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

Comparison of the correlation between moral sensitivity and clinical competence in emergency and intensive care nurses: A cross-sectional-correlation study

INTRODUCTION

Nurses' sensitivity to moral issues, especially in emergency and intensive care units is essential for providing complex nursing care. Therefore, the present study aimed to determine the correlation between moral sensitivity and clinical competence in emergency and intensive care nurses.

METHODS

The present multi-center cross-sectional correlational study was conducted in 2022 on 180 nurses in five emergency departments and four intensive care units of general hospitals affiliated to Semnan University of Medical sciences. The study tools include a demographic questionnaire, 25 item Lutzen Moral Sensitivity Questionnaire (MSQ), and a standardized Competency Inventory for Registered Nurses (CIRN). Data were analyzed by mean, standard deviation and MANOVA, Pearson's correlation coefficient test.

RESULTS

The two groups did not have significant differences in demographic characteristics (p < 0.05). Majority of two emergency department nurses (83.9%) and Intensive care nurses (81.8%) had a moderate level of moral sensitivity. Also, clinical competence of majority of emergency department nurses (73.3%) and Intensive care nurses (75.8%) were in moderate level. There was significant positive relationship between moral sensitivity with Clinical competence in emergency department nurses (p ≤ 0.01, r = 0.61). No significant relationship was observed between moral sensitivity and the clinical competence of intensive care nurses (p > 0.05, r = 0.15).

CONCLUSIONS

There is need for improving the level of knowledge of nurses about moral principles and increasing moral sensitivity which can expand the components of clinical competence, especially in intensive care units.

Constructing a Competency Evaluation Index System for Nursing Positions in a Chronic Kidney Disease Management Centre

Objective

The Chronic Kidney Disease Management Centre (CKDMC) primarily focuses on developing a new system for early screening, standardised diagnosis, treatment, and the long-term follow-up management of patients with chronic kidney disease (CKD) to enhance CKD prevention and management. Nurses play a pivotal role in the comprehensive management of CKD, contributing considerably to the improvement of patient survival. Consequently, this study constructs an evaluation index system for nursing positions in the CKDMC, delineating the required competencies of nurses and providing a foundation for their targeted training.

Methods

A literature review and semi-structured interviews were used to develop the competency evaluation index system for nursing positions at the CKDMC. The Delphi method, involving expert correspondence, was employed over two rounds of inquiry with 16 experts, focusing on screening, modifying, and refining the indicators at all levels.

Results

The response rates for the first and second rounds of the questionnaire were 100% and 93.8%, respectively, with expert authority coefficients of 0.73 for both rounds. The finalised competency evaluation index system includes 3 primary indicators (theoretical knowledge, practical skills, and professional attitude), 10 secondary indicators, and 44 tertiary indicators.

Conclusion

The study successfully established a CKD specialist nurse competency evaluation index system comprising 3 primary, 10 secondary, and 44 tertiary indicators. The consensus among experts was high, rendering the results scientific, objective, and reliable. This system can serve as a basis for the training, selection, and competency evaluation of nursing professionals in CKDMCs.

The relationship between general self-efficacy and nursing practice competence for second-year nurses: Empirical quantitative research

AIM

To examine the relationship between general self-efficacy and nursing practice competence for nurses in the second year of employment.

DESIGN

A cross-sectional design was used.

DATA SOURCES

The study included 596 nurses in their second year of employment at 75 medical facilities across Japan and used an online questionnaire survey for data collection.

RESULTS

The covariance structure analysis showed the path from general self-efficacy (latent variable) to nursing practice competence. Positive correlations were found between all factors on both scales. Multiple regression analysis results showed that the general self-efficacy factors of 'positivity in behavior' and 'confidence in social competence' affect nursing practice competence.

CONCLUSION

This study emphasizes the importance of enhancing the general self-efficacy of second-year nurses to improve their nursing practice competence. To achieve this, it suggests developing strategies from the perspective of the factors that comprise general self-efficacy.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

The findings suggest that improving general self-efficacy can enhance nursing practice competence, which could inform the development of interventions to support nurses in improving their competence. The study provides basic data for improving nurses' practice competence.

IMPACT

This study is the first to establish a relationship between general self-efficacy and nursing practice competence among second-year nurses. It demonstrates the significance of general self-efficacy in enhancing nursing practice competence, particularly for second-year nurses worldwide who may be struggling with their nursing practice competence and considering leaving the profession. The findings offer practical implications for stakeholders involved in nursing education and training programs, with potential applications in professional development.

REPORTING METHOD

This manuscript adheres to the STROBE guidelines for the reporting of cross-sectional studies.

PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public contribution.

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.

The experiences and perceptions of nurse educators of culturally and linguistically diverse nursing students' competence development - Qualitative study

BACKGROUND

Many countries are becoming increasingly culturally and linguistically diverse due to globalisation and migration. The global shortage of nurses and the consequent migration of nursing professionals is leading to increasing cultural and linguistic diversity in health care and nursing education. Nurse educators play a significant role in supporting nursing students' competence and working life readiness.

RESEARCH AIM

To describe nurse educators' experiences and perceptions regarding competence and competence development of CALD nursing students.

METHODS

The study was conducted using a descriptive qualitative approach utilising individual thematic interviews for data collection. A purposive sample consisting of 20 volunteer nurse educators from five higher education institutions was used for the purpose. Data was collected in semi-structured interviews based on a literature review of previous studies. The data were analysed using inductive content analysis. The COnsolidated criteria for REporting Qualitative research (COREQ) criteria were used in the reporting of this study.

RESULTS

According to the content analysis, three main categories describing aspects related to the competence and competence development of CALD nursing students were identified: 1) educator's competence to support student's learning process and competence development, 2) development of supportive structures and safe learning environments, and 3) student-specific competence and competence development. The educators emphasised that setting clear goals, providing encouragement, having an open discussion, and student-centered approach to support their learning process and create a safe learning environment.

CONCLUSIONS

Supporting the learning process of CALD nursing students and developing safe learning environments were considered essential for the development of competence. These areas must be supported by developing educators' pedagogical and cultural competence and providing sufficient resources for both students and educators. In addition, the curriculum must be designed to support these aspects.

Development of a Competency-Based Triage Education Application and Usability Testing for Triage Training Based on the Korean Triage and Acuity Scale

BACKGROUND

Improving the quality of emergency nursing care requires enhancing triage competency through education programs that integrate the content of the Korean Triage and Acuity Scale, a triage system specifically developed for the Korean context. Thus, this study developed a competency-based triage education application (CTEA), based on the Korean Triage and Acuity Scale, and evaluated its effectiveness through usability testing.

METHOD

The CTEA used various teaching methods and game mechanisms, including lectures, case studies, and video-based scenarios, to improve triage competency.

RESULTS

In the usability testing phase, the CTEA was refined through expert heuristic evaluation and user interviews conducted with the think-aloud method. Six themes were derived from the interviews, highlighting the need for a well-structured program with realistic scenarios, easy accessibility, gamification, functional improvements, and future triage educational applications.

