The relationship between the levels of nurses' competence and the length of their clinical experience: a tentative model for nursing competence development

Using the Analytic Hierarchy Process to Measure Nurses' Decision-Making Regarding Fall Risks and Care Strategies for Fall Prevention

Background and Purpose: Visualizing the thought processes of nurses is useful in forming evidence to prevent falls. This study aimed to quantify nursing judgment by comparing the choices made by nurses with different experiences regarding fall prevention. Methods: Questionnaires were administered to participants with <9 and ≥10 years of nursing experience to examine their importance ratings regarding fall prevention using an analytic hierarchy process (AHP). Results: Compared with the group with <9 years of experience, the group with ≥10 years of experience viewed habitual behavior in unstable activity as the most important fall risk. They also viewed early detection and alleviation of symptoms that lead to fall risk due to side effects of drugs and diseases as an important nursing practice. Conclusion: Since differences in nursing judgment between experienced and inexperienced nurses were revealed, it is possible that nursing judgment can be measured using AHP.

Level of clinical competency and associated factors of nursing students in Ethiopia: systematic review and meta-analysis

BACKGROUND

Assessing the clinical level of competency in nursing students is crucial as it represents the ultimate goal of nursing education. Poor competency result in low performance and can be affected by various factors. Thus, the aim of this study was to identify level of clinical competency and associated factors of nursing students in Ethiopia.

METHODS

systematic review and meta-analysis was employed. Searching strategy was conducted from January up to march 2024 from Web of Science, PubMed and Google Scholar. The quality of studies was assessed using PRISMA checklist. A meta-analysis was performed using R Studio with the meta package Version 1.4.1106.

RESULTS

in total, 145 studies were identified through database search, and only 7 studies were included in the meta-analysis representing 1937 nursing students. The pooled effect size of clinical competency of nursing students was 28%. Three factors were found to be associated with clinical competency: a positive clinical learning environment, student confidence in performing procedures, and effective staff-student interaction. The effect sizes of these factors were 6.30, 2.23, and 7.76, respectively.

CONCLUSION AND RECOMMENDATION

The clinical competency of nursing students was 28%, and it was associated with clinical learning environment, student confidence in performing procedures, and staff-student interaction. Nursing education programs should focus on enhancing students' competency levels by addressing specific factors. (PROSPERO) INTERNATIONAL PROSPECTIVE REGISTER OF SYSTEMATIC REVIEWS: CRD42022367057.

Assessment of nurse practitioners' capacity of using the ABC/2 formula for intracranial lesion volume measurement

BACKGROUND

This study investigates the precision of nurse practitioners (NPs) in measuring intracranial lesion volumes using the ABC/2 method, a simple yet widely used technique in neurosurgical practices. Amidst physician workforce shortages, the role of NPs in clinical practice, including specialized tasks like lesion volume estimation, is gaining importance.

METHODS

We conducted a retrospective study involving patients treated for intracranial meningiomas. NPs estimated tumor volumes using the ABC/2 method, which was then compared with automated ABC/2 estimations considered as the gold standard. Statistical analyses, including paired sample t-tests, Bland-Altman analysis, and Intraclass Correlation Coefficient (ICC) analysis, were employed to assess measurement accuracy and consistency.

RESULTS

Among the 265 meningioma patients included, NPs measured the average tumor volume as 36.95 ml, generally underestimating it compared to the 39.57 ml average obtained by the automated ABC/2 method. This underestimation, however, was clinically modest, indicated by an average percentage difference of 6.59% and a Cohen's d value of 0.08. Consistency in measurements, assessed using Bland-Altman and ICC analyses, demonstrated a high level of agreement between NPs measurements and the automated method. Additionally, no significant differences in measurement accuracy were observed either among different NPs or across NPs with varying levels of work experience.

CONCLUSIONS

Nurse practitioners can effectively employ the ABC/2 method for estimating intracranial lesion volumes with reasonable accuracy and consistency, irrespective of their work experience. This finding is pivotal in enhancing the role of NPs in neurosurgical practices and could be significant in alleviating the strain caused by the global shortage of physicians. Future research may explore extending NPs' roles in other clinical diagnostic and therapeutic tasks.

Assessing nurses' professional competency: a cross-sectional study in Palestine

BACKGROUND

Evaluating nurses' professional competence is critical for ensuring high-quality patient care. Therefore, this study aimed to evaluate the nurses' professional competence level and to identify differences based on demographics in three West Bank hospitals.

METHODS

A cross-sectional design was used, and a convenient sample of 206 nurses participated in the study. The Nurse Professional Competence (NPC) Scale was used to assess the competency level. The investigator distributed the questionnaire and explained the aim of the research. Consent forms were signed before the data collection.

RESULTS

The average competency level was 79% (SD = 11.5), with 90% being professionally competent nurses. The average "nursing care" competency was 79% (SD = 12.98), and the competency level in providing value-based care was 80% (SD = 13.35). The average competency level in technical and medical care was 78% (SD = 13.45), whereas 79% (SD = 12.85) was the average competence level in "Care Pedagogics" and "Documentation and Administration ". The average competence level in the development and leadership subscale was 78% (SD = 12.22). Nurses who attended three to five workshops had a higher level of Nursing Care Competency, (H = 11.98, p = 0.003), and were more competent in value-based care (H = 9.29, p = 0.01); in pedagogical care and patient education (H = 15.16, P = 0.001); and in providing medical and technical care (H = 12.37, p = 0.002). Nurses attending more than five workshops were more competent in documentation and administration (H = 12.55, p = 0.002), and in development and leadership subscale ( H = 7.96, p = 0.20).

