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

Development and validation of a new satisfaction scale for objective structured clinical assessments (S-OSCA): A multicenter cross-sectional study

BACKGROUND

Nursing clinical competence assessment has acquired a special relevance at the undergraduate and postgraduate levels in recent years. In this context, the Objective Structured Clinical Assessment (OSCA) has emerged as a valid and feasible method of assessing nursing competence. The Satisfaction with Nursing Skill Examination: Objective Structured Clinical Assessment (SINE-OSCA) scale is a valid and reliable 10-item measure that has been developed to evaluate nursing students' satisfaction with the OSCA in the Australian context. Given the importance that OSCA has gained in Spain, it is necessary to validate this tool to be used in one of the most spoken languages in the world.

OBJECTIVES

The purpose of the study was to carry out a modification of the SINE-OSCA, cross-cultural adaptation and a psychometric analysis of the new S-OSCA with Spanish nursing students.

DESIGN

A multicenter study of questionnaire development and validation was carried out in 2023 in four Spanish university nursing centers. The study was carried out in 3 phases: design, pilot implementation, and construct validation.

PARTICIPANTS/SETTING

The total population of students from these centers amounted to 1350 students. The final sample consisted of 364 nursing students, selected by convenience sampling.

METHODS

The process of translation and cultural adaptation of SINE-OSCA to the Spanish population was carried out following the guidelines proposed by Beaton et al. Content validation, Internal consistency and temporal reliability were evaluated.

RESULTS

The S-OSCA presents values in the psychometric indicators (V AIKEN, Bland-Altman diagram, and IVC Lawshe) that exceed the cut-off values established even considering the lower limit of the confidence intervals. This spanish version of the SINE-OSCA has a Cronbach's alpha value that is slightly higher than that reported for that original version (0.928 CI 95 % (0.913-0.94)). Regarding temporal reliability, the S-OSCA scale was completed in 40 nursing students at two times separated by an interval of 15 days. The Intraclass Correlation Coefficient (ICC) obtained was 0.974 CI 95 % (0.952-0.986).

CONCLUSIONS

The S-OSCA instrument proves to be robust enough to guarantee the quality of its results up to 15 days post-OSCA.

Stress and value: the student perspective on utilizing real vs. actor patients in objective structured clinical examinations

BACKGROUND

Studies have shown objective structured clinical examinations (OSCEs) to be one of the most reliable tools in assessing clinical performance; however in Pediatrics they primarily use manikins, simulators or parent actors which limits the comprehensiveness of the assessment. In our Pediatric Clerkship, medical students are evaluated using a standardized rubric during a clinical evaluation exercise (CEX) with real patients. This study assessed medical students' perceived stress levels and the educational value of the CEX compared an OSCE. We hypothesized there would be equal stress and value for students with the CEX experience compared to the OSCE.

METHODS

Third year students anonymously completed questionnaires after required Pediatric CEX and Internal Medicine OSCE evaluations from July 2016-June 2017. The questionnaire included questions from the Intrinsic Motivation Inventory, a validated tool used to assess feelings of stress and perceived value of an exercise.

RESULTS

A total of 147 and 145 questionnaires were completed after the CEX and OSCE. There were no differences between groups regarding levels of "nervousness" (p = 0.543) and "relaxation" (p = 0.055); students felt more "at ease" (p = 0.002) and less "pressure" (p < 0.001) during the CEX. Students perceived the CEX to be more useful and important to improve skills compared to the OSCE for the history taking, physical exam and interpersonal skills.

CONCLUSIONS

Our results indicate that the CEX was associated with lower stress levels and had higher perceived value when compared to the OSCE. This study supports the usefulness of incorporating real patients into the clinical evaluation of medical students.

Diverse Integration of Simulated Patients in Medical Education for Communication, Language, and Clinical Skills in Hungary

Medical education and communication training has been undergoing substantial changes recently in our globalized environment. Multidisciplinary simulation-based methods worldwide focus on improving effective clinical skills including history taking, physical examination, diagnostic skills, critical thinking, therapeutic skills, and others via interactions between medical students, trainees, and patients. Recently, Hungary has joined such global trends. The first simulated patient program in Hungary was developed at the University of Pécs Medical School in 2019 to aid effective patient-interviewing skills in language and communication classes. Under the supervision of linguists, communication specialists and medical professionals, the multidisciplinary program uses lay people to perform as simulated patients while using the languages of Hungarian, German, and English. Our simulated patient program plays a specific role in supporting students to learn languages for medical purposes, aiming to prepare them for handling the medical, linguistic, at the same, time emotional and sociocultural difficulties encountered while taking patient histories. Medical and linguistic experts evaluate student performance, provide feedback, and give tailored instruction so that students can advance their communicative and professional skills. This study discusses working formats and the role of constructive feedback exploring potential advantages and disadvantages, sharing ideas, and proposing recommendations on language- and communication-based integration of simulated patients. In our elective communication courses, undergraduate medical students learn to cope with a variety of patient situations through practicing medical emergencies, misunderstandings, and disagreements in a safe atmosphere provided by the MediSkillsLab. Among the benefits, we should emphasize that any course with a growing number of students can be accommodated by carefully designing the program, which allows for interprofessional collaboration. This program contributes to higher-quality medical education, promoting more skilled and compassionate healthcare specialists.

Methodological approaches and competence areas of nursing students in virtual reality simulation research - A scoping review

OBJECTIVES

To analyze methodological approaches (theoretical frameworks, study designs, methods) and competence areas of nursing students in research on virtual reality simulations (VRS) with a high level of immersion.

METHODS

A scoping review was performed. A systematic search of the literature was conducted on MEDLINE, CINAHL and ERIC databases on 30/11/22. In addition, a manual search was utilized. The extracted data relating to the research questions was descriptively analyzed and results were narratively summarized.

RESULTS

In total 23 studies were included in the review. Selected studies employed a wide range of theoretical frameworks and research designs. The studies aimed to develop competences both through complex interventions where team-based skills are required in acute situations, and they described basic nursing interventions where individual skills are required in non-acute nursing care.

CONCLUSIONS

A significant amount of the selected studies did not utilize a learning theory or an instructional design framework as a basis for their research. More knowledge was found on training specific skills compared to facilitating the attitudes and values of the participants. Therefore, there is a need for further research on whether nursing students' attitudes and values can be supported through VRS with a high level of immersion.

Clinical Evaluation of Competence in Nursing Education: What Do We Know?

AIM

The purpose of this article was to examine the research literature to identify objective, replicable measurement of clinical competence in undergraduate nursing education.

BACKGROUND

Although a standardized licensure examination is used to determine minimal competence to practice, no consensus on the definition or components of competence exists in the research literature.

METHOD

A comprehensive search was conducted to locate studies that evaluated nursing students' general competence in the clinical setting. Twelve reports published from 2010 to 2021 were examined.

RESULTS

Measures to evaluate competence were varied and contained multiple concepts including attributes of knowledge, attitudes and behaviors, ethics and values, personal attributes, and cognitive or psychomotor skills. Most studies used researcher-created instruments.

CONCLUSION

Although essential to nursing education, competence in the clinical setting is not commonly defined or evaluated. The lack of standardized instruments has contributed to the use of varied methods and measures for evaluating competence in nursing education and research.

Design of online formative assessment of nursing humanities curriculum during the COVID-19 pandemic: A teaching practice research

BACKGROUND

Under the digital transformation trend nursing education, online formative assessment (OFA) provides a new opportunity. However, the OFA of nursing humanities course lacks design and practice, and faces the challenge of enhancing effective communication between teachers and students, student participation and autonomous learning.

OBJECTIVES

To enhance the reliability of OFA in nursing humanities courses and provide practical experience for online teaching in the nursing profession.

