Empowering education Chaghari M et al.

Original Article

Journal of Advances in Medical Education & Professionalism

Empowering education: A new model for in-service training of

nursing staff

MAHMUD CHAGHARI1, MOHSEN SAFFARI1, ABBAS EBADI2*, AHMAD AMERYOUN3

1
Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran; 2Behavioral Sciences Research Center, Nursing faculty,
Baqiyatallah University of Medical Sciences, Tehran, Iran; 3Health Management Research Center, Baqiyatallah University of Medical
Sciences, Tehran, Iran

Introduction: In-service training of nurses plays an indispensable *Corresponding author:

role in improving the quality of inpatient care. Need to enhance Abbas Ebadi,
Abstract

the effectiveness of in-service training of nurses is an inevitable Behavioral Sciences Research

requirement. This study attempted to design a new optimal model Center,
Baqiyatallah University of
for in-service training of nurses.
Medical Sciences,
Methods: This qualitative study was conducted in two stages Tehran, Iran
during 2015-2016. In the first stage, the Grounded Theory was Tel: +98 912 2149019
adopted to explore the process of training 35 participating nurses. Email: ebadi1347@yahoo.
The sampling was initially purposeful and then theoretically based com
on emerging concept. Data were collected through interview, Please cite this paper as:
observation and field notes. Moreover, the data were analyzed Chaghari M, Saffari M, Ebadi
through Corbin-Strauss method and the data were coded through A, Ameryoun A. Empowering
MAXQDA-10. In the second stage, the findings were employed education: A new model for
through Walker and Avant’s strategy for theory construction so as in-service training of nursing
staff. J Adv Med Educ Prof.
to design an optimal model for in-service training of nursing staff.
2017;5(1):26-32.
Results: In the first stage, there were five major themes including
Received: 15 June 2016
unsuccessful mandatory education, empowering education, Accepted: 3 December 2016
organizational challenges of education, poor educational
management, and educational-occupational resiliency.
Empowering education was the core variable derived from the
research, based on which a grounded theory was proposed. The
new empowering education model was composed of self-directed
learning and practical learning. There are several strategies
to achieve empowering education, including the fostering of
searching skills, clinical performance monitoring, motivational
factors, participation in the design and implementation, and
problem-solving approach.
Conclusion: Empowering education is a new model for in-service
training of nurses, which matches the training programs with
andragogical needs and desirability of learning among the staff.
Owing to its practical nature, the empowering education can
facilitate occupational tasks and achieving greater mastery of
professional skills among the nurses.
Keywords: Grounded theory; Model; Nurse; Training

Introduction of organizational and the workforce interests.

E ducation plays an important role in achieving

organizational goals through a combination
Nowadays, training is an essential factor
contributing to greater efficiency of the staff and

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Chaghari M et al. Empowering education

