The meaning of effective education for critical care nursing practice: a thematic analysis

Impact of a critical care postgraduate certificate course on nurses' self-reported competence and confidence: A quasi-experimental study

BACKGROUND

Postgraduate education is said to support the development of nurses' professional competence and confidence, essential to the delivery of safe and effective care. However, there is a shortness of empirical evidence to demonstrate an increase to nurses' self-reported confidence and competence on completion of critical care postgraduate certificate-level education.

OBJECTIVES

To explore the impact of a critical care postgraduate certificate course on nurses' self-reported competence and confidence. To explore the psychometric properties and performance of the Critical Care Competence and Confidence Questionnaire.

DESIGN

A quasi-experimental pre/post-test design.

PARTICIPANTS

A total population sample of nurses completing a critical care postgraduate certificate course at an Australian University.

METHODS

The Critical Care Competence and Confidence Questionnaire was developed for this study to measure nurses' self-reported competence and confidence at baseline and follow up. Descriptive and inferential statistics were used to explore sample characteristics and changes between baseline and follow-up. Reliability of the questionnaire was explored using Cronbach's Alpha and item-total correlations.

RESULTS

There was a statistically significant increase in competence and confidence between baseline and follow-up across all questionnaire domains. Satisfactory reliability estimates were found for the questionnaire.

CONCLUSIONS

Completion of a critical care postgraduate certificate course significantly increased nurses' perceived competence and confidence. The Critical Care Competence and Confidence Questionnaire was found to be psychometrically sound for measuring nurses' self-reported competence and confidence.

Intelligence Care: A Nursing Care Strategy in Respiratory Intensive Care Unit

BACKGROUND

Working in respiratory intensive care unit (RICU) is multidimensional that requires nurses with special attributes to involve with the accountability of the critically ill patients.

OBJECTIVES

The aim of this study was to explore the appropriate nursing care strategy in the RICU in order to unify and coordinate the nursing care in special atmosphere of the RICU.

MATERIALS AND METHODS

This conventional content analysis study was conducted on 23 health care providers working in the RICU of Sina and Shariati hospitals affiliated to Tehran university of medical sciences and the RICU of Baqiyatallah university of medical sciences from August 2012 to the end of July 2013. In addition to in-depth semistructured interviews, uninterrupted observations, field notes, logs, patient's reports and documents were used. Information saturation was determined as an interview termination criterion.

RESULTS

Intelligence care emerged as a main theme, has a broad spectrum of categories and subcategories with bridges and barriers, including equality of bridges and barriers (contingency care, forced oriented task); bridges are more than barriers (human-center care, innovative care, cultural care, participatory care, feedback of nursing services, therapeutic-professional communication, specialized and independent care, and independent nurse practice), and barriers are higher than bridges (personalized care, neglecting to provide proper care, ineffectiveness of supportive caring wards, futility care, nurse burnout, and nonethical-nonprofessional communications).

CONCLUSIONS

Intelligence care is a comprehensive strategy that in addition to recognizing barriers and bridges of nursing care, with predisposing and precipitating forces it can convert barriers to bridges.

Where is the evidence that master's level nursing education makes a difference to patient care? A literature review

AIM

This paper reports on a literature review conducted to explore whether there is evidence that postgraduate nursing education at master's level affects patient care.

BACKGROUND

Continued nursing education has been shown to benefit nurses' development, though little research has been conducted in relation to patient benefit. It is increasingly widespread that nurses pursue education to master's level.

METHOD

Following a systematic review of the literature fifteen studies of mixed methodology and design were examined and data extracted using thematic analysis. Five common themes emerged relating to master's level nursing education that may ultimately affect patient care: increased confidence and self esteem; enhanced communication; personal and professional growth; knowledge and application of theory to practise; and analytical thinking and decision making.

CONCLUSION

It is apparent that there are positive gains for nurses who undertake postgraduate nursing study at master's level related to professional and personal qualities which may provide direct benefit to patients. The supportive evidence extracted from the literature was scant, however. Future research needs to focus on developing measurable and observable criteria against which the educational and skill based outcomes for master's level performance can be evaluated including constraints that may adversely affect a nurse's ability to apply knowledge and skills acquired.

'Back to the bedside': graduate level education in critical care

The need for post registration education for nurses practising at specialty level in critical care environments is widely acknowledged in nursing and educational literature. There is also clear consensus that the ultimate aim of educational preparation and practice development is to improve the delivery of nursing care to patients who are critically ill and provide support for their families. Yet the 'right' approach to educational delivery and evaluation is less clear and stimulates considerable debate amongst nursing educators, care providers, learners and regulatory bodies. The need for critical care nurses to apply advanced knowledge and technical skills to complex and dynamic practice situations necessitates the development of critical thinking and a problem-solving approach to clinical practice that can be fostered through education and experience. This paper explores the relationships within teaching, learning and practice development in critical care nursing and questions the popular assumption that 'post graduate (Master's level) education fits all'. Discussion focuses on the successful development and implementation of graduate level education for critical care nurses in the South Island of New Zealand and how this development is challenging existing approaches to the provision and evaluation of formal critical care education in New Zealand.

The knowledgeable practice of critical care nurses: a poststructural inquiry

BACKGROUND

Contemporary nursing literature emphasises the desirability of clinical nurses being "knowledgeable". However, the need for nurses constantly to acquire more knowledge is reiterated. Lack of knowledge is seen to underlie an array of professional problems. Little is known of how nurses themselves understand what it means to practise knowledgeably.

OBJECTIVE

To explore critical care nurses' understandings of knowledgeable practice and its relationship to being a "good nurse".

METHODOLOGY

A poststructuralist framework informed the study. The study participants were 12 critical care nurses. Data were generated through three individual focused interviews with each participant. Data analysis involved deconstruction of the interview texts to reveal participants' discourses of knowledgeable practice and the implications of these discourses for their subjectivity and for their work.

FINDINGS

A discourse of knowledgeable practice was revealed as central to participants' sense of identity as "good nurses". Participants believed their knowledge resided in their heads ("knowing why") and in their hands ("knowing how"). Fluency of action, which was achieved and maintained by frequent repetition of activities, contributed to their sense of being knowledgeable. Participants described being excluded from knowledge in some instances. In general, however, "actual" knowledge was of less importance than was being positioned, by themselves and others, as knowledgeable. This positioning was frequently undermined by other staff, both medical and nursing. Analysis revealed that the discourse of knowledgeable practice was underpinned by a dichotomy of ignorant/knowledgeable, in which "ignorant" was the dominant category; hence, nurses were assumed to be ignorant until they could "prove" otherwise.

CONCLUSIONS

The findings contest the notion, espoused in nursing literature, that acquisition of knowledge can "empower" nurses, thus providing the solution to problems they may experience. Rather, strategies are required that challenge and disrupt relations of power that construct nurses as "ignorant".