Basic competence in intensive and critical care nursing: development and psychometric testing of a competence scale

AIMS AND OBJECTIVES

To develop a scale to assess basic competence in intensive and critical care nursing. In this study, basic competence denotes preliminary competence to practice in an intensive care unit.

BACKGROUND

There is a need for competence assessment scales in intensive care nursing practice and education. The nursing care performed in the intensive care unit is special by its nature and needs to be assessed as such. At this moment, however, there is no tested, reliable and valid scale in this field.

DESIGN

A multi-phase, multi-method development and psychometric testing of the scale was conducted.

METHODS

The scale was developed in three phases. First, following a literature review and Delphi study, the items were created. Second, the scale was pilot tested twice by nursing students (n1 = 18, n2 = 56) and intensive care nurses (n1 = 12, n2 = 54), and revisions were made. Third, reliability and construct validity were tested by graduating nursing students (n = 139) and intensive care nurses (n = 431).

RESULTS

The Intensive and Critical Care Nursing Competence Scale (ICCN-CS-1) is a self-assessment test consisting of 144 items. Basic competence is divided into patient-related clinical competence and general professional competence. In addition, basic competence is comprised of knowledge base, skill base, attitude and value base and experience base. ICCN-CS-1 is a reliable and tolerably valid scale.

CONCLUSIONS

The ICCN-CS-1 is a promising scale for use among nursing students and nurses. Future research is needed to evaluate its construct validity further and to assess its suitability for completion during intensive care unit's orientation programmes and nursing students' clinical practice in an intensive care unit.

RELEVANCE TO CLINICAL PRACTICE

The ICCN-CS-1 can be used for basic competence assessment in professional development discussions in intensive care units, in mentor evaluation situations during nursing students' clinical practice and in intensive care nursing education.

The quality of the face-to-face counselling in paediatric ambulatory tonsillectomy: parental point of view

The objective of this study was to examine parental opinion on the quality of preoperative face-to-face counselling about the child's preoperative fasting. Families, whose child was admitted for ambulatory tonsillectomy were randomly assigned to the study groups (n = 116; 58/58). The intervention group received the information with face-to-face counselling, and the control group in written form. The parents assessed (visual analogue scale) the level of clarity, intelligibility and adequacy of the information, how well they had understood the meaning and the implementation of the child's preoperative fast, as well as their own skills and success to implement the child's fast. The parents in the intervention group felt that the information was significantly clearer, more intelligible and adequate and that they succeeded well. Face-to-face counselling is an effective way to educate the parents.

Work-related empowerment of nurse managers: a systematic review

The present study discusses how nurse managers' work-related empowerment has been investigated, in order to determine the level and relationships of empowerment among them. A systematic review was carried out, and a literature search was conducted with certain electronic databases for the period 1990-2009, using the main key words in various combinations. Only nine empirical studies in English were selected for review, in accordance with the requirements for the methodological quality and inclusion criteria. The most common type of study design was a descriptive survey (n = 5), and included various questionnaires, scales, and interviews. Nurse managers' structural, psychological, and work empowerment was found to be high or moderately high. The empowerment of nurse managers correlated positively with job satisfaction, perceived organizational support, role satisfaction, and managerial self-efficacy, and correlated negatively with emotional exhaustion and own health outcomes. Different theoretical approaches ensure a clear understanding of empowerment, but difficulties arise when the findings are synthesized across studies and settings because of the different theoretical frameworks used to conceptualize empowerment.

Competence requirements in intensive and critical care nursing--still in need of definition? A Delphi study

BACKGROUND

Empirical studies in competence are lacking in the field of intensive and critical care nursing.

OBJECTIVE

To identify competence requirements, by soliciting the views of intensive care unit nurses and physicians.

METHODS

Two rounds of the Delphi method were used in 2006 in Finland. Data were analysed by content analysis and with descriptive statistics.

RESULTS

Competence requirements in intensive and critical care nursing can be divided into five main domains: knowledge base, skill base, attitude and value base, nursing experience base and personal base of the nurse. Four of these domains can be found in the existing requirements and one new domain - personal base of the nurse - was identified.

