Measuring clinical nurse performance: development of the King's Nurse Performance Scale

Development and Psychometric Testing of Task and Contextual Performance Scales for Clinical Nurses

Background and Purpose: This study aims to develop a task performance scale and a contextual performance scale for clinical nurses and to test the scales psychometrically. Methods: This study was carried out in two phases in a private hospital group. During the first phase, the initial scales were developed, and then the validity and reliability of the scales were analyzed; 154 nurses participated in the second phase. Results: The task performance scale consisted of two factors (total variance explained: 75.87%); the contextual performance scale consisted of three factors (total variance explained: 74.05%). The content validity indexes of both scales were 0.99. The Cronbach's alpha coefficients of both scales were 0.98. The test-retest reliability and inter-rater agreement of the scales were also good. Conclusions: The scales can contribute to nursing literature and hospital managers in assessing the performance of clinical nurses.

Advanced practice and clinical supervision: An exploration of perceived facilitators and barriers in practice

AIM AND OBJECTIVES

The aim of this study was to investigate current advanced practice Masters students' experience of clinical supervision, to explore how clinical supervision works in practice and to identify students' perceptions of the facilitators and barriers to clinical supervision in their workplace.

BACKGROUND

Advanced practitioners, and in particular nurses, play a pivotal role in delivering health care across acute and primary care settings. These non-medical professionals fulfil a rapidly expanding proportion of roles traditionally undertaken by medically qualified staff within the National Health Service in the United Kingdom and often lead specialist clinics and services. To prepare for the advanced practice role, individuals are required to undertake a Master's in advanced practice to develop the required skills and knowledge and work in clinical practice with a clinical assessor/supervisor to demonstrate competence and performance.

DESIGN

A mixed method study using an online descriptive cross-sectional survey and qualitative data were collected via focus groups and has been reported using the Good Reporting of a Mixed Methods Study checklist.

RESULTS

A total of 79 students completed the online survey (from 145 AP students), a response rate of 55%. Most respondents were nurses (n = 73) with 49 (62%) in a formal advanced practice trainee role, and the majority believed their clinical supervisor had a good understanding of advanced practice and the advanced practice role. Two focus groups were held with 16 participants in total. Thematic analysis revealed five themes: (a) perceived level and amount of support from clinical supervisors, (b) skill level of clinical supervisors, (c) physicians and their perceptions on supervising, Advanced practitioners (d) clinical supervisors' preparation for the role and (e) transition from trainee to qualified advanced practitioner.

CONCLUSION

The survey revealed that advanced practitioner students perceived that clinical supervisors and workplace colleagues had a good understanding of the advanced practice role with good levels of support in practice. A more coherent approach is required for clinical supervision and an implementation framework that can be formally evaluated.

RELEVANCE TO CLINICAL PRACTICE

Several significant barriers to clinical supervision for advanced practitioner students were identified, and there are currently more barriers (including COVID-19) than facilitators.

Surviving an infectious disease outbreak: How does nurse calling influence performance during the COVID-19 fight?

AIM

To assess the performance of front-line nurses, who believed they were living out their calling, during the coronavirus disease 2019 (COVID-19) pandemic.

BACKGROUND

Although as a profession nursing generally requires high levels of performance, the disruption arising from an infectious disease outbreak increases the work stress and decreases the performance of front-line nurses. How this situation can be improved has yet to be thoroughly examined.

METHOD

We used a snowball sampling technique to recruit 339 nurses who were originally from outside Hubei but volunteered to join medical teams going to Hubei to tackle COVID-19.

RESULTS

Drawing on the theory of work as a calling, we found that living a calling had a positive effect on front-line nurses' performance through the clinical and relational care they provided. Perceived supervisor support strengthened these mediated relationships.

CONCLUSION

Our findings indicate that despite the constraints associated with pandemics, front-line nurses who are living a calling are able to provide better clinical and relational care to infected patients, which in turn improves their performance.

IMPLICATIONS FOR NURSING MANAGEMENT

The findings of this study suggest that hospitals can introduce career educational interventions to enhance nurses' ability to discern and live out their calling to improve their performance.

Job satisfaction among hospital nurses revisited: a systematic review

BACKGROUND

The current nursing shortage and high turnover is of great concern in many countries because of its impact upon the efficiency and effectiveness of any healthcare delivery system. Recruitment and retention of nurses are persistent problems associated with job satisfaction.

OBJECTIVE

To update review paper published in 2005.

DESIGN

This paper analyses 100 papers relating to job satisfaction among hospital nurses derived from systematic searches of seven databases covering English and Chinese language publications 1966-2011 (updating the original paper with 46 additional studies published 2004-2011).

