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Purpose: This review of the literature examines the effectiveness of continuing education programs in long-term care facilities. Design and Methods: A comprehensive literature search was made for evaluation studies and included computerized bibliographic databases, manual searches of journals, the bibliographies of retrieved articles, and information from key informants. Results: Forty-eight studies met our selection criteria. Rigorous research in this area has been limited. Because of the lack of follow-up evaluation, there is minimal evidence that knowledge gained from training programs is sustained in the long term. Most studies do not consider organizational and system factors when planning and implementing training initiatives. This may account for difficulties encountered in the sustained transfer of knowledge to practice. Implications: There is a need for further rigorous research on the effectiveness of continuing education in long-term care, with systematic attention to the role of organizational and system factors. Training staff in the long-term care setting is a relatively new phenomenon. In the early 1980s, researchers in the United States were reporting that nursing assistants were providing up to 90% of resident care and receiving little or no training (Waxman, Carmen, & Berkenstock, 1984). The primary treatment model was based on a custodial model of care in which staff met the basic needs of residents. Burgio and Burgio (1990) noted, in an early review of the nursing assistant training literature, that the few articles published on this topic prior to 1987, with two notable exceptions, debated whether resources should even be invested in training these workers. The paramount need for staff training was realized in the mid to late 1980s as the organization of long-term care underwent significant change. First, there was a shift in societal attitudes about health and aging toward support for a more therapeutic model of care for elderly people. The current custodial model began to give way to a new, more restorative or rehabilitative model of care. New learning and development was required to effect this change (Burgio & Scilley, 1994). |