CONCLUSION

The study revealed that participants lacked development and leadership skills. Engagement in workshops positively impacted the level of competencies among nurses. Notably, those attending more than five workshops exhibited greater competence in documentation, administration, development, and leadership in nursing care.

IMPLICATIONS

This study emphasized the role of continuing education in improving nurses' competencies and highlighted the need to conduct the study at a wider aspect to involve more hospitals with various affiliations to help structure more sensitive professional development and adopt the competencies as an integral part of staff development.

The barriers and facilitators to nursing care for patients with permanent colostomy in outpatient centers: A qualitative study

BACKGROUND

Ostomy care nurses are responsible for the management of patients with colostomy from the time of diagnosis. Currently, most ostomy care services are provided in outpatient ostomy care centers in order to reduce patients' hospital stay and reduce hospitalization-related costs. Many different factors can affect colostomy nursing care provision in these centers. Identification of these factors can facilitate quality care provision.

MATERIALS AND METHODS

This descriptive qualitative study was conducted in 2020-2021 to explore the barriers and facilitators to nursing care for patients with permanent colostomy in Tehran and Qom ostomy centers. Participants were twelve nurses with ostomy care licenses, two adult patients with permanent colostomy for at least two years, and one family caregiver of a patient with permanent colostomy purposefully selected from outpatient ostomy care centers in Iran.

RESULT

Data were collected via fifteen in-depth semi-structured interviews and were analyzed using Graneheim and Lundman's conventional content analysis. The barriers and facilitators to nursing care for patients with permanent colostomy in outpatient centers came into three main categories, namely specialized capabilities of colostomy care, care continuity, and caring status in the family.

CONCLUSION

These findings imply that not only nurses, but also patients, family caregivers, and referral systems can influence nursing care provision to permanent colostomy. Effective management of these factors can improve the quality of ostomy nursing care.

Factors affecting the development of clinical nurses' competency: A systematic review

AIM

To synthesize and analyze the literature on nursing clinical competence to assess the factors affecting nursing clinical competency.

BACKGROUND

Nursing competence affects not only patients but also nurses themselves. Competent nurses contribute to patient safety. Prioritizing clinical competency enables nurses to deliver high-quality care. Clinical nursing competency is influenced by various factors including education and training, experience, professional development, clinical judgment, decision-making skills and communication.

DESIGN

This was a systematic review.

METHODS

This study utilized an extensive literature search of online databases, including SCOPUS, Web of Science and PubMed. This review followed the guidelines provided by the Effective Practice and Organization of Care (EPOC) Cochrane Group and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

RESULTS

This systematic review provided 20 valuable articles, with a total of 6273 participants across the 20 studies, including 18 cross-sectional studies and two descriptive-correlational studies, predominantly using quantitative research methods. The analysis revealed several key factors that significantly affect nurses' clinical competency. These factors included years of experience, workplace environment, theoretical knowledge and educational level, marital status, clinical training, job satisfaction, turnover intention, job stress and critical thinking.

CONCLUSIONS

Understanding and addressing these factors are crucial for enhancing nurses' clinical competence and ultimately improving patient outcomes. Further research and interventions should be directed towards promoting supportive work environments, continuous education and the development of critical thinking skills among nurses to optimize their clinical competencies.

Knowledge and Attitude of Healthcare Providers on Managing Pre-Eclampsia and Eclampsia During Antenatal Care in Mwanza Region-Tanzania

Background

Pre-eclampsia and eclampsia are the second-leading causes of maternal death. Health care providers have a critical role in preventing and managing these conditions. Lack of knowledge among healthcare providers on managing pre-eclampsia and eclampsia has been reported in other parts of Tanzania, but more information is needed in other parts of the country so as to design appropriate targeted interventions. Hence, this study assessed the knowledge and attitude of healthcare providers on the management of pre-eclampsia and eclampsia in the Mwanza region of Tanzania.

Method

A facility-based analytical cross-sectional study was conducted from April to May 2022 among 157 health care providers in the Mwanza region. A simple random sampling method was used to select districts and dispensaries, while a census method was used to recruit health care providers. A self-administered questionnaire was used for data collection. A descriptive statistics analysis was used to determine the distribution of background information of healthcare providers. Inferential statistics were used to determine the association between variables by using a chi-square test and logistic regression. A statistically significant variable in the final model was declared with a 95% confidence interval and a p-value of 0.05.

Results

The study results showed that only 40 (25%) of healthcare providers had adequate knowledge and 56.69% had positive attitude towards the management of pre-eclampsia and eclampsia. Knowledge was predicted by having more years of working experience (1-5 years) (AOR: 0.12, 95% CI 0.03-0.53, p-value 0.005) and working in a health center (AOR: 4.58, 95% CI 1.14-18.36, p-value 0.023). For attitude, no variable was significantly associated with it.

Conclusion

The study showed that the majority of the participants had inadequate knowledge of the management of pre-eclampsia or eclampsia, despite the positive attitude they possessed. This implies that HCP may be struggling to identify the signs and symptoms of the condition in pregnant women, and this could lead to delays in diagnosis despite believing that it is important to early diagnose the condition. To address this issue, it's crucial to invest in continuing medical education and training programs for healthcare providers to update their knowledge.

What really matters for patient safety: Correlation of nurse competence with international patient safety goals

Background

Optimal level of nurse competence is imperative for patient safety and quality of care. A research gap exists in empirical evidence for associating nurses’ competencies with patient safety.

