441 The Journal of Continuing Education in Nursing �� Vol 41, No 10, 2010 Earn 2.3 Contact Hours cne arTiClE Deterrents to Nurses��� Participation in Continuing Professional Development: An Integrative Literature Review Donna J. Schweitzer, MSN, APN, CCNS, CCRN, and Teresa J. Krassa, PhD, RN, CNE abstract Background: Continuing education (CE) helps nurses keep their practice safe and current. although the literature provides information about motivating strategies, learning styles and settings, and reinforcement of the need to update skills, little research has focused on barriers to nurses��� CE program attendance. This literature review describes factors that deter nurses��� CE attendance. Methods: Ten research studies published between 1990 and 2008 addressing barriers to nurses��� CE participation were located. Results: The most frequent deterrents found were the cost of attending CE, inability to get time off from work to at- tend CE, and child care and home responsibilities. Conclusion: leaders supporting CE must understand factors that motivate and prevent nurses from participating in CE. implications from this study can assist educators to develop CE offerings to better meet staff needs and increase participation. J Contin Educ Nurs 2010 41(10):441-447. Ms. Schweitzer is Clinical Nurse Specialist, Advocate BroMenn Medical Center, Bloomington, Illinois. Dr. Krassa is Clinical Assistant Professor, University of Illinois at Chicago College of Nursing, Chi- cago, Illinois. The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support. Address correspondence to Donna J. Schweitzer, MSN, APN, CCNS, CCRN, Advocate BroMenn Medical Center, 1304 Franklin Avenue, Normal, IL 61761. E-mail: djsnrs1@msn.com. Received: June 26, 2009 Accepted: February 22, 2010 Posted: June 8, 2010. doi:10.3928/00220124-20100601-05 Tcreating echnology and nursing practice continually change, a need for nurses to pursue continuing edu- cation (CE) to remain competent. CE is well supported as one means of maintaining competency (Slusher et al., 2000). Nurses participate in CE for reasons that range from intrinsic or extrinsic motivation (Kubsch, Henniges, Lorenzoni, Eckardt, & Oleniczak, 2003) to valuing life- HOW TO OBTAIN CONTACT HOuRs BY READING THIs IssuE Instructions: 2.3 contact hours will be awarded for this activity. a contact hour is 60 minutes of instruction. This is a learner-paced Program. Vindico Medical Education does not require submission of the quiz answers. a contact hour certificate will be awarded 4-6 weeks following receipt of your completed registration Form, including the Evaluation portion. To obtain contact hours: 1. read the article: ���Deterrents to Nurses��� Participation in Continuing Professional Development: an integrative literature review,��� on pages 441-447, carefully noting the tables and other illustrative materials that are provided to enhance your knowledge and understanding of the content. 2. read each question and record your answers. after completing all questions, compare your answers to those provided within this issue. 3. Type or print your full name and address and your Social Security number in the spaces provided on the registration Form. indicate the total time spent on the activity (reading article and completing quiz). Forms and quizzes cannot be processed if this section is incomplete. all participants are required by the accreditation agency to attest to the time spent completing the activity. 4. Forward the completed registration Form with your check or money order for $15 made payable to JCEN-CNE. Payment must be in U.S. dollars drawn on a U.S. bank. This activity is valid from October 1, 2010, to September 30, 2012. Vindico Medical Education is an approved provider of continuing nursing education by the New Jersey state Nurses Association, an accredited approver by the American Nurses Credentialing Center���s Commission on Accreditation. P188-6/09-12. This activity is co-provided by Vindico Medical Education and The Journal of ConTinuing eduCaTion in nursing. Objectives: after studying the article, ���Deterrents to Nurses��� Participation in Continuing Professional Development: an integrative literature review,��� in this issue, the participant will: 1. identify reasons why nurses attend continuing education (CE) offerings. 2. Describe the main deterrents to nurses��� attending CE offerings. 3. Discuss the roles of intrinsic versus extrinsic motivation in relation to nurses��� attending CE offerings. 4. Discuss the limitations of the articles reviewed in the study sample. 5. Describe the implications of the findings of the integrative literature review for clinical nurse educators who develop CE activities for nurses. AuTHOR DIsCLOsuRE sTATEMENT The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support. COMMERCIAL suPPORT sTATEMENT all author(s) and planners have agreed that this activity will be free of bias. There is no commercial company support for this activity. There is no noncommercial support for this activity.