FINDINGS

Despite varying levels of job satisfaction across studies, sources and effects of job satisfaction were similar. Hospital nurse job satisfaction is closely related to working conditions and the organizational environment, job stress, role conflict and ambiguity, role perception and role content, organizational and professional commitment.

CONCLUSIONS

More research is required to understand the relative importance of the many identified factors relating to job satisfaction of hospital nurses. It is argued that the absence of a robust causal model reflecting moderators or moderator is undermining the development of interventions to improve nurse retention.

The relationship between knowledge and clinical performance in novice and experienced critical care nurses

PURPOSE

The purpose of this study was to measure directly the knowledge and performance of novice and experienced critical care nurses in a simulated task environment.

METHODS

Nurses were required to control the physiologic deterioration of patients with respiratory compromise in 4 scenarios and were also tested on their knowledge of the constructs present in the scenarios.

RESULTS

The results indicate that experienced nurses possessed highly superior knowledge when compared with novice nurses (P < .001). The results further demonstrated a lack of reliable differences in actual clinical performance when nurses were considered solely on the basis of their term of experience. Group differences in performance were demonstrated only when nurses who had achieved board certification in critical care nursing were compared with the remaining participants.

CONCLUSION

The results demonstrate the lack of linkage between knowledge and clinical performance, which calls into question the supposition by many in nursing that knowledge and performance are inextricably linked.

Spasticity outcome measures in spinal cord injury: psychometric properties and clinical utility

STUDY DESIGN

Comprehensive review and systematic analyses.

OBJECTIVES

Assess published psychometric evidence for spinal cord injury (SCI) spasticity outcome measures. Considerations about the influence of spasticity on function have also been identified to understand treatment effects and guide service delivery.

SETTING

London, Ontario and Vancouver, British Columbia, Canada.

METHOD

Review of measures was based on availability of psychometric data, application in clinical settings and evaluated in SCI patients.

RESULTS

Ashworth and Modified Ashworth Scales (AS, MAS), Penn Spasm Frequency Scale (PSFS), Spinal Cord Assessment Tool for Spasticity (SCATS), Visual Analogue Scale self-rated scale of spasticity (VAS) and the Wartenberg Pendulum Test (WPT) were included in this review. The most frequently used tools for SCI spasticity measurement include the AS, MAS, PSFS and VAS, of which the latter two are self-report spasticity measures. The SCATS has been partially validated for SCI, but is not widely used. The WPT has been minimally validated despite its use in a large-scale SCI spasticity randomized controlled trial.

CONCLUSIONS

Since spasticity is multidimensional, focusing on one or two spasticity outcome measures can misrepresent the extent and influence of spasticity on SCI patients. Different scales measure different aspects of spasticity and individual tools correlate weakly with each other. Spasticity may be better measured with an appropriate battery of tests, including the AS or MAS, along with PSFS. These tools would benefit from further reliability and responsiveness testing. Tools that assess the influence of spasticity on patient activities, participation and quality of life are important, but lacking.

Exploring the assessors' and nurses' experience of formal assessment of clinical competency in the administration of blood components

Blood transfusion, clinical competency, assessment, evaluation The change in nurse education from apprenticeship training to the higher education setting, has raised concerns about the lack of practical skills newly qualified nurses have on registration. Every practitioner must be able to administer blood components safely however, the Serious Hazards of Transfusion (SHOT) scheme have consistently demonstrated that 'wrong blood' incidents are the major cause of morbidity and mortality related to transfusion in the United Kingdom. As a result the SHOT working group have recommended that all practitioners should have their clinical competency formally assessed. This paper describes the development and evaluation of a tool for assessing clinical competency for staff involved in transfusing blood. The evaluation used a triangulated approach of phenomenology and survey. The tool was piloted in two different clinical settings by four registered nurses who each assessed two nurses. Individual semi-structured interviews were conducted to collate the nurses' and the assessors' experience of the process. The study participants were of the opinion that assessing clinical competency using a criterion-referenced tool gave practitioners the opportunity to relate theory to practice, promote best practice and encourage adherence to hospital transfusion policies. Formal assessment of clinical competency is therefore, a vehicle that could be used to promote safe transfusion practice, ensuring the safety of patients is paramount.

A model of job satisfaction of nurses: a reflection of nurses' working lives in Mainland China

AIM

This paper is a report of a study exploring nurses' views and experience regarding their working lives in Mainland China.

BACKGROUND

The widespread nursing shortage and high turnover has become a global issue. Job satisfaction among nurses is a key factor in nurse turnover. Although several models of job satisfaction have been suggested in Western countries, these require further development and testing in Mainland China, where the social context of the labour market is different.

METHOD

A survey design using questionnaires was adopted. A total of 512 hospital nurses in Beijing participated in the study in 2004, representing a response rate of 81%.

