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

AIM: This paper is a report of a study to assess the impact on nursing practice of critical care skills training for ward-based nurses. BACKGROUND: 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. METHODS: 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. FINDINGS: 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. CONCLUSION: 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.

Conceptualisations of trust in the organisational literature: some indicators from a complementary perspective.

PURPOSE: This paper evaluates the non-healthcare organisational literature on conceptualisations of trust. The aim of the paper is to review this diverse literature, and to reflect on the potential insights it might offer healthcare researchers, policy makers and managers. DESIGN/METHODOLOGY/APPROACH: A number of the key concepts that contribute to contrasting definitions of trust in the organisational literature are identified. FINDINGS: The paper highlights the heterogeneity of trust as an organisational concept. Aspects of trust that relate more specifically to non-healthcare settings are shown to have some potential relevance for healthcare. Five aspects of trust, considered to have particular significance to the changing face of the NHS, appear to offer scope for further exploration in healthcare settings. PRACTICAL IMPLICATIONS: The NHS continues to face changes to its organisational structures, both planned and unplanned. Healthcare providers will need to be alert to intra- and inter-organisational relationships, of which trust issues will form an inevitable part. Whilst it might be argued that the lessons offered by conceptualisations of trust within wider organisational settings have limitations, the paper demonstrates sufficient areas of overlap to encourage cross-fertilisation of ideas. ORIGINALITY/VALUE: The paper draws together previous research on a topic of increasing relevance to healthcare researchers, which has exercised management researchers for at least three decades. The paper acts as a guide to future research and practice.