Evidence of clinical competence

The need to identify anatomy-related competencies in medical education

A profound grasp of anatomy is indispensable for shaping competent and safe medical practitioners. This knowledge acquisition is pivotal in the early stages of medical education and remains crucial throughout clinical training. However, the evolving landscape of medical education has ushered in changes to the anatomy curriculum, marked by a reduction in contact hours and a streamlined content structure to accommodate novel subjects and teaching methodologies. This transformation has precipitated a quandary in defining the essential scope and depth of anatomical knowledge to be imparted. Traditionally, surgeons assumed the role of anatomy instructors until Flexner's recommendations catalyzed the integration of trained anatomists. Nevertheless, the varied backgrounds of anatomists and the heterogeneity in anatomy curricula across institutions have introduced potential disparities in the quality of graduates. Addressing these challenges mandates the identification of key anatomy competencies tailored for undergraduate medical students. The imperative lies in ensuring that these competencies span cognitive, psychomotor, and affective domains, offering not only comprehensiveness but also direct applicability to clinical practice. Hence, this viewpoint highlights the necessity of adopting a systematic approach that includes gathering input from various stakeholders in developing and implementing a universal anatomy core competency framework, ensuring graduates are equipped for the multifaceted demands of clinical practice. Overall, the manuscript provides a comprehensive overview of the challenges and opportunities in anatomy education, with a clear call to action for a transformative approach to meet the evolving needs of medical practice.

The effectiveness of immersive virtual reality applications (human anatomy) on self-directed learning competencies among undergraduate nursing students: A cross-sectional study

Technological developments have significantly impacted various aspects of life, most notably healthcare and education. A nursing education shift was required to prepare digital generation. Consequently, nurse educators must adopt innovative approaches to teaching and learning, like incorporating immersive virtual reality (VR) into human anatomy courses to improve students' learning. To examine the influence of immersive VR applications (human anatomy) on self-directed learning (SDL) competencies among undergraduate nursing students. A cross-sectional design was conducted in the health profession's faculty at Al-Quds University among the first year of the nursing program, who were enrolled in an anatomy course (N = 137). The Self-Directed Learning Instrument was used, and independent sample t-tests were conducted to compare the level of SDL among students who utilized the VR application (Human Anatomy VR). The results showed that 93.9% of the total were approximately 20 years old, and 85.4% were females. 90.5% of participants expressed satisfaction with using the VR application and that it would be beneficial in nursing courses. The average score of SDL for the whole group was 72.03 ± 13.07, and there is a positive significant relationship between SDL and students utilizing VR (p < 0.001), between SDL competencies and technological skills (p = 0.009), and type of digital tools (p = 0.049). The highest coefficient of correlation was related to planning and self-monitoring (r = 0.918), and the lowest was related to interpersonal communications (r = 0.865). VR is an additional tool for enhancing learning, and nursing students perceive immersive VR technologies positively and prefer using three-dimensional images in their anatomy courses. SDL assists students in identifying learning objectives, barriers, and outcomes through using VR technologies as teaching strategies.

Perceptions of academic staff toward the objective structured clinical examination (OSCE) in clinical nursing: Assessment method

BACKGROUND

Clinical competence is critical to evaluating nursing students' capacity to undertake professional nursing practice in a safe and professional environment without any bias of examiners. Objective structured clinical examination (OSCE) is used as an assessment method of students' clinical practice skills.

AIMS

The aim of this study is to assess the nursing faculty members' perception toward OSCE to be used as an assessment method of nursing students in their performing of nursing procedures, as well as explore the advantages and disadvantages of OSCE as perceived by study participants.

METHOD

A descriptive cross-sectional study was used among nursing faculty members (N = 73) who participated on a workshop that were conducted by Jordanian Nursing Council (JNC) between January 2022 and March 2023.

RESULT

The mean perception toward OSCE was 105.87 ± 22.02 (p value = 0.001). The majority of faculty members reported a positive perception toward the OSCE (82.2%). The negative perception was significant in gender, age group, level of education, and academic experience (p < 0.05). The majority of faculty members were agree on the advantages of OSCE.

CONCLUSION

OSCE is a vital assessment and an objective method in assessing the student's clinical competence. More studies exploring the differences of OSCE perceptions and participant's characteristics are required.

Competence of healthcare professionals in stroke care pathways: a cross-sectional study

AIMS

To describe healthcare professionals' self-assessed competence in stroke care pathways based on their self-evaluation and identify the factors associated with competence.

DESIGN

A cross-sectional, descriptive explorative study design was used.

