Measurement of clinical performance of nurses: a literature review

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.

Patients' perspective of attending nursing consultations-A pilot and feasibility study

Aim

The aims were to explore: (a) how patients with advanced heart and lung failure accept the overall framework of the nursing consultations and (b) the patients' acceptability and applicability of the nursing consultations.

Design

Qualitative study.

Methods

Interviews were conducted in an holistic frame and analysed using Graneheim and Lundman's qualitative content thematic analysis. Patients were interviewed between April and May 2018 regarding their general view of the nursing consultation and their experience of the framework inspired by R. R. Parse.

Results

The overall theme was A confidential moment with the nurse to deal with and become more aware of what is important, based on following subthemes: "An option that makes sense," "Scheduled time with the nurse is important" and "To find a new normality in everyday life." The framework addressed a space of freedom requested by the informants, for whom attending nursing consultations was useful and meaningful, enabling them to reflect on everyday challenges.

Exploring the Perceptions of Core Values of Nursing in Taiwanese Nursing Students at the Baccalaureate Level

BACKGROUND

The core values of nursing are a standard component of the nursing curriculum in Taiwan. Therefore, these values provide an essential guide for educating and evaluating the learning outcomes of nursing students. Student perceptions of those core values that relate to the process of curricula learning are key to measuring the core values of nursing.

PURPOSE

This study explores the views on the core values of nursing of baccalaureate-level nursing students at a Taiwanese university.

METHODS

This qualitative study collected data from the reflection reports of 109 students and analyzed these data using thematic content analysis.

RESULTS

The results of this study identified that the learning of core values of nursing tends to utilize the latent curriculum rather than the open curriculum. Critical thinking was perceived and experienced by asking "why." General clinical skills and basic biomedical science were categorized collectively as care ability, which relates to the thinking, analysis, and mapping of client health problems. The value of communication and teamwork capability was defined as the sequential process of accepting, interacting, communicating, and collaborating. Caring was defined as contributing empathy with respect to one's self and to others. Ethics was defined as a moral perspective, as respecting others, and as prioritizing the needs of clients. Accountability was defined as a way of observing standards within the role given in a position. Finally, lifelong learning is a process of learning that encourages more aggressive learning.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The progress of core values of nursing in this study reflects positive movement and achievement. The participants expressed the perception that the core values of nursing enhance understanding, which enables nursing educators to reframe the nursing curriculum to meet their learning needs. The perceptions of nursing students of core values of nursing may be used as a guide to increase clinical nursing competence in healthcare.

Nurse Competence Scale: a systematic and psychometric review

AIM

The aim of this study was to report a systematic and psychometric review.

BACKGROUND

The Nurse Competence Scale is currently the most widely used generic instrument to measure Registered Nurses' competence in different phases of their careers. Based on a decade of research, this review provides a summary of the existing evidence.

DESIGN

A systematic literature review of research evidence and psychometric properties.

DATA SOURCES

Nine databases from 2004 - October 2015.

REVIEW METHODS

We retrieved scientific publications in English and Finnish. Two researchers performed data selection and appraised the methodological quality using the COnsensus-based Standards for the selection of health status Measurement INstruments checklist.

RESULTS

A total of 30 studies reported in 43 publications were included. These consisted of over 11,000 competence assessments. Twenty studies were from Europe and 10 from outside Europe. In addition to experienced nurses, the Nurse Competence Scale has been used for the competence assessment of newly graduated nurses and nursing students, mainly in hospital settings. Length of work experience, age, higher education, permanent employment and participation in educational programmes correlated positively with competence. Variables including empowerment, commitment, practice environment, quality of care and critical thinking were also associated with higher competence. The Nurse Competence Scale has demonstrated good content validity and appropriate internal consistency.

CONCLUSION

The value of Nurse Competence Scale has been confirmed in determining relationships between background variables and competence. The instrument has been widely used with experienced and newly graduated nurses and their managers. Cross-cultural validation must be continued using rigorous methods.

