Clusters of competence: Relationship between self-reported professional competence and achievement on a national examination among graduating nursing students

Comparison of self-competency and executive (charge) nurse competency assessments of clinical nurses

AIM

This study compared nurses' self-competency assessments and their managers' nurse competence assessments.

BACKGROUND

Nurse competence is important for nursing care quality and patient safety. Executive (charge) nurses play a main role in the nurse competency assessment.

METHODOLOGY

In this study conducted at a university hospital between January and December 2020, the self-efficacy evaluations of nurses (n = 162) working in services other than the emergency department, operating room, and outpatient clinics of the university hospital were compared with the evaluations of nurse executives (charges) on these nurses (n = 21). Data were collected using the personal information form and the Nurse Competence Scale. A cross-sectional study design was used. The Strengthening the Reporting of Observational Studies in Epidemiology guideline was used for reporting.

RESULTS

Service nurses' self-assessments and nurses treating charge's assessment of clinical nurses evaluated the competence levels as excellent in both groups. The self-competency assessments of the nurses were higher than the charge nurses' competency assessments.

DISCUSSION

In this study, the lower competence assessment of nurses by the charge nurses was may be due to their ability to observe nurses in their teams in general and that they have more experience in evaluation.

CONCLUSION

It is suggested that professional development and competence programs be created to further develop the competencies of nurses.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Nurse competency assessments support planning to ensure patient safety. Patient care burden and planning of risky patients according to the nurse competency level will provide safe patient care.

Is Your Pregnancy Unwanted or Unhappy? Psychological Correlates of a Cluster of Pregnant Women Who Need Professional Care

BACKGROUND

A negative response towards a current pregnancy consists of two elements: unwantedness of and unhappiness about the current pregnancy. Little is clear about whether pregnant women can be categorized in terms of unwantedness and unhappiness as well as what the correlates are of these categories.

METHODS

An internet survey of 696 women in their first trimester of pregnancy examined the participants' intention of and emotional reaction towards pregnancy, borderline personality traits, adult attachment style, depression, fear of childbirth, obsessive-compulsive symptoms, fetal bonding disorder, avoidance of taking part in child care, and consideration about termination of pregnancy (TOP). About one third of the participants were followed up with in their second trimester.

RESULTS

Two-step cluster analysis using the participants' intention of and emotional reaction towards pregnancy revealed three groups of pregnant women: those who wanted and were happy about the pregnancy (Cluster 1), those who were unhappy about the pregnancy (Cluster 2), and those who did not intend to be pregnant but were happy about pregnancy (Cluster 3). Cluster 2 women, but not Cluster 3 women, were likely to be single, with borderline personality traits as well as unstable adult attachment styles, accompanied by depression, fear of childbirth, obsessive-compulsive symptoms, and fetal bonding disorder. They were more likely to avoid caring for the baby after childbirth and consider TOP.

CONCLUSION

Expectant women who were unhappy about their pregnancy were at risk of psychological adjustment and need specific perinatal mental health assessment and care.

Nurses' knowledge and self-assessment of their clinical experiences of intraosseous access: A multicentre cross-sectional study

BACKGROUND

Intraosseous access is an effective and safe option when difficult vascular access occurs. The knowledge, competence, and clinical experience of nurses are collectively essential for the successful implementation of this approach in clinical practice. Education and clinical learning are the main pillars supporting this new practice to ensure patient safety. The aim of this study was to identify the nurses' knowledge and clinical experience of intraosseous access and the factors associated with the adoption of this procedure.

METHODS

A cross-sectional study was carried out from October to December 2020. A convenience sample of 432 nurses from four Italian hospitals were involved. A structured questionnaire was used to assess the nurses' knowledge of the intraosseous access guidelines and their clinical experience.

RESULTS

Most participants were female (71.5%) with more than 10 years of experience (63.7%) working in an emergency (38.9%) and medical (37.7%) setting. Most of the participants demonstrated their knowledge of the use of a device e.g., it is used if vascular access is not rapidly achieved in a child (83.1%) and the boluses of liquids required in the intraosseous procedure (72.7%). A few participants reported having placed intraosseous access (3.5%). A higher level of educational preparation and working in emergency and paediatric settings were associated with increased knowledge.

CONCLUSIONS

Our findings highlighted a sub-optimal level of knowledge of the IO procedure, little experience of this practice in clinical contexts, also associated with a lack of adequate protocols and devices available to nurses. Nurses need to develop their knowledge and practice the skill clinically to embed this practice. University and nurse educators should emphasise the relevance of this practice in nursing education and training, so as to improve the nursing care practice and level of patient safety.

