Nurses for the future

Conceptualizing and determining core clinical competencies in nursing students: a qualitative study

AIM

This study aimed to conceptualize and explain the core clinical competencies of nursing students in Iran.

BACKGROUND/INTRODUCTION

Despite the national and international efforts to modify nursing curricula such that the students' clinical competencies are improved, there is still a widespread concern about this issue, perhaps due to the impact of factors other than the curriculum itself, such as the lack of a clear definition for the concept of clinical competency and its main components in nursing students.

METHODS

This qualitative study was conducted using conventional content analysis. The participants were selected through purposive sampling and included 14 senior students of bachelor of nursing, four nurses working in teaching hospitals and six clinical instructors. Individual semi-structured interviews were used for data collection. After recording and transcribing the interviews, content analysis was used to extract the concepts.

FINDINGS

The main theme of the study was 'multidimensionality of the concept of clinical competency,' which had six main categories, namely 'adoption of and adaptation with the nursing practice,' 'nursing knowledge,' 'self-direction in clinical learning,' 'patient care skills,' 'professional ethics' and 'the development of professional behaviours.'

DISCUSSION/CONCLUSION

Clinical competency and its dimensions among students comprise a multidimensional concept. Having a clear and comprehensive understanding of this concept and focusing on its core axes may be the most important step in improving students' clinical competency.

IMPLICATIONS FOR NURSING, HEALTH AND EDUCATION POLICY

Policymakers and nursing education authorities can identify the problems existing in the students' clinical competency and provide them with practical solutions for a standard professional education through a clear understanding of the concept of clinical competency and its dimensions.

Quelle place pour des IDE en pratique avancée en soins critiques ?

Le métier d’IDE en pratique avancée (IPA) a été créé en France, et 12 universités ont été habilitées en 2018 à délivrer le diplôme d’État d’IPA, de niveau master 2. De nombreux arguments plaident en faveur de la formation d’IPA en soins critiques (IPASC) : les IDE représentent une force disponible de professionnels de santé dont les compétences peuvent être étendues par des formations appropriées, dans un environnement de complexité technique croissante ; il est nécessaire d’améliorer l’attractivité des IDE pour la réanimation; il existe un manque d’effectifs médicaux en réanimation et une difficulté à assurer une permanence des soins de qualité dans certains services ; enfin, les IPASC existent déjà dans de nombreux pays. Le rôle clinique spécifique pourra comporter des activités d’évaluation clinique, de réalisation de gestes techniques, de prescriptions thérapeutiques, de consultation en et hors réanimation. Le rôle d’encadrement pourra comporter la rédaction des procédures de prescriptions et de soins, la formation et l’encadrement technique des IDE, l’évaluation des pratiques professionnelles et la recherche. Enfin, les IPASC pourraient participer à la fiabilisation de la permanence des soins dans certains services. Le cadre d’activité de l’IPASC, mis en place, à la carte, selon un protocole d’organisation défini avec l’équipe du service, devra ainsi répondre aux objectifs fixés par la création de cette nouvelle profession : améliorer l’accès aux soins, promouvoir une plus grande qualité des soins, améliorer l’attractivité et les perspectives de carrière des IDE dans un cadre de maîtrise des coûts de santé.

Student nurses' perceptions of their educational environment at a school of nursing in Western Cape province, South Africa: A cross-sectional study

Background

Educational environments have been found to bear a substantial relationship with the academic performance and success, as well as the retention, of students.

Objectives

The study objectives were to (1) evaluate the educational environment as perceived by undergraduate nursing students at a school of nursing (SON) in Western Cape province and (2) investigate whether the educational environment, or components thereof, is perceived negatively or positively among undergraduate nursing students of different year level, gender, home language and ethnicity.

Method

A quantitative research method with a cross-sectional design was implemented. Data were collected from 232 undergraduate nursing students from a SON at a university in Western Cape province, South Africa. The subscales and the items of the educational environment questionnaire were compared among undergraduate nursing students. Data were analysed by means of the IBM Statistical Package for Social Sciences (IBM SPSS-24) using analysis of variances (ANOVAs), independent-sample t-tests, mean scores, standard deviations and percentages.