METHODS

The data were collected during May and September 2021 through a survey sent to healthcare professionals (N=1200, n=215) working in neurological care. Competence in stroke care pathways was measured using the RN-STROKE, PT-STROKE and OT-STROKE instruments defined by four-factor model. The instruments' validity and reliability were confirmed through exploratory factor analysis and Cronbach's alpha. K-means clustering, one-way ANOVA, Chi Square, Mann Whitney U and Kruskal-Wallis were used to analyze the data. The results were reported as frequencies, percentages, mean and standard deviation. The results were reported according to STROBE guidelines.

RESULTS

Four main areas of healthcare professionals' competence in stroke care pathways were identified: (1) counseling and interaction competence (2) competence to use evidence-based information, (3) self-management and development competence, and (4) multiprofessional and collaboration competence. The study then identified three competence profiles of healthcare professionals working in the stroke care pathway. Professionals in Profile A evaluated their competence at the highest level, those in Profile B at the average level, and those in Profile C at the lowest level. Healthcare professionals' occupation and participation in their organisation's expert network were found to be associated with competence profiles.

CONCLUSION

The overall competence of healthcare professionals in the stroke care pathway was rated as good, but competence to use evidence-based information in clinical practice, in particular, should be improved. Organisations should, therefore, increase education and training in this area and provide adequate resources to enable the use of evidence-based information in clinical work.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The study identifies three profiles relating to healthcare professionals' competence in the stroke care pathway, which can be used to create continuous education and ensure better patient care according to participants' profiles.

REPORTING METHOD

The study was reported using the STROBE Statement checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Healthcare professionals' experience regarding competencies in specialized and primary stroke units: A qualitative study

AIM

To describe healthcare professionals' experience of needed competence in patient stroke care within specialist and primary healthcare.

BACKGROUND

Healthcare professionals who provide stroke care need multifaceted, multi-professional skills; ongoing training is important for competent stroke care.

DESIGN

A descriptive qualitative study.

METHODS

Six focus group interviews with semi-structured interviews were conducted in October and November 2020. Healthcare professionals (n = 25) working in stroke care units in both specialist and primary healthcare settings were interviewed. The interviews were recorded, transcribed and analyzed inductively by content analysis. The study was conducted, and results were reported according to the Consolidated Criteria for Reporting Qualitative Research.

RESULTS

Five main categories were identified: clinical competence; multiprofessional networking competence; competence in interaction skills; emotional and psychoeducational support competence; and self-management and development competence.

CONCLUSION

Competence in stroke care includes both in-depth and wide-ranging professional competences that require ongoing development. Utilizing various education models and collaborative learning approaches can help meet the requirements for developing competence in stroke care.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

PRIME-nurse practitioner competency model validation and criterion based OSCE rubric interrater reliability

The PRIME-NP (Professional-Reporter-Interpreter-Manager-Educator/Evaluation-Nurse Practitioner) Model is adapted from the RIME (Reporter-Interpreter-Manager-Educator) model used in medical education to guide medical student and resident education. The Delphi technique was used to validate the PRIME-NP Model. After two rounds of review by a group of experts in NP curriculum, the model was determined to be valid based on expert consensus. Agreement percent increase from the first round to the second round in all categories. Interrater reliability (IRR) was assessed using interclass correlation after instrument validation was completed for each of the five levels of the PRIME-NP model. Overall, the IRR of the instrument was found to be acceptable with some notable exceptions. No variance was noted in professional behaviors at any level. Variance was increased in management and educator/evaluator behaviors in higher/later course levels. The PRIME-NP Model and PRIME-NP OSCE Rubric is a valid and reliable instrument to assess NP student progression in objective structured clinical examinations. This instrument has the potential for adaptation for use in other types of health sciences education and settings.

Meeting the Needs of Older Adults with Mental Ill-Health in Non-Psychiatric Care Settings: Self-Rated Confidence in Helping and its Co-Variates within a Multiprofessional Study Sample

In this paper we sought to explore health and social care professionals' self-rated confidence in helping older adults with mental ill-health in non-psychiatric care settings. A cross-sectional survey study was performed exploring the participants' (n = 480) confidence in helping. Confidence in helping was analyzed together with background characteristics and selected explanatory variables, such as the workplace and work experience of the participants, their personal experiences of and attitudes to mental ill-health, as well as their knowledge in mental ill-health among older adults, by means of descriptive statistics and logistic regression analysis. We found that approximately half (55%) of the participants were confident in helping older adults with mental ill-health. The odds ratios for being confident in helping were significantly associated to the workplace of the professionals, professionals' attitude to and experience of mental ill-health, and knowledge of mental health among older adults. To increase confidence in helping older adults with mental ill-health, we recommend confidence-building interventions, for example, educational programs, through which knowledge of mental health among older adults is increased and negative attitudes are challenged, especially within the context of specialist somatic healthcare.