DESIGN

A quantitative research approach was used.

SETTING

This study was conducted in a comprehensive university in China.

PARTICIPANTS

We conducted teaching practice on 185 nursing undergraduates, with 89 students in the experimental group, and 96 students in the control group.

METHODS

In the 2020-2021 multicultural nursing course, student learning outcomes and questionnaires were analyzed through the online learning tool Superstar Learning, student feedback and satisfaction questionnaires, and descriptive analysis and independent sample t-tests were conducted using SPSS 25.0 software.

RESULTS

The OFA of students using Superstar Learning differed in learning performance and time to receive feedback from teachers between the experimental and control groups, and both groups had higher satisfaction levels. The experimental group's instructional design contained a synchronous classroom discussion module with better participation.

CONCLUSIONS

During the COVID-19 pandemic, the use of online learning tools can support the implementation of OFA, build an environment where teachers and students participate together, have a positive impact on the continuous updating of teachers' teaching programs and students' learning outcomes. Simultaneous classroom discussions are expected to be an effective way to improve the reliability of OFA. Our instructional design, provides best practice suggestions for future online teaching and learning.

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.

Perspectives and experiences of newly registered nurses surrounding the objective structured clinical examination in an obstetrics and gynecology hospital: A qualitative study in Shanghai, China

OBJECTIVES

Newly registered nurses in China are required to attend two years of standardized training programs after graduation, and an evaluation of the training program's effectiveness is critical. The objective structured clinical examination is a relatively new and objective approach to exploring the effectiveness of training programs and is increasingly being encouraged and used in clinics. However, the perspectives and experiences of newly registered nurses in obstetrics and gynecology regarding the objective structured clinical examination are unclear. Therefore, the objective of this study was to investigate newly registered nurses' perspectives and experiences of the objective structured clinical examination in an obstetrics and gynecology hospital.

DESIGN

This qualitative study was conducted using a phenomenological approach.

DATA SOURCES

Twenty-four newly registered nurses taking the objective structured clinical examination in a third-level obstetrics and gynecology hospital in Shanghai, China.

REVIEW METHODS

Semi-structured face-to-face interviews were conducted between July and August 2021. The Colaizzi seven-step framework was applied for data analysis.

RESULTS

Three main themes and six sub-themes emerged: 1) high satisfaction with the objective structured clinical examination; 2) gaining experience and growing as nurses; and 3) high pressure.

CONCLUSION

The objective clinical structured examination can be used to assess the competence of newly registered nurses after training in an obstetrics and gynecology hospital. The examination not only enables an objective and comprehensive evaluation of others and self-evaluation but also leads to positive psychological experiences in newly registered nurses. However, interventions are needed to relieve examination pressure and to provide effective support for participants. The objective clinical structured examination can be incorporated into the training assessment system; this study provides a basis for improving training programs and the training of newly registered nurses.

Factors Related to Clinical Competence among Graduating Nursing Students during the COVID-19 Pandemic: A Cross-Sectional Study

PURPOSE

This study investigated clinical competency, COVID-19-related anxiety, coping strategies, self-efficacy, and perceived stress among graduating nursing students during the COVID-19 pandemic.

METHODS

We conducted a cross-sectional survey. Participants were recruited from universities located in four major cities in South Korea. General demographic information, clinical competency, self-efficacy, perceived stress, COVID-19-related anxiety, and coping strategies were assessed using reliable questionnaires. Descriptive statistics, correlations, and multiple regression tests were used to analyze the data.

RESULTS

The mean clinical competency, self-efficacy, perceived stress, adaptive coping, and maladaptive coping were 138.16 ± 18.34, 83.85 ±14.02, 21.37 ± 5.79, 53.15 ± 4.64, and 30.98 ± 6.73, respectively. COVID-19-related anxiety was reported by 4.3% of participants. Clinical competency was significantly positively correlated with self-efficacy (r = .44, p < .001) and adaptive coping (r = .20, p = .035) and was significantly negatively correlated with maladaptive coping (r = .20, p = .035). The predictors of clinical competency were self-efficacy (β = .434, p < .001) and adaptive coping (β = .173, p < .039), which explained 23% of the variance in clinical competency.

CONCLUSION

Self-efficacy and adaptive coping strategies are significant predictors of clinical competence during the pandemic. Planning and implementing various curricular and non-curricular activities to increase senior students' self-efficacy and adaptive coping strategies will help prepare competent nursing graduates for the pandemic when they enter the nursing workforce.

Graduate nurses' capability upon entering the workforce: An integrative review

OBJECTIVES

To clarify capability for work readiness in newly graduated registered nurses as viewed from the perspective of clinicians in practice, educators in tertiary institutions, and graduates.

DESIGN

Integrative review.

DATA SOURCES

Databases searched for peer-reviewed studies included PubMed, MEDLINE, ERIC, Campbell collaboration, Google Scholar, and Cochrane databases.

REVIEW METHODS

Pragmatism informed this integrative review. The five-stage method described by Whittemore and Knafl was used to enable rigorous examination of the expected capability of graduate nurses. A comprehensive database search was conducted using PRISMA guidelines. Eighteen articles were appraised and analysed for this review. The capability concept was used as a framework for analysis.

RESULTS

Eighteen articles met the inclusion criteria. Findings revealed that although there is no definition for graduate nurses' work readiness, there is a common theme. Graduate nurses are expected to have broad theoretical knowledge (knowing) along with practical knowledge (doing). They are also expected to demonstrate integrity, honesty, respect, compassion, and a moral compass. A list of personal attributes and organisational acumen was also reflective of graduate readiness upon entering the workforce and identified as necessary capabilities for graduates.

CONCLUSIONS

A picture of the perfect employee is illustrated in the definition of work readiness by the participants of the original studies. Yet there is a lack of stakeholder consensus on the capabilities expected from a graduate nurse.

Improving the self-efficacy, knowledge, and attitude of nurses regarding concurrent disorder care: Results from a prospective cohort study of an interprofessional, videoconference-based programme using the ECHO model

Several challenges have been identified for patients with concurrent disorders to access adequate services and for nurses to care for them. These challenges contribute to a pressing need for continuing educational interventions, particularly within the mental health nursing workforce. To address this issue, an innovative interprofessional videoconferencing programme based on the ECHO® model (Extension for Community Healthcare Outcomes) was implemented in Quebec, Canada to support and build capacity among healthcare professionals for CD management. The aim of this prospective cohort study was to examine nurses' self-efficacy, knowledge, and attitude scores over a 12-month period. All nurses who registered in the programme between 2018 and 2020 were invited to participate in the study (N = 65). The data were collected online using a self-administered survey at baseline, after 6 months, and then 12 months following entry-to-programme. Twenty-eight nurses participated in the study (96.4% women), with a mean age of 39.1 (SD = 6.2). Compared to other professions (n = 146/174), the group of nurses also showed significant improvements in their knowledge and attitude scores, with respective effect sizes of 0.72 and -0.44 at 6 months, and 0.94 and -0.59 at 12 months. However, significant changes in self-efficacy were only found at the 12-month follow-up (P = 0.0213), among the nurses who attended more than 25% of the 20-session curriculum. ECHO is a promising intervention to improve the accessibility of evidence-based practice and to support nurses in suitably managing concurrent disorders. Further research is needed to establish the effectiveness of this educational intervention on clinical nursing practice and patient outcomes.