Results

The mean score attained for the entire participant group was 195 (standard deviation [SD] = 24.2) out of 268 (equivalent to 72.8% of maximum score), which indicated that the educational environment was perceived substantially more positively than negatively. The overall mean score was significantly higher (p < 0.05) for male students (M = 202; SD = 21) and for black students (M = 202; SD = 21). The digital resources (DR) subscale was the only subscale with a statement or item that was rated as absolute negative (M = 1.9; SD = 0.9).

Conclusion

The educational environment at the institution concerned was perceived as predominantly positive by its undergraduate nursing students. Although the educational environment was predominantly perceived as positive, the results of this study also indicated that enhancements are required to improve the physical classroom conditions, skills laboratories, DR and the implemented teaching and learning strategies. It is vital for university management to prioritise the creation of an educational environment which would ensure that quality learning takes place.

Keywords

student’s perceptions; educational environment; nursing education; Western Cape; South Africa.

Thirteen years and counting: Outcomes of a concurrent ASN/BSN enrollment program

In their 2011 report, The Future of Nursing, the Institute of Medicine called for 80% of the nursing workforce to be comprised of baccalaureate prepared Registered Nurses by the year 2020. One suggested approach to achieve this goal is the creation of programs that allow students to progress through associate and baccalaureate nursing preparation simultaneously. This paper describes the University of Central Florida's 13-year experience after implementing a Concurrent Enrollment Program. Development and structure of the program, advisement and curriculum details, facilitators and barriers are described. Data on National Council Licensure Examination for Registered Nurses pass rates, completion rates, comparison with traditional RN-BSN students, and progression to graduate school are also included. The Concurrent Program model described here between a specific university and state college partners, demonstrated positive outcomes that support achievement of the Institute of Medicine's goals.

A Comparison of Nursing Education and Workforce Planning Initiatives in the United States and England

Health care systems in England and the United States are under similar pressures to provide higher quality, more efficient care in the face of aging populations, increasing care complexity, and rising costs. In 2010 and 2011, major strategic reports were published in the two countries with recommendations for how to strengthen their respective nursing workforces to address these challenges. In England, it was the 2010 report of the Prime Minister's Commission on the Future of Nursing and Midwifery, Front Line Care: The Future of Nursing and Midwifery in England. In the United States, it was the Institute of Medicine's report The Future of Nursing: Leading Change, Advancing Health. The authors of both reports recommended shifting entry level nursing education to the baccalaureate degree and building capacity within their educational systems to prepare nurses as leaders, educators, and researchers. This article will explore how, with contrasting degrees of success, the nursing education systems in the United States and England have responded to these recommendations and examine how different regulatory and funding structures have hindered or enabled these efforts.

Professional care providers in dementia care in eight European countries; their training and involvement in early dementia stage and in home care

Knowledge concerning professionals involved in dementia care throughout its trajectory is sparse; the focus has mainly been on nursing-home care and less on home care, diagnosis and treatment of the disease and its complications despite the fact that home care is the most prominent type of care. The aim of this study was to explore and describe professional care providers involved in dementia care and their educational level applying the International Standard Classification of Education (ISCED) and further to investigate practice in the RightTimePlaceCare-countries with regard to screening, diagnostic procedures and treatment of dementia and home care. The findings demonstrate more similarities than differences in terms of type of professionals involved among the countries although untrained staff were more common in some countries. Findings also show that many types of professionals are involved, who to turn to may not be clear, for instance in terms of medical specialities and it may be unclear who bears the ultimate responsibility. The professionals involved in diagnosis, treatment and care are educated to bachelor’s level or above whilst everyday care is provided by people trained at a lower ISCED level or with no formal training. Registered nurses as well as occupational therapists have bachelor’s degrees in most countries, but not in Germany or Estonia. Professionals specifically trained in dementia care are not so common. Further research is needed to reveal not only who provides the diagnostics and treatment, but also how home care is organised and quality assured. Many different types of professionals serve as providers along the trajectory of the disease which may be difficult for the patient and the informal caregiver to cope with.