Learning goals and content for wound care education in Finnish nursing education - A Delphi study

BACKGROUND

Caring for patients with wounds requires diverse competences from nursing professionals. However, wound care education in undergraduate nursing education is often fragmented and lacks consistent learning goals and content.

OBJECTIVES

To create learning goals and content for wound care education in Bachelor's level nursing education in Finland and to assess the consensus relating to these learning goals and content among wound care experts.

DESIGN

A consensus-building approach using the Delphi technique.

SETTINGS

A Delphi panel of wound care experts built on an online platform.

PARTICIPANTS

The participants of the Delphi panel were registered nurses, authorised wound care nurses, nurse educators and physicians.

METHODS

Learning goals and content for wound care education which had been formulated on the basis of previous focus-group interviews were presented to the Delphi panel. The data were collected in 2021 with two online Delphi rounds: 51 panellists participated in the first round and 36 in the second round. The data were analysed using statistical and qualitative analysis.

RESULTS

Learning goals and content were divided into four competence areas: 1) Anatomy and physiology, 2) Care of chronic and acute wounds, 3) Wound management and care of a patient with a wound, 4) Values and attitudes. These competence areas comprised 26 learning goals and 29 pieces of content. The consensus between the panellists was high, at >90% in all competence areas.

CONCLUSIONS

The basis of registered nurses' wound care competence is built during their undergraduate nursing studies. The results of this study can be used to standardise wound care education by implementing consistent learning goals and content in Bachelor's level nursing education.

A competency roadmap for advanced practice nursing education using PRIME-NP

BACKGROUND

Clinical competency validation is essential for nurse practitioner (NP) education and public accountability. While there has been robust discussion around what constitutes clinical competency and assessment, clear and consistent definitions and measurements remain elusive.

PURPOSE

This article describes the PRIME-NP clinical competency model that is scalable, reproducible and accurately documents NP student competency across clinical courses.

METHODS

To develop the model, work in 5 discrete domains was necessary: (a) model development, (b) assessment tool to be used in Objective Structured Clinical Exams (OSCE), (c) rubrics to accompany the OSCE exam, (d) faculty education, and (e) evaluating the model use.

FINDINGS

Faculty and student outcomes reveal that the model and assessment tool acceptability and effectiveness of the model, especially for early identification for at risk students.

CONCLUSION

The PRIME-NP offered faculty the opportunity to identify at-risk students, identify a more nuanced remediation plan, and assess student competency in simulated environments.

Appropriation and application of caring science theory: Experiences of master education alumni in three Nordic countries

BACKGROUND

A theoretical foundation in caring science is invaluable for nursing care because it enriches practice by providing explanations, clarity and direction. However, after graduation, students experience the frustration of not being able to sufficiently intertwine caring science theories in practice. Consequently, the integration of caring science theories in nursing education and practice is considered an essential focus area to reduce this theory-practice gap.

AIM

This study aims to elucidate master alumni's experiences of appropriation and application of caring science after completing a master's education.

METHODS

The data were collected by semi-structured interviews with 21 alumni from Finland, Sweden and Norway who had recently completed a master's degree with caring science as the major subject. A thematic analysis was used.

FINDINGS

The analysis resulted in two main themes, both with three subthemes. Educator's bearing and a learning community are important for students' appropriation of caring science theories. Learning through reflection and the response of others evoke new paths of thought, and practice-related teaching promotes the intertwining and application of caring science theory in practice. The appropriated theory has significance to alumni by providing a guiding basis that strengthens alumni's professional bearing and way of being. The caring science theory guides alumni in providing nursing care with an increased ethical awareness and questioning approach that enables good patient care. Their professional identity and confidence in caring are also strengthened.

CONCLUSION

Educators' bearing is of outermost importance for appropriation and application of caring science theory. It has a key function in facilitating students' understanding and intertwining of caring science theory and practice. Appropriated caring science theory provides authority and courage to practice nursing care. The appropriated theory promotes alumni's ethical awareness, confidence and a sense of pride in the profession.

The Ms. Olsen test: Measurement properties of a short test of nursing staffs' competence in clinical decision-making

AIMS

To assess the measurement properties of the Ms. Olsen test for registered nurses and assistant nurses, respectively, and suggest cut-off points between competence levels.

DESIGN

Cross-sectional study. The results were analysed by implementing the Rasch Measurement Theory.

