Short hospital stays and new demands for nurse competencies

Core Competencies for Gerontogeriatric Nursing: A Validation Study

BACKGROUND

As the aging population grows, facing multifaceted health challenges and escalating care costs, equipping newly graduated nurses with the requisite skills for high-quality gerontogeriatric care becomes crucial. This study assesses the psychometric properties of a Gerontogeriatric Competency (GGC) scale to evaluate the competencies of newly graduated registered nurses (RNs).

METHODS

Using a convenience sampling approach, a nationwide, observational prospective cohort study was conducted among 272 newly graduated RNs. The evaluation framework included a sociodemographic questionnaire, three groups of questions targeting gerontogeriatric nursing education aspects, and the GGC scale, with 64 competencies. Construct validity (via confirmatory factor analysis), known-group validity and reliability (assessed by Cronbach's α) were examined.

RESULTS

The confirmatory factor analysis (CFA) showed an adequate index fit: the ratio of chi-square to degrees of freedom (χ2/df) = 2.785, the goodness-of-fit index (GFI) = 0.579, confirmatory fit index (CFI) = 0.864, the parsimony goodness-of-fit index (PGFI) = 0.526, the parsimony confirmatory-of-fit index (PCFI) = 0.809, the root mean square error of approximation (RMSEA) = 0.087, and the modified expected cross-validation index (MECVI) = 24.418. Differences were observed in gerontogeriatric competencies based on curriculum inclusion, self-confidence, knowledge in caring for older adults, and satisfaction with the nursing program content. The Cronbach's α coefficient was 0.992 for the overall scale and ranged from 0.935 to 0.983 for the GGC dimensions.

CONCLUSIONS

The GGC scale is a valid and reliable tool for assessing the gerontogeriatric competencies of new graduate RNs, highlighting its potential to enhance education, training, and, ultimately, the quality of care provided to the older population.

Adaptation of the Gerontological Nursing Competence (GeroNursingCom) instrument to Turkish: Validity and reliability study

AIM

The aim of this study was to conduct a Turkish validity and reliability study of the Gerontological Nursing Competence Scale and to adapt the scale to Turkish culture.

BACKGROUND

As the number of older people increses, gerontological nursing requires specialized expertise in older people care. High-quality basic education and further education guarantee good competence in gerontological care.

DESIGN

A methodological study of instrument translation and validation.

METHODS

The study was methodological and the sample consisted of 530 university students who agreed to participate in the study. Data were collected by online interview method using the Introductory Information Form and Gerontological Nursing Competence Scale (GeroNursingCom). Before starting the study, permission was obtained from the ethics committee, the relevant institution, the scale owner and the students. Language equivalence and content validity of the scale were ensured and Confirmatory Factor Analysis Models (CFA) was conducted. Cronbach Alpha and item-total correlation analysis were used for the reliability of the scale.

RESULTS

The scale was compatible in terms of linguistic fidelity Content Validity Index (CVI) (Language)=0.97 and content fidelity CVI (Content)=0.96. The CFA results showed that the χ2/sd value was 1.861 and since this value was less than three, it can be stated that the model provided an excellent fit to the data. Comparative Fit Index (CFI) and Non-normalized Fit Index (NNFI) values were determined as 0.99 and 0.99 respectively and these values being above 0.90 indicate that the model provides an excellent fit to the data. Square Root of Standardized Errors (SRMR) index was 0.045 and Root Mean Square Error of Approximation (RMSEA) index was 0.040 and these values were less than 0.080, indicating that the model provided an excellent fit to the data. The Cronbach's alpha reliability coefficient of 0.97 was found to be highly reliable and the Cronbach's alpha reliability coefficients calculated for the sub-dimensions ranged between 0.77 and 0.91.

CONCLUSIONS

It was determined that the gerontological nursing competence scale is valid and reliable for nursing students and can be used in both student and working nurses living in Turkey.