Nursing students' perceived knowledge, therapeutic attitudes, and interest in addictions education

BACKGROUND

Nurses care for people who use substances (SU) and have addictions across healthcare settings; however, education has been lacking about these issues. Experiences working with patients with SU paired with lack of knowledge may negatively affect attitudes.

PURPOSE

Prior to designing an addictions curriculum, we aimed to assess nursing students' perceived knowledge, attitudes, and educational interests in SU and addictions, and compare pre-licensure nursing students to registered nurses and advanced practice RNs (RN/APRNs).

METHODS

The student body at a large mid-Atlantic school of nursing was surveyed online, Fall 2019. Of 1987 students, 647 (33 %) responded; 567 complete responses were analyzed. Pre-licensure and RN/APRN student responses were compared, and comments were summarized.

RESULTS

Virtually all students agreed that it is important to be educated about SU and addictions (96 %). Students were interested in addiction courses (80 %) and a graduate certificate program (61 %), and 70 % of undergraduates were in favor of an addictions focus area as part of their BSN degree program. Perceived knowledge to address addictions was rated moderately overall. As far as learning needs, students felt they knew the least about problem gambling, communicating about SU, considering readiness to change and using community resources. RN/APRNs rated their motivation and job satisfaction in working with people with SU lower than pre-licensure students.

CONCLUSIONS

Students' responses supported and informed the development of addictions curricula, with a broad focus on addictions including substances, gambling and other addictions. Elective courses, an undergraduate focus area, and a graduate-level certificate were developed, piloted, and are now offered by the School of Nursing.

Nursing students' clinical judgment skills in simulation and clinical placement: a comparison of student self-assessment and evaluator assessment

BACKGROUND

Clinical judgment is an important and desirable learning outcome in nursing education. Students must be able to self-assess their clinical judgment in both the simulation and clinical settings to identify knowledge gaps and further improve and develop their skills. Further investigation is needed to determine the optimal conditions for and reliability of this self-assessment.

AIMS

This study aimed to compare the same group of students' self-assessment of clinical judgment with an evaluator's assessment in both simulation and clinical settings. The study further aimed to investigate whether the Dunning-Kruger effect is present in nursing students' self-assessment of clinical judgment.

METHODS

The study applied a quantitative comparative design. It was conducted in two learning settings: an academic simulation-based education course, and a clinical placement course in an acute care hospital. The sample consisted of 23 nursing students. The Lasater Clinical Judgment Rubric was used to collect data. The scores were compared using a t-test, intraclass correlation coefficient, Pearson's correlation coefficient, and Bland-Altman plots. The Dunning-Kruger effect was investigated using linear regression analysis and a scatter plot.

RESULTS

The results showed an inconsistency between student self-assessment and evaluator assessment of clinical judgment in both simulation-based education and clinical placement. Students overestimated their clinical judgment when compared to the more experienced evaluator's assessment. Differences between students' scores and the evaluator's scores were larger when the evaluator's scores were low, indicating the presence of the Dunning-Kruger effect.

CONCLUSION

It is vital to acknowledge that student self-assessment alone may not be a reliable predictor of a student's clinical judgment. Students who had a lower level of clinical judgment were likely to be less aware that this was the case. For future practice and research, we recommend a combination of student self-assessment and evaluator assessment to provide a more realistic view of students' clinical judgment skills.

Socialization in professional reality integration for nursing student transition (SPRINT) to improve professional competence: A quasi-experimental study

Background

Professional socialization could support competency achievement and assist the transition phase. It is rare to find quantitative studies examining the effects of professional socialization for nursing students (NS).

Objectives

To investigate the effects of a socialization in professional reality integration for nursing student transition (SPRINT) to improve the professional competence of undergraduate NS in Indonesia.

Design

A quasi-experimental study non-equivalent control group pre-test post-test design was conducted using convenience sampling.

Participants

One hundred twenty NS (60 participants in the experimental group and 60 participants in the control group) from two nursing departments in private universities in Indonesia.

Methods

The SPRINT educational intervention consisted of professional socialization training using several learning methods and activities. Meanwhile, the control group received conventional socialization. The Nurse Professional Competence short-form (NPC-SF) scale was evaluated prior to the participants' internship program, lasting from 6 to 12 weeks after clinical education in both groups.

