The National Health Service Knowledge and Skills Framework and its implications for continuing professional development in nursing

Enhancing skill conceptualization, critical thinking, and nursing knowledge through reflective case discussions: a systematic review

Reflective case discussion (RCD) is a reflective activity conducted by nurses, midwives, and other healthcare workers to enhance their skills, critical thinking, and knowledge. This systematic review follows the PRISMA Guideline checklist and includes articles from various databases, such as Scopus, PubMed, ProQuest, and ScienceDirect. The quality assessment of each article was performed using the Critical Appraisal Skills Program (CASP). During the initial database search, we retrieved 997 articles from Scopus, 700 articles from ProQuest, 357,554 articles from PubMed, and 1,526 articles from ScienceDirect. The search was conducted using relevant keywords, including "reflective case discussion," "nursing," "critical thinking," "skills," and "knowledge." Following the inclusion and exclusion criteria, eight relevant articles were identified, excluding duplicate studies, limited to full papers, open access, conducted in a hospital setting, and written in English. The findings demonstrate that RCD effectively enhances nurses' skills, critical thinking, and knowledge, contributing to their professionalism in patient care. RCD also proved beneficial in preventing repetitive mistakes and promoting teamwork among nurses. Thus, RCD should be embraced as a valuable form of Continuing Professional Development (CPD) and integrated into nurses' ongoing learning processes.

Describing the evidence-base for research engagement by health care providers and health care organisations: a scoping review

BACKGROUND

Having a research-engaged health and medical workforce is associated with improvements in clinical outcomes for patients. As such, there has been significant government investment internationally to support health care organisations and services to increase staff engagement with research.

OBJECTIVES

This scoping review sought to provide an overview of the literature describing strategies employed to increase research engagement by health care providers and organisations, and to undertake a qualitative analysis to generate a list of research engagement strategies.

METHODS

A scoping review using systematic search strategies was undertaken to locate peer-review publications and grey literature related to research engagement by health care providers and organisations. Research engagement was defined as a 'deliberate set of intellectual and practical activities undertaken by health care staff and organisations to conduct research'. A database search of electronic records was performed with no limit on publication date. Publications were included regardless of study type (excluding systematic reviews) and categorised as either databased (presenting data or new analysis of existing data) and non-databased (no new data or analyses). Databased publications were further classified according to study type, study design and setting. A qualitative synthesis using a Framework Approach was undertaken with all studies that described a strategy to improve research engagement.

RESULTS

A total of 152 publications were included in this study with 54% categorised as non-databased. Of the databased articles, the majority (72%) were descriptive studies describing prevalence of correlates of research engagement, 17 (25%) described intervention studies where only two were controlled studies. The following research engagement strategies were identified: i) dual skilled team/staff, ii) resources or physical infrastructure, iii) incentives, iv) leadership support of research, v) education/training, vi) networks, vii) forming partnerships or collaborations and viii) overall leadership structure of entity.

CONCLUSIONS

The literature on research engagement is primarily opinion-based and descriptive in nature. To provide the evidence needed to inform strategies, this needs to progress beyond descriptive to more rigorous well-designed intervention research.

Exploring the role of the nutrition nurse specialist in an intestinal failure tertiary referral centre

The role of the nutrition nurse specialist (NNS) is diverse and is usually integral to a wider, multidisciplinary nutrition support team (NST). Practice frameworks have been developed to identify competencies within the NNS role. A mind-mapping technique was used with the NNS team and the wider NST to explore the role of the NNS in the authors' intestinal failure tertiary referral centre. The results of this were further compared with the published competency frameworks. The mind maps from the NNS team and NST demonstrated commonality. It was encouraging to see that colleagues seem to have a similar understanding of the NNS role and contribution to the wider service. Published competency frameworks did not entirely reflect the expanded scope of practice that is undertaken within this particular team. It is important for clinical nurse specialist teams to evaluate their role and service provision and to compare this against published competency frameworks.