CONCLUSION

These findings suggest that the CTEA is effective and satisfactory for users and can contribute to improving the triage competency of emergency nurses. [J Contin Educ Nurs. 2024;55(1):33-41.].

3D human anatomy augmentation over a mannequin for the training of nursing skills

BACKGROUND

The in-depth understanding of human anatomy is the foundation for safety in nursing practice. Augmented reality is an emerging technology that can be used for integrative learning in nursing education.

OBJECTIVE

The study aimed to develop a human anatomy-based skill training system and pilot test its usability and feasibility.

METHODS

Twenty-seven nursing students participated in 3D anatomy-based skill training for intramuscular injection and Levin tube feeding using HoloLens 2. Various user interfaces including pictures, videos, animation graphics, and annotation boxes assisted users with a comprehensive understanding of the step-by-step procedures for these techniques. A one-group pre-post test was conducted to observe changes in skill performance competency, usability, and learning satisfaction.

RESULTS

After study participation, a statistically significant improvement in skill performance competency (p< 0.05) was observed. The usability results showed that students were satisfied with the usefulness of the program (9.55 ± 0.49) and scored highly for the intention to participate in other educational programs (9.62 ± 0.59). A high level of learning satisfaction was achieved (9.55 ± 0.49), with positive responses in fostering students' engagement and excitement in the application of cutting-edge technology.

CONCLUSION

The 3D anatomy-based nursing skill training demonstrated good potential to improve learning outcomes and facilitate engagement in self-directed practice. This can be integrated into undergraduate nursing education as an assistant teaching tool, contributing to the combination of knowledge and practice.

Competencies and standards in nurse education: The irresolvable tensions

This paper explores the inherent contradiction between the purpose of nurse education - to produce critical thinking, autonomous and accountable future nurses - and the prescription of standards and competencies to realize this goal. Drawing on examples from the United Kingdom's Nursing and Midwifery Council's (NMC) 'Future Nurse' standards, we argue that standards and competencies offer little more than a veneer of protection to the public and that, fundamentally, educational approaches based on 'dot point' formulations are antithetical to conditions in which genuinely critical-thinking, autonomous and accountable practitioners can develop. The purpose of this paper is to raise debate about the hegemony of competencies and standards. For the sake of academic health and the future of the nursing profession, the ubiquity of competency-based education must be critiqued and challenged.

Evaluating the Construct Validity of Competencies: A Retrospective Analysis

Background

A competency-based framework focuses on alignment between professional standards and assessment design. This alignment implies improved measurement validity, yet it has not been established that competence in one context predicts performance in another context. High-stakes competence assessments offer insights into the relationship between assessment design and competencies.

Methods/Analyses

The internationally educated nurses competency assessment program (IENCAP) was developed at Touchstone Institute in collaboration with the College of Nurses of Ontario (CNO) and includes a 12-station OSCE. Each station evaluated the same 10 competencies. We submitted competency scores to a multi-trait multi-method matrix analysis to evaluate the convergent and discriminant validity of competencies.

Results/Observations

All correlations were significant and positive; however, we did not find evidence of convergent or discriminant validity. Correlations were higher between different competencies evaluated within the same station (mean correlation = 0.60) compared to identical competencies evaluated across different stations (mean correlation = 0.19).

Discussion

The results do not provide evidence of construct validity for competencies. While competency-based approaches emphasize various generalized knowledge, skills, and attitudes, these findings indicate that the clinical context is a major determinant of performance.

Conclusion

The context-dependent nature of competencies requires multiple assessments in varied contexts. Performance on a single competency cannot be determined in a single occasion.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-023-01794-z.

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.

Self-assessed competence of final-year nursing students

AIM

To examine the overall level of self-assessed competence of final-year nursing 'bachelors' degree students in the Czech Republic. In addition, the study aimed at the factors associated with the students' level of competence.

DESIGN

A cross-sectional observational study.

METHODS

Data were collected with the Czech version of the Nurse Competence Scale from 274 final-year nursing students of the bachelor's nursing program. Data were analysed using descriptive statistics and multiple regression analyses.

RESULTS

Majority of the students (80.3%) assessed their level of competence as good or very good. The highest level of competence was assessed in the category of 'managing situations' (VAS mean 67.8) and 'work role' (VAS mean 67.2). Previous work experience in healthcare and successful supervisory experience had a positive association with self-assessed competence. Students who completed clinical placement during the COVID-19 pandemic assessed their level of competence as lower than students before the pandemic. No Patient or Public Contribution.

Developing and Implementing Entrustable Professional Activities to Prepare Global Nurses

INTRODUCTION

Nurses work in global settings and must be prepared to enter practice and provide culturally appropriate care to diverse populations. As faculty we want to ensure the achievement of programmatic, national, and global competencies for our student's successful future practice.

METHODS

Aligning current programs with American Association of Colleges of Nursing's (AACN) New Essentials provides an opportunity to consider new approaches and address challenges. By merging the New Essentials with the Consortium of Universities for Global Health (CUGH) competencies, we facilitate the achievement of programmatic outcomes, mission, and values in nursing education.

RESULTS

Using an entrustable professional activities framework provides a clear measure of achieving priority competencies. We created an approach other faculty might find helpful.

DISCUSSION

Entrustable professional activities, well established in medical education, are emerging as a valuable tool to measure the achievement of competencies in the preparation of nurses.

Development of entrustable professional activities for advanced practice nurses education

BACKGROUND

Entrustable professional activity (EPA) framework has gained popularity within competency-based healthcare education programmes across disciplines, professions, and countries. As opposed to traditional time-based approach, EPAs bridge the gaps between competency framework and clinical practice, however, limited information on nursing EPAs highlights a need to develop EPAs specific to graduate nursing education to promote patient safety and quality patient care.

OBJECTIVES

This paper described comprehensively the four-stage approach used to develop and pilot test a set of core EPAs for advanced practice nurse (APN) education.

METHOD

The four-stage approach used to develop and pilot the EPAs included: 1) team formation, 2) development of conceptual framework, 3) identifying and reviewing core EPAs, and 4) pilot testing the EPAs. Post pilot test and surveys were conducted for the EPA developers, APN preceptors and interns to explore their perceptions and experiences using the EPAs.

RESULTS

A framework of nine core EPAs was developed for APN education, including: 1) perform an initial assessment and formulate management plans, 2) manage follow-up care for a clinical encounter, 3) plan, perform and evaluate care procedures, 4) recognise and manage patients requiring urgent care, 5) manage care transitions within and between health care organisations, 6) recognise and manage pharmacological needs of patients, 7) collaborate with patients, families, and community to improve health through disease prevention and health promotion, 8) participate in health quality improvement initiative, and 9) develop self and others for professional practice.

CONCLUSION

Despite the stakeholders having generally positive attitudes towards the use of EPAs, it has its drawbacks. More research is needed to examine the psychometric properties of the EPA assessment tools and evaluate the effectiveness of EPAs in graduate nursing education. Additionally, the described set of core APN EPAs needs more refinement and rigorous testing before it can be implemented on a larger scale.

