Taiwanese health authorities are increasingly applying case management as a health care delivery strategy in the community. However, most Taiwanese public health nurses (PHNs) do not receive case management education because there are few education programs available. Several limitations in existing evaluative studies of case management continuing education programs were identified. These methodological weaknesses limit the conclusions that can be drawn about the effectiveness of these education programs. Hence, the purpose of this study was to develop, implement and evaluate a collaborative case management continuing education program for Taiwanese PHNs. The study was divided into three phases, with an expanded theoretical framework used to guide the program development, implementation and evaluation. Phase One conducted focus group discussions in order to assess the educational needs of Taiwanese PHNs. Phase Two developed a collaborative education program based on the findings of a literature review and the needs assessment. The initial program was evaluated by an expert panel and pilot testing was undertaken. Phase Three implemented and evaluated the program using an experimental research design and mixed evaluation methods. Three outcome levels were assessed, namely reaction, learning and performance by examining changes in PHNs' case management knowledge, skills and practice. The participants in the study were PHNs employed in health centres in Taipei City. The program itself involved 16 hours of workshops through four half-day sessions, conducted every two weeks during the participants' work time and at their workplace. Two types of data, focus group data and questionnaire data, were collected during the course of the study. The focus groups were conducted before and after the program delivery, for the needs assessment and program evaluation, using a subset of the participants. The focus groups were moderated by the researcher, who used a focus group discussion guide to collect data. The other data set was collected using self-report questionnaires. The participants were randomly allocated into two groups using cluster sampling, the experimental and comparison groups. Both groups were given questionnaires before the education program commenced, and then again eight weeks after the program was completed. For ethical considerations, PHNs in the comparison group also received the same program after data collection. The results revealed that the majority of participants were satisfied with the program. The education intervention significantly improved PHNs' case management knowledge, performance skills confidence, preparedness for case manager role activities, frequency of using case management skills, and frequency of using these role activities. A number of changes in case management practice were reported, in particular that the participants tended to follow the case management process more often and focus more on the quality of case management. This study was guided by an integrated theoretical framework, and used a clustered randomised controlled design to assess the effectiveness of the program across multiple levels of outcomes, hence addressing the design deficits identified in the prior evaluative studies. This study therefore provides an important contribution to the fields of nursing and case management by developing, implementing and evaluating a case management education program. Additionally, the program itself offers an evidence-based educational experience for PHNs and provides a new tool for nursing education in the context of Taiwan.
| Identifer | oai:union.ndltd.org:ADTP/265388 |
| Date | January 2007 |
| Creators | Liu, Wen-I |
| Publisher | Queensland University of Technology |
| Source Sets | Australiasian Digital Theses Program |
| Detected Language | English |
| Rights | Copyright Wen-I Liu |
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