# Situation: The nurse educator of a government hospital manages staff development for its endocrine and gastrointestinal wards. Every registered nurse must renew the professional identification card (PIC), which requires continuing professional development (CPD) units under the Continuing Professional Development Act of 2016. After a workshop on preventing medication errors, the educator wants to know whether the nurses now apply what they learned in daily work. Which finding BEST shows this?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630465  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: The nurse educator of a government hospital manages staff development for its endocrine and gastrointestinal wards. Every registered nurse must renew the professional identification card (PIC), which requires continuing professional development (CPD) units under the Continuing Professional Development Act of 2016.

After a workshop on preventing medication errors, the educator wants to know whether the nurses now apply what they learned in daily work. Which finding BEST shows this?

## 보기

1. Audits show independent double-checks in 94% of high-alert doses, up from 60% **✔ 정답**
2. Post-test scores rose from 62% to 88% at the end of the workshop
3. Participants rated the workshop 4.8 out of 5 on the evaluation form
4. Reported errors fell in a month when a new barcode scanner was also installed

**정답: 1**

## 해설

In Kirkpatrick's model, reaction is satisfaction, learning is knowledge gained, behavior is application on the job, and results are client or organizational outcomes. Audited double-check rates measure behavior in practice, which directly answers whether learning transferred to daily work.

## 심화 해설

Kirkpatrick's four levels of evaluation
Training programs are often evaluated with a four-level model. Reaction measures participants' satisfaction. Learning measures the knowledge or skills gained. Behavior measures whether participants apply what they learned on the job. Results measure outcomes for clients or the organization, such as fewer errors. The educator wants to know whether nurses now apply what they learned in daily work, which is the behavior level. Audited independent double-checks rising from 60% to 94% of high-alert doses directly measure behavior in practice, showing transfer of learning to daily work.

| Level | Question answered | Example from the options |
| --- | --- | --- |
| Reaction | Did they like it? | Rating of 4.8 out of 5 |
| Learning | Did they learn it? | Post-test rose from 62% to 88% |
| Behavior | Do they use it at work? | Double-checks rose from 60% to 94% |
| Results | Did outcomes improve? | Reported errors fell (confounded) |

Why the audit is the best evidence
An audit observes or reviews actual practice. Comparing the rate of independent double-checks before the workshop (60%) and after (94%) shows a change in what nurses do on the ward. Independent double-checks of high-alert medications such as insulin, heparin, and concentrated electrolytes are a key error-prevention behavior, so the measure is directly linked to the workshop content.

Why the other findings fall short
Post-test scores show that nurses learned the content, but knowing is not proof of doing. Satisfaction ratings measure reaction, the lowest level; liking a workshop does not show a change in practice. The fall in reported errors would be a results-level outcome, but a new barcode scanner was installed in the same month, so the improvement cannot be credited to the workshop. This is a confounding factor.

Watch out! The results level is the highest, so the error data may look like the strongest answer. But the stem asks whether nurses apply what they learned, and the error data are confounded. Answer the question that is asked.

Exam takeaway
Key point! To show transfer of training to practice, measure behavior on the job, for example by auditing practice before and after training.

## 임상 시나리오

Evaluating a WorkshopBehavior level: transfer to practice
Question: do nurses apply what they learned? That is the behavior level of evaluation.

Best evidence: audits showing independent double-checks of high-alert doses rising from 60% to 94%.

Post-test scores measure learning, ratings measure reaction, and the error drop is confounded by a new barcode scanner.

## 핵심 개념

- **Kirkpatrick model** — A four-level framework for evaluating training: reaction, learning, behavior, and results.
- **Transfer of learning** — Application of knowledge or skills gained in training to real work situations.
- **Independent double-check** — A second clinician separately verifies a high-alert medication before it is given.
- **Confounding factor** — A variable other than the one studied that may explain an observed change.

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