JNPDJournal for Nurses in Professional Development & Volume 32, Number 4, 185Y191 & Copyright B 2016 Wolters Kluwer Health, Inc. All rights reserved.Learning Needs AssessmentNot Only for Continuing Education2.0 ANCCContactHoursJobeth Pilcher, EdD, RN-BCAn accurate assessment of what participants need to learnis a crucial initial step in planning educational activities.Methods for assessing learner needs can include reviewingthe literature, benchmarking, reviewing documents, seekinglearner input, and multiple other data collection methods.The purpose of this article is to provide nursing professionaldevelopment practitioners with an overview of learning needsassessments, including definitions, categories, measurementtools, and steps to perform the assessment.Medical knowledge is growing exponentiallyand is constantly evolving. It is often the roleof the educator to assure that new knowledgereaches the end user. A significant challenge is decidingwhat educational issues should be given priority. Learning activities are time consuming and expensive todevelop and deliver. As a result, educators must makeinformed decisions regarding what and how educationshould be provided. An assessment of what needs tobe learned and strategies to best meet the need can assistwith decision making. Performing a learning needs assessment (LNA) should be considered as an essential step in theplanning process, as it can help ascertain that educationalactivities are designed for the purposes of enhancing learning outcomes, improving patient outcomes, and optimizingcost-effectiveness of organizational resources.The purpose of this article is to provide educators withan overview of LNAs, including definitions, categories,measurement tools, and steps to perform the assessment.The article is based on a detailed search and review of theliterature using healthcare and education databases. It isimportant to note that limited current literature was presenton this topic. As a result, this article includes older references and sources from a variety of professions.Jobeth Pilcher, EdD, RN-BC, is Nurse Professional Development Specialist, Center for Clinical and Patient Learning, Baylor Scott & WhiteHealth, Dallas, Texas.The author has disclosed that she has no significant relationships with,or financial interest in, any commercial companies pertaining to hisarticle.ADDRESS FOR CORRESPONDENCE: Jobeth Pilcher, 8992 Texas TrailPoetry, Terrell, TX 75160 (e mail: [email protected]).DOI: 10.1097/NND.0000000000000245DEFINITIONSAn LNA is a systematic approach to examining what individuals or groups need to learn (Adelson, Manolakas, &Moore, 1985). The LNA may be based on individual or organizational needs and can include informal or formalprocesses. The primary purpose of the LNA is to assist withand enhance planning of educational activities (Grant,2012). In health care, LNAs are often associated primarilywith continuing education (Dickerson, 2014; Meštrović &Rouse, 2015). However, experts have recommended theneed to conduct an LNA as a prerequisite for any formaleducational activity (Cekada, 2010; Li, 2014). It could evenbe argued that an LNA is appropriate for informal learning.The latter may not be as involved or formal of a process, yetit is appropriate to find out what individuals need to learnbefore providing education.LNA CATEGORIESLNAs can fall into different categories including formal gapanalysis, analysis of organizational needs, analysis of learner self-identified needs, and anticipation of future needs.Although some overlap exists, each will be discussed separately in the upcoming paragraphs. Methods for assessinglearner needs can include reviewing the literature, benchmarking, reviewing documents, seeking learner input, andother data collection methods. Table 1 provides the LNAcategories with a list of data collection tools for each. Specificexamples will be provided in the upcoming paragraphs withthe discussion of each of the LNA categories.Formal Gap AnalysisGaps can occur between what is known and what should beknown (Fox & Bennett, 1998). Gaps are commonlyexpected when novices enter the workforce or when anexperienced practitioner is exposed to new patient populations, equipment, or experiences. Gaps also exist whennew knowledge becomes available from research findings,through benchmarking, and from national initiatives.A gap analysis originally referred to the careful examination of knowledge gaps. However, the definition hasmoved beyond what an individual knows and now includes whether individuals act on the knowledge. Forexample, Norman, Shannon, and Marrin (2004) specifiedthat a gap analysis should include a formal process aimedat examining current behavior as compared with ‘‘an idealJournal for Nurses in Professional DevelopmentCopyright 2016 Wolters Kluwer Health, Inc. All rights reserved.www.jnpdonline.com185
