Funding is only the start of fixing CPD.

Sam Foster, Chief Nurse, Oxford University Hospitals, considers the Government's promise of funding for continuing professional development, and calls for transparecy and further guidance.

From staff nurse to nurse consultant: Continuing professional development part 9: support and finance.

John Fowler, Educational Consultant, explores CPD for clinically based nurses.

Análisis de los costes de cursos de formación continua y continuada en un departamento de salud / Analysis of the costs of continuing and continuous training courses in a health department

Al finalizar 2015 se examinó la documentación de las memorias de cada uno de los cursos, que se remite a la Escuela Valenciana de Estudios de la Salud desde la Unidad Docente de un departamento de salud, y se observó que no quedaba registrada ni incorporada parte de la actividad de gestión y los resultados de esta. No se conocían los datos globales que comportaba la actividad y no se podía establecer un diagnóstico previo para identificar puntos de mejora en los procesos de gestión. Para resolver esta carencia, en 2016 se crearon registros para analizar los datos de los cursos de formación continua y continuada, con el objetivo de conocer la relación entre la acción gestora y los resultados de formación, y posibilitar así un diagnóstico previo. El resultado más llamativo es la alta tasa de pérdida económica por infrautilización, frente al volumen de acciones de comunicación y gestión de renuncias

At the end of 2015, an examination was made of the documentation of the reports of each of the courses, which is sent to the Valencian School of Health Studies from the Teaching Unit of a health department. It was observed that these reports and results were not registered or were included in any management activity. The overall data of this activity was not known and a comparison could not be made to identify improvement points in the management processes. In order to resolve this deficiency, in 2016, records were created to analyse the data of the continuous and continuous training courses, with the aim of determining the relationship between the management action and the training results, and thus make a comparison and effect of the results. The most striking result is the high rate of economic loss due to under-use, compared to the volume of communication actions and management of resignations

Impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes: A cluster-randomised controlled trial.

BACKGROUND: Agitation is a common, challenging symptom affecting large numbers of people with dementia and impacting on quality of life (QoL). There is an urgent need for evidence-based, cost-effective psychosocial interventions to improve these outcomes, particularly in the absence of safe, effective pharmacological therapies. This study aimed to evaluate the efficacy of a person-centred care and psychosocial intervention incorporating an antipsychotic review, WHELD, on QoL, agitation, and antipsychotic use in people with dementia living in nursing homes, and to determine its cost. METHODS AND FINDINGS: This was a randomised controlled cluster trial conducted between 1 January 2013 and 30 September 2015 that compared the WHELD intervention with treatment as usual (TAU) in people with dementia living in 69 UK nursing homes, using an intention to treat analysis. All nursing homes allocated to the intervention received staff training in person-centred care and social interaction and education regarding antipsychotic medications (antipsychotic review), followed by ongoing delivery through a care staff champion model. The primary outcome measure was QoL (DEMQOL-Proxy). Secondary outcomes were agitation (Cohen-Mansfield Agitation Inventory [CMAI]), neuropsychiatric symptoms (Neuropsychiatric Inventory-Nursing Home Version [NPI-NH]), antipsychotic use, global deterioration (Clinical Dementia Rating), mood (Cornell Scale for Depression in Dementia), unmet needs (Camberwell Assessment of Need for the Elderly), mortality, quality of interactions (Quality of Interactions Scale [QUIS]), pain (Abbey Pain Scale), and cost. Costs were calculated using cost function figures compared with usual costs. In all, 847 people were randomised to WHELD or TAU, of whom 553 completed the 9-month randomised controlled trial. The intervention conferred a statistically significant improvement in QoL (DEMQOL-Proxy Z score 2.82, p = 0.0042; mean difference 2.54, SEM 0.88; 95% CI 0.81, 4.28; Cohen's D effect size 0.24). There were also statistically significant benefits in agitation (CMAI Z score 2.68, p = 0.0076; mean difference 4.27, SEM 1.59; 95% CI -7.39, -1.15; Cohen's D 0.23) and overall neuropsychiatric symptoms (NPI-NH Z score 3.52, p < 0.001; mean difference 4.55, SEM 1.28; 95% CI -7.07,-2.02; Cohen's D 0.30). Benefits were greatest in people with moderately severe dementia. There was a statistically significant benefit in positive care interactions as measured by QUIS (19.7% increase, SEM 8.94; 95% CI 2.12, 37.16, p = 0.03; Cohen's D 0.55). There were no statistically significant differences between WHELD and TAU for the other outcomes. A sensitivity analysis using a pre-specified imputation model confirmed statistically significant benefits in DEMQOL-Proxy, CMAI, and NPI-NH outcomes with the WHELD intervention. Antipsychotic drug use was at a low stable level in both treatment groups, and the intervention did not reduce use. The WHELD intervention reduced cost compared to TAU, and the benefits achieved were therefore associated with a cost saving. The main limitation was that antipsychotic review was based on augmenting processes within care homes to trigger medical review and did not in this study involve proactive primary care education. An additional limitation was the inherent challenge of assessing QoL in this patient group. CONCLUSIONS: These findings suggest that the WHELD intervention confers benefits in terms of QoL, agitation, and neuropsychiatric symptoms, albeit with relatively small effect sizes, as well as cost saving in a model that can readily be implemented in nursing homes. Future work should consider how to facilitate sustainability of the intervention in this setting. TRIAL REGISTRATION: ISRCTN Registry ISRCTN62237498.