Competency assessment tools for registered nurses: an integrative review

BACKGROUND

The clinical nurse educator in practice settings assists registered nurses through education and works with nurse managers to evaluate the continuing competency of registered nurses. The availability of self reporting tools with acceptable psychometric properties may contribute to an understanding of staff expertise and continued competence to perform their required duties.

METHODS

An integrative review of the literature was conducted using keyword searches in CINAHL, ERIC, and PsyciNFO. The search for tools published in the past decade focused on self-assessment of continuing competence in practicing nurses.

RESULTS

Four research reports were found with multidimensional self-reporting tools designed for use with nurses in ongoing practice. Each tool specifies a unique set of dimensions of continuing competency (e.g., clinical care, leadership, interpersonal relationships) and has had its validity or reliability tested with practicing nurses.

CONCLUSION

The results of the review showed an improvement in the development and availability of tools.However, the tools are still lacking in dimension and further investment in this area of research is needed.

The use of skills inventories to assess and grade practice: Part 1--design and implementation

Employers increasingly require evidence of competent practice and cost-effective education that is fit for purpose. Historically, universities providing nurse education have been more concerned with the testing and grading of theory at undergraduate level which ultimately defines degree classification. This may be at the expense of recognising excellence in clinical practice which should be the ultimate goal of any nurse education programme. This paper reviews the development and introduction of an assessment tool to grade clinical competence in higher education level 6 post-registration critical care courses using a skills-based assessment strategy. The knowledge and practice components for each skill are defined within a standardised template. A number of skills pertinent to the area of practice and academic module are then collected in a skills inventory for assessment and grading which contribute to degree classification.

Nursing and competencies - a natural fit: the politics of skill /competency formation in nursing

The last two decades have seen a significant restructuring of work across Australia and other industrialised economies, a critical part of which has been the appearance of competency based education and assessment. The competency movement is about creating a more flexible and mobile labour force to increase productivity and it does so by redefining work as a set of transferable or 'soft' generic skills that is transportable and is the possession of the individual. This article sought to develop an analysis of competency based clinical assessment of nursing students across a bachelor of nursing degree course. This involved an examination of a total of 406 clinical assessment tools that covered the years 1992-2009 and the three years of a bachelor degree. Data analysis generated three analytical findings: the existence of a hierarchy of competencies that prioritises soft skills over intellectual and technical skills; the appearance of skills as personal qualities or individual attributes; and the absence of context in assessment. The article argues that the convergence in nursing of soft skills and the professionalisation project reform has seen the former give legitimacy to the enduring invisibility and devaluation of nursing work.

Developing and validating scenarios to compare midwives' knowledge and skills with the International Confederation of Midwives' essential competencies in four European countries

AIM

To develop, pilot and validate a number of scenarios which encompass all of the International Confederation of Midwives' (ICM) competency statements and which are of relevance in various European countries, both those in the European Union and those which might become members in the future.

DESIGN

27 Scenarios designed to encompass all ICM competencies were tested using qualitative interviews.

SETTING

Slovenia, Germany, Scotland, Kosovo.

PARTICIPANTS

68 Experienced midwives from Slovenia, 58 from Germany, 63 from Scotland and 76 from Kosovo.

FINDINGS

Although midwives found it difficult to relate to the scenarios dealing with pre-conception competencies, after revision, all scenarios were appropriate for use in all four countries.

KEY CONCLUSIONS

The scenarios embrace all of the ICM's essential competencies for midwives in each of the countries involved. Additionally, they have face validity as shown by the spread of responses to each of the scenarios.

IMPLICATIONS FOR PRACTICE

The scenarios may be used with confidence by experienced midwives in each of the areas involved. It is also possible that the scenarios can be used for education and assessment purposes. By considering the European perspective of the project, they also offer the potential to support the mobility of midwives moving between countries within Europe by assessing competence with regard to local practices in the new situation.

Involvement of inpatient mental health clients in the practical training and assessment of mental health nursing students: Can it benefit clients and students?