Competencies and needs of nurse educators and clinical mentors for teaching in the digital age – a multi-institutional, cross-sectional study

Background

The impact of technology and digitalization on health care systems will transform the nursing profession worldwide. Nurses need digital competencies to integrate new technology in their professional activities. Nurse educators play a crucial role in promoting the acquisition of digital competences and therefore need to be digitally competent themselves. Research on digital competencies of nursing educators is scarce but suggests lack of digital knowledge and skills and support needs. Although digitalization is to be seen as a global process, regional contexts need to be taken into account, such as pre-existing competencies, local conditions, and individual needs. Thus, it remains unclear which competencies nurse educators possess and which support needs they have.

Aim of this study was to assess nurse educators’ and clinical mentors’ digital competencies and explore their needs and requirements concerning the digital aspects of their pedagogy and teaching activities in Germany.

Methods

A descriptive exploratory study with a cross-sectional design was conducted. Participants were identified using a convenience sampling approach. Data were collected during July and September 2020 using a standardized self-reported questionnaire that was developed specifically for this study. The questionnaire was provided in a paper and online format and participants could decide which format to use. It contained open- and closed-ended questions. Data were analyzed using descriptive and content analysis. Additionally, explorative subgroup analyses based on job designation, age, and gender were performed. Reporting of this study adhered to the STROBE checklist.

Results

A total of 169 educating nurses participated in the survey. The respondents considered themselves as digitally competent and showed a positive attitude towards the integration of digital technology in their teaching activities. Their perceived preparedness to integrate digital technology into teaching and training varied. Almost all respondents (98%) declared a need for further training and seemed motivated to participate in corresponding educational events. There were some indications for differences in competencies or needs between subgroups.

Conclusions

Educating nurses appear to possess basic digital competencies but there is a need to support their professional development in terms of new technologies. Findings can be used as a basis for developing supportive interventions. Further qualitative investigations could inform the design and content of such interventions.

Core competencies for a biomedical laboratory scientist - a Delphi study

BACKGROUND

After completing university education, biomedical laboratory scientists work in clinical laboratories, in biomedical research laboratories, in biotech, and in pharmaceutical companies. Laboratory diagnostics have undergone rapid development over the recent years, with the pace showing no signs of abatement. This rapid development challenges the competence of the staff and will most certainly influence the education of future staff. This study aimed to examine what was considered the necessary competencies needed to pursue a career as a biomedical laboratory scientist.

METHODS

A modified Delphi technique was used, with the panel of experts expressing their views in a series of three questionnaire. Consensus was defined as the point which 75 % or more of the panel participants agreed that a particular competency was necessary.

RESULTS

The study highlights the perceived importance of mostly generic competencies that relate to quality, quality assurance, and accuracy, as well as different aspects of safety, respect, trustworthiness (towards patients/clients and colleagues), and communication skills. The results also stress the significance of self-awareness and professionality.

CONCLUSIONS

We identified important competencies for biomedical laboratory scientists. Together with complementary information from other sources, i.e., guidelines, laws, and scientific publications, the competencies identified can be used as learning outcomes in a competency-based education to provide students with all the competencies needed to work as professional biomedical laboratory scientists.

Designing the competency-based training model of Iranian medical tourism

BACKGROUND

Despite the great comparative advantage of Iran in terms of infrastructure, technology, and human resources as well as the significance of medical tourism in the tourist industry, in practice, the quality of human resources has received less attention. Consequently, this study was conducted to design a model of competency-based training for Iranian medical tourism.

MATERIALS AND METHODS

This study was an exploratory mix, and the Delphi method and semi-structured interviews were used for the qualitative part of this study. In the second part, the analytical method was utilized for the quantitative part of this study.

RESULTS

The results indicated the main components of medical tourism to be public interactions and private interactions and seven subcomponents. Medical Tourism's Competency includes three main components and seven subcomponents.

CONCLUSION

Although some training separated and scattered is present in Iran's medical tourism. However, Iran requires a comprehensive training model of which its design was explained in this paper.

Digital serious games in developing nursing clinical competence: A systematic review and meta-analysis

OBJECTIVE

This review aimed to synthesise evidence from experimental studies of the application of digital serious games in developing nursing clinical competence.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Eight databases were searched for randomized controlled trials and quasi-experimental studies published in English from 2000 to 2021.

REVIEW METHODS

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adopted in this review. Quality appraisal was conducted using Cochrane's Risk of Bias tool and the Joanna Brigg's Institute Critical Appraisal Tool for Quasi-Experimental Designs. A narrative synthesis of studies, and a meta-analysis and subgroup analysis, was performed on the study outcomes.

RESULTS

22 experimental studies including 13 randomized controlled trials and nine quasi-experimental studies were included. Of these, 19 studies examined nursing students and three examined qualified nurses. These studies applied serious games to develop nursing competencies in management of nursing care, clinical reasoning skills, procedural skills, legal practice and quality improvement. Compared with control groups, serious games improved knowledge (SMD = 1.30, 95% CI [0.75, 1.86]) and skills (SMD = 0.38, 95% CI [0.17, 0.60]). Subgroup analysis for both knowledge and skills outcomes demonstrated that serious games were more effective than control groups with either no intervention or other educational interventions. A large effect size (SMD = 1.13, 95% CI [0.91, 1.34]) was found in favour of serious games for improving knowledge scores in management of nursing care.

CONCLUSION

The reviewed studies identified a broad application of digital serious games for developing nursing competencies. The knowledge and skills performance outcomes supported the use of serious games, which were found to be superior to conventional educational interventions. More serious games are required to be incorporated into undergraduate and continuing nursing education for workplace training, with more rigorous studies examining the effect of serious games in improving the quality and safety of clinical nursing practice.

A Sisyphean task: Developing and revising public health nursing competencies

BACKGROUND

Competencies are intended to enhance the public health workforce's skills. Competencies used to evaluate public health nursing (PHN) practice and education have been promoted by several nursing organizations. Having multiple sets of competencies raises questions about redundancies and their usefulness in evaluating PHN, as well as the central question about the value of the competencies themselves.

METHODS

A literature review of psychometric evaluation research of the competencies was performed. Qualitative content analyses were conducted of seven documents: Association of Community Health Nursing Educators', 2000 and 2010 essentials; Quad Council Coalition's 2004, 2011, and 2018 competencies; and the American Nurses Association's, 2013 and the 2021 draft of PHN scope and standards of practice with respect to competency definition, conceptual basis, and use of an established taxonomy.

RESULTS

No psychometric evaluations of the competency sets were found. Textual content analysis revealed inconsistent and or missing competency definitions and theoretical frameworks with competencies proliferating over time. Taxonomy analysis identified minimal competencies at higher complexity levels according to Bloom's revised taxonomy.