Integration of advanced practice providers into the Israeli healthcare system

Many countries around the world have integrated various types of Advanced Practice Providers (APPs) into their healthcare systems. The main motivating factors for recognizing and developing APPs worldwide include physician shortages and the need for improved access or delivery (US, France, Belgium, Scotland, Switzerland), reduced residency hours (US, UK), shortages in underserved regions (US, Canada, Finland, Australia), and cost containment (Germany, Netherlands, UK, US). Israel is experiencing a shortage of physicians in peripheral geographic regions and in critical medical specialties. Recent by-laws approved by the Knesset (Parliament), combined with Israel Ministry of Health (MOH) policies, have thus far been unable to fully address the shortages. To understand the potential contribution of APPs in Israel, we evaluated the international historical foundations and development of APP roles. We assessed how APPs have impacted healthcare in other countries by analyzing public data and published international research about APP education, safety, quality of care, motivators, barriers, and impact. We found that APPs are recognized in dozens of countries, and have similar scopes of practice, graduate level education requirements (in developed countries), and clinical training. At the same time, there is wide variability among countries in the actual function and independence of the advanced practice nurse (APN), particularly the nurse practitioner (NP). APPs have been established as cost effective, safe healthcare providers who improve healthcare access. Israel has begun to introduce APPs, specifically NPs, in a variety of fields, including geriatrics, palliative care and diabetic care. We recommend a rapid expansion of existing and new APP roles into the Israeli healthcare system based on evidence and the recommendations of international evaluations by non-government organizations. By shifting the education to a university setting, mirroring successful, evidence-based, and established APP models found internationally, Israel could lessen the projected Israeli physician shortage, improve healthcare access in specific areas, and bolster existing resources towards a larger and richer pool of healthcare providers in Israel.

The making of nursing practice law in Lebanon: a policy analysis case study

BACKGROUND

Evidence-informed decisions can strengthen health systems, improve health, and reduce health inequities. Despite the Beijing, Montreux, and Bamako calls for action, literature shows that research evidence is underemployed in policymaking, especially in the East Mediterranean region (EMR). Selecting the draft nursing practice law as a case study, this policy analysis exercise aims at generating in-depth insights on the public policymaking process, identifying the factors that influence policymaking and assessing to what extent evidence is used in this process.

METHODS

This study utilized a qualitative research design using a case study approach and was conducted in two phases: data collection and analysis, and validation. In the first phase, data was collected through key informant interviews that covered 17 stakeholders. In the second phase, a panel discussion was organized to validate the findings, identify any gaps, and gain insights and feedback of the panelists. Thematic analysis was conducted and guided by the Walt & Gilson's "Policy Triangle Framework" as themes were categorized into content, actors, process, and context.

RESULTS

Findings shed light on the complex nature of health policymaking and the unstructured approach of decision making. This study uncovered the barriers that hindered the progress of the draft nursing law and the main barriers against the use of evidence in policymaking. Findings also uncovered the risk involved in the use of international recommendations without the involvement of stakeholders and without accounting for contextual factors and implementation barriers. Findings were interpreted within the context of the Lebanese political environment and the power play between stakeholders, taking into account equity considerations.

CONCLUSIONS

This policy analysis exercise presents findings that are helpful for policymakers and all other stakeholders and can feed into revising the draft nursing law to reach an effective alternative that is feasible in Lebanon. Our findings are relevant in local and regional context as policymakers and other stakeholders can benefit from this experience when drafting laws and at the global context, as international organizations can consider this case study when developing global guidance and recommendations.