Purpose

The primary purpose of this study was to measure the association between general ward nurses' competencies with international patient safety goals.

Method

Correlational research design was adopted. Stratified random sampling was used to recruit (n  =  182) nurses working in two JCIA accredited and non-JCIA hospitals. Data were collected using the Competency Inventory for Registered Nurses and International Patient Safety Goals. The research was approved by the Institutional review board and ethics committee.

Findings

The regression analysis showed enhancement of patient safety with an improvement in nurse competencies R2  =  0.238. Nurse competencies showed a moderate positive association with an overall patient safety such as critical thinking and research aptitude (r  =  0.420, P – Value < 0.001), teaching coaching (r  =  0.469, P- Value <0.01), professional development (r  =  0.436, P – Value < 0.001), legal and ethical practices (r  =  0.434, P –Value < 0.001), interpersonal relationships (r  =  0.430, P –Value < 0.001), Leadership (r  =  0.400, P –Value < 0.001), and Clinical Care (r  =  0.541, P –Value < 0.001). Moreover, experience and professional education show positive association with both, patient safety and nurses’ competencies.

Conclusion

Nurses’ clinical competencies are crucial to enhance patient safety. Personal and professional attributes affect the competencies of nurses and patient safety. Hospital management should take mandatory steps to ensure improving nurses’ competencies for better patient safety.

Level of Social Competencies of Nurses in Primary Healthcare and their Selected Work Related Determinants - a cross-sectional study

AIM

The aim of our study was to assess the level of social competencies among primary healthcare nurses, and to identify the work-related determinants.

BACKGROUND

Developing social skills of nurses are necessary to establish better relations with patients. Improving these skills allows for higher quality of patient care, as well as patient and nurse satisfaction.

METHODS

For the study, 253 Primary Healthcare Centers were randomly chosen in the Eastern Poland. 600 questionnaires were sent to the nurses employed in these facilities. After checking whether the data met the requirements, 446 nurses took part in the survey. The data were collected using the Social Competencies Profile; the Copenhagen Psychosocial Questionnaire and the Catalog of primary healthcare nurse activities.

RESULTS

Older nurses possess lower level of social skills (r=-0.10, p=0.04). Postgraduate education in the last two years differentiated the results of social competencies (p=0.03) as well as place of residence in the subscale community awareness (p=0.04). The predictors of social skills among psychosocial work conditions were: Influence at Work (p=0.02), Possibilities for Development (p<0.001), Meaning of Work (p<0.001), Social Support (p=0.001), Quality of Leadership (p=0.03), Job Satisfaction (p<0.001) and General Health (p=0.001). On the other hand, tasks like: Activities in the treatment room (p=0.003) and Promotion and prevention (p<0.001) carried out by a nurse anticipated higher level of social skills.

CONCLUSIONS

The results of the research proved that work-related factors such as: influence at work, professional development, sense of social support, understanding of the meaning of work, perception of the quality of leadership and higher job satisfaction influence the development of social competencies of nurses, therefore, shaping an appropriate work environment is an important task, especially for leaders and managers of nursing.

IMPLICATIONS FOR NURSING MANAGEMENT

We recommend that nursing leaders and health policy makers adopt new strategies and educational programs which include social skills training as part of the curriculum for the development of the social competencies of nurses.

Validity and Reliability of the Korean Version of the Holistic Nursing Competence Scale

This methodological study aimed to verify the validity and reliability of the Korean version of the Holistic Nursing Competence Scale (HNCS), which comprises five dimensions and 36 items. The English version of the HNCS was forward and backward translated and administered to 251 participants with more than a year of work experience in a general hospital. Data were analyzed using SPSS WIN 24.0(Chicago, IL, USA), and AMOS program was used for confirmatory factor analysis. Additionally, the “Task Performance Evaluation Instrument for Clinical Nurses” was used for concurrent validity. Reliability assessed using Cronbach’s α was 0.969. Convergent, discriminant, and concurrent validity were good. Average variance extracted and construct reliability ranged from 0.845 to 0.932 and 0.980 to 0.987, respectively. The model was suitable with the chi-square value being 1216.563 (df = 584, p < 0.001), and Q value being less than three. Goodness-of-fit index, root mean square residual, and root mean square error of approximation were 0.784, 0.066, and 0.066, respectively. Moreover, comparative fit index, Tucker−Lewis index, and incremental fit index were 0.913, 0.906, and 0.913, respectively. Thus, this study verified the validity and reliability of the Korean version of the HNCS. Our findings suggest that the scale is helpful in measuring and developing the holistic nursing competence of clinical nurses.

Confidence, skills and barriers to ostomy patient care by nursing staff in Saudi Arabia

Aim

This study examined the confidence level and perceived barriers to providing ostomy care among staff nurses in Saudi Arabia.

Background

Patients with ostomies experience increased comfort and satisfaction when nurses are confident in their knowledge and skills.

Design

A descriptive, cross‐sectional design was used to conduct the research. The study included a convenience sample of 214 staff nurses from five hospitals in Riyadh, Saudi Arabia. The researchers used a survey questionnaire to gauge participants’ confidence in their knowledge and skills, as well as identify any perceived barriers to ostomy care.

Result

Overall, 95.1% of participants worked in adult care and 82.2% worked in surgical areas. There were significant relationships between the nurses’ confidence in their ostomy care knowledge and skills and their years of nursing experience and having received ostomy care training in nursing school (p < .05); however, the nurses’ level of education had no correlation (p > .05).

