Opportunities and barriers to successful learning transfer: impact of critical care skills training

Abstract

This paper is a report of a study to assess the impact on nursing practice of critical care skills training for ward-based nurses. Following a government review in the UK of adult critical care provision, new ways of working were advocated to ensure that critical care services depended on the needs of the patient, not their location in the hospital. A re-conceptualization beyond service provision in high dependency units and intensive care units was required in order to deliver an integrated service. This has ramifications for training requirements. Semi-structured interviews were used to explore perceived learning and learning transfer from a range of courses. The data were collected from course attendees (n = 47) and line-managers (n = 19) across two sites between 2005 and 2006. Learning was closely associated with the clinical application of new skills and knowledge. Commonly, course attendees and line-managers quoted increased knowledge and confidence, better assessment skills and improved interprofessional working. Time with competency assessors, availability of expanding roles, and supernumerary time were key factors for successful learning transfer. Barriers were financial pressures on hospitals, lack of perceived relevance of the course to staff or nursing practice, and lack of time to practice skills or work with clinical skills facilitators. Course design should be a collaborative activity between education providers and commissioners to ensure the impact of training on practice. Relevance of material, time to practise skills and new learning, and organizational, rather than merely individual, support are essential for successful training interventions.