organizations. In fact, it is a vital investment that nursing staff training. Grounded theory method is
will lead to internal promotion, staff development an effective method to identify these components.
and success of organizational plans. Training This study intended to provide a new model of
is an investment in achieving productivity and in-service training for the nursing staff.
employee retention through providing career
development and job satisfaction in the long Methods
run (1,2). Training programs are essential for This study was conducted in two stages.
the survival and viability of the organization in In the first stage, the Grounded Theory was
the competition arena (3). The literature review adopted to fully examine the training process of
suggests that certain training programs do not nursing staff. In the second stage, the findings
demonstrate any efficacy in improving the were employed through Walker and Avant’s
quality of patient care (4). In order to expand the strategy for theory construction (2005) (14) so
capacities and improve educational outputs, it as to design an optimal model for in-service
is crucial to develop and adopt new models of training of the nursing staff. The study took place
clinical education for nurses (5). In addition to at Baqiyatallah University of Medical Sciences
the theoretical knowledge, vocational training hospitals in Tehran. Obtaining the participants’
should enhance the technical capacity and confidence and real answers to the questions were
quality of services, leading to innovation (6). limitations of the study. For collecting deeper and
Training programs must be organized in such a better data, the researcher found a part-time job
way that they enhance the beneficial capabilities in one of the hospitals
of employees (7). In-service training includes a Data were collected from November 2013 to
set of measures taken to promote empowerment December 2015. The samples comprised a total of
and competency among employees for the 35 nurses, nursing managers, training managers
better undertaking of their tasks, thus helping and senior managers working at the hospitals.
the organization to achieve its goals (8). One The sampling was initially purposeful and then
of the main features of in-service training is theoretically based on emerging concepts and
applicability. Previous research has shown that continued until data saturation. The data were
job characteristics and professional factors can collected through semi-structured interviews,
contribute to the involvement of employees in field notes and literature review. A total of 42
in-service training (9). Nurses play an important interviews were administered with an average
role in improving health standards. Hence, they duration of 60 minutes. Each interview was
need to be updated about theoretical and practical recorded by a digital device and then implemented
knowledge in this field (10). In fact, in-service on the same day after listening for several
training serves to update the staff’s occupational times. The researcher participated in 21 training
knowledge and professional skills and improve programs and took field notes. Additionally, the
the best practices for fulfilling various tasks documents including instructions and directives
and responsibilities (8). Another important were reviewed and analyzed.
point concerning the in-service training of the The data were analyzed through Corbin and
nursing staff is their active participation in such Strauss method (2008) involving coding for
programs. Active participation of nurses in in- concepts, analysis for contexts and processes,
service training can lead to effective learning analysis for consequences, and finally integration
and development in their field of work. One of of categories to build theoretical framework (15).
the factors contributing to greater involvement The data were coded through MAXQDA-10.
of the staff in such programs is the utilization Analytical techniques included comparisons,
of adult learning principles. Adults are aware of asking questions, flip-flop technique, and
learning objectives, guide their own learning, waving-the-red-flag technique. The comparisons
and they are self-assessor (11). Moreover, self- constantly evaluated the phenomena, concepts
centered learning has been offered as a lifelong and events in terms of similarities and differences.
learning technique in medical education (12). The The questions were continuously asked about
in-service training programs for the nursing staff the essence of the data, covering topics such as
have been implemented in various forms and who, what, when, where, how and with what
methods in Iran, but have unfortunately left little consequences. Waving-the-red-flag technique
impact on their occupational outcomes (13). Due served to find out in what circumstances a
to the limited knowledge, undefined concepts and phenomenon always occurs or usually does not
undeveloped relationship between concepts, it’s occur. In this way, the Grounded Theory was
necessary to explore nursing in-service training formed. Having developed the descriptive theory,
components and design a streamlined model for the Walker and Avant’s Strategy for theory

J Adv Med Educ Prof. January 2017; Vol 5 No 1   27

Empowering education Chaghari M et al.