CONCLUSIONS

Analyzed competencies lack reliability and validity testing, making assessment difficult for PHN educators and practitioners. Multiple and competing competencies further erode PHN's visibility, even among public health nurses. With unending revisions of PHN competencies and lack of supporting evidence regarding their effect and their integration into education or practice, recommendations for future efforts are offered.

Building capacity: getting evidence-based practice into healthcare professional curricula

Fostering a culture of clinical effectiveness in healthcare is crucial to achieving optimum outcomes for patients. Evidence-based practice (EBP) is a cornerstone of clinical effectiveness. An EBP capacity-building project commenced in Ireland in 2016, in collaboration with the Centre of Evidence-Based Medicine in Oxford. A key part of this project, reported here, was the development of a competency framework for education in EBP and clinical effectiveness to ensure responsiveness of education standards and curricula of healthcare professionals in this area.

METHODS

Following a review of national and international reports, professional guidance documents and empirical literature pertaining to clinical effectiveness education (CEE), a preliminary competency framework was developed. Stakeholder consultations were conducted over a 6-month period, which consisted of 13 focus groups (n=45) and included representatives from clinical practice, higher education and professional training sectors, regulator/accrediting bodies, the Department of Health (Ireland) and patient/service user groups.

RESULTS

An overarching interprofessional competency framework for CEE was proposed and included the following domains: EBP, quality improvement processes, implementation strategies and collaborative practice: a total of 16 competencies and 60 indicators.

CONCLUSION

A competency framework for CEE for health and social care professionals is presented. It is intended that this framework will provide guidance to healthcare educators and regulators in the construction and revision of curricula, learning outcomes, teaching and assessment strategies, and graduate/clinician attributes.

The development of a self-evaluation scale for simulation laboratory practices

BACKGROUND

Simulation is an important learning-teaching tool for integrating theory and practice in nursing education.

OBJECTIVE

The aim of this study was to develop and to conduct the validity and reliability of a self-evaluation scale for simulation laboratory practices (SES-SLP) with undergraduate nurses.

METHODS

The study sample consisted of 220 undergraduate nursing students. Data were collected using a Descriptive Characteristic Form (DCF) and the 23-item Self-Evaluation Scale for Simulation Laboratory Practices (SES-SLP).

RESULTS

Cronbach's alpha value of the scale was 0.94. The scale comprised of two subscales: the developing factor (19 items) and the challenging factor (4 items). All items showed a statistically significant correlation (p < 0.05).

CONCLUSIONS

The SES-SLP is a valid and reliable scale that can be used to evaluate students' learning experience for simulation laboratory practices.

The effect of competency-based education on clinical performance of health care providers: A systematic review and meta-analysis

AIM

This study aimed to investigate the effects of competency-based education on the clinical performance of health care providers.

BACKGROUND

Having in mind the importance of developing an intervention to enhance the clinical performance of health care providers, the researchers carried out the present study to investigate the effect of competency-based education on the clinical performance of health care providers.

METHODS

This was a systematic review and meta-analysis carried out by searching six international electronic databases including PubMed, Ovid, Cochrane Library, Web of Science, ProQuest, Scopus and Google Scholar, as well as two national electronic databases including IranMedex and SID. The studies relevant to the research aims were included in the study. To assess the quality of the studies, the Cochrane Collaboration's Risk of Bias Tool was used.

RESULTS

Based on the random effects model, competency-based education could enhance the clinical performance of the health care providers in the intervention group compared with that of the control group (standardized mean difference [SMD] = -2.717, 95% CI: -3.722 to -1.712). However, more recent studies have shown that competency-based education has little effect on clinical performance (β = -.255, 95% CI: -0.319 to -0.192, P < .001).

CONCLUSION

Competency-based education can enhance the clinical performance of health care providers. However, there is increasing concern over the attenuation of the positive effect of competency-based education on the clinical performance of health care providers, which deserves further studies.

Innovative Utilization of Wright's Model for Competency Validation

Wright's competency assessment model is well known, yet implementation has been largely challenging. Some organizations have attempted enterprise-wide implementation. This article summarizes how Wright's model was used from a specific topic perspective. Centralized nursing professional development practitioners created flexible competency validation guidelines and supplemental tools (literature review, exemplar, and peer review) for use by sedation nurses regardless of experience or practice setting. Post-implementation data show 62% adoption of new validation methods after 1 year.

Academic evaluation, management and satisfaction of clinical practicums among undergraduate students: software CliPrAS@UB

AIM/OBJECTIVE

To determine the development of competency acquisition, the satisfaction of the agents involved and recording incidents with a digital platform CliPrAS @UB on the Clinical Placements I and II courses in the second and third years of the Bachelor's Degree in Nursing.

BACKGROUND

The teaching of clinical practice subjects requires an analysis of the competence evolution, a management structure and an analysis of the satisfaction of the agents involved in the subject.

DESIGN

Prospective, analytical, observational cohort study.

METHODS

The study was carried out in a public university center in Barcelona with 387 students distributed in nine centers of the network of Health Institutions.

RESULTS

An increase of 2.32 points was observed in the competence dimensions of Professional Practice and with a reduction in the average score in the skills of care provision, therapeutic communication and professional development of more than 0.08 points. Regarding the seminars, a reduction of the average global score of 0.58 points was observed.

CONCLUSIONS

The use of the CliPrAS @ UB computer platform has improved the implementation of the mandatory documents, the recording of incidents and the overall satisfaction of the students.

Development of Surgical Competence in Veterinary Students Using a Flipped Classroom Approach

Clinical skills laboratory (CSL) training was recently introduced in the renewed veterinary curriculum at Ghent University, using models and simulators for teaching practical skills. However, time in the CSL is restricted due to the large number of students combined with limited availability of personnel. Therefore, a flipped classroom (FC) model was introduced to maximize learning experiences. The goal of the present study was to evaluate the effect of flipped classroom CSL training on students' self-efficacy and practical surgical skills. Flipped classroom CSL training was implemented for the third-year pre-clinical students (n = 196) in the 6-year veterinary medicine program. Prior to CSL sessions, students studied online 'learning paths,' including text, pictures, videos of the skills, links to background information, a forum, and a compulsory pre-class quiz. A pre- and post-test were administered before and after flipped classroom CSL training. The tests consisted of a self-efficacy scale consisting of 20 items and an objective structured clinical examination (OSCE) test of surgical skills performance. Flipped classroom CSL training resulted in significantly higher self-efficacy (score/100, pre-test 55 ± 14 vs. post-test 83 ± 8, p< .001) and surgical skills performance (score/20, pre-test 5 ± 3 vs. post-test 17 ± 3, p< .001). In conclusion, this study demonstrated the feasibility and value of implementing a flipped classroom approach in combination with CSL training.

An integrative review of simulation, senior practicum and readiness for practice

Readiness for practice (RFP) is essential as new nurses will practice in a nursing shortage climate, with high acuity patients and complex technology. Nurse educators are challenged to foster readiness for practice.