Nurse competence in the interface between primary and tertiary healthcare services

AIMS

(a) To explore nurses' self-assessed competence and perceived need for more training in primary and tertiary healthcare services; and (b) to investigate the factors associated with these issues.

DESIGN

Quantitative, cross-sectional, descriptive.

METHODS

The ProffNurseSAS, the Job Satisfaction Scale and socio-demographics were used. A convenient sampling method was used to invite registered nurses from 23 primary (N = 104) and tertiary care wards (N = 26).

RESULTS

Five significant differences in self-assessed competence were identified, with none regarding the perceived need for more training between nurses working in primary versus tertiary health care. Nurses in primary health care had longer experience, and a larger proportion had continuing education. Nevertheless, this was not associated with either self-assessed competence or the perceived need for more training. Years of experience, training or reported job satisfaction was not associated with the items on the ProffNurseSAS.

CONCLUSION

Findings indicate that nurses' competence is same in primary and tertiary healthcare settings. Moreover, the findings of this research highlight areas that need further improvement and emphasis from both leaders and educational institutions when they attempt to ensure nurses' competence.

The Quality of Patient Education in Day Surgery by Adult Patients

PURPOSE

The purpose of the study was to describe the quality of patient education in day surgery as evaluated by adult patients.

DESIGN

Descriptive design using survey methodology.

METHODS

The data were collected by questionnaire and measured the quality and implementation of education resources for day surgery patients (n = 600) in a university hospital. The data were analyzed statistically using basic and multivariate methods.

FINDINGS

The implementation of patient education has been done in a patient-centered and goal-oriented way by half of respondents. Most respondents (81%) were satisfied with the interaction in patient education. The education resources were reported as good by 77% of respondents.

CONCLUSIONS

Health care staff should assess for the presence of anxiety as a barrier to the comprehension of information. In developing patient education, the professional expertise and skills of health care staff in educating patients should be used.

Assessment of radiographers' competences from the perspectives of radiographers and radiologists: a cross-sectional survey in Lithuania

BACKGROUND

Assessing radiographers' clinical competence is of major importance in all medical imaging departments, and is a fundamental prerequisite for guaranteeing professional standards in both nursing care and radiography. Despite the fact that self-assessment has been reported to be the most common form of competence evaluation only several studies defining the radiographers' self-assessment of clinical competencies were identified. The aim of the study was to evaluate radiographers' professional competence from the perspectives of radiographers and radiologists by applying the Radiographers' Competence Scale (RCS).

METHODS

The study was conducted in university hospitals of Lithuania. We used the original instrument designed by Swedish researchers - the Radiographers' Competence Scale (RCS) consisting of two domains: A "Nurse-initiated care" and B "Technical and radiographic processes". The study involved in all 397 respondents; radiographers (250) and radiologists (147) working in departments of diagnostic radiology. Each competence was evaluated twice - the level on a 10-point scale, and the frequency of practical application on a 6-point scale.

RESULTS

The overall level of the radiographers' competence and the frequency of its use in practice were evaluated high or very high by both respondent groups. The radiographers attributed the highest evaluations to such competences as "Encouraging and supporting the patient" and "Collaborating with other radiographers", while the lowest evaluations were attributed to "Guiding the patient's relatives" and "Empowering the patient by involving him/her in the examination and treatment" competences. The radiologists attributed the highest evaluations to such competences as "Collaborating with radiologists" and "Independent carrying out of the radiologist's prescriptions", while the lowest evaluations - to the same competences as the radiographers did. Irrespectively of the work experience and age, the radiographers gave significantly higher ratings to all competences that the radiologists did (p < 0.001).

CONCLUSIONS

Both groups of the respondents attributed high or very high evaluations to the competences in both the "Nurse-initiated care" and the "Technical and radiographic processes" domains.

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.