TABLE 1 LNA Categories With DataCollection StrategiesLNA CategoryLNA Data Collection ToolsGap AnalysisFormal gap analysisfor individuals andsmall groupsDebriefingPretesting and posttestingCase study with group discussionReturn demonstrationSimulationFollow-up interviewsObservationAuditsFormal gap analysis forlarger groupsReview of the literature with expertanalysisAdvisory groupsDelphi approachSurveysOrganizational NeedsJob performance LNAJob descriptionsPolicies and proceduresAuditsObservation of performancePeer reviewCompetency assessment resultsPatient recordsMorbidity patternsPatient satisfaction surveysRisk assessmentError reportingAdverse eventsFocus or advisory groupTraining LNAStandards and guidelinesAdvisory groupConsumer needs LNAPatient outcome measuresReview of adverse eventsObservationAuditsAHRQ toolsPatient satisfaction surveysServices needed for clientSWOT analysisLearner-Identified NeedsLearner-identified LNASurveysInterviewsFocus groupsDiaries/reflectionDifficulties arising from practiceFuture NeedsAnticipation LNADashboard developmentMonitoring/analysis of new literatureAnalysis of eLearningAHRQ Agency for Healthcare Research and Quality; LNA learning needsassessment; SWOT strengths, weaknesses, opportunities, and threats.186or accepted standard of practice’’ (p. 1000). Grant (2012)described a gap analysis as a method to identify discrepancieswhen comparing performance with expected competencies.A gap analysis can be used to assist individual learners orgroups of learners. A formal gap analysis is a commonly usedmethod to document the need for continuing education (CE)activities for healthcare professionals (Desilets, Dickerson, &Lavin, 2013; Meštrović & Rouse, 2015; Owen & Schmitt, 2013).A gap can be identified through a careful analysis of performance improvement outcomes, quality improvementinitiatives, or examination of sentinel events (Desilets et al.,2013). When analyzing these issues, it is important to evaluate if the problem is a gap in knowledge, skill, or practice.Lubejko (2015) recommended debriefing, pretesting andposttesting, and case study with group discussion as toolsto assess gaps in knowledge. Gaps in skills can be measuredwith case studies, return demonstration, and simulation. Gapsin practice can be measured with follow-up interviews, observation, and audits. These strategies can provide objectivemeasures of learning needs for individuals and small groupsof learners.For larger groups, surveys are a commonly used gapanalysis tool. A review of the literature can be conductedto determine if a survey tool is already available, or couldbe modified (with permission), to address the issue of interest. If not, a survey may need to be developed. Designingan effective survey requires expertise and testing to assurethat the tool measures what it is intended to measure(National Institutes for Health, 2015; Wiersma & Jurs, 2009).LNA surveys commonly employ a Likert-style answer format,with scales of 3Y7 choices. The types of questions and response choices vary based on the situation. For example, alearner can rate the level of importance of learning about apotential topic with choices ranging from ‘‘not at all’’ to ‘‘extremely important’’ (Foy, Carlson, & White, 2013). OtherLNAs may be aimed at measuring frequency of performance,with ranges from ‘‘never’’ to ‘‘often’’ (Johnson & Puglia, 2012).An LNA can address learner confidence with scales rangingfrom ‘‘not confident at all’’ to ‘‘highly confident’’ (Hecimovich& Volet, 2014). Another example can include self-ratedcompetence level, ranging from ‘‘no exposure’’ to ‘‘totallycompetent’’ (McCrystle, Murray, & Pinheiro, 2010).The advantages of using a survey include the potentialto reach a larger number of learners and gain a more variedperspective. The disadvantages include the concern regarding the learner’s ability to judge their own learningneeds and the typical low response rate associated withsurveys (Fan & Yan, 2010; Grant, 2012). In addition, ifthe survey is developed without validity or reliability testing, the results may not provide an accurate picture of thelearning needs. Validity refers to how well the survey measures what it was intended to measure (Johnson &Christensen, 2008; Wiersma & Jurs, 2009). Types of validitytesting include construct, criterion, and sampling validity.www.jnpdonline.comJuly/August 2016Copyright 2016 Wolters Kluwer Health, Inc. All rights reserved.