Advanced clinical practice in paediatric haematology and oncology: developing a capability document

Specialist roles have been developed to provide holistic care to children and young people with cancer, one of which is the advanced clinical practitioner (ACP) in paediatric oncology and haematology. A survey showed that paediatric oncology and haematology ACPs in the UK work in a wide variety of roles and that their numbers vary greatly between treatment centres. The survey also confirmed the need for a national standardised framework delineating the knowledge, skills and expertise required of ACPs working in paediatric oncology and haematology. This article describes the development of a capability document to support and standardise advanced practice in paediatric oncology and haematology. The document reflects the advanced level of critical thinking, autonomy and decision-making required of ACPs and has been endorsed by the Children's Cancer and Leukaemia Group and by the Royal College of Nursing. It is hoped that it will support ACPs to consistently deliver high-quality, safe care for the benefit of children and young people with cancer and their families.

Psychometric properties of clinical competency assessment instruments for psychiatric nurses: A systematic review of literature

BACKGROUND

Facilitating the healing process of patients with psychiatric disorders depends on high-quality mental health care and expert psychiatric nurses. A valid tool is required to objectively evaluate the quality of performance and competency of psychiatric nurses. This systematic review aimed to investigate and critique the psychometric properties of some psychiatric nursing clinical competency assessment instruments with Consensus-based standards for the selection of health status measurement instruments (COSMIN) checklist and according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA).

MATERIALS AND METHODS

To retrieve published articles using Persian and English keywords "psychiatric nursing," "competence," "competency," "tool," "checklist," "scale," "questionnaire," "psychiatric mental health nurse," were searched in databases without time limitation. Then, psychometric properties of selected instruments were evaluated using the COSMIN checklist and reported according to the PRISMA statement.

RESULTS

Most of these tools did not entirely and desirably report psychometric properties. It is not designed as a special tool for postgraduate psychiatric nursing.

CONCLUSION

The methodology of existing instruments does not meet the COSMIN checklist criteria; therefore it needs to develop. To assess the competency of psychiatric nursing postgraduate, a tool tailored to the cultural and social context and with acceptable psychometric properties is necessary.

Tablet-assisted objective structured spotter practical examination (TOSSPE): Advantages of an innovative anatomy spotter examination method for medical student assessment

The affordances of technology-based assessments, like the objectively structured practical examination, have become an integral part of gross anatomy courses. The Department of Anatomy Faculty of Medicine at the University of Warmia and Mazury developed and introduced an application for tablet devices which has been implemented in student examinations and assessments, called the tablet-assisted objective structured spotter practical examination. It was created to simplify the educational process and to build a rich learning environment, facilitating deep learning for students through examination and feedback data. The method consists of cadaver stations with traditional corresponding pin spotters in an expanded tablet application. It not only provides instant feedback on various observations of teaching-learning skills but has also positively affected the entire process of education. The method provides an unbiased evaluation of knowledge and understanding of the anatomy course, ensuring objectivity and standardization. The current study was performed on a total of 608 first-year medical students in Polish and English divisions and focused on the observed advantages since the new method was introduced. Outcomes indicate that after the implementation of the method for both the Polish and English divisions' first-year medical students, the mean score of examinations significantly increased compared to other teaching-learning methods. The study highlights that students were excited about the implementation of the new method and identified its many benefits. It is recognized that technological development and the digital environment offer a range of opportunities and added value versus traditional assessment activities, methods, and processes.

The Outcomes of an Interprofessional Simulation Program for New Graduate Nurses

This study explored the learning outcomes of an interprofessional simulation program for new graduate nurses during their training program. It was a single-group, pre-test and post-test research design. Ninety-three new graduate nurses participated in the study. The Nursing Competence Instrument and program satisfaction survey questionnaires were used to evaluate the learning outcomes of the program. Data were collected between 1 July 2019 and 30 June 2020 in a medical center in Taiwan. It was found that four nursing core competencies were significantly higher after the simulation, including advancing career talents (t = 10.12, p < 0.0001), integrating care abilities (t = 10.19, p < 0.001), dealing with tension (t = 6.87, p < 0.0001), and leading humanity concerns (t = 6.86, p < 0.001). The average satisfaction score for the interprofessional simulation training among nurses was 4.42 out of 5. In conclusion, interprofessional simulation education can help novice nurses improve their nursing core competencies. The results of this study provide an important indicator for hospitals and governments when making policy and training programs for new graduate nurses.

Evaluation of the Experience of Peer-led Mock Objective Structured Practical Examination for First- and Second-year Medical Students

BACKGROUND

The objective structured practical examination (OSPE) is used as an assessment tool of laboratory practical sessions. This study described the design and implementation of peer-led mock OSPE for first- and second-year medical students, investigated the perception of the students of the peer-led mock OSPE and the impact of attending the mock OSPE on the performance.

METHODS

This is a cross-sectional study. Two mock OSPEs were designed and conducted by third-, fourth- and fifth- year medical students for year one and two. Each mock OSPE involved six stations. Thirty-three medical students facilitated the OSPE. The OSPEs were conducted prior to the summative end of block exams. Following the mock OSPEs, an online survey was sent to the participants to assess their satisfaction, quality and benefits of the mock OSPE. The study also evaluated the impact of the mock OSPE on students' performance.

RESULTS

Out of 313 first-year students, 279 (89.1%) attended the mock OSPE and out of 298 second-year students, 213 (71.5%) attended. A total of 192 (68.8%) first-year medical students and 102 (47.9%) second-year medical students completed the questionnaire. There was no significant difference between attending and non-attending the mock OSPE in the students' performance in the summative OSPE. The majority of students felt more confident, less anxious, and lowered the levels of stress after attending the mock OSPE. More than half of the students felt that attending the mock OSPE helped in easing the steps, better preparation, provided sufficient orientation, well explained the materials and helped them to learn the concept of the final OSPE. The majority of students found the mock OSPE stimulating.

CONCLUSION

Attending the mock OSPE did not affect the students' performance in the summative OSPE. However, the peer-assessed mock OSPE improved the medical students' confidence and lowered the anxiety associated with OSPE.

The Effect of Nursing Internships on the Effectiveness of Implementing Information Technology Teaching

In nursing education, the diversity of clinical scenarios is complex and dynamic, and it is a challenge for nursing students to learn this clinical knowledge in conventional teaching mechanisms. However, integrating information technology into teaching can promote diversity of learning environment. This study aimed to investigate the effectiveness of teaching mechanisms which combined clinical simulation scenario and Information Technology Integrated Instruction. This study applied innovative experimental teaching in medical–surgical and critical care nursing courses for nursing students in their fourth or fifth year at a five-year junior college. Instructional systems design was combined with clinical simulation scenarios and technology to develop multidimensional teaching strategies. Fifth-year students' overall OSCE mean score was considerably higher than that of fourth-year students; specifically, their scores on basic life support and care for subdural hemorrhage varied substantially. Compared with fourth-year students, fifth-year students performed considerably greater on situational awareness. The results of the present study can be used to develop nursing core competencies and improve the clinical care competency of nursing personnel.

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.

Effectiveness and experiences of the Extension for Community Healthcare Outcomes (ECHO) Model in developing competencies among healthcare professionals: a mixed methods systematic review protocol

BACKGROUND

The Extension for Community Healthcare Outcomes (ECHO) Model of continuing tele-education is an innovative guided-practice model aiming at amplifying healthcare professionals' competencies in the management of chronic and complex health conditions. While data on the impact of the ECHO model is increasingly available in the literature, what influences the model effectiveness remains unclear. Therefore, the overarching aim of this systematic review is to identify, appraise, and synthesize the available quantitative (QUAN) and qualitative (QUAL) evidence regarding the ECHO Model effectiveness and the experiences/views of ECHO's participants about what influences the development of competencies in healthcare professionals.