Even though the central position of the client has been recognized in psychiatric nursing education, the client is seldom formally involved in the feedback provided to students during practical training. This research paper focuses on three questions: (1) What conditions support the gathering of meaningful client feedback to enhance the student's learning process and client's wellbeing? (2) Does the use of the practical model for client feedback lead to positive experiences, and if so, under what conditions? (3) To what extent is a client's feedback on the student's work performance, consistent with feedback from the mentor (nurse from the ward), the teacher and the student? Based on a literature review, participatory observation and contacts with experts, a practical model was developed to elicit client feedback. Using this model in two psychiatric inpatient services, clients were actively and formally involved in providing feedback to four, final year psychiatric nursing students. Clients, nurses, teachers and students were interviewed and data were analysed using a qualitative explorative research approach. Analyses revealed that client feedback becomes meaningful in a safe environment created by the psychiatric nurse. Client feedback generates a learning effect for the student and supports the student's recognition of the value and vulnerability of the psychiatric client.

Self-assessment of nursing competencies--validation of the Finnish NCS instrument with Italian nurses

AIM

Research focusing on competence assessment of practicing nurses has recently increased. However, few generic instruments are available for this purpose. This study reports cultural validation of the Italian version of the Nurse Competence Scale (NCS, English version) by exploring nurses' perceptions of the use of the NCS instrument.

METHODS

Content validity of the Italian version of the NCS was assessed during the translation and back-translation process. Thereafter, cultural validity was further explored by conducting self-assessments and semi-structured interviews with 10 nurses, who practise medicine, cardiology and intensive care wards. First, the Italian version of the 73-item NCS was used to assess nurses' competence levels and the frequency of using competencies in practice settings. Second, semi-structured interviews were conducted to evaluate nurses' perceptions of the use of the instrument.

RESULTS

The advanced beginners obtained a high overall competence level and the experienced nurses a very high overall competence level. These results are similar with the earlier findings of nurse competence levels with the NCS. The overall frequency of using NCS competencies in clinical practice indicated good cultural validity of the instrument. The instrument was considered easy to understand and to complete, and the Italian version was considered to express the domain of nursing. However, a need to make semantic specifications for some items for the Italian version was pointed out.

CONCLUSIONS

This explorative pilot study reports a first phase cultural validation process. Carefully performed translation alone does not ensure validity of translated instrument. Interview method is recommended to deepen the understanding of concept in question and the content validity of the instrument. The results support previous research findings of the use of the NCS instrument and show that it could be very useful in competence assessment for Italian nurses.

The use of scoring rubrics to determine clinical performance in the operating suite

This research evolved out of the need to examine the validity and inter-rater reliability of a set of performance-based scoring rubrics designed to measure competencies within the operating suite.

METHOD

Both holistic and analytical rubrics were developed aligned to the ACORN Standard [Australian College of Operating Room Nurses Standard NR4, 2004. ACORN Competency Standards for Perioperative Nurses: Standard NR4: The Instrument Nurse in the Perioperative Environment. Australian College of Operating Room Nurses Ltd, Adelaide] and underpinned by the Dreyfus model (1981). Three video clips that captured varying performance of nurses performing as instrument nurses in the operating suite were recorded and used as prompts by expert raters, who judged the performance using the rubrics.

RESULTS

The study found that the holistic rubrics led to more consistent judgments than the analytical rubrics, yet the latter provided more diagnostic information for intervention purposes. Despite less consistency, the Analytical Observation Form had sufficient construct validity to satisfy the requirements of criterion referencing as determined by the Item Separation Index (Rasch, 1960), including high internal consistency and greater inter-rater reliability when average ratings were used.

CONCLUSION

The study was an empirical investigation of the use of concomitant Analytical and Holistic Rubrics to determine various levels of performance in the operating suite including inter-rater reliability. The methodology chosen was theoretically sound and sufficiently flexible to be used to develop other competencies within the operating suite.

Assessing undergraduate nursing students in clinical practice: do preceptors use assessment strategies?