442 Copyright �� SlaCK incorporated long learning (Huggins, 2004 Hughes, 2005). Kubsch et al. (2003) found that nurses had generally good attitudes about CE attendance extrinsic reinforcement is a weak motivator, and intrinsic reinforcement is a key influence. Dealy and Bass (1995) showed motivating factors that included nurses��� desire to be current, obtain immediate practical benefit, secure advancement, meet formal re- quirements, and interact with colleagues. With CE atten- dance, job satisfaction is increased (Kubsch et al., 2003), burnout is decreased (Espeland, 2006 Kubsch et al., 2003), and skills are updated (Slusher et al., 2000 Wood, 2006). Orem���s model (2001) indicates that nursing agency includes the capabilities that nurses require to provide nursing care effectively it includes knowledge, skills, and ability to provide effective care. Nurses are expected to continually update their knowledge base to care effec- tively for others. Nursing prudence demands that nurses continue to advance their knowledge in nursing and its foundational disciplines (Orem, 2001). This advancement can be accomplished through CE. Some nurses do not attend CE, thereby failing to fully develop their nurs- ing agency. This study was conducted to identify factors identified in the research literature that nurses perceive as deterrents to their participation in CE. Research ques- tions were as follows: What deterrents to participation in nursing CE are re- ported in the literature? What are the implications of these deterrents for clini- cal nurse educators who are charged with providing CE opportunities for nurses? METHODs Research Design The design for this study was an integrative literature review exploring research on deterrents to nurses��� par- ticipation in CE. Integrative literature reviews mirror primary research by using the studies as the subjects and the method as the reviewing procedure. The data are the characteristics of the studies (as listed in the Table) and the results are the conclusions drawn (Ganong, 1987). The critique may show consistent findings and strengths of completed research, but may show inaccuracies, indi- cating that further study is needed (Torraco, 2005). study sample A literature search was performed using library data- bases. Key words included education, nursing, continu- ing, motivation, lifelong learning, barriers, participation, and deterrents. The initial search resulted in 96 articles. In addition, the tables of contents of The Journal of Continu- ing Education in Nursing and the reference lists of articles that appeared to meet the study criteria were examined to identify further studies. After the abstracts had been read, 16 articles appeared to meet the study criteria. On reading these 16 articles, a total of 10 studies that met the inclusion criteria were identified. The sample consists of studies examining reasons for nonparticipation in nursing CE. Inclusion criteria for the studies were as follows: (1) published between 1990 and 2008 (2) located through a computerized search of the Cumulative Index to Nursing and Allied Health Literature, MEDLINE, and ERIC da- tabases (3) published in English (4) designed to examine reasons for nonparticipation in CE (5) designed to exam- ine reasons for participation, but include an examination of the reasons for nonparticipation (6) examined face-to- face CE opportunities (not online CE opportunities) and (7) described the CE opportunity as an in-service program or seminar (not postgraduate coursework). Data Collection and Analysis A modified version of a data collection tool (Jordan, 2003) was developed to record information from each study and provide a framework for analysis of the infor- mation. This information included: (1) authors, (2) year of publication, (3) purpose, (4) conceptual framework, (5) study design, (6) sample, (7) inclusion criteria, (8) set- ting, (9) tools or instruments, (10) reliability and validity measures (for quantitative studies), (11) trustworthiness (for qualitative studies), (12) statistical analysis, (13) re- sults, (14) conclusions, (15) limitations, and (16) impli- cations for nursing education, practice, and research. Each study was critiqued using the tool and reported as described later. Ganong (1987) indicated that the study results are not the only important information to be con- sidered. Each study has characteristics that can affect the findings and therefore should be systematically exam- ined. A table was developed to show the characteristics of each study so that the reader can see the factors that may have affected the results (Table). A descriptive anal- ysis was written to compare the research studies��� designs and instrumentation, samples, results, and implications. REsuLTs study Designs and Instrumentation A quantitative, descriptive research design was used for 9 of the 10 studies. A variety of questionnaires were used, including the Bye questionnaire (Bye, 1988), Adult Atti- tude Toward Continuing Education Scale (Darkenwald & Hayes, 1988), Deterrents to Participation Scale (Scanlon, 1982), and four questionnaires developed by the authors. One study used a purely qualitative approach by con- ducting interviews with open-ended questions. Two of the quantitative studies used qualitative analysis of a few open-ended questions about participation. Earn 2.3 Contact Hours cne arTiClE