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 Table of Contents  
Year : 2017  |  Volume : 5  |  Issue : 1  |  Page : 45-46

Continuing education program: A comparative study between voluntary and mandatory regimes applied to a patient safety course

1 Department of Nursing, Clinical Hospital of Uberlândia, REBRAENSP, Federal University of Uberlândia, Uberlândia, MG, Brazil
2 Department of Nursing, Clinical Hospital of Uberlândia, REBRAENSP, Federal University of Uberlândia; Department of Nursing, Faculty of Medicine, Clinical Hospital of Uberlândia; Department of Faculty Mathematics or Statistics, Institute of Biology, REBRAENSP, Federal University of Uberlândia, Uberlândia, MG, Brazil

Date of Web Publication18-Aug-2017

Correspondence Address:
Clesnan Mendes-Rodrigues
Faculdade de Medicina, Universidade Federal de Uberlandia, Av. Para, 1720 Campus Umuarama-Bloco 2U, Sala 19, Uberlandia, MG CEP 38400-902
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpsic.jpsic_10_17

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How to cite this article:
Neto RL, Mendes-Rodrigues C. Continuing education program: A comparative study between voluntary and mandatory regimes applied to a patient safety course. J Patient Saf Infect Control 2017;5:45-6

How to cite this URL:
Neto RL, Mendes-Rodrigues C. Continuing education program: A comparative study between voluntary and mandatory regimes applied to a patient safety course. J Patient Saf Infect Control [serial online] 2017 [cited 2020 Sep 19];5:45-6. Available from: http://www.jpsiconline.com/text.asp?2017/5/1/45/213281

Although there are various continuing education strategies found in a variety of institutions, there still exist few studies that measure their efficiency, in terms of mandatory or voluntary regime participation.[1] In this study, the mandatory regime is characterised as the employee being assigned to a class during working hours (shift) and the lack of participation implies in a sanction. In the voluntary regime, there is no obligation to participate and consequently no sanction.

The Nursing staff from the Clinical Hospital of Uberlândia, a Brazilian University Hospital, offered in 2013 a Healthcare Associated Infections course (lectures). The course covered some Patient Safety contents (standard precaution mechanism, hand hygiene and infections related to bloodstream). This training is mandatory based on legislation for healthcare services.[2] The course was offered initially under a voluntary regime with seven classes. However, due to the low attendance, it was re-offered in mandatory regime with nine classes. Each professional needed to attend only one class in order to be considered as trained. To evaluate the regimes, we measured the number of trained professionals, the percentage of trained professionals, the minimum, maximum and mean number of professionals per class and the percentage of trained professionals from expected number per class (PTPENC) that was calculated by the formula PTPENC = NTPC/ENPC × 100, where NTPC is the number of trained professionals per class and ENPC is the expected number of professionals per class. The ENPC was obtained through ENPC = NP/NC, where NC is the number of classes for each course and NP is the number of professionals from institution, in our case 1152. The number of professionals per course was compared with the Chi-squared test for equal expected proportions and the means across the Student's t-test.

The results demonstrate a low adherence of staff in the voluntary regime with 68 trained professionals (5.90% of the expected) in contrast to the mandatory regime with 831 trained professionals (72.14% of the expected) (χ2 = 647; df = 1; P < 0.0001). The number of trained professionals shows ample variation among classes [Figure 1]. The mean number of trained professionals per class was 9.71 for the voluntary regime versus 92.33 trained professional per class for the mandatory regime (t = 7.33; df = 8.22; P < 0.0001), with the percentage of trained expected professionals per class at 5.90% versus 72.14%, respectively, for voluntary versus mandatory regime (t = 7.54; df = 8.13; P < 0.0001).
Figure 1: Minimum, maximum and mean (±standard error) values obtained for attendance indicators for two different regimes of participation (voluntary versus mandatory) applied to a safety patient course in a continuing education program for nursing in a University Hospital in Brazil

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These results were probably due to offering the course during working hours, with physical displacement of professionals from patient unit and with flexibility to changes in time participation in the mandatory regime, as adopted by the institution. The participation in activities outside of working hours is a limiting factor concerning participation.[3]

The voluntary regime should be used for courses that do not influence healthcare quality indicators, and involve only information sharing, since these do not seem to sensitise the staff. Although mandatory courses do not necessarily develop into any additional knowledge [4] and other methods could also improve the attendance,[5] the use of mandatory regimes is a good strategy to be adopted when it comes to obligatory training, as it has shown itself as a good option for improving attendance.


We thanks the staff from Clinical Hospital of Uberlândia (CHU), CEPEPE and SCIH from CHU, to Vernon Sipple and Eliana Borges Silva Pereira for contributions.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Griscti O, Jacono J. Effectiveness of continuing education programmes in nursing: Literature review. J Adv Nurs 2006;55:449-56.  Back to cited text no. 1
Brazil. Ministry of Health. Reference document for the National Patient Safety Program/Ministry of Health; Oswaldo Cruz Foundation; National Health Surveillance Agency - Brasília: Ministry of Health; 2014. p. 40. Availabe from: http://bvsms.saude.gov.br/bvs/publicacoes/documento_referencia_programa_nacional_seguranca.pdf. [Last accessed on 2017 May 10].  Back to cited text no. 2
Chong MC, Sellick K, Francis K, Abdullah KL. What influences Malaysian nurses to participate in continuing professional education activities? Asian Nurs Res (Korean Soc Nurs Sci) 2011;5:38-47.  Back to cited text no. 3
Senge PM. The Fifth Discipline: The Heart and Practice of Learning Organization. New York: Doubleday; 1990.  Back to cited text no. 4
López Soblechero MV, González Gaya C, Hernández Ramírez JJ. A comparative study of classroom and online distance modes of official vocational education and training. PLoS One 2014;9:e96052.  Back to cited text no. 5


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