Shaping the future of nursing: developing an appraisal framework for public engagement with nursing policy reports

It is accepted that research should be systematically examined to judge its trustworthiness and value in a particular context. No such appraisal is required of reports published by organizations that have possibly even greater influence on policy that affects the public. This paper explores a philosophical framework for appraising reports. It gives the reasons why informed engagement is important, drawing on Popper's concept of the open society, and it suggests a method for appraisal. Gadamer's concept of the two horizons and Jauss's reception theory offer a methodological framework to enable the individual citizen, whether professional or lay, to engage in debate about policy that affects him or her. By way of a worked example, the framework is applied to two international reports on nursing. Conclusions suggest that nursing policy should be subjected to robust interrogatory appraisal by both profession and public for a democratic debate and creative discourse. Although this analysis is related to international nursing policy, it has a wider relevance and application beyond nursing.

Newly hired nurses' and physicians' perceptions of the comprehensive health care orientation process: a pilot study

AIM

To examine newly hired nurses' and physicians' perceptions of their orientation process in two Finnish hospitals, and to explore correlations between the background variables and the four aspects of a comprehensive orientation process.

BACKGROUND

Internationally, health care organisations are being challenged to recruit and retain a competent workforce. Although health care orientation programmes increase retention and provide safe and quality care, studies examining it are limited.

METHOD

A cross-sectional, descriptive questionnaire survey of registered nurses (n = 145) and physicians (n = 37) working in two specialised hospital settings was conducted in 2009-2010.

RESULT

Nurses' and physicians' perceptions regarding the orientation process ranged from low to moderate. The results showed that 'appointed preceptor', 'duration of orientation' and 'profession' correlated positively and significantly with a comprehensive orientation process.

CONCLUSION

The orientation process needs to be updated constantly and refined by evaluation data. In addition, incentives and effective support from the hospital organisation must be considered in order to perform the orientation process in a more comprehensive manner.

IMPLICATIONS FOR NURSING MANAGEMENT

The results indicate that investment is needed to improve the orientation process in health care. Health care managers are in a crucial position to support the orientation process in practice and value it as a retention strategy.

Using Medicare data to assess nurse practitioner-provided care

BACKGROUND

To mitigate shortages of primary care physicians and ensure access to health care services for a growing number of Medicare beneficiaries, some policy makers have recommended expanding the supply and roles of nurse practitioners (NPs). Little is known about the number of NPs billing Medicare or their practice patterns.

PURPOSE

This study examines the geographic distribution and county characteristics of NPs billing Medicare, compares the types and quantities of primary care services provided to Medicare beneficiaries by NPs and primary care physicians, and analyzes the characteristics of beneficiaries receiving primary care from each type of clinician.

METHODS

We performed a cross-sectional analysis of 2008 Medicare administrative data from 959,848 aged and/or disabled beneficiaries continuously enrolled in fee-for-service Medicare during the study period. Outcome measures included geographic distribution of NPs measured by the rate of NPs per 1,000 Medicare beneficiaries by state, average utilization, and patient characteristics.

DISCUSSION

States with the highest rate of NPs billing were rural. Over 80% of the payments received by both NPs and primary care physicians were for evaluation and management services. Beneficiaries assigned to an NP were more likely to be female, to be dually eligible for Medicare and Medicaid, and to have qualified for Medicare because of a disability. NPs with assigned beneficiaries were significantly more likely than similar primary care physicians to practice in federally designated primary care shortage areas.

CONCLUSIONS

Approximately 45,000 NPs were providing services to beneficiaries and billing under their own provider numbers in 2008. Aspects of NP practice patterns were different from primary care physicians, and NPs appeared more likely to provide services to disadvantaged Medicare beneficiaries.

Predictive validity of the Macleod Clark Professional Identity Scale for undergraduate nursing students

BACKGROUND

The self-identification of nursing students with the profession has been linked with a successful transition, from being a student to being a professional nurse. Although there is no empirical evidence, there are suggestions that students with high professional identity are more likely to persist and complete their studies in their chosen profession.

OBJECTIVES

The purpose of this study was to evaluate the psychometric properties of a professional identity scale and to determine the relationship between professional identity and student retention in a large group of first year nursing students.