Lifelong learning and nurses' continuing professional development, a metasynthesis of the literature

Background

Continuing professional development (CPD) is central to nurses’ lifelong learning and constitutes a vital aspect for keeping nurses’ knowledge and skills up-to-date. While we know about the need for nurses’ continuing professional development, less is known about how nurses experience and perceive continuing professional development. A metasynthesis of how nurses experience and view continuing professional development may provide a basis for planning future continuing professional development interventions more effectively and take advantage of examples from different contexts. The aim of this paper is to conduct such a metasynthesis, investigating the qualitative research on nurses’ experiences of continuing professional development.

Methods

A metasynthesis of the qualitative literature was conducted. A total of 25 articles fulfilled the inclusion criteria and were reviewed.

Results

We determined five overarching themes, Organisational culture shapes the conditions, Supportive environment as a prerequisite, Attitudes and motivation reflect nurse’s professional values, Nurses’ perceptions of barriers and Perceived impact on practice as a core value. This metasynthesis highlights that nurses value continuing professional development and believe that it is fundamental to professionalism and lifelong learning. Moreover CPD is identified as important in improving patient care standards.

Conclusions

Based on the metasynthesis, we argue that access to continuing professional development could be made more attainable, realistic and relevant. Expediently, organizations should adequately fund and make continuing professional development accessible. In turn, nurses should continue to actively engage in continuing professional development to maintain high standards of nursing care through competent practice. This paper highlights the perceived benefits and challenges of continuing professional development that nurses face and offers advice and understanding in relation to continuing professional development. We believe that this metasynthesis contributes with insights and suggestions that would be valuable for nurses and policy makers and others who are involved in nurse education and continuing professional development.

Building the Case for Nurses' Continuous Professional Development in Ethiopia: A Qualitative Study of the Sick Kids-Ethiopia Paediatrics Perioperative Nursing Training Program

Background

This study describes the in-service training experience of perioperative nurses from the SickKids-Ethiopia Paediatrics Perioperative Nursing Training Program in Addis Ababa, Ethiopia. The study emphasizes specifically how nurses applied the knowledge and skills gained from the Paediatrics Perioperative Nursing Training program in their subsequent practice and consider the situational factors that facilitated or hindered implementing these new knowledge and skills.

Methods

The first author led qualitative in-depth interviews with nine perioperative nurses who participated in training in September 2016, and systematically developed descriptive codes and themes to analyze the data.

Results

The authors found that participants experienced improved knowledge, skills, confidence, and job retention related to perioperative nursing practice after participating in Paediatrics Perioperative Nursing Training. Participants also stressed key challenges including lack of access to ongoing perioperative in-service training and problematic staffing policies that impact perioperative nurses' ability to fully utilize and share new knowledge gained during CPD training.

Conclusion

The findings highlighted the value of specialized perioperative CPD training for Ethiopian nurses, yet also pointed to multidimensional challenges for knowledge translation and sustainability of best practices. The authors offer recommendations for individual and institutional strategies to address some of them.

Continuing Professional Development Engagement-A UK-based Concept Analysis

INTRODUCTION

Although much literature exists regarding the operationalization of the term engagement, this relates specifically to work/employee engagement and user, consumer, and scholarly engagement. There is no clear understanding of the term Continuing Professional Development (CPD) engagement for allied health professionals and Nurses and Midwives in the UK, although it is becoming a frequently used term. This raises the challenge of creating measures of the impact of CPD engagement. This concept analysis therefore sought to operationalize the term CPD engagement.

METHODS

A theoretical concept analysis was undertaken, as part of a Professional Doctorate, using Walker and Avant's Concept Analysis Framework. Literature was accessed via OVID, PubMed, CINAHL, ERIC, ABI INFO, and PsychINFO using search terms engagement, work/employee, user, consumer, scholarly engagement, CPD, and life-long learning.

RESULTS

Defining attributes for CPD engagement included criteria based around the terms such as self-initiated, voluntary, applied, recorded, evaluated and shared, and continuation of learning beyond the initial activity. Antecedents focused around drive and availability of resources including time, money, and support.

DISCUSSION

There are potentially many positive consequences of CPD engagement, such as job satisfaction, employee retention, and quality of service provision, that may be more easily investigated and measured against the attributes defined from this study, which indicates that CPD engagement is characterized by the following five criteria: (1) self-initiated; (2) rewarded (either intrinsically or extrinsically); (3) applied in practice; (4) recorded, evaluated, and shared with others; and finally (5) continues beyond the initial learning activity.