METHODS

The proposed systematic review was inspired by the Joanna Briggs Institute (JBI) methodology for Mixed Methods Systematic Reviews (MMSR) and will follow a convergent segregated approach. A systematic search will be undertaken using QUAN, QUAL and mixed methods (MM) studies of ECHO-affiliated programs identified in six databases. A publication date filter will be applied to find the articles published from 2003 onwards. Sources of unpublished studies and gray literature will be searched as well. Retrieved citations will independently be screened by two reviewers. Disagreements will be resolved through discussion until a consensus is reached or by including a third reviewer. Studies meeting the predefined inclusion criteria will be assessed on methodological quality and the data will be extracted using standardized data extraction forms. Separate QUAN and QUAL synthesis will be performed, and findings will be integrated using a matrix approach for the purpose of comparison and complementarity.

DISCUSSION

This MMSR will fulfill important gaps in the current literature on the ECHO Model as the first to provide estimates on its effectiveness and consider simultaneously the experiences/views of ECHO's participants. As each replication of the ECHO Model greatly varies depending on the context, topic, and targeted professionals, a better understanding of what influences the model effectiveness in developing healthcare professionals' competencies is crucial to inform future implementation.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020197579.

Effectiveness of applying clinical simulation scenarios and integrating information technology in medical-surgical nursing and critical nursing courses

BACKGROUND

To determine the impact of combining clinical simulation scenario training and Information Technology Integrated Instruction (ITII) on the teaching of nursing skills.

METHODS

120 4th-year students in a nursing program who were enrolled in medical and surgical nursing courses. 61 received innovative instruction (experimental group) and 59 received conventional instruction (control group). The ADDIE model, systematic method of course development that includes analysis, design, development, implementation, and evaluation,was used to build simulation teaching and clinical scenarios and to create and modify objective structure clinical examination (OSCE) scenario checklists for acute myocardial infarction (AMI) care, basic life support and operation of automated external defibrillator (BLS), and subdural hemorrhage (SDH) care. The modified OSCE checklists were assessed for reliability, consistency, and validity. The innovative training included flipped classrooms, clinical simulation scenarios, ITII and blended learning formats.

RESULTS

The reliability and validity of the OSCE checklists developed in this study were acceptable and comparable or higher than checklists in past studies and could be utilized as an OSCE performance tool. Students in innovative instruction obtained significantly better OSCE performance, lab scores and improvements from the previous year's grades. Significant differences were found in situational awareness (SA). No strong correlations were found between OSCE scores and clinical internship scores, and no significant differences were found between the groups in overall clinical internship performance.

CONCLUSIONS

Innovative instruction showed better performance than conventional methods in summative evaluation of knowledge components, OSCE formative evaluation and clinical nursing internship scores, as well as improved situational awareness in nursing students.

Nursing qualifications needed in municipal emergency inpatient units. A qualitative study

BACKGROUND

Providing care to older individuals with complex needs and patients with chronic illness is a concern worldwide. In Norway, this situation led to the transfer of responsibility for care and treatment to the municipalities. Providing emergency care at the municipal level - thereby reducing the need for emergency hospital admissions - is part of the Coordination Reform in Norway. This reform from 2012 warrants a reconsideration of which nursing qualifications are needed in the municipalities. The aim of the study is to explore which professional qualifications nurses need to provide emergency care in municipal emergency inpatient units.

METHOD

A qualitative design with a hermeneutic approach was employed. Interviewing physicians about nursing qualifications may be considered inappropriate. We believe that this is important for developing knowledge that can strengthen interprofessional cooperation in emergency situations. Three focus groups were conducted. Physicians with experience in municipal emergency inpatient units were interviewed.

RESULTS

We synthesised three themes from the data: (1) broad medical knowledge; (2) advanced clinical skills; and (3) ethical qualifications and a holistic approach. The first theme is about knowledge, the second is about skills, and the third conveys the need for overall competence.

CONCLUSIONS

Nurses working in municipal emergency inpatient units need advanced ethical qualifications, which integrate broad medical knowledge, advanced clinical skills and the ability to take a holistic approach. They have a considerable responsibility to work independently and safely in a setting where both the patient and the patient's family play important roles. Establishing arenas for collaborative practice between physicians and nurses on clinical issues may be a way of strengthening patient safety and nurses' clinical judgement.

An international e-Delphi study to identify core competencies for Italian cardiac nurses

AIMS

The management of cardiovascular patients requires increasingly competent nursing professionals. In Italy, there are no specific postgraduate courses focused on specialist cardiac skills development for nurses. To develop such courses, content incorporating appropriate competencies is required and this study was designed to meet this. To delineate a set of core competencies to develop national educational interventions to ensure cardiac nurses in Italy achieve international standards.

METHODS AND RESULTS

A three-round e-Delphi study including a panel of 32 expert cardiac nurses from the UK, Canada, Australia, New Zealand, and Italy was conducted; 26 respondents completed all three rounds. The first round sought a list of five competencies from each participant which they were asked to prioritize in Round 2. In Round 3, they were asked to prioritize again with the knowledge of the priorities identified in Round 2. The final list of competencies was those achieving 70% agreement among participants. We identified 14 core competencies spanning a range of areas of competence including technical, interpersonal, health promotion, use of evidence, and management. Only minor differences were evident between the Italian and the international panel regarding the priority given to some core competences, such a leadership and taking patient history.

CONCLUSION

This is the first study in Italy to delineate cardiac nurses' core competencies. As such, it provides a foundation for the development of postgraduate educational programmes for cardiac nurses including competencies that are congruent with international standards.

Exploring core competencies of clinical nurse preceptors: A nominal group technique study

AIM

The aim of this study was to explore core competencies of nurse preceptors based on the perspectives of postgraduate-year nurses, nurse preceptors and head nurses.

BACKGROUND

Perspectives of core competencies of nurse preceptors are varied among postgraduate-year nurses, nurse preceptors and head nurses, which makes it difficult to establish preceptor training programs and develop evaluation instruments.

DESIGN

A nominal group technique study.

METHODS

A nominal group technique procedure was applied to small-group and large-group discussion. The participants were recruited from the inpatient units at five nonprofit hospitals, each having over 1000 patient beds, in Taiwan. A total of 101 participants were involved in this study: 32 postgraduate-year nurses, 42 nurse preceptors and 27 head nurses, who were respectively sorted into five, six and four small groups with six to eight members in each group. After applying nominal group technique procedure, the core competencies were scored and ranked. Based on the final scores and ranking, the core competencies that the participants felt to be most important for nurse preceptors were identified. The expert panel then integrated these core competencies and derived a consensus.

RESULTS

Seven core competencies of nurse preceptors were derived, in order of declining importance: teaching traits, clinical nursing profession, communication and collaboration, teaching pedagogy, reaction of contingency, critical thinking and reflection and consultation on academic writing. All participants perceived that teaching traits (198 points) and clinical nursing profession (161 points) were the most important. Consultation of academic writing is unique, which may be due to the clinical ladder system still being implemented in Taiwan.

CONCLUSIONS

The nominal group technique is an efficient and proper method to conduct a consensus for specific issues or values among individuals and groups. The results of this study can facilitate the development of evaluation indicators or instruments as well as provide a direction of continuing education program for preceptor training.

Effectiveness of pediatric learning modules in enhancing competencies among nurses in a specialized unit

The global shortage of highly competent nurses has forced healthcare organizations to adapt to various strategies, including rotating nurses to different units, impacting their competency levels. To equip nurses with the needed competencies, the researchers developed the pediatric learning modules and conducted this study to analyze their effectiveness. Researchers employed purposive and random sampling to identify study participants, and utilized a mixed-method design, including Solomon Four Group Design and a narrative approach. A researcher-made evaluation questionnaire, competency checklists, and guide questions for a written narrative were used to collect data. Descriptive statistics and factorial analysis of covariance were utilized for data analysis. The outcomes revealed that demographic variables have no effect on knowledge and competence (p > 0.05). It was also discovered that exposure to learning modules enhanced the competence levels of nurses who were inexperienced in the pediatric setting (F = 41.183, df = 1, p = 0.000). Furthermore, results revealed that enhancing knowledge and competencies is not wholly dependent on well-structured educational sessions and training modules, but is also influenced by other factors, including time allocation for module delivery, protected time to practice, and the opportunity to apply new skills in the clinical area.