The Professional Nurse Self-Assessment Scale: Psychometric testing in Norwegian long term and home care contexts

BACKGROUND

Nurses' clinical competence is vital to ensure safe and high quality care, and the continuous assessment of nurses' clinical competence is of major concern. A validated instrument for the self-assessment of nurses' clinical competence at different educational levels across specialties and countries is lacking. The aim of this study was to test the reliability and construct validity of the new Professional Nurse Self-Assessment Scale (ProffNurse SAS) questionnaire in long term and home care contexts in Norway. The questionnaire is based on the Nordic Advanced Practice Nursing model, in which the nurse-patient relationship is central.

METHODS

The study has a cross-sectional survey design. A purposive sample of 357 registered nurses who worked in long term and home care contexts in two geographical regions encompassing eight municipalities and three counties was included. The respondents completed the 74-item ProffNurse SAS questionnaire and demographic background data was collected. Data collection was conducted in two phases: first region autumn 2011 and second region spring 2012. Exploratory factor analyses (EFA) were used to test the psychometric properties of the questionnaire and included the following steps: assessment of the factorality of the data, factor extraction by Principal Component Analysis (PCA), oblimin (oblique) factor rotation, and interpretation. Cronbach's alpha was used to estimate the internal consistency.

RESULTS

The PCA revealed a six-component structure, reducing the number of items in the questionnaire from 74 to 51. Based on the content of the highest-loading items, the six components were named: Direct Clinical Practice, Professional Development, Ethical Decision-Making, Clinical Leadership, Cooperation and Consultation, and Critical Thinking. The Cronbach's alpha values ranged from 0.940 (highest; Direct Clinical Practice) to 0.737 (lowest; Critical Thinking), leading to the estimation that the ProffNurse SAS is reliable.

CONCLUSIONS

The six components support the study's theoretical framework. The ProffNurse SAS showed acceptable reliability and construct validity and may therefore be a promising instrument for the assessment of practicing nurses' clinical competence. However, we recommend further psychometric testing in other countries and contexts and the inclusion of larger samples of nurses at various levels of education, particularly master's level APNs.

Care interaction adding challenges to old patients' well-being during surgical hospital treatment

Today, hospitals offer surgical treatment within a short hospital admission. This brief interaction may challenge the well-being of old patients. The aim of this study was to explore how the well-being of old hospitalized patients was affected by the interaction with staff during a fast-track surgical treatment and hospital admission for colon cancer. We used an ethnographic methodology with field observations and unstructured interviews focusing on one patient at a time (n=9) during a full day; the hours ranging from 7:45 a.m. to 8 p.m. Participants were between 74 and 85 years of age and of both sexes. The study was reported to the Danish Data Protection Agency with reference number (2007-58-0010). The encounter between old patients and the staff was a main theme in our findings elucidating a number of care challenges. The identified care challenges illustrated “well-being as a matter of different perspectives,” “vulnerability in contrast to well-being,” and “staff mix influencing the care encounter.” The experience of well-being in old cancer patients during hospital admission was absent or challenged when staff did not acknowledge their individual vulnerability and needs.

The impact of using electronic patient records on practices of reading and writing

The aim of this study was to investigate the use of electronic patient records in daily practice. In four wards of a large hospital district in Finland, N = 43 patients' care and activities were observed and analysed in terms of the Grounded Theory method. The findings revealed that using electronic patient records created a particular process of writing and reading. Wireless technology enabled simultaneous patient involvement and point-of-care documentation, additionally supporting real-time reading. Remote and retrospective documentation was distant in terms of both space and time. The remoteness caused double documentation, reduced accuracy and less-efficient use of time. 'Non-reading' practices were witnessed in retrospective reading, causing delays in patient care and increase in workload. Similarly, if documentation was insufficient or non-existent, the consequences were found to be detrimental to the patients. The use of an electronic patient record system has a significant impact on patient care. Therefore, it is crucial to develop wireless technology and interdisciplinary collaboration in order to improve and support high-quality patient care.