CONCLUSIONS

Competence requirements are multidimensional. Earlier descriptions of competence are not sufficient; more comprehensive and cohesive descriptions are needed. The personal base of a nurse should also be included in the competence requirements in intensive and critical care nursing.

Nurses' willingness to take care of people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)--does a teaching intervention make a difference?

The aim of this study is to describe the impact of an education intervention programme on nurses' willingness to care for HIV-positive people in Lithuania.

METHODS

The study utilizes a randomized controlled trial design (RCT). The total sample comprises 185 nurses working in medical, surgical and gynaecological units, and primary health care centres from the same hospital areas in three Lithuanian hospitals. The data were analyzed using SPSS 12.0 and descriptive statistics.

FINDINGS

Our educational intervention did not have an impact on the nurses' willingness to take care of people living with HIV (PLHIV), as their level of willingness was high already before the education intervention.

CONCLUSIONS

Further research on this issue is needed to try to understand the forces acting on our nursing staff in order to ensure appropriate care for PLHIV.

Lithuanian nurses' assessments of their empowerment

AIMS AND OBJECTIVES

The aim was to explore nurse empowerment and the factors associated with it from the viewpoint of surgical nurses.

DESIGN

A multicentre cross-sectional, descriptive, correlational study design was used.

SETTING AND PARTICIPANTS

  The data were collected from 11 units of seven largest Lithuanian hospitals located in three major cities during the period of 11/2007 to 01/2008. All the nurses (N = 270) working in the abdominal perioperative settings were invited to participate in the study; 247 questionnaires were returned giving the response rate of 91 %. The data were analyzed on the basis of 218 responses. The statistical analysis was performed by SPSS (12.0 version).

INSTRUMENTS

Two instruments, both originally developed in Finland and adapted to the Lithuanian cultural context, were used: Nurse Empowerment Scale (NES) and Good Nursing Care Scale for Nurses (GNCS-N).

RESULTS

Surgical nurses evaluated their work empowerment positively. Several background factors were associated with nurse empowerment, such as nurse education, type of nurse license (working area), the continuing nurse education (completed courses during last 5 years), the workload at hospital, the work independence, and work satisfaction. The connection between nurse empowerment and quality of nursing care was also identified (r = 0.139-0.525, p < 0.01).

CONCLUSIONS

Surgical nurses feel empowered at their work when they have higher education and have completed the continuing education courses. Nurses should have possibility to continue their studies at the university. Independent at work, satisfied, and motivated nurses have more power at their work in the surgical units in Lithuania. However, further research is needed to explore nurse empowerment in other fields of nursing care nationally and internationally.

Nurses' perceived work-related empowerment in Lithuanian context

STUDY'S RATIONALE: Empowerment is widely used within the nursing literature in different countries, but perceived empowerment of Lithuanian nurses has not been studied before. There is a lack of research which has analysed nurses' views and feelings of empowerment.

AIMS AND OBJECTIVES

The aim of this study was to describe the perception of Lithuanian nurses' work-related empowerment. The study describes how empowered the nurses felt in their work and how background factors were related to empowerment.

ETHICAL ISSUES

The permission to use the questionnaire was given by copyright holders. The questionnaire was approved by the Ethics Committee. RESEARCH METHODS AND INSTRUMENT: The data were collected using a structured questionnaire comprised of two parts: the background questions and the Work Empowerment Questionnaire divided into three areas: verbal, behavioural, and outcome empowerment. The data were analysed statistically using SPSS, and Microsoft Excel programs. The descriptive statistics, non-parametric tests and Spearman correlations were conducted. The sample consisted of 212 participants.

RESULTS

The nurses experienced strong general empowerment (mean 7.9; max 10.0). They were more confident in their abilities to perform actions related to behavioural (mean 8.3) and verbal (mean 8.0) empowerment, and less confident in outcome (mean 7.3) empowerment. All aspects of empowerment were closely related to each other (p ≤ 0.001). Several significant relations were found between the aspects of empowerment and the background variables.

STUDY LIMITATIONS

The Work Empowerment Questionnaire used in the study was originally developed in Canada. Differences in language, culture, health care organizations, and nursing practice may affect the validity of translated questionnaire in Baltic context.