Conclusion

While the majority of nurses were confident in their ability to care for patients with ostomies, they were concerned about causing stoma problems. This suggests that improving the quality of ostomy care provided by nurses may result in fewer negative outcomes for patients with ostomies.

Senior first, junior second

The seniority system exists in most companies, including in healthcare industries. Seniority often plays an essential role in the organizational success and career advance of employees. However, there are pros and cons in the application of the seniority system in all organizations, especially in the healthcare industry. This article prompts a discussion about seniority in nursing and provides some particular concerns and recommendations for consideration, and this begs the question, should senior be first and junior second?

Nurses' competency in Saudi Arabian healthcare context: A cross-sectional correlational study

AIM

To measure the competence and characteristics of nurses in Saudi Arabia delivering health care with significant correlations.

DESIGN

A cross-sectional correlational study.

METHODS

Data were collected in 2019 using a standardized questionnaire, Competency Inventory for Registered Nurses (CIRN), that included a purposive sample of 621 nurses working in Saudi Arabia.

RESULTS

A positive evaluation of nurses' overall core competency components is recognizably measured with greater competency levels in their workplace, scoring highest in "legal/ethical practice" while "critical thinking and research aptitude" represented the lowest dimension. Nurses' marital status, years of graduation, length of service, duty hours and nurse-patient ratio affect their competency level. Nurses' competence and their sociodemographic characteristics are significantly correlated attributes. Medical ward nurses are likely to have the greatest competence in delivering safe nursing care within training's legal borders.

Nurses' perception regarding patient safety climate and quality of health care in general hospitals in Japan

AIM

To clarify perceptions of nurses towards patient safety climate and quality of health care in Japan.

BACKGROUND

Nurses' perceptions of patient safety climate and quality of health care services are not well-known.

METHOD

The survey was conducted at general hospitals with 200 beds or more using the Patient Safety Climate Scale and the Modified multiple-item scale for consumer perceptions of health care service quality.

RESULTS

Significant positive correlations were found among nurses' perception towards patient safety and health care service quality. The experience of nurses as members of the committee on patient safety and their employment position did not show any significant difference in the perception towards patient safety and health care services quality. Perceptions of health care service quality were lower among those with 6- to 10-year experience than with over 21 years.

CONCLUSION

In the perception of nurses and nurse managers' continuous improvement, perceptions towards patient safety were related to reliability, assurance, responsiveness and empathy in health care service quality.

IMPLICATIONS FOR NURSING MANAGEMENT

Generalist nurses with 21 years or more experiences in multiple departments showed high perception towards health care service quality. Experienced nurses' perceptions of activities to improve patient safety and quality of health care services are important.

Comparison of midwives' self-perceived essential competencies between low and high maternal mortality ratio provinces in China

AIMS AND OBJECTIVES

To present and compare midwives' self-perceived essential competencies in regions with different maternal mortality ratios, and explore possible competency-related factors.

BACKGROUND

In China, there is an urgent need for high-quality maternal health care with equal access, as the regional disparity in the maternal mortality ratio remains a big challenge. Midwives' essential competencies refer to the minimum knowledge, skills, and professional behaviours required by midwives, and directly affect the quality of maternal care they provide. However, there is very limited literature evaluating Chinese midwives' essential competencies, especially for midwives working in regions with high maternal mortality ratios.

DESIGN

A cross-sectional survey design.

METHODS

The national cross-sectional study using an online questionnaire was conducted with a convenience sample of 2,022 midwives working in regions with different maternal mortality ratios. The STROBE guideline for cross-sectional studies was used in this study.

RESULTS

Midwives rated themselves higher on their essential competencies in intrapartum care and lower on their essential competencies in assisting or performing the operative vaginal delivery. Specifically, when compared to those from regions of low maternal mortality ratios, midwives from regions with high maternal mortality ratios reported comparatively poor self-perceived essential competencies, especially in the area of detecting and treating pregnancy and childbirth-related complications. The factors influencing midwives' self-perceived essential competencies included majors, education levels, years of experience as a midwife, participation in teaching, and access to in-service training.

CONCLUSION

In regions with high maternal mortality ratios, improving midwives' essential competencies is a key priority. Furthermore, it is recommended that midwifery education could be conducted in universities, and relevant regulations could be developed to enable midwives to provide a wider scope of care, thereby promoting the development of the midwifery workforce in China.

RELEVANCE TO CLINICAL PRACTICE

Understanding self-perceived essential competencies of Chinese midwives working in regions with different maternal mortality ratios could guide the midwifery workforce, management, especially midwives' capability building.

Self-assessed competence and need for further training among registered nurses in somatic hospital wards in Sweden: a cross-sectional survey

BACKGROUND

Professional competence and continuous professional development is essential for ensuring high quality and safe nursing care, and it might be important for motivating nurses to stay in the profession. Thus, there is a need to identify the developmental process of nursing competency. Assessment of competence and need for further training helps to identify areas for quality improvement, and to design interventions in order to facilitate continuous competence development in different work contexts. The current study aimed to 1) describe registered nurses' self-assessment of clinical competence as well as the need for further training, and 2) explore possible differences between registered nurses with varying lengths of professional experience as a nurse (≤ 0,5 year, > 0,5-5 years, and ≥ 6 years).

METHODS

A cross-sectional survey design was applied, using the Professional Nurse Self-Assessment Scale of clinical core competencies II. Registered nurses (n = 266) working in medical and surgical contexts in hospitals in Sweden responded (response rate 51%). Independent student t-test and analysis of variance were carried out.

