Competence in nursing practice: A controversial concept – A focused review of literature

Clinical competency of nurses trained in competency-based versus objective-based education in the Democratic Republic of the Congo: a qualitative study

BACKGROUND

Designing competency-based education (CBE) programmes is a priority in global nursing education for better nursing care for the population. In the Democratic Republic of the Congo (DRC), object-based education (OBE) remains mainstream in pre-service nursing education programmes. Recently, the Ministry of Health developed a self-assessment tool and quantitatively compared the clinical competency of CBE- and OBE-trained nurses. This study aimed to qualitatively triangulate the results of self-evaluation by exploring perception of supervisors, incumbent CBE-, and OBE-trained nurses in comparison with the competence of the two types of nurses, and to identify influential factors or barriers to their competence in clinical settings.

METHODS

A qualitative descriptive approach with conventional content analysis was applied. Twenty interviews with clinical supervisors who oversaw both CBE- and OBE-trained nurses, 22 focus group discussions (FGDs) with CBE-trained nurses, and 21 FGDs with OBA-trained nurses currently working in health facilities were conducted. Participants of the FGDs were selected from the participants of the DRC self-assessment competency comparison study where there was no statistically significance between CBE- and OBE-trained nurses in the demographic characteristics. Data were analysed in terms of the competencies identified by the Ministry of Health.

RESULTS

The supervisors recognised that the CBE-trained nurses had stronger competencies in professional communication, making decisions about health problems, and engaging in professional development, but were weak in clinical skills. This study identified challenges for supervisors in assuring standardised care in health facilities with OBE- and CBE-trained nurses, as well as barriers for CBE-trained nurses as a minority in the workplace in demonstrating their competencies.

CONCLUSIONS

The study results support the Ministry of Health's policy to expand CBE in pre-service education programmes but reveal that its slow implementation impedes full utilisation of the acquired competencies at health facilities. Implementation could be accelerated by strengthening cooperation among the Ministry of Health's three human resource departments, and developing and implementing a well-planned, legally binding, long-term CBE reform strategy, including an approach to the Continuing Professional Development system.

What is the purpose of nurse education (and what should it be)?

Can we take the purpose of nurse education for granted, and, more importantly, should we? That is the issue at stake in this paper. The question of purpose is conspicuously absent in the nursing literature; our aim here is to urge that it not be overlooked by demonstrating its importance to the future of nursing. We approach the question of nurse education's purpose in concrete and speculative terms through two distinct yet interrelated questions: what is the purpose of nurse education? and what should it be? Amidst the complexity and uncertainty of our time, we cast doubt on the adequacy of manualised and regulated approaches-ubiquitous in nurse education-to prepare nurses who can meet the challenges of contemporary practice. We also assert that transgressive approaches to education, as the antithesis of manualisation, reach the same impasse by (over)predetermining what the educational 'output' will be. To move beyond this impasse, we draw on the theory of Gert Biesta and Ron Barnett to contrast cultivation and existential-type education. In so doing, we do not seek to provide 'answers' to nurse education's purpose but, rather, raise the profile of what we believe is a right and proper question for the discipline to grapple with.

Psychometric Validation of the Nursing Professional Competence Scale Among Italian Nurses and Albanian Nursing Students

Background and Purpose: The main aim of this study has been the psychometric validation of an Italian translation of the Nurse Professional Competence Scale-Short Form (I-NPCS-SF), testing its validity and reliability. Methods: A multiphase design was used for the I-NPCS-SF translation and psychometric validation: (a) cultural and linguistic validation, (b) content and face validity, and (c) construct validity. Results: The I-NPCS-SF showed adequate linguistic translation, cultural adaptation, and content validity. Confirmatory factor analysis supported a four-factor structure of the I-NPCS-SF, in explaining data obtained from nurses and nursing students. Conclusions: The I-NPCS-SF demonstrated evidence of validity and reliability in measuring four professional competencies. Having an appropriate tool to be applied in the Italian context for professional competence self-assessment constitutes an essential step in measuring professional competencies.

Competency in nursing practice: a concept analysis

OBJECTIVE

Competency denotes the ability to execute a certain task or action with the necessary knowledge. Competency definitions and measurements are challenging for nursing and other professions due to their multidimensional aspects. This study aimed to clarify the concept of competency in nursing practice and propose an accurate definition.

DESIGN

Walker and Avant's approach was used to elucidate the concept of competency in nursing practice.

DATA SOURCES

ScienceDirect, PubMed, ProQuest, Scopus and CINAHL were searched from 1 January 2000 to 31 December 2021.

ELIGIBILITY CRITERIA

We included studies with the keywords: "concept analysis", "competence", "competency" and "nursing". The search was limited to full-text studies written in English that used theoretical and empirical approaches.

DATA EXTRACTION AND SYNTHESIS

We extracted the concept's uses, defining attributes, and the consequences and antecedents of the concept.

RESULTS

60 articles were identified from the search process; after excluding duplicates and works unrelated to the study aim and context following the full-text screening, 10 articles were included in this concept analysis. The common defining attributes of competency were knowledge, self-assessment and dynamic state. Competency in nursing practice had many reported positive consequences that include but are not limited to improved patient, nurse and organisational outcomes.

CONCLUSIONS

Nurses can benefit from the result of this analysis in practice to implement professional care, in particular clinical contexts and situations to enhance patients' health.

Knowledge, attitudes, behavioral and organizational factors of health professions students for a competent smoking cessation practice: An instrument adaptation and psychometric validation study in Spanish and English samples

BACKGROUND

To improve smoking cessation, training of health professions students is essential. However, no specific instrument is available to assess factors that may affect students' learning about smoking cessation practice.

AIM

To adapt and validate the Knowledge, Attitudes, Behaviors and Organization questionnaire in the population of undergraduate health professions students.

DESIGN

Methodological research.