Results

SPRINT intervention significantly increased overall professional competence scores of the experimental groups higher than the control group. By comparing the mean scores in three times measurement, the six competency areas mean score increased significantly for the experimental group while, for the control only three areas of competence increased in twelve week post-test.

Conclusion

A "SPRINT" as an innovative educational program developed in collaboration with academia, clinical preceptors, could improve professional competence. It is recommended to implement SPRINT program to assist the smooth transition from academic into clinical education.

Factors associated with changes in students' self-reported nursing competence after clinical rotations: a quantitative cohort study

BACKGROUND

The quality of nursing care in different healthcare contexts can be associated with the level of available nursing competence. Physical assessment skills are vital in nurses' assessment of patient care needs. However, in nursing education, using physical assessment skills is challenging for nursing students who struggle to apply these skills comprehensively in a clinical rotation. Therefore, this study explores changes in nursing competence, factors associated with changes after clinical rotations, and whether a Suite of Mobile Learning Tools supports changes in confident use of basic physical assessment skills.

METHODS

A quantitative cohort study with an explorative pre-and post-test design. During autumn 2019 and spring 2020, 72 s-year nursing students and 99 third-year students participated in the study. The Nurse Professional Competence scale short form was used to investigate students' self-reported changes in nursing competence, and a study-specific questionnaire was used to investigate students' confidence concerning performing physical assessments. The students voluntarily used the Suite of Mobile Learning Tools for the learning of physical assessment. Linear regression analysis was used to identify factors associated with changes in nursing competence after clinical rotation. The STROBE guidelines for cohort studies were followed for study reporting.

RESULTS

After the clinical rotation, both student groups reported changes in nursing competence and confidence in performing physical assessment skills, with statistically significant moderate or large changes in all areas. The Suite of Mobile Learning Tools was evaluated as being useful for learning physical assessment. The regression analysis showed that confidence in performing physical assessment skills, the usefulness of the Suite of Mobile Learning Tools, and a higher nursing competence at the start of clinical rotation were positively associated with overall nursing competence.

CONCLUSION

Basic physical assessment skills are an important component of nursing competence and can be considered one of the pillars of person-centered care, as proposed by the Fundamentals of Care framework. Spaced repetition and access to digital resources are suggested pedagogical approaches to enhance student confidence in the use of assessment skills within academic and clinical contexts.

Transcultural adaptation and validity of the nurse professional competence scale Korean version for graduating nursing students: An explanatory factor analysis

AIM

The study aimed to assess the validity and reliability of the short-form Nurse Professional Competence Scale-Korean version (NPC-K) among Korean nursing students at the point of graduation.

DESIGN

This was a cross-sectional survey.

METHODS

The Nurse Professional Competence scale was translated into Korean using the World Health Organization (WHO) translation method. A total of 195 graduating nursing students participated. Exploratory factor analysis for validity and Cronbach's alpha coefficients for reliability were examined.

RESULTS

Factor analysis showed that five NPC-K factors accounted for 68.38% of the total variance. Cronbach's alpha for the total scale was 0.97. The NPC-K has high internal reliability and acceptable construct validity. The content of the scale reflected nursing students' confidence in formal competence requirements based on Korean cultural and educational backgrounds. An accurate assessment of nurse professional competence using the NPC-K may help nursing academics enhance the quality of education and training.

Changes in nursing students' self-reported professional competence in simulation-based education and clinical placement: A longitudinal study

BACKGROUND

A primary learning outcome for nursing students is to achieve the professional competence necessary to provide safe and high-quality care in complex and specialized health services. Simulation-based education (SBE) and clinical placement are two educational settings in which nursing students' professional competence can be facilitated as a learning outcome.

OBJECTIVES

The study objectives were to investigate changes in nursing students' self-reported professional competence in SBE and clinical placement and the transfer of this competence from SBE to clinical placement. We also aimed to investigate which competence areas were highest and lowest rated.

DESIGN

A quantitative longitudinal survey design was applied.

SETTINGS

The study took place from May 2019 to January 2020 in a simulation center at a Norwegian university and clinical placement in hospital units.

PARTICIPANTS

Bachelor nursing students (N = 38) in their second and third year of a four-year part-time Norwegian nursing bachelor's degree program.

METHODS

The Nurse Professional Scale Short Form (NPC Scale-SF) consisting of six competence areas was used to measure nursing students' self-reported professional competence across four time points. Paired sample t-test and descriptive statistics were used to analyse data.