RESULTS

Registered nurses assessed their competence highest in statements related to cooperation with other health professionals; taking full responsibility for own activities; and acting ethically when caring for patients. They assessed their need for further training most for statements related to assessing patients' health needs by telephone; giving health promotion advice and recommendations to patients by telephone; as well as improving a creative learning environment for staff at the workplace. For self-assessed competence and need for further training, differences between the groups for 35 and 46 items respectively, out of 50 were statistically significant.

CONCLUSIONS

Although the registered nurses assessed their competence high for important competence components expected of professionals such as cooperation with other healthcare professionals, it is problematic that knowledge of interactions and side-effects of different types of medication were reported as having the highest need of training. Longitudinal follow up of newly graduated nurses regarding their continuous development of competence as well as further training is needed.

Measurement properties of scales assessing new graduate nurses' clinical competence: A systematic review of psychometric properties

BACKGROUND

New graduate nurses' competence is a concern for all healthcare organizations. Previous reports show heterogeneous levels of competency amongst them. As a positive association between competency and quality of care in clinical settings has been suggested, it is essential for researchers and clinicians to select valid, reliable, and responsive scales to assess new nurses' competence. However, a systematic evaluation of the measurement properties of scales measuring new nurses' competence had yet to be published.

OBJECTIVE

To analyse, evaluate and synthesize the measurement properties of scales used to assess new nurses' clinical competence.

DESIGN

A systematic psychometric review based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methods.

DATA SOURCES

The search strategy included a combination of keywords and thesaurus terms related to new graduate nurses, clinical competence, and competence assessment. Five databases were searched: Embase, CINAHL, MEDLINE, PsycINFO and Web of Science. The search was limited to full-text papers published in English or French, from 2010 to 2019.

REVIEW METHODS

Two independent reviewers screened eligible papers, extracted data related to validity, reliability, and responsiveness of each scale, and evaluated the quality of their measurement properties as well as risk of bias in their psychometric evaluation. Divergences were solved through discussion.

RESULTS

Ten scales were included: eight original scales, one culturally adapted and one modified. Of these scales, eight were developed or adapted in the 2010s decade and the other two scales were developed earlier. Most scales are divided into 6 to 8 subscales and use an adjectival scale with either 4, 5 or 7 points. The content validity study of all scales in this review was deemed to be doubtful or inadequate quality. Reliability was almost exclusively assessed by calculating the internal consistency with Cronbach's alpha coefficient which gives no information on equivalence or stability of the measure. Responsiveness was never properly assessed in the reviewed studies.

CONCLUSIONS

There is little evidence on the measurement properties for each scale regarding their validity and reliability; responsiveness was not assessed for any scale. Every scale evaluated in this review had different characteristics (length, subscales, response options). Therefore, selection of the most appropriate scale depends on the context and purpose of the assessment. Prospero registration number: CRD42018109711 Tweetable Abstract: Systematic review of scales measuring new nurses' competence: we must do better and conduct more validity/reliability testing of existing scales.

"I train and mentor, they take them": A qualitative study of nurses' perspectives of neonatal nursing expertise and its development in Kenyan hospitals

Aims and Objectives

Neonatal inpatient care is reliant on experienced nursing care, yet little is known about how Kenyan hospitals foster the development of newborn nursing experience in newborn units.

Design

A Qualitative ethnographic design.

Methods

Face to face 29 in depth interviews were conducted with nurses providing neonatal care in one private, one faith based and one public hospital in Nairobi, Kenya between January 2017 and March 2018. All data were transcribed verbatim, coded in the original language and analysed using a framework approach.

Results

Across the sectors, nurses perceived experience as important to the provision of quality care. They noted that hospitals could foster experience through recruitment, orientation, continuous learning and retention. However, while the private hospital facilitated experience building the public and faith-based hospitals experienced challenges due to human resource management practices and nursing shortages.

Conclusion

Health sector context influenced how experience was developed among nurses.

Implications

Nurturing experience will require that different health sectors adopt better recruitment for people interested in NBU work, better orientation and fewer rotations even without specialist nurse training.

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.

Using tabletop exercises to evaluate nurses' clinical performance of hazardous materials disaster management: A cross-sectional study

BACKGROUND

Hazardous materials (Hazmat) disaster is a specific event with low probability but may be a heavy burden on public health. Competence in Hazmat disaster emergency management is necessary for nurses who care about mass casualties in the first line, especially for nurses in military hospitals. However, less attention has been paid to evaluation of competence of Hazmat disaster emergency responses using tabletop exercises.

OBJECTIVE

To identify competence in Hazmat disaster emergency response and factors influencing performance on tabletop exercises.

METHODS

A cross-sectional design was employed in this study. Competence of nurses responding to a hazardous materials invasion was evaluated by a tabletop exercise. In each case the "Task Based Checklist" was used for evaluation. Multivariate analysis of covariance was conducted to detect the effects of traditional training on performance in Hazmat disaster tabletop exercises.

RESULTS

A total of 161 nurses were recruited for this study. A checklist with 12 items comprised of two dimensions of disaster management was created and validated (CVI = 0.90). Inter-rater reliability for the evaluators ranged from 0.88 to 1. Performance on Hazmat site control, debris management and individual skills in decontamination were found to be suboptimal. Traditional disaster nursing training had no significant influence either on performance on Hazmat site control or patient care after controlling for differences in education level, age and gender.