METHODS

The researchers conducted this study with 511 Spanish and 186 English health professions students from four different universities. We used a four-step approach: 1) adaptation of the items to the target population and validation of the content by a panel of experts; 2) a pilot study to test face validity; 3) linguistic adaptation of the Spanish version to English; and 4) the psychometric assessment based on construct validity, criterion validity and internal consistency.

RESULTS

Exploratory factor analysis revealed four subscales for the Spanish version, namely 'Individual knowledge and skills', 'Individual attitudes and beliefs', 'Organizational support' and 'Organizational resources', which accounted for 85.1% of the variance. Confirmatory factor analysis in the holdout Spanish and English samples revealed adequate goodness-of-fit values, supporting the factor structure. Hypotheses testing demonstrated significant differences by capacitation in smoking cessation interventions and degree courses, providing further evidence regarding construct validity. All the subscales correlated positively with the criterion variables (5 A's smoking cessation model), except for the 'Organizational resources' subscale, which was not significantly correlated with the 5 A's. The overall Cronbach's alpha was.83 for the Spanish version and.88 for the English one.

CONCLUSIONS

Our results provide empirical support for the use of the Knowledge, Attitudes, Behaviors and Organization questionnaire for Students as a reliable and valid instrument to assess knowledge, attitudes, behaviors and organization perceptions in health professions students, which is essential for competent smoking cessation practice. Interestingly, 'Organizational resources' subscale presented the lowest correlations among factors and did not correlate with any component of the 5 A's, suggesting the need of enhancing students' responsibility and involvement during their internships, as well as the interest of some organizations.

Culturally and linguistically diverse nurses' experiences of how competence facilitates integration into the working environment: A qualitative study

AIM

This study aims to describe culturally and linguistically diverse nurses' experiences of how they transferred their competence to meet professional competence requirements in non-English speaking environment.

BACKGROUND

Competence is one factor that affects culturally and linguistically diverse nurses' integration into the working environment. In this study, knowledge, skills, values and personal traits are included in the holistic competence concept.

DESIGN

Qualitative.

METHODS

A total of 24 culturally and linguistically diverse nurses involved in Finnish health care participated in this qualitative study. Data were collected through snowball sampling during the summer of 2021 using semi-structured interviews. The collected data were analysed using inductive content analysis.

RESULTS

The data analysis revealed a total of five main categories describing culturally and linguistically diverse nurses' experiences: 1) before immigration; 2) competence requirements in the country of immigration; 3) assessment of competencies; 4) support factors; and 5) hardships.

CONCLUSION

Degree recognition, colleagues' tolerance towards culturally and linguistically diverse nurses at the workplace and continuous education focusing on local language could improve culturally and linguistically diverse nurses' integration into the working environment.

Advanced clinical practice in paediatric haematology and oncology: developing a capability document

Specialist roles have been developed to provide holistic care to children and young people with cancer, one of which is the advanced clinical practitioner (ACP) in paediatric oncology and haematology. A survey showed that paediatric oncology and haematology ACPs in the UK work in a wide variety of roles and that their numbers vary greatly between treatment centres. The survey also confirmed the need for a national standardised framework delineating the knowledge, skills and expertise required of ACPs working in paediatric oncology and haematology. This article describes the development of a capability document to support and standardise advanced practice in paediatric oncology and haematology. The document reflects the advanced level of critical thinking, autonomy and decision-making required of ACPs and has been endorsed by the Children's Cancer and Leukaemia Group and by the Royal College of Nursing. It is hoped that it will support ACPs to consistently deliver high-quality, safe care for the benefit of children and young people with cancer and their families.

Competency and Related Factors in Preventing Emerging Infectious Diseases among Nurses in Long-Term Care Facilities in Taiwan

Emerging infectious diseases (EIDs) are a considerable threat to health, particularly in long-term care facilities (LTCFs), where residents are especially vulnerable. Nurses’ competency in EID prevention is crucial to minimize the adverse effects of EIDs in LTCFs. This study investigated nurses’ competency and related factors in EID prevention in LTCFs in Tainan, Taiwan. A cross-sectional design was employed, and nurses were recruited to complete an online survey examining the knowledge, attitude, and skills required to prevent EIDs in LTCFs. A total of 235 nurses completed the survey. The equivalent score index (SI) for knowledge regarding EID prevention was 68, indicating that the nurses did not have adequate knowledge regarding EID prevention. In contrast, the equivalent SI for the subscale of attitudes toward EID prevention was 78, indicating that the nurses exhibited moderately to highly positive attitudes toward EID prevention. However, they rated themselves as being highly skilled in EID prevention, corresponding to an equivalent SI of 91. Perceived supervisors’ approval, marital status, attitudes toward EID prevention, EID prevention skills, knowledge regarding EIDs, and being in charge of infectious disease prevention were significant predictors of the nurses’ competency. LTCF nurses, especially those working in nursing homes, should enhance their knowledge regarding EID prevention. These findings may help improve nurses’ competency in preventing EIDs by encouraging the integration of practice strategies, education, research, and policy recommendations to eliminate EIDs in LTCFs.

Future palliative competence needs - a qualitative study of physicians' and registered nurses' views

BACKGROUND

Globally, the need for palliative care will increase as a result of the ageing of populations and the rising burden of cancer, non-communicable diseases as well as some communicable diseases. Physicians and registered nurses working in palliative care should have a sufficient level of education and competence in managing the changing needs and requirements of palliative care. There is, however, need for evidence-based palliative care training and education of physicians and registered nurses. The purpose of this study was to describe the views of physicians and registered nurses regarding future competence needs within palliative care.

METHODS

The study was conducted through use of a cross-sectional qualitative design. A total of 54 physicians and 110 registered nurses completed an open-ended questionnaire about the future competence needs of palliative care. The data were analyzed using inductive content analysis.

RESULTS

The results revealed four main competence needs within palliative care for the coming decade: palliative care competence at all levels within healthcare and social welfare services; individualized palliative care competence; person-centered encounters competence; and systematic competence development within palliative care.