construction (2005) was employed to generate managers. There were 17 male and 18 female
a prescriptive theory. At first, a set of relevant samples aged 27 to 51 years old with a mean
core concepts were outlined to expand the model. age of 39.08. The education levels varied from
The core concept was derived from the grounded Bachelor's to doctorate.
theory and main concern of the participants so as This study obtained 5 major themes, 10 main
to further expand the model. At the next stage, the categories and 22 sub-categories (Table 1).
paradigmatic and meta-paradigmatic concepts The core concepts included unsuccessful
within the model were identified, followed by a mandatory education, empowering education,
review of related literature. Finally, the concepts organizational challenges of education, weakness
and statements were extracted from the selected in educational management, and educational-job
texts, which were then systematically organized resiliency. Unsuccessful training was the main
into a model. concern of the participants, while the empowering
education was the core concept extracted from
Data trustworthiness the data. Hence, the grounded theory of effort
The strategies presented by Guba and for empowering education was developed. The
Lincoln were adopted to ensure the accuracy and ultimate objective of the research was achieved
reliability of the results (16). The researcher was through analyzing the first-stage findings
continuously involved with the data, which were through Walker and Avant’s method. Since the
confirmed by the participants, the research team core category and grounded theory in the first
and two outsider experts (credibility). Moreover, stage involved effort for empowering education,
two members of the research team coded the the second stage adopted the empowering
interviews independently and finally reached education model as the core concept. Moreover,
a consensus (dependability). In collecting and the paradigmatic concepts of human, learning,
recording the data, sufficient time was allocated nursing and environment were taken into account
(18 months) and utmost accuracy was exercised as the literature review revolved mainly around
(confirmability). The data were validated by two the new model, where the conceptual framework
specialists (transferability). was composed of other concepts. The researcher
extensively and systematically reviewed the
Ethical consideration entire available literature concerning the core
This study was approved by the Ethics concept and the relevant paradigmatic concepts,
Committee of the Baqiyatallah University of whose correlations and contributing factors were
Medical Sciences. Moreover, well-informed identified based on the results obtained from the
consent of the participants was obtained during grounded theory research. In this regard, English
data collection. Furthermore, the participants and Persian literature were searched for several
remained anonymous with the right to withdraw key model concepts and elements as follows.
from the study at any stage. Certain parts of The nurses in this model adopt a holistic
the interviews were not recorded upon request approach to learning. In this regard, the nurses
of the participants and none of the interviews pursue a type of education that can enhance
were disclosed to maintain the confidentiality of knowledge and practical skills. In this model,
private data. the human is an entity in search of learning
and acquisition through effective training. The
Results environment is a set of elements and factors
The participants included 20 nurses, 5 nursing demanding practical learning. There are three
managers, 6 education managers and 4 senior theories resulting from comprehensive search:

Table 1: The major themes and main categories derived from the data
Major themes Categories
Unsuccessful -mandatory education Weak effectiveness
(Main concern) Preventive factors
Empowering education Self-directed learning
(Core variable) Practical learning
Organizational challenges of education Management limitations and conflicts
(Context) Structural-functional incompatibility of education and medical care
Weakness in educational management Insufficiency in personnel education stages
(Context) Insufficiency in organizational education process
Educational-Job resiliency Governance coincidence
(Consequence) Work accommodation

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Chaghari M et al. Empowering education

1. Malcolm Knowles theory: He believes learning refers to self-centeredness and initiative

the main approaches for adults learning is the in learning. Practicality is the effectiveness
problem-solving and collaborative research. of training in job functions. There are five
2. Clinical monitoring performance model: factors involved in achieving self-direction
Clinical supervision uses four key components and practicality. The self-directed learning can
of training, advocacy, facilitating and feedback. be enhanced by searching skills. Employees
3. The pattern of the Iranian Red Crescent through search in training categories and
Society staff training by PoorKarimi et al: This educational topics can lead to self-direction.
pattern contains resolution of problems related Similarly, practicality can be enhanced by
to organizational structure and attention to clinical supervision and clinical performance
motivational mechanisms. monitoring. There are three additional factors
Empowering education obtained from the contributing to both self-directed learning and
combination of grounded theory and results of practicality, including motivation, employee
comprehensive search. Empowering education participation in training design and educational
entails characteristics including participatory implementation and problem-solving approach.
training of the nursing staff in terms of planning Problem-solving approach refers to training the
and implementation, problem-solving approach, topics in which employees are having difficulty
result-oriented content, training implementation when doing their job duties. In addition to these
practices, focus on motivational factors, fostering topics, there are two underlying factors that can
the searching skills, and clinical performance affect all the other factors, including tackling
monitoring (Figure 1). the organizational challenges and overcoming
As illustrated in the Figure, the empowering the inefficiencies of educational management.
education entails two main components of Organizational challenges refer to some of the
self-direction and practicality. Self-directed organizational procedures that are in conflict with

Figure 1: Empowering education model

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Empowering education Chaghari M et al.