Feasibility of Training Physical Therapists to Deliver the Theory-Based Self-Management of Osteoarthritis and Low Back Pain Through Activity and Skills (SOLAS) Intervention Within a Trial

BACKGROUND

Provider training programs are frequently underevaluated, leading to ambiguity surrounding effective intervention components.

OBJECTIVE

The purpose of this study was to assess the effectiveness of a training program in guiding physical therapists to deliver the Self-management of Osteoarthritis and Low back pain through Activity and Skills (SOLAS) group education and exercise intervention (ISRCTN49875385), using a communication style underpinned by self-determination theory (SDT).

DESIGN

This was an assessment of the intervention arm training program using quantitative methods.

METHODS

Thirteen physical therapists were trained using mixed methods to deliver the SOLAS intervention. Training was evaluated using the Kirkpatrick model: (1) Reaction-physical therapists' satisfaction with training, (2) Learning-therapists' confidence in and knowledge of the SDT-based communication strategies and intervention content and their skills in applying the strategies during training, and (3) Behavior-8 therapists were audio-recorded delivering all 6 SOLAS intervention classes (n = 48), and 2 raters independently coded 50% of recordings (n = 24) using the Health Care Climate Questionnaire (HCCQ), the Controlling Coach Behavior Scale (CCBS), and an intervention-specific measure.

RESULTS

Reaction: Physical therapists reacted well to training (median [IRQ]; min-max = 4.7; [0.5]; 3.7-5.0). Learning: Physical therapists' confidence in the SDT-based communication strategies and knowledge of some intervention content components significantly improved. Behavior: Therapists delivered the intervention in a needs-supportive manner (median HCCQ = 5.3 [1.4]; 3.9-6.0; median CCBS = 6.6 ([0.5]; 6.1-6.8; median intervention specific measure = 4.0 [1.2]; 3.2-4.9). However, "goal setting" was delivered below acceptable levels by all therapists (median 2.9 [0.9]; 2.0-4.0).

LIMITATIONS

The intervention group only was assessed as part of the process evaluation of the feasibility trial.

CONCLUSIONS

Training effectively guided physical therapists to be needs-supportive during delivery of the SOLAS intervention. Refinements were outlined to improve future similar training programs, including greater emphasis on goal setting.

Analysis of University Postgraduate Nursing Education in Spain

BACKGROUND

The nursing education program framework in Spain has recently been adapted and modified. This study aimed to analyze university postgraduate master'slevel nursing education during the past 21 years in Spain in terms of educational supply and demand.

METHOD

A retrospective, longitudinal, descriptive, and observational design was used. The educational offerings at 15 university nursing schools in Spain were examined. The target population was 7,871 registered and licensed nurses who had completed postgraduate education.

RESULTS

Among the 211 programs offered, public universities' educational offerings focused on two areas-public health and emergency care-whereas most courses in private universities were in surgery. Regarding demand, 1,235 nurses were enrolled. The most frequently requested educational areas were surgery, emergency and urgent care, and public health.

CONCLUSION

Although the postgraduate nursing education situation has changed, supply and demand for this type of education in Spain are well balanced at both public and private universities. [J Nurs Educ. 2016;55(11):615-622.].

Nurses' Beliefs About Caring for Patients With Traumatic Brain Injury

Patients with traumatic brain injury (TBI) and their families rely on health care providers, particularly nurses, to provide accurate information, yet inaccurate beliefs about TBI have been found among nurses. Although prior studies have assessed nurses' beliefs about TBI recovery and rehabilitation, none have assessed specific beliefs about the nursing role to care for these patients. The purpose of this study was to investigate nurses' beliefs and learning preferences about caring for patients with moderate-to-severe TBI. A cross-sectional survey was administered to 513 nurses at a Midwestern hospital between October and December 2014 (20.3% response rate). Latent class analysis was used. Findings showed that nurses had inaccurate beliefs about TBI relating to recovery and the nursing role, and had significant differences in learning preferences. These findings have implications for development of educational and training interventions specific to nurses to ensure that they have factual information about TBI and to clarify the nursing role.

