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Behind the Scenes of Self-Study Continuing Education

Monday June 2, 2008
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Peeking behind the scenes of self-study continuing education programs at Nursing Spectrum CE is a bit like visiting the set of a popular TV show. You’ll find a team of people collaborating in masterful synergy to produce a quality product.

Let’s take a look at the “show” from beginning to end through the eyes of those who create it.

Ideas and pitches

Where do all those great ideas for CE programs come from? Like most great entertainment, the answer is “from real life.” Nan Callender-Price, RN, MA, director/editor of CE, learner-paced activities, helps real life along by conducting regular needs assessments to identify “hot” topics in the nursing field. (See “Is there an audience?”)

In addition, regular writers for Nursing Spectrum CE aren’t shy about pitching their own ideas. How those ideas rise to the top makes for some interesting stories.

Susanne Pavlovich-Danis, RN, MSN, ARNP-C, CDE, wrote Awareness Enhances Care for Muslim Patients (CE441). She got the idea from her practice, where she cares for many patients who follow the Muslim faith.

“Their whole existence changed after 9/11 — there was victimization and other bad experiences,” she says. “I wanted to enhance awareness and let nurses know how to make them more comfortable.”

Maureen Habel, RN, MA, says the idea for her course Decades Later — Post-Polio Syndrome (CE450) came from close to home — she has friends with the condition. Connie Goldsmith, RN, MPA, found inspiration for her CE Good Things Come in Nanotech Packages (CE406) while writing a book titled Cutting-Edge Medicine for fourth graders. And Connie Chettle, RN, MS, MPH, CIC, COHN-S, who usually writes on infection-related topics, finds ideas all around her: the hospital where she works, in the newspapers, and online.

These four, the most experienced of the CE writers, have written nearly 100 CE modules.

Once a topic is selected, Callender-Price chooses a writer with all the care of Steven Spielberg casting his next movie.

“We have about a dozen regular writers, each with his or her own strengths, clinical experiences, and expertise,” she says. “I have to match the right writer with the right topic.” If Callender-Price doesn’t have a writer with the appropriate expertise, she embarks on a talent search, asking for recommendations from other CE nurse planners and experts in the field.

Digging, then digging some more

Nursing Spectrum CE writers have to be as meticulous in their research as if they were writing a documentary film. After all, patient care is on the line. The information must be accurate so nurses can apply it in their practice.

Habel heads to the Internet for a thorough literature search and taps into university and medical center libraries nearby.

“My first step is to find out what’s out there, which is always a huge amount of information,” she says. “Once I get the lay of the land of what’s out there, I start working on the objectives and a basic abstract of about 50 words so I can focus the article. This is my beacon throughout the article.”

Pavlovich-Danis is a university professor, so she has easy access to databases, including CINAHL and PubMed. She reads the original articles.

“You can’t just read the abstract and get the full picture,” she explains.

To meet the demand for evidence-based information, writers tap into resources, such as AHRQ and the Cochrane Collection. Depending on the topic, writers also check national organizations such as the American Heart Association.

“I stick to sites with .edu or .org in the URL,” says Pavlovich Danis, adding with a laugh, “as opposed to ‘Jim’s website.’” However, she doesn’t discount commercial and “home grown” sites. “It’s good to know what our patients are reading. They often don’t know it’s bad information.”

Goldsmith uses EurekAlert, saying, “It’s a good source for the very latest in medicine.” She subscribes, at no charge, to the table of contents of many medical journals, such as JAMA, The New England Journal of Medicine, and Circulation, and to press releases from government agencies, such as the National Institutes of Health. Listservs are another resource: Goldsmith uses ProMed-mail, the Program for Monitoring Emerging Disease. She also takes advantage of Google Alerts (www.google.com/alerts), a free service that delivers links to news items about a specific topic on a daily, as news happens, or weekly basis directly to her e-mail in-box. “Right now I’m working on a book about malaria, so I’m getting information from around the world,” says Goldsmith. “It might be from India or it might be a magazine in the U.S.” In addition, she accesses Linkout (www.ncbi.nlm.nih.gov/projects/ linkout), which contains resources such as links to full-text publications.

Writers are often creative in finding sources. For her Muslim article, Pavlovich-Danis spoke with Muslims from different geographic areas, such as Africa, Turkey, and the Philippines.

“Each person gave me a little different insight into his or her practice, which made for a more meaningful article.”

Quality is the star

Callender-Price stresses that quality, in the form of accuracy and clinical applicability, is key for successful CE.

Even though the manuscripts undergo rigorous peer review, Pavlovich-Danis sometimes has others review it too. She doesn’t limit herself to nurses; for her module on stroke, she asked for reviews from physical therapists and speech language pathologists. Habel sometimes obtains consumer input for short teaching items that are designed for use with patients.

The tough decisions come when determining what makes it into the final cut.

“I put myself in the position of the reader,” says Habel. ”What could I do with this information after I’ve read the article. How will it improve the care of my patients?”

Writers go through a few drafts of the module reorganizing a section here, tweaking a sentence there — all to improve the manuscript.

“I try to take all the ‘gobbley gook’ out of it,” says Habel. “I make the writing crisper, clearer, and make sure there’s flow from one paragraph to another.”

The writers strive for a conversational style, while still delivering content supported by the nursing and medical literature.

Sometimes writers are paired with a content expert, says Goldsmith. “Experts may not have the time or interest to write the complete article, but have the expert knowledge.”