Development and Psychometric Testing of a Self-Rated Scale Based on National Nursing Core Competency Standards

BACKGROUND AND PURPOSE

The objectives of this study were to develop a National Nursing Core Competency Standards (NNCCS)-based instrument and determine its construct validity and internal consistency reliability.

METHODS

A methodologic research design was used to validate the 59-item scale based on the responses of 600 nurses. The scale items were culled from the client care, leadership and management, and research competencies identified in the NNCCS.

RESULTS

The results of the analyses confirmed 53 items and gave rise to a five-factor solution. The five dimensions are leadership, management, research, ethico-legal, and strategic competencies.

CONCLUSIONS

The seminal psychometric testing provided an evidence of acceptable validity and reliability of the proposed instrument. Further testing was recommended to accrue the psychometric soundness of the instrument.

Nursing students' conceptions of competence and the learning processes that support the development of competence: a phenomenographic study

The development of competence among student nurses is important to nurse educators, nursing regulatory bodies, employers and patients. Several teaching and learning strategies support the development of competence among student nurses, but the level of competence at the point of graduation remains below expected standards. Therefore, more research is needed to find strategies that can enhance the development of competence among students. The study explored students' conceptions of competence and the learning processes that support the development of competence in nursing practice. Gaining an understanding of learning and competence from the student's perspective can improve our current understanding of the development of competence. Utilising a phenomenographic approach, in-depth interviews and focus group discussions were conducted among purposively sampled groups of nursing students. The analysis of data was managed through ATLAS. ti 8.1 and followed the process of familiarisation, condensation, comparison, grouping, articulating labelling and contrasting of excerpts to generate the students' conceptions of learning. Five categories of description emerged and showed that the development of competence involves students increasing their understanding of what competence is, hence changing their learning strategies to meet the level of competence, as they understood it. In order of hierarchy from the lowest, the categories of description were: competence is understood as task completion; competence is understood as passing assessments /satisfying facilitators; competence is understood as applying theory to practice; competence is understood as performance of nursing according to clinical standards/guidelines; and competence is understood as performance that yields positive health outcomes.

Validation of the Patient-Centred Care Competency Scale Instrument for Finnish Nurses

Patient-centredness in care is a core healthcare value and an effective healthcare delivery design requiring specific nurse competences. The aim of this study was to assess (1) the reliability, validity, and sensitivity of the Finnish version of the Patient-centred Care Competency (PCC) scale and (2) Finnish nurses' self-assessed level of patient-centred care competency. The PCC was translated to Finnish (PCC-Fin) before data collection and analyses: descriptive statistics; Cronbach's alpha coefficients; item analysis; exploratory and confirmatory factor analyses; inter-scale correlational analysis; and sensitivity. Cronbach's alpha coefficients were acceptable, high for the total scale, and satisfactory for the four sub-scales. Item analysis supported the internal homogeneity of the items-to-total and inter-items within the sub-scales. Explorative factor analysis suggested a three-factor solution, but the confirmatory factor analysis confirmed the four-factor structure (Tucker-Lewis index (TLI) 0.92, goodness-of-fit index (GFI) 0.99, root mean square error of approximation (RMSEA) 0.065, standardized root mean square residual (SRMR) 0.045) with 61.2% explained variance. Analysis of the secondary data detected no differences in nurses' self-evaluations of contextual competence, so the inter-scale correlations were high. The PCC-Fin was found to be a reliable and valid instrument for the measurement of nurses' patient-centred care competence. Rasch model analysis would provide some further information about the item level functioning within the instrument.

Development and validation of the nursing clinical assessment tool (NCAT): a psychometric research study

OBJECTIVES

The aim of this pilot psychometric study was to develop and assess the reliability, validity, and applicability of a nursing clinical assessment tool (NCAT) to assess students' clinical performance in the clinical training.

METHODS

Total of 325 forms were completed by 36 clinical raters for undergraduate nursing students who were selected using convenience sampling. International quality and safety education for nurses (QSEN) and Benson and Clark's (Benson, J., & Clark, F. (1982). A guide for instrument development and validation. The American Journal of Occupational Therapy, 36(12), 789-800) model guided the construction of the NCAT. Following literature review, a cross-cultural adaptation and psychometric testing were used.

RESULTS

This newly developed tool showed substantial overall internal consistency reliability (Cronbach's alpha = 0.74). Three factors (i.e. Care Provider, Leadership & Team Work and Professionalism and Ethical Considerations) were identified for construct validity using exploratory factor analysis (EFA).

CONCLUSIONS

This study suggests that the NCAT is a reliable, valid and applicable tool. It can be used in clinical and educational settings. Further testing of the tool in similar and different cultures is recommended.

Development of the competency assessment scale for clinical nursing teachers: Results of a Delphi study and validation

BACKGROUND

Highly competent clinical faculty is a prerequisite for graduating competent nurses, and it is very important to explore the comprehensive ability and post competence of clinical nursing teachers (CNT).

OBJECTIVE

To construct the competency evaluation elements of clinical nursing teachers and test the reliability and validity of the scale.

DESIGN

A Delphi study.

SETTINGS

34 Grade A tertiary hospitals and eight colleges and universities in China, covering 14 provinces, autonomous regions, and municipalities directly under the Central Government.

METHODS

Modified Delphi method was used in this study. Between August 2018 and May 2019, 40 experts participated in three rounds of consultation to build the CNT competency assessment scale. The expert coordination coefficient (W) and the coefficient of variation (CV) were used to examine the level of coordination and concentration of expert advice. Then, the reliability and validity of the scale were tested. Using the convenient sampling method, a total of 190 questionnaires were distributed to nursing teachers, and 187 were recovered. Cronbach's α coefficient was used to evaluate the reliability of the scale. Validity was evaluated using the content validity index.

RESULTS

After the three rounds of expert consultation, the questionnaire contained five dimensions and 44 elements. After expert inquiry, the total coefficient of variation index (CVI) value of the scale was 0.992, and the CVI of each item was 0.95-1.00. The Spearman-Brown correlation coefficient was 0.984. By comparing the results of the two surveys 2 months apart, the Pearson correlation coefficient was tested, and the retest reliability was 0.852. The Cronbach's α of the scale was 0.962, indicating excellent internal consistency.

CONCLUSIONS

The scale of clinical nursing teachers' competence has high reliability and validity. This tool could be widely used to evaluate and improve nursing teaching.

Developing a consensus-based scoring rubric to enhance practice-based assessment of student nurses' clinical competence: A Delphi study

BACKGROUND

Concerns about reliability and validity of practice-based assessment of professional competencies are frequently reported in the literature. Difficulty in understanding competency statements or distinguishing different achievement levels has been found to be a major factor.

OBJECTIVES

To develop a consensus-based scoring rubric based on stakeholders' interpretations of level descriptors for student nurses' professional values competencies.

DESIGN

Two rounds of Classic e-Delphi.

SETTINGS

This study was conducted in a London based university using Bristol Online Survey website as a host.

PARTICIPANTS

100 stakeholders with vested interests in undergraduate pre-registration nurse education were purposefully invited to participate.

METHOD

Round one collected free-text interpretations of the United Kingdom Nursing and Midwifery Council professional values competency statements. Round two used a Likert scale questionnaire to measure the level of agreement to the level descriptor statements generated through round one. Responses were analysed through content analysis in round one and consensus measure in round two. A threshold of 70% agreement to determine consensus was set in advance.