CONCLUSIONS

The results offer cues for education and professional development, which can be used to support physicians and registered nurses when future palliative care competences are included in educational programs. Seamless cooperation between palliative care services and educational institutions is recommended to ensure that undergraduate and postgraduate education is based on a continuous assessment of competence requirements within the field of palliative care. Therefore, online multi-professional simulations, for example, could be used to enhance future competencies within palliative care; undergraduate medical, nursing and allied healthcare students as well as postgraduate palliative care professionals and experts of experience could work together during simulations.

Development and content validation of a measure to assess evidence-informed decision-making competence in public health nursing

There are professional expectations for public health nurses to develop competencies in evidence-informed decision-making (EIDM) due to its potential for improved client outcomes. Robust tools to assess EIDM competence can encourage increased EIDM engagement and uptake. This study aimed to develop and validate the content of a measure to assess EIDM competence among public health nurses. A four-stage process, based on measure development principles and the Standards for Educational and Psychological Testing, was used to develop and refine items for a new EIDM competence measure: a) content coverage assessment of existing measures; b) identification of existing measures for use and development of items; c) validity assessment based on content; d) validity assessment based on response process. An EIDM competence measurement tool consisting of EIDM knowledge, skills, attitudes/beliefs, and behaviour items was developed using conceptual literature and existing measures (Evidence-Based Practice Competency Tool and Evidence-Based Practice Beliefs Scale) to address limitations of existing EIDM tools identified from the content coverage assessment. Item content validity index ratings ranged from 0.64–1.00. Qualitative themes from validity assessment based on content and response process included word changes to improve clarity, reducing item redundancy, separating multi-component items, and ensuring items reflect nursing role expectations. Upon determining its reliability and validity, there is potential for the EIDM competence measure to be used in: public health nursing practice to identify competence gaps and strengths to facilitate professional development activities; in research to support development of strategies to build EIDM capacity; and for curriculum planning and development across nursing education programs.

Specific Competencies of Prehospital Emergency Nursing: The Views of Spanish University Professors

BACKGROUND

The guarantee of nursing competence in prehospital urgent care requires the identification and delimitation of the specific competencies. This work describes the importance attributed by professors of Spanish universities to the competencies of prehospital nursing positions and indicates the most appropriate training level required to achieve them.

METHOD

The current work consisted of a survey with an online questionnaire. Sixty competencies over 10 domains were studied.

RESULTS

The most valued domains were those of general and personal competencies. The competencies considered most important were "Recognizes the vital risk and knows how to perform basic and advanced life support maneuvers" and "Provides quality health care." The nursing degree is considered appropriate to train students to the required level in only eight competencies.

CONCLUSION

The proposed competencies can be considered as specific competencies necessary in prehospital emergency nursing. Effective performance requires training to a higher level than a nursing degree. [J Contin Educ Nurs. 2020;51(12):556-567.].

Measures of evidence-informed decision-making competence attributes: a psychometric systematic review

Background

The current state of evidence regarding measures that assess evidence-informed decision-making (EIDM) competence attributes (i.e., knowledge, skills, attitudes/beliefs, behaviours) among nurses is unknown. This systematic review provides a narrative synthesis of the psychometric properties and general characteristics of EIDM competence attribute measures in nursing.

Methods

The search strategy included online databases, hand searches, grey literature, and content experts. To align with the Cochrane Handbook of Systematic Reviews, psychometric outcome data (i.e., acceptability, reliability, validity) were extracted in duplicate, while all remaining data (i.e., study and measure characteristics) were extracted by one team member and checked by a second member for accuracy. Acceptability data was defined as measure completion time and overall rate of missing data. The Standards for Educational and Psychological Testing was used as the guiding framework to define reliability, and validity evidence, identified as a unified concept comprised of four validity sources: content, response process, internal structure and relationships to other variables. A narrative synthesis of measure and study characteristics, and psychometric outcomes is presented across measures and settings.

Results

A total of 5883 citations were screened with 103 studies and 35 unique measures included in the review. Measures were used or tested in acute care (n = 31 measures), public health (n = 4 measures), home health (n = 4 measures), and long-term care (n = 1 measure). Half of the measures assessed a single competence attribute (n = 19; 54.3%). Three measures (9%) assessed four competence attributes of knowledge, skills, attitudes/beliefs and behaviours. Regarding acceptability, overall missing data ranged from 1.6–25.6% across 11 measures and completion times ranged from 5 to 25 min (n = 4 measures). Internal consistency reliability was commonly reported (21 measures), with Cronbach’s alphas ranging from 0.45–0.98. Two measures reported four sources of validity evidence, and over half (n = 19; 54%) reported one source of validity evidence.

Conclusions

This review highlights a gap in the testing and use of competence attribute measures related to evidence-informed decision making in community-based and long-term care settings. Further development of measures is needed conceptually and psychometrically, as most measures assess only a single competence attribute, and lack assessment and evidence of reliability and sources of established validity evidence.

Registration

PROSPERO #CRD42018088754.

Development and validation of gerontological nurse teacher scale

Several studies have advocated for having gerontological nurse teachers with special commitment to implement an aged-friendly curriculum, in order to facilitate student nurses' interest in gerontology careers. However, there is no existing instrument to assess whether gerontological nurse teachers possess such competences. This study describes the development and validation of an instrument for assessing the competence of gerontological nurse teachers. A total of 43 items categorized into seven constructs for the Gerontological Nurse Teacher Scale (GeNTS) emerged from the literature review in 2017. Experts (N = 19) then participated in a two-round Delphi feedback for content validity in May 2018. A pre-pilot study was then undertaken in October 2018 among undergraduate nursing students (n = 7) to ensure readability and understandability, followed by a pilot study on undergraduate nursing students (n = 196) for psychometric assessment. Based on experts' feedback and psychometric assessment, the final version of GeNTS consists of 33 items across five constructs namely: knowledge and interest; theoretical course and practical training development; leadership; gerontology career promotion and concerns about aging. The items are score on a five-point Likert scale from 1 = completely disagree to 5 = completely agree.