A hallmark of Nursing Spectrum CE modules is the clinical vignette, a case study that is required for most clinical CE modules.

“We decided we wanted a more interactive exercise geared to the web,” says Callender-Price. Readers take the vignette before they take the CE post test to assess if they can apply what they’ve learned.”

Readers must get all four questions correct before proceeding to the post test.

Callender-Price says the vignettes have been a hit: “They help meet Magnet requirements, and teachers love it because it helps learners apply the knowledge.”

Writers draw from various sources to create vignettes.

“I use my experience in the hospital where I work to make it [the vignette] more effective and realistic,” says Chettle. “And I have two daughters who are nurses, so they give me ideas too.”

Patient privacy is protected and sometimes composite patients are used for the vignette.

Callender-Price reviews each manuscript several times, checking the accuracy of drug information, adding hyperlinks for key websites, and rewriting and reorganizing as necessary to make sure the material is clear.

The reviews are in

All CE offerings undergo peer review, a process that can challenge even the best writers, particularly when reviewers give conflicting advice. Writers reconcile the conflicts, working with Callender-Price as necessary, and revise the manuscript. Writers may choose not to make changes suggested by the reviewers, provided they supply a rationale for not doing so. Goldsmith notes reviewers frequently want to include additional worthwhile information; however, that’s not always an option. “We have a specific limit on our word count,” she says.

That said, writers appreciate the input from the reviewers.

“My expertise is in writing and explaining things,” says Habel. “The reviewers are the subject matter experts. With few exceptions, the reviewer comments improve the article.”

Close Up on Conflicts of Interest

Per ANCC requirements, all writers and reviewers must sign a vested interest disclosure form to alert Callender-Price if they have a “real or perceived” conflict of interest, particularly any financial relationships with entities that would have an interest in the content of the article. An example of potential “conflict” is that an author’s presentations at meetings are sponsored by a pharmaceutical company whose product is included in the article. Or, an author may receive royalties, consulting fees, or research grant funds from a company.

If a reviewer or writer discloses a conflict, it must be added to the disclosure information at the end of the CE article. Disclosure of a potential conflict of interest doesn’t mean that the content is more “suspect”; it’s simply information for the reader to be aware of. Nursing Spectrum CE guarantees that its programs are free of bias.


Camera work

Writers don’t just use words as their tools to communicate content, they also rely on images, such as photographs, illustrations, diagrams, and flow charts. It’s a way to draw readers into the article, explain complex concepts, and give resources.

“I try to pick images that show readers how to do something; I look for things that they will use in practice,” says Pavlovich-Danis. For her course on vonWillebrand Disease (CE222d), she included a chart that nurses could use to assess menstrual flow by criteria such as sanitary napkins and tampon use.

An art director, in collaboration with Callender-Price, picks the main image. This can range from the simple (a close-up of an older person’s feet to illustrate a module on how to help older patients care for their feet) to the historic (a photograph of a young child with polio for the module on post-polio syndrome) to the abstract or conceptual (such as an image of the heart with lightening rods in the background for a module on atrial fibrillation). Whatever the art, the goal is to make it complement the headline or the first sentence or paragraph of the module so that the elements grab readers’ attention and make them want to read more. It’s the movie trailer of CE.

And the show goes on…

Nursing Spectrum CE produces close to 50 CE modules each year and has won worldwide recognition, with some courses being translated for use in other countries, such as Greece and Spain. They now have several icons, such as one for APN and another for Magnet-relevant material, so nurses can quickly find topics that fit their needs.

Future plans include more specialty CE courses and more ways for long-term evaluation of the impact of CE on practice.

Like the writers, results drive Callender-Price and the Nursing Spectrum CE team. “It’s exciting to start something, see it develop it, and then see it in print and online,” she says. “The writers are great to work with, and a letter from a satisfied reader makes our day.”

It’s likely the ratings for Nursing Spectrum CE will remain high for years to come.



Cynthia Saver, RN, MS, is president of CLS Development, Inc., Columbia, Md., which provides knowledge-based services for nurses.

From Idea to Finished Product

    • Nursing Spectrum CE conducts a needs assessment to identify or confirm topics.

    • Callender-Price assigns the topic to a writer.

    • The author researches and writes a manuscript, including CE purpose, objectives, and test.

    • Callender-Price reviews the manuscript to be sure it’s on target, and then sends it out for peer review.

    • Experts in the content area of the manuscript review it for accuracy and thoroughness, based on a set of specific criteria. The reviewers and writers don't know each other's identities to ensure an unbiased review.

    • The writer revises the manuscript based on the reviewers’ feedback, and then returns it to Nursing Spectrum CE. Some back and forth between the writer and Callender-Price is usually needed to get the content just right.

    • A professional editor edits the manuscript and adds interesting headlines and subheadings.

    • An editor and an art director use a software program to arrange the content and any images (such as photographs and illustrations) so that it fits on the printed page. This “formatting” makes the article easier to read.

    • Nursing Spectrum CE staff, including Robert Hess, RN, PhD, senior VP for continuing education, do a final check of the module to catch any content and grammatical errors.

    • The module is printed in all 13 regional editions of Nursing Spectrum and NurseWeek and posted online at www.nurse.com.

    • Every two years, CE modules of 1 contact hour length are updated based on new information. The time frame is every two to three years for CE modules that offer multiple contact hours for credit.