CONCLUSIONS

To prepare nurses for roles in which they may successfully exercise the power to create change, they need experience the process of empowerment during their education, and experience later supportive management.

Outcomes assessment of the regional health information exchange: a five-year follow-up study

BACKGROUND

The implementation of a technology such as health information exchange (HIE) through a Regional Health Information System (RHIS) may improve the mobilization of health care information electronically across organizations. There is a need to coordinate care and bring together regional and local stakeholders.

OBJECTIVES

To describe how HIE had influenced health care delivery in one hospital district area in Finland.

METHOD

Trend analysis was used to evaluate the influence of a regional HIE. We conducted a retrospective, longitudinal study for the period 2004-2008 for the eleven federations of municipalities in the study area. We reviewed statistical health data from the time of implementation of an RHIS. The t-test was used to determine statistical significance. The selected outcomes were the data obtained from the regional database on total appointments, emergency department visits, laboratory tests and radiology examinations, and selected laboratory tests and radiology examinations carried out in both primary care and special health care.

RESULTS

Access to HIE may have influenced health care delivery in the study area. There are indications that there is a connection between access to regional HIE and the number of laboratory tests and radiology examinations performed in both primary care and specialized health care, as observed in the decreased frequency in outcomes such as radiology examinations, number of appointments, and emergency department visits in the study environment. The decreased frequencies of the latter suggest an increased efficiency of outpatient care, but we were not able to estimate to what extent the readily available comprehensive clinical information contributed to these trends.

CONCLUSION

Outcome assessment of HIE through an RHIS is essential for the success of health information technology (HIT) and as evidence to use in the decision-making process. As health care information becomes more digital, it increases the potential for a strong HIE effect on health care delivery.

Representations of hysterectomy as a transition process in Finnish women's and health magazines

Representations of hysterectomy as a transition process in Finnish women's and health magazines The purpose of this article was to describe representations of hysterectomy in Finnish women's and health magazines. The data used in the study were obtained from six Finnish women's and health magazines. Using content analysis, 42 articles were analysed. We identified two main categories, information about care and treatment and women's experiences. In the first category, there emerged six subcategories: role of uterus, indications for hysterectomy, operative techniques of hysterectomy, alternative methods of treatment, pros and cons of hysterectomy and patient guidance. The second category consisted of women's experiences of hysterectomy as a period of transition. The components of the transition theory were confirmed by the women's stories. We also wanted to highlight the fact that the result shows that nurses were missing from the media coverage regarding hysterectomy.

Competence of nurses and factors associated with it

OBJECTIVE

Nurse competence became a relevant topic for discussion among nurse practitioners and nurse researchers. However, the factors connected with nurse competence need deeper exploring. The aim of this study was to explore nurse competence and factors associated with it from the perspective of nurses for predicting the possible ways for upgrading the nursing practice.

MATERIALS AND METHODS

A multicenter, descriptive study was performed in 11 surgical wards of 7 Lithuanian hospitals. Data were collected from November 2007 to January 2008. Lithuanian nurses (n=218) who were working with patients after abdominal surgery participated in this study. The response rate was 91%. Two instruments, both originally developed in Finland, were used: the Nurse Competence Scale and the Good Nursing Care Scale for Nurses.

RESULTS

The overall level of nurse competence and the frequency of using the competencies in practice as perceived by nurses were high. Nurses assessed the competencies in managing situations and work role the highest and in teaching-coaching and ensuring quality the lowest. Sociodemographic factors such as nurse education, experience, professional development, independence, and work satisfaction as well as the evaluation of quality of nursing care were identified as factors associated with nurse competence.

CONCLUSIONS

The findings of study allow us to make the assumption that nurse education, nurse experience, and nurse professional development play a significant role in the evaluation of nurse competence as well as the evaluation of quality of nursing care. It is necessary to upgrade nursing education programs at all levels of nursing education in Lithuania: university, non-university, and professional development courses. The qualities of preconditions for nursing care, cooperation with relatives, caring and supporting initiative are related to nurse competence.