AIM

The aim of this integrative review was to explore the impact of simulation and senior practicum on graduating senior nursing students' readiness for practice.

BACKGROUND

Readiness for practice has been a point of concern for healthcare for quite some time. This has led to a need for better understanding for what RFP means including their perceptions of various stakeholders. Further, it is important to address what teaching and learning strategies can be implemented to assist in ensuring the graduating senior nursing student is ready for practice on graduation and for their first professional practice. Readiness for practice is defined as the ability to safely and competently care for patients by synthesizing theory, skills, attitudes and values in applying clinical reasoning in practice settings.

METHOD

An integrative review identified 48 published papers on simulation and senior practicum that met the inclusion criteria.

RESULTS

Themes identified from the senior practicum/preceptor literature included clinical reasoning, skills, barriers to the senior practicum and transition. Themes identified regarding simulation as a strategy included preparation, competence development, clinical reasoning and the number of human patient simulators used.

CONCLUSION

Although the evidence is not conclusive, simulation and senior practicums have the promise of preparing graduating nursing students for their first professional practice. However, nurse educators must ensure simulations are well-organized with clear objectives and that preceptors are supported in teaching and assessing students.

Clinical competence and its association with self-efficacy and clinical learning environments among Chinese undergraduate nursing students

Evaluation and cultivation of clinical competence in undergraduate nursing students are essential in nursing education. Self-efficacy and good clinical learning environments are expected to have a positive influence on the clinical competence of undergraduate nursing students, but few studies have focused on the relationships among clinical competence, self-efficacy, and clinical learning environments. This study aimed to examine clinical competence and its association with self-efficacy and clinical learning environments among Chinese undergraduate nursing students. A cross-sectional questionnaire survey was conducted with 1518 undergraduate nursing students being recruited from five medical colleges in China. The nursing students' clinical competence, self-efficacy, and clinical learning environments were assessed using a set of self-reported questionnaires, including Chinese versions of the Holistic Clinical Assessment Tool; General Self-Efficacy Scale; and Clinical Learning Environment, Supervision, and Nurse Teacher Evaluation Scale. Factors significantly associated with the clinical competence of undergraduate nursing students were professional interest, self-efficacy, and clinical learning environments, accounting for 36.1% of the total variance. Self-efficacy played a mediating role between clinical learning environments and clinical competence. The results of this study can be applied as reference for the enhancement of a nursing education program to improve the clinical competence of Chinese undergraduate nursing students.

Clinical competence in nursing: A hybrid concept analysis

BACKGROUND

Clinical competence (CC) is central issue in nursing. There are some controversies about this concept that needs further investigation. The present study was conducted to analyze the concept of clinical competence in nursing.

METHODS

This concept analysis was conducted using the three-phase hybrid model. In the theoretical phase, the Science Direct, PubMed, CINAHL, ProQuest, Scopus, Web of Science, SID, Iranmedex, and Magiran databases were searched to retrieve articles published from 2000 to 2020. Forty two eligible articles were included and analyzed. In the fieldwork phase, semi-structured interviews were held with eighteen university lecturers, clinical instructors, students, and hospital nurses and the data were analyzed through conventional content analysis. In the final analytic phase, the findings of the first and the second phases were combined.

RESULTS

The majority of literature defined CC in nursing as a combination of knowledge, and skills, and attitudes that is consistent with those of the fieldwork phase. Most participants in fieldwork stated that gaining CC is a process that is achieved over time through practice and repetition and increasing experience. A nurse needs to acquire personal, social and professional competencies during the study and work period. The CC has antecedents of efficient education, and organizational support. It also has consequences for patients and nurses such as satisfaction, and quality care.

CONCLUSION

CC is a continuous process of obtaining knowledge, values, and attitudes, and skills such as critical thinking skills that brings creativity and innovation in nursing practice.

Integrating Education and Competency for Safe Patient Care

In an effort to streamline educational initiatives at our institution, we developed the Nursing Education and Competency Algorithm and the Nursing Education and Competency Advisory Panel. The Nursing Education and Competency Algorithm serves as a framework in differentiating education and competency through standardization of practice. Utilizing the algorithm assists in distinguishing initiatives as one time, on-going, or if they are specific to a specialty. The Nursing Education and Competency Advisory Panel serves as a vetting structure to improve collaboration through decision-making and shared governance.

Improving the Competency of Nurses

To decrease infusion pump administration errors, time-consuming training is often initiated. The aims of this study were twofold: to develop minimum competency requirements for programming and operation of infusion pumps and to develop and validate a test for nurses based on those requirements. The test was completed by 226 nurses between May and December 2017. This study demonstrates that testing is a promising method to assess the competency of nurses in using medical devices. Moreover, test acceptability among nurses is high. Using competency requirements to develop a test offers the potential to tailor training needs and reduce training time.

Attracting Israeli nursing students to community nursing

BACKGROUND

The shift from inpatient care to community patient care has had an essential impact on the nursing profession. Despite the growing demand for community nurses in many countries, their number remains relatively low and many students do not perceive this field as an interesting career to pursue. In this review we aimed to understand if exposure of undergraduate nursing students to various nursing work settings during their studies affects their work setting choices after graduation.

METHODS

A literature search of papers relating to work setting preferences of nursing students in Israel and other countries was performed. Israel Ministry of Health, Nursing Administration documents and other related documents were also reviewed, with a focus on the nursing training program in Israel.

FINDINGS

While most first-year nursing students have limited knowledge regarding the profession, in later years, their preferences for post-graduation work settings are affected by their exposure to the various clinical fields through knowledge gained in courses together with clinical practice placements. In Israel, specific classroom courses in community nursing are allocated only 6% of the total time allocated to all classroom courses in nursing, and a single clinical placement in community nursing takes place during the third or fourth year of the nursing program, exposing students to a single aspect of community nursing during their nursing training. Studies in other countries have reported that students' experience during clinical placement contributes to shaping students' opinions of nurses' roles within that field. Nursing students who had a primary healthcare placement showed greater intention for working in this setting after graduation.

CONCLUSIONS

The lack of exposure to the various aspects of community nursing during undergraduate studies contributes to a lack of motivation for entering this field. Therefore, a profound change is needed in nursing training programs' curricula to prepare graduates to face future challenges in community nursing. Whilst both hospital and community nursing are equally important, nursing leaders and policy makers must be made aware of the various factors that contribute to new registered nurses' preferences of hospital over community nursing and build strategies for directing nurses to work in the community in order to respond to the expected nurse shortage in this setting.

Insufficiently supported in handling responsibility and demands: Findings from a qualitative study of newly graduated nurses

Aims and objectives

To explore newly graduated registered nurses' experiences and how they manage complex patient situations.

Background

Newly graduated registered nurses' working in acute care hospital settings are challenged by managing complex patient situations in rapidly changing clinical contexts involving increased patient acuity, comorbidities and staffing shortages.

Design

Qualitative study design.