METHODS

Nursing staff working in various health care settings participated (n = 757). To measure the competence of nursing staff in clinical decision-making, a 19-item scale from the Nursing Older People-Competence Evaluation Tool-the 'Ms. Olsen test'-was used. Data were collected in October 2017, 2018 and 2019.

RESULTS

The Ms. Olsen test showed reasonably good measurement properties for registered nurses and assistant nurses respectively. Results show slightly better measurement properties for registered nurses than for assistant nurses. The cut-off for registered nurses, 0.62, corresponds to managing approximately two-thirds of the items while, for assistant nurses, the cut-off of 0.01 corresponds to managing approximately half of the items.

CONCLUSION

The Ms. Olsen test is a short (7- to 10-min) test measuring competence in clinical decision-making among nursing staff working in older people nursing. Despite reasonably good measurement properties, this should be considered an initial validation in the development of a short test for assessing clinical decision-making among nursing staff in various health care setting.

IMPACT

Several scales aiming to measure nursing competence have been developed over the last decade, but measurement properties (beyond classical test theory) are seldom evaluated, few scales concern other staff groups than registered nurses and few scales have proposed or established cut-offs for safe practice. The Ms. Olsen test is a short test of clinical decision-making that demonstrates reasonably good measurement properties. Cut-off points for registered nurses and assistant nurses were established. The Ms. Olsen test may be used to measure and evaluate competence in clinical decision-making among nursing staff working in older people nursing and educational settings.

Healthcare professionals' competence in stroke care pathways: A mixed-methods systematic review

BACKGROUND

The challenges of caring for stroke patients are growing due to population ageing and improved survival rates. Healthcare professionals' competence development in stroke care is a necessity to ensure high-quality patient care.

OBJECTIVES

To identify and describe the competence areas of healthcare professionals working in the stroke patient care pathway and factors influencing these competences.

DESIGN

A mixed-methods systematic review.

METHODS

The review was conducted according to the JBI guidelines and registered in the PROSPERO database (CRD42020204062). PRISMA checklist guided the review process. Relevant original studies were identified by searching four databases-CINAHL (EBSCO), PubMed, Scopus and Medic. After researcher consensus was reached, 32 studies were selected for inclusion and subjected to content analysis and data tabulation.

RESULTS

Competence in care processes, clinical competence, competence in using self-management strategies, interaction skills, skills in acknowledging family and competence in integrating the available evidence base into patient care were identified as key competence areas. Organisation of services, specialisation in stroke care, continuous development and education, family and carer and training in oral care and cognitive rehabilitation were identified as factors that influence healthcare professionals' competence.

CONCLUSIONS

Diverse clinical and interaction competencies are needed throughout the stroke care pathway, and various factors affect healthcare professionals' competence. Further research on healthcare professionals' stroke care competence will be needed to respond to changing healthcare demand.

RELEVANCE TO CLINICAL PRACTICE

We recommend organisational support and formulation of stroke care patient guidelines in line with healthcare competence requirements. Focus should be added for nursing professions in developing interactive communication competence since nurses spend the majority of the time providing individual patient care. Also, organisations should integrate continuing training in specialised stroke care for healthcare professionals' competence development.

The development and testing of the C/WoundComp instrument for assessing chronic wound-care competence in student nurses and podiatrists

The purpose of this study was to describe the level of chronic wound-care competence among graduating student nurses and student podiatrists in comparison with that of professionals and to develop and test a new instrument (the C/WoundComp) that assesses both theoretical and practical competence in chronic wound care as well as attitudes towards wound care. The data (N = 135) were collected in 2019 from four groups (1): graduating student nurses (n = 44) (2); graduating student podiatrists (n = 28) (3); registered nurses (n = 54); and (4) podiatrists (n = 9). The data were analysed using statistical analysis. According to the results, the students' total mean competence score was 62%. Their mean score for theoretical competence was 67%, and for practical competence, it was 52%. The students' competence level was statistically significantly lower than that of the professionals (P < .0001), but the students showed a positive attitude towards chronic wound care. The instrument demonstrated preliminary validity and reliability, but this warrants further testing. This study provides new knowledge about student nurses' and student podiatrists' competence in chronic wound care, suggesting that their theoretical and practical competence is limited. In addition, it provides information on different methods of assessing competence and how they can be combined.

The development of a six-station OSCE for evaluating the clinical competency of the student nurses before graduation: A validity and reliability analysis

BACKGROUND

Assessing clinical competency in undergraduate nursing students is essential before they enter clinical practice. The objective structured clinical examination (OSCE) is widely used and is part of clinical competency assessment. Aim The aim of this study was to develop and validate a six-station OSCE for evaluating the clinical competency of the student nurses before graduation.

