Journal of Continuing Education in Nursing, 22, 113-l 18.