Long term care nursing competence and related factors among Taiwanese nurses: A national survey for those who completed the LTC training course

Factors affecting the development of clinical nurses' competency: A systematic review

AIM

To synthesize and analyze the literature on nursing clinical competence to assess the factors affecting nursing clinical competency.

BACKGROUND

Nursing competence affects not only patients but also nurses themselves. Competent nurses contribute to patient safety. Prioritizing clinical competency enables nurses to deliver high-quality care. Clinical nursing competency is influenced by various factors including education and training, experience, professional development, clinical judgment, decision-making skills and communication.

DESIGN

This was a systematic review.

METHODS

This study utilized an extensive literature search of online databases, including SCOPUS, Web of Science and PubMed. This review followed the guidelines provided by the Effective Practice and Organization of Care (EPOC) Cochrane Group and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

RESULTS

This systematic review provided 20 valuable articles, with a total of 6273 participants across the 20 studies, including 18 cross-sectional studies and two descriptive-correlational studies, predominantly using quantitative research methods. The analysis revealed several key factors that significantly affect nurses' clinical competency. These factors included years of experience, workplace environment, theoretical knowledge and educational level, marital status, clinical training, job satisfaction, turnover intention, job stress and critical thinking.

CONCLUSIONS

Understanding and addressing these factors are crucial for enhancing nurses' clinical competence and ultimately improving patient outcomes. Further research and interventions should be directed towards promoting supportive work environments, continuous education and the development of critical thinking skills among nurses to optimize their clinical competencies.

The work status of nurses in long-term care institutions in elderly care: A qualitative descriptive study

AIM

To understand the work status of nurses in long-term care institutions in China for elderly care to provide a reference for further formulating management strategies and promoting the development of long-term care teams.

METHODS

Using qualitative descriptive research methods, 31 nurses from three long-term care institutions were selected through purposive sampling for in-depth interviews, and a three-week participatory observation was conducted on the daily work of nurses in the above three long-term care institutions. Content analysis was used to analyse data.

RESULTS

In our sample, nurses in long-term care institutions had insufficient manpower, generally had low academic qualifications, and lacked professional ability. Their work enthusiasm and initiative need to be further improved. Long-term care nurses were moderately paid, and their salary satisfaction was lower than in other trades. At the same time, the social understanding of the long-term care industry was insufficient, and the social identity of nurses in long-term care institutions was low.

CONCLUSION

The development of long-term care requires the joint efforts of nurses, medical institutions, and society. By improving the system, cultivating talents and building a harmonious atmosphere, we aim to enhance the work enthusiasm of long-term care nurses and promote the stable and orderly development of the long-term care team.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurses in long-term care institutions are at the core of the ageing age and play a vital role in coping with the ageing problem, meeting long-term care needs, improving the quality of life of old people and reducing the cost of long-term care. The training and management of nurses in long-term care institutions and the construction of the entire long-term care system should be based on China's national conditions and actual needs.

Revealing a gap in the clinical competence of nursing staff in nursing homes: a cross-sectional study with the Ms. Olsen test

BACKGROUND

Nursing staff, caring for frail older people in long-term care, needs to have a certain level of clinical competence to identify diseases at an early stage and to assess and provide good nursing care. In Finland, nursing care is based on evidence-based and high-quality nursing care. However, earlier inspections by the National Supervisory Authority for Welfare and Health showed many discrepancies between the nursing staff's clinical competence and adequate and continuous education.

AIM

This study aimed to explore nursing staff, i.e. the clinical competence and decision-making skills of registered and practical nurses in nursing homes for older people in Finland and to analyse the association between nurses' clinical competence and fundamental background factors.

METHODS

We conducted a cross-sectional study of 337 participants in 50 nursing homes in the western part of Finland, between December 2020 and January 2021. The instrument used was the validated Ms. Olsen test, an extraction of NOP-CET. Statistical analyses were conducted with descriptive statistics and correlations and a cut-off for clinical competence.

RESULTS

This study with the Ms. Olsen test revealed that only one-fourth of the RNs and a third of the PNs passed the clinical competence test. In the self-evaluation, almost all participants evaluated themselves with good clinical competence. The Finnish Current Care Guidelines were used on a daily basis by 7.4% and weekly by 30%. Significant correlation was found between Swedish as a working language and mother tongue and the score for clinical competence.