FINDINGS

There was a negative relationship between nurses' job satisfaction and intention to leave their current hospitals, which was mediated by age (P < 0.05). About 40% of the variance in job satisfaction could be explained by the set of independent variables including organizational commitment, occupational stress, professional commitment, role conflict, role ambiguity, educational level, age and working years (R2 = 0.396). Organizational commitment had the strongest impact on job satisfaction, which explained 31.3% of the variance in this, followed by occupational stress and role conflict (5.5% and 1.9% respectively). In addition, both nurses' role perception and actual role content influenced job satisfaction as well as occupational stress, role conflict and role ambiguity (P < 0.05). Nurses' educational level was also a factor related to role perception, professional commitment and role conflict (P < 0.05).

CONCLUSION

Nurses' job satisfaction could be increased through promoting organizational and professional commitment and reducing occupational stress, role conflict and role ambiguity.

Professional competence: factors described by nurses as influencing their development

AIM

To discuss the results of a study that explored factors that may influence competence development.

BACKGROUND

Competence, a controversial issue in health care settings, affects many aspects of the nursing profession, including education, practice and management. Although a number of research and discussion papers have explored the issue, in particular the meaning and assessment of nursing competence, to date little research has explored factors identified by nurses themselves as influencing their development of professional competence.

METHODS

A purposive sample of 27 registered nurses was recruited from two university-affiliated hospitals. Data collection was by tape-recorded semi-structured interviews. Interviews were transcribed verbatim and analysed according to the qualitative methodology of content analysis.

FINDINGS

Six descriptive categories were identified from the data: experience, opportunities, environment, personal characteristics, motivation and theoretical knowledge.

CONCLUSIONS

The findings suggest that the factors influencing the process of developing professional competence in nursing extend across personal and extra-personal domains. An understanding of these factors may enhance the ability of nursing managers and educators to enable student and qualified nurses to pursue effective competency development pathways to prepare them to provide a high standard of care. These findings, which may have important implications for nursing practice, management and education, are being further tested in a larger study.

A project to establish a skills competency matrix for EU nurses

Enhanced nurse workforce mobility in the European Union (EU) is seen as a remedy to shortages of nurses in some EU countries and a surplus in others. However, knowledge of differences in competence, culture, skill levels and working practices of nursing staff throughout EU countries is not fully documented because currently no tangible method exists to enable comparison. The European Healthcare Training and Accreditation Network (EHTAN) project intends to address this problem by establishing an assessment and evaluation methodology through the compilation of a skills competency matrix. To this end, subsequent to a review of documentation and literature on nursing competence definition and assessment, two versions of a nursing competence self-assessment questionnaire tool have been developed. The final competence matrix will be translated and disseminated for transnational use and it is hoped that this will inform EU and national policies on the training requirements of nurses and nursing mobility and facilitate the promotion of EU-wide recognition of nursing qualifications.

Clinical competence assessment in nursing: a systematic review of the literature

BACKGROUND

The assessment of clinical competence has returned to centre stage of nurse education. However, there is little evidence to support the use of clinical competence and a wide variety of methods for its use.

RESEARCH QUESTION

The present study was designed to investigate the evidence for the use of clinical competence assessment in nursing.

DESIGN

A review using systematic methods of literature pertaining to clinical competence in nursing was conducted using defined dates, databases and search terms.

RESULTS

There is still considerable confusion about the definition of clinical competence and most of the methods in use to define or measure competence have not been developed systematically and issues of reliability and validity have barely been addressed.

CONCLUSION

The assessment of clinical competence remains almost universally accepted in the nurse education literature as a laudable pursuit yet there are aspects of it that remain at odds with the higher education of nurses.

Measurement of clinical performance of nurses: a literature review

Despite a 40-year history of researching and developing an instrument for measurement of clinical competence in nursing, there are none that are universally accepted for this purpose. This article presents a critical review of the research, which has been carried out to explore the measurement of nurses' clinical performance. To search the literature in a systematic manner, the criteria stipulated by the Cochrane Research Database were applied. The review showed that assessment tools have been developed using a variety of different methods and several instruments were found to have been developed but nothing that is universally accepted. However, the authors found that the pathway for instrument generation suggested by Smith and Kendall (1963) offers a robust approach to the generation of such a tool regardless of the practice setting. Other methods identified in this literature review also offer interested researchers an opportunity to explore the current role of the nurse, as well as the possibility of developing tools for assessing the performance of students at various stages in their education and nurses at various times after qualification.