RESULTS

For changes in the longitudinal perspective, students' self-reported professional competence increased significantly. In the transfer perspective, from SBE to clinical placement, four competence areas declined significantly. Value-based nursing care were scored highest, whilst Development, leadership, and organization of nursing care were scored lowest score at all time-points.

CONCLUSIONS

Findings indicate that nursing students' self-reported professional competence increased in the longitudinal perspective. Supporting students in transfer of professional competence should be addressed in SBE and clinical placement, whilst nursing education should be strengthened concerning development, leadership, and organization of nursing care.

What should be measured? Nursing education institutions performance: a qualitative study

OBJECTIVES

In this qualitative study, we specify important domains of a nursing education institution that need to be measured to represent its performance via students' perspectives, one of the most important stakeholders in higher education.

SETTING

This study was conducted in a nursing and midwifery faculty.

PARTICIPANTS

Participants were bachelor's, master's and Ph.D. students in nursing. Convenience sampling was used. The aim and methods of the study were explained to the students, and they were invited to participate in the focus groups. Four focus groups (n=27) were held.

RESULTS

Thirteen categories emerged that were assigned to three components of the Donabedian model. The structure component contained three categories: learning fields, equipment and facilities and human resources standards. The process component contained five categories: workshops for students and staff, student familiarity with the institution's rules and plans, teaching, students evaluation and evaluation of teaching staff by students and peers. And outcome components contained five categories: results of self-evaluation by students, graduates' outcomes, students' outcomes, students surveys results and related medical centres performance.

CONCLUSIONS

Based on the needs and ideas of this important group of stakeholders, we can proceed further. Once we specify what is important to be measured, then it is appropriate to develop or choose suitable and measurable performance indicators for each of the recognised categories.

Instruments used in graduating nursing students' exit exams: an integrative review

IMPACT STATEMENT

This review provides a comprehensive analysis of undergraduate nursing students' exit examinations and indicates that more clinical evaluation methods should be developed to ensure adequate competence.

Psychometric evaluation of Nurse Professional Competence Scale-Short-form Chinese language version among nursing graduate students

Aim

The aim of the study was to determine the psychometric properties, construct validity and internal consistency of the Chinese language version of the Nurse Professional Competence scale short form.

Design

A methodological design was used.

Methods

Questionnaire data from 260 nursing students nearing graduation from 2 universities in China were analysed using confirmatory factor analysis, known‐group validity and internal consistency.

Results

The confirmatory factor analysis revealed that the model was acceptable, and the analyses for known‐group validity revealed statistically significant differences in all factors and the total scale of the Nurse Professional Competence scale short form. Internal consistency revealed that Cronbach's alpha values exceeded 0.70 for all factors and the total scale. The Chinese language version of the Nurse Professional Competence scale short form has acceptable construct validity and good internal consistency.

The level of competence of graduating nursing students in 10 European countries-Comparison between countries

AIM

To analyse graduating nursing students' self-assessed competence level in Europe at graduation, at the beginning of nursing career.

DESIGN

An international cross-sectional evaluative design.

METHODS

Data were collected in February 2018-July 2019 from graduating nursing students in 10 European countries. Competence was assessed with a validated instrument, the Nurse Competence Scale (NCS). The sample comprised 3,490 students (response rate 45%), and data were analysed statistically.

RESULTS

In all countries, graduating nursing students assessed their competence as good (range 50.0-69.1; VAS 0-100), albeit with statistically significant differences between countries. The assessments were highest in Iceland and lowest in Lithuania. Older students, those with working experience in health care, satisfied with their current degree programme, with excellent or good study achievements, graduating to 1st study choice and having a nursing career plan for future assessed their competence higher.

Dual use of instruments for assessing nursing students professional- and clinical competence

BACKGROUND

Changes in demographics and the development of health systems have a direct impact on patients' nursing needs and nurses' ability to meet them. Modern and forward-looking nursing education programmes that will help nursing students to develop their professional competence require useful tools for assessment and self-reflection that can be combined in theoretical and clinical education.

OBJECTIVES

To investigate the associations between the Nurse Professional Competence Scale - Short Form (NPC-SF), and the tool Assessment of Clinical Education (AssCE) tool, and to assess the graduating students´ professional competence based on their self-assessment.

DESIGN

A cross-sectional descriptive study design was used.

PARTICIPANTS AND SETTINGS

A total of 151 nursing students at a Swedish university college completed the NPC-SF and the AssCE (response rate 77%).

METHODS

In their final weeks of the nursing programme, students were invited to respond to two questionnaires: the NPC Scale - Short Form (35 items) and the AssCE tool (21 items).