Reliability refers to the degree to which the survey produces consistent results. Types of reliability testing caninclude testYretest, parallel forms, interrater, internal consistency, or factor analysis. The National Institutes ofHealth (2015), and various research textbooks, providesguidance on how to develop an effective survey.Another formal gap analysis strategy can include reviewof the literature with expert analysis (Fater, 2013). A groupof experts review data or recommendations from the literature and then examine the current situation, followed byan analysis of what educational activity will help bridge thegap between the desired and actual situations (Grant,2012). For example, a current trend could be an increasingnumber of older adults, yet a lack of geriatric courses in thelocal nursing schools. An extensive review of the literaturemay show that medication interactions are a leading causeof hospital admissions and readmissions for this population. The team of geriatric and education experts maydetermine that these findings indicate a gap in nurses’knowledge regarding geriatric pharmacology. The teamwould then recommend learning activities to fill the gap.For CE purposes, this gap would need to be documentedand supported with references from the current literature.Similar gap analysis identification strategies could include aDelphi approach, nominal group process, or advisorygroups (DeSilets, 2007).Analysis of Organizational NeedsAn organizational analysis is commonly aligned with thebusiness needs and goals of the organization and often relates to workflow, process, and outcomes (Clark, 2014;Dealtry, 2002). The employee may need to learn businessprocesses or regulations affecting the organization. Business LNAs may render information regarding problems inthe organization (Cekada, 2010). In these situations, it is important to examine the results closely and target the actualproblem. An educational intervention will not solve systemissues or problems caused by insufficient resources orstaffing (Sorenson, 2002). An organizational LNA can alsobe performed to address changing needs of the organization or the customer base (Cekada, 2010). In the healthcaresetting, an organizational LNA may include job performanceneeds, training needs, and consumer needs. Each type willbe presented separately in the upcoming paragraphs.Job performance analysisAn LNA regarding job performance may be associated witha single individual or with a group. The analysis is donewhen there are concerns regarding incomplete, unsatisfactory, or incorrect performance. The data gathered can assistin determining if education could improve performance(Brown, 2002). An initial question to help make this determination is: ‘‘Can the employee perform correctly if theirjob depends on it?’’ If they can, it is probably not an educational need. A common example is hand washing. Mostexperienced healthcare professionals understand the importance of hand washing and know how to perform itcorrectly. The problem is not a learning need. Rather thaneducation, this situation might call for the managementteam to assess processes, attitudes, or other issues thatcould be affecting compliance. Whereas, if an identifiedproblem is an educational issue, the next step would includedetermining if the deficit is present for one individual, a fewpeople, or an entire group.Tools for job performance analysis can include a reviewof job descriptions, policies and procedures, and outcomes(Cekada, 2010). Additional tools may include audits, observation of performance, peer review, competency assessmentresults, patient records, morbidity patterns, patient satisfaction surveys, risk assessment, error reporting, or adverseevents (DeSilets, 2007; Grant, 2012). Another strategy caninclude using a team approach to LNA. A focus group or advisory team could examine current job performance anddesired performance and then analyze what educationalactivity will help bridge the gap between desired and actualperformances (DeSilets, 2007; Grant, 2012).Training needs analysisThe term training is often associated with skill development for the workplace (Barnes, 2014). Examples includetraining when new equipment, policies, or processes areintroduced into the work setting. Implementation of anelectronic health record is one example. The term trainingalso refers to education aimed at meeting regulatory standards or promoting safety in the workplace (Cekada,2010). Examples include fire and safety training, harassment training, infection prevention, and similar topics.In these situations, the purpose of the LNA is not to document that education is n