Methods

Data were collected using focus groups interviews of a total of 16 newly graduated registered nurses with clinical work experience of 6 months of direct patient care in an acute care hospital setting. Analyses were conducted using qualitative content analysis. COREQ reporting guidelines were used.

Results

The analysis resulted in the overarching theme “Not being sufficiently prepared and supported to meet responsibilities and demands.” The theme included three categories: “Responsibility is not in proportion to competence,” “Lack of medical competence and experience complicates patient safety” and “Strives for control to manage and organise nursing care.”

Conclusion

The results show that newly graduated registered nurses' are not sufficiently supported for the level of responsibility and the demands placed on them when providing nursing in complex patient situations in acute care hospital settings. If they are given sole responsibility for multiple complex patient situations, patient safety may be compromised.

Relevance to practice

Special attention need to be paid to NGRNs support to medical competence in the areas of assessing, planning, prioritizing, leading, and distributing nursing care in daily clinical settings for at least their first year of professional work.

Learning outcomes of a flipped classroom teaching approach in an adult-health nursing course: a quasi-experimental study

BACKGROUND

New teaching strategies must be developed not only to enhance nurse's competence but also to allow nurses to respond to the complex health care needs of today's society. The purpose of this study was to explore the learning outcomes of a flipped classroom teaching approach in an adult-health nursing course for students in a two-year Bachelor of Science in Nursing program.

METHODS

The study had a quasi-experimental design. An 18-week flipped classroom teaching approach was applied in an adult-health nursing course. In total, 485 nursing students enrolled in the study, with 287 in the experimental group and 198 in the control group. The Self-Evaluated Core Competencies Scale, Metacognitive Inventory for Nursing Students, Self-Directed Learning Readiness Scale, and self-designed learning satisfaction questionnaire were used to evaluate the students' learning outcomes.

RESULTS

The experimental group showed a statistically significant increase in the overall scores for self-evaluated core competencies, the "self-modification" subscale of the Metacognitive Inventory for Nursing Students, and in overall self-directed learning readiness; further, they also showed high levels of course satisfaction.

CONCLUSIONS

A flipped classroom teaching approach had a positive impact on student's learning motivation and contributed to better learning outcomes in an adult-health nursing course. The flipped classroom combined with hybrid teaching methods is a suitable and effective learning strategy for a registered nurse (RN) to Bachelor of Science in Nursing (BSN) program to tackle today's complex revolution in nursing curricula, and may enhance nursing students' abilities to address numerous challenges.

E-portfolios and Entrustable Professional Activities to support competency-based education in dietetics

The concept of Entrustable Professional Activities, recently pioneered in medical education, has emerged to support the implementation of competency-based education. Although competency-based frameworks are widely used in healthcare professional education to develop outcomes-based curricula, assessment of student competency in professional placement settings remains challenging. The novel concept of Entrustable Professional Activities together with established methods of competency assessment, namely e-portfolios and self-assessment, was implemented in the "[La Trobe University Dietetic program in 2015-2016. This study aimed to appraise the e-portfolio and evaluate the use of Entrustable Professional Activities to assess competence. A mixed-methods evaluation, using qualitative and quantitative surveys with follow-up structured consultations, was conducted with final year dietetics students and their supervisors. Dietetics students were comfortable with Entrustable Professional Activities and competency-based assessment, whereas supervisors preferred Entrustable Professional Activity based assessment. All stakeholders valued student self-assessment and the ongoing use of structured e-portfolios to develop and document competency. The use of structured e-portfolios, student self-assessment, and the emerging concept of Entrustable Professional Activities are useful tools to support dietetics student education in professional placement settings.

Competence perceptions of veterinary nursing students and registered veterinary nurses in Ireland: a mixed methods explanatory study

Background

Veterinary regulators require veterinary nursing students to demonstrate clinical competence prior to registration and practice as a veterinary nurse. However, in common with other medical professions, there is no one broadly accepted definition of competence. Studies in nursing have revealed that practicing nurses may view newly qualified colleagues as lacking competence, leading to disillusionment with nursing training programmes. Similar studies are lacking in veterinary nursing, despite the profession having recently undergone a similar transition from workplace-based training to undergraduate education.

Methods

A mixed methods explanatory study surveyed 66 Irish registered veterinary nurses and 31 first year veterinary nursing students at two Irish third level institutions to obtain their views on what constitutes veterinary nursing competence and when veterinary nurses develop it. The surveys were followed by student focus groups and semi-structured one-on-one interviews with registered veterinary nurses. Content analysis was employed to analyse the surveys, while the focus groups and interview transcripts underwent thematic analysis.

Results

Students perceived competence primarily as the ability to provide patient care, and they expected it to develop close to the time of graduation. RVNs held a broader definition of competence, incorporating leadership skills and confidence as well as patient care provision. RVNs expected it to take approximately two years of workplace-based experience post-graduation for a veterinary nurse to develop competence. In addition, RVNs recognised that anxiety felt by many newly qualified veterinary nurses during this period could be attenuated by mentorship from more experienced colleagues.

Conclusions

Irish RVNs and veterinary nursing students perceive competence differently, similar to previous findings from the nursing profession. Educators and regulators should provide explicit descriptions of terms such as ‘competence’ to avoid confusion and possible disillusionment amongst veterinary nursing stakeholders.

Health and social care educators' ethical competence

BACKGROUND AND PURPOSE

Educators' ethical competence is of crucial importance for developing students' ethical thinking. Previous studies describe educators' ethical codes and principles. This article aims to widen the understanding of health- and social care educators' ethical competence in relation to core values and ethos.

THEORETICAL BACKGROUND AND KEY CONCEPTS

The study is based on the didactics of caring science and theoretically links the concepts ethos and competence.

METHODS

Data material was collected from nine educational units for healthcare and social service in Finland. In total 16 semi-structured focus group interviews with 48 participants were conducted. The interviews were analysed with a thematic analysis according to Braun and Clarke.

ETHICAL CONSIDERATIONS

The study is approved by the Declaration of Helsinki, the legislation regarding personal data and the General Data Protection Regulation. The study received ethical permission from the University of Jyväskylä. Informed consent was obtained from all the educational units and participants in the study.

FINDINGS

The findings are presented based on three general patterns, an ethical basic motive, an ethical bearing and ethical actions. Subthemes are Humane view of students as unique individuals with individual learning, Bearing of tactfulness and firmness, Bearing of perceptiveness and accessibility, Bearing of satisfaction and joy over student learning, Valuing bearing towards each oneself and colleagues, Ability to interact and flexibility, Collegiality and a supportive work community and Educators as role models and inspirators.

CONCLUSION

Educators' personal and professional ethos is crucial to student learning, personal growth and ethical reasoning. Therefore, it is important to further develop educators' training regarding ethical competence.