RESULTS

In round one, 47 participants provided their interpretations of the competency statements. In round two, 51 participants completed the questionnaire. All 24 items achieved a strong consensus with 86%-100% of participants agreeing or strongly agreeing with the statements.

CONCLUSIONS

A Delphi study was successfully used to develop a consensus-based scoring rubric with clearly stated descriptors for professional values competency statements. This scoring rubric holds the potential to enhance practice-based assessment across all healthcare professional disciplines.

A Hybrid MADM Model for Newly Graduated Nurse's Competence Evaluation and Improvement

Nursing departments in hospitals must evaluate the practical competency of newly graduated nurses and assist them to increase their competence. Competency assessments often consider multiple qualitative attributes and use expert knowledge as the basis for decision-making. This study proposes a hybrid multiple attribute decision-making (MADM) model that determines practical competency of the newly graduated nurse as an evaluation framework. A causal influence-network diagram (CIND) and influential weights are obtained from nursing experts' clinical experience using the decision-making trial and evaluation laboratory (DEMATEL)-based analytical network process analysis (DANP). The MOORA-AS method is then used to evaluate the ability expectation ratio-gap for newly graduated nurses in practice. The CIND is used to allow each newly graduated nurse to reduce the performance ratio-gaps between the current level and the aspirational level from a systematic perspective. The empirical data applies to a third-class and a first-class hospital in China. The results show that the proposed hybrid MADM model has reliable results and allows nursing department decision-makers/managers to easily evaluate and systematically improve competencies for newly graduated nurses.

Clinical commitment and competence: a qualitative study

Commitment, a component of clinical competence, includes accountability and responsibility for professional roles and tasks; and, it has a positive correlation with job satisfaction and performance. This study aimed to elaborate on the concept of commitment in the field of occupational therapy using qualitative content analysis. The data was collected through interviewing 13 occupational therapists both in a focus group interview (including four participants) and in one-to-one interviews (nine other participants). The collected data was analyzed based on the Grenheim method, and commitment concept was defined under three main themes: (i) commitment to patient (five subthemes), (ii) commitment to self (three subthemes), and (iii) commitment to profession (three subthemes). This study’s findings indicated that to acquire clinical competence, therapists should be committed to their patients, to themselves, and to their profession. Future research is needed to further examine how and to what extent these commitment themes affect clinical competence as well as the interaction among them.

Anaesthesia nursing competence: Self-assessment of nursing students

BACKGROUND

The importance of competence assessment in anaesthesia nursing education has increased since nurse educators and anaesthesia care employers have identified the gap between nursing education and nursing practice. In order to ensure nursing students' preparedness for entry into anaesthesia nursing practice, it is necessary to measure whether nursing students have achieved the required competence to practice as anaesthesia care providers.

OBJECTIVES

To assess the anaesthesia nursing competence of nursing students and to describe factors related to their anaesthesia nursing competence. This study will provide new knowledge to support the curricula of nursing education and new nurses' practice in anaesthesia care.

DESIGN

Cross-sectional survey design.

METHODS

Data from a sample of Finnish nursing students (n = 205) were collected by using an on-line/paper and pencil survey (the Anaesthesia Nursing Competence Scale, 7 categories) in 2017. The assessment was based on self-assessment and used a Visual Analogue Scale (0-100). Descriptive statistics, a Pearson correlation coefficient, independent sample t-tests and a multivariable regression were used to analyse the data.

RESULTS

The self-assessed overall competence of graduating nursing students was 59 (range 43-73). Approximately half of the students reached an acceptable level (60≤) and half did not. The highest self-assessed category was collaboration within patient care, and the lowest was knowledge of anaesthesia patient care. The number of credits, anaesthesia courses, and experience of clinical practice in anaesthesia nursing were significantly related to anaesthesia nursing competence.

CONCLUSIONS

Competence development in the knowledge of anaesthesia patient care should be considered in general nursing education. Student nurses' competence could be developed by providing more opportunities for theoretical studies and clinical practice in anaesthesia nursing. A specialised post-registration education in anaesthesia nursing might be one solution to overcome the limitations in the competence that general nursing education is not fully able to cover for anaesthesia nursing.

New graduate nurses' clinical competence: A mixed methods systematic review

AIM

To appraise and synthesize evidence of empirical studies reporting assessment of new graduate nurses' clinical competence in clinical settings.

DESIGN

Mixed methods systematic review.

DATA SOURCES

The search strategy included keywords relevant to: new graduate nurse; clinical competence; and competence assessment. The searched literature databases included CINAHL, MEDLINE, Embase, PsycINFO and Web of Science. The search was limited to full-text papers in English or French, published between 2010 -September 2019.

REVIEW METHODS

Inclusion criteria were: 1) empirical studies; 2) detailed method and complete results sections; 3) competence assessment in clinical settings; and 4) new graduate nurses (≤24 months). Two independent reviewers screened eligible papers, extracted data and used the Mixed Methods Appraisal Tool framework for quality appraisal. Divergences were solved through discussion.

RESULTS

About 42 papers were included in this review: quantitative (N = 31), qualitative (N = 7) and mixed methods (N = 4). Findings suggest that new graduate nurses exhibit a good or adequate level of competence. Longitudinal studies show a significant increase in competence from 0-6 months, but findings are inconsistent from 6-12 months.

CONCLUSION

There are a multitude of quantitative tools available to measure clinical competence. This suggests a need for a review of their rigor.

IMPACT

No recent reviews comprehensively synthesized the findings from new graduate nurses' clinical competence. This review has found that new graduate nurses' competence has been mostly assessed as good, despite the expectation that they should be more competent. Longitudinal studies did not always show a significant increase in competence. These findings can help nurse educators in providing more support to new graduate nurses throughout the transition period or design improved transition programme. This review also identified quantitative tools and qualitative methods that can be used for competence assessment.

Prehospital care nurses' self reported competence: A cross-sectional study

BACKGROUND

The Swedish ambulance service has undergone major changes in recent decades due to advancements being made in medical and technical resources, professional competence, and patient care. Registered and specialist nurses share the same role, accountabilities, and responsibilities in the ambulance service, and their professional competence has not yet been evaluated.

OBJECTIVES

The aim of the study was to investigate and compare self-reported professional competence among nurses working in the ambulance service and to explore associations between potentially predictive background factors and self-reported professional competence.

METHOD

A cross-sectional study with a digital questionnaire was used for collecting data from 34 registered nurses and 71 specialist nurses. The Ambulance Nurse Competence Scale and the Research Utilization Questionnaire were used for data collection.

RESULTS

Significant differences were found among the nursing categories in terms of age, gender, education, and work experience. Prehospital emergency nurses reported the highest professional competence. Nurses with a master's degree did not report significantly higher professional competence than nurses with a bachelor's degree.

CONCLUSIONS

The findings indicated that there are differences in the professional competence of registered nurses and specialist nurses. Length of work experience in the ambulance service is an important factor associated with higher professional competence.

Implementing a Transition-to-Practice Program for Novice Clinical Nurse Specialists: A Pilot Project

PURPOSE

The aim of this study was to determine the impact of a transition-to-practice program on job satisfaction among novice clinical nurse specialists (CNSs) in the US Air Force.

PROGRAM DESCRIPTION

A needs assessment was conducted among currently practicing Air Force CNSs (n = 30) to establish the necessity for a transition-to-practice program. Newly graduated CNSs (n = 8) were paired with experienced CNS mentors and met every 2 weeks for 2 months to discuss progress on the CNS core competencies. Before beginning the program, mentees self-reported perceptions related to the core competencies. Mentors focused on areas of self-reported low competency. The Nursing Context Index was administered preintervention and postintervention to assess the program's impact on job satisfaction.