RESULT

There are significant correlations between the nursing students' responses to the NPC-SF competence areas and the AssCE areas (r = 0.19-0.57). Students score in the NPC-SF were highest in Value-based Nursing Care and lowest in Development, Leadership and Organization of Nursing Care, and in the AssCE areas student scores were highest in Examination and treatment and Professional Approach and lowest in Management and Cooperation.

CONCLUSION

The NPC-SF and AssCE are valid and reliable instruments, showing a high level of correlation. Results imply that dual use could strengthen student-centred theoretical and clinical learning as well as professional competence development. Additional research is needed to assess student's competence development during the nursing program.

Insufficiently supported in handling responsibility and demands: Findings from a qualitative study of newly graduated nurses

Aims and objectives

To explore newly graduated registered nurses' experiences and how they manage complex patient situations.

Background

Newly graduated registered nurses' working in acute care hospital settings are challenged by managing complex patient situations in rapidly changing clinical contexts involving increased patient acuity, comorbidities and staffing shortages.

Design

Qualitative study design.

Methods

Data were collected using focus groups interviews of a total of 16 newly graduated registered nurses with clinical work experience of 6 months of direct patient care in an acute care hospital setting. Analyses were conducted using qualitative content analysis. COREQ reporting guidelines were used.

Results

The analysis resulted in the overarching theme “Not being sufficiently prepared and supported to meet responsibilities and demands.” The theme included three categories: “Responsibility is not in proportion to competence,” “Lack of medical competence and experience complicates patient safety” and “Strives for control to manage and organise nursing care.”

Conclusion

The results show that newly graduated registered nurses' are not sufficiently supported for the level of responsibility and the demands placed on them when providing nursing in complex patient situations in acute care hospital settings. If they are given sole responsibility for multiple complex patient situations, patient safety may be compromised.

Relevance to practice

Special attention need to be paid to NGRNs support to medical competence in the areas of assessing, planning, prioritizing, leading, and distributing nursing care in daily clinical settings for at least their first year of professional work.

Newly graduated registered nurses' self-assessed clinical competence and their need for further training

Aim

To explore and describe changes in self-assessed clinical competence and the need for further training among newly graduated Registered Nurses during their first 15 months of professional work in acute care hospital settings.

Design

Quantitative longitudinal design.

Methods

The 50-item Professional Nurse Self-Assessment Scale of clinical core competencies II was used. A total of 45 newly graduated Registered Nurses answered the questionnaire at four different occasions. Data were collected after 2, 5, 9 and 15 months of working experience.

Result

The components "ethical decision-making," "cooperation and consultation" and "clinical leadership" were rated highest in clinical competence and lowest in need for further training. The components "professional development" and "critical thinking" were rated lowest in clinical competence and "direct clinical practice" rated highest in need for further training. The clinical competence increased significant between 9-15 months, with the exception of "critical thinking" and need for further training decreased significantly between 9-15 months, with the exception of "critical thinking."

Clusters of competence: Relationship between self-reported professional competence and achievement on a national examination among graduating nursing students

Aims

To identify clusters based on graduating nursing students’ self‐reported professional competence and their achievement on a national examination. Furthermore, to describe and compare the identified clusters regarding sample characteristics, students’ perceptions of overall quality of the nursing programme, and students’ general self‐efficacy (GSE).

Design

A cross‐sectional study combining survey data and results from a national examination.

Methods

Data were collected at two universities and one university college in Sweden in January 2017, including 179 students in the final term of the nursing programme. The study was based on the Nurse Professional Competence Scale, the GSE scale, and results from the National Clinical Final Examination. A two‐step cluster analysis was used to identify competence profiles, followed by comparative analyses between clusters.

Results

Three clusters were identified illustrating students’ different competence profiles. Students in Clusters 1 and 2 passed the examination, but differed in their self‐assessments of competence, rating themselves under and above the overall median value, respectively. Students in Cluster 3 failed the examination but rated themselves at the overall median level or higher.

Conclusion

The study illustrates how nursing students’ self‐assessed competence might differ from competency assessed by examination, which is challenging for nursing education. Self‐evaluation is a key learning outcome and is, in the long run, essential to patient safety.

Impact

The study has identified clusters of students where some overestimate and others underestimate their competence. Students who assessed their competence low but passed the exam assessed their GSE lower than other students. The findings illuminate the need for student‐centred strategies in nursing education, including elements of self‐assessment in relation to examination to make the students more aware of their clinical competence.