Competence to capability: An integrated career framework for sonographers

INTRODUCTION

Within the United Kingdom sonographers, with ultrasound as their core role, currently have a primary registration as a radiographer or another health professional. Entering with masters level qualifications, and often exhibiting a higher career banding, the sonographer career structure does not align comfortably with the existing health professional frameworks. This study aimed to explore the attitudes and opinions of a sample of practicing sonographers concerning a potential graduate sonographer role and the development of a clinical competence framework required to provide a skills escalator.

METHODS

A qualitative study using an interpretative framework was undertaken using semi-structured interviews. A homogeneous sample population of ten participants was selected using theoretical purposive sampling. The interview transcripts were thematically analyzed and coded.

RESULTS

The themes of implementing change and clinical frameworks were identified along with a sub-theme of clinical competence boundaries. All participants found it challenging to identify a role or clinical competences that a band 5/graduate sonographer could undertake, though more suggestions were offered for a band 6 sonographer.

CONCLUSION

Whilst, within the literature, clinical competences were agreed to provide the cornerstone for defining clinical roles there was some dispute as to the appropriateness of the use of core clinical competences for defining the scope of practice of health professionals above entry level to the profession. The data collected in this study demonstrated that there were skills development between graduate, specialist, advanced and consultant practitioners. Participants were focussed on clinical skills rather than wider capability skills. It is recommended that in order for advanced practice sonographers to map to the new ACP framework less focus on competence and a greater consideration of capabilities is required.

Current Trends and Opportunities for Competency Assessment in Pharmacy Education-A Literature Review

An increasing emphasis on health professional competency in recent times has been matched by an increased prevalence of competency-based education models. Assessments can generate information on competence, and authentic, practice-based assessment methods are critical. Assessment reform has emerged as an academic response to the demands of the pharmacy profession and the need to equip graduates with the necessary knowledge, skills and attributes to face the challenges of the modern workforce. The objective of this review was to identify and appraise the range of assessment methods used in entry-level pharmacy education and examine current trends in health professional assessment. The initial search located 2854 articles. After screening, 36 sources were included in the review, 13 primary research studies, 12 non-experimental pharmacy research papers, and 11 standards and guidelines from the grey literature. Primary research studies were critically appraised using the Medical Education Research Study Quality Instrument (MERSQI). This review identified three areas in pharmacy practice assessment which provide opportunities for expansion and improvement of assessment approaches: (1) integrated approaches to performance assessment; (2) simulation-based assessment approaches, and; (3) collection of validity evidence to support assessment decisions. Competency-based assessment shows great potential for expanded use in pharmacy, but there is a need for further research and development to ensure its appropriate and effective use.

Nurses' Competence Caring for Hospitalized Patients With Ventricular Assist Devices

BACKGROUND

Nursing care is an essential component of the delivery of high-quality patient care for advanced heart failure patients with ventricular assist devices (VADs). However, there is little information about how VAD patient care competence is formed, and there are no empirical data regarding the bed nurses' competence.

OBJECTIVES

The aim of this study was to explain how nurses perceived their competence related to VAD technology and how they utilized resources to equip themselves for the management of patients with implantable VADs.

METHODS

An exploratory correlational research design was used in this study. Online surveys including demographic and work characteristics questionnaires as well as VAD Innovation in Nursing Appraisal Scale (knowledge, adoption, and communication) were completed by 237 critical-care unit and progressive care unit (PCU) nurses.

RESULTS

Ventricular assist device knowledge, adoption, and communication of innovation mean scores were 3.9 ± 0.6, 3.9 ± 0.8, and 3.7 ± 0.9, respectively, indicating moderate/high levels. Critical-care unit nurses reported higher levels of knowledge (3.7 vs 3.6) and adoption (4.0 vs 3.8; P < .05) of innovation than did the PCU nurses, with no differences in communication. Compared with PCU nurses, critical-care unit nurses were more likely to seek VAD competence-related information using mass media. Innovation and adoption were associated with years of nursing experience and some hospital characteristics.

CONCLUSION

Critical-care unit nurses have higher self-reported VAD care competence than PCU nurses. Further research is needed to confirm the findings and link nurse competence with VAD patient outcomes.

Local implementation of a national curriculum and competency framework for emergency nursing: a review of the evidence

This article reviews the evidence associated with the Royal College of Nursing ( 2017 ) Emergency Care Association National Curriculum and Competency Framework for Emergency Nursing to inform the process of implementation in an emergency department. The search for evidence was guided by questions designed to reveal implications relevant to implementation of the framework. Implications identified include a need to let stakeholders know the evidence base is mostly expert opinion, clarify the terms 'competence' and 'competencies' and address concerns about validity and reliability of competency-based assessment. These implications should enhance the progress of the implementation project.

Measures assessing attributes of evidence-informed decision-making (EIDM) competence among nurses: a systematic review protocol

BACKGROUND

There are growing professional expectations for nurses to engage in and develop competence in evidence-informed decision-making (EIDM) due to opportunities for improved client and community outcomes and provision of the highest quality of care. However, EIDM is underdeveloped, with low implementation rates among nurses. The use of indicators to assess EIDM performance has potential to encourage nurses' engagement in EIDM through competence recognition and support assessment of strengths and competency gaps for individual nurses and organizations. Currently, the state of evidence regarding measures that assess EIDM competence attributes (i.e., knowledge, skills, beliefs/values, behaviors) among nurses is unknown. This systematic review aims to address this gap through a narrative synthesis of the characteristics and psychometric properties of EIDM competence measures.