CONCLUSIONS

The tabletop exercise is an innovative method for disaster nursing educators seeking to evaluate response competence in Hazmat disaster simulation exercises. It is necessary to consider the characteristics of the participants when designing the training program and educational strategies. Participants from the military hospital were shown to have limited competence in Hazmat disaster emergency management.

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.].

Evaluation of clinical competence and its related factors among ICU nurses in Kermanshah-Iran: A cross-sectional study

Objectives

The present study was conducted to evaluate the clinical competence and its related demographic factors among critical care nurses in Kermanshah, Iran.

Methods

In this cross-sectional study, 155 Iranian nurses were selected by stratified random sampling. The data collection tools included a personal information form and the “Nurse Competence Scale”. Data were analyzed using descriptive and analytical statistics.

Results

The mean score of nurses' clinical competence was equal to 76.14 ± 1.59 out of 100, which was at a “very good level”. The mean score of using clinical competence in practice was equal to 70.38 ± 15.25 out of 100, which was at a “good level”. Among the subscales of clinical competence, the highest mean score was related to “managing situation”. The mean score of “using clinical competence in practice” was related to the subscale of “therapeutic interventions”. There was no statistically significant difference among the score of clinical competence of nurses varying with different gender, age, academic degree, and work experience.

Conclusions

The clinical competence of critical care nurses in Kermanshah was at a “very good” level, and the use of clinical competence in practice was at a “good level.” Given the importance of clinical competencies in practice, nurses' clinical competence should be evaluated objectively and positive measures should be taken to promote the application of their clinical competence.

Holistic nursing competence scale: Turkish translation and psychometric testing

AIM

This study aimed to culturally adapt and evaluate the reliability and validity of the Holistic Nursing Competence Scale for application in the Turkish context.

BACKGROUND

Nurses are expected to assess well-being of individuals by considering physical, social, psychological, cultural and spiritual dimensions to enhance adaptation to diseases. In Turkey, no tools have been developed to date for the evaluation of competencies in holistic nursing in the country.

METHODS

The study was conducted with 288 nurses working in two hospitals in Ankara equipped with over 500 beds. A confirmatory factor analysis was performed in order to identify whether the items and the sub-dimensions of the adapted scale complied with the original structure comprising 36 items and five sub-scales, namely 'general aptitude', 'staff education and management', 'ethically oriented practice', 'nursing care in a team' and 'professional development'. Cronbach's alpha value was used as an estimate for reliability analysis.

RESULTS

Opinions of 11 experts were obtained for content validation of the scale, and the content validity index was 0.90. The adaptation was observed to be acceptable on the basis of structural equation model fit indices in confirmatory factor analysis. Cronbach's alpha value was estimated to be 0.97 and 0.90, respectively, for the complete scale.

CONCLUSION

The study identified the Turkish version of Holistic Nursing Competence Scale as a valid and reliable tool for the evaluation of competence in holistic nursing among nurses.

IMPLICATIONS FOR NURSING AND NURSING POLICY

The instrument may now be utilized as a tool of measurement in nursing practice, as well as in education and research, for identifying the level of competence in the holistic nursing practices among the nurses in Turkey.

Nurses' Competence Caring for Hospitalized Patients With Ventricular Assist Devices

BACKGROUND

Nursing care is an essential component of the delivery of high-quality patient care for advanced heart failure patients with ventricular assist devices (VADs). However, there is little information about how VAD patient care competence is formed, and there are no empirical data regarding the bed nurses' competence.

OBJECTIVES

The aim of this study was to explain how nurses perceived their competence related to VAD technology and how they utilized resources to equip themselves for the management of patients with implantable VADs.

METHODS

An exploratory correlational research design was used in this study. Online surveys including demographic and work characteristics questionnaires as well as VAD Innovation in Nursing Appraisal Scale (knowledge, adoption, and communication) were completed by 237 critical-care unit and progressive care unit (PCU) nurses.

RESULTS

Ventricular assist device knowledge, adoption, and communication of innovation mean scores were 3.9 ± 0.6, 3.9 ± 0.8, and 3.7 ± 0.9, respectively, indicating moderate/high levels. Critical-care unit nurses reported higher levels of knowledge (3.7 vs 3.6) and adoption (4.0 vs 3.8; P < .05) of innovation than did the PCU nurses, with no differences in communication. Compared with PCU nurses, critical-care unit nurses were more likely to seek VAD competence-related information using mass media. Innovation and adoption were associated with years of nursing experience and some hospital characteristics.

CONCLUSION

Critical-care unit nurses have higher self-reported VAD care competence than PCU nurses. Further research is needed to confirm the findings and link nurse competence with VAD patient outcomes.

Self-efficacy and Clinical Performance of Nurses Initiated and Management of Antiretroviral Therapy: Narrative Review

Introduction:

Self-efficacy plays a major role in the behaviour of a human being by how he/she approaches a goal, task or a challenge so that a desired level of performance is produced. The objective of this paper is to review and analyse literature on self-efficacy and clinical performance among professional nurses regarding quality of care in implementation of NIMART programme.

Methodology:

A literature review was conducted using online resources. Search engines included EBSCO, Google Scholar, Medline, PubMed, Psych info and BIOMED Central articles and journals published between 2007 and 2017. Relevant papers on self-efficacy and clinical performance regarding the implementation of NIMART programme in South Africa were analysed.

Results:

278 papers were identified and 22 eligible papers were selected for analysis. Reviewed literature exhibited that self-efficacy is very crucial in the clinical performance of nurses in the implementation of NIMART. Self-efficacy helps to predict motivation and performance of individuals. Lack of mentoring, support and exposure to clinical practice had negative effect on nurse’s self-efficacy.