Creating workforce transformation.

Sam Foster, Chief Nurse at Heart of England NHS Foundation Trust, looks at opportunities for continuing professional development, which is key for both recruitment and retention.

Cuts to CPD funding undermine nursing.

It is worrying that for 2016-17, Health Education England's (HEE) funding for continuing professional development has suffered significant cuts of up to 45%, with little discussion about strategic plans for CPD at a national level.

Large tax rebates possible for thousands of nurses.

Nurses who took part in an NHS training scheme could be eligible for tax rebates that may be worth thousands of pounds.

Content Integrity, Conflict of Interest, and Commercial Support: Defining and Operationalizing the Terms.

One of the hallmarks of quality continuing education developed using accreditation criteria is content integrity. Components of content integrity include identifying, resolving, and disclosing conflict of interest; ensuring content is based on the best available evidence; managing commercial support (if applicable); and presenting the educational activity free of promotion or bias. This article explores content integrity, conflict of interest, and commercial support. Understanding and being able to operationalize these concepts will enable providers to offer high-quality educational activities that promote the professional development of nurses and/or improve the quality of patient care.

Nurse practitioner continuing education: exploring influences.

PURPOSE: This article introduces the interrelated concepts of nurse practitioner (NP) continuing education (CE) funding patterns, regulatory guidance surrounding NP CE, and its effect on patient outcomes in the United States. DATA SOURCES: A literature review was done by searching online databases: MEDLINE and CINAHL. Searches included review of NP certifying body websites, Institute of Medicine, Josiah Macy Foundation, and the National Council of State Boards of Nursing websites. CONCLUSIONS: The nursing literature supports no connection between required CE and improvement in provision of care to patients, nor does it support improvement in individual provider competence. The funding patterns for nursing and medicine indicate a bias toward biomedical and pharmacological interventions. This type of funding stream may contribute to practice gaps rather than improve them. IMPLICATIONS FOR PRACTICE: Understanding factors that influence CE program availability, plus the choices NPs make regarding mandatory CE, can provide planning guidance. This guidance can help reach the goal of improved patient outcomes and decreased healthcare disparities as a result of CE interventions. NP-specific findings may potentially influence regulatory reform relevant to mandatory CE and maintenance of certification. It is important that NPs recognize existing conflicts of interest in order to make informed program choices.

Ensuring content integrity when using commercial support.

Preventing continuing education program bias when commercial support is used can be challenging. Standards have been developed by health care professional accreditation organizations that focus on independence, conflict of interest, appropriate management of commercial funds, content integrity, and disclosure to learners. Implementation of these standards can significantly reduce the risk of bias and improve dissemination of balanced clinical information.