Ethical climate and nurse competence – newly graduated nurses' perceptions

Background:

Nursing practice takes place in a social framework, in which environmental elements and interpersonal relations interact. Ethical climate of the work unit is an important element affecting nurses’ professional and ethical practice. Nevertheless, whatever the environmental circumstances, nurses are expected to be professionally competent providing high-quality care ethically and clinically.

Aim:

This study examined newly graduated nurses’ perception of the ethical climate of their work environment and its association with their self-assessed professional competence, turnover intentions and job satisfaction.

Method:

Descriptive, cross-sectional, correlational research design was applied. Participants consisted of 318 newly graduated nurses. Data were collected electronically and analysed statistically.

Ethical considerations:

Ethical approval and permissions to use instruments and conduct the study were obtained according to required procedures. Data were rendered anonymous to protect participant confidentiality. Completing the questionnaire was interpreted as consent to participate.

Findings:

Nurses’ overall perception of the ethical climate was positive. More positive perceptions related to peers, patients and physicians, and less positive to hospitals and managers. Strong associations were found between perceived ethical climate and self-assessed competence, turnover intentions in terms of changing job, and job satisfaction in terms of quality of care. Nurses at a higher competence level with positive views of job satisfaction and low turnover intentions perceived the climate significantly more positively.

Conclusion:

Nursing management responsible for and having the power to implement changes should understand their contribution in ethical leadership, as well as the multidimensional nature of nurses’ work environment and the interaction between work-related factors in planning developmental measures. Future research should focus on issues in nurse managers’ ethical leadership in creating ethical work environments. There is also a need for knowledge of newly graduated nurses’ views of factors which act as enhancers or barriers to positive ethical climates to develop. Interventions, continuing education courses, and discussions designed to promote positive ethical climates should be developed for managers, nurses, and multi-professional teams.

Nurse competence between three generational nurse cohorts: A cross-sectional study

Research indicates significant differences between nurse cohorts in many work-related factors. This study compared nurse competence between three generational cohorts comprising the current nursing workforce. The Nurse Competence Scale was used to collect data for this cross-sectional study from 2052 nurses in a university hospital in Finland. Data were analysed statistically. Significant differences were found between nurse cohorts in their competence. The length of work experience had a significant impact on the development of competence. The oldest cohort, with the longest work experience, had the highest competence scores (70.1 on a visual analogue scale), and the youngest had the lowest (59.0). All cohorts were most competent in patient-related nursing tasks, in maintenance of professional competence and in ethical care. Nurses were weakest in the development of nursing practice and the use of evidence-based knowledge. Targeted interventions in teaching-coaching for different nurse generations are needed to ensure the maintenance of nurse competence and high-quality patient care.

Do educational outcomes correspond with the requirements of nursing practice: educators' and managers' assessments of novice nurses' professional competence

Objective

This study evaluated weather educational outcomes of nurse education meet the requirements of nursing practice by exploring the correspondence between nurse educators' and nurse managers' assessments of novice nurses' professional competence. The purpose was to find competence areas contributing to the acknowledged practice–theory gap.

Design

A cross-sectional, comparative design using the Nurse Competence Scale was applied.

Subjects

The sample comprised nurse educators (n = 86) and nurse managers (n = 141).

Methods

Descriptive and inferential statistics were used in the data analysis.

Main outcome measures

Educators assessed novice nurses' competence to a significantly higher level than managers in all competence areas (p < 0.001). The biggest correspondence between educators' and mangers' assessments were in competencies related to immediate patient care, commitment to ethical values, maintaining professional skills and nurses' care of the self. The biggest differences were in competencies related to developmental and evaluation tasks, coaching activities, use of evidence-based knowledge and in activities which required mastering a comprehensive view of care situations. However, differences between educators' and managers' assessments were strongly associated with their age and work experience. Active and improved collaboration should be focused on areas in which the differences between educators' and managers' assessments greatly differ in ensuring novice nurses′ fitness for practice.