Conclusion:

Given the paucity of information on self-efficacy and clinical performance of NIMART in the South African context, future studies are warranted to gain more understanding of self-efficacy in the clinical performance of professional nurses.

Nurse understaffing is associated with adverse events in postanaesthesia care unit patients

AIMS AND OBJECTIVES

To investigate the associations between nurse staffing and the incidence and severity of hypoxaemia, arterial hypotension and bradycardia of postoperative patients during their postanaesthesia care unit stay.

BACKGROUND

Nurse understaffing has been associated with adverse patient outcomes in a variety of hospital settings. In the postanaesthesia care unit, nursing shortage is common and can be related to compromised prevention, detection and treatment of adverse events.

DESIGN

Observational, single-centre, prospective study that adhered to Strengthening the Reporting of Observational studies in Epidemiology checklist (see Supporting information Appendix S1); 2,207 patients admitted to the postanaesthesia care unit of a tertiary care hospital over a 5-month period were enrolled.

METHODS

Incidence of hypoxaemia (arterial oxygen saturation <95%), arterial hypotension (systolic blood pressure <90 mmHg) and bradycardia (heart rate <50 beats per minute), along with episode severity, was recorded. Patients were classified into three groups as follows: sufficient staffing, low and high understaffing. Risk for hypoxaemia, arterial hypotension and bradycardia was adjusted according to patient, anaesthesia and operation characteristics.

RESULTS

The incidence of hypoxaemia was significantly higher in the high understaffing group patients, while the incidence of arterial hypotension was significantly higher in both low and high understaffing group patients, compared to sufficient staffing group ones. In the high understaffing group patients, hypoxaemia and arterial hypotension episodes were of significantly higher severity.

CONCLUSIONS

These associations between hypoxaemia and arterial hypotension and postanaesthesia care unit understaffing indicate that care quality and patient safety can be compromised in case patient acuity is not matched with sufficient nursing resources.

RELEVANCE TO CLINICAL PRACTICE

Higher incidence of hypoxaemia and arterial hypotension advocates for the prevention of imbalances between patient number and care demands and the number of available nurses.

CNA Training Requirements and Resident Care Outcomes in Nursing Homes

Purpose of the Study

To examine the relationship between certified nursing assistant (CNA) training requirements and resident outcomes in U.S. nursing homes (NHs). The number and type of training hours vary by state since many U.S. states have chosen to require additional hours over the federal minimums, presumably to keep pace with the increasing complexity of care. Yet little is known about the impact of the type and amount of training CNAs are required to have on resident outcomes.

Design and Methods

Compiled data on 2010 state regulatory requirements for CNA training (clinical, total initial training, in-service, ratio of clinical to didactic hours) were linked to 2010 resident outcomes data from 15,508 NHs. Outcomes included the following NH Compare Quality Indicators (QIs) (Minimum Data Set 3.0): pain, antipsychotic use, falls with injury, depression, weight loss and pressure ulcers. Facility-level QIs were regressed on training indicators using generalized linear models with the Huber-White correction, to account for clustering of NHs within states. Models were stratified by facility size and adjusted for case-mix, ownership status, percentage of Medicaid-certified beds and urban-rural status.

Results

A higher ratio of clinical to didactic hours was related to better resident outcomes. NHs in states requiring clinical training hours above federal minimums (i.e., >16hr) had significantly lower odds of adverse outcomes, particularly pain falls with injury, and depression. Total and in-service training hours also were related to outcomes.

Implications

Additional training providing clinical experiences may aid in identifying residents at risk. This study provides empirical evidence supporting the importance of increased requirements for CNA training to improve quality of care.

Action competence: A concept analysis

AIM

The aim of this article is to analyze the concept of action competence and comprise a definition of the concept suitable to apply to virtual simulation in nursing education.

BACKGROUND

Virtual simulation has become an instructional method increasingly used in nursing education which creates a challenge for assessment of clinical competence.

DESIGN

This concept analysis was performed using Walker and Avant's eight stages of concept analysis.

DATA SOURCE

A literature search was conducted using search engines and included peer-reviewed articles from various disciplines.

RESULTS

The concept analysis resulted in an operational definition of action competence that is useful in nursing education.

CONCLUSION

The use of action competence during virtual simulation sessions provides a means for knowledge transfer, accountability of actions on the part of the students, self-awareness, and reflection. Through this process, students gain critical problem-solving skills that, through sustainability, can be applied to varying future patient scenarios. Action competence contains concrete components applicable to sustainability of knowledge gained by nursing students during virtual simulation.

Oral medicine modification for older adults: a qualitative study of nurses

OBJECTIVE

Oral medicines are frequently modified (eg, tablets crushed) for older adults. However, these modifications can have clinical, legal and/or ethical implications. Nurses bear responsibility for medicine administration and hence, perform these modifications. The aim of this study was to investigate the knowledge, attitudes and beliefs of nurses about oral medicine modification for older adults.

DESIGN

A qualitative study was conducted using semi-structured, face-to-face interviews with nurses providing care to older adults in acute and long-term care settings. Interviews were audio-recorded, transcribed verbatim and analysed thematically.

SETTINGS

Sixteen purposively selected care settings; 4 acute-care and 12 long-term care settings were included. Nurses were recruited by convenience sampling at these sites.

PARTICIPANTS

Eighteen nurses participated (83% female, 67% long-term care, 33% acute-care, median age (IQR) 38 years (32.5-52.0)).