METHODS

One-group longitudinal observational study. An OSCE of 6 stations of 10 min each was adopted. Blueprint setting, checklist development, and standard patient and examiner training were conducted. The mean, standard deviation, item scale (item-total correlation) and comparisons of extreme groups for item analysis. The inter-coder of examiners and inter-case of students were used to test reliability. Content Validity and concurrent validity were used to evaluate validity of OSCE.

RESULTS

One hundred nursing students participated in this study. The mean OSCE score of students who passed the registered nurses' examination was significantly higher than that of students who failed. Significant differences in OSCE score between students who remain versus left clinical job were observed at 3, 6 and 9 months after graduation.

CONCLUSION

The OSCE is predictable method for assessing undergraduate students' first year clinical retention.

[A Structural Model on the Nursing Competencies of Nursing Simulation Learners]

PURPOSE

The purpose of this study was to test a model of nursing competencies of nursing simulation learners. The conceptual model was based on the theory of Jeffries's simulaton theory.

METHODS

Data collection was conducted in October 2017 for 310 students from two nursing universities in Kyungbuk area for 20 days. Data analysis methods were covariance structure analysis using SPSS 21.0 and AMOS 22.0 statistical programs.

RESULTS

The hypothetical model was a good fit for the data. The model fit indices were comparative fit index=.97, normed fit index=.94, Tucker-Lewis Index=.97, root mean square error of approximation=.44, and standardized root mean square residual=.04. Teacher factors were directly related to simulation design characteristics, and it was confirmed that the curriculum, classroom operation and teaching method of the instructors were important factors. Learner factors were found to have a direct effect on nursing competence, self-confidence, and clinical performance that belong to nursing capacity. In particular, the results of this study indicate that the simulation design characteristics have a partial mediating effect on learner factors and clinical performance, and a complete mediating effect on learner factors and clinical judgment ability.

CONCLUSION

In order to improve the learner's clinical performance and clinical judgment ability, it is necessary to conduct practical training through nursing simulation besides preparing the learner and the educator.

Multifaceted competence requirements in care homes: Ethical and interactional competence emphasized

Nurses need versatile competence to care for older people in care home settings. A modified Delphi study was conducted to identify competencies registered nurses and licensed practical nurses need to care for older people in care homes. A total of 38 panelists consisting of experienced professionals in clinical and managerial roles were recruited to identify types of competencies these nurses require. In total, 80 competencies for licensed practical nurses and 81 competencies for registered nurses were identified as necessary. This study has shown that licensed practical nurses are required to have similar competencies to registered nurses in care homes. Nurse managers, nurse educators, and policy makers should pay more attention, to nurses’ work requirements, especially for licensed practical nurses, and support nurses to meet the needs of older people living in care homes.

Video education for critical care nurses to assess pain with a behavioural pain assessment tool: A descriptive comparative study

AIM

To evaluate the impact of video education on critical care nurses' knowledge and skills in using a behavioural pain assessment tool for intensive care patients and to explore the nurses' experiences with video education.

METHODS

Forty-eight nurses in one intensive care unit watched an educational video on the use of the Critical-Care Pain Observation Tool, then assessed pain in two patients with the tool and took a knowledge test. The researcher made parallel pain assessments. Interrater reliability of patients' pain assessment between nurses and the researcher was determined to examine nurses' skills in using the tool after education. Twenty nurses were interviewed about their experiences with the video education. Interviews were analysed with deductive thematic analysis.

RESULTS

The knowledge test scores indicated that the nurses learned the principles of how to use the tool. The interrater reliability of pain assessments reached a moderate level of agreement during the painful procedure, with a weighted kappa coefficient value of 0.48, CL [0.37, 0.58]. The nurses perceived video education positively, but requested additional interaction.

CONCLUSIONS

Video education is useful in teaching the principles of using a pain assessment tool. Additional clinical training is required for nurses to reach adequate skills in using the tool.

Competence for older people nursing in care and nursing homes: An integrative review

BACKGROUND

People living in care and nursing homes are vulnerable individuals with complex needs; therefore, a wide array of nursing competence is needed to ensure their well-being. When developing the quality of care in these units, it is essential to know what type of competence is required for older people nursing.

AIMS AND OBJECTIVES

The aim of this integrative review was to identify the competence needed for older people nursing in licensed practical nurses' and registered nurses' work in care and nursing homes.

DESIGN

Integrative literature review.