Skills Required for Nursing Career Advancement: A Qualitative Study

Background

Nurses require certain skills for progression in their field. Identifying these skills can provide the context for nursing career advancement.

Objectives

This study aimed to identify the skills needed for nurses’ career advancement.

Materials and Methods

A qualitative approach using content analysis was adopted to study a purposive sample of eighteen nurses working in teaching hospitals affiliated with the Qazvin, Shahid Beheshti, and Iran Universities of Medical Sciences. The data were collected through semi-structured interviews, and analyzed using conventional content analysis.

Results

The three themes extracted from the data included interpersonal capabilities, competency for career success, and personal capacities. The results showed that acquiring a variety of skills is essential for career advancement.

Conclusions

The findings showed that personal, interpersonal, and functional skills can facilitate nurses’ career advancement. The effects of these skills on career advancement depend on a variety of conditions that require further studies.

Continuing professional development training needs of medical laboratory personnel in Botswana

BACKGROUND

Laboratory professionals are expected to maintain their knowledge on the most recent advances in laboratory testing and continuing professional development (CPD) programs can address this expectation. In developing countries, accessing CPD programs is a major challenge for laboratory personnel, partly due to their limited availability. An assessment was conducted among clinical laboratory workforce in Botswana to identify and prioritize CPD training needs as well as preferred modes of CPD delivery.

METHODS

A self-administered questionnaire was disseminated to medical laboratory scientists and technicians registered with the Botswana Health Professions Council. Questions were organized into domains of competency related to (i) quality management systems, (ii) technical competence, (iii) laboratory management, leadership, and coaching, and (iv) pathophysiology, data interpretation, and research. Participants were asked to rank their self-perceived training needs using a 3-point scale in order of importance (most, moderate, and least). Furthermore, participants were asked to select any three preferences for delivery formats for the CPD.

RESULTS

Out of 350 questionnaires that were distributed, 275 were completed and returned giving an overall response rate of 79%. The most frequently selected topics for training in rank order according to key themes were (mean, range) (i) quality management systems, most important (79%, 74-84%); (ii) pathophysiology, data interpretation, and research (68%, 52-78%); (iii) technical competence (65%, 44-73%); and (iv) laboratory management, leadership, and coaching (60%, 37-77%). The top three topics selected by the participants were (i) quality systems essentials for medical laboratory, (ii) implementing a quality management system, and (iii) techniques to identify and control sources of error in laboratory procedures. The top three preferred CPD delivery modes, in rank order, were training workshops, hands-on workshops, and internet-based learning. Journal clubs at the workplace was the least preferred method of delivery of CPD credits.

CONCLUSIONS

CPD programs to be developed should focus on topics that address quality management systems, case studies, competence assessment, and customer care. The findings from this survey can also inform medical laboratory pre-service education curriculum.

Improving access to CPD for nurses: the uptake of online provision

Qualified nurses want to access courses that develop their knowledge and skills base within specific areas that are relevant to the work that they do. Traditional methods of delivery for post registration education usually involve attendance at a university or continuing professional development department for lectures and seminars. It is well known that barriers exist which prevent staff from being released to attend such educational activities, or to fund nurses education and development directly. Furthermore, education of the nursing workforce presents a dilemma for many education providers due to the range of learning styles of the current pool of potential students together with the ever changing demographics of the workforce. This paper aims to explore the dilemma faced by education providers and makes suggestions regarding possible solutions to supporting the continuing professional development of the nursing work force. In particular, education providers are encouraged to consider developing non-traditional study packages which maximise uptake through mechanisms such as on-line provision.

Critical Care nurses' understanding of the NHS knowledge and skills framework. An interpretative phenomenological analysis

AIMS

This small-scale research study aimed to explore Critical Care nurses' understanding of the National Health Service (NHS) Knowledge and Skills Framework (KSF) in relationship to its challenges and their nursing role.