METHODS

The search strategy, developed in consultation with a Health Sciences Librarian, consists of online databases, contacting experts, hand searching reference lists, key journals, websites, conference proceedings, and grey literature. Studies will be included if the following criteria are met: (1) sample includes practicing nurses and data for nurses are reported separately; (2) conducted in any healthcare setting; (3) quantitative or mixed-methods design; (4) reports use or testing of a measure assessing EIDM competence attributes (i.e., knowledge, skills, attitudes/values, and/or behaviors); and (5) published in English. Screening will be conducted independently by two reviewers using a two-stage process: (1) title and abstract level; and (2) full-text level. Data extraction of study characteristics (e.g., sample, setting) will be conducted by a single reviewer and checked for accuracy by a second reviewer. Psychometric properties of acceptability, reliability, and validity evidence for each measure will be independently extracted by two reviewers. Data on measures will be synthesized narratively according to acceptability, number of validity evidence sources established, and reliability of scores. Data pertaining to population and healthcare setting will also be reported for each measure.

DISCUSSION

This systematic review will provide a current understanding about the state of evidence with respect to EIDM competence measures in nursing to assist in determining potentially relevant and robust measures for use in different nursing practice settings.

SYSTEMATIC REVIEW REGISTRATION

Protocol registered in PROSPERO Registration #: CRD42018088754.

Facilitating affective elements in learning - In a palliative care context

The aim of this study was to explore ways clinical supervisors facilitate the learning of the affective elements of professional competence in a clinical palliative care environment. The secondary aim was to advocate for and raise awareness of the importance of the affective domain in medical education. A clinical palliative care learning environment has been reported to be emotionally challenging. The affective and transformative learning processes taking place requires special support. However, little is known about how clinical supervisors facilitate this learning processes. A qualitative, explorative study was designed to capture supervisors' perceptions of their supervision using semi-structured interviews. Six experienced clinical supervisors working within a palliative care context were recruited using convenience sampling. Data were analyzed using inductive content analysis. The affective elements were viewed as essential for learning, clinical supervision, and professional competency. Supervisors use a variety of different ways of facilitation. Four main themes were identified; building a relationship, creating space for learning, creating a pedagogical environment, and Mirroring.

Student Preparation for Nursing Leadership: Lessons from an Undergraduate Programs Review

Facilitating student achievement of nationally recognized entry-level-competencies in nursing leadership is a critical step in building capacity to promote patient safety, quality of care, and healthy work environments. Data for this substudy were drawn from a larger multi-phased, multi-method, cross-sectional, descriptive study conducted to inform comprehensive undergraduate curricular revision. The research question for this substudy was: what are the perceptions about undergraduate program preparation for nursing leadership? Frequencies and percentages summarized relevant quantitative data from the surveys and deductive content analysis was used to further explore the category of leadership which emerged from content analysis of qualitative data in the larger study. Key findings illustrate need for additional attention to learning experiences in conflict management, delegation and supervision of clinical teams, and advocacy. Greater collaboration between educational and clinical agencies is needed to find mutually beneficial strategies to support nursing leadership development for nursing students and new graduates.

[Development of the Developmental Support Competency Scale for Nurses Caring for Preterm Infants]

PURPOSE

Developmental care has been recognized as a very important component for the development and health promotion of preterm infants. However, research on how to assess developmental nursing competency has not been studied as expected. This study was done to develop and evaluate a new scale to measure nursing competency for developmental support of preterm infants.

METHODS

Concept analysis was done with using the Hybrid model of Schwartz-Barcott and Kim (2000), from which a preliminary new scale (30 items) was developed. To test the validity and reliability of the new scale being developed, data were collected from 122 NICU nurses at 4 hospitals in 3 cities in the Republic of Korea, from December, 2014 to March, 2015.

RESULTS

The final version of the Developmental Support Competency Scale for Nurses (DSCS-N) caring for premature infants was a 4-point Likert type scale, consisting of 19 items, and categorized as 6 factors, explaining 62.5% of the total variance. Each of the factors were named as follows; 'environmental support' (4 items), 'parental support' (3 items), 'interaction' (3 items), 'critical thinking' (3 items), 'professional development' (3 items), and 'partnership' (3 items). The Cronbach's α coefficient for the scale was .83 and the reliability of the subscales ranged from .60~.76.

CONCLUSION

The psychometric evaluation of the new scale demonstrated an acceptable validity and reliability. Findings indicate that the DSCS-N can be used as the tool to test the effect of educational programs for nurses and contribute to advance developmental care for preterm infants.

Samoocena usposobljenosti študentov zdravstvene nege na podlagi ICN-ovih kompetenc

Uvod: Klinično usposabljanje študentov zdravstvene nege je ključnega pomena. Pomembno je, da so diplomanti usposobljeni za samostojno, humano, odgovorno in avtonomno izvajanje zdravstvene nege. Namen raziskave je bil ugotoviti usposobljenost študentov na rednem in izrednem študiju zdravstvene nege za samostojno izvajanje zdravstvene nege. Metode: Izvedena je bila deskriptivna opazovalna raziskava. Podatki so bili zbrani z delno strukturiranim vprašalnikom na vzorcu 134 študentov tretjega letnika študijskega programa prve stopnje Zdravstvena nega. Raziskava je potekala od januarja do marca 2012. Za analizo sta bili uporabljeni deskriptivna statistika in bivariatna analiza (test hi-kvadrat, t-test). Rezultati: Statistično pomembne razlike v samooceni usposobljenosti med študenti rednega in izrednega študija so se pokazale pri etični praksi ( R =3,6, IZR =3,5, t = 2,63, p = 0,010) in pravni praksi ( R=3,3, IZR=3,1, t = 2,69, p = 0,008). Ugotovljena je bila manj kot 80% usposobljenost pri kompetencah »redno pregledujem in popravljam negovalni načrt v sodelovanju z drugimi člani negovalnega tima in pacienti« (χ2 = 0,27, p = 0,654) in »delegiram naloge glede na usposobljenost, strokovno znanje in izkušnje« (χ2 = 1,793, p = 0,181). Diskusija in zaključek: Raziskava je pokazala, da so študenti najbolje usposobljeni za medpoklicno zdravstveno varstvo, izboljševanje kakovosti in nadaljnje izobraževanje. Raziskavo bi bilo treba opraviti vsako študijsko leto ob zaključku tretjega letnika.