METHODS

We performed an integrative review using Whittemore and Knafl's method. The CINAHL, MEDLINE, PsycINFO, SocINDEX and Scopus databases were searched for studies published from 2006 to April 2016. We assessed the quality of the studies using Joanna Briggs Institute critical appraisal tools and analysed the data by applying qualitative content analysis.

RESULTS

Ten articles were included in the review. Most of the studies focused on registered nurses' work. We identified five competence areas that are needed for older people nursing in registered nurses' work in care and nursing homes: attitudinal and ethical, interactional, evidence-based care, pedagogical, and leadership and development competence. Empirical evidence of competence requirements related to licensed practical nurses' work in these facilities was scarce.

CONCLUSIONS

The competence required for registered nurses and licensed practical nurses should be clearly identified to support competence management in the care and nursing home context.

IMPLICATIONS FOR PRACTICE

Well-educated nursing staff are needed in care and nursing homes to provide high-quality care because comprehensive and advanced nurse competence is required to meet the needs of older people.

Personal care assistants' experiences of caring for people on home mechanical ventilation

AIM

The aim of this study was to describe personal care assistants' (PCA) experiences of working with a ventilator-assisted person at home.

METHODS

Data were collected from fifteen audiotaped semistructured interviews with PCAs supporting a child or adult using home mechanical ventilation (HMV). Thirteen women and two men participated; their working experience with HMV users ranged from one to 17 years (median 6 years). Data were subjected to qualitative content analysis in an inductive and interpretive manner.

FINDINGS

Five categories emerged from the data: Being part of a complex work situation; Taking on a multidimensional responsibility; Caring carried out in someone's home; Creating boundaries in an environment with indistinct limits; and Being close to another's body and soul.

CONCLUSIONS

The participants felt very close to the person they worked with, both physically and emotionally. They had a great responsibility and therefore a commensurate need for support, guidance and a well-functioning organisation around the HMV user. There is international consensus that advanced home care will continue to expand and personal care assistance is key in this development. We suggest that one way to move forward for PCAs working with HMV users is to create multiprofessional teams led by a key-person who coordinates the individual needs. More research is needed within this area from a broad perspective including the HMV-assisted persons, relatives, personal care assistants and management organisations.

Evidence of clinical competence by simulation, a hermeneutical observational study

Making the transition from theory to practise easier in nursing education through simulation is widely implemented all over the world, and there is research evidence of the positive effects of simulation. The pre-understanding for this study is based on a definition of clinical competence as encountering, knowing, performing, maturing and developing, and the hypothesis is that these categories should appear in simulated situations. The aim of the study was to explore the forms and expressions of clinical competence in simulated situations and furthermore to explore if and how clinical competence could be developed by simulation. An observational hermeneutic study with a hypothetic-deductive approach was used in 18 simulated situations with 39 bachelor degree nursing students. In the situations, the scenarios, the actors and the plots were described. The story told was "the way from suffering to health" in which three main plots emerged. The first was, doing as performing and knowing, which took the shape of knowing what to do, acting responsibly, using evidence and equipment, appearing confident and feeling comfortable, and sharing work and information with others. The second was, being as encountering the patient, which took the shape of being there for him/her and confirming by listening and answering. The third plot was becoming as maturing and developing which took the shape of learning in co-operation with other students. All the deductive categories, shapes and expressions appeared as dialectic patterns having their negative counterparts. The study showed that clinical competence can be made evident and developed by simulation and that the challenge is in encountering the patient and his/her suffering.

How to become an expert educator: a qualitative study on the view of health professionals with experience in patient education

BACKGROUND

Health professionals with the level of competency necessary to provide high-quality patient education are central to meeting patients' needs. However, research on how competencies in patient education should be developed and health professionals trained in them, is lacking. The aim of this study was to investigate the characteristics of an expert educator according to health professionals experienced in patient education for patients with coronary heart disease, and their views on how to become an expert educator.

METHODS

This descriptive qualitative study was conducted through individual interviews with health professionals experienced in patient education in cardiac care. Participants were recruited from cardiac care units and by using a snowball sampling technique. The interviews were audiotaped and transcribed verbatim. The data were analyzed with thematic approaches, using systematic text condensation.

RESULTS

Nineteen Icelandic and Norwegian registered nurses, physiotherapists, and cardiologists, who had worked in cardiac care for 12 years on average, participated in the study. Being sensitive to the patient's interests and learning needs, and possessing the ability to tailor the education to each patient's needs and context of the situation was described as the hallmarks of an expert educator. To become an expert educator, motivation and active participation of the novice educator and a supportive learning environment were considered prerequisites. Supportive educational resources, observation and experiential training, and guidance from experienced educators were given as examples of resources that enhance competence development. Experienced educators expressed the need for peer support, inter-professional cooperation, and mentoring to further develop their competency.