BACKGROUND

The NHS KSF is central to the professional development of nurses in Critical Care and supports the effective delivery of health care in the UK. KSF was implemented in 2004 yet engagement seems lacking with challenges often identified.

DESIGN

This qualitative study adopted an Interpretative Phenomenological Analysis framework.

METHOD

Data were collected from five Critical Care nurses using semi-structured interviews that were transcribed for analysis.

RESULTS

Two super-ordinate themes of 'engagement' and 'theory-practice gap' were identified. Six subthemes of 'fluency', 'transparency', 'self-assessment', 'achieving for whom', 'reflection' and 'the nursing role' further explained the super-ordinate themes. Critical Care nurses demonstrated layers of understanding about KSF. Challenges identified were primarily concerned with complex language, an unclear process and the use of reflective and self-assessment skills.

CONCLUSIONS

Two theory-practice gaps were found. Critical Care nurses understood the principles of KSF but they either did not apply or did not realize they applied these principles. They struggled to relate KSF to Critical Care practice and felt it did not capture the 'essence' of their nursing role in Critical Care.

RELEVANCE TO CLINICAL PRACTICE

Recommendations were made for embedding KSF into Critical Care practice, using education and taking a flexible approach to KSF to support the development and care delivery of Critical Care nurses.

Competence profile of an in-house educator of professionals providing elderly care (ComPro project)

BACKGROUND

The main goal of the study, conducted within the multicenter ComPro project (Competence Profiles for Learning Supporters in Elderly Care) and funded by the Leonardo da Vinci Programme in 2006-2008, was to define the competences profile of a person responsible for the inhouse education of professionals caring for the elderly persons in social care institutions.

METHODS

The qualitative (3 focus group interviews) and quantitative (the KODE®X questionnaire) approach was used to study opinions of 106 care professionals and 39 managers in social care institutions, and 35 teachers in vocational schools for workers in social care about desired competences of an in-house educator.

RESULTS

The factor analysis with Varimax rotation performed separately for each group of surveyed professionals showed 4 factors in each, which had different components with the highest correlation rates. In the managers group--factor 1 correlated most with communication and organisational competences; among care professionals--with professional knowledge and their job specific skills; among teachers--with social and didactical competences.

CONCLUSIONS

The most expected competences were different in each position, what may reflect the need of creation of a job description and a post of an in-house educator in social care institutions.

Measuring paediatric intensive care nursing knowledge in Australia and New Zealand: how the Basic Knowledge Assessment Tool for pediatric critical care nurses (PEDS-BKAT4) performs

Validated professional knowledge measures are limited in paediatric intensive care unit (PICU) nursing. The Basic Knowledge Assessment Tool for Pediatric Critical Care Nurses (PEDS-BKAT4) measures knowledge, however content and practice differences exist between various PICUs. The study aim was to evaluate the PEDS-BKAT4 in the Australian and New Zealand setting. A panel of 10 experts examined item and scale content validity. Items were evaluated for 31 evidence-based item writing flaws and for cognitive level, by a 4-person expert panel. Thirty-six PICU nurses completed the PEDS-BKAT4, with reliability and item analysis conducted. Mean item content validity was 0.70, and 43% of items had content validity less than 0.8. Overall (Scale) content validity was 0.71. Thirty-five percent of items were classified as flawed. Thirty-five percent of items were written at the 'knowledge' level, and 58% at 'understanding'. The mean PEDS-BKAT4 score was 60.8 (SD=9.6), KR-20 reliability 0.81. The mean item difficulty was 0.62, and the mean discrimination index was 0.23. The PEDS-BKAT4 was not a reliable and valid measure of basic PICU nursing knowledge in Australian and New Zealand. Further research into the types of knowledge and skills required of PICU nurses in this setting are needed to inform the development of a future tool.