Development and psychometric testing of Holistic Clinical Assessment Tool (HCAT) for undergraduate nursing students

BACKGROUND

A major focus in nursing education is on the judgement of clinical performance, and it is a complex process due to the diverse nature of nursing practice. A holistic approach in assessment of competency is advocated. Difficulties in the development of valid and reliable assessment measures in nursing competency have resulted in the development of assessment instruments with an increase in face and content validity, but few studies have tested these instruments psychometrically. It is essential to develop a holistic assessment tool to meet the needs of the clinical education. The study aims to develop a Holistic Clinical Assessment Tool (HCAT) and test its psychometric properties.

METHODS

The HCAT was developed based on the systematic literature review and the findings of qualitative studies. An expert panel was invited to evaluate the content validity of the tool. A total of 130 final-year nursing undergraduate students were recruited to evaluate the psychometric properties (i.e. factor structure, internal consistency and test-retest reliability) of the tool.

RESULTS

The HCAT has good content validity with content validity index of .979. The exploratory factor analysis reveals a four-factor structure of the tool. The internal consistency and test-retest reliability of the HCAT are satisfactory with Cronbach alpha ranging from .789 to .965 and Intraclass Correlation Coefficient ranging from .881 to .979 for the four subscales and total scale.

CONCLUSIONS

HCAT has the potential to be used as a valid measure to evaluate clinical competence in nursing students, and provide specific and ongoing feedback to enhance the holistic clinical learning experience. In addition, HCAT functions as a tool for self-reflection, peer-assessment and guides preceptors in clinical teaching and assessment.

Nurses' competence in kinaesthetics : A concept development

AIM

This study was carried out to systematically describe nurses' competence in kinaesthetics.

BACKGROUND

In elderly care the kinaesthetics program for nurses has been taught for over 25 years; however, the competence that nurses should gain through kinaesthetics training from a theoretical perspective has not yet been systematically described.

MATERIAL AND METHODS

The method was modelled after the three phases of the hybrid model of concept development by Schwartz-Barcott and Kim (2000). In the theoretical phase a working definition was established and a literature review conducted. We searched the online databases PubMed and CINAHL and the reference lists up to February 2016. In the empirical phase experts defined the attributes during a workshop in October 2013. In the analytical phase the results from the theoretical and empirical phase were combined in order to define antecedents, attributes and consequences of the concept.

RESULTS

The concept of nurses' competence in kinaesthetics includes two antecedents: (1) nurses' kinaesthetics training and (2) care recipients' need for mobility support in activities of daily living. This concept includes a set of attributes in the areas of knowledge, skills, attitudes and dynamic state. It contributes towards (1) movement competence and (2) physical and psychological well-being of both care recipients and nurses.

CONCLUSION

The concept of nurses' competence in kinaesthetics might support awareness and communication about mobility-enhancing gerontological care. Based on the attributes of nurse' competence in kinaesthetics an assessment instrument will be developed that can be used to evaluate nurses' competence in kinaesthetics in clinical practice. Further research is needed to evaluate the consequences of the developed concept.

Competency assessment tools: An exploration of the pedagogical issues facing competency assessment for nurses in the clinical environment

Competency assessment is a paradigm that is common in the healthcare environment and this being particularly true within the nursing profession. Demonstration of competence is necessary to meet the requirements of healthcare organisations and is a mandated requirement of nurses by the Nursing and Midwifery Board of Australia. Within the nursing education sector, one approach to determine competence, is through the use of competency assessment tools. Despite widespread use of competency assessment tools there remains ongoing concerns relating to the efficacy of competency assessment tools as a mean to demonstrate 'competency' amongst enrolled and registered nurses in the clinical environment. The authors of this paper ascertain that competency assessment tools run a serious risk of being nothing more than a 'quick-fix' means of assessment to demonstrate 'nursing competence' required for key performance indicators and clinical governance and that will provide evidence for accreditation standards. Based on this premise, the authors, provide an alternative approach to the use of competency assessment tools that moves away from a 'tick-box' approach to a 'patient-centred' competency model. This approach increases the reliability and validity of competency assessments, allows for the recognition of the knowledge, skills and experience of individual nurses, offers a more satisfying and rewarding approach to demonstrating 'competency' for nurses and finally, demonstrates 'real-life' competency.

The competence gap in community care: Imbalance between expected and actual nursing staff competence

Research that examines nursing staff competence that is necessary in order to provide safe community care is called for. This literature review examines Norwegian policy documents and international research with the aim to assess whether there is a match between expected and actual nursing staff competence in community care. Twelve policy documents and ten research articles were included in the review, of which key themes were identified. The Norwegian government expects a wide range of competence ranging from specific tasks in medical management to adhering to safe practice and care guidelines. Major discrepancies were identified between the advanced competence expected in policy documents and the actual competence as described by the research literature, which was mainly concerned with assistance with activities of daily living, medical knowledge, and personal abilities. There is a general lack of opportunities for competence development in the sector, implying that a general development of nursing staff competence is a pressing need in community care.

Nursing students' experiences with the use of authentic assessment rubric and case approach in the clinical laboratories

BACKGROUND

One current challenge for nurse educators is to examine effective nursing assessment tools which integrate nursing knowledge into practice. Authentic assessment allows nursing students to apply knowledge to real-life experiences. Contextualized cases have engaged students for preparation of diverse clinical situations and develop critical thinking skills.

AIM

This study aimed to explore nursing students' experiences and learning outcomes with the use of an authentic assessment rubric and a case approach.