Health care organisations such as the World Health Organisation (WHO) and An Bord Altranais (ABA, The Irish Nursing Registration Board) demand higher standards of new graduate nurses than heretofore. This is in conjunction with the implementation of degree programmes for undergraduate nurse education. These organisations stipulate that graduates must be well-educated, accountable, and can demonstrate the skills of a safe, caring and competent decision-making practitioner. The Bachelor of Science (BSc) four-year degree programme for undergraduate nurse education was introduced in Ireland in 2002, and is provided in universities and colleges of higher education throughout The Republic of Ireland. During the implementation process, each university and college of higher education developed a range of assessment strategies to clinically assess students. Preceptor nurses were subsequently assigned the responsibility of clinically assessing students, a remit previously undertaken by Clinical Ward/Unit Nurse Managers. Preceptors are qualified nurses, working in clinical units who are specially prepared to support BSc students during clinical placements. The purpose of this study was to explore to what extent preceptor nurses use the devised assessment strategies to clinically assess BSc students in one university in The Republic of Ireland. Data were collected by using a questionnaire distributed to all known preceptors in General, Psychiatric and Intellectual Disability nursing, during year four of the first cycle of the BSc programme. Findings from this descriptive study revealed that many preceptors were inexperienced, did not fully comprehend the assessment process and were not applying all of the recommended assessment strategies when assessing students in clinical practice. In light of these findings suggestions are made in the context of further research, management and education.

Performance assessment in health care providers: a critical review of evidence and current practice

AIM

To evaluate methods of performance assessment through an international literature review and a survey of current practice.

BACKGROUND

Over the past two decades health care organizations have focussed on promoting high quality care in conjunction with retaining motivated staff. Cognisant of such initiatives, we sought to evaluate assessment methods for qualified staff according to their utility in the working environment.

METHODS

A systematic literature search was completed and each paper independently reviewed. All health care organizations in Northern Ireland submitted details of their performance assessments. Each was critically appraised using a utility index.

RESULTS

Performance was not universally defined. A broad range of assessments were identified, each method had advantages and disadvantages. Although many lacked rigorous testing, areas of good practice were also noted.

CONCLUSIONS

No single method is appropriate for assessing clinical performance. Rather, this study endorses proposals for a multi-method strategy to ensure that performance assessment demonstrates all attributes required for effective nursing and midwifery practice.

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

The National Health Service Knowledge and Skills Framework has been introduced as part of the Agenda for Change Reforms in the United Kingdom to link pay and career progression to competency. The purpose of this paper is to consider the implications for nurses, their managers and the impact on university departments delivering continuing professional development for nurses. The new system has the potential to increase the human resources management aspect of the clinical nurse managers' role and could have legal implications, for example if practitioners perceive that their needs for continuing professional development have been overlooked to the detriment of their pay and career aspirations. The new system also has implications for providers of continuing professional development in the universities and is likely to demand closer liaison between education providers and trust staff who commission education and training. The Knowledge and Skills Framework is of interest to nurses and nurse educators internationally because the system, if effective, could be introduced elsewhere.

Nurse Competence Scale: development and psychometric testing

BACKGROUND

Self-assessment assists nurses to maintain and improve their practice by identifying their strengths and areas that may need to be further developed. Professional competence profiles encourage them to take an active part in the learning process of continuing education. Although competence recognition offers a way to motivate practising nurses to produce quality care, few measuring tools are available for this purpose.

AIM

This paper describes the development and testing of the Nurse Competence Scale, an instrument with which the level of nurse competence can be assessed in different hospital work environments.

METHODS

The categories of the Nurse Competence Scale were derived from Benner's From Novice to Expert competency framework. A seven-step approach, including literature review and six expert groups, was used to identify and validate the indicators of nurse competence. After a pilot test, psychometric testing of the Nurse Competence Scale (content, construct and concurrent validity, and internal consistency) was undertaken with 498 nurses. The 73-item scale consists of seven categories, with responses on a visual analogy scale format. The frequency of using competencies was additionally tested with a four-point scale.

RESULTS

Self-assessed overall scores indicated a high level of competence across categories. The Nurse Competence Scale data were normally distributed. The higher the frequency of using competencies, the higher was the self-assessed level of competence. Age and length of work experience had a positive but not very strong correlation with level of competence. According to the item analysis, the categories of the Nurse Competence Scale showed good internal consistency.

CONCLUSION

The results provide strong evidence of the reliability and validity of the Nurse Competence Scale.