the nature and goals of educational programs, (2009) concluded that the staff will perform
for example, financial constraints and conflicts successfully and fruitfully when they feel the
arisen by different management divisions against support, supervision and responsibility of the
education. In the empowering education, such management (24). That was considered in the
organizational challenges must be eliminated. current research. Concerning how to tackle the
organizational challenges, this research has
Discussion suggested that the solution is to inform and
The empowering education refers to self- guide the hospital administrators. Ammentorp
direction and practicality. Self-directed learning et al. (2012) introduced and examined a new
represents self-centeredness and initiative in model which fosters the mutual understanding
learning. Also, practicality is application of and resolution of the patients’’ problems on the
training in job functions. There have so far been part of nursing staff. This model focused on
numerous models designed for in-service training communication techniques, attempting to find
of staff. The basic models mainly focused on out how the staff listen to complaints, assist the
the procedures and functions of staff training patients to express their problems and how to
(17, 18) For instance, Craig suggested that staff correctly respond the patients’ questions (25).
training process is composed of five stages: In fact, the model concentrated on training
planning, analysis, design, implementation and practices. Similarly, the new model proposed
development (19). Some experts in the design in the current study concentrated on training
of educational models put more emphasis on practices. However, it incorporated an extensive
teaching methods and materials (20). Others teaching method based on self-directed learning,
believe that the most important component of where the adoption of strategies and evaluation
staff training is the teaching method and how of its outcomes are assigned to the learners
pedagogical concepts are conveyed (21). This themselves (11). Self-directed learning is a process
study rather emphasized the effectiveness of staff in which students are engaged in identifying
training through modifying its essence and goals. the pedagogical needs, setting the learning
Moreover, self-direction and practicality are objectives, identifying the resources for learning,
two main components of empowering education selecting and implementing the educational
aligned with the effectiveness of nursing staff strategies, and evaluating the learning outcomes
training. The empowering education adopted (26). The self-directed learning mainly serves to
several pragmatic strategies such as fostering the foster the searching skills (27). Self-direction in
searching skills, clinical performance monitoring, medical education has been adopted as a lifelong
motivational factors, staff participation in the learning strategy (12). Parsons and Rollyson J
design and implementation of training, problem- (2012) proposed a model proving effective and
solving approach, tackling organizational efficient in teaching the behavioral techniques
challenges, and overcoming the inefficiencies of and skills among the nursing staff, known as
educational management. Chen and Klimoski evidence-based education (28). This model will
(2007) proposed a model that focuses mainly on initially provide a method for the presentation of
”teaching method“and ”providing the essential pedagogical materials. Second, it will match the
grounds for staff training (22(“. The current behavioral skills as a practical model. In their
study entails solutions beyond such themes. study, Sajjadnia et al. (2013) demonstrated that
In fact, this study presented a new teaching in-service training can be far more effective when
method, where the nursing staff participate the pedagogical materials are relevant to the
in the design and implementation of training actual profession of nursing (9). Moreover, Udaya
programs. The participation of nursing staff in et al. (2011) found that task analysis could provide
the design and implementation of the training an ideal technique in outlining the content of pre-
programs can render the content materials service and in-service training (29). In simple
desirably proportionate to the staff needs and terms, the above studies suggested that nursing
wishes. Poorparimi et al. (2010) proposed a staff training content should be practical and
model for in-service training of staff at the proportionate to their job description. Similarly,
Iranian Red Crescent Society (IRCS), where the the current study incorporated practicality of
educational effectiveness was achieved through learning into the new model. This characteristic
a greater concentration on motivational factors was implemented through clinical performance
(23). The same motivational factors have been monitoring. Clinical monitoring is a modern,
incorporated into the model presented by the on-the-way-of-achieving-recognition approach
current study. In a research on in-service staff within the nursing community. In fact, it is
training at a rehabilitation center, Saunders deemed a mechanism aiming to promote the

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Chaghari M et al. Empowering education

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