Background: This study was done to identify nurses' priorities for continued learning and to examine the priorities in relation to age, educational level, location in the organization, experience, position in the organization, and shift worked. Methods: A random sample of nurses at a Veterans Affairs Medical Center completed surveys consisting of 58 educational topics and demographic information. The results were analyzed using descriptive statistics, analysis of variance, and Tukey's HSD method to identify differences within the various subgroups of nurses. Results: Of the 58 educational topics, 21 were determined to be high priority educational needs and were significantly correlated with one or more of the independent variables. Conclusion: Conducting a needs assessment can provide valuable information that will improve the delivery of high quality, relevant continuing education and improve staff satisfaction.

In 1991, the Joint Commission's nursing services standards scoring guidelines went into effect. Nancy Claflin discusses the changes in the nursing process needed to meet these revised standards under the rubrics of assessment, planning, intervention, and evaluation. She then presents an extensive implementation plan for integrating this revised nursing process into a nursing QI program. The focus of this article is both on the principles of quality improvement and the exigencies of aspects of care, standards of nursing practice, and indicators.

ssessing clinical performance is difficult. Mem-A bers of the Nursing Service Clinical Practice Committee at the Carl T. Hayden Veterans Affairs Medical Center in Phoenix developed a comprehensive program of competency assessment based on performance measures. This article describes the committee's process of developing and implementing the program and inc a blueprint for comfor all nursing staff who provide patient care. assessment includes Assessment of clinical performance has historically posed a problem in healthcare (Krichbaum, Rowan, Duckett, Ryden, & Savik, 1994) because of the complexity of the clinical environment, the difficulties inherent in the process of evaluation, and the absence of uniform standards of practice for all staff.Evaluation is the process of renderingjudgment to determine the worth, merit, or quality of a particular product or service. Accurate assessment or evaluation of any service or product first depends on the quality of the definition of that service or product. A concise definition of a service or product leads to a more effective evaluation. There have been many attempts to define or describe quality clinical performance. Evaluating the clinical performance of employees requires that each of the following be identified or developed:what is valued criteria and standards for performance reliable and valid means for measuring the achievement of standards (Krichbaum et al., 1994). The process of evaluating clinical performance parallels the process of evaluating the quality of healthcare. Explicit criteria (i.e., value-free names for variables of interest) and standards (i.e., statements that specify the expected level of performance in relation to criteria) are also essential to the quest for quality healthcare (Krichbaum et al., 1994).Clinical performance in a healthcare setting is a complex phenomenon that reflects a staff member's aptitudes, abilities, cognitions, skills, and affect. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires that a process be developed and implemented to ensure that the competen-

The education of patients and their families can support positive patient healthcare outcomes. Patient and family education is an essential component of the healthcare delivery process, but it often is fragmented, with individual disciplines providing information without coordination. At the Carl T. Hayden VA Medical Center in Phoenix, AZ, a team reviewed the facility's process for providing patient education. As a result of this review, interdisciplinary process and documentation forms that improved both the quality of education provided and the documentation of that education in the medical record were developed.

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