OUTCOMES

Overall job satisfaction among novice CNSs improved from 5.01 to 5.57 (scale, 1-7) after completing the program. Personal satisfaction (4.30-5.63) and satisfaction with professional support (5.28-6.00) showed the greatest improvement out of the 4 elements of job satisfaction evaluated.

CONCLUSIONS

Transition-to-practice programs can be beneficial for novice CNSs in establishing their practice. Future studies with larger sample sizes over longer periods of time are necessary to determine the true impact of similar programs.

Developing and psychometric testing of the anaesthesia nursing competence scale

RATIONALE, AIMS, AND OBJECTIVES

The competence of nurses in anaesthesia care is important for the quality of anaesthesia nursing care and patient safety. However, there is a lack of psychometrically tested instruments to measure the competence. Therefore, this study aimed to develop and test the psychometric properties of an anaesthesia nursing competence scale (AnestComp) assessing nurses' competence in anaesthesia care.

METHOD

The scale development and psychometric testing had three phases: (1) based on literature reviews and the description of experts, competence areas were identified and items were created; (2) the content validity of the scale was tested by a content expert group, and the scale was pilot tested; and (3) psychometric testing of scale was tested by anaesthesia nurses' (n = 222) and nursing students' (n = 205) self-assessments. The psychometric testing assessed the reliability when using Cronbach's α and the construct validity using factor analyses (confirmatory and exploratory) and known-group technique. Nursing students were included for the purpose of construct validity testing.

RESULTS

The AnestComp has 39 items and consists of seven competence areas: (a) ethics of anaesthesia care, (b) patient's risk care, (c) patient engagement with technology, (d) collaboration within patient care, (e) anaesthesia patient care with medication, (f) peri-anaesthesia nursing intervention, and (g) knowledge of anaesthesia patient care. Cronbach's α values were high in all categories (0.83-0.95), and factor analyses and known-group technique supported a seven-factor model.

CONCLUSION

The initial results supported the reliability and construct validity of the AnestComp. The scale is considered a promising instrument for measuring anaesthesia nursing competence among anaesthesia nurses. Further research with larger and more diverse samples is suggested to refine the current psychometric evaluation.

Comparison of Nursing Performance Competencies and Practical Education Needs Based on Clinical Careers of Operating Room Nurses: A Cross-Sectional Study

In order to provide appropriate practical training for quality nursing care, it is necessary to evaluate nursing performance competencies in terms of clinical careers. Using convenience sampling, this cross-sectional study aimed to identify the nursing performance competencies and practical education needs of operating room nurses by evaluating nurses' clinical careers. The participants in this study were 182 nurses working in the operating rooms of four general hospitals in Seoul, Korea. Data came from self-report questionnaires regarding nursing performance competencies and practical education needs. The results showed that participants' nursing performance competencies and practical education needs differed significantly across clinical career groups. Further, participants' nursing performance competencies were negatively correlated with practical education needs in terms of clinical career. In order to develop an effective and continuous practical education program for operating nurses, various education programs that reflect nursing performance competencies and practical education needs for particular stages of clinical careers are necessary.

The Nature of Nursing Competency in Simulation of Adult Medical-Surgical Nursing: Exploratory Factor Analysis

BACKGROUND AND PURPOSE

Educators, employers, and regulatory agencies face substantive challenges in evaluating nursing competency. Evidence on what competency is and how to measure it can mitigate the challenges.

METHODS

Participants (N = 67) completed three high-fidelity simulation tests. Each video-recorded test was scored by three raters using a 41-item instrument. Exploratory factor analysis was used to define the latent structure of the instrument.

RESULTS

A five-factor solution accounted for 56% of the variance, minimized negative loadings, and minimized the number of cross-loadings. The factors were minimally correlated (each r < .30).

CONCLUSIONS

The factors, Vigilant Action, Role Nuances, Precision, Procedural Skills, and Risk Reduction, represent integrated dimensions of competency that can be linked to specific tasks underlying safe practice.

Factors contributing to undergraduate nursing students' satisfaction with a video assessment of clinical skills

BACKGROUND

Clinical skill assessment via Objective Structured Clinical Assessment (OSCA) has many challenges for undergraduate nursing students. These include high levels of anxiety that can compromise performance during the assessment, inconsistency with assessor reliability and is inconsistent with clinical skills performance in the real world. The implementation of a Video Assessment of Clinical Skills (VACS) that integrates formative feedback may be a way to address the challenges posed by OSCA assessment.

OBJECTIVES

The aim of this study was to examine the acceptability, utility, and nursing student satisfaction with a formative feedback strategy - the Video Assessment of a Clinical Skill (VACS).

DESIGN

A cross sectional survey.

SETTINGS

Undergraduate Bachelor of Nursing degree students from a large Australian University.

PARTICIPANTS

Third year undergraduate nursing students (final year) enrolled in a Bachelor of Nursing Program.

METHODS

Participants were recruited via purposive sampling. A pre-survey (prior to VACs assessment) and post-survey (after VACS assessment) were completed. This paper reports on the open-ended responses in the post-survey that explored students' insights and perceptions into formative feedback and its impact on their learning for the VACS assessment.

RESULTS

A total of 731 open-ended responses were analysed with findings being organised into 3 major themes; (i) Flexibility and reflexivity, (ii) Editing and repeated attempts, and (iii) Working together.

CONCLUSIONS

Video Assessment of a Clinical Skill has demonstrated good utility, acceptability, and satisfaction among undergraduate nursing students.

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.].

Development of an easy-to-use questionnaire assessing critical care nursing competence in Japan: A cross-sectional study

BACKGROUND

Critical care nurses need a high level of medical competence, especially with regard to patient safety. There are several tools to measure general and critical care nursing competence, but the usability of these tools is inadequate because they include large numbers of questions. To maintain quality and safety in intensive care units (ICUs), it is necessary to be able to easily measure and evaluate critical care nursing competence. The purpose of this study was to develop an easy-to-use questionnaire assessing critical care nursing competence related to patient safety.

METHODS

A cross-sectional, descriptive, explorative study was designed to collect data from nurses working in six ICUs in tertiary hospitals in Japan. Data were collected from August 2017 to December 2018. The Critical Care Nursing Competence Questionnaire for Patient Safety (C3Q-safety) is a 22-item instrument designed to assess nursing competence related to patient safety in ICUs. Items were developed based on previous work related to critical care nursing competence and were adjusted based on a pilot study.

RESULTS

A total of 211 nurses working in ICUs participated in this study. Through descriptive statistics and factor analysis, the number of questions was reduced from 24 to 22. The C3Q-safety had four factors: decision making, collaboration, nursing intervention, and principles of nursing care. Cronbach's alpha ranged from 0.73 to 0.83. The four factors showed positive correlations with each other (0.47 to 0.72). Nurses licensed as certified nurses in intensive care and those with longer ICU work experience showed significantly higher scores on all four factors.

CONCLUSIONS

We developed an easy-to-use questionnaire to assess critical care nursing competence related to patient safety. The C3Q-safety was able to detect four areas of competence. The C3Q-safety will make it possible to easily measure critical care nursing competence and can be utilized for efficient education.

Assessing student pharmacist communication skills: Development and implementation of a communication rubric

PROBLEM DESCRIPTION

Communication between healthcare providers and those they serve has become increasingly important as the need to prevent and manage chronic conditions has increased. To adequately learn these skills, future healthcare providers must be trained and assessed prior to entry into practice.

QUALITY IMPROVEMENT METHODS

With the implementation of an integrated curriculum, the Harrison School of Pharmacy developed a communication rubric to assess student pharmacists' patient communication skills. Developed over five stages, the communication rubric contained seven criteria with three standards or performance levels. Prior to finalizing the rubric, faculty tested the rubric with 56 standardized persons (SPs) to determine its readability, functionality, and grader consistency, and also collected student perceptions of the rubric for feedback purposes.