CONCLUSIONS

Expert patient educators were described as those demonstrating sensitivity toward the patient's learning needs and an ability to individualize the patient's education. A supportive learning environment, inner motivation, and an awareness of the value of patient education were considered the main factors required to become an expert educator. The experienced educators expressed a need for continuing education and peer support.

The education received by nursing students regarding nursing older people: a scoping literature review

The situation of an ageing population is a priority for all levels of society globally, particularly related to the subsequent increased demand for care. Nurses are often the primary source of this care; therefore, research is required to develop the curricula of nursing education, to help them meet this demand. The primary aim was to analyse empirical studies that have tackled nursing students' education concerning nursing older people. This analysis was targeted at generating an overall picture of the research in this field in order to determine the areas that require further study. A scoping literature review was conducted through systematic searches in the following electronic databases: Medical Literature Analysis and Retrieval System (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Education Resources Information Center (ERIC). These searches were limited to studies with an available abstract, in English, which were conducted between 1999 and 2012. Two researchers independently applied the same inclusion and exclusion criteria to select the studies for analysis. In total, 66 articles were included in the analyses. The results were validated by the research team. The primary research areas identified included both the learning outcomes and the implementation of nurses' education in caring for older people. Students' general attitudes towards older people and ageing dominated the studies regarding learning outcomes. There was a large variation in the description of the validity and trustworthiness of the studies, with most being only at a moderate level. A limited number of studies examining the specific learning outcomes and factors influencing the implementation of education exist. Vague reporting about the validity and trustworthiness of the studies limits the use of their findings. More well-designed studies are needed to guide educational strategies to improve students' competence in nursing older people and to promote this field as a career choice.

Radiographers' professional knowledge regarding parameters and safety issues in plain radiography: a questionnaire survey

OBJECTIVE

To review the knowledge of radiographers and examine the possible sociodemographic and situational contributors to this knowledge.

METHODS

A questionnaire survey was devised and distributed to a cohort of 120 radiographers. Each questionnaire contained two sections. In the first section, background data, including sex, age, highest academic level, grade point average (GPA), length of time from graduation, work experience as a radiographer and the status of previous refresher course(s), were collected. The second section contained 17 multiple-choice questions concerning radiographic imaging parameters and safety issues.

RESULTS

The response rate was 63.8%. In univariate analytic model, higher academic degree (p < 0.001), higher GPA (r(2) = 0.11; p = 0.001), academic workplace (p = 0.04) and taking previous refresher course(s) (p = 0.01) were significantly associated with higher knowledge score. In multivariate analytic model, however, higher academic degree (B = 1.62; p = 0.01), higher GPA (B = 0.50; p = 0.01) and taking previous refresher course(s) (B = -1.26; p = 0.03) were independently associated with higher level of knowledge. Age, sex, length of time from graduation and work experience were not associated with the respondents' knowledge score.

CONCLUSION

Academic background is a robust indicator of a radiographer's professional knowledge. Refresher courses and regular knowledge assessments are highly recommended.

ADVANCES IN KNOWLEDGE

This is the first study in the literature that examines professional knowledge of radiographers in terms of technical and safety issues in plain radiography. Academic degree, GPA and refresher courses are independent predictors of this knowledge. Regular radiographer professional knowledge checks may be recommended.

Need for Preparedness

Home health care faces challenges that could affect job satisfaction and quality of care. The aim of the study was to describe nurses’ experiences of competence in home health care. The study sample comprised of interviews with six nurses and was analyzed using manifest qualitative content analysis. The category “Being prepared” and subcategories “Importance of leadership strategies,” “Training promotes safety and independence,” and “Co-operation for professional development” were identified. Organizing and planning continuous learning activities at a managerial level, such as collaborations with a focus on supervision and sense of coherence (SOC) training, could develop patient safety within home health care. The results demonstrate that professionally competent nurses working in home health care environments contribute to safe working practices to meet quality care outcomes.

District nurses' experiences with the free-choice system in Swedish primary care

This article aims to describe the experiences of district nurses regarding their work situation after the free-choice system in primary care in Sweden was implemented. The study comprised a total of 17 semi-structured narratives with district nurses. The narratives were analysed using manifest qualitative content analysis. One category,'being an underused resource', and three subcategories, 'being financially aware','being flexible' and 'being appealing', were identified. A focus on economic benefit can limit the cooperation and exchange of experiences within and between different care units, which could have a negative impact on the quality of care due to competition between different care providers. Underused resources and restrictions in terms of improvement skills have an impact on job satisfaction and the working environment, and affect the quality of care as a result.