CONCLUSION

The clinical competence test, the Ms. Olsen test, was used in Finland for the first time to evaluate the nursing staffs´ clinical competence in nursing homes. We found gaps in the clinical competence in Finnish nursing homes, both for PNs and RNs. The result differed remarkably from their self-assessments and the staff did not use the national nursing guidelines as required to develop their nursing skills and knowledge. Gaps in the clinical competence have been identified and can be used to develop targeted continuous education.

Construction of a Model of Nurse Engagement in Long-Term Care Facilities: A Moderated-Mediation Model

Aim

The aim of the study is to test a moderated mediation model that focuses on job resources mediating the relationship between organizational climate and nurse engagement in the long-term care facilities and emotional intelligence moderates this mediated relationship.

Background

The shortage of nurses is a global problem, especially in the long-term care facilities. We integrated and extended past research exploring the influence of nurse engagement and constructed a model of nurse engagement in the long-term care facilities.

Method

A cross-sectional survey was conducted on 494 nurses in long-term care facilities. Nurses were asked to complete a survey of nurse engagement, organizational climate, job resources, and emotional intelligence.

Results

The consequence demonstrated that organizational climate increased nurse engagement directly and indirectly via job resources. In addition, emotional intelligence plays a moderation role between organizational climate and job resources.

Conclusion

These phenomena revealed that a good organizational climate and job resources enable nurses to be more engaged in work. Nurse with high-emotional intelligence can take advantage of resources and improve their engagement.

Factors affecting preregistered nurses' willingness to serve in geriatric long-term care

AIM

Rapidly ageing population leads to increased demands for long-term care. Taiwan's preparation for its ageing population focuses on engaging healthcare professionals. This study explored pre-registered nurses' current knowledge, experience in geriatric long-term care (GLTC) and willingness to serve in GLTC.

DESIGN

A cross-sectional survey design and a self-developed structured questionnaire were used.

METHODS

A probability proportionate to size sampling strategy was used to collect data from students in junior college and bachelor of nursing science programmes in Taiwan in 2017. Multiple regression was adopted to predict significant factors that influence nursing students' willingness to serve in GLTC.

RESULTS

The willingness to serve in GLTC was positively correlated with their experience of living with older adults, practicum experience, taking GLTC-related courses and interest in GLTC. Willingness to serve older/disabled patients can be enhanced through school courses and practicum experiences, indicating the importance of GLTC-related courses in the training of the professional nursing workforce.

Self-compassion and nursing competency among Japanese psychiatric nurses

PURPOSE

This study examined the association of self-focus and self-compassion with nursing competency.

DESIGN AND METHODS

Data of 433 psychiatric nurses comprising demographics, other-consciousness, self-compassion, self-focus, and nursing competency were analyzed using the Other-Consciousness Scale (OCS), Self-Compassion Scale (SCS), Japanese version of the Rumination-Reflection Questionnaire (RRQ), and Oriented Problem Solving Behavior (OPSN).

FINDINGS

Higher internal aspect and lower fantastic aspect in OCS, higher reflection in RRQ, and lower SCS negative subscales predicted a higher OPSN score. The account rate of variance was 12.5%.

PRACTICE IMPLICATIONS

Psychiatric nursing education should facilitate other-consciousness and reflection enhancement, and assuage uncompassionate attitude towards self.

Challenging situations and competence of nursing staff in nursing homes for older people with dementia

BACKGROUND

Dementia causes behavioural changes in people that often lead to earlier placement in a nursing home. Staff can find these behavioural changes challenging and require specific competencies to support and care of people living with dementia. However, there is little information regarding the competencies nurses require in dementia care. Thus, the aims of this study were to determine the prevalence of challenging situations in nursing homes of older people with dementia, characterise the nursing staff's responses to such situations and contribute to a model outlining competences that dementia care nurses require.

METHODS

Data were collected using mixed methods in a cross-sectional survey of views of nursing staff (n = 106) in two nursing homes in Finland during May to June 2018 using a structured questionnaire including open-ended questions. Quantitative data acquired were analysed statistically, and responses to the open-ended question were analysed using content analysis methodology.

RESULTS

Most nurses (98%) reported that challenging situations occurred daily or weekly. The most common reported forms of challenging behaviour were as follows: wandering, restlessness, constant leaving, repeated inquiries and requests and opposition to treatment (mentioned by 95%, 90%, 85%, 83% and 83% of respondents, respectively). Five key competencies were identified from their responses: practical knowledge, theoretical knowledge, therapeutic use of self, social competence and self-management. They also indicated significant correlations between leadership and both the impact of challenging behaviour on coping at work and use of physical restraints on older people with dementia.