RESULTS OF CQI INQUIRY

At the conclusion of the 2017/18 academic year, 66.5% of second- and third-professional year students (P2s and P3s) somewhat agreed to strongly agreed that reviewing the rubric helped improve their overall patient communication; 65% of students felt that feedback was more substantial than the previous checklist. Of the P3s surveyed, 73% indicated that they preferred the new rubric.

INTERPRETATION AND DISCUSSION

The integration of the new communication rubric allowed for richer, and more meaningful feedback. The addition of multiple performance levels allowed students to focus on specific areas for improvement.

CONCLUSIONS

The communication rubric was successfully integrated into the curriculum, particularly with objective structured clinical examinations. With its integration into other curriculum areas, the communication skills of student pharmacists may be further enhanced.

The State of the Science on Clinical Evaluation in Nursing Education

AIM

The purpose was to synthesize the published evidence to present the state of the science in clinical evaluation research in nursing education.

BACKGROUND

Clinical evaluation is key to ensuring nursing students' clinical competence, application of knowledge, and critical thinking, all of which are important to patient safety and quality nursing care.

METHOD

Cooper's research synthesis method was used.

RESULTS

A comprehensive literature search resulted in 250 documents, of which 88 met study criteria. Topics were exhaustive but not mutually exclusive and included competence, instrumentation, congruence, teaching methods, objective structured clinical evaluation, faculty/preceptor issues with clinical evaluation, essential clinical behaviors, topic-based evaluation, decision-making about clinical grade, and clinical reasoning.

CONCLUSION

Nursing education science is in its infancy in many areas. Two areas most in need of future research are the need to accurately define and efficiently measure competence in the clinical area and the need for reliable and valid instrumentation.

Development of a nursing-specific Mini-CEX and evaluation of the core competencies of new nurses in postgraduate year training programs in Taiwan

BACKGROUND

Modern nursing requires a broad set of academic and practical skills, and an effective nurse must integrate these skills in a wide range of healthcare contexts. Cultivation of core competencies has recently become a key issue globally in the development of nursing education. To assess the performance of new nurses, this study developed a nursing-specific Mini-Clinical Evaluation Exercise (Mini-CEX) to evaluate the effect of postgraduate year (PGY) nurse training programs in Taiwan.

METHODS

A nursing-specific Mini-CEX was developed based on the required core competencies of nurses. Reliability and validity were confirmed in evaluator workshops carried out prior to the administration of the pilot test and final test. Thirty-two PYG trainees were recruited with a supervisor-to-trainee ratio of 1:1.94. Data were collected from February to June 2012 and analyzed using the Kruskal-Wallis test.

RESULTS

The 32 PGY trainees scored highest in the "nursing professionalism" dimension and the lowest in the "physical examination" dimension. The overall competency score was satisfactory. The trainee nurses with 19-24 months of experience scored higher than the other two groups in overall performance.

CONCLUSION

The results of this research indicate the feasibility of using our Mini-CEX tool to evaluate the competencies of PGY trainees.

Exemplary Learning Environments for the Health Professions: A Vision

In this article, the authors propose a vision for exemplary learning environments in which everyone involved in health professions education and health care collaborates toward optimal health for individuals, populations, and communities. Learning environments in the health professions can be conceptualized as complex adaptive systems, defined as a collection of individual agents whose actions are interconnected and follow a set of shared "simple rules." Using principles from complex adaptive systems as a guiding framework for the proposed vision, the authors postulate that exemplary learning environments will follow four such simple rules: Health care and health professions education share a goal of improving health for individuals, populations, and communities; in exemplary learning environments, learning is work and work is learning; exemplary learning environments recognize that collaboration with integration of diverse perspectives is essential for success; and the organizations and agents in the learning environments learn about themselves and the greater system they are part of in order to achieve continuous improvement and innovation. For each of the simple rules, the authors describe the details of the vision and how the current state diverges from this vision. They provide actionable ideas about how to reach the vision using specific examples from the literature. In addition, they identify potential targets for assessment to monitor the success of learning environments, including outcome measures at the individual, team, institutional, and societal levels. Such measurements can ensure optimal alignment between health professions education and health care and inform ongoing improvement of learning environments.

A digital resource to assess clinical competency

BACKGROUND

Objective structured clinical examinations (OSCEs) are integral to clinical competency-based assessment in health care disciplines. Traditional paper-based OSCEs require considerable administration time and students typically receive an assessment outcome with minimal feedback. We developed and implemented an iPad-based OSCE assessment system in optometry that delivered timely and specific e-feedback.

METHODS

The electronic assessment system contains all of the features of a paper-based OSCE format, including a checklist score, a global score section and pre-written feedback. It was trialed in a year-3 OSCE assessment. We evaluated students and examiners' perceptions of this digital resource via surveys and focus group interviews.

RESULTS

Over 90% of the students reported that the e-feedback was timely, facilitated self-reflection and was appropriate for assessment. Students' focus group interviews highlighted the importance of the timeliness of feedback, and students found both verbal and written feedback useful. All examiners were satisfied with the features of the assessment system and felt confident using it for assessment.

DISCUSSION

The iPad-based OSCE assessment system has enabled timely feedback to be delivered efficiently. This study has provided a model of what constitutes good e-feedback. The technology was well received by both students and examiners. It has helped to close the assessment loop by delivering usable and developmental feedback to meet students' learning needs.

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.

Exploratory Analysis of Entrustable Professional Activities as a Performance Measure During Early Pharmacy Practice Experiences

Objective. To examine entrustable professional activities (EPAs) as an assessment tool for student pharmacists completing early practice experiences. Methods. Students completed a 2-month practice experience upon conclusion of their first year. Student performance on EPAs was assessed by preceptors and students at the midpoint and conclusion of the experience using a scale that ranged from dependent (1.0) to independent (5.0). Wilcoxon Signed-Rank Test assessed for differences between the midpoint and final evaluations on student self-evaluations and between the midpoint and final evaluation on preceptor-student evaluations. Cronbach's α assessed reliability of the EPAs. Results. From May to August 2016, 147 students completed a practice experience. Student-self and preceptor-student evaluations at the midpoint and final approximated a median score of 3.0 (IQR 2) and 4.0 (IQR 3), respectively, on EPAs 1-14. Analyses revealed statistically significant increases from midpoint to final evaluation for all constructs on both evaluations. Cronbach's α yielded scores of 0.98 for the preceptor evaluations and 0.95 for the student self-evaluation. Conclusion. There was an increase in student performance over time. The EPA statements may be a reliable assessment tool for student performance in pharmacy education.

Widening Access; Developing an eLearning Resource for Health and Social Care Professionals Caring for Children and Young People with Cancer

Cancer is a key priority worldwide, and caring for children and young people with cancer requires a range of specific knowledge, skills and experience in order to deliver the complex care regimes both within the hospital or community environment. The aim of this paper is to disseminate work undertaken to design and develop pedagogical practice and innovation through an eLearning resource for health care professionals caring for children and young people with cancer across the globe. The work undertaken evaluated an existing cancer course (which has been withdrawn) that was developed and delivered through the Paediatric Oncology Nurses Forum, Royal College Nursing (Nurse Educators) and Warwick University. The evaluation consisted of 26 open and closed questions relating to the previous resource and was circulated to all health and social care professionals involved directly within specialist oncology services through the Children's Cancer and Leukaemia Group. Questionnaires were sent out to a convenience sample of 773 health care professionals and the response rate was 14%. The findings identified that the course was predominantly accessed by nurses, but other health care professionals also found it useful. Participants highlighted several areas where they believed content could be developed or was lacking. This included areas such as palliative and end of life care, nutrition, sepsis and teenagers and young people. This feedback was then used to develop a site dedicated to the care of children and young people with cancer.