METHODS

An exploratory qualitative approach using focus-group discussions and an open-ended survey was adopted. Sixteen nursing students participated in three focus-group discussions and 39 nursing students completed an open-ended survey.

RESULTS

Nursing students noted that an authentic assessment rubric with a case approach provided clarity for their learning goals; built confidence; developed knowledge, skill competencies and critical thinking skills; increased awareness of caring attributes and communication skills; and enriched and extended learning through self-, peer- and teacher-assessments.

CONCLUSIONS

These findings provide rich insights for nurse educators and curriculum developers in the use of an authentic assessment rubric and a case approach in nursing education.

Nursing Older People—Competence Evaluation Tool: Development and Psychometric Evaluation

Background and Purpose: To evaluate the quality of care provided to older people, the competence of the nursing staff must be measured. This study evaluates a new instrument called Nursing Older People—Competence Evaluation Tool (NOP-CET). Methods: A 65-item questionnaire was completed by 1,016 community-based nursing staff and evaluated for validity, reliability, precision, interpretability, acceptability, and feasibility. Results: The survey demonstrated good content validity; conceptually coherent factor structure explaining 54.98% (knowledge items), 65.03% (skills items), and 52.83% (personal attribute items) of the total variance; and internal consistency (.77–.93). Conclusions: The NOP-CET showed good validity and reliability as a measure of community-based nursing staff competence and may be used in further investigations of competence in older people nursing.

Beyond competencies: using a capability framework in developing practice standards for advanced practice nursing

AIM

This paper presents a discussion on the application of a capability framework for advanced practice nursing standards/competencies.

BACKGROUND

There is acceptance that competencies are useful and necessary for definition and education of practice-based professions. Competencies have been described as appropriate for practice in stable environments with familiar problems. Increasingly competencies are being designed for use in the health sector for advanced practice such as the nurse practitioner role. Nurse practitioners work in environments and roles that are dynamic and unpredictable necessitating attributes and skills to practice at advanced and extended levels in both familiar and unfamiliar clinical situations. Capability has been described as the combination of skills, knowledge, values and self-esteem which enables individuals to manage change, be flexible and move beyond competency.

DESIGN

A discussion paper exploring 'capability' as a framework for advanced nursing practice standards.

DATA SOURCES

Data were sourced from electronic databases as described in the background section.

IMPLICATIONS FOR NURSING

As advanced practice nursing becomes more established and formalized, novel ways of teaching and assessing the practice of experienced clinicians beyond competency are imperative for the changing context of health services.

CONCLUSION

Leading researchers into capability in health care state that traditional education and training in health disciplines concentrates mainly on developing competence. To ensure that healthcare delivery keeps pace with increasing demand and a continuously changing context there is a need to embrace capability as a framework for advanced practice and education.

Competence and competency-based nursing education: finding our way through the issues

The language of competence is widely utilized in both the regulation of nursing practice and curricular design in nursing education. The notion of competence defines what it means to be a professional, although it is not the only way of describing nursing practice. Unfortunately, there is much confusion about the concepts of competence, competency, and competency-based education. As well, the notion of competence, despite its global popularity, has flaws. In this paper we will disentangle these terms and critique the use of competence frameworks in nursing education.

Instruments Measuring Nursing Staff Competence in Community Health Care

There is currently no review of instruments that measure nursing staff competence in community health care. This study aims to (a) identify competence measurement instruments developed for nursing staff in community health care, and (b) explore conceptual and methodological issues concerning these instruments. A systematic literature search was made for the period 2000-2012. Instruments were evaluated for target group, content, and methodological quality. Of 11 identified instruments, all self-report, only four provided sufficient evidence of instrument validity. Few instruments had conceptualized competence by defining and operationalizing the concept. The evidence of the quality of the instruments varied greatly and was generally not sufficient. This review may help researchers decide which existing competence measurement instrument to use or whether they have to develop a new instrument.

A randomized controlled pilot trial comparing the impact of access to clinical endocrinology video demonstrations with access to usual revision resources on medical student performance of clinical endocrinology skills

BACKGROUND

Demonstrating competence in clinical skills is key to course completion for medical students. Methods of providing clinical instruction that foster immediate learning and potentially serve as longer-term repositories for on-demand revision, such as online videos demonstrating competent performance of clinical skills, are increasingly being used. However, their impact on learning has been little studied. The aim of this study was to determine the value of adjunctive on-demand video-based training for clinical skills acquisition by medical students in endocrinology.

METHODS

Following an endocrinology clinical tutorial program, 2nd year medical students in the pre-assessment revision period were recruited and randomized to either a set of bespoke on-line clinical skills training videos (TV), or to revision as usual (RAU). The skills demonstrated on video were history taking in diabetes mellitus (DMH), examination for diabetes lower limb complications (LLE), and examination for signs of thyroid disease (TE). Students were assessed on these clinical skills in an observed structured clinical examination two weeks after randomization. Assessors were blinded to student randomization status.

RESULTS

For both diabetes related clinical skills assessment tasks, students in the TV group performed significantly better than those in the RAU group. There were no between group differences in thyroid examination performance. For the LLE, 91.7% (n = 11/12) of students randomized to the video were rated globally as competent at the skill compared with 40% (n = 4/10) of students not randomized to the video (p = 0.024). For the DMH, 83.3% (n = 10/12) of students randomized to the video were rated globally as competent at the skill compared with 20% (n = 2/10) of students not randomized to the video (p = 0.007).

CONCLUSION

Exposure to high quality videos demonstrating clinical skills can significantly improve medical student skill performance in an observed structured clinical examination of these skills, when used as an adjunct to clinical skills face-to-face tutorials and deliberate practice of skills in a blended learning format. Video demonstrations can provide an enduring, on-demand, portable resource for revision, which can even be used at the bedside by learners. Such resources are cost-effectively scalable for large numbers of learners.