Development and psychometric testing of the 10-item satisfaction with Nursing Skill Examination: Objective Structured Clinical Assessment scale

The Objective Structured Clinical Examination (OSCE) or Assessment (OSCA) has traditionally been used in disciplines such as medicine and nursing, to assess students' competence to perform clinical skills safely in a simulated hospital environment. Despite its accepted use, a validated and reliable tool has yet to be developed and tested to assess students' perception of and satisfaction with this mode of assessment. This study developed and tested the psychometric properties of a brief Objective Structured Clinical Examination tool for assessing student perception that could have transferability across health education settings. The study used a cross-sectional survey design. Final year students (n = 727) enrolled in an undergraduate nursing program in Western Sydney completed the 10-item Satisfaction with Nursing Skill Examination: Objective Structured Clinical Assessment (SINE-OSCA) Scale in 2017. Exploratory factor analysis uncovered a one-component structure with component loading that ranged from 0.45 to 0.86. Cronbach's alpha of the SINE-OSCA was 0.91. Socio-demographic group comparisons revealed that respondents who were: i) male (p = 0.003); ii) non-native-born (p < 0.001); iii) non-English-speaking (p < 0.001); and iv) International (p = 0.001), reported higher satisfaction with clinical assessments, as measured by the SINE-OSCA scale. The SINE-OSCA scale demonstrates validity and reliability in identifying students who may have difficulty with this mode of clinical skill assessment.

Evaluation of an undergraduate nursing entrustable professional activities framework: An exploratory qualitative research

BACKGROUND

Entrustable professional activities (EPA) are mainly used in graduate medical education and professional development and have not been widely implemented in nursing undergraduate settings. Nursing EPAs were therefore developed by the Alice Lee Centre of Nursing to translate theoretical nursing competencies into clinical practice and as forms of standardized clinical assessment tools. Feedback from various stakeholders is required to further refine the framework.

OBJECTIVES

To explore the perceptions and experiences of using the new EPA framework in nursing students and hospital and university clinical instructors.

DESIGN

An exploratory qualitative study using focus group interviews.

PARTICIPANTS

Seven year-one nursing undergraduates, 12 year-two undergraduates, seven university clinical instructors, and 18 hospital clinical instructors participated in this study.

METHODS

The students formed five groups, while the clinical instructors formed seven groups, each consisting of three to four participants. Semi-structured interviews were conducted to explore stakeholders' experiences and perceptions of the EPA assessment framework. Thematic analysis was used to analyze the data.

RESULTS

Despite initial mixed reactions of confusion and relief, many students and clinical instructors commended the comprehensive and structured EPA framework and its emphasis on holistic patient-centered care. EPAs also allow flexible assessment methods, encourage critical thinking among students, and promote team-based care and peer teaching. However, the assessment using a two-dimensional matrix with multiple competencies for the EPAs, subjective assessment criteria, the lack of standardization using checklists, subjective assessment criteria, and the lack of, manpower, and time may potentially affect the accuracy of the clinical assessments. The effectiveness of the EPA framework was also dependent on the quality of feedback, students' intrinsic motivations, and learning environments. The refinement of EPAs and entrustment levels, a physical checklist, and an incorporation of EPAs into school curricula were recommended to improve practitioners' learning experiences.

CONCLUSIONS

The use of EPAs in nursing education continues to be a novel and evolving process. There remains a need for a further refinement of the EPA framework to tailor to instructors' expectations and students' capabilities.

Exploration of Factors Influencing Nurse Competence Through Nursing Profile Analysis

BACKGROUND

Nurse competence is a combination of knowledge, performance, skills, and attitudes that are required in fulfilling one's role as a nurse. So far, few comprehensive studies have explored the influencing factors of nurse competence.

METHOD

The competence levels of 160 RNs in a Chinese hospital were evaluated using a questionnaire method, and the relationship between competence results and nursing characteristics was analyzed.

RESULTS

The competence of participating nurses was at a medium level. Among all the characteristics, education and staffing levels were two main factors influencing nurse competence.

CONCLUSION

Quantity of nurses and quality of nursing service are two main issues facing the modern nursing system. The findings from this study provide useful information and suggestions on how to improve nurse competence to nurse industry personnel, including nurses, nursing employers, educators, and students. [J Contin Educ Nurs. 2019;50(12):572-580.].

Mastery learning in a bachelor's of nursing program: the Roseman University of Health Sciences experience

BACKGROUND

Roseman University of Health Sciences (RUHS) developed and delivers a mastery learning curriculum designed for students to acquire the knowledge and skills to become competent nurses. Despite a trend in nursing education to adopt competency-based education (CBE) models, there is little in the nursing literature about programs based on a mastery model. The aim of this study is to describe an undergraduate nursing program built on a mastery learning model and to report on program outcome measures.

METHODS

The 18-month BSN nursing program is divided into blocks, varying in length and focusing on a single subject. Students must demonstrate mastery, defined as ≥90% on an assessment, to pass a block. Recognizing the critical nature of health care, educators seek methods to assure that practitioners become competent to perform the services they provide.Program outcomes reported include comparisons to national standards and RUHS student exit survey data.

RESULTS

From 2013 to 2017 the RUHS College of Nursing students' pass rates ranged from 82 to 97% for the National Council Licensure Examination exam compared to national pass rates between 81.8-84.5% during the same time frame. The program completion rate ranged from 86 to 100% and employment rates exceeded accreditation standards. Students reported overall satisfaction with their education as 4.38 and with the block system as 4.74 (5 point Likert scale).

CONCLUSIONS

Roseman University's mastery learning model appears successful as measured by high levels of student satisfaction, outcomes on exams, and degree completion when compared to national averages. The results suggest that other nursing and health profession's programs can develop a successful mastery based learning model.

Developing a national musculoskeletal core capabilities framework for first point of contact practitioners

Objective

We aimed to support service transformation by developing a core capabilities framework for first contact practitioners working with people who have musculoskeletal conditions.

Methods

We conducted a modified three-round Delphi study with a multi-professional panel of 41 experts nominated through 18 national professional and patient organizations. Qualitative data from an open-ended question in round one were analysed using a thematic approach and combined with existing literature to shape a draft framework. Participants rated their agreement with each of the proposed 142 outcomes within 14 capabilities on a 10-point Likert scale in round two. The final round combined round two results with a wider online survey.

Results

Rounds two and three of the Delphi survey were completed by 37 and 27 participants, respectively. Ninety practitioners responded to the wider online survey. The final framework contains 105 outcomes within 14 capabilities, separated into four domains (person-centred approaches; assessment, investigation and diagnosis; condition management, intervention and prevention; and service and professional development). The median agreement for all 105 outcomes was at least nine on the 10-point Likert scale in the final round.

Conclusion

The framework outlines the core capabilities required for practitioners working as the first point of contact for people with musculoskeletal conditions. It provides a standard structure and language across professions, with greater consistency and portability of musculoskeletal core capabilities. Agreement on each of the 105 outcomes was universally high amongst the expert panel, and the framework is now being disseminated by Health Education England, NHS England and Skills for Health.

Preregistration nursing students' perceived confidence in learning about patient safety in selected Kenyan universities

Background

Improvement of patient safety in Kenya depends on knowledgeable nurses who are equipped with the clinical safety and sociocultural competences of patient safety.