Perceptions of Professionalism Among Nursing Faculty and Nursing Students

Although there is no consensus about the definition of professionalism, some generally recognized descriptors include knowledge, specialization, intellectual and individual responsibility, and well-developed group consciousness. In this study, Q-methodology was used to identify common viewpoints about professionalism held by nursing faculty and students, and four viewpoints emerged as humanists, portrayers, facilitators, and regulators. The humanists reflected the view that professional values include respect for human dignity, personal integrity, protection of patient privacy, and protection of patients from harm. The portrayers believed that professionalism is evidenced by one’s image, attire, and expression. For facilitators, professionalism not only involves standards and policies but also includes personal beliefs and values. The regulators believed that professionalism is fostered by a workplace in which suitable beliefs and standards are communicated, accepted, and implemented by its staff. The differences indicate that there may be numerous contextual variables that affect individuals’ perceptions of professionalism.

Implementing KSF competency testing in primary care. Part 2: Evaluation of the pilot of an appraisal tool

Assessment of competence is a way of measuring if staff are fit for purpose. Clinical competences, against which performance is measured, have been developed in a wide range of clinical settings in recent years (Department of Health (DH), 2008). Several trusts also operate an assessment centre in the recruitment and selection of staff, and these frequently involve competency testing in order to be certain that their new recruits are fit for their post. Agenda for Change (DH, 2004a) firmly links pay to the competences expressed in the Knowledge and Skills Framework (DH, 2004b; c) yet the KSF has not been implemented in all trusts. In part 1 of this article (Bentley and Dandy-Hughes, 2010), the process of Southwark PCT's competency project was described. This involved the process of writing measurable, manageable competences from the KSF, in order to develop staff to be fit for purpose. Part 2 evaluates the use of the appraisal tool that was developed from the KSF, and examines the role of the nurse consultant in education who led the competency project.

Implementing KSF competency testing in primary care. Part 1: developing an appraisal tool

The delivery of an effective community nursing workforce relies on competent staff. Commissioners will need to be assured that their providers employ competent, efficient staff who give value for money. The Knowledge and Skills Framework (KSF) was introduced as part of Agenda for Change to identify the competences required, but competency testing using the KSF has not been fully implemented across the UK, and measuring competency, using the KSF indicators, still leaves much room for variation and a non-standardized approach. In the first of this two-part article, the authors discuss the process through which the provider services of one London PCT developed standardized competences using the KSF which were linked to staff performance and which provided clear areas for individual development.

Learning needs assessment for registered nurses in two large acute care hospitals in Urban New Zealand

BACKGROUND

Ongoing education for the nursing workforce is necessary to ensure currency of knowledge in order to enable evidence based client care. The cost of education is high to the organisation and the individual, and must therefore be cost-effective, relevant and appropriate. According to research, education for nurses is not always systematically planned and developed and often relies on the interest area and assessment of the nurse educators.

AIM

To survey the learning needs of clinically based registered nurses within an acute care setting.

DESIGN AND METHOD

An anonymous questionnaire was used to collect the data. Two groups completed the questionnaire: all eligible registered nurses in two acute care hospitals located in urban New Zealand and their senior nurses such as clinical nurse managers, specialists and educators.

RESULTS

The study found agreement on learning needs and also noted differing opinions between the Registered Nurses (RNs), and their senior RNs, RNs initially registered overseas and between levels of practice, on selection and ranking of learning needs.

CONCLUSION

This survey identified a number of high learning needs for RNs working within acute care settings. Differences in perception of learning needs for RNs, between the nurses themselves and the Senior RNs exist, as well as among sub groups of RNs. As a result, educators and managers are encouraged to collaborate to realise the opportunity which exists for the provision of education across specialty areas and to work with the different groups and the individual to ensure unique learning needs are met.

Specialist nursing framework for New Zealand: a missing link in workforce planning

The current global nursing shortage challenges the provision of a well qualified and sustainable health workforce to meet future population health needs. An identified area of concern for New Zealand reaching health policy targets in chronic conditions management and primary health care is an adequate specialist nurse workforce supply. This article explores the New Zealand context underpinning this concern and contends that effective workforce planning would be supported by the development of a single unified framework for specialist nursing practice in New Zealand. A consistent national framework has the potential to support accurate data collection and enable service providers to identify and plan transparent and transferable pathways for specialist nursing service provision and development. Advanced practice nursing frameworks assist in increasing productivity through building an evidence base about advanced practice, enhancing consistency and equity of expertise; supporting a reduction in role duplication; and enabling succession planning and sustainability.