DESIGN AND METHODS

A survey design was used to examine the professional identity of first year nursing students, as measured by the Macleod Clark Professional Identity Scale (MCPIS-9). Baseline data obtained from the initial surveys were then compared with student drop-out rates 12 months later.

RESULTS

Exploratory factor analysis of the MCPIS-9 yielded a one-component solution, accounting for 43.3% of the variance. All 9 items loaded highly on one component, ranging from 0.50 to 0.79. Cronbach's alpha coefficient of the MCPIS-9 was 0.83 and corrected item-total correlation values all scored well above the 0.3 cut-off. Students who: were females, had previous nursing-related vocational training, reported nursing as their first choice, or engaged in nursing-related paid work, had statistically significant higher professional identity scores. Using logistic regression analysis, students with high professional identity scores at baseline were more likely to be still enrolled in the nursing program at 12 months, controlling for gender, language spoken at home and engagement in nursing-related employment. These results support the psychometric properties of the MCPIS-9.

CONCLUSIONS

Professional identity has a direct relationship with student retention in the nursing program. It is important to adequately measure professional identity in nursing students for the purpose of monitoring and identifying students who are at risk of leaving nursing programs.

An increase in the number of nurses with baccalaureate degrees is linked to lower rates of postsurgery mortality

An Institute of Medicine report has called for registered nurses to achieve higher levels of education, but health care policy makers and others have limited evidence to support a substantial increase in the number of nurses with baccalaureate degrees. Using Pennsylvania nurse survey and patient discharge data from 1999 and 2006, we found that a ten-point increase in the percentage of nurses holding a baccalaureate degree in nursing within a hospital was associated with an average reduction of 2.12 deaths for every 1,000 patients--and for a subset of patients with complications, an average reduction of 7.47 deaths per 1,000 patients. We estimate that if all 134 hospitals in our study had increased the percentage of their nurses with baccalaureates by ten points during our study's time period, some 500 deaths among general, orthopedic, and vascular surgery patients might have been prevented. The findings provide support for efforts to increase the production and employment of baccalaureate nurses.

Primary care nurse practitioner clinical education: challenges and opportunities

The Institute of Medicine report and the passage of the Patient Protection and Affordable Care Act present significant opportunities for the nursing profession. As the largest group of primary care providers, nurse practitioners are the critical element in the provision of comprehensive primary care, and a critical element to the success of the redesigned health care system. Nurse practitioners can bridge the gap between coverage and access and provide the patient-centered innovative approaches needed. There are, however, significant barriers that need to be addressed. This article presents a framework for creating innovative approaches to the redesign of nurse practitioner clinical education.

Millennial health care: change you can believe in

A millennium is 1,000 years. In little over a decade after the beginning of the new millennium in 2000, remarkable changes have occurred in health-care education and health-care delivery. A new millennial generation of students, trainees, junior faculty, and young practicing physicians has come of age. The numbers of women in medicine have vastly increased. Technology has impacted education with an array of educational content-delivery techniques vastly different from the usual broadcast method of teaching. New curricula have expanded to encompass teamwork with interprofessional education of the entire team. Outcomes of educational efforts now include not only knowledge transfer but also performance improvement. Delivery of health care is also dramatically different. The sentinel driver of the quality and patient safety moment, To Err Is Human, was published only 12 years ago, yet fundamental changes in expectations and measurement for health-care quality and safety have occurred to alter the health-care landscape. Financing health care has become a prime issue in the current state of the US economy. New themes in health-care delivery include teamwork and highly functioning teams to improve patient safety, the dramatic increase in palliative care and end-of-life care, and the expanded role of nursing in health-care delivery. Each issue emanating since the beginning of the millennium does not have a right vs wrong implication. This discussion is an apolitical "environmental scan" with the purpose of illuminating these dramatic changes and then outlining the implications for health-care education and health-care delivery in the coming years.

Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments

CONTEXT

Better hospital nurse staffing, more educated nurses, and improved nurse work environments have been shown to be associated with lower hospital mortality. Little is known about whether and under what conditions each type of investment works better to improve outcomes.