CONCLUSION

Challenging situations in nursing homes of older people with dementia are very common. There is a need to identify specific competencies for caring for people with dementia in addition to updating official guidelines to handle such situations. The support of supervisors and competencies related to therapeutic use of self in nursing are highly important for nurses providing care for people with dementia.

Development of emergency nursing care competency scale for school nurses

BACKGROUND

School nurses perform vital student emergency services at school, and assessing their emergency nursing care competency is critical to the safety and quality of care students receive. The purpose of the study was to develop a scale for measuring school nurses' competency.

METHODS

This was an instrument development and validation study. It was conducted according to the revised DeVellis scale development process coupled with the application of the International Council of Nurses' Nursing Care Continuum Competencies Framework. Eight experts specializing in school health and emergency care evaluated the content validity, while 386 school nurses evaluated the scale. The validity evaluation comprised factor analysis, discriminative validity analysis according to differences in school nurse experience, and criterion validity analysis. Scale internal consistency was analyzed using Cronbach's α value.

RESULTS

The final scale comprises a self-reported 5-point Likert scale with 30 items based on three factors and three sub-factors. Both the convergent validity of the items by factor and the discriminative validity were both confirmed. The criterion validity was also found to be positively correlated with the Triage Competency Scale.

CONCLUSION

The scale may be used to identify factors influencing school nurses' competency in emergency nursing care and contribute to research in competency-based education programs.

Factors Affecting the Competence of Nursing Assistants in Taiwan Long-Term Care Institutions

With the increasing number of people with disabilities caused by an aging global population, the need for long-term care is gradually increasing. Nursing assistants (NAs) are the primary providers of direct care services to older adults with disabilities, whose knowledge, skills, and beliefs affect the quality of care provided. This study aimed to investigate the influential factors affecting NAs’ current competences. A total of 255 NAs’ valid questionnaires were collected from 20 long-term care institutions in Taiwan through convenience sampling. The questionnaire comprised dimensions of demographics and care competence. The study results indicated that NAs had the greatest care competence in the domain of recognition of patient rights (4.64 ± 0.54 points). The multiple regression indicated that age, religion, job category, disability care experience, the receiving of performance bonuses, and the receiving of year-end bonuses significantly affected the level of care competence (p < 0.05). With the aforementioned findings, the results of this study serve as references for the government in employing long-term care NAs and developing management policies. Training programs for NAs should be developed to improve the quality of care provided to older adults with disabilities.

Factors Related to the Clinical Competence of Registered Nurses: Systematic Review and Meta-Analysis

PURPOSE

To determine the factors associated with the clinical competence of registered nurses.

METHODS

Systematic review and meta-analysis was used. The search strategy was limited to 10 years, ranging from January 2009 to December 2019, in Science Direct, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, ProQuest, and Google Scholar. A meta-analysis was performed using R Studio with the metafor package (Boston, MA, USA; https://rstudio.com/products/rstudio/older-versions/).

RESULTS

A total of 22 studies were included, representing 33,961 nurses. There were 28 factors associated with clinical competence. Of those, 13 factors were significantly supported and included for meta-analysis, grouped into (a) individual-related factors, (b) job satisfaction, (c) bullying, (d) burnout, and (d) specific knowledge. The effect size of those factors ranged from -0.14 to 0.50.

CONCLUSIONS

Among individual-related factors, salary has the largest effect size on competence and is considered important. Clinical competence is positively affected by job satisfaction, but negatively influenced by bullying and burnout. Although specific knowledge has a large effect size, it does not significantly affect the clinical competence of registered nurses.

CLINICAL RELEVANCE

It is critical to understand factors related to the clinical competence of registered nurses to maintain quality care and patient outcomes in clinical settings. The findings serve as data to help nurse managers find effective ways to improve the knowledge, skill, attitudes, and performance of registered nurses.

Nurses' perceptions regarding providing psychological care for older residents in long-term care facilities: A qualitative study

AIMS AND OBJECTIVES

To explore nurses' perceptions regarding providing psychological health care for older residents in long-term care facilities (LTCFs).