Objectives

This study assessed the theoretical and practical learning of these competences as perceived by nursing students.

Method

A cross-sectional descriptive study was conducted on 178 preregistration Bachelor of Nursing students from two Kenyan universities using the Health Professional Education in Patient Safety Survey. This tool assessed the students’ confidence in learning about clinical safety and the sociocultural aspects of patient safety in the classroom and clinical settings. Descriptive statistics summarised the sample and survey responses, while paired t-tests and ANOVA were used to compare responses across learning settings and year of study.

Results

The students reported higher confidence about learning on the clinical aspects than on the sociocultural issues of patient safety with the lowest mean scores recorded in ‘Understanding human and environmental factors’ and ‘Recognising, responding and disclosing adverse events’. They reported significantly higher confidence scores in the classroom setting than the clinical setting with no significant difference in reported confidence across the years of study. They were less confident in speaking up about patient safety issues in the clinical areas with 52.2% feeling that reporting a patient safety problem will result in negative repercussions.

Conclusion

Nursing programmes in Kenya need to reinforce the sociocultural aspects of patient safety in the curriculum. The patient safety culture in the clinical placements sites needs to be conducive to enable, and not hinder, the acquisition of these competences.

Evidence-Based Practice Competence in Nursing Students: An Exploratory Study With Important Implications for Educators

BACKGROUND

Evidence-based practice (EBP) is a core pillar of nursing education and an expectation in clinical practice. Students struggle to conceptualize the use of EBP into actual clinical practice despite the development of EBP competencies.

AIMS

This study explored perceptions of EBP education and competence in baccalaureate students using Melnyk's (Worldviews on Evidence-Based Nursing, 11, 2014 and 5) EBP competencies for practicing registered nurses as a basis for comparison.

METHODS

The researchers used a sequential, mixed-methods design. A survey was developed to assess information sources and patterns of use, and semistructured interviews explored factors affecting students' understanding of EBP and information-seeking behaviors in the clinical setting.

FINDINGS

There were 118 participants in the survey and 12 in follow-up interviews. A major theme was that participants had difficulties distinguishing between EBP and research. Students were able to identify experiences that fostered attainment of basic EBP competencies, such as searching for evidence, but were less able to describe higher-order activities such as integrating evidence to plan EBP changes or disseminating best practices.

LINKING EVIDENCE TO ACTION

Clinical learning environments are an ideal place to apply and see EBP in action, but nurse educators cannot assume students arrive ready to apply EBP knowledge and skills to clinical practice. Nurse educators need evidence-based tools to assess student EBP competence across a variety of settings. Research examining the generalizability of the EBP competencies in varying curricular models as well as didactic and clinical settings is needed.

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.

A review of Operating Department Practitioner students' experiences of clinical placements as a result of changing organisations in each academic year

Operating Department Practitioner students as part of their education undertake placements that enable them alongside their academic studies to meet the Health and Care Professions Council Standards of Proficiency; however, like all education providers there was an annual shortage of appropriate placements. As a result, the organisation involved in this review needed to explore an alternative approach to allocating clinical placements. In addition, the course team wanted to change how students gained their clinical skills and possibly increase their understanding of the Operating Department Practitioner role. Traditionally the institution involved (like other Operating Department Practitioner education providers) placed students in one organisation for all of their clinical placements unlike other professions such as nursing who placed students in different areas. The review resulted in students being placed in a different organisation in each year of their course. A qualitative methodology in the form of focus groups was employed to review students' views of the change and their clinical experiences. This resulted in students highlighting areas such as readiness for being qualified and links to evidenced-based practice as benefits of the new system. The review has been successful in terms of placement numbers but also student experiences, although an ongoing review is being undertaken, the change has been successful.

Competence areas of health science teachers - A systematic review of quantitative studies

BACKGROUND

In the face of rapid digitalisation and ever-higher educational requirements for healthcare professionals, it is important that health science teachers possess the relevant core competences. The education of health science teachers varies internationally and there is no consensus about the minimum qualifications and experience they require.

OBJECTIVE

The aim of this systematic review was to describe the health science teachers' competences and the factors related to it.

DESIGN

Systematic review of original quantitative studies.

DATA SOURCES

Four databases were selected from which to retrieve original studies: Cinahl (Ebsco), PubMed, Medic, Eri (ProQuest).

REVIEW METHODS

The systematic review used PICOS inclusion criteria. Original peer-reviewed quantitative studies published between 1/2007 and 1/2018 were identified. Screening was conducted by two researchers separately reading the 1885 titles, 600 abstracts, and 63 full-texts that were identified, and then agreed between them. Critical appraisal was performed using the JBI MAStARI evaluation tool. The data was extracted and then analysed narratively.

RESULTS

The core competences of health science teachers include areas of knowledge, skills and attitudes. Health science teachers evaluate their own competence as high. Only in relation to entrepreneurship and leadership knowledge was evaluated to be average. The most common factors influencing competence were teachers' title/position, healthcare experience, research activities, age, academic degree and for which type of organisation they work.

CONCLUSION

It is important to identify the core competencies required by health science teachers in order to train highly competent healthcare professionals. Based on the findings of this systematic review we suggest that teachers should be encouraged to gain university education and actively participate in research, and that younger teachers should have opportunities to practice the relevant teaching skills to build competence.

Entry-to-practice public health nursing competencies: A Delphi method and knowledge translation strategy

BACKGROUND

Sustaining and strengthening nurses 'contributions to public and population health in the 21st century depends in part on nursing education. Clearly articulated entry-to-practice competencies will contribute to the capacity of undergraduate nursing education programs to prepare graduates to promote local, national and global population health.

OBJECTIVES

The Canadian Association of Schools of Nursing created the Public Health Task Force to develop consensus on core, national entry-to-practice competencies in public health nursing for undergraduate nursing students and to support these competencies with corresponding online teaching strategies.

DESIGN

Delphi approach.

PARTICIPANTS

Nurses with public health experience in education and practice, and representatives from other public health professional organizations across Canada.

METHOD

The three-phased competency development included: 1) an environmental scan; 2) an iterative process to draft competencies; and 3) a modified Delphi process to confirm the final competency framework using face to face consultations and a survey. The knowledge translation strategy involved soliciting submissions of teaching strategies for peer-review and subsequent inclusion in an interactive online resource.

RESULTS

242 public health educators and practitioners participated in the consensus consultation. The final document outlined five competency statements with 19 accompanying indicators. A total of 123 teaching strategies were submitted for the online resource, of which 50 were accepted as exemplary teaching strategies.

CONCLUSION

This competency development process can provide guidance for the development of competencies in other countries, thus strengthening public health nursing education globally. The decision to intentionally level the competencies to entry-to-practice, as opposed to an advanced level, enhanced their application to undergraduate nursing education. The development of the additional inventory of teaching strategies created a sustainable innovative resource for public health nursing educators and practitioners world-wide to support the adoption of entry-to-practice public health nursing competencies.