OBJECTIVE

To determine the conditions under which the impact of hospital nurse staffing, nurse education, and work environment are associated with patient outcomes.

DESIGN, SETTING, AND PARTICIPANTS

Outcomes of 665 hospitals in 4 large states were studied through linked data from hospital discharge abstracts for 1,262,120 general, orthopedic, and vascular surgery patients, a random sample of 39,038 hospital staff nurses, and American Hospital Association data.

MAIN OUTCOME MEASURES

A 30-day inpatient mortality and failure-to-rescue.

RESULTS

The effect of decreasing workloads by 1 patient/nurse on deaths and failure-to-rescue is virtually nil in hospitals with poor work environments, but decreases the odds on both deaths and failures in hospitals with average environments by 4%, and in hospitals with the best environments by 9% and 10%, respectively. The effect of 10% more Bachelors of Science in Nursing Degree nurses decreases the odds on both outcomes in all hospitals, regardless of their work environment, by roughly 4%.

CONCLUSIONS

Although the positive effect of increasing percentages of Bachelors of Science in Nursing Degree nurses is consistent across all hospitals, lowering the patient-to-nurse ratios markedly improves patient outcomes in hospitals with good work environments, slightly improves them in hospitals with average environments, and has no effect in hospitals with poor environments.

Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments

CONTEXT

Better hospital nurse staffing, more educated nurses, and improved nurse work environments have been shown to be associated with lower hospital mortality. Little is known about whether and under what conditions each type of investment works better to improve outcomes.

OBJECTIVE

To determine the conditions under which the impact of hospital nurse staffing, nurse education, and work environment are associated with patient outcomes.

DESIGN, SETTING, AND PARTICIPANTS

Outcomes of 665 hospitals in 4 large states were studied through linked data from hospital discharge abstracts for 1,262,120 general, orthopedic, and vascular surgery patients, a random sample of 39,038 hospital staff nurses, and American Hospital Association data.

MAIN OUTCOME MEASURES

A 30-day inpatient mortality and failure-to-rescue.

RESULTS

The effect of decreasing workloads by 1 patient/nurse on deaths and failure-to-rescue is virtually nil in hospitals with poor work environments, but decreases the odds on both deaths and failures in hospitals with average environments by 4%, and in hospitals with the best environments by 9% and 10%, respectively. The effect of 10% more Bachelors of Science in Nursing Degree nurses decreases the odds on both outcomes in all hospitals, regardless of their work environment, by roughly 4%.

CONCLUSIONS

Although the positive effect of increasing percentages of Bachelors of Science in Nursing Degree nurses is consistent across all hospitals, lowering the patient-to-nurse ratios markedly improves patient outcomes in hospitals with good work environments, slightly improves them in hospitals with average environments, and has no effect in hospitals with poor environments.

Trends in nursing education

Many new nursing leaders assuming deanships, assistant deanships, or interim deanships have limited education, experience, or background to prepare them for the job. To assist new deans and those aspiring to be deans, the authors of this department, 2 deans, offer survival tips based on their experiences and insights. They address common issues, challenges, and opportunities that face academic executive teams, such as negotiating an executive contract, obtaining faculty lines, building effective work teams, managing difficult employees, and creating nimble organizational structure to respond to changing consumer, healthcare delivery, and community needs. The authors welcome counterpoint discussions with readers.

The Integration of Counseling and Nursing Services into Schools

The purpose of this comparative review was to examine the legislative evolution of school guidance and school nursing over the past century, in hopes of identifying reasons why guidance counselors have been more successful in compliance to recommended ratios than school nurses. A literature review was conducted including CINAHL, MEDLINE, ERIC and other EBSCO databases. The results from this review indicate school guidance programs have been included in more federal legislation, mandating funding, education and certification requirements, which gives counselors a uniformly recognizable credential understood by educators. An extensive effort to develop a national model of school guidance has assisted counselors to uniformly show how they impact student academic success. School nurses can learn how to further integrate the school nursing role into education from the example of guidance counselors.