BACKGROUND

Loneliness and depressive symptoms are commonly observed among older residents living in LTCFs. Nurses are expected to provide holistic care including physical, psychological and social care for older residents in LTCFs to fulfil their needs. Therefore, understanding nurses' feelings and thoughts regarding providing care for older residents who feel lonely, sad, unhappy or depressed is important for delivering better care.

DESIGN

A qualitative research design was employed. The Standards for Reporting Qualitative Research (SRQR) was used to enhance for reporting quality.

METHODS

Purposive sampling and snowball sampling were applied in Northern Taiwan. One-to-one in-depth interviews were conducted using a semi-structured interview guide. Twenty-one nurses with a mean age of 38.4 years were interviewed. Content analysis was performed for data analysis.

FINDINGS

Four themes were generated from the data: "insufficient psychological healthcare competency," "having a willing heart but not adequate support," "families playing an essential role in residents' mood" and "physical-oriented care model."

CONCLUSIONS

Long-term care facilitie nurses felt that they were not adequately prepared for taking care of older adults' psychological problems before their nursing career or during their practice. Unreasonable nurse-to-resident ratios and an absence of care consensus among healthcare providers can make nurses feel that they have a willing heart but not adequate support. Family members are essential in older residents' emotional status within the Taiwanese cultural context. Physical care evaluation indicators emphasised by LTCF accreditation resulted in the current care practice model.

IMPLICATIONS FOR PRACTICE

This study provides valuable information for LTCF nurses, managers and directors to develop appropriate strategies to assist nurses in providing better psychological health care for older residents. Evaluation indicators required by LTCF accreditation in Taiwan must be re-examined at the earliest stage.

Emergency Department Visits and Disease Burden Attributable to Ambulatory Care Sensitive Conditions in Elderly Adults

Many countries worldwide are aging rapidly, and the complex care needs of older adults generate an unprecedented demand for health services. Common reasons for elderly emergency department (ED) visits frequently involve conditions triggered by preventable infections also known as ambulatory care sensitive conditions (ACSCs). This study aims to describe the trend and the associated disease burden attributable to ACSC-related ED visits made by elderly patients and to characterize their ED use by nursing home residence. We designed a population-based ecological study using administrative data on Taiwan EDs between 2002 and 2013. A total of 563,647 ED visits from individuals aged 65 or over were examined. All elderly ED visits due to ACSCs (tuberculosis, upper respiratory infection, pneumonia, sepsis, cellulitis and urinary tract infection (UTI)) were further identified. Subsequent hospital admissions, related deaths after discharge, total health care costs and disability-adjusted life years (DALYs) were compared among different ACSCs. Prevalence of ACSCs was then assessed between nursing home (NH) residents and non-NH residents. Within the 12-year observation period, we find that there was a steady increase in both the rate of ACSC ED visits and the proportion of elderly with a visit. Overall, pneumonia is the most prevalent among six ACSCs for elderly ED visits (2.10%; 2.06 to 2.14), subsequent hospital admissions (5.77%; 5.59 to 5.94) and associated mortality following admission (17.37%; 16.74 to 18.01). UTI is the second prevalent ACSC consistently across ED visits (2.02%; 1.98 to 2.05), subsequent hospital admissions (2.36%, 2.25 to 2.48) and mortality following admission (10.80%; 10.28 to 11.32). Sepsis ranks third highest in the proportion of hospitalization following ED visit (2.29%; 2.18 to 2.41) and related deaths after hospital discharge (7.39%; 6.95 to 7.83), but it accounts for the highest average total health care expenditure (NT$94,595 ± 120,239; ≈US$3185.02) per case. When examining the likelihood of ACSC-attributable ED use, significantly higher odds were observed in NH residents as compared with non-NH residents for: pneumonia (adjusted odds ratio (aOR): 5.01, 95% confidence interval (CI) 4.50-5.58); UTI (aOR: 4.44, 95% CI 3.97-4.98); sepsis (aOR: 3.54, 95% CI 3.06-4.10); and tuberculosis (aOR: 2.44, 95% CI 1.63-3.65). Here we examined the ACSC-related ED care and found that, among the six ACSCs studied, pneumonia, UTI and sepsis were the leading causes of ED visits, subsequent hospital admissions, related mortality, health care costs and DALYs in Taiwanese NH elderly adults. Our findings suggest that efficient monitoring and reinforcing of quality of care in the residential and community setting might substantially reduce the number of preventable elderly ED visits and alleviate strain on the health care system.