An iterative consensus-building approach to revising a genetics/genomics competency framework for nurse education in the UK

KIRK M., TONKIN E. & SKIRTON H. (2014) An iterative consensus-building approach to revising a genetics/genomics competency framework for nurse education in the UK. Journal of Advanced Nursing 70(2), 405–420. doi: 10.1111/jan.12207

AimTo report a review of a genetics education framework using a consensus approach to agree on a contemporary and comprehensive revised framework.

BackgroundAdvances in genomic health care have been significant since the first genetics education framework for nurses was developed in 2003. These, coupled with developments in policy and international efforts to promote nursing competence in genetics, indicated that review was timely.

DesignA structured, iterative, primarily qualitative approach, based on a nominal group technique.

MethodA meeting convened in 2010 involved stakeholders in UK nursing education, practice and management, including patient representatives (n = 30). A consensus approach was used to solicit participants' views on the individual/family needs identified from real-life stories of people affected by genetic conditions and the nurses' knowledge, skills and attitudes needed to meet those needs. Five groups considered the stories in iterative rounds, reviewing comments from previous groups. Omissions and deficiencies were identified by mapping resulting themes to the original framework. Anonymous voting captured views. Educators at a second meeting developed learning outcomes for the final framework.

FindingsDeficiencies in relation to Advocacy, Information management and Ongoing care were identified. All competencies of the original framework were revised, adding an eighth competency to make explicit the need for ongoing care of the individual/family.

ConclusionModifications to the framework reflect individual/family needs and are relevant to the nursing role. The approach promoted engagement in a complex issue and provides a framework to guide nurse education in genetics/genomics; however, nursing leadership is crucial to successful implementation.

PROFESSIONAL, ACADEMIC AND INDUSTRIAL DEVELOPMENT NEEDS: A COMPETENCY MAPPING AND EXPERT OPINION REVIEW

There is a tripartite pull from academics, industry and professional bodies on the development needs of the Quantity Surveyor (QS). At best, there is scope for misunder-standings between the stakeholders as to what is being required and what is being achieved. At worst there may be actual gaps in the education and/or training being offered and some discrepancies between the levels of attainment. This research sought to review the Royal Institution of Chartered Surveyors (RICS) QS competencies and their application in the delivery of QS degree programmes. The changing development needs of QSs who satisfy the aspirations of industrial, professional and academic stakeholders were investigated through content analysis of the views of an expert forum consisting of relevant stakeholders and a series of competency mapping case studies. The study revealed that there are considerably different standards right across the RICS accredited QS programmes with respect to coverage of competencies. It is concluded that there is no standard benchmark in achieving competencies and it is open to individual interpretation. Further research in the development of a Graduate Competency Threshold Benchmark is suggested to align the disparate views of the stakeholders to accommodate changing development needs.

Comparison of self-assessed competence and experience among critical care nurses

AIM

To determine the level of self-assessed nursing competence and the relationship to age and experience in nursing.

BACKGROUND

Nursing competence is a concern for all health-care stakeholders. Methods to measure competence have been evaluated worldwide. There is little agreement about the development or reliable measure of competence. Exploring these relationships can identify strategies for education, retention, professional growth and potentially affect patient outcome measures.

METHOD

The Nurse Competence Scale (NCS) was completed by 101 critical care nurses. Statistical methods were used to analyse the data.

RESULTS

The nurses self-assessed level of competence ranged from good to excellent along with an increased frequency of using competencies. Statistically significant relationships were found among the variables.

CONCLUSIONS

Measurable, significant relationships exist among the variables. The NCS proved to be a valid and reliable instrument to measure competence.

IMPLICATIONS FOR NURSING MANAGEMENT

Objective and reliable assessment of nursing competence is an important measure for leadership and education. Further studies to identify other factors affecting the nurses' experience and the effect on competence will help to develop and promote supportive strategies.

Competence and Competency: Core Concepts for International Midwifery Practice

The global health community has implemented several initiatives over the past in the interest of accelerating country-by-country progress toward the Millennium Development Goal of improving maternal health. Skilled attendance at every birth has been recognized as an essential component of approaches for reducing maternal and perinatal morbidity and mortality.

Midwives have been acknowledged as a preferred cadre of skilled birth attendant. The International Confederation of Midwives (ICM) speaks for the global community of fully qualified (professional) midwives. The ICM document entitledEssential Competencies for Basic Midwifery Practiceis a core policy statement that defines the domains and scope of practice for those individuals who meet the international definition of midwife. This article explores the meaning of competence and competency as core concepts for the midwifery profession. An understanding of the meaning of these terms can help midwives speaking individually at the clinical practice level and midwifery associations speaking at the policy level to articulate more clearly the distinction of fully qualified midwives within the skilled birth attendant and sexual and reproductive health workforce. Competence and competency are fundamental to the domains of midwifery education, legislation, and regulation, and to the deployment and retention of professional midwives.

Acute nursing episodes which challenge graduate's competence: perceptions of registered nurses

On successful completion of nurse education programmes new graduate nurses are expected to meet the requirements for registration as a professional practitioner. Nurse educators need to collaborate with clinical colleagues to be responsive to changes in health care. Identifying challenging acute nursing episodes (CANE) that nurses' encounter in clinical practice and the aspect of competence that new graduate nurses require to manage these episodes effectively can inform undergraduate nursing curricula. Thus a qualitative, descriptive design was employed when undertaking a study to identify challenging acute nursing episodes which new graduates will encounter in clinical practice. Six focus groups were conducted in three university teaching hospitals in Ireland where a total of 28 registered nurses were recruited. Thematic analysis was used to extract themes from the focus group data. The results of this study identified 41 challenging acute nursing episodes and 4 key aspects of competence namely; patient assessment, technical/clinical skills; interactions and communications and clinical decision making. Findings of this study identify both the episodes which challenge new graduates and aspects of competence required by new graduates. These findings provide evidence for nurse educators to develop and deliver curricular content which is congruent with the realities of current day nursing practice.