An evaluation of the clinical performance of newly qualified nurses: a competency based assessment

The clinical performance of newly qualified staff nurses, or their 'fitness for purpose' has become a central professional and corporate issue and highlighted as a central causes for the reforms recommended by the Peach report (Peach 1999). However the ability to gauge the performance of newly qualified nurses remains a largely subjective exercise relying upon anecdotal evidence or general statements of newly qualified nurses' feelings of inadequacy on qualification. This article seeks to address this issue by reporting the findings of project that sought to compare the expectations of senior nurses regarding the level of competence of newly qualified nurses with that of the actual level of competency as assessed by the preceptors after 8 weeks in post. Using a specifically designed instrument to assess clinical competency a comparison has been made between 139 senior nurses' expectations of the competency of newly qualified nurses and the actual competence as assessed by preceptors of 36 newly qualified nurses after 8 weeks in post. The findings indicate that the senior nurses have clear subjective expectations of the competence level of newly qualified nurses. However these expectations are consistently lower than the actual level of competency demonstrated by the newly qualified nurses as assessed by their preceptors. This research demonstrates that through the use of a validated tool newly qualified nurses consistently perform at a higher level of competency than that expected by senior nurses. The ability to estimate competency levels by objective means should be developed. Further research is needed involving a larger sample of Trusts and Schools of Nursing to replicate the results of this study and to compare methods of the assessment of performance in terms of competency in practice on qualification. It is through developments based upon research such as this that a systematic evaluation of the contribution of Schools of Nursing to the competence of newly qualified nurses can be addressed.

Measurement Issues in Promoting Continued Competence

PURPOSE

Promoting continued competence in nursing practice has always been of concern to staff development and continuing education educators. Recently it has reached new levels of significance. As a result of the proposals made by the Pew Commission Taskforce on Health Care Workforce Regulation and the National Council of State Boards of Nursing, the profession is re-examining the question, "How do we promote and assure continued competence?" The purpose of this article is to examine the measurement issues related to answering this question.

FINDINGS

The nursing literature provides several definitions of competence, but none are operational. To measure a concept it must be operationalized. Mandatory continuing education, peer review, and practice or process audits have been used to assess continued competence. The measurement issues involved in assessing competence include selecting an appropriate measurement paradigm, selecting accurate measurement instruments, and interpreting the measurement data.

IMPLICATIONS

Staff development educators and nurse managers should collaborate in the establishment of standards of practice, the identification of essential competencies specific to the setting, and the development of appropriate methods of measurement of these competencies.

From simplicity to complexity: developing a model of practical skill performance in nursing

The purpose of this article is to present and discuss a new model of practical skill performance in nursing. The model is conceptualized as having five components: substance and sequence; accuracy; fluency; integration; and caring conduct. The model challenges the truism of 'simple' nursing procedures. It is argued that performance of practical skills in nursing is characterized by complexity on many levels. Complexity lies within and between the components of the performance model and in the interaction between the nurse and the clinical context where practical nursing actions are performed. These complexities are described. Examples that illustrate the complex and reciprocal nature of these components are drawn from an empirical study of graduate nurses' development of practical skill in surgical hospital units. Implications of the model for education, practice and research are discussed.

Shift work and its impact upon nurse performance: current knowledge and research issues

Previous research investigating shift work and its impact upon the quality of registered nurse performance and outcomes (including biological, psychosocial and organizational) is reviewed. The present study, which involved non-participant observation of staff nurses (n = 34) within their first year of practice (Part 1 or Part 12 of the United Kingdom Professional Register), is described. The findings demonstrated support for earlier research which suggested that 12 1/2 hour shifts are associated with less effective performance. This study, together with previous research, highlights important indicators for the design and management of future empirical work which is required to investigate the influence of shift work upon process as well as outcomes for nurses, service users and the employing organization. This is particularly pertinent in the light of recent changes in work patterns. The well-being and effectiveness of the nursing workforce requires enhancement, and the effective management of shift-work is a key strategy in achieving this.

An exploratory study of similarities and differences between senior students from different pre-registration nurse education courses

A triangulation design using two simulations, non-participant observation and a semi-structured interview to explore senior student nurse performance in South East England is described. A comparison of student nurse performance (registered general nurse [RGN] programme n = 34; registered nurse Project 2000 diploma programme n = 34; integrated degree programme n = 31) indicated many similarities but also some important differences in outcomes which included: a more systematic approach to information-seeking, better care-planning skills and higher quality nurse performance among integrated degree programme participants; use of a model and the immediate role of the nurse to guide information-seeking and better care-planning skills and weaknesses in clinical nurse performance among RGN programme participants; and weaknesses in the information-seeking, care-planning and clinical nurse performance among Project 2000 diploma participants. There were no significant differences between the clinical performance scores of the RGN and diploma programme participants. The interview data suggested that the integrated degree programme participants had a client focus in contrast to the professional focus of RGN and Project 2000 diploma participants. The findings, however, must be viewed within the context of an exploratory study of limited sample size. The research was funded by the English National Board for Nursing, Midwifery and Health Visiting.