Date of Award
Projects: SPU Access Only
Doctor of Nursing Practice (DNP)
Dr. Lorie Wild
Dr. Chris Hoyle
Miriam Bagalwa, BSN, RN, DNP-AGNP - CANDIDATE
Seattle Pacific University, School of Health Sciences
Background: Mortality from opioid overdose as a national health concern in the U.S directly affects the homeless population because response to drug overdose complications is often delayed. Drug use has increased among the occupants of homeless shelters, leading to increased cases of substance use disorder, especially opioid overdoses. Staff training has been found to be effective in reducing the incidence of overdose and improving the response to overdoses in homeless shelters. Training to identify the symptoms of overdose and to respond quickly using naloxone (a Food and Drug Administration approved medication that reverses opioid overdose in this vulnerable population) can save lives (Walley et al., 2013b).
Problem statement: The Homeless Shelter (THS) developed a policy and educational program that prepared staff to recognize and manage overdose in their client population. The policy included a training program to equip shelter staff with the knowledge necessary to respond to overdose events, but an evaluation of the training program was needed to assess its effectiveness. Evaluation of training programs enables organizations to identify inefficiencies, reduce uncertainties, improve decision making and enhance effectiveness (Salas et al., 2012; Patton, 2008). Therefore, evaluating the training program for THS staff was an important step in measuring its success in achieving the desired goal of safely recognizing and managing opioid overdose.
Purpose: To determine the effectiveness of the training that the staff and employees of The Homeless Shelter received, it was necessary to measure their knowledge retention, confidence, and skills, which ranged from identifying signs of overdose to administering naloxone, one-year following training.
Methods: A post-training survey design was used to evaluate the training effectiveness and included three tools: a four-question knowledge quiz, a tool to measure the staff’s confidence in responding to an overdose, and finally, a demonstration checklist. In addition, three open ended questions were also administered to get feedback on the training evaluation sessions regarding what went well, whether the training was helpful, and if there were any added suggestions. Survey data was entered into Microsoft Excel and analyzed. Open-ended questions were thematically analyzed by taking the responses and grouping them together to form overarching categories.
Results/Outcomes: All 47 staff and employees of THS were invited to participate in the evaluation exercise, since they had gone through the training the previous year. Twelve participants from homeless shelters were involved in this evaluation study. Over 50% of the participants were able to retrieve knowledge on the signs and symptoms of an overdose, as well as the correct procedure for the administration of naloxone. Importantly, participants indicated a high level of confidence in responding to an overdose, with mean scores on the confidence scale of ≥ 8.58 of 10 across all measures. Many of the participants (60 %) successfully demonstrated the skills required to administer naloxone as checked on a checklist. Themes derived from the qualitative portion of the study included: the value of a training evaluation session, a demonstration of important lessons learned from the training, and training evaluation of the staff’s practices.
Sustainability Plan: Based on results and participant feedback as a part of the evaluation, the following sustainability plan is suggested: Ensure funding/budget support for training and annual review. Apportioning a fraction of the organization’s finances to maintain the training program will ensure the program continues beyond a first run. To ensure consistency of response to overdose events, standardize NAP training for THS staff and volunteers. Annual review of the program and event debriefing sessions will ensure that evaluation procedures remain current and appropriate to the shelter’s needs. Disseminate the training program to other homeless shelters and share the evaluation of the trainings of naloxone administration to other homeless shelters. As part of the sustainability of the training program, reassessing skills, and refreshing learning on a regular basis may be helpful for knowledge retention as part of the sustainability of the training program.
Implications for Practice: This training evaluation project demonstrates the value of skills practice and general refresher training in all institutions as this helps improve the level of performance of the employees (Cowman & McCarthy, 2016). In the health and medical arena, nurses are well positioned to effectively and efficiently teach and train staff members at homeless shelters. Because of their critical thinking skills, nurses are able to recognize the signs of life-threatening circumstances during training and emphasize signs not to be missed following the ABCs of first aid. Advanced clinical practitioners are trained to measure whether the institutional goals and objectives of the training are achieved, and to enhance the monitoring and evaluation systems for related policies and procedures. This can be achieved by identifying training needs and developing policies that would improve the delivery of care and services to the homeless population. Lastly, the study adds to the body of knowledge regarding training evaluation programs and provides the basis for more research.
Cowman, M. C., & McCarthy, A. M. (2016). The impact of demographic and situational factors on training transfer in a health care setting. The Irish Journal of Management, 35(2), 129-142. doi:10.1515/ijm-2016-0009
Patton, M.Q (2008). Utilization-focused evaluation. (4th ed). Thousand Oaks, Ca: Sage Publications. https://www.sagepub.com/books/Book229324#tabview=toc
Salas, E., Tannenbaum, S.I., Kraiger, K, & Smith-Jentsch, K.A. (2012). The science of training & development in organizations: what matters in practice. Psychological Science in the Public Interest 13(2) 74 –101. https://doi.org/ 10.1177/1529100612436661
Walley, A.Y., Xuan, Z, Hackman, H.H, Quinn, E., Doe-Simkins, M., Sorensen-Alawad, A., Ruiz, S., & Ozonoff, A. (2013b). Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis. British Medical Journal, 346, f174. https:// doi.org/10.1136/bmj.f174
Bagalwa, Mimie, "EVALUATION THE NALOXONE ADMINISTRATION PROGRAM" (2020). Doctor of Nursing Practice (DNP) Scholarly Projects. 12.