The enhancement of clinical competence through caring science

This theoretical research attempts to create a new basis for dialogue between two independent research fields that are connected by an inseparable link. The first, nursing science, is a body of professional knowledge, while the second, caring as an independent body of pure knowledge, conducts basic research with an aspiration towards applicability. This theoretical research uses the guidelines of the Buberian dialogue, which provides new meaning to the concept of clinical competence. The results emphasise the need to adopt abstract knowledge into the nursing field in order to improve the graduate's clinical capabilities. The combination of assessing clinical capability in a judgmental manner together with the dialogical humanistic approach of caring science may create a genuine platform and meeting event as a maturing process, which is intended to promote educational goals, which subsequently receive new meaning, that is, a different type of assessment. However, this assessment cannot be measured since a wide range of ethical moral aspects regarding both the student and the patient will have to be included. Nevertheless, this dialogue between nursing science and caring science can implement evidence on the basis of trust and can be used as a dialogical tool for evaluating clinical skills with the goal of empowering the educational field in nursing. Consequently, this clinical competence is called 'caring maturing means', and the goal is to convert the learning process into a meaningful event with the aim of improvement.

An outcome-based evaluation of nursing competency of baccalaureate senior nursing students in Taiwan

Limited literature is available for demographic and learning factors related to performance of baccalaureate nursing students. The study aimed at examining mean differences in nursing competency between the first week and the sixth week of a nursing clinical practicum as well as evaluating mean differences in nursing competency by demographic and learning factors at the sixth week of a nursing clinical practicum controlling for baseline scores of nursing competency. A comparative study design was conducted using the competency inventory for baccalaureate senior nursing students based on learning outcomes. Participants were surveyed at the first week and the sixth week of a nursing practicum with 95% mean response rate. Paired t test was used to compare within-subjects differences in mean nursing competency. ANCOVA and Kruskal-Wallis test, and Mann-Whitney U test were conducted to compare between-subjects differences in mean nursing competency. There are significant mean differences in nursing competency in general clinical skills, lifelong learning, clinical biomedical science, caring, and critical thinking and reasoning between the 1st week and the 6th week of nursing practicum. Likewise, type of nursing program, prior schooling, type of nursing license, interest in nursing, and extracurricular activity experience were significantly related to mean total nursing competency. Similarly, demographic attributes (location of school, type of nursing program, prior schooling, type of nursing license, a family member working as a medical practitioner or a nurse, interest in nursing, attributes of preferred workplace after college) and learning factors (extracurricular activity experience, played an active role in classroom discussions and asked questions, academic class rank, and English grade, clinical biomedical science, nursing science, and nursing practicum) were significantly related to six-subscale scores of nursing competency. There are mean differences in nursing competency across several demographic and learning factors. These factors should be given greater emphasis by nurse educators in planning the academic and clinical phases of professional education.

Radiographers' self-assessed level and use of competencies-a national survey

OBJECTIVES

To describe radiographers' self-assessed level and use of competencies as well as how sociodemographic and situational factors are associated with these competencies, particularly related to work experience.

METHODS

A cross-sectional design was employed. Radiographers (n = 406) completed the self-administered 28-item questionnaire encompassing two dimensions: 'Nurse-initiated care' and 'Technical and radiographic processes'. The level of competencies was rated on a 10-point scale and the frequency of use on a 6-point scale.

RESULTS

Most competencies received high ratings both in terms of level and frequency of use. In 'Nurse-initiated care' the competency 'Adequately informing the patient' was rated the highest, while 'Identifying and encountering the patient in a state of shock' and 'Participating in quality improvement regarding patient safety and care' received the lowest ratings. In 'Technical and radiographic processes' the highest rated competencies were 'Adapting the examination to the patient's prerequisites and needs' and 'Producing accurate and correct images'. The lowest frequency of use was 'Preliminary assessment of images'.

CONCLUSION

The main findings underline the radiographers' high competency in both 'Nurse-initiated care' and 'Technical and radiographic processes'. The lower rated competencies emphasise the importance of continuous professional education and quality improvement.

MAIN MESSAGES

• Assessing radiographers' clinical competencies is fundamental for ensuring professional standards. • Most competencies received high ratings both in the nursing and in the radiographic dimensions. • The highest rated competencies focussed on information and adaptability to the patients needs. • The lowest rated competencies focussed on encountering the patient in shock and image assessments. • Age, years in present position and work place only explained a relatively small part of competency.