RESULTS

Three major themes: modifying-a necessary evil, nurses' role as patient advocate and modifying-we are working very much as a team and two minor themes: fractional dosing, and covert administration emerged from the data. Nurses viewed oral medicine modifications as being a routine and necessary occurrence in geriatric patient care due to limitations of available formulations and the presence of age-related challenges in drug administration. Nurses' knowledge of residents' requirements ensured that they advocate for those with individualised formulation needs, however, nurses rely on pharmacists for information about modifications. Nurses expressed a desire for supports including increased education and ward-specific, pharmacist-developed recommendations on common modifications.

CONCLUSIONS

This study has provided useful insights into the views of nurses regarding oral medicine modification for older adults. The unique and varied formulation requirements of older adults must be acknowledged. Increased engagement by healthcare professionals, the pharmaceutical industry, regulatory agencies and policy-makers is required to facilitate the development of age-appropriate formulations. In the interim, practical interventions, informed by the findings of this study, are required.

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.

Effects of Nurses’ Perceptions of Actual and Demanded Competence on Turnover Intentions

With the growing focus on continuous professional development, demands placed on nurses to uphold nursing competence have been increasing. This study examined how nurses with different lengths of clinical experience perceived the relationship between their actual competence and the competence they felt was demanded of them, and how this relationship was related to their turnover intentions. Survey questionnaires were distributed to 1,377 nurses, of whom 765 returned usable completed forms. The results showed that across all the groups of clinical experience, nurses perceived the demanded competence levels to be higher than their actual competence levels. However, turnover intentions were not related to nurses’ perceptions of demanded competence and were negatively related to perceptions of actual competence. The levels of competence demanded should not be considered as threats for nurses. Improving nurses’ competence may reduce their turnover intentions.

Emotional competencies in geriatric nursing: empirical evidence from a computer based large scale assessment calibration study

The care of older people was described as involving substantial emotion-related affordances. Scholars in vocational training and nursing disagree whether emotion-related skills could be conceptualized and assessed as a professional competence. Studies on emotion work and empathy regularly neglect the multidimensionality of these phenomena and their relation to the care process, and are rarely conclusive with respect to nursing behavior in practice. To test the status of emotion-related skills as a facet of client-directed geriatric nursing competence, 402 final-year nursing students from 24 German schools responded to a 62-item computer-based test. 14 items were developed to represent emotion-related affordances. Multi-dimensional IRT modeling was employed to assess a potential subdomain structure. Emotion-related test items did not form a separate subdomain, and were found to be discriminating across the whole competence continuum. Tasks concerning emotion work and empathy are reliable indicators for various levels of client-directed nursing competence. Claims for a distinct emotion-related competence in geriatric nursing, however, appear excessive with a process-oriented perspective.

Investigating the adequacy of the Competence-Turnover Intention Model: how does nursing competence affect nurses' turnover intention?

AIMS AND OBJECTIVES

The aim of this study was to test the adequacy of the Competence-Turnover Intention Model, which was developed to identify how nursing competence could affect nurses' turnover intention (nurses' intention to voluntarily leave an organisation).

BACKGROUND

Recent studies have suggested that the level of nursing competence is negatively related to nurses' intention to leave their jobs, suggesting that a lack of competence threatens both the quality and quantity of the nursing workforce. However, the mechanism of how nursing competence affects nurses' turnover intention has not been explored previously.

DESIGN

A cross-sectional survey design was used.

METHODS

Surveys were distributed to 1337 Japanese registered nurses/midwives in October, 2013. The adequacy of the model was analysed using structural equation modelling.

RESULTS

In total, 766 questionnaires were returned, with a return rate of 57%. The model fitted well with the data. The results showed that the level of nursing competence was related positively to the quantity of organisational rewards they felt they had received, and negatively related to the level of exhaustion they experienced. Moreover, the perceived organisational rewards and exhaustion were correlated with nurses' turnover intention through affective commitment.

CONCLUSIONS

The Competence-Turnover Intention Model is useful for explaining how nursing competence impacts on their turnover intention.

RELEVANCE TO CLINICAL PRACTICE

Clinical implications derived from the findings are that: promoting nursing competence is key to improving not only the quality of care provided by nurses, but also to retaining the nursing workforce, and the model can be used to develop strategies that would mitigate their turnover intention.

Competence development as perceived by degree and non-degree graduates in Japan: a longitudinal study

BACKGROUND

A degree programme is believed to prepare graduates with a higher level of competence than their diploma counterparts. However, there have been inconsistent findings reported as to whether or not degree-graduates outperformed those who take diplomas.

OBJECTIVES

This study aimed to identify graduates' perceptions of competence development in their first year of employment, and to compare the competence levels of graduates with different educational backgrounds.

DESIGN

This study adopted a longitudinal design.

SETTINGS

This study has been performed in five hospitals in Japan.

PARTICIPANTS

122 Japanese graduates participated in this study.

METHODS

The self-assessed competence of the graduates was collected in the 3rd, 6th, 9th, and 12th months of their employment using a survey method. The data were analysed using a linear mixed model.

RESULTS

The results suggested that the graduates perceived their competence to be rapidly growing during the first half of the graduate year, and slowly later. The results also indicated that the graduates' perception of their competence showed a significant variation. The most striking finding of the study was that, on average, the non-degree graduates rated their competence higher than their degree counterparts.

CONCLUSIONS

The current university orientation on emphasising intellectual and theoretical components of education, with less focus on practical components might have led to the development of lower competence among the BN graduates. A fine balance between theoretical and practical components needs to be established in a university curriculum.