A participatory action research study on continual professional development with nurses in Grenada, West Indies
Background: In Grenada, the process of revalidation requires 60 hours of continuous professional development (CPD) to be carried out over a three year period. This requirement highlights the value of CPD to the Grenada nursing council (GNC) to maintain, improve and broaden nurses' knowledge, expertise and competence. However, there is a lack of a CPD framework, guidelines and policies to guide nurses to enable engagement with CPD and compliance for revalidation. In the international context participation in CPD is expected as a means to provide quality care, but there is a wide variation of engagement. Additionally, internationally there has been a movement to reform and implement contextual frameworks to strengthen CPD for lifelong learning and improvement. Literature review: The body of knowledge on continuous professional development, including theoretical perspectives, voluntary or mandatory CPD, standards, consensus and evidence linking CPD to competencies and competency provide the foundation of this research. Aim: The primary intention has been to involve the active participation of Grenadian nurses concerned in working towards identifying the issues and explore the concepts of CPD. Additionally, to identify the organizational and personal issues surrounding CPD in Grenada. With the aim to identify structures required to propose an effective framework for CPD in Grenada. Methodology and methods: A participatory action research (PAR) paradigm guided this research. The theoretical framework underpinning this research was critical theory. The participatory action research team (PART) steered the decisions on the methods to be used. Three cycles of planning, action, analysis and reflection were carried out over a year. Data from the PART's meetings and experiences were analysed along with a national survey which informed 24 semi structured interviews to investigate the issues surrounding CPD in Grenada. Differing analysis dependent on the data was used; descriptive statistical analysis for the questionnaire and thematic analysis for the qualitative portions created the results. Findings: Significant findings from the quantitative and qualitative data analysis informed the PART to create a comprehensive CPD framework. It found that CPD is a complex process, context based and involves formal and informal activities. There is a strong concept that CPD is integral to professional identity, however there was no uniform concept of what CPD is. This study discovered that a framework was viewed essential for CPD engagement and guidance. The acceptance of both formal and informal activities supports current knowledge. Similarly, the need to embed learning theories not only enables the framework to measure CPD but leads to CPD as well. Additionally the needs and commitment of the individual, profession and institution must combine to ensure development and life long learning are achieved. As a methodology, due to its characteristics, there is evidence that action research is well suited to post colonial countries. Discussion: The research adds new insight into CPD for Grenadian nurses; namely that context based, progressive multidimensional frameworks are needed to capture the processes of CPD and ensure sustainability. The key findings show what constitutes CPD and highlights the issues surrounding availability and accessibility of CPD. This study supports those who advocate for a comprehensive framework to aid engagement. It adds to the literature that mandated activities are viewed positively as evidence of support from the institution. Additionally, engaging with meaningful CPD has complex internal and external factors. The framework proposed is supported by learning theories that encourage autonomy and self reflection as a means to embed CPD in the culture whilst mandating certain institutional requirements to address patient safety concerns. Critical theory provided a suitable explanatory approach to the findings. Lastly, utilizing PAR supports current knowledge that research findings are applied into practice thus increasing the relevance and clarifying the context and issues at hand. This new knowledge can be transferred to the region and beyond. Conclusion and recommendations: This research adds to the knowledge on CPD. Acknowledging CPD as a dynamic complex process taking into consideration the needs of the individual, the profession and the institution offers promising potential as future frameworks are evaluated. The conceptual framework is offered as a recommendation for a change in practice, additionally wider implications and recommendations in terms of a change in leadership culture to a more transformative and transparent are presented.